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Veitinger JK, Kerber AS, Gabram-Mendola SGA, Liu Y, Durham LM, Durrence D, Berzen AK, Shin JY, Snyder C, Bellcross CA, Guan Y. Screening for Individuals at Risk for Hereditary Breast and Ovarian Cancer: A Statewide Initiative, Georgia, 2012-2020. Am J Public Health 2022; 112:1249-1252. [PMID: 35862880 PMCID: PMC9382180 DOI: 10.2105/ajph.2022.306932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/04/2022]
Abstract
Georgia implemented a statewide family history screening program for hereditary breast and ovarian cancer. From November 2012 through December 2020, 29 090 individuals were screened, 16 679 of whom (57.3%) self-identified as a racial/ethnic minority. Of the 4% (1172/29 090) of individuals who screened as high risk, more than half underwent genetic consultation (793/1172; 67.7%) and testing (416/589; 70.6%). Compared with White women, Black and Hispanic women had higher uptake rates of genetic consultation. Public health settings serving racial minorities are well suited to address disparities in genetic service access. (Am J Public Health. 2022;112(9):1249-1252. https://doi.org/10.2105/AJPH.2022.306932).
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Affiliation(s)
- Julia K Veitinger
- Julia K. Veitinger is with the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Alice S. Kerber, Sheryl G. A. Gabram-Mendola, Lynn M. Durham, and Cindy Snyder are with the Georgia Center for Oncology Research and Education, Atlanta. Yuan Liu is with the Department of Biostatistics and Bioinformatics, Rollins School of Public Health & Winship Cancer Institute, Emory University. Diane Durrence, Alissa K. Berzen, and Janet Y. Shin are with the Georgia Department of Public Health, Atlanta. Cecelia A. Bellcross is with the Department of Human Genetics, Emory University School of Medicine, Atlanta. Yue Guan is with Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | - Alice S Kerber
- Julia K. Veitinger is with the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Alice S. Kerber, Sheryl G. A. Gabram-Mendola, Lynn M. Durham, and Cindy Snyder are with the Georgia Center for Oncology Research and Education, Atlanta. Yuan Liu is with the Department of Biostatistics and Bioinformatics, Rollins School of Public Health & Winship Cancer Institute, Emory University. Diane Durrence, Alissa K. Berzen, and Janet Y. Shin are with the Georgia Department of Public Health, Atlanta. Cecelia A. Bellcross is with the Department of Human Genetics, Emory University School of Medicine, Atlanta. Yue Guan is with Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | - Sheryl G A Gabram-Mendola
- Julia K. Veitinger is with the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Alice S. Kerber, Sheryl G. A. Gabram-Mendola, Lynn M. Durham, and Cindy Snyder are with the Georgia Center for Oncology Research and Education, Atlanta. Yuan Liu is with the Department of Biostatistics and Bioinformatics, Rollins School of Public Health & Winship Cancer Institute, Emory University. Diane Durrence, Alissa K. Berzen, and Janet Y. Shin are with the Georgia Department of Public Health, Atlanta. Cecelia A. Bellcross is with the Department of Human Genetics, Emory University School of Medicine, Atlanta. Yue Guan is with Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | - Yuan Liu
- Julia K. Veitinger is with the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Alice S. Kerber, Sheryl G. A. Gabram-Mendola, Lynn M. Durham, and Cindy Snyder are with the Georgia Center for Oncology Research and Education, Atlanta. Yuan Liu is with the Department of Biostatistics and Bioinformatics, Rollins School of Public Health & Winship Cancer Institute, Emory University. Diane Durrence, Alissa K. Berzen, and Janet Y. Shin are with the Georgia Department of Public Health, Atlanta. Cecelia A. Bellcross is with the Department of Human Genetics, Emory University School of Medicine, Atlanta. Yue Guan is with Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | - Lynn M Durham
