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Mustafa M, Sarfraz S, Saleem G, Khan TA, Shahid D, Taj S, Amir N. Beyond Milk and Nurture: Breastfeeding's Powerful Impact on Breast Cancer. Geburtshilfe Frauenheilkd 2024; 84:541-554. [PMID: 38884025 PMCID: PMC11175834 DOI: 10.1055/a-2313-0637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/21/2024] [Indexed: 06/18/2024] Open
Abstract
Breast cancer (BC) stands as a global concern, given its high incidence and impact on women's mortality. This complex disease has roots in various risk factors, some modifiable and others not. Understanding and identifying these factors can be instrumental in both preventing BC and improving survival rates. Remarkably, women's reproductive behaviors have emerged as critical determinants of BC susceptibility. Numerous studies have shed light on how aspects including age of menarche, first pregnancy and menopause along with number of pregnancies, hormone replacement therapies, can influence one's risk of developing BC. Furthermore, the act of breastfeeding and its duration have shown an inverse relationship with BC risk. This review delves into the biological and molecular mechanisms associated with breastfeeding that contribute to BC protection. It highlights the role of endocrine processes triggered by suckling stimulation, the gradual onset of lactational amenorrhea, delayed weaning, reduced lifetime menstrual cycles, chromosomal repair mechanisms, and immunological events throughout the lactation cycle. These insights provide a potential explanation for the protective effects conferred by breastfeeding against breast carcinomas.
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Affiliation(s)
- Muhammad Mustafa
- Kauser Abdulla Malik School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan
| | - Sadaf Sarfraz
- Kauser Abdulla Malik School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan
| | - Gullelalah Saleem
- Kauser Abdulla Malik School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan
| | - Touqeer Ahmad Khan
- Kauser Abdulla Malik School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan
| | - Damiya Shahid
- Kauser Abdulla Malik School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan
| | - Saba Taj
- Kauser Abdulla Malik School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan
| | - Noor Amir
- Kauser Abdulla Malik School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan
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2
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Berwick M, Louis-Jacques AF. Prenatal Counseling and Preparation for Breastfeeding. Obstet Gynecol Clin North Am 2023; 50:549-565. [PMID: 37500216 DOI: 10.1016/j.ogc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Breastfeeding is the gold standard of infant nutrition and current guidelines suggest exclusive breastfeeding for 6 months, with continued breastfeeding through 24 months or beyond. Obstetric care professionals can encourage and educate their patients about breastfeeding through the prenatal period when many expectant parents make decisions about their infant feeding choices. Education and support should extend through the postpartum period and include parents who may have concerns surrounding medical comorbidities, breast augmentation, or substance use disorders.
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Affiliation(s)
- Margarita Berwick
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, University of Florida, PO Box 100294, 1600 Southwest Archer Road, Gainesville, FL 32610-0294, USA.
| | - Adetola F Louis-Jacques
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, University of Florida, PO Box 100294, 1600 Southwest Archer Road, Gainesville, FL 32610-0294, USA
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3
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Boundy EO, Nelson JM, Li R. Public Belief in the Maternal Health Benefits of Breastfeeding - United States, 2018 and 2021. Prev Chronic Dis 2023; 20:E75. [PMID: 37616469 PMCID: PMC10457102 DOI: 10.5888/pcd20.230010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
The objective of this study was to better understand US public awareness of maternal health benefits of breastfeeding. Data from the 2018 and 2021 SummerStyles surveys were analyzed to explore public belief in select maternal benefits of breastfeeding. As in 2018, in 2021 a low percentage of respondents believed that breastfeeding protects the mother against breast cancer (23.9%), high blood pressure (15.5%), or type 2 diabetes (15.4%), with male, older, and unmarried respondents less likely to believe in these protective effects. More public awareness of maternal benefits of breastfeeding might help increase demand for breastfeeding-supportive programs and policies.
