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Neonatal abstinence syndrome (NAS) is associated with a range of adverse health outcomes, exorbitant health care costs, and race/ethnicity disparity. We examined key sociodemographic factors that may influence the national race/ethnicity disparity in the prevalence of NAS among Whites, Blacks and Hispanics. 2016 and 2019 cycles of cross-sectional data from HCUP-KID national all-payer pediatric inpatient-care database were used to estimate NAS prevalence (ICD-10CM code P96.1) in newborns ≥ 35 weeks gestational-age, excluding iatrogenic-cases (ICD-10CM code P96.2). Multivariable generalized-linear-models with predictive-margins were used to produce race/ethnicity-specific stratified-estimates for select sociodemographic factors, reported as risk-differences (RD) with 95% confidence-intervals (CI). Final models were adjusted for sex, payer-type, ecologic income-level, and hospital size, type, and region. The overall survey weighted-sample prevalence of NAS was 0.98% (i.e., 6282/638100) and did not differ over cycles. Blacks and Hispanics were significantly more likely than Whites to be in the lowest ecologic income quartile and on Medicaid. In fully-specified models, NAS prevalence among Whites was 1.45% (95% CI: 1.33, 1.57) higher than Blacks and 1.52% (95% CI: 1.39, 1.64) higher than Hispanics; and NAS among Blacks was 0.14% higher than Hispanics (95% CI: 0.03, 0.24). NAS prevalence was highest among Whites on Medicaid (RD: 3.79%; 95% CI: 3.55, 4.03) compared to Whites on private-insurance (RD: 0.33%; 95% CI: 0.27, 0.38), and Blacks (RD: 0.73%; 95% CI: 0.63, 0.83; RD: 0.15%; 95% CI: 0.08, 0.21), or Hispanics, with either payer-type (RD: 0.59%; 95% CI: 0.5, 0.67; RD: 0.09%; 95% CI: 0.03, 0.15) respectively. NAS prevalence was higher among Whites in the lowest income-quartile (RD: 2.22%; 95% CI: 1.99, 2.44) compared with Blacks (RD: 0.51%; 95% CI: 0.41, 0.61) and Hispanics (RD: 0.44%; 95% CI: 0.33, 0.54) in the same quartile, and all subgroups in other quartiles. NAS prevalence was higher among Whites in the Northeast (RD: 2.19%; 95% CI: 1.89, 2.5) compared to Blacks (RD: 0.54%; 95% CI: 0.33, 0.74) and Hispanics (RD: 0.31%; 95% CI: 0.17, 0.45). Although Blacks and Hispanics were more likely to be in the lowest income quartile and have Medicaid insurance, Whites on Medicaid, in the lowest income quartile, and in the Northeast, were found to have the highest NAS prevalence.

Objective: Variations in physical PROs between Non-Hispanic Black (NHB) and Hispanic compared to Non-Hispanic White (NHW) elderly women with BC may be attributable to differences in socioeconomic position (SEP), comorbidities, and tumor biology (TB). We examine the extent to which the race/ethnicity disparity in patient reported physical component score (PCS) is transmitted through these domains. Methods: Data is from the Surveillance, Epidemiology, and End Results- Medicare Health Outcomes Survey dataset (SEER-MHOS) which is used to research health outcomes in cancer patients. The analytic sample (n=19,857) included 14,936 NHW, 2,897 NHB, and 2,024 Hispanic women with newly diagnosed BC between 2010-2017. PCS were calculated using the SF-36/V linear transformation of 0-100 versions of the scale that yield a population mean of 50 and standard deviation of 10 based on 1990 population means. We estimated average controlled direct associations (ACDA) using regression models with predictive margins to evaluate crude and age/body mass index (BMI)-adjusted PCS by race/ethnicity and performed a series of ACDA [with comparison of rescaled coefficients (RC)] controlling for the domains of SEP [household income (< 30K, 30K-80K, >80K) and education attainment [HS)], comorbidities [smoking status (current smoker/current non-smoker), diabetic (yes/no), and hypertensive (yes/no)], and tumor biology [stage(1-3), grade (well/moderate/poor), and subtype (luminal A/triple negative)]. Results: Overall, NHB and Hispanic women were younger and had a higher BMI than NHW women. In baseline age/BMI adjusted models, NHWs had PCSs 3.4 points significantly higher than both NHWs and Hispanics (95% CI: 2.8, 3.9 and 2.8, 4.1, respectively). Adjusting for SEP reduced the observed disparity: NHB (1.6; 95% CI: 0.90, 2.3) and Hispanics (0.76; 95% CI: 0.04, 1.6) compared to NHW. Inclusion of all three domains highly attenuated the observed PCS disparities between the minority populations and NHWs (0.20; 95%CI: -1.1, 1.5) for NHB and (0.54; 95%CI: -0.90, 1.99) for Hispanics compared to NHWs]. Based on the method of RC, we determined the SEP accounted for the largest fraction of mediated effects, followed by comorbidities, with TB having the smallest effect. Conclusion: Our findings support the hypothesis that observed racial/ethnicity differences in physical PROs in elderly BC patients are largely mediated by differences in SEP and comorbidity, rather than TB. Citation Format: Kristen E. Champion, Kendra Krebsbach, Chloe Stallion, Keith A. Dookeran. Mediation of race/ethnicity disparities in physical patient reported outcomes (PROS) by socioeconomic position, comorbidities, and tumor biology among elderly female breast cancer (BC) patients in the SEER-MHOS database [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C113.