- Julia K. Veitinger is with the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Alice S. Kerber, Sheryl G. A. Gabram-Mendola, Lynn M. Durham, and Cindy Snyder are with the Georgia Center for Oncology Research and Education, Atlanta. Yuan Liu is with the Department of Biostatistics and Bioinformatics, Rollins School of Public Health & Winship Cancer Institute, Emory University. Diane Durrence, Alissa K. Berzen, and Janet Y. Shin are with the Georgia Department of Public Health, Atlanta. Cecelia A. Bellcross is with the Department of Human Genetics, Emory University School of Medicine, Atlanta. Yue Guan is with Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | - Diane Durrence
- Julia K. Veitinger is with the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Alice S. Kerber, Sheryl G. A. Gabram-Mendola, Lynn M. Durham, and Cindy Snyder are with the Georgia Center for Oncology Research and Education, Atlanta. Yuan Liu is with the Department of Biostatistics and Bioinformatics, Rollins School of Public Health & Winship Cancer Institute, Emory University. Diane Durrence, Alissa K. Berzen, and Janet Y. Shin are with the Georgia Department of Public Health, Atlanta. Cecelia A. Bellcross is with the Department of Human Genetics, Emory University School of Medicine, Atlanta. Yue Guan is with Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | - Alissa K Berzen
- Julia K. Veitinger is with the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Alice S. Kerber, Sheryl G. A. Gabram-Mendola, Lynn M. Durham, and Cindy Snyder are with the Georgia Center for Oncology Research and Education, Atlanta. Yuan Liu is with the Department of Biostatistics and Bioinformatics, Rollins School of Public Health & Winship Cancer Institute, Emory University. Diane Durrence, Alissa K. Berzen, and Janet Y. Shin are with the Georgia Department of Public Health, Atlanta. Cecelia A. Bellcross is with the Department of Human Genetics, Emory University School of Medicine, Atlanta. Yue Guan is with Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | - Janet Y Shin
- Julia K. Veitinger is with the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Alice S. Kerber, Sheryl G. A. Gabram-Mendola, Lynn M. Durham, and Cindy Snyder are with the Georgia Center for Oncology Research and Education, Atlanta. Yuan Liu is with the Department of Biostatistics and Bioinformatics, Rollins School of Public Health & Winship Cancer Institute, Emory University. Diane Durrence, Alissa K. Berzen, and Janet Y. Shin are with the Georgia Department of Public Health, Atlanta. Cecelia A. Bellcross is with the Department of Human Genetics, Emory University School of Medicine, Atlanta. Yue Guan is with Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | - Cindy Snyder
- Julia K. Veitinger is with the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Alice S. Kerber, Sheryl G. A. Gabram-Mendola, Lynn M. Durham, and Cindy Snyder are with the Georgia Center for Oncology Research and Education, Atlanta. Yuan Liu is with the Department of Biostatistics and Bioinformatics, Rollins School of Public Health & Winship Cancer Institute, Emory University. Diane Durrence, Alissa K. Berzen, and Janet Y. Shin are with the Georgia Department of Public Health, Atlanta. Cecelia A. Bellcross is with the Department of Human Genetics, Emory University School of Medicine, Atlanta. Yue Guan is with Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | - Cecelia A Bellcross
- Julia K. Veitinger is with the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Alice S. Kerber, Sheryl G. A. Gabram-Mendola, Lynn M. Durham, and Cindy Snyder are with the Georgia Center for Oncology Research and Education, Atlanta. Yuan Liu is with the Department of Biostatistics and Bioinformatics, Rollins School of Public Health & Winship Cancer Institute, Emory University. Diane Durrence, Alissa K. Berzen, and Janet Y. Shin are with the Georgia Department of Public Health, Atlanta. Cecelia A. Bellcross is with the Department of Human Genetics, Emory University School of Medicine, Atlanta. Yue Guan is with Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | - Yue Guan
