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Nhim V, Bencomo-Alvarez AE, Alvarado L, Kilcoyne M, Gonzalez-Henry MA, Olivas IM, Keivan M, Gaur S, Mulla ZD, Dwivedi AK, Gadad SS, Eiring AM. Racial/ethnic differences in the clinical presentation and survival of breast cancer by subtype. Front Oncol 2024; 14:1443399. [PMID: 39220652 PMCID: PMC11361935 DOI: 10.3389/fonc.2024.1443399] [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: 06/04/2024] [Accepted: 07/22/2024] [Indexed: 09/04/2024] Open
Abstract
Background Breast cancer (BC) affects racial and ethnic groups differently, leading to disparities in clinical presentation and outcomes. It is unclear how Hispanic ethnicity affects BC outcomes based on geographic location and proximity to the United States (U.S.)/Mexico border. We hypothesized that the impact of race/ethnicity on BC outcomes depends on geographic location and country of origin within each BC subtype. Methods We analyzed BC data from the Texas Cancer Registry by race/ethnicity/birthplace according to BC subtype (luminal A/luminal B/human epidermal growth factor receptor 2 [HER2]/triple-negative breast cancer[TNBC]). Other covariates included age, geographic location (U.S., Mexico), residency (border, non-border), treatments, and comorbidities. Crude and adjusted effects of race/ethnicity and birthplace on overall survival (OS) were analyzed using Cox regression methods. Results Our analysis of 76,310 patient records with specific BC subtypes revealed that Hispanic and non-Hispanic Black (NHB) patients were diagnosed at a younger age compared with non-Hispanic White (NHW) patients for all BC subtypes. For the 19,748 BC patients with complete data on race/ethnicity/birthplace/residency, Hispanic patients had a higher mortality risk in the Luminal A subtype, regardless of birthplace, whereas U.S.-born Hispanics had a higher risk of death in the TNBC subtype. In contrast, NHB patients had a higher mortality risk in the Luminal A and HER2 subtypes. Residence along the U.S./Mexico border had little impact on OS, with better outcomes in Luminal A patients and worse outcomes in Luminal B patients aged 60-74 years. Conclusion Race/ethnicity, geographic birth location, and residency were significant predictors of survival in BC. Migration, acculturation, and reduced healthcare access may contribute to outcome differences.
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Affiliation(s)
- Vutha Nhim
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
- University of Arkansas for Medical Sciences, Washington Regional Medical Center, Fayetteville, AR, United States
| | - Alfonso E. Bencomo-Alvarez
- Center of Emphasis in Cancer, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
- St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Luis Alvarado
- Biostatistics and Epidemiology Consulting Lab, Office of Research, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
| | - Michelle Kilcoyne
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
- Baylor College of Medicine, Houston, TX, United States
| | - Mayra A. Gonzalez-Henry
- Center of Emphasis in Cancer, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
| | - Idaly M. Olivas
- Center of Emphasis in Cancer, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
| | - Mehrshad Keivan
- Burrell College of Osteopathic Medicine, Las Cruces, NM, United States
| | - Sumit Gaur
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
| | - Zuber D. Mulla
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
- Office of Faculty Development, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
- Julia Jones Matthews School of Population and Public Health, Texas Tech University Health Sciences Center, Abilene, TX, United States
| | - Alok K. Dwivedi
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
- Biostatistics and Epidemiology Consulting Lab, Office of Research, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
| | - Shrikanth S. Gadad
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
- Center of Emphasis in Cancer, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
| | - Anna M. Eiring
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
- Center of Emphasis in Cancer, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
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Gonzalo-Encabo P, Sami N, Wilson RL, Kang DW, Ficarra S, Dieli-Conwright CM. Exercise as Medicine in Cardio-Oncology: Reducing Health Disparities in Hispanic and Latina Breast Cancer Survivors. Curr Oncol Rep 2023; 25:1237-1245. [PMID: 37715884 PMCID: PMC10640421 DOI: 10.1007/s11912-023-01446-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE OF REVIEW This review aims to access the current state of the evidence in exercise as medicine for cardio-oncology in Hispanic and Latina breast cancer survivors and to provide our preliminary data on the effects of supervised aerobic and resistance training on cardiovascular disease (CVD) risk in this population. RECENT FINDINGS Breast cancer survivors have a higher risk of CVD; particularly Hispanic and Latina breast cancer survivors have a higher burden than their White counterparts. Exercise has been shown to reduce CVD risk in breast cancer survivors; however, evidence in Hispanic and Latina breast cancer survivors is scarce. Our review highlights a clear need for exercise oncology clinical trials in Hispanic and Latina breast cancer survivors targeting CVD risk factors. Moreover, our exploratory results highlight that 16 weeks of aerobic and resistance training may reduce the 10-year risk of developing CVD by 15% in Hispanic and Latina breast cancer survivors.
