Cohort Of Young Women Research Articles

Abstract P5-16-16: Role of tumor microenvironment, as assessed by breast MRI background parenchymal enhancement (BPE), in modulating response to neoadjuvant chemotherapy in young women with localized breast cancer

Abstract Background: Neoadjuvant chemotherapy (NACT) is generally established as a therapeutic option for selected high-risk patients with localized breast cancer, including triple negative breast cancer (TNBC). On a patient level, achievement of pathologic complete response (pCR) at the time of surgery is associated with improved long-term outcomes and is considered to be a surrogate marker. Response to NACT is a complex phenomenon dependent on both host and tumor characteristics. While tumor characteristics, such as receptors and tumor grade, have been well studied as predictors of pCR, host characteristics to predict pCR have been less well studied. Background parenchymal enhancement (BPE) is an imaging characteristic that reflects the normal enhancement of the fibroglandular tissue on breast MRI, and could potentially modulate response to NACT by influencing the tumor microenvironment and vasculature. The aim of this study was to explore the ability of baseline BPE to predict pCR in a cohort of young women with localized breast cancer. Methods: A retrospective chart review was conducted of women ages 40 and under with stage II-III breast cancer treated with NACT at our institution from 2004 – 2014. Demographic, clinical, and pathological variables were extracted from the medical records. The primary outcome was achievement of pCR, defined as ypT0/is ypN0, after NACT. BPE pattern in the contralateral breast was obtained from pre-treatment breast MRI reports if available and otherwise was retrospectively determined by a breast radiologist blinded to patient outcomes. BPE was dichotomized as low (minimum and mild) vs. high (moderate and marked). Logistic regression was used for statistical analysis. Results: A total of 69 patients ages 40 and under received NACT for localized breast cancer during the study period and had available pre-treatment breast MRI images. Median age at diagnosis was 36 (range 27-40). The majority of patients had grade 3 (65.2%), ER+/HER2- (60.9%) tumors while 24.6% had TNBC. Among pre-treatment breast MRIs, 42 (60.9%) patients had minimum or mild BPE and 27 (39.1%) patients had moderate or marked BPE. The overall pCR rate was 39%. After controlling for tumor grade, ER status, HER2 status, clinical stage, and type of NACT, high baseline BPE was associated with a trend towards higher odds of achieving pCR compared to low BPE (OR = 1.49, 95% CI 0.47–4.71), though statistical significance was not reached (p = 0.50). When stratified by ER status, the relationship was stronger among the ER+ subset (OR 1.8, p = 0.49) compared to the ER- subset (OR 1.3, p = 0.78). Conclusions: A statistically significant association between high baseline BPE and achievement of pCR was not found in this limited sample size, but a trend towards higher pCR rates, particularly with ER+ tumors, was seen. While tumor factors have traditionally been used to predict pCR, BPE is a readily available MRI imaging characteristic that reflects the tumor microenvironment and may be useful in building a model that incorporates tumor factors along with host factors to develop personalized NACT regimens for young women with breast cancer. Citation Format: Spring L, Rutledge G, Yala A, Haddad S, Specht M, Moy B, Barzilay R, Lehman C, Bardia A. Role of tumor microenvironment, as assessed by breast MRI background parenchymal enhancement (BPE), in modulating response to neoadjuvant chemotherapy in young women with localized breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-16.

Abstract P4-19-07: Fertility concerns in young women after diagnosis of breast cancer: Experience of a breast cancer unit in México

Abstract Background Nearly 30% of all new breast cancer diagnoses occur in pre-menopausal women and about 7% of diagnoses occurring in women aged 40 years or less. Breast cancer treatment can increase the risk of early menopause and infertility. It is the major source of distress and concern form many young breast cancer patients who have no finished their families and have plans for childbearing. Methods As part of multidisciplinary approach in the Breast Cancer Unit at Centro Oncologico Estatal ISSEMYM an evaluation psychosocial aspects of sexuality, fertility and menopause after diagnosis of breast cancer has been implemented. We conducted an exploratory study to better understand fertility concerns, the role of fertility in the treatment decisions and chemotherapy acceptance in a cohort of young women newly diagnose breast cancer evaluated in a Breast Cancer Unit. We invited eligible women to participate, fertility concerns was the primary end point Results A total of 52 women were evaluated. Of these, we exclude 2 patients they have stage IV disease at re staging. Thus 50 women were included in the analyses. Median age at diagnosis was 36 years (range 23 to 40 years). 86% had children already at the time of breast cancer diagnosis. Only 4 participants (8%) reported that before their breast cancer diagnosis, they wanted to have future or additional children. Whereas forty six (92 %) did not. Of these patients 85% don't want to have children because of prior decision and 20% because fear of cancer recurrence. Forty nine patients would agree to receive chemotherapy (98%) and 51% would accept a risk of infertility of 76-100%. This acceptance was dependent on already having children. 68% would accept it only for ≥20% gain in cure. Conclusion Our study represents one of the first prospective evaluations of fertility concern in young women with recently diagnosed breast cancer in a Public Hospital in México. For the majority of young patients with breast cancer, cure remains their first priority. Most of the women have child before diagnosis and only 8% want to have additional children. Citation Format: Campos-Gomez S, Campos-Gomez KA, Ovando-Trujillo A, Palacios-Gutierrez F. Fertility concerns in young women after diagnosis of breast cancer: Experience of a breast cancer unit in México [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-19-07.

