Higher Age-adjusted Incidence Research Articles

Multimorbidity of cardiovascular disease subtypes in a prospective cohort of 1.2 million UK women

ObjectiveCardiovascular multimorbidity (CVM) is the co-occurrence of multiple cardiovascular disease subtypes (CVDs) in one person. Because common patterns and incidence of CVM are not well-described, particularly in women, we conducted...

Incidence, mortality and survival of transitional cell carcinoma in the urinary system: A population-based analysis.

The goal of this study is exploring the disparity of incidence, mortality and survival outcome among transitional cell carcinomas (TCCs) in the 4 parts of urinary system. This study comprehensively evaluates these disparities using the Surveillance, Epidemiology, and End Results (SEER) (2000-2018) database. According to the SEER database, the urinary tract is divided into 4 parts: urinary bladder, renal pelvis, ureter, and urethra. The joinpoint regression was used to analyze the secular trend of incidence and incidence-based mortality (IBM). The Kaplan-Meier method with the log-rank test is performed to evaluate survival outcomes. The bladder TCC has the highest age-adjusted incidence and mortality rate compared with TCC in other 3 locations. A slight decrease in incidence is shown in the both bladder and urethra TCCs during 2000-2018. The age-adjusted mortality rate similarly presents an initial increase among 4 locations TCCs at the beginning of study period. The survival curves demonstrate that patients with bladder TCCs have better overall survival (OS) and cancer-specific survival (CSS), whereas those with renal pelvis TCCs have the worse OS and CSS. In addition, patients with bladder TCC have the highest 1-year, 3-year, 5-year relative survival rate, and those with renal pelvis TCC have the lowest. These disparities are especially essential when we explore tumor characteristics and treatment, extrapolated from the literature on bladder TCC for upper tract urothelial carcinoma (UTUC). Notably, patients with bladder TCC especially for localized stage have better survival outcomes than those with UTUC.

Weak Social Networks in Late Life Predict Incident Alzheimer's Disease: The Kuakini Honolulu-Asia Aging Study.

We assessed 10-year longitudinal associations between late-life social networks and incidence of all-cause dementia (ACD), Alzheimer's disease (AD), and vascular dementia (VaD) in Japanese-American men. We prospectively analyzed, from baseline (1991-1993) through 1999-2000, 2636 initially nondemented Kuakini Honolulu-Asia Aging Study participants who remained dementia-free during the first 3 years of follow-up. Global cognition was evaluated by the Cognitive Abilities Screening Instrument (CASI); depressive symptoms by the 11-item Center for Epidemiologic Studies Depression (CES-D) Scale; and social networks by the Lubben Social Network Scale (LSNS). Median split of LSNS scores defined weak/strong social network groups. A panel of neurologists and geriatricians diagnosed and classified dementia; AD and VaD diagnoses comprised cases in which AD or VaD, respectively, were considered the primary cause of dementia. Median (range) baseline age was 77 (71-93) years. Participants with weak (LSNS score ≤29) versus strong (>29) social networks had higher age-adjusted incidence (in person-years) of ACD (12.6 vs. 8.7; p = .014) and AD (6.7 vs. 4.0; p = .007) but not VaD (2.4 vs. 1.4; p = .15). Kaplan-Meier curves showed a lower likelihood of survival free of ACD (log-rank p < .0001) and AD (p = .0006) for men with weak networks. In Cox proportional hazards models adjusting for age, education, APOE ɛ4, prevalent stroke, depressive symptoms, and CASI score (all at baseline), weak networks predicted increased incidence of ACD (hazard ratio [HR] = 1.52, p = .009) and AD (HR = 1.67, p = .014) but not VaD (p > .2). Weak social networks may heighten the risk of dementia and AD, underscoring the need to promote social connectedness in older adults.

Spatial and temporal analysis of myocardial infarction incidence in Zanjan province, Iran

BackgroundMyocardial Infarction (MI) is a major important public health concern and has huge burden on health system across the world. This study aimed to explore the spatial and temporal analysis of the incidence of MI to identify potential clusters of the incidence of MI patterns across rural areas in Zanjan province, Iran.Materials & methodsThis was a retrospective and geospatial analysis study of the incidence of MI data from nine hospitals during 2014–2018. Three different spatial analysis methods (Spatial autocorrelation, hot spot analysis and cluster and outlier analysis) were used to identify potential clusters and high-risk areas of the incidence of MI at the study area.ResultsThree thousand eight hundred twenty patients were registered at Zanjan hospitals due to MI during 2014–2018. The overall age-adjusted incidence rate of MI was 343 cases per 100,000 person which was raised from 88 cases in 2014 to 114 cases in 2018 per 100,000 person-year (a 30% increase, P < 0.001). Golabar region had the highest age-adjusted incidence rate of MI (515 cases per 100,000 person). Five hot spots and one high-high cluster were detected using spatial analysis methods.ConclusionThis study showed that there is a great deal of spatial variations in the pattern of the incidence of MI in Zanjan province. The high incidence rate of MI in the study area compared to the national average, is a warning to local health authorities to determine the possible causes of disease incidence and potential drivers of high-risk areas. The spatial cluster analysis provides new evidence for policy-makers to design tailored interventions to reduce the incidence of MI and allocate health resource to unmet need areas.

