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Castañeda-Avila MA, Suárez-Ramos T, Torres-Cintrón CR, Epstein MM, Gierbolini-Bermúdez A, Tortolero-Luna G, Ortiz-Ortiz KJ. Multiple myeloma incidence, mortality, and survival differences at the intersection of sex, age, and race/ethnicity: A comparison between Puerto Rico and the United States SEER population. Cancer Epidemiol 2024; 89:102537. [PMID: 38295555 DOI: 10.1016/j.canep.2024.102537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/15/2023] [Accepted: 01/21/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Multiple myeloma (MM) survival has increased during the last decades due to the introduction of new therapies. We investigated the intersectionality among age, sex, and race/ethnicity to better understand the pattern of MM incidence, mortality, and survival. METHODS Puerto Rico (PR) Central Cancer Registry and the United States of America (US) Surveillance, Epidemiology, and End Results (SEER) Program databases were used. We analyzed MM incidence and mortality trends from 2001 to 2019 using Joinpoint regression models to calculate annual percent change (APC). Age-standardized rate ratios (SRR) for incidence and mortality were used to compare PR with US SEER racial/ethnic groups during 2015-2019. Five-year survival analyses were also performed stratified by age and sex. RESULTS Regardless of age and race/ethnicity, males had higher MM incidence and mortality rates than females. PR had a higher increase in incidence rates of MM than other ethnic groups, regardless of sex and age (PR APC = 4.3 among males <65, 3.1 among males ≥65, 6.3 among females <65, and 2.6 among females ≥65 years old). No significant change in mortality APCs (p > 0.05) was observed in PR when stratified by age or sex while other groups showed a decrease. Among males < 65 years, PR had significantly higher incidence rates than non-Hispanic Whites (NHW), and US Hispanics (USH). However, among both males and females ≥ 65 years, PR had significantly lower MM mortality rates than NHW, non-Hispanic Blacks (NHB), USH, and US Overall. In terms of survival, PR showed the lowest 5-year overall survival among males < 65 years (54.6%, 95% CI: 47.2-61.5) and males ≥ 65 years (34.5%, 95% CI: 29.2-39.9) but not among females. CONCLUSION The incidence of MM in PR increased significantly over the study period, particularly among younger women. Despite the introduction of new therapies, mortality rates in PR have remained stable while other ethnic groups show significant decreases among all intersections of sex and age.
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Affiliation(s)
- Maira A Castañeda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, MA, United States
| | - Tonatiuh Suárez-Ramos
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Carlos R Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Mara M Epstein
- Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Axel Gierbolini-Bermúdez
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Guillermo Tortolero-Luna
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico; Cancer Control and Population Sciences Program, the University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico; Cancer Control and Population Sciences Program, the University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
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Schneider JL, Firemark AJ, Gille S, Davis J, Pawloski PA, Liang SY, Epstein MM, Lowery J, Lu CY, Sharaf RN, Burnett-Hartman AN, Schlieder V, Salvati ZM, Cragun D, Rahm AK, Hunter JE. "Go ahead and screen" - advice to healthcare systems for routine lynch syndrome screening from interviews with newly diagnosed colorectal cancer patients. Hered Cancer Clin Pract 2023; 21:24. [PMID: 37978552 PMCID: PMC10657118 DOI: 10.1186/s13053-023-00270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Lynch syndrome (LS) is the most common cause of inherited colorectal cancer (CRC). Universal tumor screening (UTS) of newly diagnosed CRC cases is recommended to aid in diagnosis of LS and reduce cancer-related morbidity and mortality. However, not all health systems have adopted UTS processes and implementation may be inconsistent due to system and patient-level complexities. METHODS To identify barriers, facilitators, and suggestions for improvements of the UTS process from the patient perspective, we conducted in-depth, semi-structured interviews with patients recently diagnosed with CRC, but not screened for or aware of LS. Patients were recruited from eight regionally diverse US health systems. Interviews were conducted by telephone, 60-minutes, audio-recorded, and transcribed. An inductive, constant comparative analysis approach was employed. RESULTS: We completed 75 interviews across the eight systems. Most participants were white (79%), about half (52%) were men, and the mean age was 60 years. Most self-reported either no (60%) or minimal (40%) prior awareness of LS. Overall, 96% of patients stated UTS should be a routine standard of care for CRC tumors, consistently citing four primary motivations for wanting to know their LS status and engage in the process for LS identification: "knowledge is power"; "family knowledge"; "prevention and detection"; and "treatment and surveillance." Common concerns pertaining to the process of screening for and identifying LS included: creating anticipatory worry for patients, the potential cost and the accuracy of the genetic test, and possibly having one's health insurance coverage impacted by the LS diagnosis. Patients suggested health systems communicate LS results in-person or by phone from a trained expert in LS; offer proactive verbal and written education about LS, the screening steps, and any follow-up surveillance recommendations; and support patients in communicating their LS screening to any of their blood relatives. CONCLUSION Our qualitative findings demonstrate patients with CRC have a strong desire for healthcare systems to regularly implement and offer UTS. Patients offer key insights for health systems to guide future implementation and optimization of UTS and other LS screening programs and maximize diagnosis of individuals with LS and improve cancer-related surveillance and outcomes. TRIAL REGISTRATION Not available: not a clinical trial.
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Affiliation(s)
- Jennifer L Schneider
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, 97227, Portland, OR, USA.
| | - Alison J Firemark
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, 97227, Portland, OR, USA
| | - Sara Gille
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, 97227, Portland, OR, USA
| | - James Davis
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, 97227, Portland, OR, USA
| | | | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Mara M Epstein
- Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jan Lowery
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Ravi N Sharaf
- Division of Gastroenterology, Department of Medicine, Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | - Deborah Cragun
- University of South Florida, 3720 Spectrum Blvd, Suite 304, Tampa, Fl, USA
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Epstein MM, Zhou Y, Castaneda-Avila MA, Cohen HJ. Multimorbidity in patients with monoclonal gammopathy of undetermined significance. Int J Cancer 2023; 152:2485-2492. [PMID: 36799553 DOI: 10.1002/ijc.34476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/26/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS), a precursor to multiple myeloma, is present in over 5% of adults aged 70 and older, a population with a high prevalence of multimorbidity. MGUS is often diagnosed incidentally when patients seek care for unrelated conditions. Our study sought to examine patterns of multimorbidity among MGUS patients, as overall health may impact patient care and the prioritization of MGUS surveillance. We examined patterns of comorbidities in 429 patients diagnosed with MGUS (2007-2015) and 1287 matched controls. Twenty-seven conditions were defined at diagnosis/index date using algorithms developed by the Centers for Medicare and Medicaid Chronic Conditions Warehouse. Patterns of common comorbidities were identified individually, in dyads and triads, and compared between MGUS cases and controls. We conducted a latent class analysis to identify comorbidity patterns among cases only. We also examined comorbidity patterns among a subset of 32 MGUS cases who progressed to cancer during the study period. The most common comorbidities among both MGUS cases and controls included hypertension and hyperlipidemia. Anemia (cases: 43%; controls: 16%) and chronic kidney disease (CKD; cases: 36%; controls: 18%), and dyads and triads containing those conditions, were more common among cases. Latent class analysis identified three classes of comorbidity among MGUS cases: hypertension-hyperlipidemia plus anemia and CKD (31%); low comorbidity burden (17%); and hypertension-hyperlipidemia alone (52%). The higher prevalence among cases of anemia and CKD, which may be involved in the pathogenesis of, or surveillance for, MGUS, warrants additional investigation.
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Affiliation(s)
- Mara M Epstein
- The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA
- Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Yanhua Zhou
- The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA
- Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Maira A Castaneda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
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Salvati ZM, Rahm AK, Williams MS, Ladd I, Schlieder V, Atondo J, Schneider JL, Epstein MM, Lu CY, Pawloski PA, Sharaf RN, Liang SY, Burnett-Hartman AN, Hunter JE, Burton-Akright J, Cragun D. A picture is worth a thousand words: advancing the use of visualization tools in implementation science through process mapping and matrix heat mapping. Implement Sci Commun 2023; 4:43. [PMID: 37098602 PMCID: PMC10127322 DOI: 10.1186/s43058-023-00424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/03/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Identifying key determinants is crucial for improving program implementation and achieving long-term sustainment within healthcare organizations. Organizational-level complexity and heterogeneity across multiple stakeholders can complicate our understanding of program implementation. We describe two data visualization methods used to operationalize implementation success and to consolidate and select implementation factors for further analysis. METHODS We used a combination of process mapping and matrix heat mapping to systematically synthesize and visualize qualitative data from 66 stakeholder interviews across nine healthcare organizations, to characterize universal tumor screening programs of all newly diagnosed colorectal and endometrial cancers and understand the influence of contextual factors on implementation. We constructed visual representations of protocols to compare processes and score process optimization components. We also used color-coded matrices to systematically code, summarize, and consolidate contextual data using factors from the Consolidated Framework for Implementation Research (CFIR). Combined scores were visualized in a final data matrix heat map. RESULTS Nineteen process maps were created to visually represent each protocol. Process maps identified the following gaps and inefficiencies: inconsistent execution of the protocol, no routine reflex testing, inconsistent referrals after a positive screen, no evidence of data tracking, and a lack of quality assurance measures. These barriers in patient care helped us define five process optimization components and used these to quantify program optimization on a scale from 0 (no program) to 5 (optimized), representing the degree to which a program is implemented and optimally maintained. Combined scores within the final data matrix heat map revealed patterns of contextual factors across optimized programs, non-optimized programs, and organizations with no program. CONCLUSIONS Process mapping provided an efficient method to visually compare processes including patient flow, provider interactions, and process gaps and inefficiencies across sites, thereby measuring implementation success via optimization scores. Matrix heat mapping proved useful for data visualization and consolidation, resulting in a summary matrix for cross-site comparisons and selection of relevant CFIR factors. Combining these tools enabled a systematic and transparent approach to understanding complex organizational heterogeneity prior to formal coincidence analysis, introducing a stepwise approach to data consolidation and factor selection.
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Affiliation(s)
- Zachary M Salvati
- Geisinger Department of Genomic Health, 100 N. Academy Ave, Danville, PA, 17822, USA.
| | - Alanna Kulchak Rahm
- Geisinger Department of Genomic Health, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Marc S Williams
- Geisinger Department of Genomic Health, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Ilene Ladd
- Geisinger Department of Genomic Health, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Victoria Schlieder
- Geisinger Department of Genomic Health, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Jamie Atondo
- Geisinger Department of Genomic Health, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Jennifer L Schneider
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97202, USA
| | - Mara M Epstein
- Department of Medicine and the Meyers Primary Care Institute, University of Massachusetts Medical School, 365 Plantation St. Biotech 1, Suite 100, Worcester, MA, 01605, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
| | | | - Ravi N Sharaf
- Division of Gastroenterology, Department of Medicine, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA, 94301, USA
| | - Andrea N Burnett-Hartman
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S. Parker Rd., Ste 200, Aurora, CO, 80014, USA
| | - Jessica Ezzell Hunter
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | | | - Deborah Cragun
- University of South Florida, 3720 Spectrum Blvd, Suite 304, Tampa, FL, 33612, USA
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Castaneda-Avila MA, Oyinbo AG, Epstein MM, Ortiz-Ortiz KJ, Tortolero-Luna G, Lapane KL. Trends and Factors Associated with Fecal Occult Blood Test Utilization among Hispanic Adults in Puerto Rico and the United States: BRFSS 2012-2020. Cancer Prev Res (Phila) 2023; 16:229-237. [PMID: 36720120 PMCID: PMC10073332 DOI: 10.1158/1940-6207.capr-22-0423] [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] [Received: 09/25/2022] [Revised: 12/03/2022] [Accepted: 01/27/2023] [Indexed: 02/02/2023]
Abstract
Identifying factors associated with colorectal cancer screening utilization is important to guide colorectal cancer prevention and control programs. We evaluated trends and factors associated with previous-year fecal occult blood test (FOBT) use among Hispanic adults living in Puerto Rico and the U.S. mainland. Using data from the Behavioral Risk Factor Surveillance System (2012-2020), trends in FOBT use were analyzed using joinpoint regression to estimate annual percentage change (APC). Logistic regression stratified by location identified factors associated with FOBT use. FOBT was more common among Hispanic adults ages 50 to 75 years living in Puerto Rico than in the U.S. mainland [Puerto Rico: 20.5%[2012] to 45.6%[2020], APC = 11.4%; U.S. mainland: 9.9%[2012] to 16.7%[2020], APC = 5.9%]. Factors inversely associated with FOBT use were similar in Puerto Rico and the U.S. mainland, including lack of health insurance, not having a personal doctor, having a checkup >12 months ago, and not being able to see a doctor due to cost, as were factors associated with higher FOBT use, including older age, retirement, or having two or more chronic diseases. Among Hispanics living in the U.S. mainland, lack of exercise and less education were inversely associated with FOBT. Factors related to poor access to healthcare were associated with lower use of FOBT among Hispanics. Efforts to improve colorectal cancer screening in Hispanics are necessary to address health disparities across the colorectal cancer care continuum. PREVENTION RELEVANCE Colorectal cancer screening reduces cancer incidence and mortality. All screening modalities, including less invasive FOBT tests, are underutilized, especially in non-White and low-income populations. Evaluation of trends and factors associated with the increase in the use of colorectal cancer screening can inform programs to address the lack of screening among racial minorities.
