Risk Reduction Methods Research Articles

Assessing Venous Thromboembolism Risk in Critically Ill Children: A Report from the Children's Hospital-Acquired Thrombosis (CHAT) Consortium

Introduction Incidence of hospital-acquired venous thromboembolism (HA-VTE) in children has been increasing in the absence of proven effective preventative interventions. To decrease the incidence of HA-VTE, we must first identify children at the highest risk by creating a risk assessment model (RAM). Critically ill children, especially those with a central venous catheter (CVC), inflammatory condition and/or prolonged hospital stay have been identified as high-risk. To date, studies of HA-VTE in critically ill children have only been at single-center and have not been well-validated in diverse populations. The Children's Hospital-Acquired Thrombosis (CHAT) consortium established a large multicenter Registry to develop and validate pediatric RAMs for HA-VTE. This multicenter study aimed to derive a RAM for HA-VTE among critically ill children (RAM-ICU) performed upon admission/transfer to a pediatric intensive care unit (PICU). The CHAT Registry consists of retrospectively-identified, imaging confirmed cases of symptomatic HA-VTE and hospitalized controls (without HA-VTE) aged 0-21 years from eight U.S. centers. Controls were frequency-matched by year of admission and center. Details on demographics, medical history and hospital course were extracted from the medical record. For the RAM-ICU, only HA-VTE subjects and controls admitted/transferred into an ICU were included. Subjects who had a cardiac surgery up to 2 weeks prior to ICU admission were excluded. Fourteen variables that were present at or within 24 hours of ICU admission/transfer were evaluated by univariate logistic regression. These included demographics, medications, medical history, recent surgeries, mechanical ventilation, patient mobility and presence of a CVC. Those variables with p-values of <0.1 in univariate analyses were included in a multivariable logistic regression model. For the final model, variables with p-values of <0.05 were considered statistically significant. Results Out of 1172 HA-VTE cases and 952 controls in the Registry, 535 cases and 188 controls met inclusion criteria for the RAM-ICU. With discrepant subject distribution as expected due to previously reported increased incidence of HA-VTE in critically ill children. Median age was 0.8 years (IQR 0.1-10.2) for cases and 2.6 years (IQR 0.2-8.35) for controls. Fifty-eight percent of cases and 50% of controls were male. The Table presents the unadjusted analysis which revealed eight variables associated with HA-VTE (P<0.05): recent hospitalization (prior to current hospitalization), procedure with intravascular instruments within 24 hours of ICU admission, CVC present or placed within 24 hours of ICU admission, congenital heart disease, autoimmune disease or serious infection (includes autoimmune/inflammatory disorder, inflammatory bowel disease, juvenile rheumatoid arthritis, lupus, or major blood, organ or urinary infection), mechanical ventilation within 24 hours of ICU admission, and other past medical history (Table). Variables that remained statistically-significant, independent risk factors in an adjusted (multivariable) logistic regression included presence of a CVC (4.53; 95% CI=2.80-7.33), congenital heart disease (OR=2.32; 95% CI=1.42-3.78), and autoimmune disease or serious infection (OR=2.52; 95% CI=1.52-4.17) (Table). Conclusions With the increasing incidence of pediatric HA-VTE, there is an urgent need to identify children at high risk and incorporate risk reduction methods. The CHAT RAM-ICU represents the largest, multicenter pediatric study evaluating HA-VTE risk in children admitted/transferred to an ICU, with 535 HA-VTE cases and 188 controls. Recent placement of a CVC, congenital heart disease, and autoimmune disease or serious infection are significant, independent risk factors for HA-VTE in critically ill children. We will prospectively validate the RAM-ICU in a multicenter prospective study funded via the Hemophilia and Thrombosis Research Society. Disclosures Jaffray: CSL Behring: Research Funding. Mahajerin:Alexion: Speakers Bureau; Genentech: Consultancy, Speakers Bureau; Kedrion: Membership on an entity's Board of Directors or advisory committees; Spark: Speakers Bureau. Silvey:Genentech: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Bayer: Membership on an entity's Board of Directors or advisory committees. Croteau:Spark Therapeutics: Research Funding; Spark Therapeutics: Research Funding; Novo Nordisk: Consultancy, Honoraria, Research Funding; Novo Nordisk: Consultancy, Honoraria, Research Funding; Shire: Consultancy, Honoraria; Shire: Consultancy, Honoraria; CSL Behring: Consultancy, Honoraria; CSL Behring: Consultancy, Honoraria; Bayer: Consultancy, Honoraria; Bayer: Consultancy, Honoraria; Pfizer: Research Funding; Genentech: Consultancy, Honoraria; Pfizer: Research Funding; Octapharma: Honoraria; Genentech: Consultancy, Honoraria; Octapharma: Honoraria. Young:CSL Behring: Consultancy, Honoraria; Bioverativ/Sanofi: Consultancy, Honoraria; Freeline: Consultancy, Honoraria; Genentech/Roche: Consultancy, Honoraria, Research Funding; Grifols: Consultancy, Honoraria; Kedrion: Consultancy, Honoraria; Novo Nordisk: Consultancy, Honoraria; Spark: Consultancy, Honoraria; Shire/Takeda: Consultancy, Honoraria; Uniqure: Consultancy, Honoraria. Goldenberg:NIH: Other: research support and salary support.