PCN27 Real-World Characteristics and Outcomes of Patients with Metastatic Ductal Adenocarcinoma (MPDAC) Treated with Liposomal Irinotecan-Based Regimens By Race

Racial disparities persist in outcomes for patients with pancreatic cancer in the United States, with Black or African American patients having higher age-adjusted incidence and mortality than White patients. Similarly, results from the pivotal phase 3 study, NAPOLI-1, and recent literature suggest that participants of East Asian ethnic origin experience better outcomes than other ethnic groups with liposomal irinotecan+5-fluorouracil/leucovorin following gemcitabine. This study seeks to describe clinical characteristics and treatment outcomes based on race. This retrospective observational study utilized the Flatiron Health EHR-derived de-identified database from over 280 cancer clinics in the US. Data were analyzed for adult patients with mPDAC treated with liposomal irinotecan-based regimens between January 2015 and February 2020. Patients were stratified based on their self-reported race. Median overall survival (OS) from treatment initiation was derived using Kaplan-Meier analysis. Of the included 608 patients (median age 68 years (y), IQR: 61-74) with mPDAC and treated with a liposomal irinotecan-based regimen, 448 patients (73.7%) were White, 48 patients (7.9%) were Black or African American, 13 (2.1%) were Asian, and 99 (16.3%) were of other race or the data were missing. White patients had a median age at metastatic diagnosis of 69y (IQR: 61–74), Black patients, 64y (60-71), and Asian patients 65y (63-72). ECOG scores of 0-1 were reported for 61.6% of White patients, 58.3% of Black patients, and 61.5% of Asian patients. Overall, median OS was 4.7 months (95% CI: 4.2–5.4). Median OS was 4.6 months 4.1–5.6) among White patients, 3.8 months (3.1–5.6) among Black patients, and 12 months (3.4–NR) among Asian patients. This analysis found racial disparities may persist in survival outcomes among patients with mPDAC treated with liposomal irinotecan-based regimens. Further studies are needed to characterize and understand the biological and socio-economic factors contributing to these disparate outcomes.

Abstract PO-153: Triple negative breast cancer (TNBC) in Indiana: A population-based cohort study from the Indiana Cancer Registry

Abstract Background: TNBC has a poor prognosis compared to estrogen receptor (ER) and HER2 positive breast cancer, yet its etiology is unclear. Despite having a low incidence of all breast cancers, Indiana (IN) has a diverse socioeconomic, racial, concentrate urban/rural makeup, and thus provides a perfect study population to explore the etiology of TNBC through investigating the occurrence based on the geographical and demographical incidences in the state. Methods: Cancer registry data from the State Department of Health was used to examine the incidence, characteristics, and distribution of TNBC across the state of Indiana. TNBC cases were identified as those with negative ER, progesterone (PR), and HER2 status; whereas controls were positive for any of the three receptors. During 2010-2015, 19,267 invasive breast cancer cases had receptor status available for this analysis. Covariables such as age, tumor biology, and breast cancer subtypes were evaluated by multiple t-tests and chi-squared testing. To compare the occurrence of TNBC among different ages and races within a specific area, the 5-year Standard Incidence Ratio (SIR) was used and ratios over one signify the percentage above the expected number of cases. SIR was calculated by dividing observed cases by expected cases during the study period. To obtain the expected number of cases the highest NCI SEER all ages all race incidence rates 2000-2016 was used, as no state incidence rates for TNBC are available. Results: Indiana has 15% greater (p= 1.54E-13) incidence of TNBC compared to the nation. The age-adjusted incidence of TNBC broken down to the county level verified 59% of counties having rates above the national rate of 13.9. Nearly one third (28%) of TNBC incidence, were in Lake (Southeast of Chicago) and Marion (Indianapolis) counties. These are the most populated, urban, and racially diverse counties in IN. SIRs for both counties were remarkably higher than expected. Moreover, in Marion and Lake, the Black-specific SIR for TNBC was 1.4 (p=5E-6) and 1.7 (p=2.494E-8) while the Caucasian-specific SIR was 1.3 (p=1E-6) and 1.3 (p=9E-4). Analysis of specific zip codes within each county revealed clustered areas with extremely high SIRs, ranging from 2 to 238% above expected. Conclusion: Our results demonstrated significantly higher incidence rates of TNBC in Indiana. The highest age-adjusted incidence of TNBC was focused around urban, industrial, low income, heavily African American zip codes. This aligns with work by Downey et al which describes a highly significant 1.76 increased toxic concentration ratio exposure for Blacks compared to Whites in Indianapolis/Marion County (2007). Higher than expected ratios for both races implies that environmental exposures could be contributing to an increased incidence. This is the first study to show the geographical clustering of TNBC incidence, primarily around highly urban areas. Citation Format: Casey L. Bales, Fei Shen, Guanglong Jiang, Walker Nurrenbern, Jaqueline Flores, Bryan Schneider, Tim McFarlane. Triple negative breast cancer (TNBC) in Indiana: A population-based cohort study from the Indiana Cancer Registry [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-153.