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Affiliation(s)
- Paola Gonzalo-Encabo
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Ciencias Biomédicas, Área de Educación Física y Deportiva, Madrid, Spain
| | - Nathalie Sami
- Department of Internal Medicine, Los Angeles County-University of Southern California Medical Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Rebekah L Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Salvatore Ficarra
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144, Palermo, Italy
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
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Koch PA, Paul R, Contento IR, Gray HL, Marín-Chollom AM, Santiago-Torres M, Shen H, Jones SMW, Hershman DL, Greenlee H. Mi Vida Saludable: Content Validity and Reliability of The Preferences and Self-Efficacy of Diet and Physical Activity Behaviors Questionnaire for Latina Women (PSEDPALW) for Cancer Survivors. Nutrients 2023; 15:3563. [PMID: 37630753 PMCID: PMC10457843 DOI: 10.3390/nu15163563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
The purpose of this study is to conduct validity and reliability testing of a new instrument, the Preferences and Self-Efficacy of Diet and Physical Activity Behaviors Questionnaire for Latina Women (PSEDPALW), which is for women who identify as Latina and are breast cancer survivors. PSEDPALW measures preferences and self-efficacy for four behaviors: physical activity (PA), fruit and vegetable (FV) intake, dietary fat (DF) intake, and added sugar (AS) intake (eight scales in total). Validity testing was conducted through an expert panel review and a cognitive interviewing focus group (n = 4). Reliability was tested via internal consistency reliability (n = 118) and test-retest reliability (n = 30). Validity testing was used to refine PSEDPALW. Reliability testing was conducted on three versions with 104, 47, and 41 items. PA scales had acceptable Cronbach's α (>0.70) but low ICC (NS). FV and DF scales had acceptable Cronbach's α (>0.70), with preferences for the shorter (47- and 41-item) versions (Cronbach's α < 0.70), and all scales had moderate ICC (p < 0.05, except the FV scale on the 104-item version (p = 0.07)). The AS preferences scale had Cronbach's α < 0.70, with self-efficacy > 0.70 for all versions and ICC moderate for all versions (p ≤ 0.01). PSEDPALW may be useful to assess diet and physical activity preferences and self-efficacy in theory-based diet and physical activity interventions in women who identify as Latina and are breast cancer survivors.
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Affiliation(s)
- Pamela A. Koch
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA; (R.P.); (I.R.C.)
| | - Rachel Paul
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA; (R.P.); (I.R.C.)
| | - Isobel R. Contento
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA; (R.P.); (I.R.C.)
| | - Heewon L. Gray
- College of Public Health, University of South Florida, Tampa, FL 33612, USA;
| | - Amanda M. Marín-Chollom
- Department of Psychological Science, Central Connecticut State University, New Britain, CT 06050, USA;
| | | | - Hanjie Shen
- Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; (M.S.-T.); (H.S.); (S.M.W.J.); (H.G.)
| | - Salene M. W. Jones
- Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; (M.S.-T.); (H.S.); (S.M.W.J.); (H.G.)
| | - Dawn L. Hershman
- College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, New York, NY 10027, USA;
| | - Heather Greenlee
- Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; (M.S.-T.); (H.S.); (S.M.W.J.); (H.G.)