TARGETED TOOL TO MEASURE DEMENTIA LITERACY IN PREVENTION AND TREATMENT AMONG SEXUAL AND GENDER MINORITY OLDER ADULTS

Dementia prevalence among sexual minority adults age 60+ in the US is approximately 7.4%. This represents over 200,000 sexual minority older adults living with Alzheimer’s disease (AD). Compared to the general aging population, LGBTQ older adults face unique challenges throughout their life-course that may increase exposure to risk factors associated with neurocognitive dysfunction and progression to dementia. Culturally-competent instruments to measure dementia literacy are needed to inform the design of targeted educational interventions for early diagnosis and improved health outcomes. We sought to develop and test a measure of dementia literacy in a community sample of LBGTQ older adults. Following a comprehensive analysis of existing scales, items were adapted resulting in a 35-item survey containing subjective and objective literacy measures. Participants were recruited through community centers in Washington, DC and Maryland. Forty LGBTQ older adults (50-80 years) completed the questionnaire. The analysis of these data was used to modify the original survey. A final 25-item questionnaire was administered to another sample of 50 individuals. 60% correctly identified dementia symptoms from vignettes. Nearly-half believed that dementia symptoms could be reduced by lifestyle changes and drug therapies. Commonly identified risks for dementia included aging, family history, genetics, stroke, and brain injuries. Frequently-endorsed methods for risk reduction included physical activity, intellectual/brain training and social activities. Education level, age, and socioeconomic variables were strongly associated with literacy. Most respondents did not associate cardiovascular/metabolic risk factors with dementia risk. Knowledge of risk factors underlying AD may help underserved populations close current health disparities gaps.

Reacting to negative online customer reviews

PurposeThe purpose of this paper is to investigate the effects of explanation and compensation, as specific accommodative management responses to negative online customer reviews, on potential customers.Design/methodology/approachThe scenario-based online experiment with 306 participants investigates the effects of explanation and compensation on potential customers’ purchase intentions in the hotel segment of the hospitality industry.FindingsThe results reveal that combining an explanation with compensation is the most effective management response; providing neither an explanation nor compensation is the least effective. The effects of management responses that entail providing only an explanation or compensation do not differ significantly.Research limitations/implicationsContinued research should investigate the effects of specific accommodative management responses in other service industries and other cultural settings and consider different kinds of explanations and compensation.Practical implicationsHotel managers in the hospitality industry should reply to negative online customer reviews by combining an explanation with compensation. Service providers that currently lack structures and procedures to identify service failures and their causes or that cannot take corrective actions should provide compensation. Service providers that currently have limited financial resources should provide explanations.Originality/valueThis study analyses the effects of explanation and compensation on potential customers’ purchase intentions. In addressing the effects on potential customers, instead of on complainants, the conceptual framework represents a novel combination of management responses from service recovery research with signalling theory, the search-experience-credence framework and risk reduction methods.