Abstract B103: Racial and geographic disparities in stage of presentation in the colorectal cancer hotspot region of North Carolina

Abstract Background: Despite improvements in colorectal cancer (CRC) screening, treatment, and long-term outcomes, recent epidemiological studies have demonstrated that geographic disparities in CRC persist. Spatial mapping has identified distinct hotspots of increased CRC death rates, including 11 rural counties in eastern North Carolina (NC). The primary aim of this study was to (1) measure CRC incidence by stage in the NC hotspot and non-hotspot regions, and (2) determine if racial disparities exist in stage-stratified incidence and overall mortality rates by geographic region. Methods: CRC diagnosis and death data from 2008-2016 were obtained from the NC Central Cancer Registry and analyzed by hotspot and non-hotspot regions by summary cancer stage at diagnosis and race. The non-hotspot region was defined as 71 NC counties outside of eastern NC. Death rates (95% CI) were expressed per 100,000 person-years and age-adjusted to the 2000 U.S. standard population. Regional rates were calculated for the 8-year interval. Results: Within the hotspot region in eastern NC, the overall incidence rate of CRC is higher than non-hotspot NC [43.7 (95% CI 39.2-48.8) vs 38.4 (95% CI 37.6-39.2)]. Within the hotspot counties, overall incidence rates are higher among African American (AA) compared to White patients [51.1 (95% CI 43.4-59.9) vs. 39.1 (95% CI 33.6-45.4)], and this disparity persists across all stage categories. The incidence among AA and White patients with localized disease is 18.4 and 14.4, respectively; for regional disease, 16.7 vs. 13.9; and for distant disease, 11.4 and 7.8. Similar racial disparities in CRC incidence are also observed within the non-hotspot counties (localized 16.1 vs. 13.5, regional 15.2 vs. 13.5, and distant 11.3 vs. 7.8). CRC mortality rates in the hotspot counties are higher among both AA and White patients (21.7 and 15.5, respectively) compared to non-hotspot NC (19.1 and 12.8, respectively), although the absolute difference by race is similar (6.2 vs. 6.3, respectively). Conclusions: Patients residing within the 11 rural hotspot counties in NC have higher age-adjusted incidence of localized, regional, and distant CRC and higher mortality rates than patients in non-hotspot counties. Noteworthy racial disparities exist in both stage at presentation and mortality rates; however, absolute racial disparities appear similar in both geographic regions. Future work should investigate the underlying etiology for both increased CRC incidence and mortality among AA and White patients in the NC hotspot counties. Citation Format: Tyler Hinshaw, Suzanne Lea, Justin Arcury, Alexander A Parikh, Rebecca A Snyder. Racial and geographic disparities in stage of presentation in the colorectal cancer hotspot region of North Carolina [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B103.

The increasing incidence of colorectal cancer in younger patients in the United States: Who, what, when, and where?

1573 Background: Prior studies have shown an increase in the rate of colorectal cancer (CRC) in young individuals in the United States. However, few studies have evaluated the health disparities that exist in this population, particularly using large, national cohorts. We examined differences in age, race, stage, region, and tumor location in younger and older patients with CRC. Methods: Data were extracted from the United States Cancer Statistics (USCS) for individuals diagnosed between 2001 and 2014. CRC incidence data among individuals &lt; 50 years old were compared to those &gt; 50 years old. Age-specific and age-adjusted incidences and trend analyses reported as annual percent change (APC) were performed using SEER*Stat and Joinpoint regression. Results: Of 1,886,441 individuals, the overall age-adjusted incidence of CRC decreased from 52.59 (per 100,000) in 2001 to 35.22 in 2014, with an APC of -3.24. Although over 35% cases were diagnosed in the Southern United States, the Northeast had the highest age-adjusted incidence at 45.26 per 100,000 patients. Younger patients were diagnosed with distant disease at 25.8% compared to only 18.4% in older patients. Younger patients were also more likely to have sigmoid or rectal cancers compared to older patients (64.3% vs. 45.7%). Of the 170,244 individuals &lt; 50 years, 90,855 (53.4%) were men and 79,389 (46.6%) were women. The age-specific incidence in this younger cohort increased from 5.63 to 6.48 between 2001-2014, with an APC of +1.24 in 2001-2008 compared to +2.55 in 2012-2014. The incidence of CRC in patients aged 0-29, 30-39, and 40-49 years was 0.41 (per 100,000), 6.08, and 21.09, respectively. Black individuals &lt; 50 years had the highest age-specific incidence of CRC (7.16 per 100,000) compared to Asian (6.43), White (6.07), or Hispanic (4.76) individuals. Conclusions: Our data suggests that CRC is increasing in young patients, particularly for those between 40-49 years and Black individuals. In our younger cohort, CRC was more commonly found in the sigmoid colon and rectum compared to older patients. Further research is warranted to direct resources towards improved colonoscopy or sigmoidoscopy screening for younger patients at risk.

