Reproductive risk factors for breast cancer and association with novel breast density measurements among Hispanic, Black, and White women.

PURPOSE: There are differences in the distributions of breast cancer incidence and risk factors by race and ethnicity. Given the strong association between breast density and breast cancer, it is of interest describe racial and ethnic variation in the determinants of breast density. METHODS: We characterized racial and ethnic variation in reproductive history and several measures of breast density for Hispanic (n = 286), non-Hispanic Black (n = 255), and non-Hispanic White (n = 1694) women imaged at a single hospital. We quantified associations between reproductive factors and percent volumetric density (PVD), dense volume (DV), non-dense volume (NDV), and a novel measure of pixel intensity variation (V) using multivariable-adjusted linear regression, and tested for statistical heterogeneity by race and ethnicity. RESULTS: Reproductive factors most strongly associated with breast density were age at menarche, parity, and oral contraceptive use. Variation by race and ethnicity was most evident for the associations between reproductive factors and NDV (minimum p-heterogeneity:0.008) and V (minimum p-heterogeneity:0.004) and least evident for PVD (minimum p-heterogeneity:0.042) and DV (minimum p-heterogeneity:0.041). CONCLUSION: Reproductive choices, particularly those related to childbearing and oral contraceptive use, may contribute to racial and ethnic variation in breast density.

Breast cancer survivorship experiences among Black women.

BACKGROUND: Black women experience significant disparities in breast cancer across the care continuum, including survivorship. Ensuring that Black women obtain high-quality follow-up care is critical but understudied. This study was aimed at understanding the experiences and needs of Black women during breast cancer survivorship. METHODS: Black patients diagnosed with invasive breast cancer within the past 5 years were invited to participate in a focus group and complete a survey. Focus groups examined the following: (1) the transition from active treatment to survivorship; (2) interactions with health care providers; (3) survivorship experiences, information needs, and preferences; and (4) existing educational materials. Results were thematically coded and analyzed for main themes. Surveys collected information on sociodemographics, health care experiences, quality of life, lifestyle, and education needs. RESULTS: The study enrolled 53 participants, 43 of whom completed a survey and participated in one of 11 focus groups. The median age was 54 years, 44% had private insurance, 81% were English speaking, and 86% had completed their treatment more than a year before. Participants identified the importance of relationships with health care providers, gaps in survivorship care, experiences with cancer-related symptoms, challenges with mental health, worry about recurrence, body image, cancer financial toxicity, and coping through religion and spirituality. Unmet needs were centered around preparation for long-term symptoms, diet and physical activity, emotional support, and more explanations of information resources. Participants reported preferences for educational videos, personal stories, and culturally relevant content. CONCLUSIONS: Some Black breast cancer survivors may have specific challenges and preferences. Supportive interventions that address these concerns can be responsive and help to ameliorate disparities.

Impact of age, race, and family history on COVID-19-related changes in breast cancer screening among the Boston mammography cohort study.

PURPOSE: We studied women enrolled in the Boston Mammography Cohort Study to investigate whether subgroups defined by age, race, or family history of breast cancer experienced differences in the incidence of screening or diagnostic imaging rates during the COVID-19 lockdown and had slower rebound in the incidence of these rates during reopening. METHODS: We compared the incidence of monthly breast cancer screening and diagnostic imaging rates over during the pre-COVID-19 (January 2019-February 2020), lockdown (March-May 2020), and reopening periods (June-December 2020), and tested for differences in the monthly incidence within the same period by age (< 50 vs ≥ 50), race (White vs non-White), and first-degree family history of breast cancer (yes vs no). RESULTS: Overall, we observed a decline in breast cancer screening and diagnostic imaging rates over the three time periods (pre-COVID-19, lockdown, and reopening). The monthly incidence of breast cancer screening rates for women age ≥ 50 was 5% higher (p = 0.005) in the pre-COVID-19 period (January 2019-February 2020) but was 19% lower in the reopening phase (June-December 2020) than that of women aged < 50 (p < 0.001). White participants had 36% higher monthly incidence of breast cancer diagnostic imaging rates than non-White participants (p = 0.018). CONCLUSION: The rebound in screening was lower in women age ≥ 50 and lower in non-White women for diagnostic imaging. Careful attention must be paid as the COVID-19 recovery continues to ensure equitable resumption of care.