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4
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Kallamadi PR, Esari D, Addi UR, Kesavan R, Putcha UK, Nagini S, Reddy GB. Obesity Associated with Prediabetes Increases the Risk of Breast Cancer Development and Progression-A Study on an Obese Rat Model with Impaired Glucose Tolerance. Int J Mol Sci 2023; 24:11441. [PMID: 37511200 PMCID: PMC10380482 DOI: 10.3390/ijms241411441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Patients with comorbidities of obesity and diabetes are recognized to be at high risk of breast cancer development and face worse breast cancer outcomes. Though several reports showed the reinforced link between obesity, diabetes, and prediabetes with breast cancer, the underlying molecular mechanisms are still unknown. The present study aimed to investigate the underlying molecular link between increased risks of breast cancer due to coincident diabetes or obesity using a spontaneous obese rat model with impaired glucose tolerance (WNIN/GR-Ob rat). A single dose of solubilized DMBA suspension (40 mg/kg body weight) was orally administered to the animals at the age of 60 days to induce breast tumors. The tumor incidence, latency period, tumor frequency, and tumor volume were measured. Histology, immunohistochemistry, and immunoblotting were performed to evaluate the tumor morphology and expression levels of signal molecules. The development of mammary tumors in GR-Ob rats was characterized by early onset and shorter latency periods compared to control lean rats. While 62% of obese rats developed breast tumors, tumor development in lean rats was only 21%. Overexpression of ER, PR, Ki67, and p53 markers was observed in tumor tissues of obese rats in comparison with lean rats. The levels of the hallmarks of cell proliferation and angiogenesis involved in IGF-1/PI3K/Akt/GSK3β/β-catenin signaling pathway molecules were upregulated in obese rat breast tumors compared to lean rats. Furthermore, obesity with prediabetes is associated with changes in IGF-1 signaling and acts on PI3K/Akt/GSK3β/β-catenin signaling, which results in rapid cell proliferation and development of breast tumors in obese rats than the lean rats. These results indicate that tumor onset and development were faster in spontaneous obese rat models with impaired glucose tolerance than in their lean counterparts.
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Affiliation(s)
| | - Deepshika Esari
- ICMR-National Institute of Nutrition, Hyderabad 500007, India
| | | | - Rushendhiran Kesavan
- UT Southwestern Medical Center, Children Research Institute, Dallas, TX 75390, USA
| | | | - Siddavaram Nagini
- Department of Biochemistry and Biotechnology, Annamalai University, Annamalinagar 608002, India
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5
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Bacon DR, Ngeve SM, Jordan SG. Granulomatous mastitis: An underdiagnosed inflammatory disease afflicting minority women. Radiol Case Rep 2021; 16:3990-3994. [PMID: 34745405 PMCID: PMC8554342 DOI: 10.1016/j.radcr.2021.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022] Open
Abstract
Granulomatous mastitis (GM) is an underdiagnosed and understudied benign inflammatory disease of the breast whose accurate diagnosis is confounded by mimicry of other breast pathologies (infectious mastitis and abscess, malignancy) and limited clinician knowledge of the disease. GM disproportionately affects minority women, furthering health disparities for a demographic already disadvantaged in the care of breast diseases. The first step in diagnosis is ultrasound followed by core needle biopsy yielding granulomatous inflammation. To far lesser degree, mammography, and MRI may play a role in narrowing the differential. A high index of clinical suspicion and multidisciplinary approach is required. The presence of Corynebacterium kroppensteddti may indicate one subtype of granulomatous mastitis called cystic neutrophilic granulomatous mastitis; disease stratification, and individualized therapy are on the horizon.
