Mobile mammography in New York City: analysis of 32,350 women utilizing a screening mammogram program

Mobile mammography vans (mammovans) may help close the gap to access of breast cancer screening by providing resources to underserved communities. Minimal data exists on the populations served, the ability of mammovans to reach underserved populations, and the outcomes of participants. We sought to determine the demographic characteristics, number of breast cancers diagnosed, and number of women who used the American Italian Cancer Foundation (AICF) Mobile, No-Cost Breast Cancer Screening Program within the five boroughs of New York City. Data were collected by the AICF from 2014 to 2019 on a voluntary basis from participants at each screening location. Women aged 40 to 79 years who had not had a mammogram in the previous 12 months were invited to participate. Each participant underwent a clinical breast exam by a nurse practitioner followed by a screening mammogram. Images were read by a board-certified radiologist contracted by the AICF from Multi Diagnostic Services. There were 32,350 participants in this study. Sixty-three percent reported an annual household income ≤$25,000, and 30% did not have health insurance. More than half of participants identified as either African American (28%) or Hispanic (27%). Additional testing was performed for 5359 women found to have abnormal results on screening. In total, 68 cases of breast cancer were detected. Breast cancer disparities are multifactorial, with the greatest factor being limited access to care. Mobile, no-cost mammogram screening programs show great promise in helping to close the gap to screening access

Charges, length of stay, and complication associations with trauma center ownership in adult patients with mild to moderate trauma

Background: For-profit (FP) trauma centers (TCs) charge more for trauma care than not-for-profit (NFP) centers. We sought to determine charges, length of stay (LOS), and complications associations with TC ownership status (FP, NFP, and government) for three diagnoses among patients with overall low injury severity. Methods: Adult patients treated at TCs with an International Classification of Diseases-based injury severity score (ICISS) survival probability ≥ 0.85 were identified. Only those who with a principal diagnosis of femur, tibial or rib fractures were included. Results: Total charges were significantly higher at FP centers than NFP and lower at government centers (89.6% and -12.8%, respectively). FP TCs had a 12.5% longer LOS and government TCs had a 20.4% longer LOS than NFP TCs. Conclusion: Patients presenting to FP TCs with mild/moderate femur, tibial, or rib fractures experienced higher charges and increased LOS compared with government or NFP centers. There was no difference in overall complication rates.Journal ArticlePre-prin

Disparities in demographics and outcomes based on trauma center ownership

Introduction: Ownership may influence trauma center (TC) location. For-profit (FP) TCs require a favorable payor mix to thrive, whereas not-for-profit (NFP) centers may rely on government funding, grants, and patient volume. We hypothesized that the demographics of trauma patients would be different for NFP and FP TCs due to ownership type. We also hypothesized that these demographic differences might be associated with outcomes such as length of stay, reported complications, and mortality. Methods: We used the Florida Agency for Health Care Administration (AHCA) 2016-2017 inpatient dataset to examine differences in outcomes by trauma center ownership type. Negative binomial and logistical regression was used to compare trauma ownership, length of stay (LOS), reported complications, and mortality of severely injured nonelderly adult trauma patients. Results: Our study analyzed risk factors and outcomes for 10,700 trauma alert patients. Patients treated at FP TCs were less likely to be Black (OR 0.70, 95% CI: 0.62-0.78), to be uninsured (OR 0.40, 95% CI 0.36-0.45), have Medicare (OR 0.53, 95% CI 0.43-0.66), or Medicaid (OR 0.57, 95% CI 0.50-0.65) (all P < 0.001). Patients treated at FP centers were less likely to have comorbidities (OR 0.89, 95% CI 0.82-0.96) and were associated with a longer LOS (0.10, 95% 0.05-0.15, P < 0.001) in nonelderly adult trauma patients. FP TCs were associated with fewer reported complications (OR 0.83, 95% CI 0.74-0.94) and were associated with a higher likelihood of mortality in nonelderly adults (OR 1.70, 95% CI 1.35-2.12, P < 0.001). Conclusions: Among this cohort of severe International Classification of Diseases-based injury severity score (ICISS) patients, complications were less likely, but LOS and mortality were increased among FP TC patients. FP centers cared for fewer patients who were Black, uninsured, or who were Medicare/Medicaid/noncommercial insurance.Journal Articl

Omission of axillary dissection following nodal downstaging with neoadjuvant chemotherapy

Importance Data on oncological outcomes after omission of axillary lymph node dissection (ALND) in patients with breast cancer that downstages from node positive to negative with neoadjuvant chemotherapy are sparse. Additionally, the best axillary surgical staging technique in this scenario is unknown. Objective To investigate oncological outcomes after sentinel lymph node biopsy (SLNB) with dual-tracer mapping or targeted axillary dissection (TAD), which combines SLNB with localization and retrieval of the clipped lymph node. Design, Setting, and Participants In this multicenter retrospective cohort study that was conducted at 25 centers in 11 countries, 1144 patients with consecutive stage II to III biopsy-proven node-positive breast cancer were included between April 2013 and December 2020. The cumulative incidence rates of axillary, locoregional, and any invasive (locoregional or distant) recurrence were determined by competing risk analysis. Exposure Omission of ALND after SLNB or TAD. Main Outcomes and Measures The primary end points were the 3-year and 5-year rates of any axillary recurrence. Secondary end points included locoregional recurrence, any invasive (locoregional and distant) recurrence, and the number of lymph nodes removed. Results A total of 1144 patients (median [IQR] age, 50 [41-59] years; 78 [6.8%] Asian, 105 [9.2%] Black, 102 [8.9%] Hispanic, and 816 [71.0%] White individuals; 666 SLNB [58.2%] and 478 TAD [41.8%]) were included. A total of 1060 patients (93%) had N1 disease, 619 (54%) had ERBB2 (formerly HER2)–positive illness, and 758 (66%) had a breast pathologic complete response. TAD patients were more likely to receive nodal radiation therapy (85% vs 78%; P = .01). The clipped node was successfully retrieved in 97% of TAD cases and 86% of SLNB cases (without localization). The mean (SD) number of sentinel lymph nodes retrieved was 3 (2) vs 4 (2) (P &lt; .001), and the mean (SD) number of total lymph nodes removed was 3.95 (1.97) vs 4.44 (2.04) (P &lt; .001) in the TAD and SLNB groups, respectively. The 5-year rates of any axillary, locoregional, and any invasive recurrence in the entire cohort were 1.0% (95% CI, 0.49%-2.0%), 2.7% (95% CI, 1.6%-4.1%), and 10% (95% CI, 8.3%-13%), respectively. The 3-year cumulative incidence of axillary recurrence did not differ between TAD and SLNB (0.5% vs 0.8%; P = .55). Conclusions and Relevance The results of this cohort study showed that axillary recurrence was rare in this setting and was not significantly lower after TAD vs SLNB. These results support omission of ALND in this population