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Heintzman J, Hodes T, Parras D, Lucas JA, Guzman CEV, Chan B, Banegas MP, Marino M. The role of language in mammography orders among low-income Latinas over a 10-year period. Prev Med 2023; 175:107657. [PMID: 37573954 PMCID: PMC10602713 DOI: 10.1016/j.ypmed.2023.107657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Latinas in the United States have higher mortality from breast cancer, but longitudinal studies of mammography ordering (a crucial initial step towards screening) in primary care are lacking. METHODS We conducted an analysis of mammography order rates in Latinas (by language preference) and non-Latina white women (N = 181,755) over a > 10 year period in a multi-state network of community health centers (CHCs). We evaluated two outcomes (ever having a mammogram order and annual rate of mammography orders) using generalized estimating equation modeling. RESULTS Approximately one-third of all patients had ever had a mammogram order. Among those receiving mammogram orders, English-preferring Latinas had lower mammogram order rates than non-Hispanic white women (RR = 0.92, 95% CI = 0.89-0.95). Spanish-preferring Latinas had higher odds of ever having a mammogram ordered than non-Hispanic whites (odds ratio = 2.12, 95% CI = 2.06-2.18) and, if ever ordered, had a higher rate of annual mammogram orders (rate ratio = 1.53, 95% CI = 1.50-1.56). CONCLUSION These findings suggest that breast cancer detection barriers in low-income Latinas may not stem from a lack of orders in primary care, but in the subsequent accessibility of receiving ordered services.
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Affiliation(s)
- John Heintzman
- Family Medicine, Oregon Health and Science University (OHSU), Primary Care Equity in Latinos (PRIMER) Center (www.primerlab.org), 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
| | - Tahlia Hodes
- Dept of Family Medicine, OHSU, Portland, OR, United States of America
| | - Daniel Parras
- Health Choice Network, Miami, FL, United States of America
| | - Jennifer A Lucas
- Dept of Family Medicine, OHSU, Portland, OR, United States of America
| | | | - Brian Chan
- OCHIN, Inc., Portland, OR, United States of America
| | - Matthew P Banegas
- Department of Radiation Oncology, University of California at San Diego, San Diego, CA, United States of America
| | - Miguel Marino
- Dept of Family Medicine, OHSU, OHSU-PSU School of Public Health, Portland, OR, United States of America
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Health Disparities in Patients Seeking Physiological Surgical Treatment for Lymphedema. Plast Reconstr Surg 2023; 151:217-224. [PMID: 36576830 DOI: 10.1097/prs.0000000000009761] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Previous studies have demonstrated racial disparities in breast cancer treatment and secondary lymphedema. However, no studies have yet examined the effects of race and socioeconomic status on physiological surgical treatment for lymphedema. The authors aimed to evaluate whether disparities exist within patients seeking physiological surgical lymphedema treatment. METHODS A retrospective review was performed of patients presenting for physiological surgical treatment of lymphedema from 2013 to 2019. Data on demographics, medical history, socioeconomic factors, lymphedema, and treatments were collected. RESULTS A total of 789 patients (712 women and 77 men) seeking physiological surgical treatment of lymphedema were selected. Their mean age was 54.4 ± 13.4 years. A total of 620 patients (78.5%) self-reported as White, 120 (15.2%) as Black, 17 (2.2%) as Asian, five (0.6%) as Hispanic, and eight (2.4%) as multiracial. A total of 566 patients (71.7%) met criteria for surgical candidacy. White race was associated with increased rates of surgical candidacy compared with Black race (46.6% versus 77.2%; P < 0.0001). Compared with White patients, Black patients presented with a longer symptom duration (11.07 versus 6.99 years; P < 0.001), had a higher body mass index (mean, 34.5 versus 28.1; P < 1 × 10 -10 ), had a higher International Society of Lymphology stage ( P < 0.05), and were less likely to have maximized medical treatment for lymphedema (30.8% versus 55.4%; P < 0.01). CONCLUSIONS This study demonstrates racial disparities in patients seeking physiological surgical treatment for lymphedema. Black patients present later with more severe disease, receive less nonsurgical treatment before consultation, and are less likely to meet criteria for physiological surgery. Improved patient and provider education on lymphedema and appropriate diagnosis and nonsurgical treatment is of primary importance to address this disparity.