Key Points Question Is maternal history of neonatal death associated with subsequent neonatal mortality? Findings In this cross-sectional study using nationally representative data of 127 336 singleton live births in India, maternal history of neonatal death was associated with more than 2-fold increased odds of subsequent neonatal mortality. Meaning This finding suggests that maternal history of neonatal death should be part of routine antenatal assessment to identify mothers and neonates who may be at increased risk and need extended care., This cross-sectional study examines the association of maternal history of neonatal death with subsequent neonatal death among multiparous women in India., Importance Among the United Nations’ Sustainable Development Goals is to reduce the neonatal mortality rate to 12 per 1000 live births by 2030. Identifying high-risk pregnancies can help achieve this target in low-resource countries, such as India, which accounts for one-fourth of global neonatal deaths. Objective To analyze the association of maternal history of neonatal death with subsequent neonatal mortality. Design, Setting, and Participants This cross-sectional study included a nationally representative sample of singleton live births from multiparous women. Data were obtained from the 2016 National Family Health Survey in India. Data were analyzed from November 2018 to January 2020. Exposures Maternal history of neonatal death and a comprehensive set of covariates, including socioeconomic environment, maternal anthropometry, and pregnancy care. Main Outcomes and Measures Subsequent neonatal mortality. Population-attributable risk associated with history of neonatal death was calculated, and sensitivity analyses were performed. Results The overall study population consisted of 127 336 singleton live births from multiparous women aged 15 to 49 (mean [SD] age, 28.8 [5.2] years) years when the survey was undertaken. In our analytic sample, 11 101 (8.7%) mothers had a history of neonatal death, and 506 of 2224 total neonatal deaths (22.8%) were attributed to women with history of neonatal death. The prevalence of history of neonatal death differed by selected covariates and across states or union territories. Maternal history of neonatal death was associated with significantly higher odds of neonatal mortality (adjusted odds ratio, 2.23; 95% CI, 1.96-2.55), and this remained consistent across different subgroups. The population-attributable risk associated with maternal history of neonatal death was 11.8%. Stronger associations were found for maternal history of multiple neonatal deaths (adjusted odds ratio, 3.50; 95% CI, 2.78-4.41) and in respect to the risk of mortality in early neonatal period (ie, 0-2 completed days) (adjusted odds ratio, 2.45; 95% CI, 2.09-2.86). Conclusions and Relevance These findings suggest that maternal history of neonatal death is a potentially useful risk factor to identify women and neonates who may need extended and enhanced pregnancy care.

We use regression models to examine baseline differences in physical and mental health PROs [Physical and Mental Component Summary T-scores (PCS/MCS: are linear transformations of the 0-100 possible range scoring for 8 SF-36/VR-12 sub-scales, with mean of 50 and standard deviation (SD) of 10, normed to the US population)] among non-Hispanic black (NHB), non-Hispanic white (NHW), and Hispanic elderly female patients, with newly diagnosed breast cancer (BC) between 2010-2015 in the Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) database (a cancer registry that provides value health-related quality of life information on patients enrolled in Medicare Advantage). The study analytic sample consisted of 11,765 NHW, 1,988 NHB and 1,361 Hispanic women with overall mean age and BMI of 50.1 years (SD: 10.5) and 27.5 kg/m^2 (SD: 6.6), respectively. Compared with NHW both NHB and Hispanic women had significantly elevated BMI [NHB risk difference (RD) 3.43, 95% CI: 3.09, 3.77; Hispanic RD 0.84, 95% CI: 0.44, 1.24]; but significantly lower age at diagnosis [NHB RD -2.86, 95% CI: -3.36, -2.37; Hispanic RD -1.67, 95% CI: -2.26, -1.09]. Compared with NHW, both crude PCS and MCS scores were significantly worse for NHB and Hispanic women [PCS: NHB RD -4.26, 95% CI: -4.87, -3.65; Hispanic RD -3.29, 95% CI: -4.01, -2.56; MCS: NHB RD -3.79, 95% CI: -4.37, -3.22; Hispanic RD -4.09, 95% CI: -4.76, -3.43]. These differences also persisted after adjustment for BMI and age [compared with NHW, PCS: NHB RD -2.09, 95% CI: -2.76, -1.43; Hispanic RD -3.26, 95% CI: -4.06, -2.45; MCS: NHB RD -3.2, 95% CI: -3.86, -2.54; Hispanic RD -4.21, 95% CI: -4.99, -3.43]. There were however no significant differences in PCS or MCS scores between NHB and Hispanic women after adjustment for age and BMI. Our results show that elderly NHB and Hispanic women with BC in the SEER-MHOS database are significantly more likely to have poorer physical and mental outcomes compared with NHW. However, this PRO disparity was not evident between NHB and Hispanic women and requires further exploration. Citation Format: Kendra R. Krebsbach, Chloe L. Stallion, Keith A. Dookeran. Examination of race/ethnicity differences in patient reported outcomes (PROs) among elderly female breast cancer patients in the SEER-MHOS database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5867.

To assess comorbid conditions and clinical outcomes among late preterm and low birth weight term infants (2.5 kg) who failed the Infant Car Seat Challenge (ICSC) on the Mother-Baby Unit.This was a retrospective chart review of consecutive infants who failed ICSC on the Mother-Baby Unit and were subsequently admitted to the neonatal intensive care unit at Prentice Women's Hospital between January 1, 2009, and December 31, 2015. Regression models were used to estimate risk differences (RDs) with 95% CIs for factors related to length of stay.A total of 148 infants were studied (43% male; 37% delivered via cesarean). ICSC failure in the Mother-Baby Unit was due to desaturation, bradycardia, and tachypnea in 59%, 37%, and 4% of infants, respectively. During monitoring on the neonatal intensive care unit, 39% of infants experienced apnea (48% in preterm vs 17% in term infants) in the supine position, 19% received phototherapy, and 2% and 6.8% received nasogastric and thermoregulatory support, respectively. Univariate predictors of increased duration of stay (days) were younger gestational age, apnea, nasogastric support, intravenous fluids, and antibiotics (all P .05). In multivariable analysis adjusted for gestational age and discharge weight, only apnea (RD, 4.87; 95% CI, 2.99-6.74; P .001), administration of antibiotics (RD, 3.25; 95% CI, 0.29-6.21; P .032), and intravenous fluid support (RD, 4.87; 95% CI, 0.076-9.66; P .047) remained independent predictors of a longer duration of stay.Infants who failed ICSC were at risk for comorbid conditions that prolonged hospital stay beyond the neonatal intensive care unit observation period. Almost one-half of late preterm infants who failed ICSC had apnea events in the supine position.

Evidence shows that both biological and nonbiological factors contribute to health disparities. Genetics, in particular, plays a part in how common diseases manifest themselves. Today, unprecedented advances in genetically based diagnoses and treatments provide opportunities for personalized medicine. However, disadvantaged groups may lack access to these advances, and treatments based on research on non-Hispanic whites might not be generalizable to members of minority groups. Unless genetic technologies become universally accessible, existing disparities could be widened. Addressing this issue will require integrated strategies, including expanding genetic research, improving genetic literacy, and enhancing access to genetic technologies among minority populations in a way that avoids harms such as stigmatization.

