Facilitators of and barriers to gastric cancer and precursor diagnosis among South Texas residents: Social determinants of health

BACKGROUND

Latinos/Hispanics are at higher risk for developing gastric cancer (GC) compared with non-Hispanic whites, and social determinants of health (SDoH) are thought to contribute.

AIMS/MATERIALS AND METHODS

This study addressed SDoH and their interactions contributing to disparities in the testing and treatment of Helicobacter pylori (HP) infection and diagnosis of GC and its known precursors, among Latinos/Hispanics relative to non-Latinos at two affiliated but independent health systems in San Antonio, Texas, using a mixed methods approach.

RESULTS

Secondary data abstraction and analysis showed that GCs represented 2.6% (n = 600) of our population. Men and older individuals were at higher GC risk. Individuals with military insurance were 2.7 times as likely to be diagnosed as private insurance. Latinos/Hispanics had significantly (24%) higher GC risk than Whites. Poverty and lack of insurance contributed to GC risk among the minorities classified as other (Asians, Native Americans, Multiracial; all p < 0.01). All SDoH were associated with H. pylori infection (p < 0.001). Qualitative analysis of patient and provider interviews showed providers reporting insurance as a major care barrier; patients reported appointment delays, and lack of clinic staff. Providers universally agreed treatment of H. pylori was necessary, but disagreed on its prevalence. Patients did not report discussing H. pylori or its cancer risk with providers.

DISCUSSION/CONCLUSION

These data indicate the importance of considering SDoH in diagnosis and treatment of GC and its precursors, and educating providers and patients on H. pylori risks for GC.

Gastric adenocarcinoma burden and late-stage diagnosis in Latino and non-Latino populations in the United States and Texas, during 2004-2016: A multilevel analysis

Background

Gastric cancer disproportionately affects Latinos, but little is known about regional effects and risk factors. We compared primary incidence, late‐stage diagnosis, and risk factors for gastric adenocarcinoma (GCA) from 2004 to 2016 in Latinos and non‐Latinos in the United States, Texas (TX), and South Texas (STX).

Methods

We collected case data from Surveillance, Epidemiology, and End Results (SEER) and the Texas Cancer Registry. We generated average annual age‐adjusted incidence rates, rate ratios (RRs), and 95% confidence intervals (CIs) using SEER*Stat software and analyzed the cases by anatomic site, demographics, and county‐level risk factors using SAS 9.4. We constructed multilevel logistic regression models for late‐stage GCA, adjusting for patient‐ and county‐level characteristics.

Results

Latinos had higher overall GCA incidence rates in all regions, with the greatest disparities in overlap GCA in STX males (RR 4.39; 95% CI: 2.85, 6.93). There were no differences in cardia GCA rates for non‐Hispanic Whites (NHWs) and Latino women in all regions. Younger patients, patients with overlapping or not otherwise specified (NOS) lesions, and patients diagnosed during 2012–2016 had higher odds of late‐stage GCA. The stratification by location showed no differences in late‐stage disease between NHWs and Latinos. The stratification by anatomic site showed Latinos with cardia GCA were more likely to have late‐stage GCA than NHWs (OR: 1.13, p = 0.008). At the county level, higher odds of late‐stage GCA were associated with medium and high social deprivation levels in TX without STX (OR: 1.25 and 1.20, p = 0.007 and 0.028, respectively), and medium social deprivation index (SDI) in patients with NOS GCA (OR: 1.21, p = 0.01).

Conclusions

STX Latinos experience greater GCA disparities than those in TX and the United States. Younger age and social deprivation increase the risk for late‐stage GCA, while Latinos and women are at higher risk specifically for late‐stage cardia GCA. There is a need for population‐specific, culturally responsive intervention and prevention measures, and additional research to elucidate contributing risk factors.

Latinos had higher gastric adenocarcinoma incidence than non‐Latinos in the U.S., Texas and South Texas from 2004 to 2016. Younger age and social deprivation increased risk of late‐stage diagnosis, while Latino ethnicity and female gender increased risk of late‐stage gastric adenocarcinoma of the cardia specifically.