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Hu Q, Kang W, Wang Q, Luo T. Role of CDK4/6 inhibitors in patients with hormone receptor (HR)-positive, human epidermal receptor-2 negative (HER-2) metastatic breast cancer study protocol for a systematic review, network meta-analysis and cost-effectiveness analysis. BMJ Open 2022; 12:e056374. [PMID: 35636793 PMCID: PMC9152932 DOI: 10.1136/bmjopen-2021-056374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION It is currently unclear which cyclin-dependent kinase 4/6 (CDK4/6) inhibitor, combined with endocrine therapy, is the preferred treatment approach in patients with hormone receptor (HR)-positive, human epidermal receptor-2 (HER2) negative metastatic breast cancer. The aim of this study was to evaluate the existing evidence for the comparative efficacy, safety and cost-effectiveness of different CDK4/6 inhibitors for metastatic breast cancer in first-line and second-line settings. METHODS AND ANALYSIS We will systematically conduct a literature search in Embase, PubMed and the Cochrane Library and additional searches by handsearching citations of previous systematic reviews. We will also screen major conference proceedings (American Society of Clinical Oncology, European Society of Medical Oncology and San Antonio Breast Cancer Symposium). Preliminary scoping searches were conducted in July 2021, but the search will be updated when new trials are available. The primary outcome was progression-free survival. The secondary outcomes were overall survival, objective response rates, grade 3-4 haematological and non-haematological toxicities, quality-adjusted life years and incremental cost-effectiveness ratios. The risk of bias will be assessed by Cochrane risk of bias tools, and the quality of evidence will be assessed by the Grading of Recommendations Assessment, Development and Evaluation. Subgroup analyses and sensitivity analyses will be performed to further confirm our findings. In addition, one-way sensitivity analysis and probabilistic sensitivity analyses will be conducted to determine uncertainty. ETHICS AND DISSEMINATION This study does not require ethics approval as only secondary data will be collected. The results of our study will provide an overview of the current level of CDK4/6 inhibitors for patients with HR-positive, HER2-negative metastatic breast cancer, and undertake subgroup analyses to explore variables that might affect these effects. The results of this study will be presented at an international clinical conference and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021266597.
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Affiliation(s)
- Qiancheng Hu
- Department of Abdominal Oncology, Cancer Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Wenli Kang
- Department of International Medical Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Qingfeng Wang
- Department of Abdominal Oncology, Cancer Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Ting Luo
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Tang Z, Ji Y, Min Y, Zhang X, Xu W, Zhao L, Zhang J, Long L, Feng J, Wen Y. Prognostic Factors and Models for Elderly (≥70 Years Old) Primary Operable Triple-Negative Breast Cancer: Analysis From the National Cancer Database. Front Endocrinol (Lausanne) 2022; 13:856268. [PMID: 35370936 PMCID: PMC8969604 DOI: 10.3389/fendo.2022.856268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer. In the elderly (≥70 years old) primary operable (T1-3N0-1M0) TNBC, individualized treatment modalities for this population are pivotal and important, but limited studies are explored. METHODS The clinicopathological features of elderly primary operable TNBC patients were retrospectively selected from the Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and December 2015. Kaplan-Meier curves were used to show the survival patterns in the different subgroups. Multivariate Cox analysis was used to identify independent risk factors in the 3-, 5-, and 7- year overall survival (OS) and cancer-specific survival (CSS) in this subpopulation. The predictive model was further developed and validated for clinical use. RESULT Between 2010 and 2015 years, a total of 4,761 elderly primary operable TNBC patients were enrolled for the study, with a mean age of 76 years and a median follow-up of 56 months. The multivariate Cox analysis showed that age (increased per year: hazard ratio (HR) = 1.05), race (Asian/Pacific Islander and American Indian/Alaska Native, HR = 0.73), differentiation grade (grade II: HR = 2.01; grade III/IV: HR = 2.67), larger tumor size (T1c: HR = 1.83; T2: HR = 2.78; T3: HR = 4.93), positive N stage (N1mi: HR = 1.60; N1: HR = 1.54), receiving radiation therapy (HR = 0.66), and receiving adjuvant chemotherapy (HR = 0.61) were the independent prognostic factors for OS, and a similar prognostic pattern was also determined in CSS. Besides, two nomograms for predicting the 3-, 5-, and 7-year OS and CSS in this population were developed with a favorable concordance index of 0.716 and 0.746, respectively. CONCLUSION The results highlight that both radiation and adjuvant chemotherapy are significantly associated with favorable long-term OS and CSS probability in elderly primary operable TNBC patients. Based on the determined independent prognostic factors, the novel nomograms could assist the oncologists to make individualized clinical decisions for the subpopulation at different risks.