To assess national expenditure associated with preterm-infant brain MRI and potential impact of reduction per Choosing Wisely campaign 2015 recommendation to “avoid routine screening term-equivalent or discharge brain MRIs in preterm-infants”. Cross-sectional U.S. trend data from the Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) database (2006, 2009, 2012, 2016) was used to estimate overall national expenditure associated with brain MRI among infants with gestational age (GA) ≤36 weeks, and also when classified as ‘not indicated’ (NI-MRI) i.e., equivalent to routine use without clinical indications and regarded as low-value service (LVS). Associated cost was determined by querying CMS-database for physician-fee-schedules to find the highest global procedure-cost per cycle, then adjusting for inflation. Sensitivity-analyses were conducted to account for additional clinical charges associated with NI-MRI. 3,768 (0.26%) of 1,472,236 preterm-infants had brain MRI across all cycles (inflation-adjusted total $3,690,088). Overall proportion of brain MRIs increased across 2006–2012 from 0.25%-0.33% but decreased in 2016 to 0.16% (PP for interaction $1.2 million.

It is theorized that the black/white race disparity in aggressive breast cancer (BC) subtype might be transmitted through social and reproductive influences. Recent studies suggest that type 2 diabetes mellitus (diabetes) may also contribute to the disparity but the role of diabetes is unclear and in need of further study. Hence, we examined to what extent the black/white race disparity in triple-negative (TN) BC might be transmitted through these influences. Our study sample is a previously reported historical cohort of 419 consecutively enrolled (331 non-Hispanic black (nHB) and 88 nH white (nHW)) women with primary BC aged 24-94 years, treated between 2000-2005 at an NCI-MBCCOP facility in Chicago, IL (Dookeran et al. 2012). US 2000 census ZIP Code Tabulation Area (ZCTA) data matched to patient address zip codes at diagnosis was used to develop a single binary measure of socioeconomic position (SEP) (> US poverty mean vs. referent of US poverty mean Citation Format: Keith A. Dookeran. Mediation of black/white race disparity in triple-negative breast cancer: Effect of type 2 diabetes mellitus [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-159.

1565 Background: The higher rates of triple negative (TN) breast cancer (BC) observed among black compared to white women may be attributable to social and reproductive factors, as well as biological conditions like diabetes mellitus type 2. We examine the extent to which the black/white race disparity in TNBC is transmitted through these factors. Methods: Data are from the Nurses’ Health Study I and II prospective cohorts and include non-Hispanic (nH) black (n = 97) and nH white (n = 8,876) women aged 25-55 years at enrollment with invasive BC diagnoses. Participant characteristics are self-reported or drawn from medical records. We estimated average controlled direct associations (ACDA) using logistic regression with model-based standardization to evaluate the age/body mass index (BMI)-adjusted prevalence difference for TN versus luminal A/B type BC by race, and performed a series of ACDA (with comparison of rescaled coefficients (RC)) controlling for diabetes, mean family income before diagnosis (cont.), husband’s education ( < college, college, graduate school), parental ownership of participant’s childhood home (yes/no), age at menarche (cont.), age at first birth (cont.), parity (integer), and breastfeeding (BF) (parous/never BF, parous/ever BF). Results: Compared to nH whites, nh black women had higher prevalence of TNBC (24.5% v. 45.4%; p < 0.01), higher prevalence of diabetes (5.5% v. 11.3%; p = 0.01), lower prevalence of BF (59.2% v. 46.6%; p = 0.02), higher mean BMI (26.1 v. 29.9; p < 0.01), and lower mean family income ($17,304 v. 15,750; p < 0.01). BMI, age, and menopause were positively associated with prevalence of diabetes. In the age/BMI adjusted model, nH black women were 20%-points more likely than nH whites to have TNBC (95% Confidence Interval (CI): 0.11, 0.29). This disparity was reduced to 18.1% after also adjusting for BF (95% CI: 0.09, 0.28), to 13.7% after additionally adjusting for socioeconomic indicators (95% CI: 0.02, 0.25), and to 13.3% after adjusting for all potential mediators (95% CI: 0.01, 0.26). Based on the method of RC, socioeconomic indicators accounted for the largest fraction of mediated effects and BF accounted for most of main effect attenuation associated with reproductive factors; diabetes accounted for negligible effect. Conclusions: Our findings support the hypothesis that observed racial differences in TNBC diagnoses may be at least partially mediated by differences in socioeconomic position and reproductive patterns, namely breastfeeding.

To examine racial/ethnic disparities in mastectomy practice and explore mediating factors to explain the disparity. Participants included 989 females aged 30–79 years, from a population-based study of newly diagnosed (primary in situ/invasive) breast cancer patients, in Chicago, Illinois, from 2005 to 2008, who completed an interview. Medical records were also abstracted for tumor, diagnostic, and treatment information. Multivariable logistic regression models with model-based standardization were used to estimate risk differences. Differences in rescaled coefficients were used to estimate the proportion of the disparity that could be mediated by patient and tumor characteristics. Mastectomy prevalence overall was 40 %. Factors significantly associated with increased rates of mastectomy (p

Prior study suggests that p53 status behaves as an independent marker of prognosis in African American (AA) women with breast cancer. We investigate whether the influence of p53 is unique to AAs or is present in other race/ethnic groups, and how this compares with known prognostic factors.Cox regression models [hazard ratios (HRs), 95% confidence intervals (CIs)] were used to select and evaluate factors prognostic for all-cause mortality in 331 AA and 203 non-AA consecutively treated women.Statistically significant baseline prognostic factors were as follows. For AAs: stage [(III/I) HR 5.57; 95% CI 3.08-10.09], grade [(higher/low) HR 1.55; 95% CI 1.14-2.11], estrogen receptor (ER)/progesterone receptor (PR) status [(-/+) HR 2.01; 95% CI 1.38-2.93], triple negative (ER-, PR-, HER2-) subtype [(+/-) HR 1.95; 95% CI 1.33-2.85], and p53 status [(+/-) HR 1.69; 95% CI 1.10-2.58]. For non-AAs: stage [HR 11.93; 95% CI 2.80-50.84], grade [HR 1.61; 95% CI 0.96-2.71], and ER/PR status [HR 2.13; 95% CI 1.19-3.81]. There was a differential effect of race within p53 groups (P=0.05) and in multivariate modeling p53-positive status remained an adverse prognostic factor in AAs only [HR 1.82; 95% CI 1.04-3.17]. Compared to non-AAs, 5-year unadjusted survival was worse for AAs overall (73.4% vs. 63.6%; P=0.032), and also for AAs with p53-positive status (80.3% vs. 54.2%; P=0.016), but not for AAs with p53-negative disease (68.4% vs. 67.9%; P=0.81).Among women with breast cancer of different race/ethnicity, an adverse prognostic effect as a result of p53 positivity was only observed in AA women.