Discussing sudden unexpected death in epilepsy with children and young people with epilepsy and their parents/carers: A mixed methods systematic review

PurposeTo synthesise the quantitative and qualitative evidence on the views and experiences of children and young people with epilepsy (CYPwE), their family members/caregivers and healthcare professionals on conversations between healthcare professionals and CYPwE/caregivers about the possibility of sudden unexplained death in epilepsy (SUDEP). MethodsMixed methods systematic review in accordance with Joanna Briggs Institute methodology, PRISMA guidelines and guided by an a-priori protocol. Results656 potentially relevant studies were identified, 11 of which fulfilled the inclusion criteria for the review: 6 quantitative studies, 4 qualitative studies and 1 opinion/text article. Data synthesis resulted in the following 2 integrated findings: (i) Caregivers, and where appropriate CYPwE, should be provided with information on SUDEP and how it relates to them; (ii) Information on SUDEP should be delivered face-to-face, with supporting written information, by a suitably knowledgeable healthcare professional whom the caregiver/CYPwE feels comfortable with, at an appropriate time at or close to diagnosis. ConclusionThis review confirms that healthcare professionals should discus SUDEP with CYPwE and/or their caregivers at or around the time of diagnosis and that the discussion should include prevalence of SUDEP, risk factors and risk reduction methods relative to the individual concerned. Apart from delivering SUDEP information face-to-face, with written or online information provided to reinforce messages, there is a lack of evidence on “how” to impart this sensitive information. Further research exploring the most acceptable and effective methods of discussing SUDEP with CYPwE and their caregivers is therefore indicated.

Primary prevention of cardiovascular disease in South African women living with HIV.

The colliding epidemics of HIV and cardiovascular disease (CVD) are of great public health concern. People living with HIV (PLHIV) are more predisposed to CVD development as a result of a multitude of contributors. Women living with HIV (WLHIV) appear to be at a higher risk of developing CVD given a heightened immune activation and, in South Africa particularly, a higher body mass index compared with their male counterparts. The World Health Organization (WHO) has made recommendations for the provision of a CVD risk assessment for all PLHIV and has developed regional CVD prediction charts to identify PLHIV who may require primary prevention strategies by means of interventions such as the WHO Package of Essential Non-communicable Disease Interventions for primary health care in low-resource settings (WHO PEN). However, methods of risk prediction and risk reduction integrated strategies for atherosclerotic CVD in PLHIV such as the WHO PEN, particularly in women who may have sex-specific risk factors and culture-specific perceptions of body image, remain a major research gap in developing countries. Further research is crucial in guiding primary health care policy in South Africa.

Investigation of controlling factors on toxic metal leaching behavior in municipal solid wastes incineration fly ash.

Municipal solid wastes incineration (MSWI) fly ash has drawn worldwide attention for its substantial annual generation capacity and high toxic metals leachability. Although many factors have been shown to affect the leachability of metals in fly ash, the controlling factors, which guide the selection of appropriate risk reduction method, remain unclear. The purpose of this study was to evaluate the effects of the two most important factors, total metal content, and remaining alkaline substances of MSWI fly ash, on the leaching behavior of toxic metals. In this work, a series of leaching tests and sequential extraction procedures were performed for seven fly ash samples collected from one MSWI plant. Results show that particulate size distribution, morphology, and mineralogy of all samples are similar, indicating the effects of these properties on metal leaching behavior can be ignored. In leaching tests, although the leaching behavior in terms of metal species and concentration levels vary as expected, only the leachate Pb concentration in four samples (up to 17.32 mg/L) exceeds the threshold in Chinese regulation (0.25 mg/L). The variation of the leachate Pb concentration is not consistent with the change of the total Pb concentration in fly ash. Further correlation analysis evidences that the acid-soluble Pb, which is highly correlated to the calcium content of fly ash, dominates the concentration of leachate Pb. Notably, when the addition of lime is about 1.5 times over the theoretical value, the concentration of leachate Pb would exceed the threshold regardless of the total Pb concentration in fly ash. Overall, this study demonstrates that the remaining alkaline substances (mainly calcium-bearing compounds), rather than the total content of metals, are the controlling factor of metal leaching behavior in fly ash. Thus, strategies to delicately optimize the quantity of lime addition in acid gas purification process should be considered to minimize MSWI fly ash environmental risks in the future.

