The Flint Food Store Survey: combining spatial analysis with a modified Nutrition Environment Measures Survey in Stores (NEMS-S) to measure the community and consumer nutrition environments

Objective The goal of the present study was to use a methodology that accurately and reliably describes the availability, price and quality of healthy foods at both the store and community levels using the Nutrition Environment Measures Survey in Stores (NEMS-S), to propose a spatial methodology for integrating these store and community data into measures for defining objective food access. Setting Two hundred and sixty-five retail food stores in and within 2 miles (3·2 km) of Flint, Michigan, USA, were mapped using ArcGIS mapping software. Design A survey based on the validated NEMS-S was conducted at each retail food store. Scores were assigned to each store based on a modified version of the NEMS-S scoring system and linked to the mapped locations of stores. Neighbourhood characteristics (race and socio-economic distress) were appended to each store. Finally, spatial and kernel density analyses were run on the mapped store scores to obtain healthy food density metrics. Results Regression analyses revealed that neighbourhoods with higher socio-economic distress had significantly lower dairy sub-scores compared with their lower-distress counterparts (β coefficient=−1·3; P=0·04). Additionally, supermarkets were present only in neighbourhoods with \u3c60 % African-American population and low socio-economic distress. Two areas in Flint had an overall NEMS-S score of 0. Conclusions By identifying areas with poor access to healthy foods via a validated metric, this research can be used help local government and organizations target interventions to high-need areas. Furthermore, the methodology used for the survey and the mapping exercise can be replicated in other cities to provide comparable results

The impact of race and glycemic control on triple negative breast cancer in type 2 diabetics

BACKGROUND: Although the association between type 2 diabetes (T2D) and breast cancer is well established, the relationship between glycemic control and breast cancer by hormone receptor subtype is poorly understood. We sought to investigate the relationship between glycemic control and the incidence of triple negative breast cancer (TNBC) among patients with T2D. Furthermore, we hoped to elucidate whether this hypothesized risk was further moderated by demographic factors, such as patient race. METHODS: A retrospective cohort study evaluating 1,679 patients with T2D diagnosed with breast cancer between 2010-2020 was conducted. Data including tumor hormone receptor status, Hgb A1c measured within 3 months of cancer diagnosis date, and patient race were ascertained via chart review. Tumor subtype was categorized as either hormone receptor-positive (ER+, PR+ or both) or triple-negative (ER/PR- and HER2/neu-). Based on Hgb A1c measurements, subjects were assigned to one of three categories of glycemic control: well-controlled (Hgb A1c less than 7.0), moderately controlled (Hgb A1c 7.0-9.4), or poorly controlled (Hgb A1c greater than or equal to 9.5) T2D. RESULTS: Accounting for all study subjects, the incidence of TNBC increased with worsening glycemic control (12.7% vs 15.2% vs 21.8%, P=0.040). Among non-Hispanic White patients, a significant increase in the incidence of TNBC with worsening glycemic control was also observed (9.2% vs 13.2% vs 21.9%, P=.010). Among Black patients, the incidence of TNBC did not significantly change across the three levels of glycemic control (17.6% vs 17.6% vs 22.7%, P=.700). Comparing the incidence rates of breast cancer by subtype between non-Hispanic White and Black patients across the three categories of glycemic control, a significant difference was only observed among patients with well-controlled T2D (17.6% of Black patients with TNBC versus 9.2% of nonHispanic White patients, P\u3c.001; 87.4% of non-Hispanic White patients with hormone receptor positive breast cancer versus 75.6% of Black patients, P\u3c.001). CONCLUSION: Poor glycemic control is associated with a higher incidence of TNBC in patients with T2D overall. A significant increase in the incidence of TNBC with lesser degrees of glycemic control was only observed in the population of non-Hispanic white patients. Although previous studies have shown that Black patients are 2-3 times more likely to develop TNBC than their non-Hispanic White counterparts, a statistically significant racial difference in the rates of breast cancer by subtype was only noted among those with well-controlled T2D. Together our data not only suggests that T2D may serve as a modifiable risk factor for the development of TNBC, but also that the risk conferred by poor glycemic control may bear more significance for non-Hispanic White patients than Black patients

Multi-disciplinary clinic discussion associated with decreased performance of breast MRI and increased eligibility for breast conservation

Background/Objective: The management of breast cancer benefits from a multi-disciplinary approach as this leads to better adherence to management guidelines. There is much variability in the utilization of MRI in the management of breast cancer. This study examines the effect of implementation of a multi-disciplinary clinic (MDC) on the utilization of MRI and breast-conserving therapy (BCT). Methods: We conducted a retrospective review of patients who were diagnosed with invasive breast cancer 1 year prior to and after the implementation of an MDC at our institution. We examined various clinical factors including age, sex, tumor characteristics, radiologic studies, surgical and medical treatment, and rates of BCT. We performed univariate analysis to compare differences among rates of pre-treatment MRI and BCT between patients who were and were not presented at the MDC. Results: A total of 539 patients were eligible for the study. There were 122 patients who were diagnosed prior to MDC, and 419 patients discussed at MDC. There was no difference in the average age (59.9 vs 62.2, p=0.1). There were no differences between the non-MDC and MDC patients among rates of BCT offered if eligible (96.8% vs 96.7%, p=0.95) and BCT performed if eligible (98.8% vs 93.9%, p=0.07). There was, however, a significant difference between the 2 groups in rates of pre-treatment MRI performed (32.2% vs 14.4%, p\u3c0.001). When comparing the groups that did not have a pre-treatment MRI and those that did, there was a decrease in the rate of BCT eligibility (82% vs 72.9%, p=0.02), BCT offered (98.6% vs 87.0%, p\u3c0.001), but not in the rates of BCT performed if eligible (95% vs 94.2%, p=0.82). Conclusions: Having a pre-treatment MRI resulted in patients more likely to be considered ineligible for BCT, and also less likely to be offered BCT. Having lower rates of BCT offered is a negative repercussion that may be mitigated through an MDC approach because patients are less likely to have a pretreatment MRI when presented at MDC. Further research is warranted, and more detailed conclusions may be obtained through prospective trials such as the ALLIANCE-MRI trial

The Flint Food Store Survey: combining spatial analysis with a modified Nutrition Environment Measures Survey in Stores (NEMS-S) to measure the community and consumer nutrition environments

Objective The goal of the present study was to use a methodology that accurately and reliably describes the availability, price and quality of healthy foods at both the store and community levels using the Nutrition Environment Measures Survey in Stores (NEMS-S), to propose a spatial methodology for integrating these store and community data into measures for defining objective food access. Setting Two hundred and sixty-five retail food stores in and within 2 miles (3·2 km) of Flint, Michigan, USA, were mapped using ArcGIS mapping software. Design A survey based on the validated NEMS-S was conducted at each retail food store. Scores were assigned to each store based on a modified version of the NEMS-S scoring system and linked to the mapped locations of stores. Neighbourhood characteristics (race and socio-economic distress) were appended to each store. Finally, spatial and kernel density analyses were run on the mapped store scores to obtain healthy food density metrics. Results Regression analyses revealed that neighbourhoods with higher socio-economic distress had significantly lower dairy sub-scores compared with their lower-distress counterparts (β coefficient=−1·3; P=0·04). Additionally, supermarkets were present only in neighbourhoods with \u3c60 % African-American population and low socio-economic distress. Two areas in Flint had an overall NEMS-S score of 0. Conclusions By identifying areas with poor access to healthy foods via a validated metric, this research can be used help local government and organizations target interventions to high-need areas. Furthermore, the methodology used for the survey and the mapping exercise can be replicated in other cities to provide comparable results