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Fayanju OM, Greenup RA, Zafar SY, Hyslop T, Hwang ES, Fish LJ. Modifiable Barriers and Facilitators for Breast Cancer Care: A Thematic Analysis of Patient and Provider Perspectives. J Surg Res 2023; 284:269-279. [PMID: 36610386 PMCID: PMC10020986 DOI: 10.1016/j.jss.2022.11.074] [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: 08/24/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We sought to examine patient and provider perspectives regarding modifiable contributors to breast cancer treatment and to assess perceptual alignment between these two groups. MATERIALS Participants were women≥18 y with stage 0-IV breast cancer who received all oncologic care in a single health system and physicians and advanced practice providers who provided medical, radiation, or surgical oncology care for breast cancer. All completed ∼45-min semistructured interviews that were recorded and transcribed verbatim. A 5-stage approach to thematic analysis was conducted, with emergent themes and exemplar quotes placed into clinical, psychological, social/logistical, financial, and lifestyle categories using a multilevel conceptual framework. RESULTS Eighteen patients (9 Black, 9 White, and median age 60 y) and 10 providers (6 physicians and 4 advanced practice providers) were interviewed from May to November 2018. Both patients and providers perceived suboptimal communication, parking and transportation, and competing family-caregiving responsibilities as modifiable barriers to care. Treatment costs were cited by patients as barriers that were inadequately addressed even with referrals to financial counselors, but providers did not raise the issue of cost unless prompted by patients and did not feel prepared to discuss the topic when it arose. Providers cited obesity as a barrier to treatment, a view not shared by patients. CONCLUSIONS Several modifiable factors were recognized by both patients and providers as either promoting or detracting from treatment receipt, but there was also significant incongruence and asymmetry. Alignment of provider and patient perceptions regarding contributors to guideline-concordant care receipt could mitigate disparities in breast cancer treatment and outcomes.
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Affiliation(s)
- Oluwadamilola M Fayanju
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Forge, Duke University, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina.
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - S Yousuf Zafar
- Duke Cancer Institute, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina; Change Healthcare, Nashville, Tennessee
| | - Terry Hyslop
- Duke Cancer Institute, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina
| | - Laura J Fish
- Duke Cancer Institute, Durham, North Carolina; Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina
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Moura JBD, Ghedin CC, Takakura ÉT, Scandolara TB, Rech D, Panis C. Hereditary Breast and Ovarian Cancer Screening Syndrome Profile in Women Diagnosed with Breast Cancer from Paraná State Southwest. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:616-621. [PMID: 34547796 PMCID: PMC10183857 DOI: 10.1055/s-0041-1733998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study evaluated the risk of the hereditary breast and ovarian cancer (HBOC) syndrome in patients with breast cancer by using the Family History Screening 7 (FHS-7) tool, a validated low-cost questionnaire with high sensitivity able to screen the HBOC risk in the population. METHODS Women diagnosed with breast cancer (n = 101) assisted by the Unified Health System at the 8th Regional Health Municipal Office of the state of Paraná answered the FHS-7, and the results were analyzed using IBM SPSS Statistics for Windows, Version 25.0. software (IBM Corp., Armonk, NY, USA). RESULTS The risk of HBOC was 19.80% (n = 20). Patients at risk exhibited aggressive tumor characteristics, such as high-grade tumors (30%), presence of angiolymphatic emboli (35%), and premenopausal at diagnosis (50%). Significant associations between the prevalence of high-grade tumors were observed in women younger than 50 years at diagnosis with HBOC (p = 0.003). CONCLUSION Our findings suggest a possible family inheritance associated with worse clinical features in women with breast cancer in this population, indicating that HBOC investigation can be initially performed with low-cost instruments such as FHS-7.