Small Nuclear Power Plants – Primary Avenue for Reducing Risks and their Consequences in Nuclear Power

The potential for improving safety and systems efficiency via unit power reduction of NPP in spite of an increase of the specific costs is investigated. An approach to significant reduction of the risk due to the human factor by switching to small- and medium-size power-generating units is considered. This approach can becharacterized as a method of risk reduction by means of ‘power insurance.’ The qualitative technical and economic effects from the reduction of different forms of risk in the implementation of small- and mediumsize NPP designs as compared with large NPP are analyzed: public acceptance; search for investors and their financial risk; availability of NPP sites; cost increase due to longer construction times; radiation and nuclear safety risks; electric power interruptions; minimization of the reserve power in the power system; and, adaptability to the rate of regional energy growth. Variants of the classification of integral risks over the entire life cycle of an NPP design are presented.

Економічна оцінка використання торгових стратегій на товарному біржовому ринку

Introduction. The development of the domestic economy largely depends on the stock sector. Exchanges are one of the key elements of the market mechanism. Their role is to establish links between producer and end consumer. Exchanges help to determine the objective market value of products, increase its competitiveness. The purpose of the research is to generalize the theoretical aspects of evaluating the use of trading strategies in the commodity exchange market. Results. The main shortcomings of the developed strategies of traders are highlighted. It is established that the influence of the trader is the most unpredictable factor in the process of forming and implementing strategies. The importance of keeping a trader's diary is noted. It was found that the trader reflects not quite the real situation in the process of keeping a diary. This reduces the level of objectivity of information. The structure is described and the method of filling in the trader's diary is considered. The role of keeping a transaction log for the trader is substantiated. The importance of risk management in the process of exchange trading is noted. The role of the decision-making mechanism is described in the trading stock market in conditions of uncertainty. The essence and stages of risk management strategy are determined. Price types of risks are characterized. Risk assessment methods are systematized. The main methods of risk management are given. Methods of risk avoidance, methods of risk reduction, methods of risk absorption and financing, methods of risk transfer are described. Emphasis is placed on the expediency of consistent use of these methods. Measures to minimize the degree of risk (diversification of assets, hedging and risk insurance, creation of reserves to cover risks) are identified. Conclusions. The development of traders' strategy should reduce risks in exchange activities. The formation of such a strategy takes into account many factors. It is proved that the use of risk management methods is the key to the effective operation of traders. The possible results from the introduction of such methods are described. Keywords: commodity exchange, trader, trading strategy, risk management, economic evaluation.

Domain-independent approach to risk reduction

The popular domain-specific approach to risk reduction created the illusion that efficient risk reduction can be delivered successfully solely by using methods offered by the specific domain. As a result, many industries have been deprived of efficient risk reducing strategy and solutions. This paper argues that risk reduction is underlined by domain-independent methods and principles which, combined with knowledge from the specific domain, help to generate effective risk reduction solutions. In this respect, the paper introduces a powerful method for reducing the likelihood of computational errors based on combining the domain-independent method of segmentation and local knowledge of the chain rule for differentiation. The paper also demonstrates that lack of knowledge of domain-independent principles for risk reduction misses opportunities to reduce the risk of failure even in a mature field like stress analysis. The domain-independent methods for risk reduction do not rely on reliability data or knowledge of physical mechanisms underlying possible failure modes and are particularly well suited for developing new designs, with unknown failure mechanisms and failure history. In many cases, the reliability improvement and risk reduction by using the domain-independent methods reduces risk at no extra cost or at a relatively small cost. The presented domain-independent methods work across unrelated domains and this is demonstrated by the supplied examples which range from various areas of engineering and technology, computer science, project management, health risk management, business and mathematics. The domain-independent risk reduction methods presented in this paper promote building products and systems characterised by high-reliability and resilience.