Clinicopathologic differences and mortality among Latinos and non-Latino whites with gastric cancer at a majority-minority cancer center in South Texas

BACKGROUND

Latino patients have a higher incidence of gastric cancer compared to non-Latino white patients nationwide, with greater disparities in South Texas. However, the impact of Latino ethnicity on mortality in gastric cancer is controversial. We evaluated clinicopathological characteristics and survival outcomes in Latino vs. non-Latino white patients at our National Cancer Institute (NCI)-designated cancer center and its affiliated hospital.

METHODS

We conducted a retrospective chart review of Latino and non-Latino white patients diagnosed with gastric cancer who were seen at Mays Cancer Center at the University of Texas Health in San Antonio, Texas, from 2000-2018. Median overall survival (mOS) was estimated from Kaplan-Meier curves and groups were compared with the log-rank test.

RESULTS

A total of 193 patients met inclusion criteria and 65% (n=126) were Latino. Median age for all patients was 61 years. Female patients represented almost 50% of Latinos vs. 36% of non-Latino whites. There were no differences in Eastern Cooperative Oncology Group (ECOG) performance status, primary tumor location, stage, Helicobacter pylori status, HER2 status, or histologic subtype at diagnosis. Median overall survival was 14 months (95% CI: 13-36) for Latinos vs. 33 months (95% CI: 14 to n/a) for non-Latino whites (P=0.36).

CONCLUSIONS

Compared to non-Latino white patients, Latino patients with gastric cancer at a majority-minority cancer center in South Texas did not have significant differences in baseline clinicopathologic features or survival outcomes. Further prospective studies are needed to evaluate epidemiologic, pathogenetic, and molecular differences in gastric cancer in order to identify variables associated with treatment efficacy and survival.

Quality of life outcomes from a randomized controlled trial of patient navigation in Latina breast cancer survivors

INTRODUCTION

Breast cancer survivorship is a life-long process involving challenges to health-care communities and individuals, especially Latinas. Patient Navigation has shown some success in meeting these challenges. The purpose of this study was to compare the effects of an enhanced Patient Navigation program (Intervention; PN+) vs Control (PN) over time on general cancer and breast cancer-specific quality of life (QoL) in Latina breast cancer survivors (BCS).

METHODS

We conducted a 2-year, two-arm randomized controlled trial of the "Staying Healthy" program among Latina BCS. The design compared PN+ vs PN over time. We recruited 60 patients into each study arm and randomized them by sequential numerical assignment. PN+ participants received culturally tailored educational materials and active, personalized Patient Navigation services, including phone calls, transportation, and care coordination. PN participants were navigated only upon request. Primary outcomes included general cancer (Functional Assessments of Cancer Therapy [FACTS]-G) and breast cancer-specific (FACT-B) QoL.

RESULTS

PN+ participants had significantly improved QoL measures compared to PN at 6-month follow-up on all subscales (P-values .007-.04) except physical well-being (PWB; P = .11). Intervention effect size coefficient (standard error) for FACT-G overall was 7.9 (3.1); P = .01. For FACT-B, it was 10.9 (3.9); P = .006. Again, all subscales showed significant effects [range 1.7-3.1 (0.8-1.2); P-values .006-.04], except for PWB [1.5 (1.0); P = .16] and social/family well-being (SWB) [2.1 (1.1); P = .06]. There were no differences between groups at baseline.

DISCUSSION

Multiple cultural, psychosocial, and socioeconomic variables contributing to these intervention effects will be addressed in future studies. As the national BCS population continues to increase, more Patient Navigation-focused partnerships among patients, health-care professionals, research groups, and community organizations are needed to improve BCS experiences. The Staying Healthy program has the potential to serve as a national survivorship care model for improving Latina BCS QoL.

