Abstract P4-10-03: Tobacco exposure and breast cancer

Background: Smoking is a known risk factor for various types of cancer, and breast cancer patients who smoke are known to have higher breast cancer mortality. However, few studies have found an association between smoking and breast cancer incidence or tumor biology. The Athena Breast Health Network distributes an intake questionnaire at the UCSF and UCSD breast care centers which can be used to investigate links between tobacco exposure and the characteristics of incident breast cancer.

Methods: Intake questionnaires were distributed to all new patients at the UCSF and UCSD breast care centers from December 2012 to May 2018. Patients who completed the questionnaire with a known diagnosis of breast cancer were compared to those without in a case-control study. Breast cancer diagnoses were determined by ICD9 diagnosis codes from the patients' medical records. The association of smoking and breast cancer prevalence and biology was analyzed using generalized linear models and Fisher tests in R.

Results: Of the 7727 patients who completed the Athena intake questionnaire at UCSF and UCSD, 5499 consented to have their data used for research. A first analysis was conducted on 4175 UCSF patients alone: 2186 of the UCSF patients who had completed the questionnaire had a documented breast cancer diagnosis, vs 1989 with no known diagnosis at the time of this analysis. 1096 of the 4175 UCSF patients reported having ever smoked, including 73 who had accrued 30 or more pack years. Complete pathology data was available for 1120 cancer patients. Controlling for age, more patients with invasive breast cancer reported having ever smoked, with an odd's ratio (OR) of 2.32 (p = .0043). By including DCIS, the OR drops slightly to 2.26 (p = .0058). Taking alcohol consumption into account as a confounder lowered the OR to 2.19 (p = .0454). Overall, the risk of breast cancer increases with each additional pack year (OR = 1.08, p = .0211), independent of age. There are no significant differences in tumor biology for any smoking group.

Conclusions: A history of smoking is associated with an increased risk of developing breast cancer and is directly related to cumulative pack years exposure. This association should be further validated in cohort studies.

Citation Format: Dreher N, Layton TM, Parker BA, Shibley WP, Acerbi I, Wallace AM, Blair S, Pierce JP, Glantz S, Guydish J, Hiatt R, van 't Veer L, Esserman L, Athena Breast Health Network Investigators and Advocate Partners. Tobacco exposure and breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-03.

Abstract OT2-08-01: Personalized breast cancer screening in a population based study: Women Informed to Screen Depending On Measures of risk (WISDOM)

Background: WISDOM is a 100,000 healthy women preference-tolerant, pragmatic study comparing annual to personalized risk-based breast screening. The novelty of WISDOM personalized screening is the integration of previously validated genetic and clinical risk factors (age, family history, breast biopsy results, ethnicity, mammographic density) into a single risk assessment model that directs the starting age, timing, and frequency of screening. The goal of WISDOM is to determine if personalized screening, compared to annual screening, is as safe, less morbid, enables prevention, and is preferred by women. The study is registered on ClinicalTrials.gov, NCT02620852.

Methods: Women aged 40-74 years with no history of breast cancer or DCIS, and no previous double mastectomy can join the study online at wisdomstudy.org. Participants can elect randomization or self-select a study arm, and provide electronic consent and Release for Medical Information using DocuSign. For all participants, 5-year risk of developing breast cancer is calculated according to the Breast Cancer Screening Consortium (BCSC) model. Participants in the personalized arm undergo panel-based mutation testing, and their 5-year risk is calculated using the BCSC score combined with a Polygenic Risk Score (BCSC-PRS) that includes 75 single nucleotide polymorphisms (SNPs, increase to 229) known to increase breast cancer risk. SNPs and mutations (BRCA1, BRCA2, TP53, PTEN, STK11, CDH1, ATM, PALB2, and CHEK2) are assessed by saliva-based testing through Color Genomics. 5-year risk level thresholds are used to stratify for low-, moderate- and high risk. Risk stratification determines age to start, stop, and frequency of screening.