Nitrated meat products are associated with suicide behavior in psychiatric patients

There has been little previous study of the association between dietary factors and suicide. The association between food exposures and suicide attempt history was investigated in a sample of 270 individuals with schizophrenia, bipolar disorder, or major depressive disorder. Individuals who had a suicide attempt history were almost 3 times as likely to report eating cured meat, typically prepared with added nitrates, compared to patients without a suicide attempt history, adjusting for demographic and clinical variables. A suicide attempt history was 6 times greater in those who in addition were cigarette smokers and had a history of substance abuse compared to those who did not have any of these risk factors. If dietary factors were shown to affect suicide risk, an additional method of risk reduction would be available which could be widely disseminated to address this major public health problem.

ABOUT METHODS OF DECREASE IN FIRE HAZARD AT GAS STATIONS


 
 
 
 In article gas stations which are still subject to public appointment are considered and located in the territory of the cities and other settlements therefore the large number of people can get to a defeat zone at possible accidents, not being working personnel of an object. Ways and methods of risk reduction his rationality and expediency are also given at emergence of accident and prevention of its possible development.
 
 
 

Sperm viral decontamination: a juncture between prevention and risk minimization in the ART laboratory

The present report describes the transition of a technique designed for the removal of infectious pathogens from animal semen to a clinical application in human immunodeficiency virus-seropositive males requesting assisted reproductive technology treatment. The relevance and application of the decontamination technique in the present-day and emerging viral epidemics is questioned. The medical history and screening of a patient will verify the type and level of viral infection, and if viruses are attached and/or potentially internalized in the sperm cell of a carrier. The procedure will only be relevant as a risk-reduction method during assisted reproductive technology treatment if the viral infection/load is known, as applied to human immunodeficiency virus positive male patients at our Unit.

Identifying and reducing risks in functional endoscopic sinus surgery through a hierarchical task analysis.

ObjectiveTo develop a hierarchical task listing of steps required to perform successful Functional Endoscopic Sinus Surgery (FESS). To complete a technical and human factor analysis of tasks resulting in the identification of errors, frequency of occurrence, severity, and reduction through remediation.MethodsA triangulation of methods was used in order to derive the steps required to complete a FESS: 1) a literature review was carried out of published descriptions of FESS techniques; 2) observations of three FESS; 3) interviews with surgeons on FESS techniques. Data sets were combined to develop a task analysis of a correct approach to conducting FESS. A review by 12 surgeons, and observation of 25 FESS resulted in refinement of the task analysis. With input from five consultant surgeons and one consultant anesthetist, a Systematic Human Error Reduction and Prediction Approach (SHERPA) was used to identify the risks and mitigating steps in FESS.ResultsTen tasks and 49 subtasks required for a correct approach to completing FESS were identified based on literature review and expert consensus. A risk score for each subtask was calculated from a suitable risk matrix. Risk reduction methods at each subtask were detailed. High‐scoring subtasks were evaluated and varying strategies examined to reduce the likelihood and mitigate the impact of error. The study demonstrates the usefulness of the HTA and SHERPA approach in standardization and optimization of clinical practice in order to improve patient safety.ConclusionHierarchical Task Analysis and SHERPA are valuable tools to deconstruct expert performance and to highlight potential errors in FESS. The HTA and SHERPA approach to surgical procedures are useful learning and assessment tools for novice surgeons. The information derived offers the opportunity to improve surgical training and enhance patient safety by identifying high‐risk steps in the procedure, and how risk can be mitigated.Level of Evidence2c Outcomes Research

Meeting the Challenges of International Crises: The Experience of the Iranian Blood Transfusion Organization.

