The increasing availability of personal genomic tests has led to discussions about the validity and utility of such tests and the balance of benefits and harms. A multidisciplinary workshop was convened by the National Institutes of Health and the Centers for Disease Control and Prevention to review the scientific foundation for using personal genomics in risk assessment and disease prevention and to develop recommendations for targeted research. The clinical validity and utility of personal genomics is a moving target with rapidly developing discoveries but little translation research to close the gap between discoveries and health impact. Workshop participants made recommendations in five domains: (1) developing and applying scientific standards for assessing personal genomic tests; (2) developing and applying a multidisciplinary research agenda, including observational studies and clinical trials to fill knowledge gaps in clinical validity and utility; (3) enhancing credible knowledge synthesis and information dissemination to clinicians and consumers; (4) linking scientific findings to evidence-based recommendations for use of personal genomics; and (5) assessing how the concept of personal utility can affect health benefits, costs, and risks by developing appropriate metrics for evaluation. To fulfill the promise of personal genomics, a rigorous multidisciplinary research agenda is needed.

Mushrooms are fungi, biologically distinct from plant- and animal-derived foods (fruits, vegetables, grains, dairy, protein [meat, fish, poultry, legumes, nuts, and seeds]) that comprise the US Department of Agriculture food patterns operationalized by consumer-focused MyPlate messages. Although mushrooms provide nutrients found in these food groups, they also have a unique nutrient profile. Classified into food grouping systems by their use as a vegetable, mushrooms’ increasing use in main entrées in plant-based diets is growing, supporting consumers’ efforts to follow dietary guidance recommendations. Mushrooms’ nutrient and culinary characteristics suggest it may be time to reevaluate food groupings and health benefits in the context of 3 separate food kingdoms: plants/botany, animals/zoology, and fungi/mycology.

The Mushroom Council convened the Mushrooms and Health Summit in Washington, DC, on 9-10 September 2013. The proceedings are synthesized in this article. Although mushrooms have long been regarded as health-promoting foods, research specific to their role in a healthful diet and in health promotion has advanced in the past decade. The earliest mushroom cultivation was documented in China, which remains among the top global mushroom producers, along with the United States, Italy, The Netherlands, and Poland. Although considered a vegetable in dietary advice, mushrooms are fungi, set apart by vitamin B-12 in very low quantity but in the same form found in meat, ergosterol converted with UV light to vitamin D2, and conjugated linoleic acid. Mushrooms are a rare source of ergothioneine as well as selenium, fiber, and several other vitamins and minerals. Some preclinical and clinical studies suggest impacts of mushrooms on cognition, weight management, oral health, and cancer risk. Preliminary evidence suggests that mushrooms may support healthy immune and inflammatory responses through interaction with the gut microbiota, enhancing development of adaptive immunity, and improved immune cell functionality. In addition to imparting direct nutritional and health benefits, analysis of U.S. food intake survey data reveals that mushrooms are associated with higher dietary quality. Also, early sensory research suggests that mushrooms blended with meats and lower sodium dishes are well liked and may help to reduce intakes of red meat and salt without compromising taste. As research progresses on the specific health effects of mushrooms, there is a need for effective communication efforts to leverage mushrooms to improve overall dietary quality.

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The effects of beef substitution with crimini or white mushrooms (Agaricus bisporus) on the flavor profiles of carne asada and beef taco blends were measured with a descriptive analysis panel. Sensory mitigation of sodium reduction through the incorporation of mushrooms was also investigated in the taco blends. The substitution of beef with mushrooms in the carne asada did not alter the overall flavor strength of the dish, but the incorporation of 50% or 80% ground mushroom in the beef taco blend did enhance its overall flavor as well as mushroom, veggie, onion, garlic and earthy flavors, and umami and sweet tastes. Overall flavor intensity of the 25% reduced-salt version of the 80% mushroom taco blend matched that of the full-salt versions of the 100% and 50% beef formulations, thus indicating that the substitution of 80% of the meat with mushrooms did mitigate the 25% sodium reduction in terms of the overall flavor impact of the dish, even if it did not quite compensate for the reduction in salty taste. This proof-of-concept study for the Healthy Flavors Research Initiative indicates that because of their flavor-enhancing umami principles, mushrooms can be used as a healthy substitute for meat and a mitigating agent for sodium reduction in meat-based dishes without loss of overall flavor.