Enrollment: As of July 2018, the WISDOM study is open to all eligible women in California, North Dakota, South Dakota, Minnesota and Iowa. To date, 23,329 eligible women have registered and 14,393 women have consented to participate in the trial. We analyzed 3,255 participants who have completed risk assessment in the personalized arm. The median age was 56 years. 82% were Caucasian, 1% African-American, and 6% Asian. 9% self-reported as Hispanic. We are partnering with health insurers and self-insured companies using coverage with evidence progression. To strengthen generalizability, we are expanding to other states. WISDOM enrollment will continue past 2019.

Feasibility: To evaluate the addition of PRS, we used paired statistical tests (McNemar) to compare the distributions of BCSC, and BCSC-PRS risk estimates around low-risk (<1.3%), and very-high risk (>6%) thresholds, the latter corresponding to 5-year risk of a BRCA mutation carrier. The median 5-year risk was 1.5% (IQR 1.0-2.1%) using the BCSC model, and 1.4% (IQR 0.8-2.5%) using the BCSC-PRS model. The BCSC-PRS model classified more women into the low (<1%) and very high (≥6%) risk categories compared to the BCSC model (p < 0.001).

Conclusions: Our findings demonstrate that incorporating genetic variants into a validated clinical model is feasible and impacts risk classification compared to a model without genetic risk factors. Results at 5 years will reveal if this classification improves healthcare value by reducing screen volumes and costs without jeopardizing outcomes.

Citation Format: Acerbi I, Shieh Y, Madlensky L, Tice J, Ziv E, Eklund M, Blanco A, DeRosa D, Tong B, Goodman D, Nassereddine L, Anderson N, Harvey H, Layton T, Park HL, Petruse A, Stewart S, Wernisch J, Risty L, Koenig B, Sarrafan S, Firouzian R, Kaplan C, Hiatt R, Parker BA, Wenger N, Lee V, Heditsian D, Brain S, Stover Fiscalini A, Borowsky AD, Anton-Culver H, Naeim A, Kaster A, Talley M, van 't Veer LJ, LaCroix A, Wisdom Study and Athena Breast Health Network Investigators and Advocate Partners, Esserman LJ. Personalized breast cancer screening in a population based study: Women Informed to Screen Depending On Measures of risk (WISDOM) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-08-01.

The Prognostic Significance of Functional Limitations among Women with Breast Cancer

Background:With the aging of the population, functional limitations are a growing burden among women with breast cancer. The prognostic impact of functional status among breast cancer survivors is not well understood.Methods:A total of 2270 women diagnosed with breast cancer between 1997 and 2000, and followed in the prospective cohort study, Life after Cancer Epidemiology (LACE) were included. Information on functional limitations, health behaviors, anthropometric and demographic factors was self-reported by participants at enrollment. Tumor characteristics, treatment and outcomes were ascertained from medical records.Associations between functional limitations and survival from all causes, breast cancer specific causes and competing causes were analyzed with delayed entry Cox proportional hazards regression.Results:Thirty-nine percent of the cohort reported one or more limitations at study entry. Compared to women without functional limitations (n=1,345), those with one or more limitations (n = 857) were proportionately more likely to be elderly, less educated and more obese (all p<.0001). Over a mean follow-up of 7 years, breast cancer survivors with functional limitations had higher overall crude mortality than their counterparts with no limitations [137 (50.9%) versus 132 (49.1%) respectively, p<.0001]. When covariates were taken into account, the presence of functional limitations was associated with deaths from all causes [hazard ratio (HR)=1.39, 95% confidence intervals (CI) 1.06-1.83] and those from competing causes (HR=2.60, 95%CI 1.69-3.98) but not with breast cancer specific deaths (HR=.90, 95%CI .71-1.14).Conclusion:More breast cancer cases with functional limitations die of competing causes than of breast cancer. Interventions aimed at regaining physical function should lead to improvements in life expectancy in this population.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2067.

Evaluation of four maternal smoking questions

OBJECTIVE

The authors evaluated four questions about maternal smoking during pregnancy for use on birth certificates.