ABSTRACTCrises require a timely and well-prepared response by health services, especially those that are directly engaged with the lives of the patients such as blood services. The Iranian Blood Transfusion Organization as a single national authority of blood transfusion has left many crises behind. In this study, we examined the main international crises that the blood transfusion organization has faced during its 44-year history and objectively evaluated the methods for crisis risk reduction, both administrative and operational, all of which have led to fundamental advances in the organization. By proper planning and effective strategy setting, the Iranian Blood Transfusion Organization has managed to cope with international threats and in some cases has turned threats into opportunities to implement new, permanent administrative and operational strategies. It is not prudent for blood transfusion centers to develop their disaster risk reduction strategies on an individual-country basis in a world where global risk and crisis factors are rapidly increasing. Reduction of risk for blood transfusion centers must become a strategic priority nationally and globally. (Disaster Med Public Health Preparedness. 2019;13:410-413).

Quantitative risk assessment of offshore carbon dioxide injection system considering seismic effects

Quantitative risk analysis (QRA) is one of the most generally used safety analysis measures for risk management in process industries. Currently, earthquakes occur worldwide, resulting in significant damage. Despite the importance of considering the danger of earthquakes, however, seismic effects are often not included in risk analysis owing to difficulties in considering the multi-hazard nature and domino effects of earthquakes.In this study, an improved methodology for QRA was proposed to consider the seismic effects including domino effects, and multi-hazard impacts of an earthquake by using a Bayesian network (BN). This analysis was applied to a topside CO2 injection system for underground storage, which is susceptible to seismic effects. Because frequency analysis is based on a causal relationship, the BN can be used to simultaneously consider domino effects and multi-hazard risks. As a result, the societal risk integral, one of the factors in risk analysis, was 9.667×10-4/year in modified QRA; this value shows an increase of 3.9% compared with the societal risk integral in conventional QRA. Furthermore, the value can be increased to 35% in the sensitivity analysis depending on annual exceedance probability (AEP). This result shows the importance of considering seismic effects, including both the domino effect and multi-hazard impacts, in QRA. A risk reduction method was additionally applied to mitigate the process risk.

A surface runoff mapping method for optimizing risk assessment on railways

Railways are critical infrastructures for the transportation of people and goods and network failures must be controlled in order to maintain safety and to limit economic losses. The railway network is exposed to natural hazards and particularly to intense pluvial runoff. Due to the complexity of the phenomenon, management of risks induced by pluvial runoff raises technical and scientific issues. An innovative method for runoff susceptibility mapping, called IRIP for “Indicator of Intense Pluvial Runoff”, has been created and adapted to the railway context. The objective of this paper is to evaluate the relevance of the mapping method and to provide application advice. The mapping method is evaluated by comparison with the results of a hydraulic diagnosis, on a 20 km railway line, using quantitative and qualitative comparisons. On the basis of contingency tables, probabilities of detection (POD, railway sections exposed and detected by IRIP) and false alarm ratios (FAR, railway sections detected by IRIP whereas they are not exposed) are computed. POD range from 94 to 100% and FAR range from 20 to 26%. Then spatial information provided by the maps is compared with field observations and recommendations. It is shown that the mapping method can bring substantial contribution to risk identification and that the IRIP method can allow pushing forward the current risk reduction methods. Thus, the surface runoff maps open up new opportunities to manage surface runoff, such as targeting mitigation actions at the origin of the hazard in partnership with the other territory stakeholders.

Does stress increase risk of breast cancer? A 15-year prospective study.

The possible impact of stress on cancer incidence remains controversial. We prospectively evaluated associations between life event stressors, social support, personality characteristics (optimism, anger control, antiemotionality), and risk of developing primary breast cancer (BCa), in women at increased familial risk of BCa. A prospective cohort, repeated measures design was used. Recruitment was through the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer, which collects genetic, epidemiological, and clinical data from Australasian families with multiple BCa cases. Acute and chronic stressors for the prior 3years and psychosocial, clinical, and epidemiological variables were measured at cohort entry and at 3-yearly intervals. Cox proportional hazard regression analysis controlling for BCa risk factors and familial clustering was undertaken. The primary outcome was histopathologically confirmed BCa (invasive or ductal carcinoma in situ, including occult cases diagnosed during risk-reducing mastectomy). Of 3595 consecutive women invited to participate, 3054 (85.0%) consented. Of these, 2739 (89.7%) from 990 families (range 1-16 per family) completed at least 1 assessment point. During the study, 103 women were diagnosed with BCa. No stressor or psychosocial variable or interaction between them was significantly associated with BCa in unadjusted or adjusted models (total acute stressors HR=1.03 [0.99-1.08], P=.19; total chronic stressors HR=1.0 [0.90-1.11], P=.98). This study did not demonstrate an association between acute and chronic stressors, social support, optimism, antiemotionality or anger control, and BCa risk. Women should focus on proven methods of BCa risk reduction.