Risk of luteal phase pregnancy with any-cycle-day initiation of subdermal contraceptive implants

ObjectivesTo determine rates of luteal phase pregnancy (LPP) in young women initiating subdermal implants on any day of the menstrual cycle. Study designWe assessed a retrospective cohort of young women receiving contraceptive implants at an adolescent Title-X clinic. Patients with negative pregnancy tests were eligible for same-day insertion, regardless of cycle day, contraceptive use, or last intercourse. We computed LPP rates for those within manufacturer guidelines for insertion (≤5 days of menstrual onset or ≤7 days post-discontinuing hormonal contraception) and outside these guidelines. We reviewed medical records for last menstrual period (LMP), current hormonal contraception, emergency contraception (EC) provision, and pregnancy tests ≤12 weeks post-implant placement, or later evidence of pregnancy. For patients with positive pregnancy tests or reports, we used standard obstetrical dating (LMP and ultrasound) to determine if conception occurred ±2 weeks of implant placement. ResultsOf 3180 insertions, 1868 (58.8%) were outside recommended guidelines. Women with insertions within-guidelines were older (20.2 vs. 19.3 years; p<0.001) and more likely to be white (40.4% vs. 29.5%; OR=1.6, 95% CI: 1.4–1.9). Definitive pregnancy data was documented for 1726 patients: 660 (50.3%) in the within guidelines group, and 1066 (57.0%) in the outside guidelines group. Rates of LPP were 0.3% (2/660; 95% CI=0.0–1.1%) in the within guidelines group and 0.9% (10/1066; 95% CI=0.5–1.7%) in the outside guidelines group. ConclusionThe risk of LPP following any-cycle-day insertion of contraceptive implants with negative pregnancy testing is low, regardless of menstrual cycle timing, recent contraceptive use or use of EC. ImplicationsAdopting a protocol of contraceptive implant placement that includes insertion on any cycle day with a negative pregnancy test, and EC as indicated, does not increase the risk of luteal phase pregnancies, even in a young population with complex reproductive behaviors and challenging historical narratives.

Alcohol consumption over time and mortality in the Swedish Women’s Lifestyle and Health cohort

BackgroundAlcohol consumption is steadily increasing in high-income countries but the harm and possible net benefits of light-to-moderate drinking remain controversial. We prospectively investigated the association between time-varying alcohol consumption and...

Pre-natal exposures and breast tissue composition: findings from a British pre-birth cohort of young women and a systematic review.

BackgroundBreast density, the amount of fibroglandular tissue in the adult breast for a women’s age and body mass index, is a strong biomarker of susceptibility to breast cancer, which may, like breast cancer risk itself, be influenced by events early in life. In the present study, we investigated the association between pre-natal exposures and breast tissue composition.MethodsA sample of 500 young, nulliparous women (aged approximately 21 years) from a U.K. pre-birth cohort underwent a magnetic resonance imaging examination of their breasts to estimate percent water, a measure of the relative amount of fibroglandular tissue equivalent to mammographic percent density. Information on pre-natal exposures was collected throughout the mothers’ pregnancy and shortly after delivery. Regression models were used to investigate associations between percent water and pre-natal exposures. Mediation analysis, and a systematic review and meta-analysis of the published literature, were also conducted.ResultsAdjusted percent water in young women was positively associated with maternal height (p for linear trend [p t] = 0.005), maternal mammographic density in middle age (p t = 0.018) and the participant’s birth size (p t < 0.001 for birthweight). A 1-SD increment in weight (473 g), length (2.3 cm), head circumference (1.2 cm) and Ponderal Index (4.1 g/cm3) at birth were associated with 3 % (95 % CI 2–5 %), 2 % (95 % CI 0–3 %), 3 % (95 % CI 1–4 %) and 1 % (95 % CI 0–3 %), respectively, increases in mean adjusted percent water. The effect of maternal height on the participants’ percent water was partly mediated through birth size, but there was little evidence that the effect of birthweight was primarily mediated via adult body size. The meta-analysis supported the study findings, with breast density being positively associated with birth size.ConclusionsThese findings provide strong evidence of pre-natal influences on breast tissue composition. The positive association between birth size and relative amount of fibroglandular tissue indicates that breast density and breast cancer risk may share a common pre-natal origin.Electronic supplementary materialThe online version of this article (doi:10.1186/s13058-016-0751-z) contains supplementary material, which is available to authorized users.