- Julia K. Veitinger is with the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Alice S. Kerber, Sheryl G. A. Gabram-Mendola, Lynn M. Durham, and Cindy Snyder are with the Georgia Center for Oncology Research and Education, Atlanta. Yuan Liu is with the Department of Biostatistics and Bioinformatics, Rollins School of Public Health & Winship Cancer Institute, Emory University. Diane Durrence, Alissa K. Berzen, and Janet Y. Shin are with the Georgia Department of Public Health, Atlanta. Cecelia A. Bellcross is with the Department of Human Genetics, Emory University School of Medicine, Atlanta. Yue Guan is with Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
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Collin LJ, Ross-Driscoll K, Nash R, Miller-Kleinhenz JM, Moubadder L, Osborn C, Subhedar PD, Gabram-Mendola SGA, Switchenko JM, Ward KC, McCullough LE. ASO Visual Abstract: Time to Surgical Treatment and Facility Characteristics as Potential Drivers of Racial Disparities in Breast Cancer Mortality: Delay, Facilities, and Breast Cancer Mortality. Ann Surg Oncol 2022. [PMID: 35474558 DOI: 10.1245/s10434-022-11794-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Katie Ross-Driscoll
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Leah Moubadder
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Catherine Osborn
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Preeti D Subhedar
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Sheryl G A Gabram-Mendola
- Emory University, Atlanta, GA, USA.,Georgia Center for Oncology Research and Education, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Collin LJ, Ross-Driscoll K, Nash R, Miller-Kleinhenz JM, Moubadder L, Osborn C, Subhedar PD, Gabram-Mendola SGA, Switchenko JM, Ward KC, McCullough LE. Time to Surgical Treatment and Facility Characteristics as Potential Drivers of Racial Disparities in Breast Cancer Mortality. Ann Surg Oncol 2022; 29:4728-4738. [PMID: 35435562 PMCID: PMC9703360 DOI: 10.1245/s10434-022-11720-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/21/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Black women are more likely to die of breast cancer than White women. This study evaluated the contribution of time to primary surgical management and surgical facility characteristics to racial disparities in breast cancer mortality among both Black and White women. METHODS The study identified 2224 Black and 3787 White women with a diagnosis with stages I to III breast cancer (2010-2014). Outcomes included time to surgical treatment (> 30 days from diagnosis) and breast cancer mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) associating surgical facility characteristics with surgical delay were computed, and Cox proportional hazards regression was used to compute hazard ratios (HRs) and 95% CIs associating delay and facility characteristics with breast cancer mortality. RESULTS Black women were two times more likely to have a surgical delay (OR, 2.15; 95% CI, 1.92-2.41) than White women. Racial disparity in surgical delay was least pronounced among women treated at a non-profit facility (OR, 1.95; 95% CI, 1.70-2.25). The estimated mortality rate for Black women was two times that for White women (HR, 2.00; 95% CI, 1.83-2.46). Racial disparities in breast cancer mortality were least pronounced among women who experienced no surgical delay (HR, 1.81; 95% CI, 1.28-2.56), received surgery at a government facility (HR, 1.31; 95% CI, 0.76-2.27), or underwent treatment at a Commission on Cancer-accredited facility (HR, 1.82; 95% CI, 1.38-2.40). CONCLUSIONS Black women were more likely to experience a surgical delay and breast cancer death. Persistent racial disparities in breast cancer mortality were observed across facility characteristics except for government facilities.