Carotenoid Intake and Circulating Carotenoids Are Inversely Associated with the Risk of Bladder Cancer: A Dose-Response Meta-analysis

Some evidence indicates that carotenoids may reduce the risk of bladder cancer (BC), but the association is unclear. We conducted a systematic review and meta-analysis of case-control and cohort studies investigating the relation between carotenoid intake or circulating carotenoid concentrations and BC risk in men and women. All relevant epidemiologic studies were identified by a search of PubMed and Scopus databases, and the Cochrane Library from inception to April 2019 with no restrictions. A random-effects model was used to calculate pooled RRs and their 95% CIs across studies for high compared with low categories of intake or circulating concentrations. We also performed a dose-response meta-analysis using the Greenland and Longnecker method and random-effects models. A total of 22 studies involving 516,740 adults were included in the meta-analysis. The pooled RRs of BC for the highest compared with the lowest category of carotenoid intake and circulating carotenoid concentrations were 0.88 (95% CI: 0.76, 1.03) and 0.36 (95% CI: 0.12, 1.07), respectively. The pooled RR of BC for the highest compared with lowest circulating lutein and zeaxanthin concentrations was 0.53 (95% CI: 0.33, 0.84). Dose-response analysis showed that BC risk decreased by 42% for every 1 mg increase in daily dietary β-cryptoxanthin intake (RR: 0.58; 95% CI: 0.36, 0.94); by 76% for every 1 μmol/L increase in circulating concentration of α-carotene (RR: 0.24; 95% CI: 0.08, 0.67); by 27% for every 1 μmol/L increase in circulating concentration of β-carotene (RR: 0.73; 95% CI: 0.57, 0.94); and by 56% for every 1 μmol/L increase in circulating concentrations of lutein and zeaxanthin (RR: 0.44; 95% CI: 0.28, 0.67). Dietary β-cryptoxanthin intake and circulating concentrations of α-carotene, β-carotene, and lutein and zeaxanthin were inversely associated with BC risk. The protocol was registered at PROSPERO as CRD42019133240.

Improving quality of life among latino cancer survivors: Design of a randomized trial of patient navigation

Latino cancer survivors have lower survival rates for most cancers relative to non-Latino whites, including, colorectal, prostate, and breast. In addition, Latinos experience health disparities in both access to care and quality of care. Experts recommend providing psychosocial services as an integral part of quality cancer care; however, there continues to be a paucity of information on the efficacy of Patient Navigators (PNs) in linking Latino cancer survivors to appropriate psychosocial services. Redes En Acción: The National Latino Cancer Research Network partnered with LIVESTRONG Cancer Navigation Services Patient Navigation program (PN-LCNS) to provide an intervention to improve wellness and increase access to psychosocial services among non-metastatic Latino cancer survivors from Texas and Chicago using trained bilingual, bicultural PNs. The study design involved a mixed-methods approach in two phases. Phase I used a Community-Based Participatory Research (CBPR) approach wherein PNs engaged community partners who provide services to breast, colorectal and prostate Latino cancer survivors. Phase II was a randomized controlled trial (RCT) that evaluated the efficacy of combining PN-facilitated interventions with the culturally tailored and CBPR-informed PN-LCNS in 300 breast, prostate and colorectal Latino cancer survivors. Outcomes investigated were improvements in: 1) quality of life (QOL), both general and disease-specific, and; 2) treatment follow-up compliance. While limited work has addressed the psychosocial needs of Latino cancer survivors, culturally-competent interventions using PNs have potential to address these needs and significantly improve Latino cancer survivorship.

Dietary intervention among breast cancer survivors increased adherence to a Mediterranean-style, anti-inflammatory dietary pattern: the Rx for Better Breast Health Randomized Controlled Trial

PURPOSE

The goal of this education and culinary-based dietary intervention was to increase adherence to a Mediterranean-style, anti-inflammatory dietary pattern in breast cancer survivors (BCS) by promoting the consumption of anti-inflammatory foods, herbs, and spices.

METHODS

Overweight and obese, early-stage, BCS were randomized to the Intervention (n = 76) or Control (n = 77). The 6-month intervention included monthly nutrition and cooking workshops, Motivational Interviewing telephone calls, and individualized newsletters. Control participants received monthly informational brochures and no navigational services. Dietary intakes were collected via questionnaire and 3-day food records at baseline and 6 months.