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Affiliation(s)
- Maira A. Castaneda-Avila
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Atinuke G. Oyinbo
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Mara M. Epstein
- Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA
| | - Karen J. Ortiz-Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Kate L. Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
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Rhee J, Birmann BM, De Roos AJ, Epstein MM, Martinez-Maza O, Breen EC, Magpantay LI, Levin LI, Visvanathan K, Hosgood HD, Rohan TE, Smoller SW, Bassig BA, Qi L, Shu XO, Koh WP, Zheng W, Yuan JM, Weinstein SJ, Albanes D, Lan Q, Rothman N, Purdue MP. Circulating immune markers and risks of non-Hodgkin lymphoma subtypes: A pooled analysis. Int J Cancer 2023; 152:865-878. [PMID: 36151863 PMCID: PMC9812887 DOI: 10.1002/ijc.34299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 01/07/2023]
Abstract
Although prediagnostic circulating concentrations of the immune activation markers soluble CD27 (sCD27), sCD30 and chemokine ligand-13 (CXCL13) have been associated with non-Hodgkin lymphoma (NHL) risk, studies have been limited by sample size in associations with NHL subtypes. We pooled data from eight nested case-control studies to investigate subtype-specific relationships for these analytes. Using polytomous regression, we calculated odds ratios (ORs) with 95% confidence intervals (CIs) relating study-specific analyte tertiles to selected subtypes vs controls (n = 3310): chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL; n = 623), diffuse large B cell lymphoma (DLBCL; n = 621), follicular lymphoma (FL; n = 398), marginal zone lymphoma (MZL; n = 138), mantle cell lymphoma (MCL; n = 82) and T cell lymphoma (TCL; n = 92). We observed associations with DLBCL for elevated sCD27 [OR for third vs first tertile (ORT3 ) = 2.2, 95% CI = 1.6-3.1], sCD30 (ORT3 = 2.0, 95% CI = 1.6-2.5) and CXCL13 (ORT3 = 2.3, 95% CI = 1.8-3.0). We also observed associations with sCD27 for CLL/SLL (ORT3 = 3.3, 95% CI = 2.4-4.6), MZL (ORT3 = 7.7, 95% CI = 3.0-20.1) and TCL (ORT3 = 3.4, 95% CI = 1.5-7.7), and between sCD30 and FL (ORT3 = 2.7, 95% CI = 2.0-3.5). In analyses stratified by time from phlebotomy to case diagnosis, the sCD27-TCL and all three DLBCL associations were equivalent across both follow-up periods (<7.5, ≥7.5 years). For other analyte-subtype comparisons, associations were stronger for the follow-up period closer to phlebotomy, particularly for indolent subtypes. In conclusion, we found robust evidence of an association between these immune markers and DLBCL, consistent with hypotheses that mechanisms related to immune activation are important in its pathogenesis. Our other findings, particularly for the rarer subtypes MZL and TCL, require further investigation.
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Affiliation(s)
- Jongeun Rhee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Brenda M. Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Anneclaire J. De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Mara M. Epstein
- Department of Medicine and the Meyers Health Care Institute, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Otoniel Martinez-Maza
- Department of Microbiology, Immunology & Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA AIDS Institute, Los Angeles, CA, USA
- Department of Obstetrics & Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Elizabeth C. Breen
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Larry I. Magpantay
- UCLA AIDS Institute, Los Angeles, CA, USA
- Department of Obstetrics & Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lynn I. Levin
- Statistics and Epidemiology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Kala Visvanathan
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - H. Dean Hosgood
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Thomas E. Rohan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sylvia W. Smoller
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bryan A. Bassig
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Formerly at the U.S. National Cancer Institute. This author is currently employed by the U.S. Centers for Disease Control and Prevention, National Center for Health Statistics. All work on this study by the author was conducted while employed by the National Cancer Institute
| | - Lihong Qi
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore 117609, Singapore
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephanie J. Weinstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Mark P. Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Ardisson Korat AV, Chiu YH, Bertrand KA, Zhang S, Epstein MM, Rosner BA, Chiuve S, Campos H, Giovannucci EL, Chavarro JE, Birmann BM. A prospective analysis of red blood cell membrane polyunsaturated fatty acid levels and risk of non-Hodgkin lymphoma. Leuk Lymphoma 2022; 63:3351-3361. [PMID: 36255154 PMCID: PMC9877158 DOI: 10.1080/10428194.2022.2131419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/09/2022] [Accepted: 09/18/2022] [Indexed: 01/25/2023]
Abstract
Published studies report inconsistent associations of polyunsaturated fatty acid (PUFA) intake with non-Hodgkin lymphoma (NHL) risk. We conducted a nested case-control study in Nurses' Health Study and Health Professionals Follow-Up Study participants to evaluate a hypothesis of inverse association of pre-diagnosis red blood cell (RBC) membrane PUFA levels with risk of NHL endpoints. We confirmed 583 NHL cases and matched 583 controls by cohort/sex, age, race and blood draw date/time. We estimated odds ratios (OR) and 95% confidence intervals (CI) for risk of NHL endpoints using logistic regression. RBC PUFA levels were not associated with all NHL risk; cis 20:2n-6 was associated with follicular lymphoma risk (OR [95% CI] per one standard deviation increase: 1.35 [1.03-1.77]), and the omega-6/omega-3 PUFA ratio was associated with diffuse large B-cell lymphoma risk (2.33 [1.23-4.43]). Overall, PUFA did not demonstrate a role in NHL etiology; the two unexpected positive associations lack clear biologic explanations.
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Affiliation(s)
- Andres V. Ardisson Korat
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Yu-Han Chiu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Shumin Zhang
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Johnson & Johnson, New Brunswick, NJ
| | - Mara M. Epstein
- Department of Medicine and The Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA
| | - Bernard A. Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Stephanie Chiuve
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- AbbVie Pharmaceuticals, North Chicago, IL
| | - Hannia Campos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Centro de Investigación e Innovación en Nutrición Translacional y Salud, Universidad Hispanoamericana, San Jose, Costa Rica
| | - Edward L. Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jorge E. Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Brenda M. Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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Du S, Carfang L, Restrepo E, Benjamin C, Epstein MM, Fairley R, Roudebush L, Hertz C, Eshraghi L, Warner ET. Patient-Reported Experiences of Breast Cancer Screening, Diagnosis, and Treatment Delay, and Telemedicine Adoption during COVID-19. Curr Oncol 2022; 29:5919-5932. [PMID: 36005205 PMCID: PMC9406797 DOI: 10.3390/curroncol29080467] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/08/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To evaluate and quantify potential sociodemographic disparities in breast cancer screening, diagnosis, and treatment due to the COVID-19 pandemic, and the use of telemedicine. Methods: We fielded a 52-item web-based questionnaire from 14 May 2020 to 1 July 2020 in partnership with several U.S.-based breast cancer advocacy groups. Individuals aged 18 or older were eligible for this study if they: (1) received routine breast cancer screening; OR (2) were undergoing diagnostic evaluation for breast cancer; OR (3) had ever been diagnosed with breast cancer. We used descriptive statistics to understand the extent of cancer care delay and telemedicine adoption and used multivariable logistic regression models to estimate the association of sociodemographic factors with odds of COVID-19-related delays in care and telemedicine use. Results: Of 554 eligible survey participants, 493 provided complete data on demographic and socioeconomic factors and were included in the analysis. Approximately half (n = 248, 50.3%) had a personal history of breast cancer. Overall, 188 (38.1%) participants had experienced any COVID-19-related delay in care including screening, diagnosis, or treatment, and 339 (68.8) reported having at least one virtual appointment during the study period. Compared to other insurance types, participants with Medicaid insurance were 2.58 times more likely to report a COVID-19-related delay in care (OR 2.58, 95% Cl: 1.05, 6.32; p = 0.039). Compared to participants with a household income of less than USD 50,000, those with a household income of USD 150,000 or more were 2.38 (OR 2.38, 95% Cl: 1.09, 5.17; p = 0.029) times more likely to adopt virtual appointments. Self-insured participants were 70% less likely to use virtual appointment compared to those in other insurance categories (OR 0.28, 95% Cl: 0.11, 0.73; p = 0.009). Conclusions: The COVID-19 pandemic has had a significant impact on breast cancer screening, diagnosis, and treatment, and accelerated the delivery of virtual care. Lower-income groups and patients with certain insurance categories such as Medicaid or self-insured could be more likely to experience care delay or less likely to use telemedicine. Careful attention must be paid to vulnerable groups to insure equity in breast cancer-related service utilization and telemedicine access during and beyond the COVID-19 pandemic.
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Affiliation(s)
- Simo Du
- SurvivingBreastCancer.org, Boston, MA 02119, USA
| | | | - Emily Restrepo
- Mongan Institute, Clinical Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Mara M. Epstein
- Meyers Health Care Institute, a Joint Endeavor of the University of Massachusetts Medical School, Fallon Health, and Reliant Medical Group, Worcester, MA 01605, USA
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Ricki Fairley
- TOUCH, The Black Brest Cancer Alliance, Annapolis, MD 21403, USA
| | - Laura Roudebush
- Dr. Susan Love Foundation for Breast Cancer Research, West Hollywood, CA 90069, USA
| | - Crystal Hertz
- Dr. Susan Love Foundation for Breast Cancer Research, West Hollywood, CA 90069, USA
| | - Leah Eshraghi
- Dr. Susan Love Foundation for Breast Cancer Research, West Hollywood, CA 90069, USA
| | - Erica T. Warner
- Mongan Institute, Clinical Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Correspondence:
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9
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Epstein MM, Sundaresan D, Fair M, Fouayzi H, Warner ET, Garber LD, Gurwitz JH, Field TS. Trends in breast and prostate cancer screening and diagnostic procedures during the COVID-19 pandemic in central Massachusetts. Cancer Causes Control 2022; 33:1313-1323. [PMID: 35933572 PMCID: PMC9361987 DOI: 10.1007/s10552-022-01616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2021] [Accepted: 07/18/2022] [Indexed: 10/24/2022]
Abstract
PURPOSE We calculated rates of breast and prostate cancer screening and diagnostic procedures performed during the COVID-19 pandemic through December 2021 compared to the same months in 2019 in a large healthcare provider group in central Massachusetts. METHODS We included active patients of the provider group between January 2019 and December 2021 aged 30-85 years. Monthly rates of screening mammography and digital breast tomosynthesis, breast MRI, total prostate specific antigen (PSA), and breast or prostate biopsy per 1,000 people were compared by year overall, by age, and race/ethnicity. Completed procedures were identified by relevant codes in electronic health record data. RESULTS Rates of screening mammography, tomosynthesis, and PSA testing reached the lowest levels in April-May 2020. Breast cancer screening rates decreased 43% in March and 99% in April and May 2020, compared to 2019. Breast cancer screening rates increased gradually beginning in June 2020 through 2021, although more slowly in Black and Hispanic women and in women aged 75-85. PSA testing rates decreased 34% in March, 78% in April, and 53% in May 2020, but rebounded to pre-pandemic levels by June 2020; trends were similar across groups defined by age and race/ethnicity. CONCLUSION The observed decline in two common screening procedures during the COVID-19 pandemic reflects the impact of the pandemic on cancer early detection and signals potential downstream effects on the prognosis of delayed cancer diagnoses. The slower rate of return for breast cancer screening procedures in certain subgroups should be investigated to ensure all women return for routine screenings.
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Affiliation(s)
- Mara M Epstein
- The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, 365 Plantation Street Biotech 1, Suite 100, Worcester, MA, 01605, USA. .,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | | | | | - Hassan Fouayzi
- The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, 365 Plantation Street Biotech 1, Suite 100, Worcester, MA, 01605, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, USA
| | - Erica T Warner
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Mongan Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Jerry H Gurwitz
- The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, 365 Plantation Street Biotech 1, Suite 100, Worcester, MA, 01605, USA.,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Terry S Field
- The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, 365 Plantation Street Biotech 1, Suite 100, Worcester, MA, 01605, USA.,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
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10
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Castañeda-Avila MA, Lapane KL, Person SD, Zhou Y, Gurwitz J, Mazor KM, Epstein MM. Multi-trajectory models of serum biomarkers among patients with monoclonal gammopathy of undetermined significance. Hematol Oncol 2022; 40:409-416. [PMID: 35304925 PMCID: PMC9378561 DOI: 10.1002/hon.2992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/08/2022] [Accepted: 03/03/2022] [Indexed: 11/10/2022]
Abstract
Understanding the progression of monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM) is needed to identify patients who would benefit from closer clinical surveillance. Given that two of the defining criteria of MM are renal failure and anemia, we described the trajectories of creatinine (Cr) and hemoglobin (Hgb) over time in patients with a diagnosis of MGUS. Patients diagnosed with MGUS (n = 424) were identified by a previously validated case-finding algorithm using health claims and electronic health record data (2007-2015) and followed through 2018. Group-based trajectory modeling identified patients with distinct laboratory value trajectories of Cr (mg/dl) and Hgb (g/dl). Most patients were non-Hispanic White (97.6%) with a mean age of 75 years at MGUS diagnosis. Three multi-trajectory groups were identified: (1) Normal Cr/Hgb (n = 225; 53.1%)-stable serum Cr levels and decreasing, normal Hgb levels; (2) Normal Cr/lower-normal Hgb group (n = 188; 44.3%)-stable, slightly elevated levels of Cr and decreasing levels of Hgb; and (3) High Cr/borderline Hgb group (n = 11; 2.6%)-increased Cr levels and stable low levels of Hgb. Patients with MGUS in Group 2 were older than patients in other groups, and patients in group 3 had more comorbidities than participants in all other groups. Few patients developed MM during the study period. We were able to identify distinct biomarker trajectories in patients with MGUS over time. Future research should investigate how these trajectories may be related to the risk of progression to MM, including M-protein levels.
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Affiliation(s)
- Maira A Castañeda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sharina D Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Yanhua Zhou
- Meyers Health Care Institute, a Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, Worcester, Massachusetts, USA
| | - Jerry Gurwitz
- Meyers Health Care Institute, a Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, Worcester, Massachusetts, USA.,Department of Medicine, Division of Geriatric Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Kathleen M Mazor
- Meyers Health Care Institute, a Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, Worcester, Massachusetts, USA.,Department of Medicine, Division of Geriatric Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mara M Epstein
- Meyers Health Care Institute, a Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, Worcester, Massachusetts, USA.,Department of Medicine, Division of Geriatric Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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11
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Rhee J, Birmann BM, De Roos AJ, Epstein MM, Martinez-Maza O, Breen EC, Levin LI, Visvanathan K, Hosgood HD, Rohan T, Qi L, Lan Q, Rothman N, Purdue MP. Abstract 685: Circulating immune markers and risks of non-Hodgkin lymphoma subtypes: A pooled analysis. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Peripheral blood levels of soluble CD27 (sCD27), sCD30 and chemokine ligand-13 (CXCL13) are proposed markers of immune activation, the effects of which may influence the development of non-Hodgkin lymphoma (NHL). Pre-diagnostic circulating levels of sCD27, sCD30 and CXCL13 have been associated with NHL, although individual studies have typically been underpowered to assess associations for individual NHL subtypes. We pooled data from eight case-control studies nested within general-population cohorts to investigate subtype-specific relationships with these immune markers.
