Caryn E. Peterson

Prediagnosis Food Patterns Are Associated with Length of Survival from Epithelial Ovarian Cancer

BACKGROUND Dietary factors have been the focus of many studies on the etiology of ovarian cancer and may potentially affect survival. Indeed, three recent studies outside the United States have suggested that diet plays a role in ovarian cancer survival. OBJECTIVE The study purpose was to evaluate the hypothesis that women diagnosed with ovarian cancer whose reported prediagnosis food patterns more closely reflect recommendations for optimal health experience a survival advantage compared with those reporting poorer diets. DESIGN A longitudinal follow-up study design was used to examine prediagnosis usual diet effects on survival among 341 Cook County, Illinois, residents diagnosed with epithelial ovarian cancer during 1994-1998. These women participated in a previous case-control study where diet was assessed using a validated food frequency questionnaire. This diet information was categorized utilizing the Dietary Guidelines for Americans 2005. Deaths through 2005 were ascertained using a national death index search. STATISTICAL ANALYSIS Hazard ratios (HR) and 95% confidence intervals (CI) adjusting for important covariables were obtained from proportional hazards regression models to evaluate diet effects on survival from ovarian cancer. RESULTS Comparisons of high to low food group or subgroup intakes demonstrated statistically significant prediagnosis food pattern associations with survival time. Longer survival was associated with total fruits and vegetables (HR 0.61, 95% CI 0.38 to 0.98, P for trend=0.10) and vegetables separately (HR 0.66, 95% CI 0.43 to 1.01, P for trend <0.05). Subgroup analyses showed only yellow and cruciferous vegetables to significantly favor survival. Conversely, a survival disadvantage was shown for meats, not generally recommended (HR 2.28, 95% CI 1.34 to 3.89, P for trend <0.01), and specifically the red and cured/processed meats subgroups. An increased HR was also observed for the milk (all types) subgroup (HR 2.15, 95% CI 1.20 to 3.84, P for trend <0.05). CONCLUSIONS Prediagnosis adherence to diets that reflect recommendations for optimal nutrition and cancer prevention may have benefits that continue even after an ovarian cancer diagnosis.

How Do We More Effectively Move Epidemiology into Policy Action

A major focus of the American College of Epidemiologys Policy Committee has been to review the translation of epidemiologic evidence into policy by developing case studies. This article summarizes crosscutting policy process lessons across the eight cases developed to date through two workshops held in 2009 and 2011. A framework for evidence-based public health policy has emerged to suggest that process, content, and outcomes are all needed to help move policy forward. The most readily and apparent contributions from epidemiologists are towards content and outcomes activities, and although this is apparent in all of the case studies presented, much of the 2011 workshop discussion focused on six process issues. Policy and process issues are not well incorporated into current epidemiologic training, and controversy remains over the role of the epidemiologist as an advocate for policy changes. As these case studies show, epidemiologic evidence impacts policy to address emerging public health problems, yet few epidemiologists are formally trained in the domains to support policy development. As we continue to learn from current policy efforts, we encourage the incorporation of these case studies and the emerging experience within epidemiologic training programs.

The effect of neighborhood disadvantage on the racial disparity in ovarian cancer-specific survival in a large hospital-based study in cook county, illinois.

This paper examines the effect of neighborhood disadvantage on racial disparities in ovarian cancer-specific survival. Despite treatment advances for ovarian cancer, survival remains shorter for African-American compared to White women. Neighborhood disadvantage is implicated in racial disparities across a variety of health outcomes and may contribute to racial disparities in ovarian cancer-specific survival. Data were obtained from 581 women (100 African-American and 481 White) diagnosed with epithelial ovarian cancer between June 1, 1994, and December 31, 1998 in Cook County, IL, USA, which includes the city of Chicago. Neighborhood disadvantage score at the time of diagnosis was calculated for each woman based on Browning and Cagney’s index of concentrated disadvantage. Cox proportional hazard models measured the association of self-identified African-American race with ovarian cancer-specific survival after adjusting for age, tumor characteristics, surgical debulking, and neighborhood disadvantage. There was a statistically significant negative association (−0.645) between ovarian cancer-specific survival and neighborhood disadvantage (p = 0.008). After adjusting for age and tumor characteristics, African-American women were more likely than Whites to die of ovarian cancer (HR = 1.59, p = 0.003). After accounting for neighborhood disadvantage, this risk was attenuated (HR = 1.32, p = 0.10). These findings demonstrate that neighborhood disadvantage is associated with ovarian cancer-specific survival and may contribute to the racial disparity in survival.

Association of genetic ancestry with breast cancer in ethnically diverse women from Chicago.