Rauscher et al. (2016) recently suggested that the black/white race disparity in aggressive ER/PR-negative breast cancer (BC) might be transmitted through social and reproductive influences. Hence, we examined to what extent the black/white race disparity in aggressive triple-negative (TN) BC might be transmitted through social, reproductive and molecular influences. Our study sample is a previously reported historical cohort of 419 consecutively enrolled (331 non-Hispanic (nH) black and 88 nH white) women with primary BC aged 24-94 years, treated between 2000-2005 at an NCI-MBCCOP facility in Chicago, IL (Dookeran et al. 2012). US 2000 census ZIP Code Tabulation Area (ZCTA) data matched to patient address zip codes at diagnosis was used to develop a single binary measure of socioeconomic position (SEP) (> US poverty mean vs. referent of US poverty mean Citation Format: Keith A. Dookeran. Mediation of black/white race disparity in triple-negative breast cancer by socioeconomic position, parity and p53 status [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4250.

e13588Background: It is theorized that the black/white race disparity in aggressive breast cancer (BC) subtype might be transmitted through social and reproductive influences. As few studies have s...

A total of 653 referrals from general practitioners to an acute surgical service were audited prospectively over a period of 4 months. Middle-grade staff accepting these referrals were able to deal with 182 (27·9 per cent) of these calls without surgical admission. A further 189 (28·9 per cent) referrals were seen on a surgical assessment unit and were not admitted to a surgical ward. The resultant cost saving was approximately 10 000. This confirms that the ready provision of an experienced surgical opinion in combination with early assessment can reduce the number of unnecessary acute surgical admissions referred from general practitioners.

Introduction: The family of 2-pore domain K+ (K2P) channel genes has 15 members, are background channels which enable the leak of K+ ions from cells, and are considered to be important for baseline activity of cells at rest including membrane potential, calcium homeostasis and volume regulation. Prior studies support the hypothesis that alterations of expression or function of K2P channels in cancer cells may play a significant role in tumor development and progression. In the vast majority of tumors, the abnormally expressed channel is wild type. The role of K2P channel genes in breast cancer is currently emerging. A recent microarray database study suggests that all but 5 K2P gene family members showed altered expression in breast cancer. Other studies suggest potential clinical utility of K2P channel genes as biomarkers associated with TN subtype. A weighted gene co-expression network analysis study showed that upregulation of KCNK5 was associated with poor outcome for TN related tumors. TN tumors are also known to occur more frequently in women of non-Hispanic (nH) black race and association between black race and unique KCNK4 and KCNK9 breast tumor methylation patterns have been suggested; KCNK9 association with TN subtype has also been observed. However, there is a paucity of studies characterizing K2P genes in clinical breast cancer, and the goal of our study was the systematic evaluation of the relationship between K2P gene DNA methylation/expression and TN breast tumor subtype, in the large publically available TCGA dataset. Methods: TCGA invasive breast cancer data was available for 1040 women of which 767 had Illumina HM450 methylation beta-values and 959 had RSEM mRNA expression z-scores (single values from level 3 data). We evaluated the direction and association of all K2P gene expression/methylation loci and TN subtype using age and race adjusted glm models. Age and race adjusted Cox models were used for analysis of disease free (DFS) and overall survival (OS). CpG methylation loci within 25kb from either end of the genes of interest were included for examination (UCSC genome browser, hg37). A total of 724 CG loci were included using this approach, but after exclusion of probes with null reads, the number of loci available for study was reduced to 608. Methylation glm model results were sorted on p-values (smallest to largest) and the top 10 associated loci were selected for reporting and further analysis. Selected loci were then checked for functionality related to expression using Spearman's correlation. Bonferroni corrected p-values were used where appropriate. Results: Overexpression of KCNK5, KCNK9, KCNK10 and KCNK12, and underexpression of KCNK6 and KCNK15, were significantly associated with TN subtype (all p Conclusions: TN subtype is associated with specific K2P channel gene over and underexpression patterns, and similar expression patterns observed in blacks is consistent with more frequent TN disease. Our findings also suggest a link between KCNK9 overexpression and worse survival in breast cancer. Both KCNK5 and KCNK9 showed hypomethylation patterns correlated with negative expression, and overall gene overexpression related to TN subtype, and these findings appear to be consistent with prior literature. Citation Format: Keith A. Dookeran, Maria Argos. Two-pore domain potassium (K+) channel genes and triple-negative (TN) subtype in The Cancer Genome Atlas (TCGA) breast cancer dataset. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B07.

In oestrogen receptor positive breast cancer cell lines the synthesis of pS2 and cathepsin D is oestrogen regulated. Using immunohistochemistry the expression of pS2 and cathepsin D has been determined and compared in 194 primary breast carcinomas. The findings have been related to receptor status and pathological features. There was a significant association between pS2 and oestrogen receptor (p p > 0.01), but no other relationship with receptor status was observed. Overall, pS2 had a closer relationship to oestrogen receptor than cathepsin D.

The pS2 protein is oestrogen-regulated in breast cancer cell lines. Previous studies have shown a relationship to oestrogen receptor in primary breast carcinomas. This study examined 178 breast carcinomas for pS2 using immunohistochemistry. A high frequency (77 per cent) of positive tumours was found, using a 10 per cent cut-off point to define a positive tumour. There was no relationship with menopausal status or node status, a significant association with differentiation, a weak association with oestrogen receptor, and no association with progesterone receptor or overall survival. Two patterns of cellular localization were observed: cytoplasmic and membrane. The former showed a stronger relationship with oestrogen receptor status, although there were oestrogen receptor-negative tumours with marked pS2 staining. Membrane staining showed a stronger relationship with differentiation, with a staining pattern similar to that observed for milk fat globule membrane. The staining patterns observed may support a role for pS2 in a secretory mechanism. However, the expression and function of pS2 in breast carcinomas remain complex, and are not simply related to oestrogen regulation.