Which female cancer patients fail to receive fertility counseling before treatment in the state of Georgia?

To assess which characteristics are associated with failure to receive fertility counseling among a cohort of young women diagnosed with cancer. Population-based cohort study. Not applicable. A total of 1,282 cancer survivors, of whom 1,116 met the inclusion criteria for the analysis. None. The main outcome in this study was whether or not women reported receiving any information at the time of their cancer diagnosis on how cancer treatment might affect their ability to become pregnant. Forty percent of cancer survivors reported that they did not receive fertility counseling at the time of cancer diagnosis. Women were more likely to fail to receive counseling if they had only a high school education or less or if they had given birth. Cancer-related variables that were associated with a lack of counseling included not receiving chemotherapy as part of treatment and diagnosis with certain cancer types. Counseling about the risk of infertility and available fertility preservation options is important to cancer patients. Additionally, counseling can make women aware of other adverse reproductive outcomes, such as early menopause and its associated symptoms. Less-educated women and parous women are at particular risk of not getting fertility-related information. Programs that focus on training not just the oncologist, but also other health care providers involved with cancer care, to provide fertility counseling may help to expand access.

Introduction to Special National Longitudinal Surveys Issue

ThisspecialissueoftheJournalofMarriageand Family celebrates 50 years of the National Longitudinal Surveys. In 1964, Professor Herbert Parnes wrote a proposal for a five-year longitudinal study to interview men approaching retirement age to describe their employment patterns as they neared the completion of their careers and to ascertain their plans for retirement. Thus began the first U.S. National Longitudinal Survey (NLS): the NLS Cohort of Older Men. The first interview took place on April 11, 1966, and in the 50 years since, seven different longitudinal surveys that make up the National Longitudinal Surveys have collectively interviewed close to 54,000 respondents with approximately 730,000 interviews.The NLS Older Men's cohort consisted of 5,020 men born between 1906 and 1921 who were between ages 45 and 59 and living in the United States when first interviewed in 1966. They were therefore born during a span of years when the first traffic light was introduced into the United States and average life expectancy for men was around 48 years, and it was a time of new innovations with expanding railways and early airplanes. These men ended up being interviewed 13 times during the next 24 years rather than 5, with a final interview occurring in 1990 when they were 71 to 83 years old.In the following year, 1967, a sample of 5,083 Mature Women born between 1922 and 1937 was drawn to study the return of women to the labor force as their children grew up and to investigate how women balanced the roles of homemaker, mother, and labor force participant. These women were born during a 15-year span when the Equal Rights Amendment was first introduced in the U.S. Senate, sliced bread was launched, Wall Street crashed, the Mickey Mouse comic strip debuted, and the Empire State Building opened in New York City. A total of 22 surveys were undertaken with these women, with their first interview at ages 30 to 44 and their last interview in 2003 at ages 63 to 77.Two cohorts of younger people were also initiated around the same time. Started in 1966 was the Young Men's cohort, which consisted of 5,225 males born between 1941 and 1952 who were ages 14 to 24 when first interviewed. This was a sample intended to chronicle the employment patterns of men transitioning from school and making initial career and job decisions that would impact their employment in the decades to follow. Twelve interviews were conducted between 1966 and 1981 when the study ended. Originated 2 years later in 1968 was the Young Women's cohort, which was made up of 5,159 females also ages 14 to 24 as they were completing school, making career and job decisions, and starting families. Twenty-two interviews were undertaken with this cohort, which ended in 2003. To place them in historical context, members of these two cohorts were born during years when M&Ms and slinky toys were created, Mount Rushmore was completed, Korea was divided into North and South, the United Nations and UNICEF were founded, Polaroid cameras were invented, the State of Israel was founded, the first organ transplant was undertaken, and color television was introduced. We hope that we may be able to reinterview members of both of these younger cohorts in the future.Then there are the three cohorts that are still ongoing. The first is the 1979 National Longitudinal Survey of Youth (NLSY79), which comprised a sample of 12,686 men and women born between 1957 and 1964 who were selected to replicate the NLS of Young Women and Young Men cohorts and designed to help researchers and policy makers evaluate the expanded employment and training programs for youths legislated by the 1977 amendments to the Comprehensive Employment and Training Act. These late baby boomers were born during the years when Alaska and Hawaii became the final two U.S. states admitted to the union, hula hoops became a national fad, and John Glenn became the first American to orbit the Earth.Originally there were oversamples of Blacks, Hispanics, poor Whites, and military youth in the NLSY79, although most military oversample cases and the economically disadvantaged non-Black, non-Hispanic oversample had to be dropped later on due to a lack of funds. …

Correlation between viral load, multiplicity of infection, and persistence of HPV16 and HPV18 infection in a Dutch cohort of young women