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Affiliation(s)
- Daniel R Bacon
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Smith M Ngeve
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sheryl G Jordan
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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6
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Islam JY, Camacho-Rivera M, Vidot DC. Examining COVID-19 Preventive Behaviors among Cancer Survivors in the United States: An Analysis of the COVID-19 Impact Survey. Cancer Epidemiol Biomarkers Prev 2020; 29:2583-2590. [PMID: 32978173 PMCID: PMC7871461 DOI: 10.1158/1055-9965.epi-20-0801] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/06/2020] [Accepted: 09/22/2020] [Indexed: 12/26/2022] Open
Abstract
Background: The COVID-19 pandemic has impacted adults with chronic diseases, and their health care delivery. Patterns of COVID-19–related preventive behaviors practiced by cancer survivors are unknown, including practices related to canceling doctor's appointments. We evaluated COVID-19–related preventive behaviors among cancer survivors in the United States. Methods: We used nationally representative data of 10,760 U.S. adults from the COVID-19 Impact Survey. We defined cancer survivors as those with a self-reported diagnosis of cancer (n = 854, 7.6%). We present frequencies and χ2 tests to evaluate COVID-19–related preventive behaviors among cancer survivors. We estimated determinants of canceling doctor's appointments among cancer survivors using Poisson regression models. Results: Cancer survivors were more likely to practice preventive behaviors, including social distancing (93%, χ2P < 0.001), wearing a face mask (93%, χ2P < 0.001), and avoiding crowded areas (84%, χ2P < 0.001) compared with adults without cancer. Cancer survivors were more likely to cancel doctor's appointments (41%, χ2P < 0.001), whereas they were less likely to cancel other social activities such as work (19%, χ2P < 0.001) and school-related (13%, χ2P < 0.001) activities. After adjustment for covariates, while non-Hispanic (NH)-Black cancer survivors were less likely to cancel a doctor's appointment compared with NH-White cancer survivors, cancer survivors aged 18 to 29, who were female, and who had least one comorbid condition were more likely. Conclusions: Cancer survivors are adhering to recommended preventive behaviors. Cancer survivor's continuity of care may be impacted by COVID-19, specifically young adults, females, and those with existing comorbid conditions. Impact: Insights into cancer survivors whose care may be most impacted by COVID-19 will be valuable toward surveillance and survivorship of U.S. cancer survivors.
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Affiliation(s)
- Jessica Y Islam
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, New York, New York
| | - Denise C Vidot
- Sylvester Comprehensive Cancer Center, School of Nursing and Health Studies, University of Miami, Coral Gables, Miami
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Nahleh Z, Otoukesh S, Mirshahidi HR, Nguyen AL, Nagaraj G, Botrus G, Badri N, Diab N, Alvarado A, Sanchez LA, Dwivedi AK. Disparities in breast cancer: a multi-institutional comparative analysis focusing on American Hispanics. Cancer Med 2018; 7:2710-2717. [PMID: 29733543 PMCID: PMC6010853 DOI: 10.1002/cam4.1509] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 03/01/2018] [Accepted: 03/28/2018] [Indexed: 01/15/2023] Open
Abstract
Breast cancer (BC) is the leading cause of cancer death in Hispanic/Latino women nationwide. Hispanic women are more likely to be presented with advanced disease and adverse prognosis subtypes. The aim of this study is to describe the clinico‐ pathological characteristics and disparities in breast cancer in this group at two tertiary care University‐based medical centers. After IRB approval, Cancer registry was used to analyze the variables of 3441 patients with breast cancer diagnosed and treated consecutively at two large tertiary University based medical and cancer center database centers in El Paso, TX and Loma Linda, CA between 2005 and 2015. Association between race/ethnicity and cancer type, stage, hormone receptor status and treatment option were investigated. Overall 45.5% of the patients were Hispanic (n: 1566) and those were more likely to be diagnosed at a younger age (57 years) similar to African Americans, more likely to have invasive ductal carcinoma type (82.7%) & triple negative disease (17.1%, 95%CI: 15% to 19%). 58.8% of Hispanics (95%CI: 56% to 61%) have hormone receptor (HR)+ & HER2− as opposed to 71% in non‐Hispanic White people. In addition, Hispanic individuals presented with advanced stages of BC (25.3%, 95% CI: 23% to 28%) similar to African American (25.4%), and had a lower proportion of lumpectomy (50%) similar to African American (50%). When compared to African American patients, Hispanic patients had a higher prevalence of triple negative BC (17.11% in Hispanics Versus 13.86% in African American). Conclusion: Hispanics had significantly higher relative risk of advanced stages at presentation (Relative Risk Ratio (RRR) = 2.05, P < 0.001), triple negative tumors (RRR = 2.64, P < 0.0001), HER2 + /HR ‐ disease (RRR = 1.77, P < 0.0001), and less HR+ /HER2− BC (RRR = 0.69, P < 0.0001). Hispanics and African Americans are diagnosed with breast cancer at a younger age, have a higher prevalence of Triple negative breast cancer, and are diagnosed at more advanced stages of disease. Increasing awareness and targeting minority populations for health promotion interventions, screening and early detection continue to be of paramount importance to reduce the burden of health disparities.