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Affiliation(s)
| | - Carla Camila Ghedin
- Laboratory of Tumor Biology, Universidade do Estado do Paraná, Francisco Beltrão, PR, Brazil
| | - Érika Tomie Takakura
- Laboratory of Tumor Biology, Universidade do Estado do Paraná, Francisco Beltrão, PR, Brazil
| | - Thalita Basso Scandolara
- Laboratory of Tumor Biology, Universidade do Estado do Paraná, Francisco Beltrão, PR, Brazil.,Department of Genetics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Daniel Rech
- Center of Health Sciences, Francisco Beltrão Cancer Hospital, Francisco Beltrão, PR, Brazil
| | - Carolina Panis
- Laboratory of Tumor Biology, Universidade do Estado do Paraná, Francisco Beltrão, PR, Brazil
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Segerer R, Peschel C, Kämmerer U, Häussler S, Wöckel A, Segerer S. Factors Impacting on Decision-Making towards Prophylactic Surgeries in BRCA Mutation Carriers and Women with Familial Predisposition. Breast Care (Basel) 2020; 15:253-259. [PMID: 32774219 DOI: 10.1159/000503370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/29/2019] [Indexed: 12/19/2022] Open
Abstract
Background/Objectives BRCA mutation carriers and women at high risk of breast/ovarian cancer are faced with the intricate question to opt for prophylactic surgeries and/or a periodic screening. The aim of this study was therefore to identify objective and emotional factors that have an impact on the decision-making process. Methods Ninety-five women with BRCA mutations or women at increased breast/ovarian cancer lifetime risk were counseled at our outpatient department and either opted for prophylactic surgery or periodic screening. To identify the psychological factors that could have influenced the decision-making, a standardized questionnaire was applied. Additionally, clinical data were collected and were reviewed by a personal talk. Results Seventy-one of the patients opted for an increased surveillance only, 21 for prophylactic surgeries. Positive predictors for prophylactic surgeries were sociodemographic characteristics such as parity and objective variables such as verified mutation status. Hierarchical regression analysis revealed that the need for safety in health issues has been the only significant psychological predictor of surgery beyond the objective factors. Fear of surgical procedures, menopausal symptoms after surgery, loss of attractiveness, or fear of interferences with sexual life did not significantly affect decision-making. Conclusion Decision-making towards prophylactic surgeries is influenced by objective but also emotional factors. Knowing that fear and anxiety also have an important impact on decision-making, distinct counselling about the procedures, the subsequent risk reduction as well as the psychological effects of prophylactic surgeries are essential.
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Affiliation(s)
- Robin Segerer
- Institut für Psychologie, Universität Basel, Basel, Switzerland
| | - Clara Peschel
- Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Stuttgart, Germany
| | | | | | - Achim Wöckel
- Universitätsfrauenklinik Würzburg, Würzburg, Germany
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Thorvaldsdottir B, Aradottir M, Stefansson OA, Bodvarsdottir SK, Eyfjörd JE. Telomere Length Is Predictive of Breast Cancer Risk in BRCA2 Mutation Carriers. Cancer Epidemiol Biomarkers Prev 2017; 26:1248-1254. [PMID: 28235830 DOI: 10.1158/1055-9965.epi-16-0946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/02/2017] [Accepted: 02/13/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Germline BRCA2 mutations increase risk of breast cancer and other malignancies. BRCA2 has been shown to play a role in telomere protection and maintenance. Telomere length (TL) has been studied as a modifying factor for various diseases, including breast cancer. Previous research on TL in BRCA mutation carriers has produced contradicting results.Methods: We measured blood TL, using a high-throughput monochrome multiplex qPCR method, in a well-defined Icelandic cohort of female BRCA2 mutation carriers (n = 169), sporadic breast cancer patients (n = 561), and healthy controls (n = 537).Results: Breast cancer cases had significantly shorter TL than unaffected women (P < 0.0001), both BRCA2 mutation carriers (P = 0.0097) and noncarriers (P = 0.00006). Using exclusively samples acquired before breast cancer diagnosis, we found that shorter telomeres were significantly associated with increased breast cancer risk in BRCA2 mutation carriers [HR, 3.60; 95% confidence interval (CI), 1.17-11.28; P, 0.025] but not in non-carriers (HR,1.40; 95% CI, 0.89-2.22; P, 0.15). We found no association between TL and breast cancer-specific survival.Conclusions: Blood TL is predictive of breast cancer risk in BRCA2 mutation carriers. Breast cancer cases have significantly shorter TL than unaffected women, regardless of BRCA2 status, indicating that samples taken after breast cancer diagnosis should not be included in evaluations of TL and breast cancer risk.Impact: Our study is built on a well-defined cohort, highly accurate methods, and long follow-up and can therefore help to clarify some previously published, contradictory results. Our findings also suggest that BRCA2 has an important role in telomere maintenance, even in normal blood cells. Cancer Epidemiol Biomarkers Prev; 26(8); 1248-54. ©2017 AACR.