BackgroundPersistent high-risk human papillomavirus infection precedes the development of cervical cancer. Here we evaluated the contribution of HPV16/18 viral load and the presence of infections with multiple HPV types to persistence and clearance of HPV16/18 infections. MethodsVaginal self-swabs were obtained from young women (16–29 y) with one year interval. HPV genotyping was performed using the highly sensitive SPF10-DEIA-LiPA25 system. HPV16/18 DNA loads were quantified via an adapted, highly sensitive qPCR protocol targeting the L1 gene. ResultsWe identified 227 HPV16 and 111 HPV18 infections with follow-up. For HPV16 132/227 (58%) were persistent and 95/227 cleared. For HPV18 49/111 (44%) infections were persistent and 62/111 cleared. Baseline viral load was significantly higher in persistent infections than in clearing infections for both HPV16 (p=0.022) and HPV18 (p=0.013). At baseline, only HPV16 viral load was significantly higher in multiple HPV infections compared with single infections (p=0.003). In logistic regression analysis HPV16 and HPV18 viral load were found to contribute to persistency with OR=1.279 (95%CI=1.074–1.524) and OR=1.256 (95%CI=1.028–1.533) per log-unit increase HPV16 and HPV18 viral load respectively. The presence of multiple HPV type infections was not associated with higher persistency. ConclusionHPV16/18 viral load might be used as a marker for persisting infections and is affected by the presence of multiple HPV infections. Evaluation of these parameters at the population level may be of value to assess the presence of persistent or clearing HPV16/18 infections as an early marker, and may provide useful quantitative information in (epidemiological) vaccine monitoring studies.

Improving Vitamin D Status and Related Health in Young Women: The Safe-D study - Part B.

BackgroundVitamin D deficiency is highly prevalent and associated with increased risk of a number of chronic health conditions including cardiovascular disease, poor bone and muscle health, poor mental health, infection, and diabetes. Vitamin D deficiency affects millions of Australians, potentially causing considerable suffering, economic loss, and mortality.ObjectiveTo measure the effectiveness of a (1) mobile-based app (behavioral) and (2) pharmacological intervention to increase circulating 25-hydroxyvitamin D (serum 25 OHD) levels and health outcomes over 4 months of intervention compared with usual care in a cohort of young women with suboptimal serum 25 OHD levels (25-75 nmol/L).MethodsParticipants with 25 OHD levels 25 to 75 nmol/L are invited to participate in this study. Participants are randomized to one of three groups in 1:1:1 ratio: a mobile phone–based application, vitamin D supplementation (1000 IU/day), and a control group. Data collection points are at baseline, 4, and 12 months post baseline with the major endpoints being at 4 months. A wide-range of information is collected from participants throughout the course of this study. General health, behavioral and demographic information, medications, smoking, alcohol and other substance use, health risk factors, nutrition, eating patterns and disorders, and mental health data are sourced from self-administered, Web-based surveys. Clinical data include anthropometric measurements, a silicone skin cast of the hand, cutaneous melanin density, bone mineral density, and body composition scans obtained through site visits. Main analyses will be conducted in two ways on an intention-to-treat (ITT) basis using the last observation carried forward approach as an imputation for missing data, and on a per protocol basis to compare the intervention arms against the control group at 4 and 12 months.ResultsPublication of trial results is anticipated in 2017.ConclusionsThe study will allow assessment of the effects of a mobile-based app behavioral intervention and vitamin D supplementation on vitamin D status and will evaluate the effects of improving vitamin D levels on several health outcomes.

Abstract P4-10-04: Employment trends in young women following a breast cancer diagnosis