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Affiliation(s)
- Zeina Nahleh
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, Florida
| | - Salman Otoukesh
- Division of Hematology-Oncology, Department of Internal Medicine, Loma Linda University Health, Loma Linda, California
| | - Hamid Reza Mirshahidi
- Division of Hematology-Oncology, Department of Internal Medicine, Loma Linda University Health, Loma Linda, California
| | - Anthony Loc Nguyen
- Department of Internal Medicine, Loma Linda University, Loma Linda, California
| | - Gayathri Nagaraj
- Division of Hematology-Oncology, Department of Internal Medicine, Loma Linda University Health, Loma Linda, California
| | - Gehan Botrus
- Department of Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, Texas
| | - Nabeel Badri
- Department of Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, Texas
| | - Nabih Diab
- Department of Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, Texas
| | - Andres Alvarado
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, EL Paso, Texas
| | - Luis A Sanchez
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, EL Paso, Texas
| | - Alok K Dwivedi
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, EL Paso, Texas
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Prieto D, Soto-Ferrari M, Tija R, Peña L, Burke L, Miller L, Berndt K, Hill B, Haghsenas J, Maltz E, White E, Atwood M, Norman E. Literature review of data-based models for identification of factors associated with racial disparities in breast cancer mortality. Health Syst (Basingstoke) 2018; 8:75-98. [PMID: 31275571 PMCID: PMC6598506 DOI: 10.1080/20476965.2018.1440925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 01/03/2023] Open
Abstract
In the United States, early detection methods have contributed to the reduction of overall breast cancer mortality but this pattern has not been observed uniformly across all racial groups. A vast body of research literature shows a set of health care, socio-economic, biological, physical, and behavioural factors influencing the mortality disparity. In this paper, we review the modelling frameworks, statistical tests, and databases used in understanding influential factors, and we discuss the factors documented in the modelling literature. Our findings suggest that disparities research relies on conventional modelling and statistical tools for quantitative analysis, and there exist opportunities to implement data-based modelling frameworks for (1) exploring mechanisms triggering disparities, (2) increasing the collection of behavioural data, and (3) monitoring factors associated with the mortality disparity across time.
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Affiliation(s)
- Diana Prieto
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
- Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - Milton Soto-Ferrari
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
- Department of Marketing and Operations, Scott College of Business, Terre Haute, IN, USA
| | - Rindy Tija
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Lorena Peña
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Leandra Burke
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Lisa Miller
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Kelsey Berndt
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Brian Hill
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jafar Haghsenas
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Ethan Maltz
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Evan White
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Maggie Atwood
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Earl Norman
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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9
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Nahleh Z, Botrus G, Dwivedi A, Badri N, Otoukesh S, Diab N, Biswas S, Jennings M, Elzamly S. Clinico-pathologic disparities of breast cancer in Hispanic/Latina women. Breast Dis 2018; 37:147-154. [PMID: 29376844 DOI: 10.3233/bd-170309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Breast cancer is the leading cause of cancer death in Hispanic/Latina women nationwide. Limited cancer research has been conducted in this population. El Paso, Texas is a large border city with a population of around 900,000, of which 85% are Latinos and would provide a suitable setting for this study. The aim of this study is to evaluate ethnic differences and cancer characteristics in Hispanic/latina women with breast cancer. METHODS After IRB approval, we retrospectively analyzed the variables of patients with breast cancer treated consecutively at a large tertiary medical center in El Paso, TX between 2005-2015. Descriptive statistics, bivariate, and multivariable analyses were conducted. RESULTS 1,252 patients were identified. Mean age at diagnosis was 57 years. 1074 were Hispanics/Latinas (86%). When comparing Hispanics versus non-Hispanics, 31% of Hispanics compared to 24% Non-Hispanics were diagnosed at age <50 (P = 0.043). More Hispanics are uninsured (34%) compared to Non-Hispanics (25%) (p = 0.008). Hispanics presenting with advanced stages were more likely to be uninsured (P = 0.02). CONCLUSIONS This analysis confirms that Hispanics/Latinas are diagnosed with breast cancer at a younger age and are more commonly uninsured than Non-Hispanics. We did not observe significant differences in the prevalence of ER+, triple negative or Her2 -neu positive disease or stages at presentation between the 2 groups in this cohort, however the non-Hispanic group was constituted only 14% of the studied population. A larger multi-institutional comparative study is being conducted to confirm these findings.