RESULTS

One hundred twenty-five BCS (n = 60 I; n = 65 C) completed post-testing (81.7%) and were included in analyses. Adherence to Mediterranean diet guidelines significantly increased in the intervention group, but not in the control group (+ 22.5% vs. + 2.7%, P < 0.001). Upon further analysis of adherence to individual dietary guidelines, the intervention group significantly improved adherence to only three guidelines: consuming ≥ 3 servings of fish or shellfish/week, reducing red meat intake to < 1 serving/day, and limiting consumption of commercial sweets and baked goods to < 3 times/week. The intervention arm increased the use of spices and herbs compared to control (+ 146.2% vs. +33.3%, P < 0.001), including significantly more frequent consumption of cinnamon, turmeric, garlic, ginger, black pepper, and rosemary.

CONCLUSION

An education and culinary-based intervention in BCS successfully increased adherence to a more Mediterranean-style, anti-inflammatory dietary pattern by increasing the consumption of anti-inflammatory foods, spices, and herbs and decreasing the consumption of pro-inflammatory foods.

An anti-inflammatory dietary intervention to reduce breast cancer recurrence risk: Study design and baseline data

U.S. breast cancer survivors (BCSs) are expected to increase to 4 million in the next 5-10years. Cancer recurrence risk is highest among obese survivors. Inflammatory (Pro-I) biomarkers including C-reactive protein (CRP), Interleukins -3, -6, and -8 (IL-3, IL-6, IL-8), and Tumor Necrosis Factor (TNF)-α have been associated with cancer recurrence risk. Nutritional interventions aimed at reducing inflammation (INF) may contribute to reduced cancer recurrence risk, but studies have been limited to animal models. The goals of this one-year, culinary-based, pilot intervention were to: 1) decrease Pro-I biomarkers and increase anti-inflammatory (AI) cytokine, IL-10, by promoting AI food incorporation into BCS diets; and 2) examine intervention effects on cancer risk factors including body mass index (BMI) and circulating adipose stromal cells (ASCs). A total of 153 BCSs were recruited. Overweight and obese women aged 18 or older were randomized into Intervention (IG; n=76) and Control (CG; n=77) groups. CG received monthly nutritional brochures from the American Institute for Cancer Research. IG attended 6 monthly workshops (lectures on AI topics and chef-prepared food demonstrations), and received monthly newsletters and telephone calls incorporating Motivational Interviewing. At baseline, 6- and 12-month assessments, fasting serum was assayed for Pro-I/AI marker and ASC levels. Using R and Stata version 14 (Stata Corp, 2015), no significant differences were found between groups on baseline demographic variables. Correlations between serum cytokine levels, BMI, % body fat, ASCs, and self-reported variables are discussed.

Helicobacter Pylori Infection in Texas Hispanic and Non-Hispanic White Men: Implications for Gastric Cancer Risk Disparities

Chronic Helicobacter pylori ( H. pylori) infection is a major gastric adenocarcinoma (GA) risk factor. GA disproportionately affects U.S. Hispanics compared with non-Hispanic Whites (NHWs). Since H. pylori infection studies in Hispanics are few, infection rates in Hispanic and NHW men in Bexar County were compared, and relationships with ethnicity and obesity examined. Age- and zip code-matched participants from a community-dwelling cohort were randomly selected. Sera from 284 men were analyzed by enzyme immunoassay for H. pylori antibodies. Adjusted risk ratio estimation for matched data was conducted to identify differences. Hispanics had a markedly higher prevalence of infection (30.3%) than NHWs (9.2%). Matched risk ratio (mRR) analyses revealed a strong association between H. pylori seropositivity and Hispanic ethnicity (mRR = 3.31; 95% CI [1.91, 5.73], adjusted by BMI, smoking status, and family history of cancer (mRR range = 3.28-3.89). BMI mRRs (range = 1.19-1.22) were significant in all models. In this cohort, Hispanic men had higher H. pylori infection rates than NHWs, and parallel the disproportionately higher rates of GA; obesity contributes to this higher prevalence. Future studies should address country of origin, acculturation, and other factors influencing obesity to further elucidate risk of GA in Hispanic populations.