Abstract Background: Workplace concerns are particularly salient for young women with breast cancer (BC), and a cancer diagnosis (dx) and treatment may affect their careers. We sought to evaluate the perceived impact of dx on employment, describe job changes, and identify factors associated with transition out of the workforce after dx of BC at a young age. Methods: As part of an ongoing, multi-center cohort of young women diagnosed with BC at age ≤ 40, we surveyed women with early-stage BC about their pre- and post-dx employment status. Additional items assessed socio-demographic and treatment information; tumor characteristics were ascertained via pathology and medical record review. We used logistic regression to identify predictors of transitioning from pre-dx employment to unemployment at 1 year after dx. Among women employed 1 year after dx, we evaluated job satisfaction, perceived impact of dx on job performance, accommodations made by employers, and perceived likelihood of employment in the future. Results: 76% of women (555/730) were employed both before dx and at 1 year; 13% were not employed at either time point; 7% were employed pre-dx but unemployed at 1 year; 4% were not employed prior to dx but reported employment at 1 year. Among women employed 1 year after dx, 74% (427/581) were somewhat or completely satisfied with their job. Only 6% said cancer or treatment limited their ability to perform their job quite a bit or very much; 38% said their ability was affected a little bit. Most (63%) said their employers had made accommodations for them, and almost all women (93%) said it was very likely they would be working in 1 year. In multivariable analyses (Table 1), women with stage 3 disease (vs. stage 1), were more likely to transition out of the workforce following dx, while women with a college or graduate degree (vs. no college degree) were less likely to transition out. Conclusion: Most young women with early stage BC remain employed and report a willingness by their employer to make accommodations following a breast cancer dx. While few women reported that their dx or treatment limited their job performance, the finding that women with more advanced disease were more likely to transition out of the workforce suggests an impact of dx/treatment burden on employment. Women without a college degree were also at risk for unemployment post-dx, suggesting that job type, socioeconomic status, and environment affect employment outcomes. Attention to these subgroups of women is warranted to ensure that they are sufficiently supported given the potential adverse psychosocial and financial impacts of unemployment on patients, families, communities, and society. Table 1. Multivariable analysis of factors associated with transition out of workforce 1year post-dx (N=634) OR (95% CI)Stage (ref=1) 04.52 (0.60-33.85)21.11 (0.48-2.58)34.05 (1.53-10.72)*White non-Hispanic (ref=non-WNH)1.47 (0.56-3.81)College graduate (ref=no college degree)0.44 (0.22-0.90)*Married/Living as married (ref=unmarried)0.95 (0.43-2.08)Parous (ref=nulliparous)1.75 (0.83-3.69)Age at diagnosis (years)0.98 (0.90-1.06)Mastectomy (ref=lumpectomy)1.74 (0.75-4.05)Endocrine therapy (ref=none)0.75 (0.41-1.39)Chemotherapy (ref=none)5.20 (0.93-29.22)Radiation (ref=none)1.38 (0.64-2.96)*p&amp;lt;0.05 Citation Format: Partridge AH, Rosenberg SM, Rajagopal PS, Ruddy KJ, Tamimi RM, Schapira L, Come S, Borges V, Gelber S. Employment trends in young women following a breast cancer diagnosis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-10-04.

Education stalls and subsequent stalls in African fertility: A descriptive overview

Background: Recent stalls in fertility decline have been observed in a few countries in sub-Saharan Africa, and so far no plausible common reason has been identified in the literature. This paper develops the hypothesis that these fertility stalls could be associated with stalls in the progress of education among the women of the relevant cohorts, possibly resulting partly from the Structural Adjustment Programs (SAPs) of the 1980s. Methods: We descriptively link the change in the education composition of successive cohorts of young women in sub-Saharan Africa and the recent fertility stalls. We use reconstructed data on population by age, gender, and level of education from www.wittgenstein centre.org/dataexplorer, and fertility rates from the United Nations. Results: In most sub-Saharan African countries, we observe that the same countries that had fertility stalls had a stall in the progress of education, particularly for young women who were of primary school age during the 1980s, when most of the countries were under structural adjustment. Conversely, stalls in fertility are less common in countries that did not have an education stall, possibly in relation to SAPs. Conclusions: The results point to the possibility of a link between the recent fertility stalls and discontinuities in the improvement of the education of the relevant cohorts, which in turn could be related to the SAPs in the 1980s. This descriptive finding now needs to be corroborated through more detailed cohort-specific fertility analysis. If the education-fertility link can be further established, it will have important implications for the projections of population growth in affected countries.

Association between perception of maternal bonding styles and social anxiety disorder among young women.

To evaluate the association between social anxiety disorder (SAD) and perceived maternal bonding styles among young women during pregnancy and 30 months after childbirth. A cohort of young women from the city of Pelotas, Brazil was followed up from pregnancy to 30 months postpartum. The Mini Neuropsychiatric Interview Plus was used to assess SAD and the Parental Bonding Instrument was administered to measure maternal bonding styles. Poisson regression with robust variance was used for multivariable analysis. After adjusting for potential confounding factors, SAD prevalence was 6.39 times higher among young women who perceived their mothers as neglectful (prevalence ratio [PR] 6.39; 95% confidence interval [95%CI] 1.2-32.0), and 5.57 times higher in women who perceived their mothers as affectionless controlling (PR = 5.57; 95%CI 1.5-19.7) when compared with those who received optimal care. Maternal bonding style may have an influence on the development of SAD. Therefore, support and early prevention strategies should be offered to the family.

A review of the online prognositc model predict using the POSH cohort (women aged ≤40 years at breast cancer diagnosis)

Breast cancer is the most common cancer women in the UK, with approximately 50,000 new cases each year. PREDICT (http://www.predict.nhs.uk) is an online prognostic tool developed to help determine the best available treatment and long-term outcome for early breast cancer. This study was conducted to establish how well PREDICT performs in estimating survival in a large cohort of younger women (aged ≤40 years) recruited to the POSH study.

Oncogenic Human Papillomavirus Infections in 18- to 24-Year-Old Female Online Daters.

