Objective: The aim of PARENTs was to determine whether imaging of the placenta by novel multi-parametric MRI techniques in early pregnancy could help predict adverse pregnancy outcomes due to ischemic placental disease (IPD). Additionally, we sought to determine maternal characteristics and environmental risk factors that contribute to IPD and secondary adverse pregnancy outcomes. Study Design: Potential subjects in their first trimester of pregnancy, who agreed to MRI imaging of the placenta and measures of assessment of environmental pollution, were recruited into PARENTs, a prospective population-based cohort study. Participants were seen at three study visits during pregnancy and again at their delivery from 2015 to 2019. We collected data from interviews, chart abstractions, and imaging. Maternal biospecimens (serum, plasma, and urine) at antepartum study visits and delivery specimens (placenta, cord, and maternal blood) were collected, processed, and stored. The primary outcome was a composite of IPD, which included any of the following: placental abruption, hypertensive disease of pregnancy, fetal growth restriction (FGR), or a newborn of small-for-gestational-age (SGA). Results: In this pilot cohort, of the 190 subjects who completed pregnancy to viable delivery, 50 (26%) developed IPD. Among demographic characteristics, having a history of prior IPD in multiparous women was associated with the development of IPD. In the multiple novel perfusion measurements taken of the in vivo placenta using MRI, decreased high placental blood flow (hPBF; ml/100g/min) in early pregnancy (between 14-16 weeks) was found to be significantly associated with the later development of IPD. Conclusion: Successful recruitment of the PARENTs prospective cohort demonstrated the feasibility and acceptability of the use of MRI in human pregnancy to study the placenta in vivo and at the same time collect environmental exposure data. Analysis is ongoing and we hope these methods will assist researchers in the design of prospective imaging studies of pregnancy.
Background The incidence of metastatic breast cancer is rising, but few studies have analyzed Asian American women with a focus on screening and obesity rates.Methods Data from the U.S. Cancer Statistics were examined for trends and incidence rates of breast cancer. Using the Center for Disease Control data mammogram compliance and obesity rates in Asian women were analyzed.Results Over our 18-year study period, the incidence of postmenopausal metastatic breast cancer increased by 2.19% annually in Asian women compared to only 1.03% in White women. Asians also had higher rates of mammogram non-compliance compared to other racial groups. Of Asians, the rates of obesity in postmenopausal women were highest in those aged 65–74 years.Conclusions Compared to other races, Asians have the highest increase in the incidence of metastatic breast cancer with lower rates of screening mammograms. Further research is needed to better understand these disparities.
10537 Background: In the United States, Asian women have traditionally been considered at low risk for breast cancer; yet it is unknown how distant stage disease has trended by geographic, demographic, and modifiable risk factors since 2001. Methods: Data were obtained from the United States Cancer Statistics (USCS) program from 2001-2018, the Behavioral Risk Factor Surveillance System (BRFSS) from 2000-2018. SEER*Stat 8.3.9.2 and the Joinpoint regression program 4.9.0.0 were used to calculate the incidences and trends of distant stage breast cancer per 100,000 women. The trend was presented as average annual or biennial percent change (AAPC or ABPC). Results: Using the USCS program, the overall incidence of postmenopausal breast cancer decreased from 367.90 to 345.07 (per 100,000); however, the incidence of distant stage cancer increased from 16.75 to 19.77 (per 100,000) over 18 years. The incidence is the highest for Black, followed by White, Hispanic, and Asian women at 27.14, 19.86, 14.15, and 11.98 (per 100,000) in 2018, respectively. The annual increase is highest in Asian, followed by Black, White, and Hispanic women at 2.28%, 1.44%, 1.17%, and 0.87% (P < 0.001), respectively. On intersection analysis, postmenopausal Asian women living in the Northeast have the highest annual rise at 2.54% (P = 0.004). BRFSS data revealed that the proportion of women non-compliant with screening mammograms decreased from 36.03% in 2000 to 20.93% in 2018. In 2018, Asian women were the most non-compliant followed by Hispanic, Black, and White women at 40.99%, 40.06%, 21.67%, and 18.17%, respectively. Over time, White, Black, and Hispanic women improved on compliance by 3.43%, 3.32%, and 1.24% (p < 0.05) on screening rates biennially; however, Asian women have not made any improvement (ABPC 0.80%, p = 0.410). On intersectional analysis, the most non-compliant group in 2018 were Asian women in the Midwest at 54.48%. We then evaluated upstream social determinants of breast cancer, such as obesity. While the baseline incidence of obesity in Asian Americans is low compared to other racial groups, it has increased from 9.22 in 2001 to 13.67 (per 100,000) in 2016. Specifically, the incidence of obesity increased the most in postmenopausal Asian 65 to 74-year-olds at 3% compared to White, Hispanic, and Black Americans of the same age group at 2.5%, 2.2%, and 1.1% (p < 0.05), respectively. Conclusions: Although the incidence of breast cancer has decreased in the United States since 2001, the rate of distant stage breast cancer continues to rise. Postmenopausal Asian women with distant stage breast cancer are increasing at the highest rate compared to other racial groups. Further, Asian women are more non-compliant with screening mammograms and have an increased rate of obesity. Tailored interventions are warranted to enhance primary and secondary prevention and decrease distant stage cancer in this high-risk group.
Methods Using the Florida Cancer Data System (FCDS), women with EC diagnosed from 1981-2016 were identified. Demographic and clinical information were abstracted. Women who self-identified as Black and born in the US, Jamaica, or Haiti were included. Statistical analyses were performed using chi-square, Cox proportional hazards models, and the Kaplan-Meier methods with significance set at p<0.05. Results 3434 women met inclusion criteria. Compared to USB, JB and HB had more high-grade histologies, more advanced disease, were uninsured or government-insured, and received more chemotherapy (all p<0.05) (table 1). In multivariate analyses, age (HR 1.02, p=0.008), distant disease (HR 2.32, p<0.001), high-grade histology (HR 2.15, p<0.001), surgery (HR 0.23, p<0.001), and chemotherapy (HR 0.67, p=0.01) were independently associated with OS. In addition, relative to HB women, USB (HR 0.59, p=0.004), and JB (HR 0.54, p=0.026) had improved OS. Among patients with serous EC, HB women had markedly worse median OS (18.5 months) compared to USB (32.2 months) and JB (41 months) (p=0.027) (figure 1). Conclusions Country of birth affects EC survival, with Haitian women demonstrating worse outcomes. Understanding the biologic and social etiologies of these findings is necessary.
germ cell cancers in Native Chinese is nearly 2-fold higher compared to US Asians 0.66 vs. 0.36 per 100,000. In Native Chinese, the incidence is increasing with an average annual percent change (AAPC) at 1.4% (p=0.006) whereas in US Asians there is no change (AAPC=-0.10%, p=0.89). To further evaluate the trends in Native Chinese, we found that the incidence (in 2018) of immature teratomas was nearly 3fold higher compared to dysgerminoma and yolk-sac tumors (0.32 vs. 0.11 vs. 0.10). Moreover, immature teratomas are increasing at 3.46% per year (p<0.001) whereas the dysgerminoma and yolk-sac tumors have remained stable. An intersectional analysis showed Native Chinese at age 10-14 with immature teratoma had the highest annual increase (7.56%, p=0.016). Conclusions Incidences of germ cell tumors have increased in Native Chinese but remained stable in US Asians. The higher incidence and increasing rates of the immature teratoma subtype warrants further studies on potential genetic and environmental factors.
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