Dorothy Long Parma

Time to definitive diagnosis of breast cancer in Latina and non-Hispanic white women: the six cities study

Time delay after an abnormal screening mammogram may have a critical impact on tumor size, stage at diagnosis, treatment, prognosis, and survival of subsequent breast cancer. This study was undertaken to evaluate disparities between Latina and non-Hispanic white (NHW) women in time to definitive diagnosis of breast cancer after an abnormal screening mammogram, as well as factors contributing to such disparities.As part of the activities of the National Cancer Institute (NCI)-funded Redes En Acción research network, clinical records of 186 Latinas and 74 NHWs who received abnormal screening mammogram results were reviewed to determine the time to obtain a definitive diagnosis. Data was obtained from participating clinics in six U.S. cities and included demographics, clinical history, and mammogram characteristics. Kaplan-Meier estimates and Cox proportional hazards models were used to test differences in median time to definitive diagnosis by ethnicity after adjusting for clinic site, demographics, and clinical characteristics.Time-to-event analysis showed that Latinas took 2.2 times longer to reach 50% definitively diagnosed with breast cancer relative to NHWs, and three times longer to reach 80% diagnosed (p=0.001). Latinas’ median time to definitive diagnosis was 60 days compared to 27 for NHWs, a 59% gap in diagnosis rates (adjusted Hazard Ratio [aHR] = 1.59, 95% CI = 1.09, 2.31; p=0.015). BI-RADS-4/5 women’s diagnosis rate was more than twice that of BI-RADS-3 (aHR = 2.11, 95% CI = 1.18, 3.78; p=0.011).Disparities in time between receipt of abnormal screening result and definitive diagnosis adversely affect Latinas compared to NHWs, and remain significant after adjusting for demographic and clinical variables. With cancer now the leading cause of mortality among Latinos, a greater need exists for ethnically and culturally appropriate interventions like patient navigation to facilitate Latinas’ successful entry into, and progression through, the cancer care system.

Effects of six months of Yoga on inflammatory serum markers prognostic of recurrence risk in breast cancer survivors

Yoga-based exercise has proven to be beneficial for practitioners, including cancer survivors. This study reports on the effect on inflammatory biological markers for 20 breast cancer survivors who participated in a six-month yoga-based (YE) exercise program. Results are compared to a comprehensive exercise (CE) program group and a comparison (C) exercise group who chose their own exercises.“Pre” and “post” assessments included measures of anthropometrics, cardiorespiratory capacity, and inflammatory markers interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNFα) and C-reactive protein (CRP). Descriptive statistics, effect size (d), and dependent sample ‘t’ tests for all outcome measures were calculated for the YE group.Significant improvements were seen in decreased % body fat, (−3.00%, d = −0.44, p = <.001) but not in cardiorespiratory capacity or in inflammatory serum markers. To compare YE outcomes with the other two groups, a one-way analysis of co-variance (ANCOVA) was used, controlling for age, BMI, cardiorespiratory capacity and serum marker baseline values. We found no differences between groups. Moreover, we did not see significant changes in any inflammatory marker for any group.Our results support the effectiveness of yoga-based exercise modified for breast cancer survivors for improving body composition. Larger studies are needed to determine if there are significant changes in inflammatory serum markers as a result of specific exercise modalities.

Motivation, exercise, and stress in breast cancer survivors

PurposeReduced stress and reduced risk of cancer recurrence are among the many benefits of physical activity (PA) for cancer survivors. Exercise behaviors are linked to motivational factors. We investigated the associations between motivational profile, self-reported levels of PA and stress, and mental functioning in 94 posttreatment breast cancer survivors who voluntarily enrolled in an exercise program.MethodsParticipants completed the Apter Motivational Style Profile (AMSP), Lifetime of Physical Activity (LTPA) Questionnaire, International Physical Activity Questionnaire (IPAQ), Medical Outcomes Short Form SF-36® (SF-36), and Perceived Stress Scale (PSS) and provided 10 saliva specimens (to measure cortisol levels). PA levels were calculated in metabolic equivalent hours per week (MET-hours/week).ResultsParticipants reported high levels of current and historical PA (M = 39.2 MET-h/week, SD = 39.7; M = 14.2 MET-h/week, SD = 15.4, respectively). They also reported high levels of stress (M = 33.6, SD = 4.5) coupled with low mental functionality as measured by SF-36 mental component scale (MCS) (M = 44.4, SD = 8.8). PSS was negatively associated with MCS (r = −0.27, p = 0.009). Salivary cortisol was not associated with any measure. Participants had a conformist (“follow rules”) and alloic (“about others”) motivational profile. No motivational, exercise history, or stress variables were associated with current PA.ConclusionsAs expected, participants reported higher levels of stress and lower mental functioning. Participants presented a unique motivational profile relative to the general population. Further research into the associations of motivation, exercise behaviors, and stress is warranted.