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Affiliation(s)
- Birna Thorvaldsdottir
- Cancer Research Laboratory, Biomedical Center, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Margret Aradottir
- Cancer Research Laboratory, Biomedical Center, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Olafur A Stefansson
- Cancer Research Laboratory, Biomedical Center, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sigridur K Bodvarsdottir
- Cancer Research Laboratory, Biomedical Center, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jorunn E Eyfjörd
- Cancer Research Laboratory, Biomedical Center, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
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Psychological distress and dyslipidemia in chinese police officers: a 4-year follow-up study in Tianjin, China. J Occup Environ Med 2015; 57:400-5. [PMID: 25629802 DOI: 10.1097/jom.0000000000000372] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed at investigating whether psychological distress in police officers was associated with dyslipidemia. METHODS A survey was conducted to examine the psychological distress among 5867 police officers in Tianjin, China, from 2007 to 2011. Psychological distress was measured using the Symptom Check List-90-Revised. Cox proportional hazard regression was used to calculate the hazard ratios (HR) of the incidence of dyslipidemia predicted by psychological distress. RESULTS Among the 3300 participants without dyslipidemia at baseline (2567 with dyslipidemia), 60.5% (n = 1829) developed incident dyslipidemia 2.61 years (median) later. The adjusted HR was 1.15 (95% confidence interval, 1.05 to 1.26) after the adjustment of police classifications and other variables. The adjusted HR for police officers in charge of traffic control was 1.30 (95% confidence interval, 1.09 to 1.56). CONCLUSIONS Further investigations for associations of psychological factors with dyslipidemia and cardiovascular diseases are needed.
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Abstract
High serum levels of insulin-like growth factor I (IGF-I) are associated with an increased risk of sporadic breast cancer (BC). Furthermore, insulin and markers of insulin resistance, such as abdominal obesity, high blood glucose, high serum testosterone and metabolic syndrome, may affect both BC incidence and prognosis. We hypothesized that all these factors might be relevant also for hereditary BC, due to a deleterious mutation of BRCA genes. Epidemiological observation suggested that weight, energy intake (usually associated with higher bio-availability of growth factors) and physical activity may be relevant in BRCA mutation carriers. Mechanistic studies hypothesized a functional interaction between BRCA genes and the IGF-I system. We have provided some evidence that high serum levels of IGF-I are associated with a significantly increased penetrance. We are recruiting a larger cohort of BRCA mutation carriers in order to test potential modulators of penetrance and prognosis. Within this cohort, we have planned a randomized controlled trial to test whether moderate calorie and protein restriction, together with physical activity, decrease IGF-I. Eligible study subjects are women with or without BC, aged 18-70, with a proven deleterious BRCA mutation, and without metastases. All the women will receive recommendations for the dietary prevention of cancer. The women will be then randomized into an active life-style intervention group and into a control group that will receive only the baseline recommendations. We expect to significantly reduce IGF-I in the intervention group. This trial and the subsequent cohort follow-up might open up primary prevention options for genetic BC.
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Pettapiece-Phillips R, Narod SA, Kotsopoulos J. The role of body size and physical activity on the risk of breast cancer in BRCA mutation carriers. Cancer Causes Control 2015; 26:333-44. [PMID: 25579073 DOI: 10.1007/s10552-014-0521-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 12/23/2014] [Indexed: 01/18/2023]
Abstract
Women who inherit a BRCA mutation face a high lifetime risk of developing breast cancer. Given the high penetrance of these mutations, prevention is of extreme importance. Here, we review the literature regarding the role of body size and of physical activity in the context of BRCA-associated breast cancer. There is some evidence to support a protective role of a healthy body size and of regular physical activity among mutation carriers, particularly during adolescence or early adulthood. Factors which increase the physiologic expression of the normal copy of the BRCA1 or BRCA2 gene and thereby normalize protein levels, contribute to stem cell homeostasis, and/or affect hormone levels, might mitigate the effects of an inherited BRCA mutation. Preliminary evidence from one in vivo study and from one epidemiologic report suggests that an increase in BRCA1 mRNA expression occurs with increasing levels of physical activity. The prospect of changing lifestyle for the purpose of preventing breast cancer in high-risk women, complemented by mechanistic evidence, warrants evaluation in large-scale prospective studies.