Background. p53 overexpression has been identified as a poor prognostic marker in breast cancer. We investigate the value of p53 status within the context of stage and intrinsic subtype classification (subtype), in a group of AfricanAmerican (AA) women of lower socioeconomic status (SES) with primary breast cancer. Methods. Participants were 331 consecutive AA women treated at an urban hospital (median follow-up 41 months) with known subtype [luminal A = estrogen receptor (ER)? and/or progesterone receptor (PR)?, human epidermal growth factor receptor 2 (HER2)-; luminal B = ER? and/ or PR?, HER2?; HER2 ?= ER- ,P R-, HER2?; basal = ER- ,P R-, HER2-, cytokeratin (CK)5/6?, and/or HER1?; and unclassified = negative for all five markers] and p53 (Pab1801 antibody) immunohistochemical status. Proportional hazards regression models were used to select and evaluate factors prognostic for all-cause mortality. Results. p53? status was associated with grade 3 tumors, ER/PR– status, and basal subtype. On univariate analysis, factors related to survival were stage, grade [(3/1) hazard ratio (HR) = 2.64; 95% confidence interval (CI), 1.15– 6.07], subtype [(ex. basal/luminal A) HR = 2.15; 95% CI, 1.34–3.45], and p53 status [(?/- )H R= 1.77; 95% CI, 1.15–2.72]. Multivariable modeling indicated that p53? status remained a negative prognostic factor (HR = 1.63; 95% CI, 1.01–2.59) after adjustment for effects of age, stage, grade, and subtype; 5-year adjusted survival was significantly greater for p53- (66.7%) than p53? cases (54.7%). Conclusion. p53 status is an independent predictor of survival after consideration of other strong prognostic factors such as stage, tumor grade, and subtype, and thus may be useful in identifying AA women at high risk of breast cancer mortality.

Background: Lymph node biopsy is a critical component of a diagnostic work-up for patients with invasive breast cancer and is necessary for evaluating the extent and stage of disease so that appropriate treatment can be recommended. The standard procedure prior to the advent of sentinel lymph node biopsy (SLNB) procedures was axillary lymph node dissection (ALND), which is associated with debilitating side effects such as lymphedema. SLNB diffused into practice during the early 2000s and is associated with fewer side effects; for this reason, SLNB has become the standard of care for women diagnosed with invasive breast cancer without clinically palpable lymph node involvement. Using data from the Breast Cancer Care in Chicago study (BCCC), we investigated racial/ethnic disparities in the receipt of SLNB vs. ALND and whether certain tumor, patient, or facility characteristics might help to explain the likelihood of receiving a SLNB. Methods: A total of 989 female patients newly diagnosed with breast cancer were recruited and interviewed for the study. Eligible patients were female, resided in Chicago, had a first primary in situ or invasive breast cancer; were diagnosed between 2005 and 2008 between the ages of 30 and 79 at diagnosis; and self-identified as either non-Latina (nL) White, nL Black or Latina. Of these, 74% (N=731) consented to medical record abstraction and had complete information on receipt of either ALND or SLNB. The racial/ethnic disparity in receipt of SLNB was estimated as a prevalence difference (PD) using logistic regression with marginal based standardization. Mediation analyses were conducted using the method of rescaled coefficients (Karlson, Holm, and Breen). All models were adjusted for age at diagnosis. Results: Roughly half of patients (57%) received a SLNB; nL White women were more likely to receive a SLNB as compared to nL Black and Hispanic women (67% vs 50% and 50%; p= Conclusion: During the mid to late 2000s when the practice of SLNB as an alternative to ALND was reaching about half of eligible patients in Chicago, ethnic minority patients were less likely than their nL White counterparts to receive SLNB. Facility accreditation explained a substantial portion of this disparity. Better access and opportunities to go to highly accredited facilities may decrease this disparity. Citation Format: Bethliz Irizarry, Keith Dookeran, Garth Rauscher. Exploring disparities in sentinel lymph node biopsy within the Breast Cancer Care in Chicago study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C31.

Introduction: Compared to non-Hispanic (nH) white, nH black women are more likely to present with biologically aggressive estrogen and progesterone receptor (ER/PR)-negative (ERN) and triple negative (TN) breast cancer subtypes which are associated with worse prognosis (black:white disparity). These subtypes also exhibit greater genetic instability, with TP53 being the single most recurrently mutated gene. KCNK9 is a maternally imprinted and functionally mono-allelic 2-pore domain potassium channel proto-oncogene located at chromosomal region 8q24.3, encoding TASK-3. KCNK9 overexpression may arise via loss of methylation (LOM) or copy number amplification (CNA). We examined KCNK9 and TP53 as potential mediators of the black:white racial disparity in aggressive breast cancer subtypes. Methods: Using publically available TCGA data on 1040 women with invasive breast cancer, we examined: associations of KCNK9 LOM (HM450 beta values; highest third loss vs. others), amplification (putative CNA from GISTIC; any vs. neutral), and mRNA overexpression (RNA-Seq from RSEM; z-score > +1 SD vs. others) with ERN and TN subtype, and overall survival (OS) and disease-free survival (DFS). General TP53 pathway function was examined using mRNA expression z-scores for six related genes (TP53 MDM2 MDM4 CDKN2A CDKN2B TP53BP1). Prevalence risk ratios (RRs) with 95% confidence intervals (CIs) were estimated via logistic regression with model-based standardization (predictive margins) and hazard ratios (HRs) using Cox proportional hazards models, and all models were adjusted at baseline for age as a continuous variable and stage as categorical variable. In mediation analysis, we estimated the proportionate reduction in the racial disparity in aggressive subtypes after accounting for differences in KCNK9 and TP53 pathway biomarkers by comparison of rescaled coefficients using the method of Karlson, Holm and Breen in adjusted models. Death from any cause was considered an event for all-cause mortality (i.e. OS), and recurrence or progression of disease was considered an event for DFS. Results: KCNK9 LOM, amplification and overexpression were each significantly associated with ERN and TN subtype and black race (all p Conclusions: KCNK9 appears to be a molecular driver of aggressive breast tumor subtype, and in combination with aberrant TP53 pathway overexpression, largely accounts for observed black:white disparity in more biologically aggressive breast cancer subtypes. Citation Format: Keith A. Dookeran, Jacob K. Kresovich, Maria Argos, Garth H. Rauscher. The role of KCNK9 and TP53 on the racial disparity in biologically aggressive breast cancer subtype in The Cancer Genome Atlas (TCGA). [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B49.