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Affiliation(s)
- Ellen O Boundy
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Centers for Disease Control and Prevention, MS H24-4, 1600 Clifton Rd, NE, Atlanta, Georgia 30333
- US Public Health Service, Rockville, Maryland
| | - Jennifer M Nelson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | - Ruowei Li
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abraham M, Lak MA, Gurz D, Nolasco FOM, Kondraju PK, Iqbal J. A Narrative Review of Breastfeeding and Its Correlation With Breast Cancer: Current Understanding and Outcomes. Cureus 2023; 15:e44081. [PMID: 37750138 PMCID: PMC10518059 DOI: 10.7759/cureus.44081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
Breastfeeding has been extensively studied in relation to breast cancer risk. The results of the reviewed studies consistently show a decreased risk of breast cancer associated with breastfeeding, especially for 12 months or longer. This protective effect is attributed to hormonal, immunological, and physiological changes during lactation. Breastfeeding also appears to have a greater impact on reducing breast cancer risk in premenopausal women and specific breast cancer subtypes. Encouraging breastfeeding has dual benefits: benefiting infants and reducing breast cancer risk long-term. Healthcare professionals should provide evidence-based guidance on breastfeeding initiation, duration, and exclusivity, while public health policies should support breastfeeding by creating enabling environments. This review examines the existing literature and analyzes the correlation between breastfeeding and breast cancer risk.
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Affiliation(s)
- Merin Abraham
- Department of Internal Medicine, Kasturba Medical College, Manipal, IND
| | - Muhammad Ali Lak
- Department of Internal Medicine, Combined Military Hospital, Lahore, PAK
| | - Danyel Gurz
- Department of Internal Medicine, Combined Military Hospital, Lahore, PAK
| | | | | | - Javed Iqbal
- Department of Neurosurgery, Mayo Hospital, Lahore, PAK
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Gyamfi A, Jefferson UT, O'Neill B, Lucas R, Spatz DL, Henderson WA. Disparities in 6 Month Exclusive Breastfeeding in Ghana, Africa: A Scoping Review. J Hum Lact 2022:8903344221130988. [PMID: 36305494 DOI: 10.1177/08903344221130988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exclusive breastfeeding practice for 6 months is a critical global public health goal. In 2020, only 44% of infants globally, 31% in Central and West Africa, and 43% in Ghana, were exclusively breastfed for the first 6 months of life. RESEARCH AIM To critically evaluate disparities in exclusive breastfeeding practice for 6 months in Ghana. METHODS The scoping review was guided by Arksey and O'Malley's (2005) six-stage scoping review process. The online databases of American Psychological Association PsychInfo (APA PsychInfo), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Scopus were searched with keywords inclusive of Ghana, exclusive breastfeeding, breastfeeding, infant feeding, lactation, lactating, and exclusive. Eligibility criteria included full-text, peer-reviewed research articles written in the English language without limitation to specific years. Data were analyzed thematically. RESULTS Initially, 317 records were identified, and 15 full-text articles were eligible for the scoping review. Four main themes emerged as disparities in exclusive breastfeeding practice in Ghana. The themes were healthcare (prenatal clinic visits, delivery place, exclusive breastfeeding knowledge), personal (maternal age, Human Immunodeficiency Virus status, parity, type of delivery, breast problem), employment (unemployed, formal, or informal sector worker), and sociocultural (ethnicity/region, family support, religious beliefs, cultural practices). CONCLUSION Disparities in exclusive breastfeeding in Ghana warrant the collaborative efforts of stakeholders for successful mitigation. Future researchers should explore the role of religion and sociocultural practices to protect, promote, and support 6 months of exclusive breastfeeding in Ghana.