Methods: After pooling, immune marker data for 2,455 cases diagnosed >2 years after blood collection and 3,310 controls were available for analysis. Using polytomous regression models, we calculated odds ratios (ORs) with 95% confidence intervals (CIs) relating study-specific tertiles of each immune marker to the following subtypes: chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL; n=623), diffuse large B-cell lymphoma (DLBCL; n=621), follicular lymphoma (FL; n=398), marginal zone lymphoma (MZL; n=138), mantle cell lymphoma (MCL; n=82) and T-cell lymphoma (TCL; n=92).
Results: We observed associations with DLBCL for elevated levels of sCD27 [OR for 3rd vs. 1st tertile (ORT3) = 2.2, 95% CI = 1.6-3.1; Ptrend = 9.3x10-6), sCD30 (ORT3 = 2.0, 95% CI 1.6-2.5; Ptrend = 6.5 x10-10) and CXCL-13 (ORT3 = 2.3, 95% CI 1.8-3.0; Ptrend = 3.9 x10-12). These associations remained in a model simultaneously adjusting for all three markers. We also observed associations with sCD27 for CLL/SLL (ORT3 = 3.3, 95% CI = 2.4-4.6; Ptrend = 1.6x10-13), MZL (ORT3 =7.7, 95% CI 3.0-20.1; Ptrend = 2.3x10-6) and TCL (ORT3 = 3.4, 95% CI 1.5-7.7; Ptrend = 0.003), and between sCD30 and FL (ORT3 = 2.7, 95% CI 2.0-3.5; Ptrend = 1.7x10-12), all of which remained after adjustment for the other immune markers. In analyses stratified by follow-up time from blood collection to case diagnosis, the sCD27-TCL association and all three DLBCL associations were equivalent across both follow-up periods (>2-<7.5, ≥7.5 years). The sCD27-CLL/SLL, sCD27-MZL and sCD30-FL associations were weaker for cases diagnosed ≥7.5 years post-phlebotomy compared to the earlier follow-up period but remained statistically significant. Conclusions: In this pooled analysis, to our knowledge the first of its kind, we found robust evidence of an association between the three immune markers and DLBCL, consistent with hypotheses that mechanisms related to immune activation are important in the etiology of this malignancy. Other findings are notable, particularly the strong associations with sCD27 for the rare subtypes MZL and TCL, but require further investigation before causal inferences can be drawn.
Citation Format: Jongeun Rhee, Brenda M. Birmann, Anneclaire J. De Roos, Mara M. Epstein, Otoniel Martinez-Maza, Elizabeth C. Breen, Lynn I. Levin, Kala Visvanathan, H Dean Hosgood, Thomas Rohan, Lihong Qi, Qing Lan, Nathaniel Rothman, Mark P. Purdue. Circulating immune markers and risks of non-Hodgkin lymphoma subtypes: A pooled analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 685.
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Affiliation(s)
| | - Brenda M. Birmann
- 2Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | - Mara M. Epstein
- 4University of Massachusetts Chan Medical School, Worcester, MA
| | | | - Elizabeth C. Breen
- 6David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Lynn I. Levin
- 7Walter Reed Army Institute of Research, Silver Spring, MD
| | | | | | | | - Lihong Qi
- 10University of California Davis, Davis, CA
| | - Qing Lan
- 1National Cancer Institute, Rockville, MD
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12
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Joseph CLM, Tang A, Chesla DW, Epstein MM, Pawloski PA, Stevens AB, Waring SC, Ahmedani BK, Johnson CC, Peltz-Rauchman CD. Demographic differences in willingness to share electronic health records in the All of Us Research Program. J Am Med Inform Assoc 2022; 29:1271-1278. [PMID: 35472083 PMCID: PMC9196689 DOI: 10.1093/jamia/ocac055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/15/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Participant willingness to share electronic health record (EHR) information is central to success of the National Institutes of Health All of Us Research Program (AoURP). We describe the demographic characteristics of participants who decline access to their EHR data. MATERIALS AND METHODS We included participants enrolling in AoURP between June 6, 2017 and December 31, 2019 through the Trans-American Consortium for the Health Care Systems Research Network (TACH). TACH is a consortium of health care systems spanning 6 states, and an AoURP research partner. RESULTS We analyzed data for 25 852 participants (89.3% of those enrolled). Mean age = 52.0 years (SD 16.8), with 66.5% White, 18.7% Black/African American, 7.7% Hispanic, 32.5% female, and 76% with >a high school diploma. Overall, 2.3% of participants declined to share access to their EHR data (range across TACH sites = 1.3% to 3.5%). Younger age, female sex, and education >high school were significantly associated with decline to share EHR data, odds ratio (95% confidence interval) = 1.26 (1.19-1.33), 1.74 (1.42-2.14), and 2.44 (1.86-3.21), respectively. Results were similar when several sensitivity analyses were performed. DISCUSSION AoURP seeks a dataset reflecting our nation's diversity in all aspects of participation. Those under-represented in biomedical research may be reluctant to share access to their EHR data. CONCLUSION In our data, race and ethnicity were not independently related to participant decision to decline access to their EHR information. Results suggest that the value of the AoURP dataset is unlikely to be constrained by the size or the racial/ethnic composition of this subgroup.
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Affiliation(s)
| | - Amy Tang
- Henry Ford Health System, Public Health Sciences, Detroit, Michigan, USA
| | - David W Chesla
- Spectrum Health, Research and Development, Grand Rapids, Michigan, USA
| | - Mara M Epstein
- The Meyers Primary Care Institute, Worcester, Massachusetts, USA
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Alan B Stevens
- Baylor Scott and White Medical Center Temple, Center for Applied Health Research, Temple, Texas, USA
| | - Stephen C Waring
- Essentia Institute for Rural Health, Division of Research, Duluth, Minnesota, USA
| | - Brian K Ahmedani
- Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, Michigan, USA
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13
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Castaneda-Avila MA, Baek J, Epstein MM, Forrester SN, Ortiz AP, Lapane KL. Association Between Body Mass Index and Cancer Screening Adherence Among Latinas in the United States and Puerto Rico. Women's Health Reports 2022; 3:552-562. [PMID: 37096019 PMCID: PMC10122236 DOI: 10.1089/whr.2021.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/12/2022]
Abstract
Background Research on the role of body size on cancer screening is mixed with few studies among Latinas in the United States. We evaluated the association between body size and cancer screening adherence among Latinas living in Puerto Rico and the rest of the United States. Methods We conducted a cross-sectional study using 2012-2018 Behavioral Risk Factor Surveillance System data among Latinas 50-64 years of age (n = 16,410). Breast, cervical, and colorectal cancer screening (guideline adherent: yes/no), height and weight were self-reported. Prevalence ratios (PRs) derived from Poisson models were estimated for each cancer screening utilization for Puerto Rico versus rest of the United States by body mass index (BMI) category. Results Nearly a quarter of women lacked adherence with breast and cervical cancer screening and 43.6% were nonadherent to colorectal cancer screening. Latinas with BMI ≥40.0 kg/m2 in both groups were more likely to lack adherence to cervical cancer screening than women with BMI 18.5-24.9 kg/m2. For those with BMI ≥40.0 kg/m2, Latinas in Puerto Rico were more likely to lack adherence to colorectal cancer screening recommendations than Latinas living in the rest of the United States (adjusted PR: 1.38; 95% confidence interval = 1.12-1.70). Conclusions The role of body size in cancer screening utilization among Latinas differs in women living in Puerto Rico versus in the rest of the United States and varies by cancer type. Understanding Latinas' experience can inform culturally adapted interventions to promote cancer screening.
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Affiliation(s)
- Maira A. Castaneda-Avila
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jonggyu Baek
- Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mara M. Epstein
- Meyers Health Care Institute, a Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, Worcester, Massachusetts, USA
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sarah N. Forrester
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ana P. Ortiz
- University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Kate L. Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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14
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Castaneda-Avila MA, Mazor KM, Lapane K, Epstein MM. Abstract PO-239: Patient and provider experiences with an incidentally diagnosed cancer precursor: A qualitative study. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Monoclonal gammopathy of undetermined significance (MGUS) is a prevalent, yet incidentally diagnosed precursor to multiple myeloma. We sought to gather foundational knowledge about the experiences of patients and healthcare providers during the process of diagnosing MGUS. Methods: We conducted semi-structured qualitative interviews. We recruited 14 patients using ResearchMatch and Facebook, and eight local healthcare providers. Interviews were analyzed using thematic analysis. Results: We identified three themes focused on the process of receiving or giving an MGUS diagnosis, relating to: (1) providers' explanations, (2) patients' understanding, and (3) the response to diagnosis. Providers reported that they explained MGUS using similar language for all patients, regardless of literacy level or other factors. Providers also indicated the challenges of explaining MGUS to non-English speaking patients using an interpreter. Although all patients were able to offer some description of MGUS in their own words, several patients reported they really did not understand what this diagnosis means. Providers acknowledged that an MGUS diagnosis may lead some patients to experience anxiety. Providers also reported that the referral to a hematologist-oncologist could be inherently stressful for some patients and make them worried about having cancer. Patients reported varied responses to receiving an MGUS diagnosis ranging from relief to anxiety about MGUS progression to multiple myeloma. Conclusion: We observed that providers tend to use consistent language when explaining an MGUS diagnosis to patients. Patients diagnosed with MGUS have a basic understanding of their condition, yet some patients feel anxiety around the diagnosis, which may affect other aspects of their lives. For underserved populations, providers may need to use interpreters to ensure all patients understand their condition. These findings are an important first step in understanding patients' experiences as they are diagnosed with MGUS.
Citation Format: Maira A. Castaneda-Avila, Kathleen M. Mazor, Kate Lapane, Mara M. Epstein. Patient and provider experiences with an incidentally diagnosed cancer precursor: A qualitative study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-239.
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Affiliation(s)
| | | | - Kate Lapane
- University of Massachusetts Medical School, Worcester, MA
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15
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Castañeda-Avila MA, Lapane KL, Person SD, Jesdale BM, Zhou Y, Mazor KM, Epstein MM. Differences in Hospital, Emergency Room and Outpatient Visits Among Adults With and Without Monoclonal Gammopathy of Undetermined Significance. Cancer Control 2022; 29:10732748221126936. [PMID: 36112886 PMCID: PMC9478713 DOI: 10.1177/10732748221126936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION This study evaluated the impact of receiving a monoclonal gammopathy of undetermined significance (MGUS) diagnosis on healthcare utilization from patients at a community-based multispecialty provider organization. METHODS A cohort of patients with MGUS (n = 429) were matched on sex, age, and length of enrollment to a cohort of patients without MGUS (n = 1286). Healthcare utilization was assessed: 1-12 months before, 1 month before and after, and 1-12 months after diagnosis/index date. Multivariable conditional Poisson models compared change in utilization of each service in patients with and without MGUS. RESULTS During the 2 months around diagnosis/index date, the rates of emergency room, hospital and outpatient visits were higher for patients with MGUS than patients without MGUS. In the year before MGUS diagnosis, the association was still elevated, although attenuated. CONCLUSION Understanding the care of MGUS patients is important given that multiple myeloma patients with a pre-existing MGUS diagnosis may have a better prognosis.
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Affiliation(s)
- Maira A Castañeda-Avila
- Department of Population and Quantitative Health Sciences, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sharina D Person
- Department of Population and Quantitative Health Sciences, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Yanhua Zhou
- Meyers Health Care Institute, a Joint Endeavor of the University of Massachusetts Medical Chan School, Fallon Health, and Reliant Medical Group, Worcester, MA, USA
| | - Kathleen M Mazor
- Meyers Health Care Institute, a Joint Endeavor of the University of Massachusetts Medical Chan School, Fallon Health, and Reliant Medical Group, Worcester, MA, USA.,Division of Geriatric Medicine, Department of Medicine, 12262University of Massachusetts Medical Chan School, Worcester, MA, USA
| | - Mara M Epstein
- Meyers Health Care Institute, a Joint Endeavor of the University of Massachusetts Medical Chan School, Fallon Health, and Reliant Medical Group, Worcester, MA, USA.,Division of Geriatric Medicine, Department of Medicine, 12262University of Massachusetts Medical Chan School, Worcester, MA, USA
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16
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Fillmore NR, DuMontier C, Yildirim C, La J, Epstein MM, Cheng D, Cirstea D, Yellapragada S, Abel GA, Gaziano JM, Do N, Brophy M, Kim DH, Munshi NC, Driver JA. Defining Multimorbidity and Its Impact in Older United States Veterans Newly Treated for Multiple Myeloma. J Natl Cancer Inst 2021; 113:1084-1093. [PMID: 33523236 PMCID: PMC8328982 DOI: 10.1093/jnci/djab007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Received: 11/09/2020] [Revised: 12/26/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Traditional count-based measures of comorbidity are unlikely to capture the complexity of multiple chronic conditions (multimorbidity) in older adults with cancer. We aimed to define patterns of multimorbidity and their impact in older United States veterans with multiple myeloma (MM). METHODS We measured 66 chronic conditions in 5076 veterans aged 65 years and older newly treated for MM in the national Veterans Affairs health-care system from 2004 to 2017. Latent class analysis was used to identify patterns of multimorbidity among these conditions. These patterns were then assessed for their association with overall survival, our primary outcome. Secondary outcomes included emergency department visits and hospitalizations. RESULTS Five patterns of multimorbidity emerged from the latent class analysis, and survival varied across these patterns (log-rank 2-sided P < .001). Older veterans with cardiovascular and metabolic disease (30.9%, hazard ratio [HR] = 1.33, 95% confidence interval [CI] = 1.21 to 1.45), psychiatric and substance use disorders (9.7%, HR = 1.58, 95% CI = 1.39 to 1.79), chronic lung disease (15.9%, HR = 1.69, 95% CI = 1.53 to 1.87), and multisystem impairment (13.8%, HR = 2.25, 95% CI = 2.03 to 2.50) had higher mortality compared with veterans with minimal comorbidity (29.7%, reference). Associations with mortality were maintained after adjustment for sociodemographic variables, measures of disease risk, and the count-based Charlson Comorbidity Index. Multimorbidity patterns were also associated with emergency department visits and hospitalizations. CONCLUSIONS Our findings demonstrate the need to move beyond count-based measures of comorbidity and consider cancer in the context of multiple chronic conditions.