Background: The COVID 19 pandemic has disrupted all aspects of healthcare, including the diagnosis and treatment of breast cancer. In March 2020, the Society of Surgical Oncology, the American College of Surgeons, and the American Society of Breast Surgeons issued guidelines regarding the timing of surgery for cancer patients to preserve hospital resources and minimize exposure of patients and staff to COVID 19. Recommendations included delaying breast cancer surgery if possible, and using neoadjuvant chemotherapy or neoadjuvant endocrine therapy to treat selected patients while waiting for definitive surgery. In California, the “shelter in place” (SiP) order began March 17, 2020, and both screening mammography and elective surgeries were stopped in a large, integrated health care system. We evaluated the impact of these operational changes on the presentation and treatment of breast cancer patients in our system.Methods:We performed a retrospective review of patients newly diagnosed between 3/17/20, the starting date of SiP, and 5/18/20, when elective operations resumed in our system. We compared this cohort to patients who were diagnosed between 3/17/19 and 5/18/19. Age, histology, anatomic staging features, grade, receptor status, and initial treatment were compared between the cohorts. For the patients who underwent surgery, we compared the time from biopsy to time to surgery (TTS) and the type of operation. Comparisons involving categorical variables were performed using the chi-square test. Normally-distributed continuous variables were compared using two sample-t-tests. P-values of <0.05 were considered statistically significant.Results:There were 790 patients in the 2019 cohort and 279 in the 2020 cohort. There were no significant differences in age at presentation, histologic subtypes, nodal status, or operation type between the two groups. The T-stages at presentation of the 2020 group were higher than those of the 2019 group; 29% presented with T1c tumors in 2020 vs 26% in 2019, and 37% with T2 tumors in 2020 vs 30% in 2019 (p=0.03). A higher percentage of patients presented with distant metastatic disease at the time of diagnosis in 2020 (7% in 2020 vs 2% in 2019, p<0.001), although the absolute numbers of patients were similar (19 patients in 2020 vs 17 patients in 2019). Of patients with invasive breast cancer, a higher percentage of patients presented with grade 3 tumors in 2020 (35% in 2020 vs 24% in 2019, p=0.002), and triple negative tumors (15% vs 10%, p=0.02). Fewer patients underwent surgery first in 2020 (73% in 2020 vs 85% in 2019, p<0.001) and more underwent neoadjuvant chemotherapy (13% in 2020 vs 9% in 2019, p=0.03). Only 4% of the 2020 surgery group had been placed on neoadjuvant endocrine therapy while awaiting definitive surgery. The TTS for patients with surgery as the initial treatment was significantly shorter for the 2020 group (mean 22 days in 2020 vs 31 days in 2019, p<0.001).Conclusions: Without screening mammography, newly-diagnosed patients in a large, integrated health care system during the COVID 19 pandemic presented with more advanced and aggressive breast cancers as compared to the equivalent time period in 2019. Fewer patients underwent surgery first, and more underwent neoadjuvant chemotherapy. The TTS for breast cancer patients in 2020 was significantly shorter than in 2019, which we hypothesize was due to the availability of operating rooms since elective operations had been stopped. This study demonstrates the ability of a large, integrated health care system to deliver timely breast cancer care to patients presenting with symptomatic disease during the constraints of the COVID 19 pandemic, and highlights the importance of screening in the early detection of breast cancer. Citation Format: Sharon B. Chang, Alison C. Savitz, Brooke Vuong, Annie Tang, Margaret Mentakis, Amy M. Miller, Veronica C. Shim, Gillian E. Kuehner. Characterization of breast cancer management during the COVID 19 pandemic in a large integrated healthcare delivery system: Stage at diagnosis and timing/modality of first treatment [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS2-06.