Purpose: Non-Hispanic (nH) Black and Hispanic (or minority) breast cancer patients tend to be diagnosed with more aggressive forms of breast cancer compared to their nH White counterparts. Prior research as well as analyses from the current study has identified hormonal and reproductive factors associated with breast cancer aggressiveness subtypes. We explored the potential role of hormonal and reproductive factors, and the potential contribution of DNA methylation, in explaining the racial/ethnic disparity in tumor aggressiveness in a population based study of breast cancer disparities. Methods: The breast Cancer Care in Chicago (BCCC) study included 989 recently diagnosed nH White, nH Black and Hispanic patients with first primary breast cancer. Analyses include a subset of 286 patients with available tumor immunohistochemistry (IHC) data on estrogen and progesterone receptor (ER/PR), HER2, p53 and Ki67 status. A tumor aggressiveness score (TAS) with a high internal reliability coefficient (Chronbach's alpha=0.76) was created from tumor grade and IHC data on ER, PR, HER2, p53 and Ki67. Values were standardized to have a mean of 0 and standard deviation of 1, then summed together and re-standardized to create the score. Pyrosequencing assays for DNA methylation were conducted on a set of DNA sequences identified based on prior literature, ENCODE data for DNA methylation, and transcription for normal vs. cancer cell lines from the UCSC genome browser. Of the 286 patients with tumor aggressiveness data, 214 had available methylation data for BRCA1, GSTM2, EGFR, RASSF1, Sat2 and TFF1 genes. Multivariable linear regression models were estimated with standardized aggressiveness score as the dependent variable and using nested models to conduct likelihood ratio tests for both forward (type 1) and backwards (type 3) analyses. A method of rescaled-coefficients was then used to estimate an average controlled direct effect representing the ethnic disparity in breast cancer tumor aggressiveness and the extent to which the disparity might be explained by patient reproductive factors and tumor DNA methylation. Because stage at diagnosis is downstream of, and strongly influenced by, tumor aggressiveness, it was excluded from our analyses. Results: Factors significantly associated with having a higher TAS (p< 0.05) included: nH black or Hispanic race/ethnicity; younger age at first birth; nulliparity; positive family history (FH) of breast cancer, longer use of oral contraceptives; higher pathologic stage; and higher mean BRCA1, GSTM2 and TFF2 methylation levels. In multivariable modeling, variables retained for further analysis included: FH, nulliparity, and methylation of BRCA1, GSTM2, TFF1 and Sat2. In forwards (type 1) analysis of nested models, both nulliparity (p= 0.034) and DNA methylation variables (p< 0.001) were retained. In backwards (type 3) analyses, DNA methylation variables (p< 0.001) but not nulliparity (p= 0.261) were retained. As independent domains, DNA methylation variables explained 46% of the ethnic disparity in TAS (p= 0.054), whereas nulliparity explained 38% (p= 0.058), and family history did not explain any of the disparity. Further, the combination of DNA methylation variables and nulliparity together explained 63% of the disparity (p= 0.033). Conclusions: Our findings suggest that DNA methylation of specific genes may influence breast cancer tumor aggressiveness and may help to explain the preponderance of aggressive subtypes diagnosed in ethnic minority women. DNA methylation may represent a promising avenue for biomarker development for early detection for biologically aggressive tumor types in vulnerable populations. These findings require replication and validation in other studies. Citation Format: Keith A. Dookeran, Abeer M. Mahmoud, Matthew Poulin, Liying Yan, Melanie Ehrlich, Jacob K. Kresovich, Virgilia Macias, Andre Kajdacsy-Balla, Elizabeth Wiley, Garth H. Rauscher. Exploring the role of reproductive factors and DNA methylation in ethnic disparities in breast cancer tumor aggressiveness. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B51.

1086 Background: Background: KCNK9 is a maternally imprinted and functionally mono-allelic 2-pore domain K+ channel proto-oncogene. It has been posited that loss of KCNK9 methylation (LOM) is assoc...

Purpose: To examine population-based racial/ethnic disparities in mastectomy use among women with breast cancer, and explore potential predictors of this disparity. Methods: Participants were 989 women aged 30-79 years, in a cross-sectional, population-based (NCI-funded, Breast Cancer Care in Chicago) study of newly diagnosed female breast cancer (primary in-situ/invasive) in Chicago, Illinois, from 2005-2008. Participants submitted to an in-person interview of social, health care and attitudinal factors. Medical records were abstracted for tumor characteristics and diagnostic/treatment variables. Multivariable logistic regression models with model-based-standardization were used to estimate risk differences (RDs) with bias-corrected bootstrapped 95% confidence Intervals (CIs). Models incorporated variables pertaining to various domains (socioeconomic disadvantage, cultural beliefs, health care access, and tumor aggression/progression) in order to estimate disparities in mastectomy use, and the extent to which various domains might account for the disparity. Results: There were 397 non-Hispanic (nH) White, 411 nH Black and 181 Hispanic participants. Prevalence proportions for mastectomy use were 40% overall, 34% among nH Whites, 44% among nH Blacks, and 45% among Hispanics. Factors significantly associated with increased mastectomy use overall (p< 0.05) included: younger age at diagnosis; minority ethnicity; lower socioeconomic status (SES); lack of recency of, and adherence to, screening mammography; higher tumor pathologic stage at diagnosis and higher grade; and specific self-reported beliefs/misconceptions regarding breast cancer management (notably: only need to have a lump checked if it gets bigger, mammograms can cause breast cancer, and if a breast tumor is cut open in surgery it will grow faster). In age-adjusted models, compared to nH Whites, mastectomy use was significantly increased by 10 percentage points in both nH Blacks (RD= 0.10, 95% CI: 0.02, 0.17, p= 0.006) and Hispanics (RD= 0.10, 95% CI: 0.01, 0.19, p= 0.029). In models accounting for differences in tumor stage at diagnosis and grade, the apparent disparity was reduced by about half in both nH Blacks (RD= 0.05, 95% CI: -0.03, 0.13) and Hispanics (RD= 0.04, 95% CI: -0.07, 0.13). Additional control for differences in SES, access and utilization, and beliefs/misconceptions eliminated the mastectomy disparity completely for nH Black patients (RD= -0.04, 95% CI: -0.16, 0.09) and further diminished the disparity for Hispanic patients (RD= 0.03, 95% CI: -0.10, 0.16). Conclusions: In this population-based study, compared to nH Whites, significant disparities in mastectomy use for treatment of primary breast cancer were observed in nH Black and Hispanic women. These findings could substantially be explained by differences in tumor aggression/progression. Differences in beliefs, sociodemographics, and access variables may be contributing to disparities in mastectomy either directly or through their influence on stage at diagnosis. Our findings suggest that the best approach to reducing disparities in mastectomy would be to intervene on factors that could reduce disparities in stage at diagnosis. Citation Format: Keith Anthony Dookeran, Abigail Silva, Garth Rauscher. Race/ethnicity and disparities in mastectomy use in the Breast Cancer Care in Chicago Study. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B34. doi:10.1158/1538-7755.DISP13-B34

