Breast MRI in the Diagnostic and Preoperative Workup Among Medicare Beneficiaries With Breast Cancer

We compared the frequency and sequence of breast imaging and biopsy use for the diagnostic and preoperative workup of breast cancer according to breast MRI use among older women

The Role of Preoperative Magnetic Resonance Imaging in the Assessment and Surgical Treatment of Interval and Screen-Detected Breast Cancer in Older Women

We describe the relationship between preoperative Magnetic Resonance Imaging (MRI) and the utilization of additional imaging, biopsy, and primary surgical treatment for subgroups of women with interval versus screen-detected breast cancer. We determined the proportion of women receiving additional breast imaging or biopsy and type of primary surgical treatment, stratified by use of preoperative MRI, separately for both groups

Locoregional treatment of breast cancer in women with and without preoperative magnetic resonance imaging

Preoperative magnetic resonance imaging (MRI) use has increased among older women diagnosed with breast cancer. MRI detects additional malignancy, but its impact on locoregional surgery and radiation treatment remains unclear

Costs of diagnostic and preoperative workup with and without breast MRI in older women with a breast cancer diagnosis

Abstract Background Breast cancer in the U.S. - estimated at 232,670 incident cases in 2014 - has the highest aggregate economic burden of care relative to other female cancers. Yet, the amount of cost attributed to diagnostic/preoperative work up has not been characterized. We examined the costs of imaging and biopsy among women enrolled in Medicare who did and did not receive diagnostic/preoperative Magnetic Resonance Imaging (MRI). Methods Using Surveillance, Epidemiology and End Results (SEER)- Medicare data, we compared the per capita costs (PCC) based on amount paid, between diagnosis date and primary surgical treatment for a breast cancer diagnosis (2005–2009) with and without diagnostic/preoperative MRI. We compared the groups with and without MRI using multivariable models, adjusting for woman and tumor characteristics. Results Of the 53,653 women in the cohort, within the diagnostic/preoperative window, 20 % (N = 10,776) received diagnostic/preoperative MRI. Total unadjusted median costs were almost double for women with MRI vs. without ($2,251 vs.$1,152). Adjusted costs were higher among women receiving MRI, with significant differences in total costs ($1,065), imaging costs ($928), and biopsies costs ($138). Conclusion Costs of diagnostic/preoperative workups among women with MRI are higher than those without. Using these cost estimates in comparative effectiveness models should be considered when assessing the benefits and harms of diagnostic/preoperative MRI

Using appreciative inquiry to develop, implement and evaluate a multi-organisation ‘Cultivating Compassion’ programme for health professionals and support staff

The ‘Cultivating Compassion’ project was developed in response to a research and innovation call relating to compassion training for National Health Service staff in the South East of England. The project aims included the following: the use of Appreciative Inquiry to develop, implement and evaluate a sustainable and evidence-based programme of compassion awareness training through engaging with a diverse group of health professionals and support staff; an evaluation of a ‘train the trainers’ approach; and an evaluation of ‘compassion lead’ roles and a multi-modal compassion toolkit. The project team included academics from two universities and one medical school, NHS staff from three separate organisations and service users. The participants recruited to the study included doctors, nurses, receptionists, chaplains and others working in close contact with service users from within four NHS organisations in the South East of England. The main findings from the project using thematic analysis from participant focus groups and interviews identified project enablers and inhibitors, the value of project resources, and shifts in perspectives. Project conclusions highlighted the importance of effective senior-level support and organisational leadership in cultivating compassion within a healthcare organisation and the importance of the integration of compassion-promoting resources within existing staff development initiatives

Breast cancer risk factors in relation to breast density (United States)

OBJECTIVES: Evaluate known breast cancer risk factors in relation to breast density. METHODS: We examined factors in relation to breast density in 144,018 New Hampshire (NH) women with at least one mammogram recorded in a statewide mammography registry. Mammographic breast density was measured by radiologists using the BI-RADS classification; risk factors of interest were obtained from patient intake forms and questionnaires. RESULTS: Initial analyses showed a strong inverse influence of age and body mass index (BMI) on breast density. In addition, women with late age at menarche, late age at first birth, premenopausal women, and those currently using hormone therapy (HT) tended to have higher breast density, while those with greater parity tended to have less dense breasts. Analyses stratified on age and BMI suggested interactions, which were formally assessed in a multivariable model. The impact of current HT use, relative to nonuse, differed across age groups, with an inverse association in younger women, and a positive association in older women (p < 0.0001 for the interaction). The positive effects of age at menarche and age at first birth, and the inverse influence of parity were less apparent in women with low BMI than in those with high BMI (p = 0.04, p < 0.0001 and p = 0.01, respectively, for the interactions). We also noted stronger positive effects for age at first birth in postmenopausal women (p = 0.004 for the interaction). The multivariable model indicated a slight positive influence of family history of breast cancer. CONCLUSIONS: The influence of age at menarche and reproductive factors on breast density is less evident in women with high BMI. Density is reduced in young women using HT, but increased in HT users of age 50 or more

A Downstream CpG Island Controls Transcript Initiation and Elongation and the Methylation State of the Imprinted Airn Macro ncRNA Promoter

A CpG island (CGI) lies at the 5′ end of the Airn macro non-protein-coding (nc) RNA that represses the flanking Igf2r promoter in cis on paternally inherited chromosomes. In addition to being modified on maternally inherited chromosomes by a DNA methylation imprint, the Airn CGI shows two unusual organization features: its position immediately downstream of the Airn promoter and transcription start site and a series of tandem direct repeats (TDRs) occupying its second half. The physical separation of the Airn promoter from the CGI provides a model to investigate if the CGI plays distinct transcriptional and epigenetic roles. We used homologous recombination to generate embryonic stem cells carrying deletions at the endogenous locus of the entire CGI or just the TDRs. The deleted Airn alleles were analyzed by using an ES cell imprinting model that recapitulates the onset of Igf2r imprinted expression in embryonic development or by using knock-out mice. The results show that the CGI is required for efficient Airn initiation and to maintain the unmethylated state of the Airn promoter, which are both necessary for Igf2r repression on the paternal chromosome. The TDRs occupying the second half of the CGI play a minor role in Airn transcriptional elongation or processivity, but are essential for methylation on the maternal Airn promoter that is necessary for Igf2r to be expressed from this chromosome. Together the data indicate the existence of a class of regulatory CGIs in the mammalian genome that act downstream of the promoter and transcription start

The association of prescription opioid use with incident cancer: A Surveillance, Epidemiology, and End Results‐Medicare population‐based case‐control study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167541/1/cncr33285.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167541/2/cncr33285_am.pd