Mobile health units are increasingly utilized to address barriers to mammography screening. Despite the existence of mobile mammography outreach throughout the US, there is a paucity of data describing the populations served by mobile units and the ability of these programs to reach underserved populations, address disparities, and report on outcomes of screening performance. To evaluate the association of variables associated with outcomes for women undergoing breast cancer screening and clinical evaluation on a mobile unit. Retrospective analysis of women undergoing mammography screening during the period 2008–2010. Logistic regression was fitted using generalized estimating equations to account for potential repeat annual visits to the mobile unit. In total, 4,543 mammograms and/or clinical breast exams were conducted on 3,923 women with a mean age of 54.6, 29 % of whom had either never been screened or had not had a screening in 5 years. Age < 50 years, lack of insurance, Hispanic ethnicity, current smoking, or having a family relative (<50 years of age) with a diagnosis of cancer were associated with increased odds of a suspicious mammogram finding (BIRADS 4,5,6). Thirty-one breast cancers were detected. The mobile outreach initiative successfully engaged many women who had not had a recent mammogram. Lack of insurance and current smoking were modifiable variables associated with abnormal screens requiring follow up.
Purpose: Despite incidence rates that have been rising for decades, the molecular underpinnings that support the development of clear cell renal cell carcinoma (ccRCC) remain unclear. Herein, we evaluate expression levels of the hypoxia-induced autocrine survival factor endothelin-2 (EDN2) in patient-matched ccRCC and normal kidney samples.Methods: We identified 169 patients who underwent nephrectomy for histologically confirmed, localized ccRCC at our institution from 2000 to 2003 and had fresh-frozen tumor and normal kidney samples available. After mRNA was extracted from microdissected tissue, we conducted real time PCR to determine expression levels of EDN2. We normalized the expression data using four control genes and then fit linear mixed models to evaluate differential expression between tumor and normal samples. In addition, we explored potential interactions with relevant clinicopathologic characteristics including tumor stage and grade.Results: Of the 161 patients analyzed, 65% were male, 58% were stage pT1, and 43% were nuclear grade 1 or 2. Overall, EDN2 expression was higher in tumor samples compared to paired normal samples with an average fold change (FC) of 2.0 (P-value < 0.0001). This overexpression in tumor versus normal tissue was apparent in early stage (pT1) tumors but not later stage (pT2, pT3) tumors (FC of 2.9 v. 1.1 respectively; interaction P-value = 0.001). Similarly, over-expression was more pronounced in low grade (1, 2) tumors compared to high grade (3, 4) tumors (FC of 3.5 v. 1.3 respectively; interaction P-value = 0.0002).Conclusions: While independent validation is required, our patient-based data suggest that up-regulation of EDN2 is a common and early event in localized ccRCC. If confirmed in future studies, EDN2 could represent a target for the development of novel chemopreventive or neo-adjuvant therapeutics for ccRCC. Circulating 25-Hydroxyvitamin-D and Risk of Colorectal Adenomas and Hyperplastic PolypsAdams S, Newcomb P, Burnett-Hartman A, Mandelson M, Potter J Background: Colorectal adenomas are clear precursors of cancer; hyperplastic polyps have recently been hypothesized to also have malignant potential. However, these two distinct colorectal lesions are probably on different molecular pathways to neoplasia. An inverse association between vitamin D and adenoma risk has been reported, but this is the first study, to our knowledge, that examines circulating 25(OH)D in relation to risk of hyperplastic polyps.Methods: We conducted a colonoscopy-based casecontrol study of adenomas and hyperplastic polyps among 474 members of a large integrated health plan. Self-administered questionnaires provided data on demographics and colorectal polyp risk factors, and we as- Conclusions: There is no evidence in our study that the established inverse association between circulating 25(OH)D and colorectal adenoma applies to hyperplastic polyps.
Background: Breast cancer is the second most common cancer in women and the second leading cause of cancer death in the US. Women with a diagnosis of breast cancer have a risk of developing contralateral breast cancer of up to 11%. Despite lack of clear evidence supporting an increase in the rate of the procedure, rates of contralateral prophylactic mastectomy (CPM) increased dramatically in the past 10 years. Genetic predisposition to breast cancer is an indication for CPM, however it is inconsistently documented. We sought to explore the trends in CPM and variables associated with CPM and genetic counseling within a large healthcare system over a 15-year period. Methods: Retrospective review of CPM documented by the Network Tumor Registry period 1994 — 2008 performed within a four hospital health system in Louisville, KY. We calculated time trends of CPM as a proportion of mastectomy patients each year, and we analyzed clinical, pathologic, and demographic variables among mastectomy patients who underwent CPM compared to those who did not have procedure. Descriptive variables included: age, year of diagnosis, tumor grade, tumor stage, tumor size, tumor histology type, estrogen receptor status, progesterone receptor status, lymph node status, node dissection type previous cancer diagnosis, family history, menopausal status, use of immediate reconstruction, and type of insurance. Our statistical analysis included chi-square (x2), and odds ratios (OR) to determine differences among groups. We evaluated the prevalence and timing of genetic testing among CPM patients by matching CPM patient level data with a prospectively maintained genetic testing comprehensive database. CPM patient level data was matched with corresponding genetic counseling data to determine the trends in usage of genetic counseling. Results: During the study period, 2,496 women with stage I-III invasive breast cancer underwent mastectomy: 2,288 (91.7%) had unilateral mastectomy (UM) alone and 208 (8.7%) underwent UM and CPM. The proportion of all female mastectomy patients who had CPM increased from 0% in 1994 to 27.1% in 2008. Variables significantly associated with CPM were: Age under 65, immediate breast reconstruction, private insurance, family history of cancer and lobular tumor histology. Favorable tumor characteristics such as stage I and tumor size of < 1cm were associated with higher CPM rates, compared to > Stage I disease and tumors > 1cm. There was a statistically significant association with CPM and negative lymph nodes and a history of hormone use. No differences were found in UM vs. UM+CPM by race, ethnicity, tumor grade, ER/PR status or previous history of cancer. Among the 208 CPM patients, 44 (21.2%) received genetic testing and 6 (2.9%) were positive for BRCA mutations. Of the 44 women who received genetic testing, 5 (11.4%) did so prior to surgery. Conclusions: Performance of CPM was associated factors such as small tumor size and age <65 and private insurance. Genetic counseling was rarely used in the risk-assessment of potential CPM patients. Given the increasing frequency of this procedure, this warrants further investigation. Citation Information: Cancer Prev Res 2010;3(12 Suppl):B6.
Objective: To describe the initial outcomes of an incentive driven medical home and navigation program on preventive services among healthcare system employees.Methods: Quasi-experimental design examining participation, use of preventive services and adherence to medical guidelines and emergency room use in a five hospital integrated health system. Employees were required to complete a health risk assessment (HRA), visit a Primary Care Provider (PCP) and submit PCP visit screening and biometric results in order to be eligible for the financial incentives. Subsidized lifestyle change intervention and navigation programs were also offered to participants. Descriptive statistics and Chi Square were used to analyze results for the 5,435 employee participants and 3,623 non-participants during thee 1-year intervention.Results: Preventive care visits for participants increased by 35% compared to an increase of 3% for non-participants. Nonadherence to medical guidelines decreased 7% for participants and increased 18% for non-participants. Inappropriate emergency room use overall decreased from 20% to 14%.Conclusions: One year after introduction of the wellness program, preventive visits increased, compliance with medical care increased and inappropriate emergency room visits were reduced.
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