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Affiliation(s)
- Z Nahleh
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida 2950 Cleveland Clinic Blvd, Weston, Fl 33331, USA
| | - G Botrus
- Department of Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TX, USA
| | - A Dwivedi
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center Foster School of Medicine, EL Paso, TX, USA
| | - N Badri
- Department of Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TX, USA
| | - S Otoukesh
- Department of Internal Medicine, Loma Linda University, Loma Linda, CA, USA
| | - N Diab
- Department of Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TX, USA
| | - S Biswas
- Department of Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TX, USA
| | - M Jennings
- Department of Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TX, USA
| | - S Elzamly
- Pathology Department, Faculty of Medicine, Benha University, Benha, Egypt
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10
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Gonzalez-Reyes C, Marcial-Medina C, Cervantes-Anaya N, Cortes-Reynosa P, Salazar EP. Migration and invasion induced by linoleic acid are mediated through fascin in MDA-MB-231 breast cancer cells. Mol Cell Biochem 2017; 443:1-10. [PMID: 29052029 DOI: 10.1007/s11010-017-3205-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 10/14/2017] [Indexed: 12/12/2022]
Abstract
Epidemiological studies strongly suggest an association between high levels of dietary fat intake and an increased risk of developing breast cancer. Linoleic acid (LA) is an essential omega-6 PUFA and the major fatty acid in occidental diets. In breast cancer cells, LA induces expression of plasminogen activator inhibitor-1, proliferation, migration, and invasion. Fascin is an actin crosslinker globular protein that generates actin bundles made of parallel actin filaments, which mediate formation and stability of microspikes, stress fibers, membrane ruffles, and filopodia. However, the role of fascin in migration and invasion induced by LA in MDA-MB-231 breast cancer cells remains to be studied. We demonstrate here that LA induces an increase of fascin expression in MDA-MB-231 and MCF12A mammary epithelial cells. Particularly, LA induces the formation of filopodia and lamellipodia and the localization of fascin in these actin structures in MDA-MB-231 breast cancer cells. However, LA only induces formation of microspikes and the localization of fascin in these actin structures in mammary non-tumorigenic epithelial cells MCF12A. In addition, LA induces migration, invasion, and matrix metalloproteinase-9 secretion through a fascin-dependent pathway in MDA-MB-231 cells. In summary, our findings demonstrate that fascin is required for migration and invasion induced by LA in MDA-MB-231 breast cancer cells.
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Affiliation(s)
- Christian Gonzalez-Reyes
- Departamento de Biologia Celular, Cinvestav-IPN, Av IPN # 2508, San Pedro Zacatenco, 07360, Mexico City, Mexico
| | - Cleofas Marcial-Medina
- Departamento de Biologia Celular, Cinvestav-IPN, Av IPN # 2508, San Pedro Zacatenco, 07360, Mexico City, Mexico
| | - Nancy Cervantes-Anaya
- Departamento de Biologia Celular, Cinvestav-IPN, Av IPN # 2508, San Pedro Zacatenco, 07360, Mexico City, Mexico
| | - Pedro Cortes-Reynosa
- Departamento de Biologia Celular, Cinvestav-IPN, Av IPN # 2508, San Pedro Zacatenco, 07360, Mexico City, Mexico
| | - Eduardo Perez Salazar
- Departamento de Biologia Celular, Cinvestav-IPN, Av IPN # 2508, San Pedro Zacatenco, 07360, Mexico City, Mexico.