Although risk factors for HPV infections in young women are well defined, the risk associated with meeting male sex partners via the Internet is unclear. We analyzed cross-sectional data from 282 women aged 18 to 24 years who reported using Internet dating Web sites in the past year. Women were mailed vaginal self-sampling kits for polymerase chain reaction-based HPV genotyping (including 19 oncogenic types) and sexual behavior and health history questionnaires. Generalized linear models were used to evaluate risk factors for prevalent oncogenic HPV infections. Thirty-five percent of women reported having met a male sex partner via the Internet in the past 6 months, and 42% reported a history of HPV vaccination. The prevalence of oncogenic HPV infection was 37%, and 9% of women tested positive for HPV-16 or HPV-18. Having met a male sex partner via the Internet in the past 6 months was not significantly associated with oncogenic HPV infection. In multivariate analyses, variables associated with an increased likelihood of oncogenic HPV infection included male partners in the past 6 months who were reported to have at least 1 concurrent partnership (adjusted prevalence ratio [aPR], 1.51; 95% confidence interval [CI], 1.11-2.06) and not always using condoms with male partners in the past 6 months (aPR, 1.86; 95% CI, 1.05-3.30). Self-reporting a history of receiving at least 1 dose of HPV vaccine was inversely associated with testing positive for HPV-16 or HPV-18 (aPR, 0.39; 95% CI, 0.16-0.97). Although measures of recent sexual behavior were associated with prevalent oncogenic HPV infection, male partners met online were not associated with an increased likelihood of infection in this cohort of young women.

Abstract P2-10-03: Decision-making surrounding adjuvant chemotherapy in young women with early stage breast cancer

Abstract Background: There is an increasing recognition that many young women with breast cancer will have favorable outcomes without chemotherapy. We sought to characterize decision-making surrounding adjuvant chemotherapy treatment (CT) in this population for whom chemotherapy has historically been a standard of care. Methods: As part of an ongoing, multi-center, prospective cohort of young women diagnosed with breast cancer at age 40 and younger, we identified 657 women with Stage I-III breast cancer. Participants were asked to complete surveys by mail that included questions about socio-demographics, decision-making, and treatment history within the first year following diagnosis. Tumor characteristics were ascertained via pathology and medical record review. We used Chi-square tests to compare: decisional involvement (patient-driven vs. shared vs. physician-driven), degree of confidence, and feeling informed about the CT decision (the latter two measured on a 0-10 scale, categorized as follows: 0-5=low; moderate=6-8; 9-10=high) between women who did and did not receive CT. To explore clinical appropriateness of the CT decision, we used logistic regression to assess the relationship between tumor characteristics and non-receipt of CT among women with Stage I/II disease. Results: Among women with Stage I (n=250), II (n=312), and III (n=95), disease, 66%, 95%, and 100%, received CT, respectively. A greater proportion of women who had CT were highly confident with their decision compared with women who did not have CT (80% vs. 60%, p&amp;lt;0.0001); women who did not have CT were more likely to report a low level of feeling informed about the CT decision compared to women who received CT (20% vs. 5%, p&amp;lt;0.0001). Women who did not have CT were also more likely to report the final CT decision as made by their doctor (49% vs. 28%) and less likely to report a shared decision (33% vs. 59%, p&amp;lt;0.0001). Non-receipt of CT in women with Stage I/II disease (n=546) was associated within having node negative disease, T1 (vs. T2 or larger), Her2- negative, and hormone receptor positive tumors. Conclusion: Although non-receipt of CT would be expected to be viewed favorably by patients and doctors, we found that women who received CT felt more confident and better informed than those who received no CT. Given that women who did not have CT were also less likely to perceive the CT decision as shared, improved communication together with better decisional support may be beneficial, especially for women who do not receive adjuvant chemotherapy. Citation Format: Shoshana M Rosenberg, Karen Sepucha, Kathryn J Ruddy, Lidia Schapira, Steven Come, Virginia Borges, Evan Morgan, Nancy U Lin, Shari Gelber, Rulla M Tamimi, Ann H Partridge. Decision-making surrounding adjuvant chemotherapy in young women with early stage breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-10-03.

G497(P) Human papilloma virus vaccination coverage rates in ‘looked after’ young women – another marker of health disadvantage?

Aims Vaccination of young women against human papilloma virus (HPV) has important health benefits, not least in reducing lifetime cervical cancer risk. Young women who are ‘looked after’ are a vulnerable group, known to face disadvantage in several areas, including in relation to their health. Are we able to achieve HPV coverage rates in this group comparable to the general population in order to safeguard their future health? We set out to study this in our own Health Board area. Methods We studied young women aged 12–18 years, ‘looked after’ by three Local Authorities co-terminus with our Health Board’s geographical area, who by virtue of their age should have received a 3 dose HPV vaccination course. We compared vaccination coverage in this group, using their recorded vaccination status on the All Wales Child Health Database, with a cohort of young women who were not ‘looked after’, and who had completed academic year 9 and were resident in the same Health Board area, using NPHS Wales ‘COVER’ data. We statistically analysed differences observed. We established that ethical approval was not required to undertake this study. Results Of 2555 young women who had completed year 9 and who were not ‘looked after’, 2308 had completed a 3 dose HPV vaccination course (90.3%). Of the 157 eligible young women ‘looked after’, 131 had received a comparable 3 dose vaccination course (83.4%). The difference was statistically significant (X2 7.763, p 0.005). Conclusion Our study of young women who should have completed a 3 dose HPV vaccination course highlights that those ‘looked after’ were significantly less likely to be vaccinated. We have identified yet another area of health disadvantage for this group which could have important consequences for their future health. Action is required to address this and our own recommendations will be discussed, in addition to what we see as the possible reasons for this difference. We suggest that HPV vaccination coverage rates in young women ‘looked after’ should be reviewed across the United Kingdom by those health professionals who work with this vulnerable group.