Introduction Non-Hispanic (nH) Black and Hispanic women are disproportionately affected by early onset disease, later stage, and with more aggressive, higher grade and ER/PR negative breast cancers. The purpose of this analysis was to examine whether genetic ancestry could account for these variation in breast cancer characteristics, once data were stratified by self-reported race/ethnicity and adjusted for potential confounding by social and behavioral factors. Methods We used a panel of 100 ancestry informative markers (AIMs) to estimate individual genetic ancestry in 656 women from the “Breast Cancer Care in Chicago” study, a multi-ethnic cohort of breast cancer patients to examine the association between individual genetic ancestry and breast cancer characteristics. In addition we examined the association of individual AIMs and breast cancer to identify genes/regions that may potentially play a role in breast cancer disease disparities. Results As expected, nH Black and Hispanic patients were more likely than nH White patients to be diagnosed at later stages, with higher grade, and with ER/PR negative tumors. Higher European genetic ancestry was protective against later stage at diagnosis (OR 0.7 95%CI: 0.54–0.92) among Hispanic patients, and higher grade (OR 0.73, 95%CI: 0.56–0.95) among nH Black patients. After adjustment for multiple social and behavioral risk factors, the association with later stage remained, while the association with grade was not significant. We also found that the AIM SNP rs10954631 on chromosome 7 was associated with later stage (p = 0.02) and higher grade (p = 0.012) in nH Whites and later stage (p = 0.03) in nH Blacks. Conclusion Non-European genetic ancestry was associated with later stage at diagnosis in ethnic minorities. The relation between genetic ancestry and stage at diagnosis may be due to genetic factors and/or unmeasured environmental factors that are overrepresented within certain racial/ethnic groups.

Combined Antioxidant Carotenoids and the Risk of Persistent Human Papillomavirus Infection

Persistent infection with human papillomavirus (HPV) is the primary etiologic factor for cervical cancer. The synergistic effect of carotenoids on HPV persistence has not been examined. To explore these potential synergies, we developed 2 measures of carotenoid status using circulating and dietary intake nutrients in which each nutrient was given equal weighting. We then compared persistent HPV infection with its counterpart, intermittent infection. In the analysis using the Crude Index, no association was observed between circulating nutrients and persistent infection with oncogenic HPV [odds ratio (OR)adjusted = 0.8, 95% confidence interval (CI) = 0.3–2.2)] or any type HPV (ORadjusted = 0.8, 95% CI = 0.3–2.1). Similar results were obtained using the Cumulative Index. However, associations between dietary intake and persistent infection were observed using both indexes. When the analysis was restricted to oncogenic HPV, a 50% higher risk was observed for women with low dietary carotenoid status using the Crude Index (ORadjusted = 1.5, 95% CI = 0.6–3.7). In the analysis using any type HPV, the adjusted OR for women with low dietary intake of combined carotenoids using the Cumulative Index was 2.4 (95% CI = 1.1–5.2). These results may be consistent with the hypothesis that low levels of carotenoids may increase the risk of persistent HPV infection.

Measures of economic advantage associated with HPV-positive head and neck cancers among non-Hispanic black and white males identified through the National Cancer Database

BACKGROUND National trends show dramatic increases in the incidence of HPV-related head and neck squamous cell carcinomas (HNSCCs) among black and white males. Using cases identified through the National Cancer Data Base, we assessed factors associated with HPV 16- or 16/18 positive HNSCCs among non-Hispanic black and white males diagnosed in the U.S. between 2009 and 2013. METHODS This sample included 21,524 HNSCCs with known HPV status. Adjusted relative risks (RRs) and 95% confidence intervals (CIs) were estimated using log-binomial regression. RESULTS Compared to those with HPV-negative tumors, male patients diagnosed with HPV-positive HNSCCs were non-Hispanic white, younger at diagnosis, lived in zip-code areas with higher median household income and higher educational attainment, had private health insurance and no reported comorbidities at diagnosis. Although the risk of HPV-positive HNSCCs increased with measures of higher area-level socioeconomic status, the effect was stronger for non-Hispanic black males (RRAdjusted=1.76, 95% CI 1.49-2.09) than for whites (RRAdjusted=1.12, 95% CI 1.08-1.16). The peak age for diagnosis of HPV-positive HNSCCs occurred in those diagnosed at 45-49 years (RRAdjusted=1.57, 95% CI 1.42-1.73). Oropharyngeal tumors were strongly associated with HPV-positivity (RRAdjusted=4.32, 95% CI 4.03-4.63). In the analysis restricted to oropharyngeal anatomic sites, similar patterns persisted. CONCLUSION In our analysis, measures of economic advantage were associated with an increased risk of HPV-positive HNSCCs. In order to develop effective interventions, greater understanding of the risk factors for HPV-positive HNSCCs is needed among both high-risk males and their healthcare providers.

Efficacy of a food safety comic book on knowledge and self-reported behavior for persons living with AIDS.