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Affiliation(s)
- Nathanael R Fillmore
- VA Boston CSP Center, Boston, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Clark DuMontier
- Harvard Medical School, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- New England GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, Boston, MA, USA
| | - Cenk Yildirim
- VA Boston CSP Center, Boston, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Jennifer La
- VA Boston CSP Center, Boston, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Mara M Epstein
- The Meyers Primary Care Institute and the Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - David Cheng
- Massachusetts General Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Diana Cirstea
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarvari Yellapragada
- Michael E Debakey VA Medical Center and Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Gregory A Abel
- Divisions of Hematologic Malignancy and Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
| | - Nhan Do
- VA Boston CSP Center, Boston, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Mary Brophy
- VA Boston CSP Center, Boston, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Dae H Kim
- Harvard Medical School, Boston, MA, USA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nikhil C Munshi
- VA Boston Healthcare System, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jane A Driver
- Harvard Medical School, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- New England GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, Boston, MA, USA
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Castañeda-Avila MA, Jesdale BM, Beccia A, Bey GS, Epstein MM. Differences in survival among multiple myeloma patients in the United States SEER population by neighborhood socioeconomic status and race/ethnicity. Cancer Causes Control 2021; 32:1021-1028. [PMID: 34089470 DOI: 10.1007/s10552-021-01454-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/26/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE We examined the combined influences of race/ethnicity and neighborhood socioeconomic status (SES) on long-term survival among patients with multiple myeloma (MM). METHODS Data from the 2000-2015 NCI Surveillance, Epidemiology, and End Results Program (SEER-18) were used. Census tract-level SES index was assessed in tertiles (low, medium, high SES). Competing-risk modeling was used to estimate sub-hazard ratios (SHR) and 95% confidence intervals (CIs) for SES tertile adjusted for sex and age at diagnosis and stratified by race/ethnicity. RESULTS Overall, living in a low SES neighborhood was associated with worse MM survival. However, we observed some variation in the association by racial/ethnic group. Living in a low versus a high SES neighborhood was associated with a 35% (95% CI = 1.16-1.57) increase in MM-specific mortality risk among Asian/Pacific Islander cases, a 17% (95% CI = 1.12-1.22) increase among White cases, a 14% (95% CI = 1.04-1.23) increase among Black cases, and a 7% (95% CI = 0.96-1.19) increase among Hispanic cases. CONCLUSION These results suggest that the influence of both SES and race/ethnicity should be considered when considering interventions to remedy disparities in MM survival.
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Affiliation(s)
- Maira A Castañeda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Road North, Worcester, MA, 01655, USA.
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Road North, Worcester, MA, 01655, USA
| | - Ariel Beccia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Road North, Worcester, MA, 01655, USA
| | - Ganga S Bey
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Mara M Epstein
- Meyers Primary Care Institute and the Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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18
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Epstein MM, Dutcher SK, Maro JC, Saphirak C, DeLuccia S, Ramanathan M, Dhawale T, Harchandani S, Delude C, Hou L, Gertz A, DiNunzio N, McMahill-Walraven CN, Selvan MS, Vigeant J, Cole DV, Leishear K, Gurwitz JH, Andrade S, Cocoros NM. Validation of an electronic algorithm for Hodgkin and non-Hodgkin lymphoma in ICD-10-CM. Pharmacoepidemiol Drug Saf 2021; 30:910-917. [PMID: 33899311 DOI: 10.1002/pds.5256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE Lymphoma is a health outcome of interest for drug safety studies. Studies using administrative claims data require the accurate identification of lymphoma cases. We developed and validated an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)-based algorithm to identify lymphoma in healthcare claims data. METHODS We developed a three-component algorithm to identify patients aged ≥15 years who were newly diagnosed with Hodgkin (HL) or non-Hodgkin (NHL) lymphoma from January 2016 through July 2018 among members of four Data Partners within the FDA's Sentinel System. The algorithm identified potential cases as patients with ≥2 ICD-10-CM lymphoma diagnosis codes on different dates within 183 days; ≥1 procedure code for a diagnostic procedure (e.g., biopsy, flow cytometry) and ≥1 procedure code for a relevant imaging study within 90 days of the first lymphoma diagnosis code. Cases identified by the algorithm were adjudicated via chart review and a positive predictive value (PPV) was calculated. RESULTS We identified 8723 potential lymphoma cases via the algorithm and randomly sampled 213 for validation. We retrieved 138 charts (65%) and adjudicated 134 (63%). The overall PPV was 77% (95% confidence interval: 69%-84%). Most cases also had subtype information available, with 88% of cases identified as NHL and 11% as HL. CONCLUSIONS Seventy-seven percent of lymphoma cases identified by an algorithm based on ICD-10-CM diagnosis and procedure codes and applied to claims data were true cases. This novel algorithm represents an efficient, cost-effective way to target an important health outcome of interest for large-scale drug safety and public health surveillance studies.
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Affiliation(s)
- Mara M Epstein
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,The Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
| | - Sarah K Dutcher
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Judith C Maro
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Cassandra Saphirak
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,The Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
| | - Sandra DeLuccia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Muthalagu Ramanathan
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Tejaswini Dhawale
- Division of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sonali Harchandani
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Christopher Delude
- The Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
| | - Laura Hou
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Autumn Gertz
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Nina DiNunzio
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mano S Selvan
- Humana Healthcare Research, Inc. (HHR), Sugar Land, Texas, USA
| | - Justin Vigeant
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - David V Cole
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Kira Leishear
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jerry H Gurwitz
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,The Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
| | - Susan Andrade
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,The Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
| | - Noelle M Cocoros
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
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19
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Frendl DM, FitzGerald G, Epstein MM, Allison JJ, Sokoloff MH, Ware JE. Predicting the 10-year risk of death from other causes in men with localized prostate cancer using patient-reported factors: Development of a tool. PLoS One 2020; 15:e0240039. [PMID: 33284845 PMCID: PMC7721137 DOI: 10.1371/journal.pone.0240039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 09/17/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To develop a tool for estimating the 10-year risk of death from other causes in men with localized prostate cancer. SUBJECTS AND METHODS We identified 2,425 patients from the Surveillance Epidemiology and End Results-Medicare Health Outcomes Survey database, age <80, newly diagnosed with clinical stage T1-T3a prostate cancer from 1/1/1998-12/31/2009, with follow-up through 2/28/2013. We developed a Fine and Gray competing-risks model for 10-year other cause mortality considering age, patient-reported comorbid medical conditions, component scores and items of the SF-36 Health Survey, activities of daily living, and sociodemographic characteristics. Model discrimination and calibration were compared to predictions from Social Security life table mortality risk estimates. RESULTS Over a median follow-up of 7.7 years, 76 men died of prostate-specific causes and 465 died of other causes. The strongest predictors of 10-year other cause mortality risk included increasing age at diagnosis, higher approximated Charlson Comorbidity Index score, worse patient-reported general health (fair or poor vs. excellent-good), smoking at diagnosis, and marital status (all other vs. married) (all p<0.05). Model discrimination improved over Social Security life tables (c-index of 0.70 vs. 0.59, respectively). Predictions were more accurate than predictions from the Social Security life tables, which overestimated risk in our population. CONCLUSIONS We provide a tool for estimating the 10-year risk of dying from other causes when making decisions about treating prostate cancer using pre-treatment patient-reported characteristics.
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Affiliation(s)
- Daniel M. Frendl
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Gordon FitzGerald
- Department of Surgery Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Mara M. Epstein
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
- Meyers Primary Care Institute, Worcester, MA, United States of America
| | - Jeroan J. Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Mitchell H. Sokoloff
- Department of Urology, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - John E. Ware
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
- John Ware Research Group, Watertown, MA, United States of America
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20
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Ardisson Korat AV, Chiu YH, Bertrand KA, Zhang S, Epstein MM, Rosner BA, Chiuve S, Campos H, Giovannucci EL, Chavarro JE, Birmann BM. Red blood cell membrane trans fatty acid levels and risk of non-Hodgkin lymphoma: a prospective nested case-control study. Am J Clin Nutr 2020; 112:1576-1583. [PMID: 33022699 PMCID: PMC7727472 DOI: 10.1093/ajcn/nqaa251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Trans fatty acid (TFA) intake persists in much of the world, posing ongoing threats to public health that warrant further elucidation. Published evidence suggests a positive association of self-reported TFA intake with non-Hodgkin lymphoma (NHL) risk. OBJECTIVES To confirm those reports, we conducted a prospective study of prediagnosis RBC membrane TFA levels and risk of NHL and common NHL histologic subtypes. METHODS We conducted a nested case-control study in Nurses' Health Study and Health Professionals Follow-Up Study participants with archived RBC specimens and no history of cancer at blood draw (1989-1090 and 1994-1995, respectively). We confirmed 583 incident NHL cases (332 women and 251 men) and individually matched 583 controls on cohort (sex), age, race, and blood draw date/time. We analyzed RBC membrane TFA using GLC (in 2013-2014) and expressed individual TFA levels as a percentage of total fatty acids. We used unconditional logistic regression adjusted for the matching factors to estimate ORs and 95% CIs for overall NHL risk per 1 SD increase in TFA level and assessed histologic subtype-specific associations with multivariable polytomous logistic regression. RESULTS Total and individual TFA levels were not associated with risk of all NHL or most subtypes. We observed a positive association of total TFA levels with diffuse large B cell lymphoma (DLBCL) risk [n = 98 cases; OR (95% CI) per 1 SD increase: 1.30 (1.05, 1.61); P = 0.015], driven by trans 18:1n-9(ω-9)/elaidic acid [OR (95% CI): 1.34 (1.08, 1.66); P = 0.007], trans 18:1n-7/vaccenic acid [OR (95% CI): 1.28 (1.04, 1.58); P = 0.023], and trans 18:2n-6t,t [OR (95% CI): 1.26 (1.01, 1.57); P = 0.037]. CONCLUSIONS Our findings extended evidence for TFA intake and DLBCL risk but not for other NHL subtypes. Reduced TFA consumption through dietary choices or health policy measures may support prevention of DLBCL, an aggressive NHL subtype.
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Affiliation(s)
- Andres V Ardisson Korat
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Yu-Han Chiu
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Shumin Zhang
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Mara M Epstein
- Department of Medicine and the Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bernard A Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA,Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Stephanie Chiuve
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,AbbVie Pharmaceuticals, North Chicago, IL, USA
| | - Hannia Campos
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Centro de Investigación e Innovación en Nutrición Translacional y Salud, Universidad Hispanoamericana, San Jose, Costa Rica
| | - Edward L Giovannucci
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
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21
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Frendl DM, Epstein MM, Fouayzi H, Krajenta R, Rybicki BA, Sokoloff MH. Prostate-specific antigen testing after the US Preventive Services Task Force recommendation: a population-based analysis of electronic health data. Cancer Causes Control 2020; 31:861-867. [PMID: 32556947 PMCID: PMC7384921 DOI: 10.1007/s10552-020-01324-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 06/11/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study describes longitudinal trends in the use of prostate-specific antigen (PSA)-based testing in two geographically distinct healthcare systems following the 2011 US Preventive Services Task Force (USPSTF) recommendations against routine PSA screening. METHODS We analyzed population-based health claims data from 253,139 men aged 40-80 who were enrolled at two US healthcare systems. We assessed trends in the percentage of eligible men receiving ≥ 1 PSA test per year by time period (2000-2008, 2009-2011, 2012-2014), age (40-54, 55-69, 70-80), and race (white, black, other, unknown), and conducted a joinpoint regression analysis. RESULTS Men aged 55-69 and 70-80 years of all races had similar use of PSA testing between 2000 and 2011, ranging between 47 and 56% of eligible men by year, while only 22-26% of men aged 40-54 had a PSA test per year during this period. Overall, the percentage of men receiving at least one PSA test per year decreased by 26% between 2009-2011 and 2012-2014, with similar trends across race and age groups. PSA testing declined significantly after 2011 (annual percent change = - 11.28). CONCLUSIONS Following the 2011 USPSTF recommendations against routine PSA screening, declines in PSA testing were observed among men of all races and across all age groups in two large US healthcare systems.
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Affiliation(s)
- Daniel M Frendl
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Mara M Epstein
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Fallon Health, and Reliant Medical Group, Worcester, MA, USA.
| | - Hassan Fouayzi
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Fallon Health, and Reliant Medical Group, Worcester, MA, USA
| | - Richard Krajenta
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | - Benjamin A Rybicki
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | - Mitchell H Sokoloff
- Department of Urology, University of Massachusetts Medical School, Worcester, MA, USA
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22
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Banegas MP, Rivera DR, O'Keeffe-Rosetti MC, Carroll NM, Pawloski PA, Tabano DC, Epstein MM, Yeung K, Hornbrook MC, Lu C, Ritzwoller DP. Long-Term Patterns of Oral Anticancer Agent Adoption, Duration, and Switching in Patients With CML. J Natl Compr Canc Netw 2020; 17:1166-1172. [PMID: 31590146 DOI: 10.6004/jnccn.2019.7303] [Citation(s) in RCA: 8] [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: 12/18/2018] [Accepted: 03/29/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Oral tyrosine kinase inhibitors (TKIs) have been the standard of care for chronic myeloid leukemia (CML) since 2001. However, few studies have evaluated changes in the treatment landscape of CML over time. This study assessed the long-term treatment patterns of oral anticancer therapies among patients with CML. METHODS This retrospective cohort study included patients newly diagnosed with CML between January 1, 2000, and December 31, 2016, from 10 integrated healthcare systems. The proportion of patients treated with 5 FDA-approved oral TKI agents-bosutinib, dasatinib, imatinib, nilotinib, and ponatinib-in the 12 months after diagnosis were measured, overall and by year, between 2000 and 2017. We assessed the use of each oral agent through the fourth-line setting. Multivariable logistic regression estimated the odds of receiving any oral agent, adjusting for sociodemographic and clinical characteristics. RESULTS Among 853 patients with CML, 81% received an oral agent between 2000 and 2017. Use of non-oral therapies decreased from 100% in 2000 to 5% in 2005, coinciding with imatinib uptake from 65% in 2001 to 98% in 2005. Approximately 28% of patients switched to a second-line agent, 9% switched to a third-line agent, and 2% switched to a fourth-line agent. Adjusted analysis showed that age at diagnosis, year of diagnosis, and comorbidity burden were statistically significantly associated with odds of receiving an oral agent. CONCLUSIONS A dramatic shift was seen in CML treatments away from traditional, nonoral chemotherapy toward use of novel oral TKIs between 2000 and 2017. As the costs of oral anticancer agents reach new highs, studies assessing the long-term health and financial outcomes among patients with CML are warranted.