How the science of injury prevention contributes to advancing home fire safety in the USA: successes and opportunities

BackgroundIn the decades since the landmark report-America Burning-was published in 1973, the number of home fire deaths has shrunk from >5500 per year to 2650 in 2015. This paper: (1)...

Obesity, Metabolic Syndrome, and Breast Cancer: From Prevention to Intervention.

Obesity contributes to an estimated forty-percent, or 630,000 cases, of malignant neoplasms diagnosed in the United States[1] and higher body mass index (BMI) has been associated with at least seventeen types of solid tumors, including 9% of all breast cancer cases. In this review, we discuss the impact of obesity and consequences of obesity, including the metabolic syndrome and type 2 diabetes mellitus, on breast cancer risk and recurrence. Recent work has identified multiple molecular mechanisms that may underlie the association between obesity and breast cancer. In particular, insulin resistance, increased inflammatory cytokines, leptin signaling, and adipokine signaling have been shown to affect breast cancer risk and outcomes. While obesity is associated with higher breast cancer incidences and worse breast cancer outcomes, several risk reduction methods have been shown to attenuate these risks. Both metformin and statins have been shown to improve disease free survival and overall survival compared to non-users. Metformin also has been associated with lower risk of breast cancer incidence. Furthermore, increased physical activity and weight loss have been shown to decrease risk of breast cancer, especially in post-menopausal women. These studies have emphasized the potential impact that lifestyle changes can have on breast cancer risk and outcomes, and demonstrate the need for randomized control trials to evaluate the roles of metformin and statins for the treatment and chemoprevention of breast cancer.

Abstract P5-22-22: Breast tumor location in BRCA mutation carriers and implications for prevention

Abstract Introduction: Close to 65% of BRCA mutation carriers do not choose prophylactic mastectomy, despite their high breast cancer risk. Breast reduction mammoplasty is a surgical technique shown to reduce breast cancer risk and can be modified to target specific areas of the breast. We wondered if a majority of tumors in BRCA mutation carriers would be confined to one quadrant, allowing for the use of targeted cosmetic mammoplasty as a novel method of risk reduction. Methods: We reviewed imaging reports on 103 consecutive patients with BRCA mutations and invasive breast cancer, and categorized tumor location by quadrant. Tumors spanning >1 quadrant were classified as being in both. Bilateral cancers were counted separately. Categorical variables were compared with the chi-squaredtest. Results: Mean age at breast cancer diagnosis was 44 years with mean tumor size of 2.2 cm (0.1-7cm). 92% of tumors were invasive ductal carcinoma, 46% were hormone receptor positive, 10% Her2 positive, and 44% triple negative. 70% of the tumors were unicentric. Tumors were significantly more likely to be in the upper outer quadrant whether or not multicentric tumors were included in the analysis (p<0.00001). Her2 positive tumors were more likely to be multicentric than other subtypes (p=0.021). Conclusions: More than half of breast cancers in BRCA mutation carriers form in the upper outer quadrant, suggesting that removing this quadrant through breast reduction mammoplasty could significantly reduce breast cancer risk. For women who are not ready for prophylactic mastectomy, this data supports an intermediate risk reduction step instead of only offering surveillance. Citation Format: Hosseini A, Esserman LJ, Wallace AM, Au A, Mukhtar RA. Breast tumor location in BRCA mutation carriers and implications for prevention [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-22.