Abstract B36: Helicobacter pylori exposure among Hispanic and non-Hispanic white men in San Antonio, Texas: Implications for gastric cancer risk disparities

Background: Chronic Helicobacter pylori (H. pylori) infection is the most common gastric adenocarcinoma (GCA) risk factor. GCA more commonly affects U.S. Hispanics compared to non-Hispanic whites (NHWs). No study has examined this infection in South Texas Hispanics, a population facing multiple health disparities. This pilot project aimed to determine H. pylori exposure rates in Hispanic and NHW men residing in Bexar County, and examine relationships with ethnicity, residence, socioeconomic status, smoking history and cancer family history.

Methods: Age- and zip-code-matched subjects from a large community-dwelling cohort were randomly selected. Sera from 286 (143 Hispanic, 143 NHW) men were analyzed by enzyme immunoassay for H. pylori antibodies.

Results: Almost 20% of samples were H. pylori-positive; exposure was significantly higher among Hispanics (30.1%) compared to NHWs (9.1%). Unconditional logistic regression analyses of the seropositive-matched subsample showed strong associations between H. pylori seropositivity and Hispanic ethnicity (odds ratio [O.R.]=17.5; p&lt;0.001) and BMI category (O.R.=6.5; p=0.01 overweight and 4.0; p=0.02 obese). Ethnicity remained the strongest predictor of seropositivity after adjusting for all other factors (adjusted O.R.=16.9; p&lt;0.001). Adjusted O.R.s for overweight/obesity were high but non-significant.

Conclusions: H. pylori exposure rates are higher in South Texas Hispanic men and parallel the disproportionately-higher rates of GCA. Obesity is a contributing factor. This is the first study to explore the relationship between H. pylori exposure and Hispanic ethnicity and other GCA risk factors in South Texas. Results have implications for future studies on preventive measures targeted at reducing infectious burden and GCA risk in this vulnerable population.

Citation Format: Dorothy Long Parma, Edgar Munoz, Susan M. Ogden, Robin J. Leach, Ian M. Thompson, Jr., Amelie G. Ramirez. Helicobacter pylori exposure among Hispanic and non-Hispanic white men in San Antonio, Texas: Implications for gastric cancer risk disparities. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B36.

Abstract B20: Geospatial analysis of hepatocellular carcinoma and its risk factors in Texas (1995-2010)

Introduction: Between 1995 and 2010 there have been 1.4 million incident cancer cases in Texas. While Hepatocellular Carcinoma (HCC) accounted for a small proportion (ranked 21st in incidence), it ranked 9th by cause of death attributed to the tumor. Mortality rate was 68%, with average overall survival time 16.6 months. Unlike most cancers, HCC has resisted attempts to reduce its impact; incidence rates continue to increase especially among those &lt; 65 years of age. We investigated the ecological relationships between HCC and 16 known/potential risk factors (PRFs) in all 254 Texas (TX) counties in order to specifically target health promotion and HCC prevention efforts.

Methods: County-level data on PRFs was obtained from the TX Department of State Health Services--Reportable Diseases, County Health Rankings, TX Cancer Registry, and the Centers for Disease Control and Prevention. HCC cases were defined using the International Classification of Diseases (ICDO-3 topography C22.0 and morphologies 8170–8175). Incidence rates were calculated using the Surveillance, Epidemiology and End Results (SEER) Stat Statistical software version 8.1.5.

Correlation analysis between HCC rates and each PRF was conducted using ordinary least squares linear regression (p&lt;0.05). Choynowski's double-sided Poisson probability map was used to identify counties with rates significantly different than expected on all PRFs and HCC.

Comparisons were performed by overlapping areas showing high probabilities in variable pairs, and indicating whether they were concordant (both high, both low), or discordant (one high, one low).