METHODS

Question 1 (yes/no format) and Question 2 (trimester-specific design) were tested among 1171 women who delivered at two Kaiser Permanente medical centers in northern California. Responses to Questions 1 and 2 were compared with smoking information provided by participants in telephone interviews conducted during pregnancy. Question 3 (multiple choice format) and Question 4 (month- and grouped month-specific design) were tested among 900 women who enrolled in a statewide prenatal screening program and who delivered in 20 hospitals in four Central Valley counties. Responses to Questions 3 and 4 were compared with mid-pregnancy serum cotinine levels. The authors evaluated the four questions in terms of conciseness, response rate, data accuracy, and type of data requested.

RESULTS

Questions 1 and 2 were the most concise. Response rates could not be calculated for Questions 1 and 2. Response rates were 86.0% for Question 3 and 74.2% for Question 4. Sensitivity was 47.3% for Question 1, 62.1% for Question 2, 83.8% for Question 3, and 86.7% for Question 4. The types of data requested by Questions 2 and 4 seem to best satisfy the needs of the broad audience of birth certificate users.

CONCLUSIONS

No single question was clearly superior. The authors propose a combination of Questions 2 and 4, which asks about average number of cigarettes smoked per day in the three months before pregnancy and in each trimester of pregnancy.

Seroprevalence of CagA-positive strains among Helicobacter pylori-infected, healthy young adults

Helicobacter pylori is categorized into two phenotypes on the basis of the presence or absence of the CagA protein. CagA protein-positive H. pylori are more closely associated with peptic ulcer disease and cancer. Whether CagA-positive strains are similarly represented among racial or ethnic groups in northern California was investigated. Sera from 152 H. pylori-infected healthy young adults were tested by ELISA for IgG against CagA. CagA antibodies were detected in 79.4% of blacks, 63.8% of Hispanics, and 50% of whites. After adjusting for demographic factors, blacks had significantly more infections with CagA-positive H. pylori than did whites (odds ratio [OR] = 5.0; 95% confidence interval [CI] = 1.6-15.3) or Hispanics (OR = 5.5, 95% CI = 1.9-16.0). Also, there was a higher prevalence of CagA in persons born in developing countries than in persons born in industrialized nations (OR = 3.5, 95% CI = 1.3-9.4). This suggests either a genetic predisposition of racial or ethnic groups to infection with particular H. pylori phenotypes or transmission of H. pylori within relatively segregated population groups.

Safety of combined oligosaccharide conjugate Haemophilus influenzae type b (HbOC) and whole cell diphtheria-tetanus toxoids-pertussis vaccine in infancy. The Kaiser Permanente Pediatric Vaccine Study Group

The safety of the combined oligosaccharide conjugate Haemophilus influenzae (Hib) type b (HbOC) and whole cell diphtheria-tetanus toxoids-pertussis (DTP) vaccine (Tetramune, HbOC-DTP; Lederle) in infancy was evaluated in 6644 recipients of this vaccine and compared with 3914 recipients of separate injections of whole cell DTP and HbOC vaccines when given as a three dose regimen to infants at 2, 4 and 6 months of age in each group. Of the total number of infants in the study, a subset of 1435 were enrolled into the study and then randomly assigned to receive either the Hib-DPT combined vaccine or the separate components. This subset was used to assess local and systemic side effects which were evaluated utilizing telephone interviews 48 to 72 hours after vaccine. The remaining children in the study population were enrolled in a nonrandomized manner. For these children parents were offered the experimental Hib-DPT vaccine and refusers were given HbOC and DTP. Both of these groups of children as well as the randomized subset described above were used to assess rates of episodes of hospitalization, emergency room utilization and sudden infant death syndrome in HbOC-DTP recipients and children who received HbOC and DTP separately. Immunogenicity was evaluated in 123 children by collection of a single serum sample 30 days after the third dose of HbOC-DTP. The observed immunogenicity was comparable to that observed in other recent studies for HbOC and DTP component antigens. The profile of local and systemic side effects observed was virtually identical to that observed after DTP plus HbOC given separately.(ABSTRACT TRUNCATED AT 250 WORDS)