P043 FOCUSING ON THE FUTURE: REDUCING BARRIERS AND IMPROVING ACCESS TO IBD SPECIALTY CARE ACROSS CANADA

Abstract Background Inflammatory Bowel Disease (IBD) is a chronic immune-mediated disease which affects nearly two million North Americans, with Canada demonstrating the highest age-adjusted incidence and prevalence rates globally. Resulting from compounding prevalence rates, the IBD clinical burden continues to grow. With high demand and limited resources, timely access to specialty healthcare services continues to be a difficulty faced by both patients and healthcare providers. Despite this pervasive issue, there has been no published research to date elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across Canada. Aims The aim of the study was to elicit a qualitative stream of data to better understand phenomena related to access to healthcare for individuals living with IBD from a patient-centered perspective. Methods Patients diagnosed with IBD (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s &amp; Colitis Canada. To ensure geographic diversity and representation, patients were recruited from both urban and rural regions. In order to acquire multiple access perspectives, patients were invited to bring a family member who was involved in their care to the focus groups. Co-facilitated by a researcher and a patient research partner, the focus groups were held in seven provinces across Canada. All focus groups were audio recorded, transcribed verbatim, and coded for themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of patient experiences in relation to IBD care access. Results A total of 63 participants were recruited in fourteen focus groups across seven provinces. The majority of participants were female (41/63, 65%) and from urban/suburban regions (34/63, 54%). The mean age of participants was 48 years (SD=16 years, range=16 to 77 years). Preliminary analyses illustrated three patient-identified access barrier themes: 1) Lack of multidisciplinary care (psycho-social and nutrition support), 2) Diagnostic delay, and 3) Inability to effectively receive and provide communication with healthcare providers. In response, four solutions were proposed: 1) Integration of holistic care into the clinical practice, 2) Readily accessible psycho-social and nutritional support, 3) Increased patient advocacy, and 4) Continuity and liaison through provision of a healthcare navigator resource. Conclusions The complexity of specialty care access for IBD patients cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the significant impact these factors have on patients and the care received. Through the use of patient-centered exploration of barriers and facilitators, access to IBD specialty care in can be better understood and improved on both a provincial and national scale.

06 FOCUSING ON THE FUTURE: REDUCING BARRIERS AND IMPROVING ACCESS TO IBD SPECIALTY CARE

Inflammatory Bowel Disease (IBD) is a chronic, immune-mediated disease that affects approximately two million North Americans. Canada has the highest age-adjusted incidence and prevalence rates of IBD globally. Given its cumulative prevalence, the IBD clinical burden in North America continues to grow. Limitations in accessing specialty healthcare services is not a new issue facing patients and healthcare providers. Despite this persistent problem, no research elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across diverse geographic regions has been conducted. The aim of the current study was to elicit a qualitative stream of data to better understand phenomena related to access to healthcare for Canadians living with IBD from a patient-centered perspective. IBD patients (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s & Colitis Canada. Patients were recruited from both urban and rural locales to ensure adequate representation from geographically diverse regions. Focus groups provided a powerful and more naturalistic tool through which a focused understanding of the patient experience was derived. Co-facilitated by a researcher and a patient research partner, the focus groups were held in Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia. Patient demographics were collected to contextualize observed themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of patient experiences. Eastern Canadian focus groups have been completed, with recruitment underway for the Western Canadian focus groups. A total of 20 participants were recruited as of October 2018. The majority of participants were male (11/20, 55%) and were from urban/suburban regions (10/20, 50%). The mean age of participants was 44 years of age (SD=12 years, range=24 to 67 years). Preliminary analyses show that the main patient-identified barriers to accessing IBD care fall into the following categories: 1) Lack of multidisciplinary care (including psycho-social support), 2) Diagnostic delay, and 3) Inability to effectively receive and provide communication with healthcare providers. Solutions identified by patients included: 1) Integration of more holistic care into the clinical practice, 2) Readily accessible psychiatric and nutritional support, 3) Increased patient advocacy, and 4) Continuity and liaison through provision of a healthcare navigator resource. Healthcare access for IBD patients is complex. It is important to not only have a robust understanding of the healthcare system structure and processes but also the significant impact these factors have on patients. Access improvement research can be best tackled through patient-centered exploration of themes related to access to care.