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Affiliation(s)
- Matthew P Banegas
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Donna R Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Nikki M Carroll
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado
| | | | - David C Tabano
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado.,Denver Public Health, Denver, Colorado
| | - Mara M Epstein
- Meyers Primary Care Institute, Worcester, Massachusetts.,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kai Yeung
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Mark C Hornbrook
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Christine Lu
- Harvard Medical School, Boston, Massachusetts; and.,Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Debra P Ritzwoller
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado
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23
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Burnett-Hartman AN, Udaltsova N, Kushi LH, Neslund-Dudas C, Rahm AK, Pawloski PA, Corley DA, Knerr S, Feigelson HS, Hunter JE, Tabano DC, Epstein MM, Honda SA, Ter-Minassian M, Lynch JA, Lu CY. Clinical Molecular Marker Testing Data Capture to Promote Precision Medicine Research Within the Cancer Research Network. JCO Clin Cancer Inform 2020; 3:1-10. [PMID: 31487201 DOI: 10.1200/cci.19.00026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate health care systems for the availability of population-level data on the frequency of use and results of clinical molecular marker tests to inform precision cancer care. METHODS We assessed cancer-related molecular marker test data availability across 12 US health care systems in the Cancer Research Network. Overall, these systems provide care to a diverse population of more than 12 million people in the United States. We performed qualitative analyses of test data availability for five blood-based protein, nine germline, and 14 tissue-based tumor marker tests in each health care system's electronic health record and tumor registry using key informants, test code lists, and manual review of data types and output. We then performed quantitative analyses to estimate the proportion of patients with cancer with test utilization data and results for specific molecular marker tests. RESULTS Health systems were able to systematically capture population-level data on all five blood protein markers, six of 14 tissue-based tumor markers, and none of the nine germline markers. Successful, systematic data capture was achievable for tests with electronic data feeds for test results (blood protein markers) or through prior manual abstraction by tumor registrars (select tumor-based markers). For test results stored in scanned image files (particularly germline and tumor marker tests), information on which test was performed and test results was not readily accessible in an electronic format. CONCLUSION Even in health care systems with sophisticated electronic health records, there were few codified data elements available for evaluating precision cancer medicine test use and results at the population level. Health care organizations should establish standards for electronic reporting of precision medicine tests to expedite cancer research and facilitate the implementation of precision medicine approaches.
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Affiliation(s)
| | | | | | | | | | | | | | - Sarah Knerr
- University of Washington and Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | | | - David C Tabano
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Mara M Epstein
- University of Massachusetts Medical School, Worcester, MA
| | | | | | - Julie A Lynch
- Department of Veterans Affairs Salt Lake City Health System, Salt Lake City, UT
| | - Christine Y Lu
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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24
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Castañeda-Avila MA, Lapane KL, Jesdale BM, Crawford SL, Epstein MM. Variation in Colorectal Cancer Screening Practices According to Cardiovascular Disease Status and Race/Ethnicity. J Racial Ethn Health Disparities 2020; 8:166-173. [PMID: 32383046 DOI: 10.1007/s40615-020-00768-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess current estimates of colorectal cancer (CRC) screening practices in relation to cardiovascular disease (CVD) status and whether this association varies by race/ethnicity. METHODS Cross-sectional analysis of the Behavioral Risk Factor Surveillance System data from 2012, 2014, 2016, and 2018 among US adults aged 50-75 years (n = 807,937). Participants' self-reported CRC screening practices were categorized as being up-to-date, not up-to-date, or never screened. Multinomial logistic regression was used to assess whether self-reported prevalent CVD was associated with CRC screening practices after adjusting for several potentially confounding variables; additional analyses were stratified by race/ethnicity. RESULTS One-quarter of US adults had never been screened for CRC, while 67.0% reported being up-to-date with CRC screening. The proportion of Hispanics who had never been screened (35.3%) was higher than non-Hispanic Whites (23.5%) and Blacks (20.6%). Adults with CVD were less likely to never have been screened (adjusted odds ratio (aOR), 0.92; 95% confidence interval (CI), 0.88-0.95) or not to be up-to-date (aOR, 0.90; 95% CI, 0.86-0.94) on CRC screening than those without CVD. CONCLUSION The presence of CVD is associated with better adherence to CRC screening guidelines. Poor CRC screening utilization in Hispanics should be a priority for further investigation and intervention.
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Affiliation(s)
- Maira A Castañeda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Road North, Worcester, MA, 01655, USA.
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Road North, Worcester, MA, 01655, USA
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Road North, Worcester, MA, 01655, USA
| | - Sybil L Crawford
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
| | - Mara M Epstein
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Road North, Worcester, MA, 01655, USA.,Meyers Primary Care Institute and the Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Lee C, Check DK, Manace Brenman L, Kushi LH, Epstein MM, Neslund-Dudas C, Pawloski PA, Achacoso N, Laurent C, Fehrenbacher L, Habel LA. Adjuvant endocrine therapy for breast cancer patients: impact of a health system outreach program to improve adherence. Breast Cancer Res Treat 2020; 180:219-226. [PMID: 31975315 DOI: 10.1007/s10549-020-05539-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/17/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Reports suggest that up to 50% of women with hormone receptor-positive (HR+) breast cancer (BC) do not complete the recommended 5 years of adjuvant endocrine therapy (AET). We examined the impact of an outreach program at Kaiser Permanente Northern California (KPNC) on adherence and discontinuation of AET among patients who initiated AET. METHODS We assembled a retrospective cohort of all KPNC patients diagnosed with HR+, stage I-III BC initiating AET before (n = 4287) and after (n = 3580) implementation of the outreach program. We compared adherence proportions and discontinuation rates before and after program implementation, both crude and adjusted for age, race/ethnicity, education, income, and stage. We conducted a pooled analysis of data from six Cancer Research Network (CRN) sites that had not implemented programs for improving AET adherence, using identical methods and time periods, to assess possible secular trends. RESULTS In the pre-outreach period, estimated adherence in years 1, 2, and 3 following AET initiation was 75.2%, 71.0%, and 67.3%; following the outreach program, the estimates were 79.4%, 75.6%, and 72.2% (p-values < .0001 for pairwise comparisons). Results were comparable after adjusting for clinical and demographic factors. The estimated cumulative incidence of discontinuation was 0.22 (0.21-0.24) and 0.18 (0.17-0.19) at 3 years for pre- and post-outreach groups (p-value < .0001). We found no evidence of an increase in adherence between the study periods at the CRN sites with no AET adherence program. CONCLUSION Adherence and discontinuation after AET initiation improved modestly following implementation of the outreach program.
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Affiliation(s)
- Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
| | - Devon K Check
- Department of Population Health Sciences, Duke University School of Medicine, Duke Cancer Institute, Durham, NC, USA
| | - Leslie Manace Brenman
- Kaiser Permanente Northern California Breast Cancer Tracking System, Oakland, CA, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mara M Epstein
- Meyers Primary Care Institute and the Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christine Neslund-Dudas
- Department of Public Health Sciences, Henry Ford Health System and the Henry Ford Cancer Institute, Detroit, MI, USA
| | | | - Ninah Achacoso
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Cecile Laurent
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Louis Fehrenbacher
- Kaiser Permanente Northern California Medical Oncology, Oakland, CA, USA
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Clarke CL, Kushi LH, Chubak J, Pawloski PA, Bulkley JE, Epstein MM, Burnett-Hartman AN, Powell B, Pearce CL, Feigelson HS. Abstract DP-004: DESCRIBING THE ODDS OF LONG-TERM SURVIVAL AMONG WOMEN DIAGNOSED WITH HIGH-GRADE SEROUS OVARIAN CANCER USING ELECTRONIC MEDICAL RECORDS. Clin Cancer Res 2019. [DOI: 10.1158/1557-3265.ovcasymp18-dp-004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Relatively little is known about factors associated with long-term survival (LTS) following a diagnosis of ovarian cancer. We conducted a retrospective observational study of high-grade serous ovarian cancer (HGSOC) to explore predictors of LTS, defined as >= 7 years of survivorship, using data from five participating health plans in the Cancer Research Network (CRN, http:\\crn.cancer.gov). Our primary data source was the Virtual Data Warehouse (VDW), a common data model which includes standardized, individual-level data extracted from the electronic data systems of each study site. We included 642 women with incident HGSOC diagnosed between 2000 and 2008 to allow for at least 7 years of follow-up. We conducted a multivariable logistic regression analysis to compare characteristics of women who survived >=7 years after diagnosis (n=148) to those who died within 7 years of diagnosis (n=494). In addition to stage and grade, predictors considered for the model included age, race, smoking status at time of diagnosis, body mass index (BMI) within the year prior to diagnosis, and CA-125 level prior to cancer treatment. We examined estrogen and hormonal contraceptive use, as well as the prevalence of comorbidities in the year prior to diagnosis of ovarian cancer. We also included variables for receipt of surgery, radiation, and chemotherapy. We used forward selection to include variables, and retained them in the final model if they had a p-value of <= 0.3. Our final model included CRN study site, age, stage at diagnosis, CA-125 (categorized as <35 or >=35 units/ml), Charlson comorbidity score, receipt of chemotherapy, BMI, and five separate comorbid conditions: weight loss, hypothyroidism, liver disease, chronic pulmonary disease and hypertension. Of these, only younger age, lower stage, and receipt of chemotherapy were statistically significantly associated with LTS. The OR for LTS was 2.9 (95% CI: 1.2-6.3) for ages 18-49 years at diagnosis compared to >=70 years of age. Those who were diagnosed at stage IV had statistically significantly lower odds of surviving >=7 years than any other stage of disease. The OR for LTS for stage I vs. stage IV was 46.6 (95% CI: 46.7 – 15.9), stage II vs. stage IV was 14.1 (95% CI: 5.3-37.0) and stage III vs. stage IV was 5.3 (95% CI: 2.7-10.4). The OR was 2.9 (95% CI: 1.0-8.4) for receipt of chemotherapy versus no chemotherapy after adjusting for all other covariates. Our analysis of data from electronic medical records did not identify any new characteristics that may be associated with ovarian cancer LTS.
Citation Format: Christina L. Clarke, Lawrence H. Kushi, Jessica Chubak, Pamala A. Pawloski, Joanna E. Bulkley, Mara M. Epstein, Andrea N. Burnett-Hartman, Bethan Powell, C. Leigh Pearce, Heather Spencer Feigelson. DESCRIBING THE ODDS OF LONG-TERM SURVIVAL AMONG WOMEN DIAGNOSED WITH HIGH-GRADE SEROUS OVARIAN CANCER USING ELECTRONIC MEDICAL RECORDS [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr DP-004.
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Affiliation(s)
| | | | | | | | | | - Mara M. Epstein
- 6Meyers Primary Care Institute, MA,
- 7University of Massachusetts Medical School,
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Clarke CL, Kushi LH, Chubak J, Pawloski PA, Bulkley JE, Epstein MM, Burnett-Hartman AN, Powell B, Pearce CL, Spencer Feigelson H. Predictors of Long-Term Survival among High-Grade Serous Ovarian Cancer Patients. Cancer Epidemiol Biomarkers Prev 2019; 28:996-999. [PMID: 30967418 DOI: 10.1158/1055-9965.epi-18-1324] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Received: 12/13/2018] [Revised: 02/05/2019] [Accepted: 02/15/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Relatively little is known about factors associated with long-term survival (LTS) following a diagnosis of ovarian cancer. METHODS We conducted a retrospective study of high-grade serous ovarian cancer (HGSOC) to explore predictors of LTS (defined as ≥7 years of survival) using electronic medical record data from a network of integrated health care systems. Multivariable logistic regression with forward selection was used to compare characteristics of women who survived ≥7 years after diagnosis (n = 148) to those who died within 7 years of diagnosis (n = 494). RESULTS Our final model included study site, age, stage at diagnosis, CA-125, comorbidity score, receipt of chemotherapy, BMI, and four separate comorbid conditions: weight loss, depression, hypothyroidism, and liver disease. Of these, only younger age, lower stage, and depression were statistically significantly associated with LTS. CONCLUSIONS We did not identify any new characteristics associated with HGSOC survival. IMPACT Prognosis of ovarian cancer generally remains poor. Large, pooled studies of ovarian cancer are needed to identify characteristics that may improve survival.