Religion/Spirituality and Prevalent Hypertension among Ethnic Cohorts in the Study on Stress, Spirituality, and Health.

BACKGROUND: Hypertension is a significant public health issue, particularly for Blacks, Hispanics/Latinos, and South Asians who are at greater risk than whites. Religion and spirituality (R/S) have been shown to be protective, but this has been identified primarily in whites with limited R/S measures examined (i.e., religious service attendance). PURPOSE: To assess hypertension prevalence (HP) in four racial/ethnic groups while incorporating an array of R/S variables, including individual prayer, group prayer, nontheistic daily spiritual experiences, yoga, gratitude, positive religious coping, and negative religious coping. METHODS: Data were drawn from the Study on Stress, Spirituality, and Health, a consortium of ethnically diverse U.S. cohorts. The sample included 994 Black women, 838 Hispanic/Latino men and women, 879 South Asian men and women, and 3681 white women. Using a cross-sectional design, prevalence ratios for R/S and hypertension were reported for each cohort, in addition to pooled analyses. Given differences in R/S among men and women, all models were stratified by gender. RESULTS: Different patterns of associations were found between women and men. Among women: 1) religious attendance was associated with lower HP among Black and white women; 2) gratitude was linked to lower HP among Hispanic/Latino, South Asian, and white women; 3) individual prayer was associated with higher HP among Hispanic/Latino and white women; 4) yoga was associated with higher HP among South Asian women, and 5) negative religious coping was linked to higher HP among Black women. Among men: significant results were only found among Hispanic/Latino men. Religious attendance and individual prayer were associated with higher HP, while group prayer and negative religious coping were associated with lower HP. CONCLUSION: Religion/spirituality is a multifaceted construct that manifests differently by race/ethnicity and gender. Medical practitioners should avoid a one-size-fits-all approach to this topic when evaluating prevalent hypertension in diverse communities.

Hypertension is a serious public health issue that affects many Americans, though non-whites are at greater risk than whites. In this study, we examine Black, Hispanic/Latino, and South Asian samples, comparing their hypertension rates to whites. We ask whether one or more aspects of religion and spirituality (R/S) might be associated with prevalent hypertension (i.e., prevalence of hypertension at a single point in time). Religious service attendance is the primary R/S variable examined in relation to hypertension, but we expand this to include individual prayer, prayer in groups, daily spiritual experiences, yoga practice, feelings of gratitude, using God to help cope with problems (positive religious coping), and experiencing doubt or fear about God in the face of challenges (negative religious coping). The results were mixed across racial/ethnic group and gender. Among women, higher religious attendance and gratitude were associated with lower hypertension prevalence, but individual prayer was associated with higher prevalence. Few associations were noted between R/S and hypertension among men. Given these findings, along with extant research, it is important for medical practitioners serving diverse communities to recognize R/S may operate differently for men and women in varied religious and ethnic groups, with differing implications for prevalent hypertension.

A genome-wide association study of mammographic texture variation.