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Affiliation(s)
- Adwoa Gyamfi
- St Michael's Midwifery Training School, Ashanti Region, Ghana.,School of Nursing, University of Connecticut, Storrs, CT, USA
| | | | - Barbara O'Neill
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Ruth Lucas
- School of Nursing, University of Connecticut, Storrs, CT, USA.,School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Diane Lynn Spatz
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Wendy A Henderson
- School of Nursing, University of Connecticut, Storrs, CT, USA.,School of Medicine, University of Connecticut, Farmington, CT, USA
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Ragusa R, Marranzano M, La Rosa VL, Giorgianni G, Commodari E, Quattrocchi R, Cacciola S, Guardabasso V. Factors Influencing Uptake of Breastfeeding: The Role of Early Promotion in the Maternity Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4783. [PMID: 33946146 PMCID: PMC8124212 DOI: 10.3390/ijerph18094783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study aimed to explore the prevalence of breastfeeding at birth points in Sicily and the relevance of the factors influencing the adoption of exclusive breastfeeding during hospitalization linked to childbirth. METHODS A survey was conducted to monitor the prevalence of breastfeeding in seven out of nine facilities providing maternity services in the province of Catania (Sicily, Southern Italy) in the years 2016-2018. An online questionnaire was administered using an electronic tablet by the midwife to the mother after discharge. RESULTS Women who had a higher educational qualification breastfed in a greater proportion (59.6%; odds ratio OR 0.60 for abandoning breastfeeding). Having had a caesarean section moderately impaired breastfeeding uptake, with an almost double chance of declining exclusive breastfeeding (OR = 1.74). Starting breastfeeding within 1 h from delivery showed a significant facilitating effect (OR = 0.58). Rooming-in had a strong facilitating effect on exclusive breastfeeding. A breastfeeding advocacy program was shown to protect from abandoning breastfeeding. CONCLUSIONS It is important to offer in all hospitals the possibility and support for breastfeeding in the first moments after childbirth to increase the number of those who will then continue with exclusive breastfeeding.
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Affiliation(s)
- Rosalia Ragusa
- Health Technology Assessment Committee, University Hospital “G. Rodolico—San Marco”, 95123 Catania, Italy;
| | - Marina Marranzano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (M.M.); (G.G.)
| | | | - Gabriele Giorgianni
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (M.M.); (G.G.)
| | - Elena Commodari
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy;
| | - Rosalba Quattrocchi
- Health Promotion Unit, University Hospital “G. Rodolico—San Marco”, 95123 Catania, Italy;
| | - Salvatore Cacciola
- Health Education Unit, Azienda Sanitaria Provinciale 3, 95124 Catania, Italy;
| | - Vincenzo Guardabasso
- Research Promotion Office, University Hospital “G. Rodolico—San Marco”, 95123 Catania, Italy;
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Duche H, Tsegay AT, Tamirat KS. Identifying Risk Factors of Breast Cancer Among Women Attending Selected Hospitals of Addis Ababa City: Hospital-Based Unmatched Case-Control Study. BREAST CANCER-TARGETS AND THERAPY 2021; 13:189-197. [PMID: 33746517 PMCID: PMC7967025 DOI: 10.2147/bctt.s293867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/03/2021] [Indexed: 12/17/2022]
Abstract
Background Breast cancer, one of the chronic diseases, is the most common cancer among women in the world. In Ethiopia, late-stage breast cancer is widely diagnosed and women have very little access to adequate medication, pain relief, or palliative care. In addition, there are few research on risk factors for breast cancer in Ethiopia. A safer way out of this is to concentrate on prevention; one of the prevention methods is to recognize risk factors sooner. The study therefore aimed to establish risk factors for breast cancer among women in hospitals in the city of Addis Ababa. Methods Hospital-based, unmatched case-control research conducted in selected Addis Ababa hospitals from April to September 2017 (Case=110 and Control=110). Data were collected by standardized questionnaires for both cases and controls. Cases were initially detected by mammography screening accompanied by histopathological examinations, while controls were those women who were negative by mammogram testing, stress levels were assessed by perceived stress scale (PSS) and body mass index measured by WHO norm. Summary statistics Computed and binary logistic regression analysis to classify risk factors for breast cancer modified odds ratio (AOR) with 95% confidence interval (CI) calculated. Results The participants’ mean age of was 43.80 years (SD ±12.63) and 39.64 years (SD ±12.91) for cases and controls, respectively. Physical activity (AOR=0.2, 95% CI: 0.10, 0.41) was correlated with lower probability of breast cancer, while never breastfeed (AOR=3.4, 95% CI: 1.21, 9.67); menopausal state (AOR=6.8, 95% CI: 1.92, 24.16), and body mass index above 25. 1 kg/m2 (AOR=5.9, 95% CI: 2.16, 16.48) were factors risk factors for breast cancer. Conclusion This research shows the importance of physical exercise, breastfeeding, menopausal status, and nutritional status in the occurrence of breast cancer. Actions aimed at increasing physical activity, breastfeeding habits and keeping a balanced diet will help to minimize the incidence of breast cancer.