Longitudinal trajectory patterns of social support: correlates and associated mental health in an Australian national cohort of young women.

Although social support is a significant contributor to health and well-being, little is known about patterns of perceived social support over time in young adulthood. It is also unclear which personal characteristics are associated with different patterns, and whether there is an association between social support and mental health over time. We explore these issues in a large national cohort of young women. We used six waves of longitudinal data spanning 16 years, from 10,369 women from the Australian Longitudinal Study on Women's Health, initially aged 18-23. We used group-based trajectory modelling to identify patterns of social support across Surveys 2-6; multinomial logistic regression to identify socio-demographic and health-behaviour predictors at Survey 1 and correlates at Survey 6 for each trajectory group; and generalised linear mixed modelling to estimate mean levels of mental health over the trajectory period for each group, adjusted for confounders. Four distinct trajectory groups of social support were identified: 'High' (58.5 %), 'Decreasing' (20.6 %), 'Low' (9.3 %), and 'Increasing' (11.6 %). Poor health and living outside metropolitan areas at both Surveys 1 and 6 were characteristics of women in all trajectory groups other than the 'High' group, as were early motherhood and being un-partnered at age 34-39. Other characteristics were specific to one or two trajectory groups. Patterns of mental health over time were consistent with patterns of social support. Longitudinal trajectory patterns of social support are associated with mental health, health behaviours, and demographic factors even in early adulthood.

Loss to follow-up was used to estimate bias in a longitudinal study: a new approach

ObjectivesTo examine bias arising from loss to follow-up due to lack of contact. Study Design and SettingThe 1973–1978 cohort of Australian Longitudinal Study on Women's Health was first surveyed in 1996 and followed up in 2000, 2003, 2006, and 2009. At the 2000 survey, 9,688 women responded (responders), 2,972 could not be contacted, of whom 1,515 responded subsequently (temporary no contact) and 1,457 did not (permanent no contact). Characteristics were compared for these groups at baseline and follow-up in 2003, 2006, or 2009. Relative risk ratios were used to estimate bias. ResultsNo-contacts were younger, more likely to live in cities, to be less educated and stressed about money than responders. No-contacts were more likely to be in de facto relationships, separated, divorced, or widowed, to have experienced partner violence and be smokers. Compared with temporary no contact, permanent no contact were less educated, less likely to be studying or employed. Despite differences in prevalence estimates, relative odds ratios were close to one and had confidence intervals that included one, indicating little effect of bias. ConclusionAlthough various characteristics were related to loss to follow-up, the relative risks estimates did not indicate serious bias due to loss to follow-up in this cohort of young women.

Recruitment via the Internet and social networking sites: the 1989-1995 cohort of the Australian Longitudinal Study on Women's Health.

BackgroundFaced with the challenge of recruiting young adults for health studies, researchers have increasingly turned to the Internet and social networking sites, such as Facebook, as part of their recruitment strategy. As yet, few large-scale studies are available that report on the characteristics and representativeness of the sample obtained from such recruitment methods.ObjectiveThe intent of the study was to describe the sociodemographic and health characteristics of a national sample of young Australian women recruited mainly through the Internet and social networking sites and to discuss the representativeness of their sociodemographic, health, and lifestyle characteristics relative to the population.MethodsA cohort of 17,069 women (born between 1989 and 1995) was recruited in 2012-13 for the Australian Longitudinal Study on Women’s Health. Sociodemographic characteristics (percentages, means, and 95% confidence intervals) from the online survey data were compared with women aged 18-23 years from the 2011 Australian Census. Sample data were compared by age and education level with data from the 2011-13 Australian Health Survey (AHS).ResultsCompared to the Australian Census data, study participants were broadly representative in terms of geographical distribution across Australia, marital status (95.62%, 16,321/17,069) were never married), and age distribution. A higher percentage had attained university (22.52%, 3844/17,069) and trade/certificate/diploma qualifications (25.94%, 4428/17,069) compared with this age group of women in the national population (9.4% and 21.7% respectively). Among study participants, 22.05% (3721/16,877) were not in paid employment with 35.18% (5931/16,857) studying 16 or more hours a week. A higher percentage of study participants rated their health in the online survey as fair or poor (rather than good, very good, or excellent) compared with those participating in face-to-face interviews in the AHS (18.77%, 3203/17,069 vs 10.1%). A higher percentage of study participants were current smokers (21.78%, 3718/17,069 vs 16.4%) and physically active (59.30%, 10,089/17,014 were classified as sufficiently active vs 48.3%) but alcohol consumption was lower (59.58%, 9865/16,558 reported drinking alcohol at least once per month vs 65.9% in the AHS). Using self-reported height and weight to determine body mass index (BMI, kg/m2), 34.80% (5901/16,956) of the cohort were classified as overweight or obese (BMI of 25 or more), compared with 33.6% respectively using measured height and weight in the AHS.ConclusionsFindings indicated that using the Internet and social networking sites for an online survey represent a feasible recruitment strategy for a national cohort of young women and result in a broadly representative sample of the Australian population.