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Affiliation(s)
- Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Katie Ross-Driscoll
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Leah Moubadder
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Catherine Osborn
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Preeti D Subhedar
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sheryl G A Gabram-Mendola
- Emory University, Atlanta, GA, USA.,Georgia Center for Oncology Research and Education, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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White BN, Lu IM, Kao LS, Dixon JB, Weiler MJ, Frank ND, Binkley J, Subhedar P, Okoli J, Buhariwalla K, Suarez-Ligon A, Gabram-Mendola SGA. An infrared 3D scanning device as a novel limb volume measurement tool in breast cancer patients. World J Surg Oncol 2020; 18:278. [PMID: 33109204 PMCID: PMC7592580 DOI: 10.1186/s12957-020-02043-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022] Open
Abstract
Abstract Background Lymphedema is a common complication of breast cancer treatment that affects one in five breast cancer survivors, yet there is no reliable method to detect lymphedema in the subclinical range. The objective of this study was to determine the feasibility and reliability of using an infrared 3D scanning device (ISD) as a peri-operative limb volume measurement tool. Methods Fifteen patients were analyzed based on inclusion criteria. Peri-operative measurements were obtained using tape measure and an ISD. Volumes were calculated using a standard algorithm for tape measure and a custom algorithm for ISD measurements. Linear regression models were used to assess ISD and tape measurement volume and circumference correlation. One-way ANOVA was used to compare change in percent difference at set time points post-operatively (2–3 weeks, 4–6 weeks, and 7–12 weeks) for both ISD and tape measure. t tests for unequal variances with the Bonferroni correction were performed among these groups. Results There is a positive linear correlation (R2 = 0.8518) between absolute volume measurements by the ISD and tape measure. Analyses over 2–10 weeks post-operatively showed that the ISD was able to detect volume changes in both the unaffected and the affected arm. Furthermore, the affected arm tended to have a greater increase in volume in the majority of patients, indicating these patients could be at risk for lymphedema. Conclusions Technology utilizing infrared 3D scanners can reliably measure limb volume pre- and post-treatment similarly to tape measure in a small sample of patients. Further research using 3D scanning technology with a longer follow up is warranted.
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Affiliation(s)
- Bernadette N White
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA
| | - Iris M Lu
- Georgia Institute of Technology, Atlanta, GA, USA
| | - LeslieAnn S Kao
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA
| | | | | | | | - Jill Binkley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA
| | - Preeti Subhedar
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA
| | - Joel Okoli
- Morehouse School of Medicine, Atlanta, GA, USA
| | | | | | - Sheryl G A Gabram-Mendola
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA.
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Adams EK, Chien LN, Gabram-Mendola SGA. Treatment patterns among medicaid-eligible women with breast cancer in georgia: are patterns different under the breast and cervical cancer prevention and treatment act? J Oncol Pract 2012; 8:46-52. [PMID: 22548011 DOI: 10.1200/jop.2011.000221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2011] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To investigate breast cancer treatment of patients enrolled under traditional Medicaid categories versus those in the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) in Georgia. METHODS Georgia Comprehensive Cancer Registry linked to Medicaid enrollment files were used to identify 2,048 enrollees with a primary cancer of the breast, of whom 1,046 were enrolled in BCCPTA, 674 were disabled, and 328 were in other Medicaid eligibility groups. Logistic regressions were used to estimate factors associated with the odds of receiving lumpectomy, mastectomy, or other surgery in addition to any drug regimen (hormonal or chemotherapy) and radiation. RESULTS Women in BCCPTA were more likely to receive any treatment (odds ratio [OR] = 4.71; 95% CI, 2.48 to 8.96), any drug regimen (OR = 3.58; 95% CI, 2.32 to 5.51), any radiation (OR = 1.61; 95% CI, 1.15to 2.24), and any definitive surgery (OR = 2.52; 95% CI, 1.74 to 3.66) than the "other" eligibility group after controlling for covariates. There were no significant differences by eligibility group in the receipt of a lumpectomy versus a mastectomy. However, women in BCCPTA were more likely to receive more adjuvant follow-up after a mastectomy. CONCLUSION The BCCPTA program in Georgia appears to create a quicker pathway for low-income, previously uninsured women with breast cancer to access services and, in turn, receive more treatment than women enrolled in the other, more traditional Medicaid eligibility groups. Yet the overall rate of adjuvant therapy, whether radiation, hormonal, or chemotherapy, appears to fall short of national criteria. This deserves attention in Georgia and, most likely, Medicaid programs in other states as well.
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