Association between alcoholic and caffeinated beverages and premenstrual syndrome

We examined the association between alcohol and caffeine consumption and premenstrual syndrome (PMS). One hundred two women with PMS matched by age and race to an equal number of women without PMS were compared for differences in intake of alcoholic and caffeinated beverages, with differences determined using Student's t-tests and conditional logistic regression for matched pairs. Information on alcohol and caffeinated beverage consumption was obtained from three 24-hour dietary recall interviews conducted during the postmenstrual period and from three conducted during the premenstrual period. Results showed that no significant difference was observed in total caffeine intake or in the individual caffeinated beverages consumed during either the post-menstrual or the premenstrual period. For alcohol consumption, however, women with PMS drank 1.41 (95% confidence interval; range, 0.34-2.47) more servings per week during the postmenstrual period. Based on post-menstrual consumption, women in the heaviest drinking category (> or = 10 drinks per week) were significantly more likely to have moderate to severe PMS (P < .005) than nondrinkers. This same significant relation, but to a lesser degree, was observed based on premenstrual consumption. We conclude that because PMS is more strongly associated with alcohol consumed in the symptom-free, postmenstrual period, drinking is unlikely to be simply a response to PMS symptoms as others have previously suggested.

Safety, immunogenicity, and efficacy in infancy of oligosaccharide conjugate Haemophilus influenzae type b vaccine in a United States population: possible implications for optimal use

Between February 1988 and June 1990, the safety, immunogenicity, and efficacy of Haemophilus influenzae type b (Hib) oligosaccharide conjugate (HbOC) vaccine was evaluated in a prelicensure trial of 61,080 children. HbOC was found to be safe and immunogenic in infancy. Extended follow-up revealed that as of 31 December 1990, 30 cases of invasive Hib disease had occurred in 74,699 children; 26 were in unvaccinated children and 4 in children who had received only one dose. No disease occurred in children who had received two or three doses. By 30 September 1991, another case had occurred in an unvaccinated child. Comparison of these efficacy data with those of Hib capsular polysaccharide-outer membrane protein conjugate vaccine (PRP-OMP) reveals that both were effective in preventing disease in the first year of life. However, the small cohort in the PRP-OMP study did not allow demonstration of duration of protection beyond 1 year. Ongoing surveillance in larger populations is necessary to allow comparison of the duration of immunity provided by these vaccines.

Efficacy in infancy of oligosaccharide conjugate Haemophilus influenzae type b (HbOC) vaccine in a United States population of 61,080 children. The Northern California Kaiser Permanente Vaccine Study Center Pediatrics Group

The efficacy of the HbOC conjugate Haemophilus influenzae type b vaccine was evaluated in a study population of 61,080 infants in the Northern California Kaiser Permanente Medical Care Program. Between February, 1988, and June, 1990, the HbOC vaccine was given as part of a three-dose series at 2, 4, and 6 months of age to 20,800 infants. The study population included children with a well-care visit at a study center during the first 6 months of life. There were 25 cases of Haemophilus influenzae type b disease in the study population: 22 in unvaccinated children and 3 in children who received only one dose of HbOC vaccine. The efficacy of the full three-dose series was evaluated by several methods: a primary analysis comparing fully vaccinated children with unvaccinated children from 7 to 18 months of age; a stratified exact analysis adjusted for age and seasonality; and a case-control analysis which further adjusted for known risk factors. The efficacy of three doses of vaccine was 100% with the lower bound of the 95% confidence interval for the three analyses at 68, 71, and 64%, respectively. There were no cases of disease resulting from two doses of HbOC vaccine yielding an estimate of 100% efficacy (95% confidence interval, 47 to 100) for two doses of HbOC vaccine. However, for children who had received only one dose of HbOC vaccine, vaccine efficacy was estimated to be 26% and the possibility that one dose of HbOC vaccine had no efficacy could not be excluded.(ABSTRACT TRUNCATED AT 250 WORDS)