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Affiliation(s)
- Rachael Pettapiece-Phillips
- Women's College Research Institute, Women's College Hospital, 790 Bay Street, 7th Floor, Toronto, ON, M5G 1N8, Canada
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Prosperi MCF, Ingham SL, Howell A, Lalloo F, Buchan IE, Evans DG. Can multiple SNP testing in BRCA2 and BRCA1 female carriers be used to improve risk prediction models in conjunction with clinical assessment? BMC Med Inform Decis Mak 2014; 14:87. [PMID: 25274085 PMCID: PMC4197237 DOI: 10.1186/1472-6947-14-87] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/25/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Several single nucleotide polymorphisms (SNPs) at different loci have been associated with breast cancer susceptibility, accounting for around 10% of the familial component. Recent studies have found direct associations between specific SNPs and breast cancer in BRCA1/2 mutation carriers. Our aim was to determine whether validated susceptibility SNP scores improve the predictive ability of risk models in comparison/conjunction to other clinical/demographic information. METHODS Female BRCA1/2 carriers were identified from the Manchester genetic database, and included in the study regardless of breast cancer status or age. DNA was extracted from blood samples provided by these women and used for gene and SNP profiling. Estimates of survival were examined with Kaplan-Meier curves. Multivariable Cox proportional hazards models were fit in the separate BRCA datasets and in menopausal stages screening different combinations of clinical/demographic/genetic variables. Nonlinear random survival forests were also fit to identify relevant interactions. Models were compared using Harrell's concordance index (1 - c-index). RESULTS 548 female BRCA1 mutation carriers and 523 BRCA2 carriers were identified from the database. Median Kaplan-Meier estimate of survival was 46.0 years (44.9-48.1) for BRCA1 carriers and 48.9 (47.3-50.4) for BRCA2. By fitting Cox models and random survival forests, including both a genetic SNP score and clinical/demographic variables, average 1 - c-index values were 0.221 (st.dev. 0.019) for BRCA1 carriers and 0.215 (st.dev. 0.018) for BRCA2 carriers. CONCLUSIONS Random survival forests did not yield higher performance compared to Cox proportional hazards. We found improvement in prediction performance when coupling the genetic SNP score with clinical/demographic markers, which warrants further investigation.
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Affiliation(s)
- Mattia CF Prosperi
- />Institute of Population Health, Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Sarah L Ingham
- />Institute of Population Health, Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Anthony Howell
- />Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
| | - Fiona Lalloo
- />Department of Genetic Medicine, Manchester Academic Health Science Centre, St. Mary’s Hospital, University of Manchester, Manchester, UK
| | - Iain E Buchan
- />Institute of Population Health, Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Dafydd Gareth Evans
- />Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
- />Department of Genetic Medicine, Manchester Academic Health Science Centre, St. Mary’s Hospital, University of Manchester, Manchester, UK
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Cabrera-Bueno F, Alvarez-Cubero MJ, Fernandez-Rosado F, Martinez-Espin E, Entrala-Bernal C. Response to An Expanding Role of Biomarkers in Acute Aortic Syndromes. Clin Cardiol 2014; 37:589. [DOI: 10.1002/clc.22317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Fernando Cabrera-Bueno
- Cardiology Department; Section of Marfan Universitary Hospital “Virgen de la Victoria” Malaga; Spain
| | - Maria Jesus Alvarez-Cubero
- GENYO (Pfizer-University of Granada Andalusian Government Centre for Genomics and Oncological Research) Granada; Spain
| | - Francisco Fernandez-Rosado
- Lorgen G.P, S.L., Business Innovation Center - BIC/CEEL; Technological area of Health Science; Av. de la Innovación 1 Granada 18016 Spain
| | - Esther Martinez-Espin
- Lorgen G.P, S.L., Business Innovation Center - BIC/CEEL; Technological area of Health Science; Av. de la Innovación 1 Granada 18016 Spain
| | - Carmen Entrala-Bernal
- Lorgen G.P, S.L., Business Innovation Center - BIC/CEEL; Technological area of Health Science; Av. de la Innovación 1 Granada 18016 Spain
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Killick E, Tymrakiewicz M, Cieza-Borrella C, Smith P, Thompson DJ, Pooley KA, Easton DF, Bancroft E, Page E, Leongamornlert D, Kote-Jarai Z, Eeles RA. Telomere length shows no association with BRCA1 and BRCA2 mutation status. PLoS One 2014; 9:e86659. [PMID: 24489760 PMCID: PMC3906069 DOI: 10.1371/journal.pone.0086659] [Citation(s) in RCA: 7] [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: 08/15/2013] [Accepted: 12/11/2013] [Indexed: 01/17/2023] Open
