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BackgroundAlthough advances in screening, detection, diagnosis, and treatment have reduced overall breast cancer mortality, well-documented socioeconomic and racial/ethnic disparities persist. The objective of this study was to utilize the area deprivation index (ADI), a compositive measure of neighborhood disadvantage, on breast cancer survival in South Florida, predominantly consisting of Miami-Dade County residents. The ADI is based on a measure created by the Health Resources & Services Administration (HRSA) over three decades ago, and has since been refined, adapted, and validated to the Census Block Group neighborhood level. The ADI score (1-10) includes factors from the domains of income/employment (e.g., median family income), education (e.g., % population >25 with Table: ADI (Tertiles) and Breast Cancer-Specific SurvivalHR (95% CI)Area Deprivation Index (vs. most advantaged)ADI Tertile 21.27 (1.00, 1.63)ADI Tertile 3 (more disadvantaged)1.50 (1.17, 1.91)Race (vs. NHW)Hispanic0.94 (0.72, 1.22)NHB1.71 (1.27, 2.31)Age1.02 (1.01, 1.02)Insurance (vs. Private)Government1.49 (1.19, 1.86)Insurance, NOS0.97 (0.62, 1.51)Uninsured1.15 (0.87, 1.52)Unknown1.19 (0.78, 1.82)Receptor Status (vs. ER+/HER2-)ER+/HER2+1.40 (1.06, 1.86)ER-/HER2-2.11 (1.70, 2.60)ER-/HER2+1.20 (0.85, 1.69)Unknown0.88 (0.51, 1.51)Body Mass Index (vs. Normal Weight (18.5 – 24.9)Underweight (Less than 18.5)1.40 (0.72, 2.72)Overweight (25.0 – 29.9)0.70 (0.56, 0.88)Obese (> 29.9)0.79 (0.63, 0.98)Hypertension0.84 (0.67, 1.03)Diabetes Mellitus1.02 (0.74, 1.40)NCCN-guideline concordant Treatment0.84 (0.75, 0.94) Citation Format: Neha Goel, Seraphina Choi, Sina Yadegarynia, Kristin Rojas, Susan Kesmodel, Erin Kobetz, Ashly Westrick. Neighborhood disadvantage predicts worse breast cancer-specific survival [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-08.

ImportanceNeighborhood-level disadvantage is an important factor in the creation and persistence of underresourced neighborhoods with an undue burden of disparate breast cancer–specific survival outcomes. Although studies have evaluated neighborhood-level disadvantage and breast cancer–specific survival after accounting for individual-level socioeconomic status (SES) in large national cancer databases, these studies are limited by age, socioeconomic, and racial and ethnic diversity.ObjectiveTo investigate neighborhood SES (using a validated comprehensive composite measure) and breast cancer–specific survival in a majority-minority population.Design, Setting, and ParticipantsThis retrospective multi-institutional cohort study included patients with stage I to IV breast cancer treated at a National Cancer Institute–designated cancer center and sister safety-net hospital from January 10, 2007, to September 9, 2016. Mean (SD) follow-up time was 60.3 (41.4) months. Data analysis was performed from March 2022 to March 2023.ExposuresNeighborhood SES was measured using the Area Deprivation Index (tertiles), a validated comprehensive composite measure of neighborhood SES.Main Outcomes and MeasuresThe primary outcome was breast cancer–specific survival. Random effects frailty models for breast cancer–specific survival were performed controlling for individual-level sociodemographic, comorbidity, breast cancer risk factor, access to care, tumor, and National Comprehensive Cancer Network guideline-concordant treatment characteristics. The Area Deprivation Index was calculated for each patient at the census block group level and categorized into tertiles (T1-T3).ResultsA total of 5027 women with breast cancer were included: 55.8% were Hispanic, 17.5% were non-Hispanic Black, and 27.0% were non-Hispanic White. Mean (SD) age was 55.5 (11.7) years. Women living in the most disadvantaged neighborhoods (T3) had shorter breast cancer–specific survival compared with those living in the most advantaged neighborhoods (T1) after controlling for individual-level sociodemographic, comorbidity, breast cancer risk factor, access to care, tumor, and National Comprehensive Cancer Network guideline-concordant treatment characteristics (T3 vs T1: hazard ratio, 1.29; 95% CI, 1.01-1.65; P Conclusions and RelevanceIn this cohort study, a shorter breast cancer–specific survival in women from disadvantaged neighborhoods compared with advantaged neighborhoods was identified, even after controlling for individual-level sociodemographic, comorbidity, breast cancer risk factor, access to care, tumor, and National Comprehensive Cancer Network guideline-concordant treatment characteristics. The findings suggest potential unaccounted mechanisms, including unmeasured social determinants of health and access to care measures. This study also lays the foundation for future research to evaluate whether social adversity from living in a disadvantaged neighborhood is associated with more aggressive tumor biologic factors, and ultimately shorter breast cancer-specific survival, through social genomic and/or epigenomic alterations.