Collagen/hydroxylapatite implant for augmenting deficient alveolar ridges: twelve-month clinical data

In a multicenter study, 77 edentulous patients had mandibular augmentation with implants of purified fibrillar collagen combined with dense hydroxylapatite (Alveoform Biograft); 22 of these patients also had maxillary augmentation. Most patients had Class III or IV mandibular atrophy, and had outpatient surgery with the subperiosteal tunneling technique. Temporary splints were worn for 24 hours post-surgery. Mean ridge height was 15.3 mm before surgery and 19.5 mm after 12 months, an augmentation of 4.2 mm. Predictable compaction occurred largely in the first few months after denture loading. Most patients, surgeons, and prosthodontists assessed the results of the procedure as good to excellent at 1 year following implantation. Adverse experiences, largely dehiscence and paresthesia, tended to resolve over time. Sera from ten patients demonstrated antibodies to bovine collagen that were not clinically significant. Alveolar augmentation with collagen/hydroxylapatite achieved clinically significant results that compared favorably with those achieved with other types of ceramic implants.

Evaluation of collagen/hydroxylapatite for augmenting deficient alveolar ridges: a preliminary report

A multicenter study was undertaken to evaluate a new alveolar ridge augmentation material composed of purified fibrillar collagen and particulate hydroxylapatite (PFC/HA). In a study of 77 patients and 99 reconstructed ridges, this material provided superior handling properties over HA alone as evidenced by its ease of surgical placement and manipulation, and the rarity of particle migration or displacement. Moreover, the rapid development of ridge firmness and stability allowed for the loading of dentures within three to six weeks. Prosthodontist evaluations and surveys of patient satisfaction showed great satisfaction with denture fit, comfort, esthetics, speech, and ability to masticate.

Studies on allylic peroxides. II. Allyl-t-butyl peroxide

Allyl-tert-butyl peroxide decomposes thermally in toluene with kd = 1013.8 exp (−33200/θ) (s−1). Product studies show the reaction to be a mixture of homolysis and radical-induced decomposition, the latter involving both radical addition to C=C and allyl hydrogen abstraction by alkoxy radicals. Computer modelling of the system gives good agreement with the experimental results and suggests that the overall decomposition is about 50% homolysis.

The Reaction of Hydroperoxides with Triphenylarsine and Triphenylstibine

Triphenylstibine reduced t-BuO2H to t-BuOH almost as fast as Ph3P does, while triphenylarsine reacts only 1/60 as fast. Both reductions are first-order in each component; in ethanol k2 for Ph3Sb and Ph3As are 106.7e−9.7/RT and 109. 1e−15.7/RT, respectively. The reductions are not very sensitive to choice of solvent, but are strongly catalyzed by compounds of molybdenum and vanadium.The relative rate order PH3P ≥ Ph3Sb > Ph3As is ascribed to two conflicting trends, availability of d-orbitals for π-bonding with peroxidic oxygen, and the Group VB to oxygen bond strength.

Unusual Reactions of Peroxides. II. Decomposition of Diphenylmethyl Peroxides

Thermal decomposition of bisdiphenylmethyl peroxide at 110–130 °C in solution yields approximately 90% H2 + 2Ph2CO by a nonradical mechanism. In C2Cl4, toluene, or nitrobenzene log k (s−1) = 11.0 ± 0.5 − (27 000 ± 1000)/2.303RT. Photolytic decomposition of this peroxide in toluene yielded no H2.t-Butyl diphenylmethyl peroxide decomposed in toluene with log k (s−1) = 16.7 − 38 600/2.303RT, giving free radical products and no H2. There is some evidence for facile disproportionation of the initial alkoxy radicals in the solvent cage.