BACKGROUND: Breast parenchymal texture features, including grayscale variation (V), capture the patterns of texture variation on a mammogram and are associated with breast cancer risk, independent of mammographic density (MD). However, our knowledge on the genetic basis of these texture features is limited. METHODS: We conducted a genome-wide association study of V in 7040 European-ancestry women. V assessments were generated from digitized film mammograms. We used linear regression to test the single-nucleotide polymorphism (SNP)-phenotype associations adjusting for age, body mass index (BMI), MD phenotypes, and the top four genetic principal components. We further calculated genetic correlations and performed SNP-set tests of V with MD, breast cancer risk, and other breast cancer risk factors. RESULTS: We identified three genome-wide significant loci associated with V: rs138141444 (6q24.1) in ECT2L, rs79670367 (8q24.22) in LINC01591, and rs113174754 (12q22) near PGAM1P5. 6q24.1 and 8q24.22 have not previously been associated with MD phenotypes or breast cancer risk, while 12q22 is a known locus for both MD and breast cancer risk. Among known MD and breast cancer risk SNPs, we identified four variants that were associated with V at the Bonferroni-corrected thresholds accounting for the number of SNPs tested: rs335189 (5q23.2) in PRDM6, rs13256025 (8p21.2) in EBF2, rs11836164 (12p12.1) near SSPN, and rs17817449 (16q12.2) in FTO. We observed significant genetic correlations between V and mammographic dense area (rg = 0.79, P = 5.91 × 10-5), percent density (rg = 0.73, P = 1.00 × 10-4), and adult BMI (rg = - 0.36, P = 3.88 × 10-7). Additional significant relationships were observed for non-dense area (z = - 4.14, P = 3.42 × 10-5), estrogen receptor-positive breast cancer (z = 3.41, P = 6.41 × 10-4), and childhood body fatness (z = - 4.91, P = 9.05 × 10-7) from the SNP-set tests. CONCLUSIONS: These findings provide new insights into the genetic basis of mammographic texture variation and their associations with MD, breast cancer risk, and other breast cancer risk factors.

Trends in breast and prostate cancer screening and diagnostic procedures during the COVID-19 pandemic in central Massachusetts.

PURPOSE: We calculated rates of breast and prostate cancer screening and diagnostic procedures performed during the COVID-19 pandemic through December 2021 compared to the same months in 2019 in a large healthcare provider group in central Massachusetts. METHODS: We included active patients of the provider group between January 2019 and December 2021 aged 30-85 years. Monthly rates of screening mammography and digital breast tomosynthesis, breast MRI, total prostate specific antigen (PSA), and breast or prostate biopsy per 1,000 people were compared by year overall, by age, and race/ethnicity. Completed procedures were identified by relevant codes in electronic health record data. RESULTS: Rates of screening mammography, tomosynthesis, and PSA testing reached the lowest levels in April-May 2020. Breast cancer screening rates decreased 43% in March and 99% in April and May 2020, compared to 2019. Breast cancer screening rates increased gradually beginning in June 2020 through 2021, although more slowly in Black and Hispanic women and in women aged 75-85. PSA testing rates decreased 34% in March, 78% in April, and 53% in May 2020, but rebounded to pre-pandemic levels by June 2020; trends were similar across groups defined by age and race/ethnicity. CONCLUSION: The observed decline in two common screening procedures during the COVID-19 pandemic reflects the impact of the pandemic on cancer early detection and signals potential downstream effects on the prognosis of delayed cancer diagnoses. The slower rate of return for breast cancer screening procedures in certain subgroups should be investigated to ensure all women return for routine screenings.

Internalized stigma among cancer patients enrolled in a smoking cessation trial: The role of cancer type and associations with psychological distress.

PURPOSE: Cancer patients who smoke may experience significant stigma due both to their disease, and negative attitudes and beliefs regarding smoking. We investigated whether internalized stigma differed between currently smoking cancer patients diagnosed with lung or head and neck cancers, other smoking related cancers, and non smoking-related cancers, and whether internalized stigma was associated with psychological distress. METHODS: This cross-sectional analysis used baseline data on 293 participants enrolled in a multi-site randomized smoking cessation intervention trial of patients with recently diagnosed cancer. Internalized stigma was assessed using five Internalized Shame items from the Social Impact of Disease Scale. Smoking-related cancers included lung, head and neck, esophageal, bladder, kidney, liver, pancreatic, colorectal, anal, small intestinal, gastric, and cervical. We used multivariable linear regression to examine whether mean internalized stigma levels differed between individuals with lung and head and neck cancers, other smoking-related cancers, and non smoking-related cancers, adjusting for potential confounders. We further examined the association of internalized stigma with depression, anxiety, and perceived stress, overall and among cancer type groups. RESULTS: Thirty-nine percent of participants were diagnosed with lung or head and neck cancer, 21% with another smoking-related cancer, and 40% with a non smoking-related cancer. In multivariable-adjusted models, participants with lung or head and neck cancers (11.6, 95% confidence intervals (CI) = 10.8-12.2; p < 0.0001) or other smoking-related cancers (10.7, 95% CI = 9.8-11.7; p = 0.03) had higher mean internalized stigma scores compared to those non-smoking-related cancers (9.3, 95% CI = 8.6-10.0). We observed similar positive associations between internalized stigma and depressive symptoms, anxiety, and perceived stress among participants with smoking-related and non smoking-related cancers. CONCLUSIONS: Among smokers, those with smoking-related cancers experienced the highest levels of internalized stigma, and greater internalized stigma was associated with greater psychological distress across cancer types. Providers should assess patients for internalized and other forms of stigma, refer patients for appropriate psychosocial support services, and address stigma in smoking cessation programs.

