Influence of Primary Care Physician Availability and Socioeconomic Deprivation on Breast Cancer from 1988 to 2008: A Spatio-Temporal Analysis

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. It is unclear how county-level primary care physician (PCP) availability and socioeconomic deprivation affect the spatial and temporal variation of breast cancer incidence and mortality.We used the 1988-2008 public-use county-based data from nine Surveillance, Epidemiology, and End Results (SEER) programs to analyze the temporal and spatial disparity of PCP availability and socioeconomic deprivation on early-stage incidence, advanced-stage incidence and breast cancer mortality. The spatio-temporal analysis was implemented by a novel structural additive modeling approach.Greater PCP availability was significantly associated with higher early-stage incidence, advanced-stage incidence and mortality during the entire study period while socioeconomic deprivation was significantly negatively associated with early-stage incidence, advanced-stage incidence, and mortality up to 1992. However, the observed influence of PCP availability and socioeconomic deprivation varied by county.We showed important associations of PCP availability and socioeconomic deprivation with the three breast cancer indicators. However, the effect of these associations varied over time and across counties. The association of PCP availability and socioeconomic deprivation was stronger in selected counties

Circulating sphingosine-1-phosphate inversely correlates with chemotherapy-induced weight gain during early breast cancer

Weight gain in women receiving chemotherapy for breast cancer is associated with a higher risk of recurrence. Using metabonomic profiling, we recently reported that plasma lactate and alanine were prognostic for weight gain in individuals with breast cancer receiving chemotherapy. The role of lipid second messengers has not been studied. We assessed serum levels of sphingosine-1-phosphate (S1P), a known secreted lipid second messenger with a role in cell growth, in sequential samples from post-menopausal women receiving standard chemotherapy for early breast cancer and correlated these with body mass measurements and metabonomic profiling. While serum S1P levels prior to treatment did not correlate with body weight changes or circulating alanine and lactate, S1P levels measured during therapy were inversely correlated with weight gain (P = 0.04), but not weight loss (P = 0.74) or no change in weight (P = 0.5), suggesting a role of dynamic circulating S1P in adipocyte growth. These data provide evidence for an association between serum S1P and weight gain during chemotherapy cycles in women with breast cancer. Lipid second messengers have a role in chemotherapy-induced weight gain in breast cancer