Abstract
This study aimed to determine whether telomere length (TL) is a marker of cancer risk or genetic status amongst two cohorts of BRCA1 and BRCA2 mutation carriers and controls. The first group was a prospective set of 665 male BRCA1/2 mutation carriers and controls (mean age 53 years), all healthy at time of enrollment and blood donation, 21 of whom have developed prostate cancer whilst on study. The second group consisted of 283 female BRCA1/2 mutation carriers and controls (mean age 48 years), half of whom had been diagnosed with breast cancer prior to enrollment. TL was quantified by qPCR from DNA extracted from peripheral blood lymphocytes. Weighted and unweighted Cox regressions and linear regression analyses were used to assess whether TL was associated with BRCA1/2 mutation status or cancer risk. We found no evidence for association between developing cancer or being a BRCA1 or BRCA2 mutation carrier and telomere length. It is the first study investigating TL in a cohort of genetically predisposed males and although TL and BRCA status was previously studied in females our results don't support the previous finding of association between hereditary breast cancer and shorter TL.
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Affiliation(s)
- Emma Killick
- Division of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Oncogentics, Institute of Cancer Research, Surrey, United Kingdom
| | | | | | - Paula Smith
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Deborah J. Thompson
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Karen A. Pooley
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Doug F. Easton
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Elizabeth Bancroft
- Cancer Genetics, Royal Marsden Hospital NHS Trust, London, United Kingdom
| | - Elizabeth Page
- Oncogentics, Institute of Cancer Research, Surrey, United Kingdom
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Kim A, Scharf K, Senthil M, Solomon N, Garberoglio C, Lum SS. The prevalence of overweight and obesity in a breast clinic population: consideration for weight loss as a therapeutic intervention. Surg Obes Relat Dis 2013; 10:348-53. [PMID: 24094868 DOI: 10.1016/j.soard.2013.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/01/2013] [Accepted: 07/29/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Obesity is an important risk factor for breast cancer and weight loss may be associated with a decreased risk for breast cancer and its recurrence. We evaluated the prevalence of overweight, obesity, and obesity-related co-morbidities in a breast health clinic population to determine the potential need for weight loss intervention. METHODS A retrospective review was conducted of sequential patients seen at a breast health clinic from July 1 to December 31, 2011. Body mass index (BMI), reason for visit (breast cancer diagnosis, high risk for breast cancer, or benign condition), and presence of obesity-related co-morbidities were recorded. RESULTS The 302 patients who met inclusion criteria had a median age of 52 years (10-91) and median BMI of 26 kg/m(2) (15.4-56.5). Overall, 36.8% of patients had a BMI between 18.5-24.9 kg/m(2); 32.1%, 25-29.9 kg/m(2); 14.2%, 30-34.9 kg/m(2); 8.3%, 35-39.9 kg/m(2); and 4.3%, ≥ 40 kg/m(2). Overweight or obesity (BMI ≥ 25 kg/m(2)) occurred in 64.2% of breast cancer, 65.0% of high-risk, and 57.1% of benign patients (P value not significant). Criteria for bariatric surgery (BMI 35-39.9 kg/m(2) with ≥ 1 obesity-related co-morbidity or BMI ≥ 40 kg/m(2)) were met in 8.2% of breast cancer, 16.7% of high-risk, and 11.5% of benign patients (P value not significant). CONCLUSIONS Regardless of diagnosis, a significant proportion of patients visiting the breast health clinic meet criteria for weight loss intervention, including bariatric surgery. Weight management represents an underutilized therapeutic modality that could potentially decrease the risk of breast cancer and its recurrence, and improve overall prognosis.
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Affiliation(s)
- Angela Kim
- Loma Linda University School of Medicine, Loma Linda, California
| | - Keith Scharf
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Maheswari Senthil
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Naveenraj Solomon
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Carlos Garberoglio
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Sharon S Lum
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California.
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