Cardiovascular Disease in Adult Cancer Survivors: a Review of Current Evidence, Strategies for Prevention and Management, and Future Directions for Cardio-oncology.

PURPOSE OF REVIEW: Cardiovascular disease is long-term complication of both cancer and anti-cancer treatment and can have significant ramifications for health-related quality of life and mortality. This narrative review explores the current evidence linking cardiovascular disease and cancer, as well as exploring strategies for the prevention and management of cardiovascular disease, and outlines future opportunities in the field of cardio-oncology. RECENT FINDINGS: Cancer confers risk for various cardiovascular diseases including heart failure, cardiomyopathy, arrhythmia, coronary heart disease, stroke, venous thromboembolism, and valvular heart disease. Cancer treatment, in particular agents such as platinum-based chemotherapy, anthracyclines, hormonal treatments, and thoracic radiotherapy, further increases risk. While cardiovascular disease can be identified early and effectively managed in cancer survivors, cardiovascular screening and management does not typically feature in routine long-term cancer care of adult cancer survivors. Cancer and cancer treatment can accelerate the development of cardiovascular disease. Further research into screening and management strategies for cardiovascular disease, along with evidence-based guidelines, is required to ensure adult cancer survivors receive appropriate long-term care.

The Association of Religion and Spirituality with Obesity and Weight Change in the USA: A Large-Scale Cohort Study.

The association between religion, spirituality, and body weight is controversial, given the methodological limitations of existing studies. Using the Nurses' Health Study II cohort, follow-up occurred from 2001 to 2015, with up to 35,547 participants assessed for the religious or spiritual coping and religious service attendance analyses. Cox regression and generalized estimating equations evaluated associations with obesity and weight change, respectively. Religious or spiritual coping and religious service attendance had little evidence of an association with obesity. Compared with not using religious or spiritual coping at all, the fully adjusted hazard ratios (HRs) were minimally different across categories: a little bit (HR = 1.05, 95% CI: 0.92-1.18), a medium amount (HR = 1.09, 95% CI: 0.96-1.24), and a lot (HR = 1.10; 95% CI: 0.96-1.25) (Ptrend = 0.17). Compared with participants who never or almost never attend religious meetings or services, there was little evidence of an association between those attending less than once/month (HR = 1.08, 95% CI: 0.97-1.10), 1-3 times/month (HR = 1.01, 95% CI: 0.90-1.13), once/week (HR = 0.92, 95% CI: 0.83-1.02), and more than once/week (HR = 0.94, 95% CI: 0.82-1.07) (Ptrend = 0.06). Findings were similar for weight change. There was no significant association between religious or spiritual coping, religious service attendance, obesity, and weight change. While religion and spirituality are prominent in American society, they are not important psychosocial factors influencing body weight in this sample.

Potential of using mammography screening appointments to identify high-risk women: cross sectional survey results from the national health interview survey.