Gastric-type adenocarcinomas of the uterine cervix have been described within the literature in detail; however, the description of gastric-type endometrial adenocarcinomas is a recent development, with only two cases originating from Japan in the world literature to date. According to these prior reports, the recognition of this pattern of differentiation is critical, as it is often associated with deep myoinvasion, positive regional lymph nodes, and poor outcome despite appropriate adjuvant treatment. We present two cases of endometrial adenocarcinoma with gastric-type differentiation in patients from the United States with superficial myoinvasion and positive patient outcomes. Gastric-type differentiation in endometrial adenocarcinomas is rare and likely underrecognized. Continued reporting of these cases is necessary to further understand the natural history and clinical implications of this entity.

Between the years 2010 and 2012, the lifetime probability of developing female breast cancer was 12.3%, or approximately 1 in 8. Worldwide, breast cancer is the most common cancer in women. Survival is increasing. Between 2005 and 2011, the 5-year relative survival was found to be 89%. This is thought to be due to both the increase in utilization of population-wide screening, as well as advances in treatment. Less than 10% of breast cancers can be attributed to an inherited genetic mutation. Breast cancer is more commonly associated with environmental, reproductive, and lifestyle factors, some of which are potentially modifiable.

The technique of autologous fat transplantation has been dramatically improved since its first introduction in 1893. This surgical approach has more recently been used in both the reconstructive and cosmetic setting, and has subsequently been the subject of much controversy. We sought to compose a detailed and systematic literature review of recent literature on the topic in order to provide surgeons with the data in an organized and easily accessible manner. We selected 19 studies and systematically documented trends in their methods, follow-up procedures, and outcomes, paying particular attention to complications. We chose to include studies that analyzed the outcomes of the surgical procedure in both reconstructive and cosmetic cases. Most authors reported satisfactory or greater results, and we concluded that it appears as though autologous fat transplantation to the breast is a safe option for patients seeking both reconstructive and cosmetic surgery.

Background The optimal management of patients with combined carotid and coronary artery disease requiring cardiac surgery is still unknown. Staged carotid endarterectomy and carotid artery stenting (CAS), each followed by coronary artery bypass graft (CABG), are options frequently employed. However, for patients with severe carotid artery disease in urgent need of open cardiac revascularization, staged operations may not be the most appropriate alternative. The aim of this study was to describe our experience using a synchronous CAS-CABG method with minimal interprocedural time. We used this synchronous combination of procedures in patients with combined carotid and coronary artery disease admitted for urgent CABG. Methods Patients with concomitant severe carotid and coronary artery disease scheduled for synchronous CAS and urgent CABG between December 2006 and January 2010 were included in the study. All procedures were performed at a single center: the Cardiovascular Foundation of Colombia, in Floridablanca, Santander, Colombia. The study cohort was characterized according to demographic and clinical characteristics, which included degree of carotid stenosis, presence/absence of preoperative neurological symptoms, and cardiac operative risk profile. All patients underwent CAS under embolic protection devices and then CABG within the next 2 hours. Patients received aspirin pre- and postprocedure but were started on clopidogrel only after CABG. The primary end point of the study was the composite incidence rate of myocardial infarction, stroke, and death 30 days after CAS-CABG. Results Fifteen patients with concomitant severe carotid and coronary artery disease underwent synchronous CAS-CABG. Most patients (60%) were men, and mean (± standard deviation) age was 65.2 (± 8.4) years. Most patients (93%) were neurologically asymptomatic. The median (interquartile range) ejection fraction and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) for the cohort were 55% (36%-62%) and 9.7% (4.6%-14.8%), respectively. There were no deaths, major strokes, minor strokes, or myocardial infarctions during the procedure or within 30 days of CAS-CABG. One patient experienced neurological symptoms likely as a result of transient ischemic attack ipsilateral to the CAS procedure. None of the patients required cardiac or carotid reinterventions, and there were no cases of postoperative bleeding requiring reoperation. Conclusions Synchronous CAS-CABG, when CABG is performed within the 2 hours of the CAS procedure, may be a viable alternative to the more generally accepted staged combination, particularly among patients for whom CABG cannot be postponed. We hope that this strategy will be further evaluated in larger prospective studies and adequately powered randomized clinical trials.