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Affiliation(s)
- Henock Duche
- Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Adino Tesfahun Tsegay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Gyamfi A, O'Neill B, Henderson WA, Lucas R. Black/African American Breastfeeding Experience: Cultural, Sociological, and Health Dimensions Through an Equity Lens. Breastfeed Med 2021; 16:103-111. [PMID: 33591226 PMCID: PMC7891224 DOI: 10.1089/bfm.2020.0312] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Disparities in breastfeeding (BF) continue to be a public health challenge, as currently only 42% of infants in the world and 25.6% of infants in the United States are exclusively breastfed for the first 6 months of life. In 2019, the infants least likely to be exclusively breastfed at 6 months are African Americans (AA) (17.2%). Materials and Methods: A scoping review of the literature was undertaken by using Arksey and O'Malley's six-stage framework to determine key themes of AA women's experience BF through an equity lens. Electronic databases of CINAHL and PubMed were searched for peer-reviewed, full-text articles written in the English language within the past 5 years by using the terms BF, AA, Black, sociological, cultural, equity, health, attitude, exposure, initiation, continuation, barriers, and facilitators. Results: Initially, 497 articles were identified, and 26 peer-reviewed articles met the eligibility criteria. Through an equity lens, three main themes emerged, which summarized AA women's BF experience: cultural (family, peers and community support; misconceptions; personal factors), sociological (prejudices, racism, home environment; financial status; sexuality issues; BF role models; employment policies), and health dimensions (family involvement; timely and honest information from staff; baby-friendly hospital initiatives; postnatal follow-up; special supplemental nutrition program for women, infants, and children). Conclusion: For AA women, exclusively BF is beset with diverse cultural, health, and sociological challenges. Multifaceted approaches are needed for successful resolution of BF challenges to bridge the racial gap in BF in the United States. Future studies may explore interventions targeted to modifiable barriers to improve BF outcomes.
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Affiliation(s)
- Adwoa Gyamfi
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Barbara O'Neill
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Wendy A Henderson
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Ruth Lucas
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
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Hoyt-Austin A, Dove MS, Abrahão R, Kair LR, Schwarz EB. Awareness That Breastfeeding Reduces Breast Cancer Risk: 2015-2017 National Survey of Family Growth. Obstet Gynecol 2020; 136:1154-1156. [PMID: 33156184 PMCID: PMC7724754 DOI: 10.1097/aog.0000000000004162] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Only 38.5% of U.S. women are aware that breastfeeding is associated with reduced incidence of breast cancer, and efforts are needed to educate pregnant women of the maternal health benefits breastfeeding provides.