PURPOSE: Mammography screening encounters may represent ideal opportunities to identify high-risk women for risk-based screening. During mammography appointments, radiology practices evaluate breast density and ascertain known breast cancer risk factors. Our purpose was to evaluate the potential for mammographic screening encounters to identify high-risk women by estimating the (1) proportion of high-risk women who report that they have undergone mammographic screening and the (2) proportion of high-risk women who receive recommendations for breast MRI screening. METHODS: Women ages 30-85 without breast cancer histories were included from the 2015 National Health Interview Survey, a nationally representative cross-sectional household survey (response rate 80%). Breast Cancer Risk Assessment Tool was used to determine high-risk (lifetime risk>20%). Among high-risk women, primary outcome was proportion reporting mammography screening, secondary outcome was receipt of a breast MRI recommendation after recent mammogram, accounting for complex survey design. RESULTS: 14,958 women were included. 1.0% were high-risk of whom: 91.9% ever had a mammogram, 68.0% had a mammogram within the last year, 81.5% had a mammogram within the last 2 years. 6.4% were recommended to undergo breast MRI. Among high-risk women, women with dense breast tissue were more likely (OR 496.0, 95%CI 52.6,4674.0) and older women were less likely (OR 0.91, 95%CI 0.84,0.99) to receive recommendations for breast MRI. CONCLUSIONS: Among high-risk women, 92% reported undergoing at least one mammogram in their lives. 94% did not receive recommendations for breast MRI screening and 32% did not have a mammogram within the last year. To identify high-risk women, breast imaging centers should consider determining lifetime breast cancer risk during mammography screening visits.

The trajectory of racial/ethnic disparities in the use of cancer screening before and during the COVID-19 pandemic: A large U.S. academic center analysis.

Cancer screening rates declined sharply early in the COVID-19 pandemic. The impact of the pandemic may have exacerbated existing disparities in cancer screening due to the disproportionate burden of illness and job loss among racial/ ethnic minorities, and potentially, uneven resumption of care between different racial/ ethnic groups. Using electronic health record data from Mass General Brigham (MGB), we assessed changes in rates of breast, cervical, colorectal and lung cancer screening before and during the pandemic. Among patients who received primary care in an MGB-affiliated primary care practice, cancer screening rates were calculated as the number of individuals who received a screening test for each cancer type over the number of individuals due for each test, during each month between April 2019-November 2020. We conducted an interrupted time-series analysis to test for changes in screening rates by race/ethnicity before and during the pandemic. Prior to the pandemic, relative to White individuals, Asian women were less likely to receive breast cancer screening (p < 0.001), and Latinx and Black individuals were less likely to screen for lung cancer (p < 0.001 and p = 0.02). Our results did not show significant improvement or worsening of racial/ethnic disparities for any cancer screening type as screening resumed. However, as of November 2020 rates of screening for breast cancer were lower than pre-pandemic levels for Latinx individuals, and lung cancer screening rates were higher than baseline for Latinx, Black or White individuals. Further monitoring of disparities in cancer screening is warranted as the pandemic evolves.

Religious Service Attendance, Religious Coping, and Risk of Hypertension in Women Participating in the Nurses' Health Study II.

The association between religious service attendance, religious coping, and hypertension is unclear. Prospective research and assessment of potential mediators is needed to understand this relationship. From 2001-2013, we prospectively followed 44,281 nonhypertensive women who provided information on religious service attendance and religious coping in the Nurses' Health Study II. Cox regression and mediation analyses were conducted to assess associations between religion and hypertension. There were 453,706 person-years of follow-up and 11,773 incident hypertension cases. Women who attended religious services were less likely to develop hypertension. In the fully adjusting model, compared with women who never or almost never attend religious meetings or services, women attending less than once per month (hazard ratio (HR) = 0.97, 95% confidence interval (CI): 0.91, 1.03), 1-3 times per month (HR = 0.94, 95% CI: 0.88, 1.00), once per week (HR = 0.93, 95% CI: 0.88, 0.98), or more than once per week (HR = 0.91, 95% CI: 0.86, 0.97) showed a decreased risk of hypertension (P for trend = 0.001). Body mass index was an important mediator (11.5%; P < 0.001). Religious coping had a marginal association with hypertension. In conclusion, religious service attendance was modestly associated with hypertension in an inverse dose-response manner and partially mediated through body mass index. Future research is needed on biological or social reasons for the lower risk of hypertension.