Using GeoDa, Univariate Moran's I was calculated to evaluate spatial autocorrelation of HCC and all PRFs. Bivariate Moran's I was used to determine which PRFs clustered geographically with HCC. Contiguity-based spatial weights were calculated using the Rook's and Queen's method of first and second order. Spatial Lag regression analysis was performed to test spatial relationships of HCC and multiple PRFs. Due to the inverse relationship between population proportions of Non-Hispanic whites (NHW) and Hispanics, these variables were run in separate linear models.

Results: Correlation analysis showed 12 PRFs significantly associated to HCC. All 12 PRFs were spatially auto correlated (p&lt;0.05), and 8 (Diabetes, Chlamydia, NHW, Hispanics, physical inactivity, High School graduation rates, age over 65, violent crime rate) retained significant geographic clustering with HCC under all contiguity methods. Excessive alcohol consumption (EAC) remained significant only in Rook contiguity, likely due to low n (63) of counties with data. Spatial regression analysis showed strong spatial correlations between HCC and ethnicity (NHW, Hispanics) (p&lt;0.001), HIV (p&lt;0.001) and EAC (p&lt;0.01). P values did not vary across all contiguity methods for all 3 PRFs.

Conclusion: Several PRFs clustered spatially and varied geographically with HCC rates, particularly in areas with low NHW/high Hispanic populations and counties along the South TX/Mexico border. HIV's significant spatial correlation with HCC is important, as co-infection with known HCC risk factor Hepatitis C virus (HCV) accelerates liver fibrosis development vs. HCV infection alone. This study highlights the need for interventions targeted to multiple HCC PRFs including EAC and HIV, particularly in South TX.

Citation Format: Laura Manuel, Edgar Munoz, Dorothy Long Parma, Amelie Ramirez. Geospatial analysis of hepatocellular carcinoma and its risk factors in Texas (1995-2010). [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B20.

Effects of six months of Yoga on inflammatory serum markers prognostic of recurrence risk in breast cancer survivors

Yoga-based exercise has proven to be beneficial for practitioners, including cancer survivors. This study reports on the effect on inflammatory biological markers for 20 breast cancer survivors who participated in a six-month yoga-based (YE) exercise program. Results are compared to a comprehensive exercise (CE) program group and a comparison (C) exercise group who chose their own exercises. "Pre" and "post" assessments included measures of anthropometrics, cardiorespiratory capacity, and inflammatory markers interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNFα) and C-reactive protein (CRP). Descriptive statistics, effect size (d), and dependent sample 't' tests for all outcome measures were calculated for the YE group. Significant improvements were seen in decreased % body fat, (-3.00%, d = -0.44, p = <.001) but not in cardiorespiratory capacity or in inflammatory serum markers. To compare YE outcomes with the other two groups, a one-way analysis of co-variance (ANCOVA) was used, controlling for age, BMI, cardiorespiratory capacity and serum marker baseline values. We found no differences between groups. Moreover, we did not see significant changes in any inflammatory marker for any group. Our results support the effectiveness of yoga-based exercise modified for breast cancer survivors for improving body composition. Larger studies are needed to determine if there are significant changes in inflammatory serum markers as a result of specific exercise modalities.

Association of obesity and circulating adipose stromal cells among breast cancer survivors

A positive association of obesity with breast cancer incidence and mortality is well established. Recent reports indicate that adipose stromal cells (ASCs) play an important role in breast cancer development and progression by producing estrogens and tumor-promoting cytokines. Furthermore, circulating ASCs have been uniquely detected in obese individuals, which is likely due to increased tissue remodeling and cell mobilization. The number of circulating ASCs is even more prominent in obese patients with colon and prostate cancers, both of which are exacerbated by obesity. To determine whether a similar association exists for breast cancer, we collected blood samples from a cohort of breast cancer survivors and enumerated circulating ASCs by flow cytometry on the basis of the previously established ASC-associated immunophenotype (CD34+/CD31-/CD45-). We found significantly higher levels of circulating ASCs (p<0.001) in breast cancer survivors with body mass index (BMI)≥30 kg/m2 than their non-obese counterparts (BMI<30). We also compared circulating ASCs before and after exercise of only the obese subjects enrolled in a 6-month individualized exercise program, but found no statistically significant difference, likely due to limited number of subjects in the study. Our findings suggest that circulating ASCs can serve as a potential biomarker for future studies of the impacts of obesity and physical activity on breast cancer recurrence and survival.