Interleukin-12 (IL-12) mediates significant antitumor effects in animal models but associated with dose-dependent toxicity in human. To achieve local expression of IL-12 at the tumor site without systemic toxicity, we performed intra-arterial administration of fibroblasts genetically engineered to produce IL-12 protein with or without retrovirus (CRIP-IL-12 or 3T3-IL-12) in liver metastasis model. Rat breast cancer cells (MADB-106) were injected into the portal vein of syngeneic Fisher rats on day 0, and fibroblasts were injected into the hepatic artery on day 7. On day 21, liver weight and number of liver tumors were examined. As controls, CRIP cells expressing retrovirus carrying lacZ marker gene (CRIP-lacZ) or saline (Hanks balanced salt solution, HBSS) were injected. Administration of CRIP-IL-12 significantly reduced tumor metastasis in liver measured by number of foci (CRIP-IL-12: 45.2±36.7, CRIP-lacZ: >250, HBSS: >250, P

The accurate clinical diagnosis of acute appendicitis is dificult, and many techniques have been suggested to improve diagnostic accuracy such as laparoscopy, ultrasonography and barium enema examination. In this study serial total leucocyte counts and serial C-reactive protein (CRP) concentrations in acute appendicitis were measured. The sensitivity and specificity of serial leucocyte counts in acute appendicitis were 92 and 100 per cent, and for CRP concentrations 69 and 75 per cent, respectively. The sensitivity and specificity of serial total leucocyte counts fulfilled the criteria for a diagnostic test. It is suggested that in patients with equivocal clinical findings, clinical observation combined with serial leucocyte counts may improve decision making.

Locoregional therapy of hepatic-metastatic disease may overcome the limitations of systemic therapy by allowing tumor drug dose intensification without increasing systemic toxicity. This may result in improved efficacy. We have demonstrated that the novel topoisomerase I inhibitor 9-Aminocamptothecin (9-AC) when dissolved in Ethiodol acts as a sustained release preparation, with good antitumor activity. Its benefit as a depot hepatic intraarterial (i.a.) therapy for hepatic metastases was compared to systemic therapy with an aqueous colloidal dispersion (CD) preparation of 9-AC in a rat model, since a lack of demonstrable benefit of the locoregional therapy, would argue against further clinical evaluation.Fisher rats underwent direct intraportal injection of 2 x 10(5) MADB106 adenocarcinoma cells and were treated 6 to 7 days later with: (a) bolus i.a. 9-AC (60 micrograms) in 60 microliters of Ethiodol; (b) bolus i.a. CD/9-AC (60 micrograms) in 200 microliters water; (c) bolus i.a. Ethiodol only (60 microliters), or (d) CD/9-AC (60 micrograms) in 200 microliters water, via a mini-osmotic pump pumping at 1 microliter/hr for 7 days intraperitoneally (i.p.). Livers were harvested 10 to 12 days later, and the number of metastases on the surface were counted blindly.Bolus hepatic i.a. 9-AC/Ethiodol was found to be significantly superior in reducing the number of hepatic metastases, when compared to the aqueous CD preparation administered in the same manner, or by continuous infusion via mini-osmotic pump i.p. (p0.01). Systemic therapy was also associated with substantial toxicity.These results suggest that locoregional therapy of hepatic neoplasms with 9-AC/Ethiodol would be associated with clinical efficacy far exceeding that associated with its systemic administration.

e12519 Background: Race-based mortality differences have been reported for intrinsic breast tumor subtypes. p53 status has recently emerged as a marker of worse prognosis among African-American (AA) women with breast cancer; however, the impact of p53 status on mortality by specific subtype is not clear. Methods: Multivariable (age, stage and race adjusted) stratified (subtype and p53) analyses with proportional hazards regression models [hazard ratios (HR), 95% confidence intervals (CIs)] for all-cause mortality, in a cohort of 331 AA and 203 non-AA women (115 Hispanic, 88 non-Hispanic white) of lower socioeconomic status, consecutively treated for breast cancer at an urban hospital, with 60.4 months median follow-up, and known intrinsic subtype and p53 immunohistochemical status. Results: The Table shows the effect of p53 status and demonstrates increased mortality hazards across all subtype strata for AA women compared to non-AA. The largest change in hazards was observed for luminal A and HER2 subtype tumors with higher stage, but this pattern was also evident for lower stage tumors. Hazards of death were least increased across basal type tumors. Conclusions: Across each level of subtype, p53+ status increased the hazards of death in AA women with breast cancer. However, mortality hazards appeared most increased in women with luminal A and HER2 type tumors. [Table: see text]

1553 Background: African American (AA) race is often associated with lower socioeconomic status (SES) and features of aggressive tumor biology in breast cancer, including: ER/PR-negative (-) subtyp...

10590 Background: We previously identified p53 as an independent marker of prognosis in African-American (AA) women with breast cancer. However, it is unclear whether the influence of p53 is unique...