Acceptability of an Interactive Computer-Animated Agent to Promote Patient-Provider Communication About Breast Density: a Mixed Method Pilot Study.

BACKGROUND: Half of women undergoing mammography have dense breasts. Mandatory dense breast notification and educational materials have been shown to confuse women, rather than empower them. OBJECTIVE: This study used a mixed method, multi-stakeholder approach to assess acceptability of an interactive, computer-animated agent that provided breast density information to women and changes in knowledge, satisfaction, and informational needs. DESIGN: A pre-post survey and qualitative focus groups assessed the acceptability of the computer-animated agent among women. An anonymous, online survey measuring acceptability was delivered to a multi-stakeholder group. PARTICIPANTS: English-speaking, mammography-eligible women ages 40-74 were invited and 44 women participated in one of nine focus groups. In addition, 14 stakeholders representing primary care, radiology, patient advocates, public health practitioners, and researchers completed the online survey. INTERVENTIONS: A prototype of a computer-animated agent was delivered to women in a group setting; stakeholders viewed the prototype independently. MAIN MEASURES: Data collected included open-ended qualitative questions that guided discussion about the content and form of the computer-animated agent. Structured surveys included domains related to knowledge, acceptability, and satisfaction. Stakeholder acceptability was measured with a series of statements about aspects of the intervention and delivery approach and are reported as the proportion of respondents who endorsed each statement. KEY RESULTS: Six of 12 knowledge items demonstrated improvement post-intervention, satisfaction with the agent was high (81%), but the number of unanswered questions did not improve (67% vs. 54%, p = 0.37). Understanding of the distinction between connective and fatty tissue in the breast did not increase (30% vs. 26%, p = 0.48). Results of the multi-stakeholder survey suggest broad acceptability of the approach and agent. CONCLUSIONS: Findings highlight the benefits of a brief interactive educational exposure as well as misperceptions that persisted. Results demonstrate the need for an evidence-based, accessible intervention that is easy to understand for patients.

Race and sex differences in patient provider communication and awareness of lung cancer screening in the health information National Trends Survey, 2013-2017.

Despite demonstrated reduction in lung cancer mortality, lung cancer screening uptake has been low. We investigated differences in discussions with physicians about lung cancer screening and awareness using repeated cross-sectional data from three cycles [4.2 (2013); 4.4(2014) and 5.1 (2017)] of the Health Information National Trends Survey. We included 4207 respondents age 55 to 80 who responded to this question: 'In the past year, have you talked with your doctor about having a test to check for lung cancer?'. We used logistic regression accounting for complex sample weighting to generate multivariable adjusted odds ratios (ORs) and 95% confidence intervals (CIs). The proportion of participants reporting lung cancer screening discussions was low and did not increase over time. In the most recent cycle, 15.7% of current smokers and 9.9% of former smokers said they had discussed screening. Compared to males, females were 32% less likely to report a lung cancer screening discussion (OR: 0.68, 95% CI: 0.50-0.93) and the association was strongest among non-Hispanic White females. Estimates were similar among never (OR: 0.72, 95% CI: 0.43-1.20), current (OR: 0.73, 95% CI: 0.39-1.36), and former (OR: 0.66, 95% CI: 0.40-1.10) smokers. Females were 32% less likely than males to be aware of a lung cancer screening test (OR: 0.68, 95% CI: 0.47-0.99) and this association was strongest for non-Hispanic Black females (OR: 0.38, 95% CI: 0.19-0.77). Too few providers have discussed lung cancer screening with potentially eligible patients, particularly female patients. Further research is needed to evaluate possible causes for this finding.

Mammography decision making: Trends and predictors of provider communication in the Health Information National Trends Survey, 2011 to 2014.