Time to definitive diagnosis of breast cancer in Latina and non-Hispanic white women: the six cities study

Time delay after an abnormal screening mammogram may have a critical impact on tumor size, stage at diagnosis, treatment, prognosis, and survival of subsequent breast cancer. This study was undertaken to evaluate disparities between Latina and non-Hispanic white (NHW) women in time to definitive diagnosis of breast cancer after an abnormal screening mammogram, as well as factors contributing to such disparities. As part of the activities of the National Cancer Institute (NCI)-funded Redes En Acción research network, clinical records of 186 Latinas and 74 NHWs who received abnormal screening mammogram results were reviewed to determine the time to obtain a definitive diagnosis. Data was obtained from participating clinics in six U.S. cities and included demographics, clinical history, and mammogram characteristics. Kaplan-Meier estimates and Cox proportional hazards models were used to test differences in median time to definitive diagnosis by ethnicity after adjusting for clinic site, demographics, and clinical characteristics. Time-to-event analysis showed that Latinas took 2.2 times longer to reach 50% definitively diagnosed with breast cancer relative to NHWs, and three times longer to reach 80% diagnosed (p=0.001). Latinas' median time to definitive diagnosis was 60 days compared to 27 for NHWs, a 59% gap in diagnosis rates (adjusted Hazard Ratio [aHR] = 1.59, 95% CI = 1.09, 2.31; p=0.015). BI-RADS-4/5 women's diagnosis rate was more than twice that of BI-RADS-3 (aHR = 2.11, 95% CI = 1.18, 3.78; p=0.011). Disparities in time between receipt of abnormal screening result and definitive diagnosis adversely affect Latinas compared to NHWs, and remain significant after adjusting for demographic and clinical variables. With cancer now the leading cause of mortality among Latinos, a greater need exists for ethnically and culturally appropriate interventions like patient navigation to facilitate Latinas' successful entry into, and progression through, the cancer care system.

Motivation, exercise, and stress in breast cancer survivors

PURPOSE

Reduced stress and reduced risk of cancer recurrence are among the many benefits of physical activity (PA) for cancer survivors. Exercise behaviors are linked to motivational factors. We investigated the associations between motivational profile, self-reported levels of PA and stress, and mental functioning in 94 posttreatment breast cancer survivors who voluntarily enrolled in an exercise program.

METHODS

Participants completed the Apter Motivational Style Profile (AMSP), Lifetime of Physical Activity (LTPA) Questionnaire, International Physical Activity Questionnaire (IPAQ), Medical Outcomes Short Form SF-36® (SF-36), and Perceived Stress Scale (PSS) and provided 10 saliva specimens (to measure cortisol levels). PA levels were calculated in metabolic equivalent hours per week (MET-hours/week).

RESULTS

Participants reported high levels of current and historical PA (M = 39.2 MET-h/week, SD = 39.7; M = 14.2 MET-h/week, SD = 15.4, respectively). They also reported high levels of stress (M = 33.6, SD = 4.5) coupled with low mental functionality as measured by SF-36 mental component scale (MCS) (M = 44.4, SD = 8.8). PSS was negatively associated with MCS (r = -0.27, p = 0.009). Salivary cortisol was not associated with any measure. Participants had a conformist ("follow rules") and alloic ("about others") motivational profile. No motivational, exercise history, or stress variables were associated with current PA.

CONCLUSIONS

As expected, participants reported higher levels of stress and lower mental functioning. Participants presented a unique motivational profile relative to the general population. Further research into the associations of motivation, exercise behaviors, and stress is warranted.