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Affiliation(s)
- Christina L Clarke
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jessica Chubak
- Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | | | - Joanna E Bulkley
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Mara M Epstein
- Meyers Primary Care Institute, Worcester, Massachusetts
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Bethan Powell
- Gynecologic Oncology Program, Kaiser Permanente Northern California, San Francisco, California
| | - Celeste L Pearce
- School of Public Health, University of Michigan, Ann Arbor, Michigan
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Castañeda-Avila MA, Ortiz-Ortiz KJ, Torres-Cintrón CR, Birmann BM, Epstein MM. Trends in cause of death among patients with multiple myeloma in Puerto Rico and the United States SEER population, 1987-2013. Int J Cancer 2019; 146:35-43. [PMID: 30802944 DOI: 10.1002/ijc.32232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 01/10/2023]
Abstract
Multiple myeloma (MM) survival has improved due to recent developments in MM treatment. As a result, other co-morbid conditions may be of increasing importance to MM patients' long-term survival. This study examines trends in common causes of death among patients with MM in Puerto Rico, and in the US Surveillance, Epidemiology, and End Results (SEER) population. We analyzed the primary cause of death among incident MM cases recorded in the Puerto Rico Central Cancer Registry (n = 3,018) and the US SEER Program (n = 67,733) between 1987 and 2013. We calculated the cumulative incidence of death due to the eight most common causes and analyzed temporal trends in mortality rates using joinpoint regression. Analyses of SEER were also stratified by Hispanic ethnicity. MM accounted for approximately 72% of all reported deaths among persons diagnosed with MM in Puerto Rico and in SEER. In both populations, the proportion of patients who died from MM decreased with increasing time since diagnosis. Age-standardized temporal trends showed a decreased MM-specific mortality rate among US SEER (annual percent change [APC] = -5.0) and Puerto Rican (APC = -1.8) patients during the study period, and particularly after 2003 in non-Hispanic SEER patients. Temporal decline in non-MM causes of death was also observed among US SEER (APC = -2.1) and Puerto Rican (APC = -0.1) populations. MM-specific mortality decreased, yet remained the predominant cause of death for individuals diagnosed with MM over a 26-year period. The most pronounced decreases in MM-specific death occurred after 2003, which suggests a possible influence of more recently developed MM therapies.
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Affiliation(s)
- Maira A Castañeda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Karen J Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Carlos R Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Mara M Epstein
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.,Meyers Primary Care Institute and the Department of Medicine, University of Massachusetts Medical School, Worcester, MA
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29
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Ardisson KAV, Chiu YH, Bertrand KS, Zhang S, Laden F, Epstein MM, Rosner BA, Chiuve S, Campos H, Giovannucci EL, Chavarro JE, Birmann BM. A Prospective Analysis of Red Blood Cell Trans Fatty Acid Levels and Risk of Non-Hodgkin Lymphoma. Cancer Epidemiol Biomarkers Prev 2019. [DOI: 10.1158/1055-9965.epi-19-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
To confirm previous reports of increased non-Hodgkin lymphoma (NHL) risk with higher intake of dietary trans fatty acids (TFA), we conducted the first prospective study of pre-diagnosis red blood cell (RBC) TFA levels and risk of NHL and common NHL histologic subtypes (diffuse large-B cell lymphoma (DLBCL), follicular lymphoma, chronic lymphocytic lymphoma/small lymphocytic leukemia, other B-cell NHL, T-cell NHL). Methods: We conducted a nested case-control study in Nurses' Health Study (NHS) and Health Professionals Follow-Up Study (HPFS) participants with archived RBC specimens and no history of cancer at sample collection (NHS: 1989–90; HPFS: 1994–5). We confirmed 583 NHL cases (332 women in NHS, 251 men in HPFS) and matched 583 controls by cohort (sex), age, race/ethnicity and blood draw date/time. We analyzed RBC TFAs using gas-liquid chromatography; individual TFA levels were expressed as a percentage of total fatty acids. We used unconditional logistic regression, adjusted for the matching factors, to estimate odds ratios (OR) and 95% confidence intervals (CI) for overall NHL risk per 1 standard deviation (SD) unit increase in TFA level. We fitted multivariate polytomous logistic regression models to assess associations for the specific subtypes listed above. Results: Total and individual RBC TFAs were not associated with overall NHL risk or risk of most histologic subtypes. However, we observed a positive association of total RBC TFA with DLBCL risk (n = 86 cases; OR [95% CI] per 1 SD: 1.29 [1.02, 1.64]), driven primarily by 18:1 TFAs (1.35 [1.07, 1.72]). Among 18:1 TFA isomers, we found a positive association for trans 18:1 n-9 (elaidic acid; 1.33 [1.05, 1.68]) but not for other isomers. Conclusions: We observed significant positive associations for RBC TFA levels with DLBCL risk. These findings are consistent with published studies of self-reported TFA intake; further, previous studies have shown that TFA levels – particularly trans 18:1n-9, which is industrially-derived – are positively correlated with biomarkers of inflammation and immune activation, supporting the biologic plausibility of our findings. Food industry and public health measures to diminish TFA intake may help to reduce risk of NHL, and particularly of DLBCL.
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Rahm AK, Cragun D, Hunter JE, Epstein MM, Lowery J, Lu CY, Pawloski PA, Sharaf RN, Liang SY, Burnett-Hartman AN, Gudgeon JM, Hao J, Snyder S, Gogoi R, Ladd I, Williams MS. Implementing universal Lynch syndrome screening (IMPULSS): protocol for a multi-site study to identify strategies to implement, adapt, and sustain genomic medicine programs in different organizational contexts. BMC Health Serv Res 2018; 18:824. [PMID: 30376847 PMCID: PMC6208012 DOI: 10.1186/s12913-018-3636-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 08/18/2018] [Accepted: 10/18/2018] [Indexed: 12/21/2022] Open
Abstract
Background Systematic screening of all colorectal tumors for Lynch Syndrome (LS) has been recommended since 2009. Currently, implementation of LS screening in healthcare systems remains variable, likely because LS screening involves the complex coordination of multiple departments and individuals across the healthcare system. Our specific aims are to (1) describe variation in LS screening implementation across multiple healthcare systems; (2) identify conditions associated with both practice variation and optimal implementation; (3) determine the relative effectiveness, efficiency, and costs of different LS screening protocols by healthcare system; and (4) develop and test in a real-world setting an organizational toolkit for LS screening program implementation and improvement. This toolkit will promote effective implementation of LS screening in various complex health systems. Methods This study includes eight healthcare systems with 22 clinical sites at varied stages of implementing LS screening programs. Guided by the Consolidated Framework for Implementation Research (CFIR), we will conduct in-depth semi-structured interviews with patients and organizational stakeholders and perform economic evaluation of site-specific implementation costs. These processes will result in a comprehensive cross-case analysis of different organizational contexts. We will utilize qualitative data analysis and configurational comparative methodology to identify facilitators and barriers at the organizational level that are minimally sufficient and necessary for optimal LS screening implementation. Discussion The overarching goal of this project is to combine our data with theories and tools from implementation science to create an organizational toolkit to facilitate implementation of LS screening in various real-world settings. Our organizational toolkit will account for issues of complex coordination of care involving multiple stakeholders to enhance implementation, sustainability, and ongoing improvement of evidence-based LS screening programs. Successful implementation of such programs will ultimately reduce suffering of patients and their family members from preventable cancers, decrease waste in healthcare system costs, and inform strategies to facilitate the promise of precision medicine. Trial registration N/A Electronic supplementary material The online version of this article (10.1186/s12913-018-3636-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alanna Kulchak Rahm
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA, 17822, USA.
| | - Deborah Cragun
- University of South Florida, 3720 Spectrum Blvd, Suite 304, Tampa, FL, 33612, USA
| | - Jessica Ezzell Hunter
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97202, USA
| | - Mara M Epstein
- Department of Medicine and the Meyers Primary Care Institute, University of Massachusetts Medical School, 365 Plantation St. Biotech 1, Suite 100, Worcester, MA, 01605, USA
| | - Jan Lowery
- Colorado Center for Personalized Medicine, University of Colorado, Aurora, CO, 80045, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
| | | | - Ravi N Sharaf
- Division of Gastroenterology, Department of Medicine, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA, 94301, USA
| | - Andrea N Burnett-Hartman
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S. Parker Rd., Ste 200, Aurora, CO, 80014, USA
| | - James M Gudgeon
- Intermountain Healthcare, Precision Genomics, IMC campus, Bldg. 2, Suite 610, 5121 S. Cottonwood Street, Murray, UT, 84107, USA
| | - Jing Hao
- Geisinger Department of Epidemiology and Health Services Research 100 N, Academy Ave Danville, Mahoning Township, PA, 17822, USA
| | - Susan Snyder
- Geisinger Department of Epidemiology and Health Services Research 100 N, Academy Ave Danville, Mahoning Township, PA, 17822, USA
| | - Radhika Gogoi
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Ilene Ladd
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Marc S Williams
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA, 17822, USA
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Chiu YH, Bertrand KA, Zhang S, Laden F, Epstein MM, Rosner BA, Chiuve S, Campos H, Giovannucci EL, Chavarro JE, Birmann BM. A prospective analysis of circulating saturated and monounsaturated fatty acids and risk of non-Hodgkin lymphoma. Int J Cancer 2018; 143:1914-1922. [PMID: 29756258 DOI: 10.1002/ijc.31602] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 04/09/2018] [Accepted: 04/27/2018] [Indexed: 01/14/2023]
Abstract
Circulating saturated (SFA) and monounsaturated fatty acids (MUFA), which are predominantly derived from endogenous metabolism, may influence non-Hodgkin lymphoma (NHL) risk by modulating inflammation or lymphocyte membrane stability. However, few biomarker studies have evaluated NHL risk associated with these fats. We conducted a prospective study of 583 incident NHL cases and 583 individually matched controls with archived pre-diagnosis red blood cell (RBC) specimens in the Nurses' Health Study (NHS) and Health Professionals Follow-Up Study (HPFS). RBC membrane fatty acid levels were measured using gas chromatography. Using multivariable logistic regression, we estimated odds ratios (OR) and 95% confidence intervals (CI) for risk of NHL and major NHL subtypes including T cell NHL (T-NHL), B cell NHL (B-NHL) and three individual B-NHLs: chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma. RBC SFA and MUFA levels were not associated with NHL risk overall. However, RBC very long chain SFA levels (VLCSFA; 20:0, 22:0, 23:0) were inversely associated with B-NHLs other than CLL/SLL; ORs (95% CIs) per standard deviation (SD) increase in level were 0.81 (0.70, 0.95) for 20:0, 0.82 (0.70, 0.95) for 22:0 and 0.82 (0.70, 0.96) for 23:0 VLCSFA. Also, both VLCSFA and MUFA levels were inversely associated with T-NHL [ORs (95% CIs) per SD: VLCSFA, 0.63 (0.40, 0.99); MUFA, 0.63 (0.40, 0.99)]. The findings of inverse associations for VLCSFAs with B-NHLs other than CLL/SLL and for VLCSFA and MUFA with T-NHL suggest an influence of fatty acid metabolism on lymphomagenesis.
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Affiliation(s)
- Yu-Han Chiu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Shumin Zhang
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Francine Laden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Mara M Epstein
- Department of Medicine and the Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA
| | - Bernard A Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Stephanie Chiuve
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,AbbVie Pharmaceuticals, North Chicago, IL
| | - Hannia Campos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Centro de Investigación e Innovación en Nutrición Translacional y Salud, Universidad Hispanoamericana, San José, Costa Rica
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
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Castañeda-Avila MA, Ortiz-Ortiz KJ, Torres-Cintrón CR, Epstein MM. Abstract A32: Trends in cause of death among Puerto Rican and United States multiple myeloma patients. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-a32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background/objective: Multiple myeloma (MM) is an incurable, yet treatable, cancer of plasma cells. Due to recent improvements in treatment, people diagnosed with MM have been living longer, and other comorbid conditions may be of increasing importance. This study examines temporal trends in specific causes of death among MM patients in Puerto Rico (PR) and the United States (U.S.).
Methods: We analyzed primary cause of death among all incident MM cancer cases recorded in the Puerto Rico Central Cancer Registry (PRCCR) (n=3,018) and the US Surveillance, Epidemiology, and End Results Program (SEER) (n=67,733) between 1987-2013, overall and by follow-up time, age, and sex. We calculated the cumulative incidence of death due to seven selected causes and analyzed age-adjusted mortality trends by MM and other causes using joinpoint regression.
Results: MM accounted for 71.7% and 71.3% of all reported deaths in PR and the U.S., respectively, among people diagnosed with MM. In PR, the proportion of patients who died from MM decreased with increasing follow-up time since diagnosis (72.3% of deaths with ≤2 years vs 65.6% with >5 years of follow-up) and the proportion of patients who died from circulatory (4.6% vs 9.0%) and respiratory system (3.7% vs 5.0%) diseases increased slightly. A similar trend of decreasing MM deaths with follow-up time was observed in the U.S. (73.2% of deaths with ≤2 years vs 66.5% with >5 years of follow-up). Joinpoint regression showed a decreasing trend in MM mortality in the U.S. and PR.
Conclusion: In both PR and the U.S., people diagnosed with MM are still more likely to die from MM than from another cause. However, a decrease in MM mortality is evident, particularly in more recent years, but this decrease is lower in Puerto Rico.
Citation Format: Maira A. Castañeda-Avila, Karen J. Ortiz-Ortiz, Carlos R. Torres-Cintrón, Mara M. Epstein. Trends in cause of death among Puerto Rican and United States multiple myeloma patients [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A32.
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Affiliation(s)
| | - Karen J. Ortiz-Ortiz
- 2Puerto Rico Central Cancer Registry, University of Puerto Rico, San Juan, Puerto Rico
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Epstein MM, Rosner B, Breen EC, Batista JL, Giovannucci EL, Magpantay L, Aster JC, Rodig SJ, Bertrand KA, Laden F, Martínez-Maza O, Birmann BM. Pre-diagnosis plasma immune markers and risk of non-Hodgkin lymphoma in two prospective cohort studies. Haematologica 2018; 103:1679-1687. [PMID: 29930163 PMCID: PMC6165815 DOI: 10.3324/haematol.2017.183236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/15/2018] [Indexed: 12/21/2022] Open
Abstract
Inflammation and B-cell hyperactivation have been associated with non-Hodgkin lymphoma development. This prospective analysis aimed to further elucidate pre-diagnosis plasma immune marker profiles associated with non-Hodgkin lymphoma risk. We identified 598 incident lymphoma cases and 601 matched controls in Nurses' Health Study and Health Professionals Follow-up Study participants with archived pre-diagnosis plasma samples and measured 13 immune marker levels with multiplexed immunoassays. Using multivariable logistic regression we calculated Odds Ratios (OR) and 95% Confidence Intervals (CI) per standard deviation unit increase in biomarker concentration for risk of non-Hodgkin lymphoma and major histological subtype, stratifying additional models by years (<5, 5 to <10, ≥10) after blood draw. Soluble interleukin-2 receptor-α, CXC chemokine ligand 13, soluble CD30, and soluble tumor necrosis factor receptor-2 were individually positively associated, and B-cell activating factor of the tumor necrosis factor family inversely associated, with all non-Hodgkin lymphoma and one or more subtypes. The biomarker combinations associated independently with lymphoma varied somewhat by subtype and years after blood draw. Of note, the unexpected inverse association between B-cell activating factor and chronic lymphocytic leukemia/small lymphocytic lymphoma risk (OR: 95%CI: 0.51, 0.43-0.62) persisted more than ten years after blood draw (OR: 0.70; 95%CI: 0.52-0.93). In conclusion, immune activation precedes non-Hodgkin lymphoma diagnosis by several years. Decreased B-cell activating factor levels may denote nascent chronic lymphocytic leukemia many years pre-diagnosis.