Background: Heterogeneity exists in survival and prognosis among women of different race with ER/PR negative (-) breast cancer. Minority women often have lower SES, which may be a confounding factor. We evaluated survival and prognosis in a cohort of lower SES non-Hispanic White (NHW), African-American (AA), and Hispanic (HIS) women, in an attempt to disaggregate the effects of race and SES in ER/PR- breast cancer. Methods: Chi-square test was used to examine relationship significance [odds ratios (OR), 95% confidence intervals (CIs)]; survival function estimates were generated using Kaplan-Meier (KM) method and compared using log-rank test; proportional hazards regression models [hazard ratios (HR), 95% CIs] were used to select and evaluate factors prognostic for all-cause mortality, in 213 consecutive [30 NHW, 135 AA & 48 HIS] women treated at an urban hospital [44 months median follow-up] with ER/PR- disease. Results: HIS women were younger than NHW [OR, 0.36; 95% CI, 0.14-0.94; p =0.0368] and AA [OR, 0.50; 95% CI, 0.26-0.96; p =0386]. Compared to NHW and HIS, AA women had more comorbid disease [ORs: 3.53; 95% CI, 1.43-8.66; p =0.0053; & 2.12; 95% CI, 1.04-4.33; p =0.0392], and worse poverty status level (PL) [ORs: 5.43; 95% CI, 2.17-13.69; p =0.0001; & 2.79; 95% CI 1.17-6.65; p =0.0192]. No significant differences were noted between groups for stage at diagnosis, grade, p53 or HER2 status, and chemotherapy use. Baseline prognostic factors were: age [HR, 0.99/yr; 95% CI, 0.98-1.02; p =0.822]; stage [(II-IV/I) HR, 2.45; 95% CI, 1.85-3.24; p /≤ census mean) HR, 2.43; 95% CI, 1.12-5.28; p =0.025]; and chemotherapy [(+/-) HR, 0.51; 95% CI, 0.29-0.89; p =0.017]. Race was not associated with greater hazard mortality [(Other/AA) HR, 0.83; 95% CI, 0.60-1.14; p =0.255], and unadjusted 5-yr survival for NHW, AA and HIS women was 60.9%, 52.4%, and 64.4%. 5-yr survival by race was also not different for women aged Conclusion: Survival is not significantly different among lower SES women with ER/PR- breast cancer of different race. Stage and chemotherapy use, but not race, remained independent prognostic factors in Cox models for ER/PR- and TN disease. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 859.

10554 Background: Survival disparity for African-American (AA) women with breast cancer has been associated with more frequent aggressive tumor phenotype, manifested as higher stage, high grade and negative estrogen/progesterone receptor (ER/PR) status. However, AAs more often have low socioeconomic status (SES), and other studies suggest that low SES, not simply race, is associated with these prognostic features. We hypothesized that low SES AAs and non-AAs with breast cancer would demonstrate similar aggressive tumor phenotype and prognosis. Methods: Variables were analyzed for 538 consecutive low SES women treated between 1/00–12/05. Comparison between racial groups was done with independent t-test & Chi-square test. Associations were examined with logistic-regression, and compared as odds ratios (OR) & 95% confidence intervals (CI). Survival was computed using Log-rank test & Kaplan-Meier method. Results: At median follow-up of 32 months, there were 335 AAs & 203 non-AAs. No significant differences occurred between racial groups for tumor size & grade, node status, stage, ER/PR status, and frequency of survival events. HER2+ status was more frequent in non-AAs (25.1% vs. 17.9% AAs; p=0.048). No significant differences occurred between races for treatment with surgery, chemo & endocrine therapy, however radiation was more common in non-AAs (73.4% vs. 62.2% AAs; p=0.012) but AAs were significantly older (p=0.0001) and had more comorbid disease (p=0.0001). See Table for prevalence of aggressive tumor features. Age-adjusted logistic-regression showed no racial predilection for negative ER/PR, high grade and higher stage, but AAs were less likely to be HER2+ (OR=0.644; 95% CI=0.415–1.00; p=0.05). Log-rank tests showed no differences between racial groups for age & stage-specific disease-free & overall survival. Conclusions: These results confirm that among similar low SES women with breast cancer, there is no racial predilection for aggressive tumor phenotype and poor prognosis. [Table: see text] No significant financial relationships to disclose.

10001 Background: Abnormal nuclear accumulation of p53 protein may predict poorer survival & aggressive tumor biology in African-American (AA) women with breast cancer. We hypothesized that compared to Hispanics or whites, survival would be worse for AA women with p53 positive tumors. Methods: Tumors from 195 consecutive AA, 46 Hispanic & 52 white women were evaluated for p53 expression with IHC, using antibody Pab1801 on paraffin embedded tissue, at the SHCC MBCCOP, in Chicago. Staining was scored on the UK Receptor Group 0–8 system with score ≥2 read as positive. Survival was computed by the Kaplan-Meier method & correlated with p53 expression. Univariate analyses were done with two-sided log-rank test & multivariate analysis was done with Cox proportional-hazards model. Results: There were no significant differences between racial groups regarding tumor size, grade, node status, stage, estrogen receptor (ER) status, treatment & p53 expression. Hispanics were significantly younger (p=0.014). For AA, Hispanic & white women respectively, p53 expression was 29.2%, 34.8% & 18.8%. High grade (p=0.0001) & negative ER status (p=0.006) were significantly associated with p53 expression in AA women; similar results were seen in whites (p=0.014 & p=0.031 respectively), however although the trend for grade was similar, only negative ER status was significantly associated with p53 expression in Hispanics. AA women with p53 positive tumors had significantly worse survival compared to AA women with p53 negative tumors (Hazard Ratio=1.945; 95% CI=1.040–3.638; p=0.037). However, comparison of survival between races for women with p53 positive tumors (p=0.793) and also for women with p53 negative tumors (p=0.4027) was not different. Multivariate analysis demonstrated that there was no interaction (p=0.523) between p53 expression & stage as predictors of poor survival in AA women. Conclusions: Analyses between racial groups demonstrated that AA, Hispanic & white women with breast tumors with abnormal p53 expression had similar associations with high tumor grade, negative ER status and survival. However within racial groups, abnormal p53 expression was only able to predict significantly worse survival in AA women. This association appeared to be independent of stage. [Table: see text]

Peripheral tuberculous lymphadenopathy is the commonest form of extrapulmonary tuberculosis. Sixty-seven patients with peripheral tuberculous lymphadenopathy who presented to general surgeons and underwent lymph node biopsy between 1979 and 1989 are reviewed. Fifty-four patients (81 per cent) were of Indian subcontinent ethnic origin and 13 (19 per cent) were of white ethnic origin. The sites most commonly afected were the cervical lymph nodes. Biopsy specimens obtained by open operation were sent for microbiological examination in all but 13 cases, of whom seven were patients of white ethnic origin. Tuberculous lymphadenopathy remains an important differential diagnosis of cervical lymphadenopathy and it is essential that peripheral lymph node biopsies are examined both histologically and microbiologically.

One hundred and ninety referrals from general practitioners (GPs) to an acute surgical unit were audited prospectively over a 6-month period. A total of 78 admissions were considered inappropriate of whom 23 patients were thought to have needed neither surgical admission nor opinion. The estimated expenditure resulting from admissions deemed inappropriate was 25,000 pounds. The daytime commitments of more senior staff on routine emergency duty days meant they were not easily available to deal with calls concerning acute GP referrals. These admissions reduce the efficiency of the service; this may be improved by a senior member of the team accepting and screening GP calls.