06 FOCUSING ON THE FUTURE: REDUCING BARRIERS AND IMPROVING ACCESS TO IBD SPECIALTY CARE

Inflammatory Bowel Disease (IBD) is a chronic, immune-mediated disease that affects approximately two million North Americans. Canada has the highest age-adjusted incidence and prevalence rates of IBD globally. Given its cumulative prevalence, the IBD clinical burden in North America continues to grow. Limitations in accessing specialty healthcare services is not a new issue facing patients and healthcare providers. Despite this persistent problem, no research elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across diverse geographic regions has been conducted. The aim of the current study was to elicit a qualitative stream of data to better understand phenomena related to access to healthcare for Canadians living with IBD from a patient-centered perspective. IBD patients (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s & Colitis Canada. Patients were recruited from both urban and rural locales to ensure adequate representation from geographically diverse regions. Focus groups provided a powerful and more naturalistic tool through which a focused understanding of the patient experience was derived. Co-facilitated by a researcher and a patient research partner, the focus groups were held in Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia. Patient demographics were collected to contextualize observed themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of patient experiences. Eastern Canadian focus groups have been completed, with recruitment underway for the Western Canadian focus groups. A total of 20 participants were recruited as of October 2018. The majority of participants were male (11/20, 55%) and were from urban/suburban regions (10/20, 50%). The mean age of participants was 44 years of age (SD=12 years, range=24 to 67 years). Preliminary analyses show that the main patient-identified barriers to accessing IBD care fall into the following categories: 1) Lack of multidisciplinary care (including psycho-social support), 2) Diagnostic delay, and 3) Inability to effectively receive and provide communication with healthcare providers. Solutions identified by patients included: 1) Integration of more holistic care into the clinical practice, 2) Readily accessible psychiatric and nutritional support, 3) Increased patient advocacy, and 4) Continuity and liaison through provision of a healthcare navigator resource. Healthcare access for IBD patients is complex. It is important to not only have a robust understanding of the healthcare system structure and processes but also the significant impact these factors have on patients. Access improvement research can be best tackled through patient-centered exploration of themes related to access to care.

Uterine Corpus Malignancies in Appalachia Kentucky: Incidence, Survival, and Related Health Disparities.

Uterine cancer is the nation's most common gynecologic malignancy, but it is understudied in the geographically and socioeconomically diverse state of Kentucky (KY). Our aim was to assess the frequency, distribution, and survival of uterine corpus malignancies in KY, and specifically the differences between Appalachia (AP) and non-Appalachia (NAP) KY. This population-based cohort study used Surveillance, Epidemiology, and End Results data and the Kentucky Cancer Registry to study uterine corpus malignancy between January 1, 2000 and December 31, 2014. The analysis looked at the incidence between diagnoses in AP and NAP. The evaluation criteria included tumor histology (type I, type II, sarcoma, and mixed uterine malignancy), age, race, smoking status, stage at diagnosis, insurance status, and county of residence at diagnosis. The overall age-adjusted incidence rate and survival are similar for US and KY populations; however, histologic types and distribution differ. Compared with the United States, the incidence of corpus cancers in KY is higher for type I (P = 0.03), but lower for type II (P = 0.003), sarcoma (P = 0.006), and mixed (P < 0.001). AP KY has a higher incidence of type I (P < 0.0001) and mixed malignancy (P = 0.04), younger age at diagnosis (P < 0.0001), larger non-Hispanic white population (P < 0.0001), fewer smokers (P = 0.002), and more uninsured and Medicaid recipients (P < 0.0001) compared with NAP KY. The hazard ratio for death is similar in AP and NAP KY (0.896; 95% confidence interval 0.795-1.009). Type I and mixed uterine corpus cancers have a higher age-adjusted incidence and a younger age at diagnosis in AP compared with NAP KY.