Introduction Persons living with AIDS are highly vulnerable to foodborne enteric infections with the potential for substantial morbidity and mortality. Educational materials about foodborne enteric infections intended for this immunocompromised population have not been assessed for their efficacy in improving knowledge or encouraging behavior change. Methods/Results AIDS patients in four healthcare facilities in Chicago, New Orleans, and Puerto Rico were recruited using fliers and word of mouth to healthcare providers. Those who contacted research staff were interviewed to determine food safety knowledge gaps and risky behaviors. A food safety educational comic book that targeted knowledge gaps was created, piloted, and provided to these patients who were instructed to read it and return at least 2 weeks later for a follow-up interview. The overall food safety score was determined by the number of the 26 knowledge/belief/behavior questions from the survey answered correctly. Among 150 patients who participated in both the baseline and follow-up questionnaire, the intervention resulted in a substantial increase in the food safety score (baseline 59%, post-intervention 81%, p<0.001). The intervention produced a significant increase in all the food safety knowledge, belief, and behavior items that comprised the food safety score. Many of these increases were from baseline knowledge below 80 percent to well above 90%. Most (85%) of the patients stated they made a change to their behavior since receiving the educational booklet. Conclusion This comic book format intervention to educate persons living with AIDS was highly effective. Future studies should examine to what extent long-term behavioral changes result.

Society of Behavioral Medicine position statement: Society of Behavioral Medicine supports oral cancer early detection by all healthcare providers

In response to the increasing incidence of certain oral and oropharyngeal cancers, the Society of Behavioral Medicine (SBM) calls on healthcare providers and legislators to expand awareness of oral and oropharyngeal cancer risk factors, increase early detection, and support policies that increase utilization of dental services. SBM supports the American Dental Associations 2017 guideline for evaluating potentially malignant oral cavity disorders and makes the following recommendations to healthcare providers and legislators. We encourage healthcare providers and healthcare systems to treat oral exams as a routine part of patient examination; communicate to patients about oral/oropharyngeal cancers and risk factors; encourage HPV vaccination for appropriate patients based on recommendations from the Advisory Committee on Immunization Practices; support avoidance of tobacco use and reduction of alcohol consumption; and follow the current recommendations for evaluating potentially malignant oral cavity lesions. Because greater evidence is needed to inform practice guidelines in the primary care setting, we call for more research in collaborative health and dental services. We encourage legislators to support policies that expand Medicaid to cover adult dental services, increase Medicaid reimbursement for dental services, and require dental care under any modification of, or replacement of, the Affordable Care Act.

Abstract 1768: Racial/ethnic differences in endometrioid endometrial cancer survival among cases identified through the National Cancer Database

OBJECTIVES: Past research suggests that at the local level, Non-Hispanic whites (NHW) have better survival when diagnosed with endometrioid endometrial cancer (EEC) than non-Hispanic blacks (NHB), Hispanics, and American Indians; however, little is known about survival differences at a national level and among other minorities. This study examined whether racial and ethnic differences in 5-year survival are present in U.S. women (NHW, NHB, Hispanics, non-Hispanic Asians (NHA), non-Hispanic Pacific Islanders/Hawaiians (NHPI), non-Hispanic American Indians/Aleutians or Eskimos (NHAI/AN) and non-Hispanics Others (NHO). METHODS: EEC cases from the National Cancer Database were analyzed to evaluate racial/ethnic differences in 5-year survival among women diagnosed with EEC between 1998 and 2007. Chi-Square test was used to examine whether differences in demographic, clinical, institutional, and treatment variables varied by race/ethnicity. Multivariable Cox proportional hazard regression models were fit to estimate the adjusted hazard ratio (HR) and 95% confidence interval (95% CI) between race/ethnicity and survival. RESULTS: A total of 178,310 women were diagnosed with EEC between 1998 and 2007. Of these; 74.8% were NHW, 8.3% were NHB, 13.9% were Hispanic, 1.8% were NHA, 0.2% were NHPI, 0.2% were NHAI/AN and 0.8% were NHO. Adjusting for covariates, NHB (HR = 1.29; 95%CI 1.24-1.34) and NHPI (HR = 1.59; 95%CI 1.50-1.67) had poorer survival than NHW. Yet results show that NHA (HR = 0.83; 95%CI 0.74-0.92) and NHO (HR = 0.81; 95%CI 0.69-0.94) had a better survival when compared to NHW. No survival differences were detected between Hispanics, NHAI/AN and NHW. CONCLUSIONS: Results identify racial/ethnic differences in 5-year survival among women diagnosed with EEC cancer in the U.S. between 1998 and 2007. NHA and NHO had a better and NHB and NHPI had a poorer survival when compared to NHW. Citation Format: Anna B. Beckmeyer-Borowko, Caryn E. Peterson, Katherine C. Brewer, Mary O. Otoo, Faith G. Davis, Kent F. Hoskins, Charlotte E. Joslin. Racial/ethnic differences in endometrioid endometrial cancer survival among cases identified through the National Cancer Database. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1768.