Survey of Medical Trainees Indicates a Need for Increased Access to Obstetrics and Gynecology Care.

INTRODUCTION: Given the higher rates of infertility and complicated pregnancies among female physicians, we identified a need to assess access to obstetrics and gynecology (OBGYN) care for medical trainees. We hypothesized that medical students and residents are not up-to-date on routine OBGYN care.  Methods: We administered an optional, anonymous survey to all medical students and residents at Albany Medical College (Albany, NY, USA) who self-identified as having a uterus to assess their access to gynecologic care in November 2022. Data collected included demographic information, care-seeking practices, reproductive health screening history, contraception use, and menstrual cycle irregularities.  Results: A total of 184 trainees responded to the survey; 71% were medical students and 29% were residents. Around 11% of respondents had never seen an OBGYN provider. About 45% of respondents had not seen a provider in the last year, 20% had not seen a provider in the last three years, and 37% had not seen a provider since beginning their training. Of the trainees, 26% were not up to date on recommended cervical cancer screening; 35% indicated they had irregular menses; and 50% had not received sexually transmitted infection (STI) testing in the last year. Older age was associated with a lower rate of STI testing. Age and trainee type were both associated with having ever seen an OBGYN provider; both older participants and residents were more likely than younger participants and medical students to have answered 'yes.' Race was also associated with having ever seen an OBGYN provider.  Conclusions: Trainees accessed OBGYN care at lower-than-expected rates. There is an opportunity to improve access to OBGYN care for these trainees, which should be recommended to improve reproductive health in this group.

Colonoscopy screening and surveillance disparities during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has increased barriers to accessing preventive healthcare. This study identifies populations disproportionately underrepresented in screening and surveillance colonoscopies during the COVID-19 pandemic. METHODS: In this single-center cohort study, colonoscopy procedures were reviewed during 6-month intervals before the pandemic (July 1, 2019 - December 31, 2019) and during the pandemic (July 1, 2020 - December 31, 2020 and January 1, 2021 - June 30, 2021). 7095 patients were categorized based on procedure indication, demographics, Charlson Comorbidity Index and Social Vulnerability Index (SVI). Statistics performed using VassarStats. RESULTS: 2387 (2019) colonoscopies pre-pandemic and 2585 (2020) and 2123 (2021) during the pandemic were identified. There was a decrease in colonoscopies performed during months when COVID-19 cases peaked. The total number of average CRC risk patients presenting for first colonoscopy declined during the pandemic: 232 (10 %) pre-pandemic to 190 (7 %) in 2020, 145 (7 %) in 2021 (p < 0.001). Fewer of these patients presented from highly vulnerable communities, SVI > 0.8, during the pandemic, 39 in 2019 vs 16 in 2020 and 22 in 2021. Of all screening and surveillance patients, fewer presented from communities with SVI > 0.8 during the pandemic, 106 in 2019 versus 67 in 2020 and 77 in 2021. CONCLUSION: It is important to address the decline in CRC preventive care during this pandemic among average CRC risk first-time screeners and vulnerable community patients. An emphasis on addressing social determinants of health and establishing patients in gastroenterology clinics is imperative to promote future health in these populations.

Inadequate DNA Damage Repair Promotes Mammary Transdifferentiation, Leading to BRCA1 Breast Cancer.

Loss of BRCA1 p220 function often results in basal-like breast cancer (BLBC), but the underlying disease mechanism is largely opaque. In mammary epithelial cells (MECs), BRCA1 interacts with multiple proteins, including NUMB and HES1, to form complexes that participate in interstrand crosslink (ICL) DNA repair and MEC differentiation control. Unrepaired ICL damage results in aberrant transdifferentiation to a mesenchymal state of cultured, human basal-like MECs and to a basal/mesenchymal state in primary mouse luminal MECs. Loss of BRCA1, NUMB, or HES1 or chemically induced ICL damage in primary murine luminal MECs results in persistent DNA damage that triggers luminal to basal/mesenchymal transdifferentiation. In vivo single-cell analysis revealed a time-dependent evolution from normal luminal MECs to luminal progenitor-like tumor cells with basal/mesenchymal transdifferentiation during murine BRCA1 BLBC development. Growing DNA damage accompanied this malignant transformation.