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Affiliation(s)
- Zhuowei Tang
- Department of Breast Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
- *Correspondence: Zhuowei Tang, ; Yuzhu Ji,
| | - Yuzhu Ji
- Department of Pathology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
- *Correspondence: Zhuowei Tang, ; Yuzhu Ji,
| | - Yu Min
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaohong Zhang
- Department of Breast Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Weiyun Xu
- Department of Breast Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Lijuan Zhao
- Department of Breast Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Jing Zhang
- Department of Breast Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Li Long
- Department of Breast Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Jing Feng
- Department of Breast Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Yixue Wen
- Department of Breast Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
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Nobel TB, Asumeng CK, Jasek J, Van Beck KC, Mathur R, Qiao B, Brown JJ. Disparities in mortality-to-incidence ratios by race/ethnicity for female breast cancer in New York City, 2002-2016. Cancer Med 2020; 9:8226-8234. [PMID: 33006431 PMCID: PMC7643684 DOI: 10.1002/cam4.3309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/07/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022] Open
Abstract
Background Racial disparities in New York City (NYC) breast cancer incidence and mortality rates have previously been demonstrated. Disease stage at diagnosis and mortality‐to‐incidence ratio (MIR) may present better measures of differences in screening and treatment access. Racial/ethnic trends in NYC MIR have not previously been assessed. Methods Mammogram rates were compared using the NYC Community Health Survey, 2002‐2014. Breast cancer diagnosis, stage, and mortality were from the New York State Cancer Registry, 2000‐2016. Primary outcomes were MIR, the ratio of age‐adjusted mortality to incidence rates, and stage at diagnosis. Joinpoint regression analysis identified significant trends. Results Mammogram rates in 2002‐2014 among Black and Latina women ages 40 and older (79.9% and 78.4%, respectively) were stable and higher than among White (73.6%) and Asian/Pacific‐Islander women (70.4%) (P < .0001). There were 82 733 incident cases of breast cancer and 16 225 deaths in 2000‐2016. White women had the highest incidence, however, rates among Black, Latina, and Asian/Pacific Islander women significantly increased. Black and Latina women presented with local disease (Stage I) less frequently (53.2%, 57.6%, respectively) than White (62.5%) and Asian/Pacific‐Islander women (63.0%). Black women presented with distant disease (Stage IV) more frequently than all other groups (Black 8.7%, Latina 5.8%, White 6.0%, and Asian 4.2%). Black women had the highest breast cancer mortality rate and MIR (Black 0.25, Latina 0.18, White 0.17, and Asian women 0.11). Conclusions More advanced disease at diagnosis coupled with a slower decrease in breast cancer mortality among Black and Latina women may partially explain persistent disparities in MIR especially prominent among Black women. Assessment of racial/ethnic differences in screening quality and access to high‐quality treatment may help identify areas for targeted interventions to improve equity in breast cancer outcomes.
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Affiliation(s)
- Tamar B Nobel
- Department of Environmental Medicine and Public Health, Mount Sinai Hospital, New York, NY, USA
| | - Charles K Asumeng
- Cancer Prevention and Control Program, Bureau of Chronic Disease Prevention, New York City Department of Health and Mental Hygiene, Queens, NY, 11101, USA
| | - John Jasek
- Research and Evaluation, Bureau of Chronic Disease Prevention, NYC DOHMH, Queens, NY, USA
| | - Kellie C Van Beck
- Cancer Prevention and Control Program, Bureau of Chronic Disease Prevention, New York City Department of Health and Mental Hygiene, Queens, NY, 11101, USA
| | - Ruchi Mathur
- Cancer Prevention and Control Program, Bureau of Chronic Disease Prevention, New York City Department of Health and Mental Hygiene, Queens, NY, 11101, USA
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY, USA
| | - Jennifer J Brown
- Cancer Prevention and Control Program, Bureau of Chronic Disease Prevention, New York City Department of Health and Mental Hygiene, Queens, NY, 11101, USA
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