Effect of Intravenous Iron Therapy on Quality of Life in Non-Anemic Iron-Deficient Young Women with Fatigue

▪IntroductionIron deficiency is defined as the presence of insufficient iron to maintain normal physiological function of tissues. Even in the absence of anemia, studies have demonstrated the effect of iron deficiency on cognition, exercise performance and endurance capacity. Menstruating women are at increased risk for developing iron deficiency. Studies have shown benefit of oral iron therapy in adult females but orally administered iron can be poorly absorbed and is often accompanied by gastrointestinal side effects impacting patient compliance. Intravenous iron therapy has been shown to be well tolerated and useful in adult patients but has not been well studied in a homogenous group of patients in the pediatric setting. The main objective of this study is to demonstrate the effect of a standardized regimen of intravenous iron on the quality of life of a prospective cohort of young women with low serum ferritin and symptoms of fatigue as measured by a standardized quality of life fatigue scale.MethodsOur study design is a prospective observational study. We include young post-menarchal girls with serum ferritin < 20 ng/ml and symptoms of fatigue as documented by the standardized and validated Peds QLTM Multidimensional Fatigue Scale (Score < 70). Only patients who have failed oral iron therapy due to poor response, non-compliance or side effects are included on our study. Patients with hemoglobin < 10g/dl are excluded from the study. Patients receive four 15-20 minute infusions of 200 mg intravenous iron sucrose given over a 14-day period. Hemodynamic stability is carefully monitored. Laboratory values including hemoglobin, iron, TIBC, iron saturations, ferritin, reticulocyte count and reticulocyte hemoglobin concentration are obtained prior to treatment, at the time of the fourth infusion, 6 weeks and 3 months after treatment. The Peds QLTM Multidimensional Fatigue Scale, using child self-report and parent proxy-report is administered at these time points as well.ResultsNine patients have been included in this study and recruitment is ongoing. Six adolescent girls (ages 16-18 years) have completed all four infusions. All the patients tolerated the infusions well without any severe adverse effects. The mean pre-treatment ferritin level was 11.33 ng/ml (SD 6.713) and the mean post-treatment ferritin level was 273.33ng/ml (SD 154.23) (p = 0.002); [95% CI: -402.427 to -121.57]. There was a statistically significant improvement in the quality of life and fatigue scores as measured by the standardized Peds QLTM Multidimensional Fatigue Scale for both the patient and parent questionnaires. The mean score for the patients pre-treatment was 41.172 (SD 20.696) and post-treatment was 75.043 (SD 10.657) (p = 0.005); [95% CI: -55.268 to -12.476]. The mean score for the parents pre-treatment was 43.048 (SD 21.307) and post-treatment was 73.608 (SD 13.145) (p = 0.01); [95 % CI: -53.334 to -7.786]. The individual ferritin levels, hemoglobin levels and fatigue scores of the subjects that have completed all the infusions have been included in the Table. The patients who were not anemic before the iron infusions did not have a significant change in hemoglobin levels. The post-treatment hemoglobin levels for patient 5 and patient 6 were obtained at the fourth infusion. Abstract 4858. TableSubjectAge (years)Pre-Ferritin (ng/ml)Post-Ferritin (ng/ml)PedsQL Patient-PrePedsQL Patient-PostPedsQL Parent-PrePedsQL Parent-PostPre-treatment Hemoglobin (g/dl)Post-treatment Hemoglobin (g/dl)1181726626.3970.8336.1170.8312.912.7217313572.27583.361.1111.713.4317171891890.5537.584.7211.913.1417621036.1158.3334.7263.8813.513.85161857133.337520.8366.6711.911.761672696180.5545.8394.4410.510.5ConclusionAlthough our study population is small, our results demonstrate promise that intravenous iron objectively improves fatigue and quality of life in young women with iron deficiency and mild/no anemia. Intravenous iron appears to be well tolerated and effective in this adolescent age group and leads to a substantial increase in ferritin levels. In non-anemic patients, iron administration did not influence hemoglobin concentration. Therefore, the fatigue-reducing effects of iron therapy reflect the non-hematological functions of iron. DisclosuresNo relevant conflicts of interest to declare.