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11
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Zhu RM, Lin W, Zhang W, Ren JT, Su Y, He JR, Lin Y, Su FX, Xie XM, Tang LY, Ren ZF. Modification effects of genetic polymorphisms in FTO, IL-6, and HSPD1 on the associations of diabetes with breast cancer risk and survival. PLoS One 2017; 12:e0178850. [PMID: 28591216 PMCID: PMC5462388 DOI: 10.1371/journal.pone.0178850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 05/21/2017] [Indexed: 12/29/2022] Open
Abstract
The contribution of diabetes to breast cancer remains uncertain among Chinese females, which may result from different genetic factors. We evaluated the associations of diabetes, combined with the polymorphisms in the genes of fat mass and obesity-associated gene (FTO), interleukin 6 (IL-6), and heat shock protein 60 (HSPD1), with breast cancer risk and survival in a Chinese Han population. The information on the history of diabetes was collected from 1551 incident breast cancer cases and 1605 age-frequency matched controls in Guangzhou, China. In total, 1168 cases were followed up. Diabetes was associated with both an increased risk of breast cancer [OR (95%CI): 1.67 (1.11, 2.52)] and a poor overall survival and progression free survival for breast cancer patients [HRs (95%CIs): 2.66 (1.10, 6.44) and 2.46 (1.29, 4.70), respectively]. IL-6 rs1800796 and HSPD1 rs2605039 had interactions with diabetes on breast cancer risk. Among women with CC genotype of IL-6 rs1800796 or GG genotype of HSPD1 rs2605039, diabetic individuals had a remarkably increased risk of breast cancer compared to non-diabetic women with ORs and 95%CIs of 2.53 (1.45, 4.41) and 6.40 (2.29, 17.87), respectively. GT/TT genotypes of HSPD1 rs2605039 was also associated with a better progression free survival for breast cancer patients [HR (95%CI): 0.70 (0.49, 0.99)]. Our results suggest that the contribution of diabetes to breast cancer risk might be modified by IL-6 rs1800796 and HSPD1 rs2605039. Diabetes and HSPD1 rs2605039 might also influence breast cancer prognosis.
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Affiliation(s)
- Rui-Mei Zhu
- Department of Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Wei Lin
- Department of Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Wei Zhang
- Department of Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jun-Ting Ren
- Department of Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yi Su
- Department of Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jian-Rong He
- The Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Ying Lin
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Feng-Xi Su
- The Second Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Ming Xie
- The Cancer Center, Sun Yat-Sen University, Guangzhou, China
| | - Lu-Ying Tang
- The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- * E-mail: (LT); (ZR)
| | - Ze-Fang Ren
- Department of Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- * E-mail: (LT); (ZR)
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12
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Maskarinec G, Fontaine A, Torfadottir JE, Lipscombe LL, Lega IC, Figueroa J, Wild S. The Relation of Type 2 Diabetes and Breast Cancer Incidence in Asian, Hispanic and African American Populations-A Review. Can J Diabetes 2017; 42:100-105. [PMID: 28506814 DOI: 10.1016/j.jcjd.2017.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/14/2017] [Accepted: 02/21/2017] [Indexed: 02/08/2023]
Abstract
In addition to rising type 2 diabetes and breast cancer incidence rates worldwide, diabetes may also increase breast cancer risk, and the association may vary by ethnicity. This review summarizes published data evaluating the association between diabetes and breast cancer in women of Asian, Hispanic and African American ancestry while considering a measure of obesity, body mass index (BMI). Published reports were identified through a search of PubMed and previous publications. Of 15 age-adjusted studies, 11 reported on Asian women from various countries, 3 on Hispanics and 1 on African Americans. The studies of Asian women described significant associations in 8 reports, with risk estimates of 1.5 to 8.4, but 3 were case-control studies and 6 did not adjust for BMI. The 3 case-control studies of Hispanic people included BMI, but only 1 detected a weak association between diabetes and breast cancer risk and was limited to postmenopausal women. The only study of African American women was a prospective cohort, and it showed no significant association between diabetes and breast cancer. In contrast to a 10% to 20% higher risk for breast cancer associated with diabetes reported for Caucasian women, there is little evidence for an association in Hispanics and African Americans. Although several studies of Asian women included in our review reported a higher risk for breast cancer with diabetes, methodologic shortcomings, such as lack of adjustment for obesity, use of a general population as controls, case-control design and small sample sizes, raise questions about the validity of the findings.