BACKGROUND: In 2009, the US Preventive Services Task Force recommended that the decision to initiate screening mammography before age 50 years should be individualized. Herein, the authors examined whether health care providers are communicating regarding mammography decision making with women and whether communication is associated with screening behavior. METHODS: Data were drawn from the 2011 to 2014 Health Information National Trends Survey (HINTS). A total of 5915 female respondents aged ≥ 40 years who responded to the following question were included: "Has a doctor or other health professional ever told you that you could choose whether or not to have a mammogram?" We used logistic regression to generate odds ratios (ORs) and 95% confidence intervals (95% CIs) for predictors of provider communication and assessed whether provider communication was associated with mammography in the previous 2 years overall and stratified by age. RESULTS: Fewer than 50% of the women reported provider communication regarding mammogram choice. Women who reported provider communication were not found to be more likely to report no mammogram within the past 2 years (OR, 1.07; 95% CI, 0.87-1.31) compared with those who did not. When stratified by 10-year age group, provider communication was associated with a higher likelihood of no mammogram only among women age ≥70 years (OR, 1.64; 95% CI, 1.15-2.34), and was associated with a lower likelihood of no mammogram only among women aged 40 to 49 years (OR, 0.63; 95% CI, 0.43-0.92). CONCLUSIONS: Between 2011 and 2014, less than one-half of women received communication regarding mammogram choice despite recommendations from the US Preventive Services Task Force. Provider communication regarding mammogram choice can influence screening behavior, particularly for younger and older women. Cancer 2017;123:401-409. © 2016 American Cancer Society.

Impact of race, ethnicity, and BMI on achievement of pathologic complete response following neoadjuvant chemotherapy for breast cancer: a pooled analysis of four prospective Alliance clinical trials (A151426).

Previous studies demonstrated poor response to neoadjuvant systemic therapy (NST) for breast cancer among black women and women who are overweight or obese, but this may be due to chemotherapy underdosing. We assessed associations of race, ethnicity, and body mass index (BMI) with pathologic complete response (pCR) in clinical trial populations. 1797 women enrolled in four NST trials (CALGB 40601, 40603; ACOSOG Z1041, Z1071) were included. Tumor subtypes were defined by estrogen receptor (ER) and HER2 status. Logistic regression generated odds ratios (OR) and 95 % confidence intervals (CI) for the associations of race, ethnicity, and BMI with in-breast pCR adjusting for subtype, study arm, lymph node status, tumor size, and tumor grade. 253 (14.1 %) were black, 199 (11.1 %) Hispanic, 520 (28.9 %) overweight, and 743 (41.4 %) obese. Compared to whites, Blacks and Hispanics were more likely to be obese and Blacks were more likely to have triple-negative cancer. pCR rates differed significantly by tumor subtype. In multivariate analyses, neither race (black vs white: OR 1.18, 95 % CI 0.85-1.62) nor ethnicity (Hispanic vs non-Hispanic; OR 1.30, 95 % CI 0.67-2.53) were significant predictors of pCR overall or by subtype. Overweight and obese women had lower pCR rates in ER+/HER2+, but higher pCR rates in ER-/HER2+ cancers. There was no difference in pCR according to race or ethnicity. Overall, there was no major difference in pCR rates by BMI. These findings suggest that pCR with optimally dosed NST is a function of tumor, rather than patient, biology.

Faculty Promotion and Attrition: The Importance of Coauthor Network Reach at an Academic Medical Center.