[The relevance of molecular biology studies in the genetic counselling of Argentine retinoblastoma families]

OBJECTIVE

Evaluate the relevance of RB1 mutations detection in the genetic counselling of Argentine retinoblastoma families.

METHODS

We included in this study 34 Argentine families with bilateral and unilateral Retinoblastoma (Rb). 130 DNA samples from leukocytes, tumors and chorionic villus were analyzed by indirect and direct molecular biology assays like Southern blot, segregation of polymorphisms BamHI, Rbi4, XbaI y Rb 1.20 (PCR-RFLP, PCR-STR), PCR-heteroduplex and sequencing of RB1 gene.

RESULTS

Molecular biology analysis was informative in 18 out of 34 families studied (53%), 56% with bilateral and 44% with unilateral Rb. DNA tumor samples of 11 patients were available and could be studied by loss of heterozygosity (LOH) detection, that allowed us to identify the mutated RB1 allele in 9 (82%) patients. When tumor samples were not analized, the studies were informative only in 9 out of 23 patients (39%); we used direct mutation detection in 17 (41% informative) and indirect assays in 20 (60% informative) patients.

CONCLUSIONS

The results prove the necessity to have DNA tumor, when the patient has been enucleated, and emphasize the importance of direct mutation detection in families with early sporadic Rb without tumor sample. The RB1 molecular biology contributed to the adequate genetic counselling of Argentine patients and relatives and their appropriate early treatment planning (Arch Soc Esp Oftalmol 2009; 84: 557-562).

Identification of RB1 germline mutations in Argentinian families with sporadic bilateral retinoblastoma

Hereditary predisposition to retinoblastoma is caused by germline mutations in the RB1 gene. Most of these mutations occur de novo and differ from one patient to another. DNA samples from 10 families with a child presenting sporadic bilateral retinoblastoma have been analysed for the causative mutation. Using intragenic DNA polymorphisms we detected large deletions in two patients. Heteroduplex and DNA sequence analysis of PCR products from each exon and the promoter region showed small mutations in four patients: a C to T transition in exon 18; 1 bp and 2 bp deletion in exons 20 and 19 respectively; and a 4 bp insertion in exon 7. All these mutations are likely to result in premature termination of transcription. In one of these families, an unaffected carrier was detected. This emphasises the importance of detection of the causative mutation for predictive diagnosis in families with sporadic bilateral retinoblastoma.

Expression of c-myc and c-fos protooncogenes in the anterior pituitary gland of the rat. Effect of estrogen

Thymidine incorporation into the DNA of the anterior pituitary gland is stimulated by estrogen. We studied the relationship between this effect and expression of the protooncogenes c-myc and c-fos. Within one hour after estrogen administration, the level of c-myc and c-fos mRNA increased in the anterior pituitary gland and remained high throughout the experimental period (16 to 22 hrs). Transcription of the prolactin gene, one of the targets of estrogen action, was stimulated at the same time intervals. There were no modifications in the growth hormone mRNA level. Thus, estrogen induced the expression of c-myc and c-fos in the anterior pituitary gland in an early period.

Expression of c-myc and c-fos oncogenes in different rat brain regions during postnatal development

We have studied the expression of c-myc and c-fos proto-oncogenes in various areas of the central nervous system during postnatal development. c-myc mRNA levels increased during the first 5 days and then decreased over the next 15 days in all nervous regions studied. c-fos mRNA levels changed in a different way in four brain areas. While in cerebral cortex and cerebellum there was a sharp decrease during the first 10 days, in white matter and hypothalamus c-fos transcript levels remained high during the same period, decreasing at a later stage. Changes in oncogenes mRNA levels are related to various developmental events, such as neurite growth, myelination and cell proliferation. The dissimilar patterns of c-myc and c-fos expression suggests that they play different functions in CNS maturation. c-myc mRNA levels are temporally related to active neurite growth and to cell proliferation. Changes in c-fos mRNA correlate in time with early developmental processes and also with those occurring at later stages, such as myelination.