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Affiliation(s)
- Adrienne Hoyt-Austin
- Departments of Pediatrics, Public Health Sciences, and Medicine and the Center for Healthcare Policy & Research, University of California, Davis, Sacramento, California
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10
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Basree MM, Shinde N, Koivisto C, Cuitino M, Kladney R, Zhang J, Stephens J, Palettas M, Zhang A, Kim HK, Acero-Bedoya S, Trimboli A, Stover DG, Ludwig T, Ganju R, Weng D, Shields P, Freudenheim J, Leone GW, Sizemore GM, Majumder S, Ramaswamy B. Abrupt involution induces inflammation, estrogenic signaling, and hyperplasia linking lack of breastfeeding with increased risk of breast cancer. Breast Cancer Res 2019; 21:80. [PMID: 31315645 PMCID: PMC6637535 DOI: 10.1186/s13058-019-1163-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/21/2019] [Indexed: 12/12/2022] Open
Abstract
Background A large collaborative analysis of data from 47 epidemiological studies concluded that longer duration of breastfeeding reduces the risk of developing breast cancer. Despite the strong epidemiological evidence, the molecular mechanisms linking prolonged breastfeeding to decreased risk of breast cancer remain poorly understood. Methods We modeled two types of breastfeeding behaviors in wild type FVB/N mice: (1) normal or gradual involution of breast tissue following prolonged breastfeeding and (2) forced or abrupt involution following short-term breastfeeding. To accomplish this, pups were gradually weaned between 28 and 31 days (gradual involution) or abruptly at 7 days postpartum (abrupt involution). Mammary glands were examined for histological changes, proliferation, and inflammatory markers by immunohistochemistry. Fluorescence-activated cell sorting was used to quantify mammary epithelial subpopulations. Gene set enrichment analysis was used to analyze gene expression data from mouse mammary luminal progenitor cells. Similar analysis was done using gene expression data generated from human breast samples obtained from parous women enrolled on a tissue collection study, OSU-2011C0094, and were undergoing reduction mammoplasty without history of breast cancer. Results Mammary glands from mice that underwent abrupt involution exhibited denser stroma, altered collagen composition, higher inflammation and proliferation, increased estrogen receptor α and progesterone receptor expression compared to those that underwent gradual involution. Importantly, when aged to 4 months postpartum, mice that were in the abrupt involution cohort developed ductal hyperplasia and squamous metaplasia. Abrupt involution also resulted in a significant expansion of the luminal progenitor cell compartment associated with enrichment of Notch and estrogen signaling pathway genes. Breast tissues obtained from healthy women who breastfed for < 6 months vs ≥ 6 months showed significant enrichment of Notch signaling pathway genes, along with a trend for enrichment for luminal progenitor gene signature similar to what is observed in BRCA1 mutation carriers and basal-like breast tumors. Conclusions We report here for the first time that forced or abrupt involution of the mammary glands following pregnancy and lack of breastfeeding results in expansion of luminal progenitor cells, higher inflammation, proliferation, and ductal hyperplasia, a known risk factor for developing breast cancer. Electronic supplementary material The online version of this article (10.1186/s13058-019-1163-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mustafa M Basree
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA
| | - Neelam Shinde
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA
| | - Christopher Koivisto
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Biochemistry & Molecular Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Maria Cuitino
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Biochemistry & Molecular Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Raleigh Kladney
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA
| | - Jianying Zhang
- Department of Biomedical Informatics' Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Julie Stephens
- Department of Biomedical Informatics' Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Marilly Palettas
- Department of Biomedical Informatics' Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Allen Zhang
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA
| | - Hee Kyung Kim
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA
| | - Santiago Acero-Bedoya
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA
| | - Anthony Trimboli
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Biochemistry & Molecular Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel G Stover
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA.,Department of Internal Medicine, College of Medicine, The Ohio State University, 320 West 10th Avenue, Columbus, OH, 43210, USA
| | - Thomas Ludwig
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA
| | - Ramesh Ganju
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA.,Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Daniel Weng
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA.,Department of Internal Medicine, College of Medicine, The Ohio State University, 320 West 10th Avenue, Columbus, OH, 43210, USA
| | - Peter Shields
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA.,Department of Internal Medicine, College of Medicine, The Ohio State University, 320 West 10th Avenue, Columbus, OH, 43210, USA
| | - Jo Freudenheim
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, USA
| | - Gustavo W Leone
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Biochemistry & Molecular Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Gina M Sizemore
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA.,Department of Radiation Oncology, The Ohio State University, Columbus, OH, USA
| | - Sarmila Majumder
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA.
| | - Bhuvaneswari Ramaswamy
- The Comprehensive Cancer Center, College of Medicine, The Ohio State University, 460 West 12th Avenue, Columbus, OH, 43210, USA. .,Department of Internal Medicine, College of Medicine, The Ohio State University, 320 West 10th Avenue, Columbus, OH, 43210, USA.
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