The Reaction of Hydroperoxides with Triphenylphosphine

The reductions of n-butyl, sec-butyl, and tert-butyl hydroperoxides by triphenylphosphine in ethanol have been shown to follow second-order kinetics with k2's equal, respectively to 107.2e−8.4/RT, 109.0e−10.8/RT, 108.8e−11.2/RT. Similar results obtain in CH2Cl2, but in hexane the rate equation requires an additional term, k3[Ph3P][RO2H]2, though the overall reaction is somewhat faster than in the other solvents.Retardation, apparently by adventitious impurities, has been observed in some cases, but attempts to inhibit the reaction by free radical traps were unsuccessful. Parallels with reduction of hydroperoxides by organic sulfides suggest a similar non-radical mechanism.

Catalysis of the Reduction of Hydroperoxides by Triphenylphosphine

The reaction of hydroperoxides with triphenylphosphine is catalyzed by the addition of strong acid. Likewise in hydroxylic solvents, the log of the bimolecular rate constant increases linearly with the solvents' autoprotolysis constants. Soluble salts of molybdenum or vanadium are 104 to 105 times more effective catalysts than H+. The reaction shows promise as a method for quantitative comparison of the effectiveness of these compounds in augmenting the electrophilic character of hydroperoxides.

Interaction of s-butyl peroxy and alkoxy radicals

Contrary to previous suggestions, the interactions of 2 s-butyl peroxy radicals yields no di-s-butyl peroxide. Di-s-butyl peroxide has been shown to result from mixing s-butyl hydroperoxide with oxalyl chloride, presumably via 2 s-butyoxy radicals produced in a solvent cage from homolysis of di-s-butyl peroxyoxalate formed insitu.

Hemolytic decomposition of di-sec-butyl peroxide

Rates and products have been determined for the thermal decomposition of sec-butyl peroxide at 110–150 °C in several solvents.The decomposition was shown to be unimolecular with energies of activation in toluene, benzene, and cyclohexane of 35.5 ± 1.0, 33.2 ± 1.0, 33.8 ± 1.0 kcal/mole respectively. The activation energy of thermal decomposition for the deuterated peroxide was found to be 37.2 + 1.0 kcal/mole in toluene.About 70–80% of the products could be explained by known reactions of free alkoxy radicals, and very little, if any, disproportionation of two sec-butoxy radicals in the solvent cage could be detected.The other 20–30% of the peroxide yielded H2 and methyl ethyl ketone. The yield of H2 was unaffected by the nature or the viscosity of the solvent, but H2 was not formed when s-Bu2O2 was photolyzed in toluene at 35 °C nor when the peroxide was thermally decomposed in the gas phase.α,α′-Dideutero-sec-butyl peroxide was prepared and decomposed in toluene at 110–150 °C. The yield of D2 was about the same as the yield of H2 from s-Bu2O2, but the rate of decomposition (at 135 °C) was only 1/1.55 as fast.Mechanisms for hydrogen production are discussed, but none satisfactorily explains all the evidence.

Analysis of False-Positive Borderline Diagnoses in a Glaucoma Detection Program*

Various glaucoma tests were given to 465 patients from the Department of Ophthalmology, University of Tennessee College of Medicine. An average of approximately 1.5 false-positive tests was found in each of 122 borderline cases that were proved not to have glaucoma after a continuous follow-up of from three months to three years. The significance of these false-positive tests was pointed out; explanations were given for them; recommendations were offered for their reduction.

THE INDUCED DECOMPOSITION OF tert-BUTYL HYDROPEROXIDE

In a study of the "induced" decomposition of hydroperoxides by alkoxy radicals, tert-butyl hydroperoxide has been decomposed by the action of di-tert-butyl peroxyoxalate at 45°. The homolytic cleavage of peroxalate to tert-butoxy was unaffected by the presence of hydroperoxide and 7 to 10 molecules of hydroperoxide were destroyed for each radical thus produced. The kinetics have been analyzed and a mechanism developed which has significance for any system containing peroxy radicals.

THE EFFECT OF STRUCTURE ON THE THERMAL STABILITY OF HYDROPEROXIDES. II

not available