BACKGROUND: Business literature has demonstrated the importance of networking and connections in career advancement. This is a little-studied area in academic medicine. OBJECTIVE: To examine predictors of intra-organizational connections, as measured by network reach (the number of first- and second-degree coauthors), and their association with probability of promotion and attrition. DESIGN: Prospective cohort study between 2008 and 2012. SETTING: Academic medical center. PARTICIPANTS: A total of 5787 Harvard Medical School (HMS) faculty with a rank of assistant professor or full-time instructor as of January 1, 2008. MAIN MEASURES: Using negative binomial models, multivariable-adjusted predictors of continuous network reach were assessed according to rank. Poisson regression was used to compute relative risk (RR) and 95 % confidence intervals (CI) for the association between network reach (in four categories) and two outcomes: promotion or attrition. Models were adjusted for demographic, professional and productivity metrics. KEY RESULTS: Network reach was positively associated with number of first-, last- and middle-author publications and h-index. Among assistant professors, men and whites had greater network reach than women and underrepresented minorities (p < 0.001). Compared to those in the lowest category of network reach in 2008, instructors in the highest category were three times as likely to have been promoted to assistant professor by 2012 (RR: 3.16, 95 % CI: 2.60, 3.86; p-trend <0.001) after adjustment for covariates. Network reach was positively associated with promotion from assistant to associate professor (RR: 1.82, 95 % CI: 1.32, 2.50; p-trend <0.001). Those in the highest category of network reach in 2008 were 17 % less likely to have left HMS by 2012 (RR: 0.83, 95 % CI 0.70, 0.98) compared to those in the lowest category. CONCLUSIONS: These results demonstrate that coauthor network metrics can provide useful information for understanding faculty advancement and retention in academic medicine. They can and should be investigated at other institutions.

Women's Information Needs and Educational Preferences Regarding Lung Cancer Screening.

Background: Physicians are less likely to discuss lung cancer screening (LCS) with women, and women have lower awareness of LCS availability. The objective of this qualitative study was to determine information needs, patient-provider communication barriers, and preferences for LCS education among women. Materials and Methods: Eight semistructured qualitative focus groups were conducted with 28 self-identified women meeting LCS eligibility criteria. Participants were recruited through a large health system, from a community-based LCS program, and through a national online database between October 2020 and March 2021. Focus groups were led by a trained moderator via Zoom. Audio recordings were transcribed and analyzed using thematic analysis by investigators. Results: LCS decision-making influences included: (1) Health care provider recommendation; (2) Self-advocacy; (3) Insurance coverage and cost; (4) Family; and (5) Interest in early detection. Participants preferred video and print materials, available at physician's office or shared by physician, without scare tactics or shaming about smoking, use clear language, with diverse participants and images. Preferred content focused on: (1) Benefits of early detection; (2) Lung cancer definition, statistics, and risk factors; (3) Benefits of quitting smoking; (4) Demonstration or explanation of how LCS is done; and (5) Availability of other tests and potential harms of screening. Conclusion: Women in our study had limited awareness of LCS and their eligibility and wanted recommendation and support for LCS from their health care providers. We identified addressable information needs about lung cancer and the screening process that can be used to improve LCS uptake in women and shared decision-making processes.

Reproductive Factors Related to Childbearing and a Novel Automated Mammographic Measure, V.

BACKGROUND: We investigated the associations between several reproductive factors related to childbearing and the variation (V) measure (a novel, objective, single summary measure of breast image intensity) by menopausal status. METHODS: Our study included 3,814 cancer-free women within the Nurses' Health Study (NHS) and NHSII cohorts. The data on reproductive variables and covariates were obtained from biennial questionnaires closest to the mammogram date. V-measures were obtained from mammographic images using a previously developed algorithm capturing the standard deviation of pixel values. We used multivariate linear regression to examine the associations of parity, age at first birth, time between menarche and first birth, time since last pregnancy, and lifetime breastfeeding duration with V-measure, adjusting for breast cancer risk factors, including the percentage of mammographic density (PMD). We further examined whether these associations were statistically accounted for (mediated) by PMD. RESULTS: Among premenopausal women, none of the reproductive factors were associated with V. Among postmenopausal women, inverse associations of parity and positive associations of age at first birth with V were mediated by PMD (percent mediated: nulliparity: 66.7%, P < 0.0001; parity: 50.5%, P < 0.01; age at first birth 76.1%, P < 0.001) and were no longer significant in PMD-adjusted models. Lifetime duration of breastfeeding was positively associated with V [>36 vs. 0 ≤1 months ß = 0.29; 95% confidence interval (CI) 0.07; 0.52, Ptrend < 0.01], independent of PMD. CONCLUSIONS: Parity, age at first birth, and breastfeeding were associated with postmenopausal V. IMPACT: This study highlights associations of reproductive factors with mammographic image intensity.