PS2-39: Evaluating Prevalence of Pathology Prognostic Indicators in a Cohort of Women Residing in Rural Pennsylvania (PA) Counties

Abstract

Mammography utilization gap has been significantly narrowed between urban and rural settings in recent years. Yet, evaluation of breast cancer incidence and mortality data suggest that women residing in rural areas in the US experience a higher incidence of breast cancer and shorter disease free and overall survival regardless of access to health care services. We have implemented a cohort study design to evaluate the pathologic prognostic indicators of breast cancer at the initial presentation of the disease and their association with shorter survival among women in rural PA. We identified women (n=550) diagnosed with their first primary invasive cancer between January 1, 2001 and December 31, 2007 from the Cancer Registry at Geisinger Health System (GHS). Pathologic, clinical and demographic data were retrieved from electronic health records. The mean age at the initial clinical presentation of the disease was 67(± 12.5). The majority, were diagnosed with either stages I and II, 58.6% and 26.8%, respectively. About 6.9% of women were diagnosed with stage III and 7.6% with stages IV. The proportions of women diagnosed with histologic grade 1, 2, and 3 were 31.8%, 41.7% and 26.5%, respectively. Assessment of the joint distribution of estrogen receptor (ER) and progesterone receptor (PR) yielded 58.6% as phenotypic positive for both receptors and, 26.8% as negative. The remaining 16.5% were discordant for the expression of hormone receptors. Sub-typing of breast cancer biomarkers by the three prognostic markers, ER, PR and HER 2/neu, yielded 69.7% as hormone receptor positive, epidermal growth factor negative; 7.5% as triple positive; 3.5% as hormone receptor negative, epidermal growth factor positive and 19.3% as triple negative. Preliminary findings from this ongoing research project suggest that the prevalence of triple negative breast cancer is higher in this population. Expression of other markers such as HER1, Viminetin, CK 5/6, P53 and E-Cadherin are also being evaluated. Context: Consensus guidelines recommend thiazides for first-line treatment in uncomplicated hypertension. Most patients require two or more drugs and little is known about the relative efficacy and outcomes of second-line treatments including thiazide. Objective: To compare differences in blood pressure, renal function and medical outcomes between commonly used two drug regimens, each including thiazide. Design: Retrospective cohort using data from a longitudinal electronic medical record. Setting: Large group medical practice. Patients: All patients >60 years treated for hypertension between 2001 and 2006. Main Outcome Measures: Changes in blood pressure and renal function, incident medical events, and time to failure indicated by an event or regimen change. Results: Of 47,419 patients, 6,534 received second -line therapy including thiazide for > 3 months. Thiazides + angiotensin converting enzyme inhibitors (ACE-I), and thiazides + potassium sparing diuretics (P S) were associated with the greatest reductions in systolic pressure, and t...