Background The United States Preventive Services Task Force (USPSTF) endorses routine screening for genetic risk for breast/ovarian cancer as a component of primary healthcare. Implementation of this recommendation may prove challenging, especially in clinics serving disadvantaged communities. Methods We tested the feasibility of implementing the USPSTF mandate at a Federally Qualified Health Center (FQHC) in order to identify women eligible for genetic counseling (GC). A 12-month usual care phase was followed by a 12-month enrollment phase, during which cancer genetic risk assessment (CGRA) was systematically performed for all women age 25–69 years presenting for an annual exam. Women eligible for GC were recruited to participate in the study. Results After initiating CGRA, 112 women eligible for GC consented to study participation, and 56% of them received a referral for counseling from their PCP. A subgroup of 50 participants were seen by the same PCP during both the usual care and the enrollment phases. None of them were referred for counseling during usual care, compared to 64% after initiation of CGRA (p< 0.001). Only 16% of referred participants attended a GC session. Conclusion Implementing USPSTF recommendations for CGRA as a standard component of primary healthcare is feasible in FQHCs and improves referral of minority women for genetic counseling, but more work is needed to understand the beliefs and barriers that prevent many underserved women from accessing cancer genetic services.
IMPORTANCE Black women bear a disproportionate burden of breast cancer mortality in the US, in part due to inequities in the use of mammography. Population screening for breast cancer risk in primary care is a promising strategy for mitigating breast cancer disparities, but it is unknown whether this strategy would be associated with increased mammography rates in underserved women of racial and ethnic minority groups.OBJECTIVE To examine whether providing individualized breast cancer risk estimates is associated with an increase in the rate of screening mammography. DESIGN, SETTING, AND PARTICIPANTSA cohort study was conducted in women receiving individualized risk estimates as part of routine primary health care at federally qualified health centers in medically underserved communities in Chicago, Illinois. The study was conducted from
1. Bax is a very important pro-apoptosis molecule. HCT116/Bax(-/-) cells do not express the pro-apoptosis Bcl-2 family member, Bax. In the present study, the anticancer effects of gossypol on HCT116 and HCT116/Bax(-/-) cells were compared in terms of inhibition of cell growth, inhibition of colony formation and induction of apoptosis. 2. Following treatment with concentrations more than 20 micromol/L gossypol, only slight differences (not significant) were seen between HCT116 and HCT116/Bax(-/-) cells in terms of the inhibition of cell growth and induction of apoptosis. No difference was seen in the inhibition of colony formation. Gossypol had no effect at concentrations < 2 micromol/L. The only effective concentration of gossypol to result in differences between HCT116 and HCT116/Bax(-/-) cells was 5 micromol/L. However, even at this concentration, Bax deficiency did not result in complete abolition of gossypol-induced growth inhibition or apoptosis. Exposure of cells to 5 micromol/L gossypol for 24 h did not cause any significant difference in the activation of caspase 2 between HCT116 and HCT116/Bax(-/-) cells; however, activation of caspase 3, 8 and 9 was significantly elevated in HCT116 cells, with the effect on caspase 3 activation being the greatest, compared with HCT116/Bax(-/-) cells. 3. These findings suggest that the contribution of Bax to gossypol-induced growth inhibition and apoptosis is dose dependent and that gossypol-induced apoptosis requires activation of caspase 3, 8, and 9.
Hepatitis B virus (HBV) reactivation is a known complication of immunosuppressive therapy. While patients who are undergoing treatment with anti-CD20 agents or stem cell transplantation are commonly screened for chronic HBV infection prior to treatment, there are no consensus guidelines regarding HBV screening for patients undergoing chemotherapy for solid tumors. We present a rare case of fulminant liver failure due to HBV reactivation in a patient receiving chemotherapy for breast cancer. Our case highlights the importance of developing definitive guidelines regarding HBV screening in patients receiving chemotherapy for solid tumors and raises the question of the need for universal screening.
205 Background: Patients with chronic hepatitis B (HBV) who undergo chemotherapy without antiviral prophylaxis may develop HBV reactivation, hepatitis, liver injury, and even death. The University of Illinois Cancer Center (UICC) lacks a standardized guideline for screening patients for HBV prior to chemotherapy initiation. A retrospective chart review was conducted on chemotherapy orders submitted to UICC pharmacy over 4 weeks for both hematological and solid tumor malignancies. Of 63 new orders for intravenous chemotherapy, only 14 patients (22%) underwent HBV screening prior to chemotherapy initiation. We aimed to increase HBV screening from 22% to 50% over 2 months. Methods: A multidisciplinary taskforce comprised of hematology/oncology and hepatology physicians, clinical pharmacy, and nursing was created. An ideal process map was created identifying a clear management schema for HBV screening including differences in screening tests for various populations and management recommendations for positive test results. Two Plan-Do-Study-Act (PDSA) cycles were tested with post intervention data collected over eight weeks. Results: Of 192 chemotherapy orders submitted to outpatient pharmacy over 8 weeks, 62 patients (32%) were determined to be appropriate for HBV screening prior to initiation of chemotherapy. Of these, 36 patients (58%) were screened appropriately for HBV. Additionally, a subset analysis revealed 100% of patients successfully screened for HBV prior to initiation of anti-CD20 therapies. Conclusions: At UICC, a multidisciplinary team created and successfully piloted the implementation of a HBV screening policy in both hematological and solid tumor malignancies. Our initial aim was reached after 8 weeks of implementation, and ongoing efforts are being conducted to further improve HBV screening rates to 90%.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.