The Value of BRCA 1 Gene Mutation in Patients with Breast Cancer

Introduction: Breast cancer (BC) is the most common malignant tumor in females in almost all of countries with highest age-adjusted incidence in developed countries (73%) and includes the 23% of all types of cancers. World Health Organization (WHO) report shows that this prevalence rising 2% per year. As a matter of fact, BC is responsible for most of deaths due to cancer in women all over the world. According to surveys which were globally conducted, the overall rate of BC is higher in American and European women compared to the Asian, and it may be related to the life style of Asian population. Aim of the work: Aim of this work was to determine the diagnostic value of BRCA1 gene mutations in female patients with breast cancer, also to correlate them with the presence or absence of family history of breast cancer and to allow identification of individuals at high risk. Patients and Methods: The study was carried on fifty women, included twenty-five female patients with breast cancer presented to Medical Oncology Department at Sohag University Hospital from 2015 to 2017, their age ranged from (25-70 years). Patients were diagnosed by clinical examination and confirmed by mammography and surgical biopsies; fine needle aspiration cytology (FNAC) or core needle biopsy (CNB) and CA15-3. Other twenty-five women were healthy control not relatives to the patients. Results: Our study suggested that the prevalence of BRCA 1 mutations is lower in Sohag Conclusion: Also, the low percentage of the 185delAG mutation in BRCA1 in BC suggested that is insufficient to justify screening in the Egyptian population. Our study suggested that the prevalence of BRCA 1 mutations is lower in Sohag. So, complete BRCA 1 genes sequence analysis might be required for identification of specific mutation in Egyptian.

Leveraging National Cancer Institute Programmatic Collaboration for Uterine Cervix Cancer Patient Accrual in Puerto Rico.

Women in the U.S. Commonwealth of Puerto Rico (PR) have a higher age-adjusted incidence rate for uterine cervix cancer than the U.S. mainland as well as substantial access and economic barriers to cancer care. The National Cancer Institute (NCI) funds a Minority/Underserved NCI Community Oncology Research Program in PR (PRNCORP) as part of a national network of community-based health-care systems to conduct multisite cancer clinical trials in diverse populations. Participation by the PRNCORP in NCI’s uterine cervix cancer clinical trials, however, has remained limited. This study reports on the findings of an NCI site visit in PR to assess barriers impeding site activation and accrual to its sponsored gynecologic cancer clinical trials. Qualitative, semi-structured individual, and group interviews were conducted at six PRNCORP-affiliated locations to ascertain: long-term trial accrual objectives; key stakeholders in PR that address uterine cervix cancer care; key challenges or barriers to activating and to enrolling patients in NCI uterine cervix cancer treatment trials; and resources, policies, or procedures in place or needed on the island to support NCI-sponsored clinical trials. An NCI-sponsored uterine cervix cancer radiation–chemotherapy intervention clinical trial (NCT02466971), already activated on the island, served as a test case to identify relevant patient accrual and site barriers. The site visit identified five key barriers to accrual: (1) lack of central personnel to coordinate referrals for treatment plans, medical tests, and medical imaging across the island’s clinical trial access points; (2) patient insurance coverage; (3) lack of a coordinated brachytherapy schedule at San Juan-centric service providers; (4) limited credentialed radiotherapy machines island-wide; and (5) too few radiology medical physicists tasked to credential trial-specified positron emission tomography scanners island-wide. PR offers a unique opportunity to study overarching and tactical strategies for improving accrual to NCI-sponsored gynecologic cancer clinical trials. Interview findings support adding and re-tasking personnel for coordinated trial-eligible patient referral, accrual, and treatment.

Patient Wait Time Recall Accuracy for Gastroenterology Specialty Consultation in Nova Scotia

BACKGROUND: Inflammatory Bowel Disease (IBD) is a chronic disease with lifelong health, social, and economic burden. The province of Nova Scotia (NS) has the highest age-adjusted incidence and prevalence rates of IBD in Canada, with Canada having the highest prevalence rates of IBD in the world. The Canadian Association of Gastroenterology guidelines suggest wait times between two and 16 weeks for those with active IBD symptoms. Despite these guidelines, a 2015 audit of the NS Health Authority revealed that 50% of IBD referrals were seen within 12 weeks and 90% of referrals waiting longer (up to two years). Long wait times can lead to increased anxiety, decreased quality of life, and reduction in patient satisfaction and overall health. Estimating wait times is complex but essential in order to evaluate access to specialty care. Aims: 1) To determine whether patients referred to GI specialty services in NS can accurately estimate the length of time between GP referral and first GI specialty appointment; 2) To examine demographic, disease-related, and system factors which may influence the accuracy of patient wait time estimates. METHODS: Questionnaires were distributed to patients following their appointment with a luminal GI or IBD nurse practitioner. Patients were asked to estimate their wait time for seeing a GI specialist. They were also asked to report on factors that could influence their wait time recall (geographic locale, age, employment status, completed education, disease severity, and relevant comorbidities). Completed questionnaires were returned and retrospective chart reviews were performed to validate the patients' responses. Descriptive analyses (means, standard deviations) on disease phenotype, complications and surgeries, current and past medication use, distance travelled to appointment, and perceived acceptability of wait times were completed. Spearman's correlations were run on wait time estimates and actual wait times to determine level of estimate accuracy. RESULTS: A total of 70 patients were prospectively enrolled as of July 2017. Forty-three (61.4%) patients were female, with an average age of 45.3 years (SD=20.3 years). When patients were asked to estimate their wait time between referral and seeing a GI specialist, they reported an average of 35.7 weeks. Following retrospective chart reviews, the patient estimates were shown to be conservative. In reality, records showed the average patient waited 39.8 weeks from the time the referral was sent to seeing a GI specialist. Spearman's correlation was used to determine the relationship between patient estimates and referral dates. There was a strong positive correlation between patient estimates and referral dates (rs=0.8, N=67, P<0.0001). CONCLUSION(S): This study is the first of its kind to look at the accuracy of patient recall of wait times for gastroenterology. The initial pilot data highlights the reality of excessive wait times in NS for patients seeking GI speciality care and suggests that patient wait time recall may be used to provide estimates of specialist wait times for patients with IBD. Future research will look at access to GI care using a healthcare systems mapping approach using patient recall to estimate perceived wait times to better inform clinical care pathways in the province.