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Affiliation(s)
- Mara M Epstein
- Department of Medicine and the Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bernard Rosner
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Elizabeth C Breen
- UCLA AIDS Institute, Los Angeles, CA, USA.,Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Julie L Batista
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Edward L Giovannucci
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Larry Magpantay
- UCLA AIDS Institute, Los Angeles, CA, USA.,Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jon C Aster
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Francine Laden
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Otoniel Martínez-Maza
- UCLA AIDS Institute, Los Angeles, CA, USA.,Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Department of Microbiology, Immunology & Molecular Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Mack DS, Epstein MM, Dubé C, Clark RE, Lapane KL. Screening mammography among nursing home residents in the United States: Current guidelines and practice. J Geriatr Oncol 2018; 9:626-634. [PMID: 29875079 DOI: 10.1016/j.jgo.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/16/2018] [Accepted: 05/04/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines. MATERIALS AND METHODS Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65-74, ≥75 years), was estimated for all women aged ≥65 years residing in US Medicare- and Medicaid- certified nursing homes (≥1 year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n = 389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility. RESULTS Women on average were 85.4 (standard deviation ±8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65-74 years (95% Confidence Interval (CI): 6.8%-7.3%) and 1.7% among those ≥75 years (95% CI, 1.7%-1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities. CONCLUSIONS These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening.
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Affiliation(s)
- Deborah S Mack
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Mara M Epstein
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States; Department of Medicine, Division of Geriatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catherine Dubé
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Robin E Clark
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States; Department of Family Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Alford SH, Divine G, Chao C, Habel LA, Janakiraman N, Wang Y, Feigelson HS, Scholes D, Roblin D, Epstein MM, Engel L, Havstad S, Wells K, Yood MU, Fortuny J, Johnson CC. Serum cholesterol trajectories in the 10 years prior to lymphoma diagnosis. Cancer Causes Control 2017; 29:143-156. [PMID: 29192350 DOI: 10.1007/s10552-017-0987-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 11/21/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Many studies suggest a role for cholesterol in cancer development. Serum cholesterol levels have been observed to be low in newly diagnosed lymphoma cases. The objective of these analyses was to examine the time-varying relationship of cholesterol with lymphomagenesis in the 10 years prior to diagnosis by lymphoma subtype. METHODS Participants were selected from the combined membership of six National Cancer Institute-funded Cancer Research Network health plans from 1998 to 2008, excluding members with human immunodeficiency virus, cancer (except lymphoma), or organ transplants. Incident lymphoma cases within this population were ascertained and matched with up to five controls. Total serum cholesterol, high-density lipoprotein, and low-density lipoprotein were collected from plan databases. Multilevel, multivariable longitudinal models were fit after choosing the best polynomial order by deviance statistics for selected lymphoma histotypes to examine pre-diagnosis cholesterol trajectories: Hodgkin lymphoma (n = 519) and all non-Hodgkin lymphomas combined (n = 12,635) as well as six subtypes of the latter. RESULTS For all categories, lymphoma cases had statistically significantly lower estimated total serum cholesterol, high-density lipoprotein, and low-density lipoprotein levels than controls in the years prior to diagnosis/index date. Between-group differences were most pronounced 3-4 years prior to diagnosis, when cases' cholesterol levels declined steeply. CONCLUSIONS This analysis is the first to examine changes in serum cholesterol for a decade prior to lymphoma diagnosis. A drop in cholesterol levels was evident several years before diagnosis. Our results suggest that cholesterol-related pathways have an important relationship with lymphomagenesis and low cholesterol could be a preclinical lymphoma marker.
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Affiliation(s)
- Sharon Hensley Alford
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, 3E, Detroit, MI, 48202, USA
| | - George Divine
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, 3E, Detroit, MI, 48202, USA
| | - Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Yun Wang
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, 3E, Detroit, MI, 48202, USA
| | | | - Delia Scholes
- Kaiser Permanente Washington, KPWA Health Research Institute, Seattle, WA, USA
| | - Doug Roblin
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Mara M Epstein
- Department of Medicine, The Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lawrence Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, 3E, Detroit, MI, 48202, USA
| | - Karen Wells
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, 3E, Detroit, MI, 48202, USA
| | | | | | - Christine Cole Johnson
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, 3E, Detroit, MI, 48202, USA.
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Changi K, Bosnjak B, Gonzalez-Obeso C, Kluger R, Rodríguez-Cabello JC, Hoffmann O, Epstein MM. Biocompatibility and immunogenicity of elastin-like recombinamer biomaterials in mouse models. J Biomed Mater Res A 2017; 106:924-934. [PMID: 29105979 DOI: 10.1002/jbm.a.36290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 10/20/2017] [Accepted: 11/02/2017] [Indexed: 12/20/2022]
Abstract
Novel thermo-sensitive elastin-like recombinamers (ELRs) containing bioactive molecules were created for use as a biomimetic biomaterial for tissue regeneration. For effective use for in vivo applications, it is essential to ensure that they do not induce adverse inflammatory, immune, or allergic responses that inhibit tissue repair. Therefore, we sought to establish a pre-clinical approach to evaluate biocompatibility in experimental mice using ELRs as a prototype biomaterial. First, we measured in vitro proliferation and cytokine production from BALB/c and C57BL/6 mouse splenocytes incubated with ELRs. Second, we used a rapid, high throughput in vivo approach in which inflammatory cells and cytokines were measured following an intraperitoneal implantation. Lastly, a subchronic in vivo approach was used in which ELRs or positive controls were subcutaneously implanted and the implantation sites were assessed for inflammation and gene expression. We found that ELRs induced mild inflammation and minimal fibrosis compared to the intense response to Vitoss. Additionally, implantation increased antigen-specific antibody titers for both groups and gene expression profiling of the implantation sites revealed the upregulation of inflammation, fibrosis, and wound healing-related genes in ELR and positive control-implanted mice compared to sham controls. These data demonstrate that ELRs appear safe for use in tissue engineering. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 924-934, 2018.
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Affiliation(s)
- K Changi
- Department of Dermatology, Laboratory of Experimental Allergy, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - B Bosnjak
- Department of Dermatology, Laboratory of Experimental Allergy, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - C Gonzalez-Obeso
- BIOFORGE (Group for Advanced Materials and Nanobiotechnology), CIBER-BBN, University of Valladolid, Valladolid, Spain
| | - R Kluger
- Danube Hospital Vienna, Vienna, Austria
| | - J C Rodríguez-Cabello
- BIOFORGE (Group for Advanced Materials and Nanobiotechnology), CIBER-BBN, University of Valladolid, Valladolid, Spain
| | - O Hoffmann
- Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria
| | - M M Epstein
- Department of Dermatology, Laboratory of Experimental Allergy, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
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Tabung FK, Birmann BM, Epstein MM, Martínez-Maza O, Breen EC, Wu K, Giovannucci EL. Influence of Dietary Patterns on Plasma Soluble CD14, a Surrogate Marker of Gut Barrier Dysfunction. Curr Dev Nutr 2017; 1:e001396. [PMID: 29595830 PMCID: PMC5867900 DOI: 10.3945/cdn.117.001396] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/31/2017] [Accepted: 10/17/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Specific foods and nutrients, including alcohol, may contribute to gut barrier dysfunction. However, to our knowledge, the influence of whole diets is currently unknown. OBJECTIVE We aimed to cross-sectionally investigate associations of dietary patterns with plasma soluble CD14 (sCD14), which is released by macrophages on stimulation with endotoxin and has been used as a marker of gut hyperpermeability. METHODS We used food-frequency questionnaire data collected from 689 women in the Nurses' Health Study and 509 men in the Health Professionals Follow-Up Study. Our principal component analysis identified 2 dietary patterns: "Western" (higher intakes of red meat, processed meat, desserts, and refined grains) and "prudent" (higher intakes of fruits, vegetables, fish, and whole grains). In multivariable-adjusted logistic regression analyses, we estimated ORs and 95% CIs for high (equal to or greater than the median compared with less than the median) sCD14 concentrations in quintiles of each dietary pattern. Using logistic regression, we also investigated the joint association of the Western dietary pattern and alcohol intake or C-reactive protein (CRP) with sCD14 concentrations. RESULTS Western dietary pattern scores were positively associated with sCD14 concentrations (OR: 1.86; 95% CI: 1.24, 2.79; P-trend = 0.0005; comparing extreme quintiles). Analyses of joint associations suggested that the strongest associations with higher sCD14 concentrations were for persons with both high Western pattern scores and high alcohol intake compared with participants with low scores for both (OR: 2.96; 95% CI: 1.61, 5.45) or for participants with both high Western pattern scores and high CRP values compared with those with low scores for both (OR: 4.11; 95% CI: 2.57, 6.58). The prudent pattern was not associated with sCD14 concentrations. CONCLUSIONS Higher consumption of the Western dietary pattern is associated with a marker of macrophage activation and gut hyperpermeability, especially when coupled with high alcohol intake and heightened systemic inflammation. Our findings need confirmation in studies with additional markers of gut barrier dysfunction.
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Affiliation(s)
- Fred K Tabung
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Brenda M Birmann
- Departments of Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Mara M Epstein
- Department of Medicine and the Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA
| | - Otoniel Martínez-Maza
- Departments of Obstetrics and Gynecology, Immunology, and Molecular Genetics
- Departments of Microbiology, Immunology, and Molecular Genetics
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Elizabeth C Breen
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine
| | - Kana Wu
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Edward L Giovannucci
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Departments of Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Buist DSM, Field TS, Banegas MP, Clancy HA, Doria-Rose VP, Epstein MM, Greenlee RT, McDonald S, Nichols HB, Pawloski PA, Kushi LH. Training in the Conduct of Population-Based Multi-Site and Multi-Disciplinary Studies: the Cancer Research Network's Scholars Program. J Cancer Educ 2017; 32:283-292. [PMID: 26490950 PMCID: PMC4902776 DOI: 10.1007/s13187-015-0925-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Expanding research capacity of large research networks within health care delivery systems requires strategically training both embedded and external investigators in necessary skills for this purpose. Researchers new to these settings frequently lack the skills and specialized knowledge conducive to multi-site and multi-disciplinary research set in delivery systems. This report describes the goals and components of the Cancer Research Network (CRN) Scholars Program, a 26-month training program developed to increase the capacity for cancer research conducted within the network's participating sites, its progression from training embedded investigators to a mix of internal and external investigators, and the content evolution of the training program. The CRN Scholars program was launched in 2007 to assist junior investigators from member sites develop independent and sustainable research programs within the CRN. Resulting from CRN's increased emphasis on promoting external collaborations, the 2013 Scholars program began recruiting junior investigators from external institutions committed to conducting delivery system science. Based on involvement of this broader population and feedback from prior Scholar cohorts, the program has honed its focus on specific opportunities and issues encountered in conducting cancer research within health care delivery systems. Efficiency and effectiveness of working within networks is accelerated by strategic and mentored navigation of these networks. Investing in training programs specific to these settings provides the opportunity to improve multi-disciplinary and multi-institutional collaboration, particularly for early-stage investigators. Aspects of the CRN Scholars Program may help inform others considering developing similar programs to expand delivery system research or within large, multi-disciplinary research networks.
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Affiliation(s)
- Diana S M Buist
- Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA.
| | - Terry S Field
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Community Health Plan, Worcester, MA, USA
| | | | - Heather A Clancy
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | | | - Mara M Epstein
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Community Health Plan, Worcester, MA, USA
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Sarah McDonald
- Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | | | - Pamala A Pawloski
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - Lawrence H Kushi
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
- University of California Davis School of Medicine, Sacramento, CA, USA
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Epstein MM, Divine G, Chao CR, Wells KE, Feigelson HS, Scholes D, Roblin D, Ulcickas Yood M, Engel LS, Taylor A, Fortuny J, Habel LA, Johnson CC. Statin use and risk of multiple myeloma: An analysis from the cancer research network. Int J Cancer 2017; 141:480-487. [PMID: 28425616 DOI: 10.1002/ijc.30745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/03/2017] [Indexed: 01/24/2023]
Abstract
Animal and human data suggest statins may be protective against developing multiple myeloma; however, findings may be biased by the interrelationship with lipid levels. We investigated the association between statin use and risk of multiple myeloma in a large US population, with an emphasis on accounting for this potential bias. We conducted a case-control study nested within 6 US integrated healthcare systems participating in the National Cancer Institute-funded Cancer Research Network. Adults aged ≥40 years who were diagnosed with multiple myeloma from 1998-2008 were identified through cancer registries (N = 2,532). For each case, five controls were matched on age, sex, health plan, and membership duration prior to diagnosis/index date. Statin prescriptions were ascertained from electronic pharmacy records. To address potential biases related to lipid levels and medication prescribing practices, multivariable marginal structural models were used to model statin use (≥6 cumulative months) and risk of multiple myeloma, with examination of multiple latency periods. Statin use 48-72 months prior to diagnosis/index date was associated with a suggestive 20-28% reduced risk of developing multiple myeloma, compared to non-users. Recent initiation of statins was not associated with myeloma risk (risk ratio range 0.90-0.99 with 0-36 months latency). Older patients had more consistent protective associations across all latency periods (risk ratio range 0.67-0.87). Our results suggest that the association between statin use and multiple myeloma risk may vary by exposure window and age. Future research is warranted to investigate the timing of statin use in relation to myeloma diagnosis.