Lifestyle and Clinical Correlates of Hepatocellular Carcinoma in South Texas: A Matched Case-control Study

Accepted Manuscript Lifestyle and clinical correlates of hepatocellular carcinoma in South Texas: a matched case-control study Amelie G. Ramirez, Edgar Munoz, Dorothy Long Parma, Joel E. Michalek, Alan E.C. Holden, Timothy D. Phillips, Bradley H. Pollock PII: DOI: Reference: S1542-3565(17)30322-1 10.1016/j.cgh.2017.03.022 YJCGH 55166 To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 18 March 2017 Please cite this article as: Ramirez AG, Munoz E, Parma DL, Michalek JE, Holden AEC, Phillips TD, Pollock BH, Lifestyle and clinical correlates of hepatocellular carcinoma in South Texas: a matched case-control study, Clinical Gastroenterology and Hepatology (2017), doi: 10.1016/j.cgh.2017.03.022. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

An anti-inflammatory dietary intervention to reduce breast cancer recurrence risk: Study design and baseline data

U.S. breast cancer survivors (BCSs) are expected to increase to 4 million in the next 5-10years. Cancer recurrence risk is highest among obese survivors. Inflammatory (Pro-I) biomarkers including C-reactive protein (CRP), Interleukins -3, -6, and -8 (IL-3, IL-6, IL-8), and Tumor Necrosis Factor (TNF)-α have been associated with cancer recurrence risk. Nutritional interventions aimed at reducing inflammation (INF) may contribute to reduced cancer recurrence risk, but studies have been limited to animal models. The goals of this one-year, culinary-based, pilot intervention were to: 1) decrease Pro-I biomarkers and increase anti-inflammatory (AI) cytokine, IL-10, by promoting AI food incorporation into BCS diets; and 2) examine intervention effects on cancer risk factors including body mass index (BMI) and circulating adipose stromal cells (ASCs). A total of 153 BCSs were recruited. Overweight and obese women aged 18 or older were randomized into Intervention (IG; n=76) and Control (CG; n=77) groups. CG received monthly nutritional brochures from the American Institute for Cancer Research. IG attended 6 monthly workshops (lectures on AI topics and chef-prepared food demonstrations), and received monthly newsletters and telephone calls incorporating Motivational Interviewing. At baseline, 6- and 12-month assessments, fasting serum was assayed for Pro-I/AI marker and ASC levels. Using R and Stata version 14 (Stata Corp, 2015), no significant differences were found between groups on baseline demographic variables. Correlations between serum cytokine levels, BMI, % body fat, ASCs, and self-reported variables are discussed.

Helicobacter Pylori Infection in Texas Hispanic and Non-Hispanic White Men: Implications for Gastric Cancer Risk Disparities

Chronic Helicobacter pylori (H. pylori) infection is a major gastric adenocarcinoma (GA) risk factor. GA disproportionately affects U.S. Hispanics compared with non-Hispanic Whites (NHWs). Since H. pylori infection studies in Hispanics are few, infection rates in Hispanic and NHW men in Bexar County were compared, and relationships with ethnicity and obesity examined. Age- and zip code-matched participants from a community-dwelling cohort were randomly selected. Sera from 284 men were analyzed by enzyme immunoassay for H. pylori antibodies. Adjusted risk ratio estimation for matched data was conducted to identify differences. Hispanics had a markedly higher prevalence of infection (30.3%) than NHWs (9.2%). Matched risk ratio (mRR) analyses revealed a strong association between H. pylori seropositivity and Hispanic ethnicity (mRR = 3.31; 95% CI [1.91, 5.73], adjusted by BMI, smoking status, and family history of cancer (mRR range = 3.28-3.89). BMI mRRs (range = 1.19-1.22) were significant in all models. In this cohort, Hispanic men had higher H. pylori infection rates than NHWs, and parallel the disproportionately higher rates of GA; obesity contributes to this higher prevalence. Future studies should address country of origin, acculturation, and other factors influencing obesity to further elucidate risk of GA in Hispanic populations.