Hypertension predisposes to the formation of saccular intracranial aneurysms in 467 unruptured and 1053 ruptured patients in Eastern Finland

Objective. Hypertension associates with subarachnoid hemorrhage from saccular intracranial aneurysm (sIA-SAH) when compared to matched controls or general population. Few series compare hypertension in unruptured sIA versus sIA-SAH, so its impact on the sIA disease remains uncertain.Methods. Kuopio sIA Database (www.uef.fi/ns) contains all cases of unruptured and ruptured sIAs admitted to Kuopio University Hospital from its Eastern Finnish catchment population. We compared the age-adjusted incidence of drug-treated hypertension in 467 unruptured and 1053 ruptured sIA patients admitted to Kuopio University Hospital from 1995 to 2007, using the national registry of prescribed medicines.Results. Antihypertensive medication was more frequent in the unruptured (73% versus 62%) with higher age-adjusted incidence. At sIA diagnosis, the sIA-SAH group had more often untreated hypertension (29% versus 23%). The size of unruptured sIAs increased with age at sIA diagnosis, independently of hypertension. Multiple sIAs, familial sIA, and sIA-SAH were not associated with hypertension in multivariate analysis. Results indicate that drug-treated hypertension associates with the formation of sIAs rather than their growth or rupture.Conclusion. Hypertension is highly prevalent in the carriers of unruptured sIAs when compared to those with ruptured sIA. Hypertension may associate with the sIA formation, and may predispose to the rupture of sIA if untreated.

Abstract 2552: A genome-wide association study of prostate cancer in West African men.

Abstract Age-adjusted mortality rates for prostate cancer are higher for Africa compared with North America or Western Europe. In addition, African American men are noted to have higher age-adjusted incidence rates of this malignancy than European American men. Coupled with the fact that West Africa is the principal ancestral region of African-American men has led to the hypothesis that there may exist distinct ancestral genetic profiles which mediate prostate cancer risk. In addition, advantages of conducting a genome-wide association study (GWAS) of prostate cancer in African men include a more discrete linkage disequilibrium (LD) structure, a higher number of private single nucleotide polymorphisms (SNPs), the predominance of symptomatic disease, and assessment of unique exposures. The Ghana Prostate Study was conducted collaboratively involving the US National Cancer Institute (NCI) and the University of Ghana during 2006-2012. The NCI Cancer Genomics Research Laboratory genotyped 494 prostate cancer cases and 498 population controls using the Illumina HumanOmni5-Quad BeadChip. Associations were assessed using multivariate logistic regression adjusted for age and genetic ancestry. We sought to validate the 30 most promising SNP associations with prostate cancer through the African American Prostate Cancer GWAS Consortium. A novel locus at 10p14 for prostate cancer risk was the strongest signal detected, and the 8 SNPs at this locus were in LD. This locus is located 360 kb 5’ of GATA3 and the 8 SNPs reside within an intron of LincRNA gene RP11-543F8.2. Analysis of African 1000 Genomes Project data did not indicate LD between 10p14 SNPs and splice or exonic SNPs of this gene, while HaploReg found no significant enrichment of enhancer elements. None of the most promising 30 SNPs replicated in the African American Prostate Cancer GWAS Consortium. This may be due to chance or differences in population genetics, environment, and/or proportion of symptomatic disease. Further genetic studies of prostate cancer in African men are needed to validate the 10p14 susceptibility locus. Citation Format: Michael B. Cook, Zhaoming Wang, Edward D. Yeboah, Andrew A. Adjei, Yao Tettey, Richard B. Biritwum, Evelyn Tay, Ann Truelove, Shelley Niwa, Lisa Chu, Meredith Yeager, Amy Hutchinson, Kai Yu, Christopher A. Haiman, African American Prostate Cancer GWAS Consortium, Robert N. Hoover, Ann Hsing, Stephen J. Chanock. A genome-wide association study of prostate cancer in West African men. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2552. doi:10.1158/1538-7445.AM2013-2552

Racial differences in patients with hepatocellular carcinoma: A large single-institution experience.