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Affiliation(s)
- Mara M Epstein
- Meyers Primary Care Institute and Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - George Divine
- Department of Public Health Sciences, Henry Ford Hospital & Health System, Detroit, MI
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Karen E Wells
- Department of Public Health Sciences, Henry Ford Hospital & Health System, Detroit, MI
| | | | - Delia Scholes
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente, Seattle, Washington, WA
| | - Douglas Roblin
- School of Public Health, Georgia State University, Atlanta, GA; Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, GA
| | | | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Taylor
- Department of Public Health Sciences, Henry Ford Hospital & Health System, Detroit, MI
| | | | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Christine C Johnson
- Department of Public Health Sciences, Henry Ford Hospital & Health System, Detroit, MI
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Miller A, Yates J, Epstein MM, Fantasia J, Frendl D, Afiadata A, Sokoloff M, Luckmann R. Impact of 2012 USPSTF Screening PSA Guideline Statement: Changes in Primary Care Provider Practice Patterns and Attitudes. Urol Pract 2017; 4:126-131. [PMID: 37592666 DOI: 10.1016/j.urpr.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Prostate specific antigen use in prostate cancer screening has undergone significant changes since the 2012 release of the USPSTF (United States Preventive Services Task Force) guideline statement. The effect on specific primary care provider practice patterns and attitudes is not well characterized. We describe the impact of the USPSTF statement on prostate cancer screening practices, attitudes and knowledge among primary care providers. METHODS A survey composed of 25 questions was mailed electronically to approximately 350 primary care providers within a single academic health care system. Responses were recorded and could not be traced to the respondent. RESULTS A total of 73 primary care providers (21%) responded to the survey. Of the respondents 75% reported a change in prostate specific antigen screening practices resulting from the USPSTF recommendations and 35% reported a decrease in digital rectal examination use, although the latter test is not explicitly addressed in the guideline statement. A third of respondents believe that prostate specific antigen screening has "likely had no role" in the 2-decade decline in prostate cancer mortality and 70% agree that prostate specific antigen screening may "impart more harm than good" to the patient. Despite these opinions, there was markedly greater concern for medicolegal consequences of a missed diagnosis compared to over diagnosis. CONCLUSIONS The results of the survey, while limited to a single large academic center, show the impact of the USPSTF 2012 statement on physician attitudes and practice patterns. The results define the need for more educational opportunities for primary care providers regarding the USPSTF statement, American Urological Association guidelines and identification of patients appropriate for prostate specific antigen screening.
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Affiliation(s)
- Alexander Miller
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jennifer Yates
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Mara M Epstein
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jennifer Fantasia
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Daniel Frendl
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Mitchell Sokoloff
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Roger Luckmann
- University of Massachusetts Medical School, Worcester, Massachusetts
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Ziebell RA, Chubak J, Epstein MM. Multiple Myeloma Data in the Cancer Research Network. J Patient Cent Res Rev 2016. [DOI: 10.17294/2330-0698.1291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Epstein MM, Frendl DM, Fouayzi H, Krajenta R, Rybicki BA, Sokoloff MH. The Impact of Clinical Guidelines on Prostate Cancer Screening Practices in a Population-Based Setting, 2000–2013. J Patient Cent Res Rev 2016. [DOI: 10.17294/2330-0698.1295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Epstein MM, Chang ET, Zhang Y, Fung TT, Batista JL, Ambinder RF, Zheng T, Mueller NE, Birmann BM. Dietary pattern and risk of hodgkin lymphoma in a population-based case-control study. Am J Epidemiol 2015; 182:405-16. [PMID: 26182945 DOI: 10.1093/aje/kwv072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/18/2015] [Indexed: 12/22/2022] Open
Abstract
Classic Hodgkin lymphoma (cHL) has few known modifiable risk factors, and the relationship between diet and cHL risk is unclear. We performed the first investigation of an association between dietary pattern and cHL risk in 435 cHL cases and 563 population-based controls from Massachusetts and Connecticut (1997-2000) who completed baseline diet questionnaires. We identified 4 major dietary patterns ("vegetable," "high meat," "fruit/low-fat dairy," "desserts/sweets") using principal components analysis. We computed multivariable odds ratios and 95% confidence intervals for associations of dietary pattern score (quartiles) with younger-adult (age <50 years), older-adult (age ≥50 years), and overall cHL risk. Secondary analyses examined associations by histological subtype and tumor Epstein-Barr virus (EBV) status. A diet high in desserts/sweets was associated with younger-adult (odds ratio(quartile 4 vs. quartile 1) = 1.60, 95% confidence interval: 1.05, 2.45; Ptrend = 0.008) and EBV-negative, younger-adult (odds ratio = 2.11, 95% confidence interval: 1.31, 3.41; Ptrend = 0.007) cHL risk. A high meat diet was associated with older-adult (odds ratio = 3.34, 95% confidence interval: 1.02, 10.91; Ptrend = 0.04) and EBV-negative, older-adult (odds ratio = 4.64, 95% confidence interval: 1.03, 20.86; Ptrend = 0.04) cHL risk. Other dietary patterns were not clearly associated with cHL. We report the first evidence for a role of dietary pattern in cHL etiology. Diets featuring high intake of meat or desserts and sweets may increase cHL risk.
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Banegas MP, Buist DS, Epstein MM, Field TS, Clarke Hillyer G, Lott JP, Pawloski PA. The CRN Scholars Program: Career Development Within CRN. J Patient Cent Res Rev 2015. [DOI: 10.17294/2330-0698.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Epstein MM, Owens CL, Peterson D, Neergheen V, McManus V, Multerer D, Greenlee RT. Variation in Pathology Examination of Extended Core Prostate Biopsies: A CRN Pilot Project. J Patient Cent Res Rev 2015. [DOI: 10.17294/2330-0698.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Siddiqui MM, Wilson KM, Epstein MM, Rider JR, Martin NE, Stampfer MJ, Giovannucci EL, Mucci LA. Vasectomy and risk of aggressive prostate cancer: a 24-year follow-up study. J Clin Oncol 2015; 32:3033-8. [PMID: 25002716 DOI: 10.1200/jco.2013.54.8446] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Conflicting reports remain regarding the association between vasectomy, a common form of male contraception in the United States, and prostate cancer risk. We examined prospectively this association with extended follow-up and an emphasis on advanced and lethal disease. PATIENTS AND METHODS Among 49,405 U.S. men in the Health Professionals Follow-Up Study, age 40 to 75 years at baseline in 1986, 6,023 patients with prostate cancer were diagnosed during the follow-up to 2010, including 811 lethal cases. In total, 12,321 men (25%) had vasectomies. We used Cox proportional hazards models to estimate the relative risk (RR) and 95% CIs of total, advanced, high-grade, and lethal disease, with adjustment for a variety of possible confounders. RESULTS Vasectomy was associated with a small increased risk of prostate cancer overall (RR, 1.10; 95% CI, 1.04 to 1.17). Risk was elevated for high-grade (Gleason score 8 to 10; RR, 1.22; 95% CI, 1.03 to 1.45) and lethal disease (death or distant metastasis; RR, 1.19; 95% CI, 1.00 to 1.43). Among a subcohort of men receiving regular prostate-specific antigen screening, the association with lethal cancer was stronger (RR, 1.56; 95% CI, 1.03 to 2.36). Vasectomy was not associated with the risk of low-grade or localized disease. Additional analyses suggested that the associations were not driven by differences in sex hormone levels, sexually transmitted infections, or cancer treatment. CONCLUSION Our data support the hypothesis that vasectomy is associated with a modest increased incidence of lethal prostate cancer. The results do not appear to be due to detection bias, and confounding by infections or cancer treatment is unlikely.
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Markt SC, Rider JR, Penney KL, Schumacher FR, Epstein MM, Fall K, Sesso HD, Stampfer MJ, Mucci LA. Genetic variation across C-reactive protein and risk of prostate cancer. Prostate 2014; 74:1034-42. [PMID: 24844401 PMCID: PMC4063346 DOI: 10.1002/pros.22820] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/15/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Inflammation has been hypothesized to play an important etiological role in the initiation or progression of prostate cancer. Circulating levels of the systemic inflammation marker C-reactive protein (CRP) have been associated with increased risk of prostate cancer. We investigated the role of genetic variation in CRP and prostate cancer, under the hypothesis that variants may alter risk of disease. METHODS We undertook a case-control study nested within the prospective Physicians' Health Study among 1,286 men with incident prostate cancer and 1,264 controls. Four single-nucleotide polymorphisms (SNPs) were selected to capture the common genetic variation across CRP (r(2) > 0.8). We used unconditional logistic regression to assess the association between each SNP and risk of prostate cancer. Linear regression models explored associations between each genotype and plasma CRP levels. RESULTS None of the CRP SNPs were associated with prostate cancer overall. Individuals with one copy of the minor allele (C) in rs1800947 had an increased risk of high-grade prostate cancer (OR: 1.7; 95% CI: 1.1-2.8), and significantly lower mean CRP levels (P-value <0.001), however, we found no significant association with lethal disease. Mean CRP levels were significantly elevated in men with one or two copies of the minor allele in rs3093075 and rs1417939, but these were unrelated to prostate cancer risk. CONCLUSION Our findings suggest that SNPs in the CRP gene are not associated with risk of overall or lethal prostate cancer. Polymorphisms in CRP rs1800947 may be associated with higher grade disease, but our results require replication in other cohorts.
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Affiliation(s)
- Sarah C. Markt
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Jennifer R. Rider
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kathryn L. Penney
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Fredrick R. Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Mara M. Epstein
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Katja Fall
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Clinical Epidemiology and Biostatistics, Örebro University, Sweden
| | - Howard D. Sesso
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School
| | - Meir J. Stampfer
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Russnes KM, Wilson KM, Epstein MM, Kasperzyk JL, Stampfer MJ, Kenfield SA, Smeland S, Blomhoff R, Giovannucci EL, Willett WC, Mucci LA. Total antioxidant intake in relation to prostate cancer incidence in the Health Professionals Follow-Up Study. Int J Cancer 2013; 134:1156-65. [PMID: 23959920 DOI: 10.1002/ijc.28438] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 07/14/2013] [Accepted: 07/25/2013] [Indexed: 12/31/2022]
Abstract
Epidemiologic evidence on the association of antioxidant intake and prostate cancer incidence is inconsistent. Total antioxidant intake and prostate cancer incidence have not previously been examined. Using the ferric-reducing antioxidant potential (FRAP) assay, the total antioxidant content (TAC) of diet and supplements was assessed in relation to prostate cancer incidence. A prospective cohort of 47,896 men aged 40-75 years was followed from 1986 to 2008 for prostate cancer incidence (N = 5,656), and they completed food frequency questionnaires (FFQs) every 4 years. A FRAP value was assigned to each item in the FFQ, and for each individual, TAC scores for diet, supplements and both (total) were calculated. Major contributors of TAC intake at baseline were coffee (28%), fruit and vegetables (23%) and dietary supplements (23%). In multivariate analyses for dietary TAC a weak inverse association was observed [highest versus lowest quintiles: 0.91 (0.83-1.00, p-trend = 0.03) for total prostate cancer and 0.81 (0.64-1.01, p-trend = 0.04) for advanced prostate cancer]; this association was mainly due to coffee. No association of total TAC on prostate cancer incidence was observed. A positive association with lethal and advanced prostate cancers was observed in the highest quintile of supplemental TAC intake: 1.28 (0.98-1.65, p-trend < 0.01) and 1.15 (0.92-1.43, p-trend = 0.04). The weak association between dietary antioxidant intake and reduced prostate cancer incidence may be related to specific antioxidants in coffee, to nonantioxidant coffee compounds or other effects of drinking coffee. The indication of increased risk for lethal and advanced prostate cancers with high TAC intake from supplements warrants further investigation.
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Affiliation(s)
- Kjell M Russnes
- Department of Epidemiology, Harvard School of Public Health, Boston, MA; Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Epstein MM, Breen EC, Magpantay L, Detels R, Lepone L, Penugonda S, Bream JH, Jacobson LP, Martínez-Maza O, Birmann BM. Temporal stability of serum concentrations of cytokines and soluble receptors measured across two years in low-risk HIV-seronegative men. Cancer Epidemiol Biomarkers Prev 2013; 22:2009-15. [PMID: 23983237 DOI: 10.1158/1055-9965.epi-13-0379] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [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] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Prospective cohort studies often quantify serum immune biomarkers at a single time point to determine risk of cancer and other chronic diseases that develop years later. Estimates of the within-person temporal stability of serum markers partly assess the utility of single biomarker measurements and may have important implications for the design of prospective studies of chronic disease risk. METHODS Using archived sera collected from 200 HIV-seronegative men at three visits spaced over approximately 2 years, concentrations of 14 biomarkers (ApoA1, sCD14, sgp130, sIL-6R, sIL-2Rα, sTNFR2, BAFF/BLyS, CXCL13, IFN-γ, interleukin [IL]-1β, IL-6, IL-8, IL-10, and TNF-α) were measured in a single laboratory. Age- and ethnicity-adjusted intraclass correlation coefficients (ICC) were calculated for each biomarker, and mixed linear regression models were used to examine the influence of age, ethnicity, season, and study site on biomarker concentrations. RESULTS Across all three study visits, most biomarkers had ICC values indicating fair to excellent within-person stability. ApoA1 (ICC = 0.88) and TNF-α (ICC = 0.87) showed the greatest stability; the ICC for IL-8 (ICC = 0.33) was remarkably less stable. The ICCs were similar when calculated between pairs of consecutive visits. The covariables did not influence biomarker levels or their temporal stability. All biomarkers showed moderate to strong pairwise correlations across visits. CONCLUSIONS Serum concentrations of most evaluated immune biomarkers displayed acceptable to excellent within-person temporal reliability over a 2-year period. Further investigation may be required to clarify the stability of IL-8. IMPACT These findings lend support to using these serologic immune biomarkers in prospective studies investigating associations with chronic diseases.
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Affiliation(s)
- Mara M Epstein
- Authors' Affiliations: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; UCLA AIDS Institute, and Departments of Psychiatry & Biobehavioral Sciences and Obstetrics & Gynecology, David Geffen School of Medicine at UCLA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California; Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Medicine-Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Departments of Molecular Microbiology and Immunology and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, Immunology & Molecular Genetics, and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California
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