Abstract B20: Geospatial analysis of hepatocellular carcinoma and its risk factors in Texas (1995-2010)

Introduction: Between 1995 and 2010 there have been 1.4 million incident cancer cases in Texas. While Hepatocellular Carcinoma (HCC) accounted for a small proportion (ranked 21st in incidence), it ranked 9th by cause of death attributed to the tumor. Mortality rate was 68%, with average overall survival time 16.6 months. Unlike most cancers, HCC has resisted attempts to reduce its impact; incidence rates continue to increase especially among those Methods: County-level data on PRFs was obtained from the TX Department of State Health Services--Reportable Diseases, County Health Rankings, TX Cancer Registry, and the Centers for Disease Control and Prevention. HCC cases were defined using the International Classification of Diseases (ICDO-3 topography C22.0 and morphologies 8170–8175). Incidence rates were calculated using the Surveillance, Epidemiology and End Results (SEER) Stat Statistical software version 8.1.5. Correlation analysis between HCC rates and each PRF was conducted using ordinary least squares linear regression (p Comparisons were performed by overlapping areas showing high probabilities in variable pairs, and indicating whether they were concordant (both high, both low), or discordant (one high, one low). Using GeoDa, Univariate Moran9s I was calculated to evaluate spatial autocorrelation of HCC and all PRFs. Bivariate Moran9s I was used to determine which PRFs clustered geographically with HCC. Contiguity-based spatial weights were calculated using the Rook9s and Queen9s method of first and second order. Spatial Lag regression analysis was performed to test spatial relationships of HCC and multiple PRFs. Due to the inverse relationship between population proportions of Non-Hispanic whites (NHW) and Hispanics, these variables were run in separate linear models. Results: Correlation analysis showed 12 PRFs significantly associated to HCC. All 12 PRFs were spatially auto correlated (p Conclusion: Several PRFs clustered spatially and varied geographically with HCC rates, particularly in areas with low NHW/high Hispanic populations and counties along the South TX/Mexico border. HIV9s significant spatial correlation with HCC is important, as co-infection with known HCC risk factor Hepatitis C virus (HCV) accelerates liver fibrosis development vs. HCV infection alone. This study highlights the need for interventions targeted to multiple HCC PRFs including EAC and HIV, particularly in South TX. Citation Format: Laura Manuel, Edgar Munoz, Dorothy Long Parma, Amelie Ramirez. Geospatial analysis of hepatocellular carcinoma and its risk factors in Texas (1995-2010). [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 B20.

Abstract B36: Helicobacter pylori exposure among Hispanic and non-Hispanic white men in San Antonio, Texas: Implications for gastric cancer risk disparities

Background: Chronic Helicobacter pylori ( H. pylori ) infection is the most common gastric adenocarcinoma (GCA) risk factor. GCA more commonly affects U.S. Hispanics compared to non-Hispanic whites (NHWs). No study has examined this infection in South Texas Hispanics, a population facing multiple health disparities. This pilot project aimed to determine H. pylori exposure rates in Hispanic and NHW men residing in Bexar County, and examine relationships with ethnicity, residence, socioeconomic status, smoking history and cancer family history. Methods: Age- and zip-code-matched subjects from a large community-dwelling cohort were randomly selected. Sera from 286 (143 Hispanic, 143 NHW) men were analyzed by enzyme immunoassay for H. pylori antibodies. Results: Almost 20% of samples were H. pylori -positive; exposure was significantly higher among Hispanics (30.1%) compared to NHWs (9.1%). Unconditional logistic regression analyses of the seropositive-matched subsample showed strong associations between H. pylori seropositivity and Hispanic ethnicity (odds ratio [O.R.]=17.5; p ) and BMI category (O.R.=6.5; p=0.01 overweight and 4.0; p=0.02 obese). Ethnicity remained the strongest predictor of seropositivity after adjusting for all other factors (adjusted O.R.=16.9; p ). Adjusted O.R.s for overweight/obesity were high but non-significant. Conclusions: H. pylori exposure rates are higher in South Texas Hispanic men and parallel the disproportionately-higher rates of GCA. Obesity is a contributing factor. This is the first study to explore the relationship between H. pylori exposure and Hispanic ethnicity and other GCA risk factors in South Texas. Results have implications for future studies on preventive measures targeted at reducing infectious burden and GCA risk in this vulnerable population. Citation Format: Dorothy Long Parma, Edgar Munoz, Susan M. Ogden, Robin J. Leach, Ian M. Thompson, Jr., Amelie G. Ramirez. Helicobacter pylori exposure among Hispanic and non-Hispanic white men in San Antonio, Texas: Implications for gastric cancer risk disparities. [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 B36.