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Affiliation(s)
- Gertraud Maskarinec
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, United States.
| | - Angelique Fontaine
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, United States
| | | | - Lorraine L Lipscombe
- Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Iliana C Lega
- Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jonine Figueroa
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
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13
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The metabolic syndrome and mammographic breast density in a racially diverse and predominantly immigrant sample of women. Cancer Causes Control 2015; 26:1393-403. [PMID: 26169301 DOI: 10.1007/s10552-015-0630-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/01/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE The metabolic syndrome [MetS, clustering of elevated blood pressure, triglycerides and glucose, reduced high-density lipoprotein cholesterol (HDL-C), abdominal obesity] has been associated with increased breast cancer risk, but less is known about its association with mammographic breast density, a strong risk factor for breast cancer. METHODS We collected data on risk factors, body size, and blood pressure via in-person interviews and examinations and measured glucose, triglycerides, and HDL-C from dried blood spots from women recruited through a mammography screening clinic (n = 373; 68 % Hispanic, 17 % African-American, 63 % foreign born). We performed linear regression models to examine the associations of each MetS component and the MetS cluster (≥3 components) with percent density and dense breast area, measured using a computer-assisted technique and Cumulus software. RESULTS About 45 % of women had the MetS, with the prevalence of the individual components ranging from 68 % for abdominal obesity to 33 % for elevated triglycerides. The prevalence of the MetS increased with higher body mass index (BMI) and postmenopausal status, but did not vary substantially by ethnicity, immigrant generational status, parity, age at menarche, or alcohol consumption. Low HDL-C (<50 mg/dL), but not the MetS cluster or the other MetS components, was associated with larger dense breast area after adjusting for age, BMI, fasting time, and educational attainment (β = 8.77, 95 % CI 2.39, 15.14). The MetS and its individual components were not associated with BMI-adjusted percent density. CONCLUSIONS HDL-C alone may have an influence on dense breast tissue that is independent of BMI, and may be in the same direction as its association with breast cancer risk.
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Abstract
Overweight and obesity have reached pandemic levels on a worldwide basis and are associated with increased risk and worse prognosis for many but not all malignancies. Pathophysiologic processes that affect this association are reviewed, with a focus on the relationship between type 2 diabetes mellitus and cancer, lessons learned from the use of murine models to study the association, the impact of obesity on pancreatic cancer, the effects of dietary fats and cholesterol on cancer promotion, and the mechanisms by which the intestinal microbiome affects obesity and cancer.
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Affiliation(s)
- Nathan A Berger
- Departments of Medicine, Biochemistry, and Genetics, Center for Science, Health and Society, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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15
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Blumhardt R, Wolin EA, Phillips WT, Salman UA, Walker RC, Stack BC, Metter D. Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review. Endocr Relat Cancer 2014; 21:R473-84. [PMID: 25277792 DOI: 10.1530/erc-14-0286] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and the fifth most common cancer in women. DTC therapy requires a multimodal approach, including surgery, which is beyond the scope of this paper. However, for over 50 years, the post-operative management of the DTC post-thyroidectomy patient has included radioactive iodine (RAI) ablation and/or therapy. Before 2000, a typical RAI post-operative dose recommendation was 100 mCi for remnant ablation, 150 mCi for locoregional nodal disease, and 175-200 mCi for distant metastases. Recent recommendations have been made to decrease the dose in order to limit the perceived adverse effects of RAI including salivary gland dysfunction and inducing secondary primary malignancies. A significant controversy has thus arisen regarding the use of RAI, particularly in the management of the low-risk DTC patient. This debate includes the definition of the low-risk patient, RAI dose selection, and whether or not RAI is needed in all patients. To allow the reader to form an opinion regarding post-operative RAI therapy in DTC, a literature review of the risks and benefits is presented.
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Affiliation(s)
- Ralph Blumhardt
- University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ely A Wolin
- University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - William T Phillips
- University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Umber A Salman
- University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ronald C Walker
- University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brendan C Stack
- University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Darlene Metter
- University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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