Purpose Concerns about the potential for genomic advances to increase health disparities have been raised. Thus it is important to assess referral and uptake of genetic counseling (GC) and testing in minority populations at high risk for hereditary breast and ovarian cancer (HBOC). Methods Black women diagnosed with invasive breast cancer ≤ age 50 in 2009-2012 were recruited through the Florida State Cancer Registry 6-18 months following diagnosis and completed a baseline questionnaire. Summary statistics, Chi-square tests, and path modeling were conducted to examine which demographic and clinical variables were associated with referral and access to genetic services. Results Of the 440 participants, all met national criteria for GC yet only 224 (51%) were referred for or received GC and/or HBOC testing. Variables most strongly associated with healthcare provider referral for GC included having a college education (OR=2.1), diagnosis at or below age 45 (OR=2.0), and triple negative tumor receptor status (OR=1.7). The strongest association with receipt of GC and/or HBOC testing was healthcare provider referral (OR=7.9), followed by private health insurance at diagnosis (OR=2.8), and household income greater than $35,000 in the year prior to diagnosis (OR=2.0). Conclusions Study findings suggest efforts are needed to improve genetic services access among a population-based sample of high-risk Black women. These results indicate that socioeconomic factors and physician referral patterns contribute to disparities in access to genetic services within this underserved minority population.
tumor board checklist with review of all newly diagnosed head and neck patients prior to and after implementation.
7517 Background: Non-small cell lung cancer (NSCLC) that presents with bilateral lung lesions, but without extra-thoracic metastasis, is uncommon. Prognosis is typically poor: No long-term survivor is expected with systemic chemotherapy. However, small reports have suggested the feasibility of bilateral resections. To date, the predictors of survival following this treatment approach remain unknown. Methods: Our institutional tumor registry was searched for patients who underwent bilateral resections of NSCLC during 1998–2006. Patients with metachronous presentations (second lesion found ≥ 2 years afterward) were excluded. Kaplan-Meier survival estimate and Cox proportional hazards model were used to identify survival predictors. Results: Of the 2582 patients operated for NSCLC, 50 patients were included in this analysis. Median age was 69.2 years. Median tumor sizes were 2.0 cms; Adenocarcinomas were the most common (51%). Of 103 thoracotomies, pneumonectomy was performed in 3 patients. Overall peri-operative mortality was 1.9%. Median progression-free survival was 46.0 months (95% CI, 33.1–66.6); overall survival was 77.5 months (95% CI, 43.1–111.1). Performance status, presence of comorbidity, and pathological vascular invasion were important prognostic factors (Table). Risk score based on the sum of these factors (present =1; absent =0) was a strong predictor of survival. Patients with score ≥ 2 (N=11) had a median survival of 17.2 months, compared with 83.5 months among those with score ≤ 1 (HR 5.52, 95% CI 2.27–13.46; p=0.0002). Conclusions: In this largest series of surgery for synchronous bilateral NSCLC to date, the overall survival rate at 5 years is approximately 50%. Performance status, comorbidity, and vascular invasion are strong predictors of survival. Patients with vascular invasion are at an increased risk of progression or death and adjuvant therapy should be considered. [Table: see text] No significant financial relationships to disclose.
IntroductionBreast conserving surgery in the setting of ductal carcinoma in situ (DCIS) produces many challenges. Re-excision rates for close or negative margins after lumpectomy are common due to difficulty in intraoperative margin status assessment. The objective of this study was to review our experience with various margin assessment techniques in the setting of a preoperative diagnosis of DCIS on core needle biopsy (CNB).MethodsA prospectively gathered database of surgically-treated breast cancer patients was reviewed for patients with a diagnosis of DCIS as the most significant lesion on CNB from 1997 to 2009. Of 425 patients with a diagnosis of DCIS by CNB, 231 patients underwent a lumpectomy. Patients' age, tumor characteristics, type of surgery, margin assessment technique, and follow up data were recorded.Results231 patients underwent a lumpectomy following a CNB of DCIS. 138 patients (59.7%) had intra-operative touch prep (TP) analysis of all 6 margins, 39 patients (16.9%) underwent intra-operative gross evaluation of margins, 53 (22.9%) patients had no intra-operative analysis, and one patient (0.4%) had a frozen section analysis. Success at achieving negative margins (>2mm) with initial lumpectomy was 66.7% (92/138) for TP analysis, 56.4% (22/39) for gross evaluation, and 52.8% (28/53) for no margin assessment. These percentages did not reach statistical significance by odds ratios (TP to Gross p= 0.24, TP to None p=0.08, Gross to None p=0.73). After excluding patients that required mastectomy following an unsuccessful lumpectomy, ipsilateral breast recurrence rates were 6.3% (8/127) for the touch prep patients after a mean follow up of 4.0 years, 0.0% (0/31) for the gross evaluation patients after a mean follow up of 1.9 years, and 10.5% (4/38) for the patients with no intraoperative assessment after a mean follow up of 3.8 years. Characteristics of each group are listed in Table 1.ConclusionsReexcision for close or positive margins is required for a significant percentage of patients who undergo lumpectomy after a preoperative diagnosis of DCIS on CNB. Although intraoperative TP analysis had the highest success of preventing reexcision, long term data suggest that recurrence rates between intraoperative TP and gross evaluation are both acceptable with short term follow up.Table 1: Characteristics of patients undergoing lumpectomy with a preoperative diagnosis of DCIS on CNBMargin AssessmentTouch PrepGrossNoneFrozenNumber of cases13839531Patient Median Age59.758.956.359.8Cases not needing Reexcision66.7%(92/138)56.4% (22/39)52.8% (28/53)0%(0/1)Cases that received mastectomy8.0%(11/138)20.5%(8/39)26.4%(14/53)100%(1/1)DCIS Grade3- 512- 631- 22Unk- 23- 162- 151- 5Unk- 33-252-201- 7Unk- 13- 02- 01- 1Unk- 0Cases with Necrosis50%(69/138)53.9%(21/39)62.3%(33/53)0%(0/1)Cases upgraded to Invasive Cancer12.3%(17/138)15.4%(6/39)35.9%(19/53)0%(0/1)ReceivedRadiation after lumpectomy85.0%(108/127)67.7% (21/31)76.3%(29/38)0%(0/1)ReceivedTamoxifen after lumpectomy34.7%(44/127)25.8%(8/31)31.2%(12/38)0%(0/1)Ipsilateral breastRecurrence after lumpectomy6.3%(8/127)0%(0/31)10.5% (4/38)0%(0/1)Follow up after lumpectomy (years)4.0(0-10.6)1.9(0.19-5.6)3.8(0.17-9.4)6.0 Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4122.
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