318 Background: Hepatocellular carcinoma (HCC) disproportionately affects minorities with higher age-adjusted incidence and mortality rates in Hispanics (H) and blacks (B) versus non-Hispanic whites (C). While H have the fastest rising rates of HCC of all ethnic groups per SEER analysis, little is known about race specific risk factors and disease characteristics. Methods: We retrospectively reviewed HCC patients (pts) treated at University of Illinois-Chicago between 1998 and 2005. Demographics, disease characteristics, treatment patterns, and survival were analyzed with descriptive statistics and chi-square p values. Results: Mean age of HCC pts (N=195) at diagnosis was 59.7 years + 9.8 (19.5% female; 22% aged 65 or older; 61.5% Medicare or Medicaid; 4.1% without insurance; 22.6% H; 31.2% B). Compared to C and B, H pts were more likely to have ascites and NASH and less likely to have ever smoked or have hepatitis C. Compared to B, H pts were more likely to have metabolic syndrome, diabetes, and encephalopathy (HE). Compared to C, B pts had lower MELD scores. Conclusions: In our patient population, Hispanic patients were significantly more likely to have diabetes and NASH, and lower frequency of tobacco use, HCV, and elevated AFP levels at diagnosis. [Table: see text]

The effectiveness of continuous subcutaneous insulin pumps with continuous glucose monitoring in outpatient adolescents with type 1 diabetes: A systematic review.

Review question/objective The review question is: Are metabolic outcomes improved in outpatient adolescents (aged 13 to 19 years) with type 1 diabetes on a Continuous Subcutaneous Insulin Infusion (CSII) when continuous glucose monitoring is used, compared to self-glucose monitoring alone? Types of participants This review will consider studies, which include adolescent patients, aged 13 to 19 years, in the outpatient setting with type 1 diabetes mellitus utilising a cutaneous subcutaneous insulin pump. Types of intervention(s)/phenomena of interest This review will consider studies, which evaluate continuous glucose monitoring compared to self-glucose monitoring alone, in adolescents utilising a continuous subcutaneous insulin infusion. Types of outcomes This review will consider studies, which include the following outcome measures: number of hypoglycemic episodes (glucose <70mg/dL) and haemoglobin A1C level.

Epidemiology of hip fracture in the elderly in Spain

Objective To describe the incidence and epidemiological characteristics of hip fracture (HF) in patients aged 65 years or over in the various autonomous regions (AR) of Spain from the year 2000 to 2002 and to determine which factors affect in-hospital mortality. Methods Retrospective, observational study including all patients aged > 65 years with acute hip fracture in the 19 AR of Spain from 2000 to 2002. Data were obtained from the National Record of the Minimum Basic Data Set of the Ministry of Health. We analyzed the following: incidence rates (crude and age- and gender-adjusted rates) and incidence of hospital admission by season, length of hospital stay and in-hospital mortality. We used regression analysis to identify the factors that influenced in-hospital mortality. Results There were 107,718 cases of HF in patients aged > 65 years; of these, 74% were women, with a mean age of 79 years (SD 14). The crude incidence rate for HF was 511 cases per 100,000 > 65-year-old patients per year (265 cases per 100,000 men and 688 per 100,000 women and year). Incidence adjusted for age and gender was 503 cases per 100,000 inhabitants per year. Catalonia had the highest age-adjusted incidence and Galicia the lowest (623 and 317 cases per 100,000 inhabitants per year, respectively). Incidence rates increased from spring (24.1%) to winter (25.8%). The mean length of hospital stay was 15 days (SD 13). Seasonal influence and length of stay varied greatly between autonomous regions. While the overall in-hospital mortality rate was 5.3%, the rate for males was double that of females (8.9% and 4.8%, respectively), and in-hospital mortality increased with comorbidity (each point on the Charlson index increased mortality by 34.5%) was higher in winter (11% more risk compared to warmer seasons) and in cold climate regions (15% more risk compared to regions with a warm climate, i.e.: Catalonia, Valencia, Murcia, Andalusia, Balearic Islands and Canary Islands). Conclusions Hip fracture mainly affects elderly women and presents great variability in incidence, seasonality, length of hospital stay and mortality between the different autonomous regions in Spain. Elderly male patients with severe comorbid conditions, who are admitted in winter and in cold climate regions are more at risk of in-hospital mortality.