Kathryn M. Larsen

Abstract 2599: Association of periodontal disease and breast health in women undergoing screening mammography

It is well established that chronic and persistent inflammation contributes to cancer development. Chronic inflammation is often associated with periodontal disease, or gum disease. Periodontal disease, which can be prevented or ameliorated by following proper oral hygiene, is known to be associated with various systemic disorders including coronary heart disease and some cancers, including head and neck cancer and pancreatic cancer. However, little is known about its potential association with breast cancer, with only one report in which periodontal disease was a positive predictor for breast cancer in a Swedish cohort. To examine if a potential link exists between periodontal disease and breast cancer in a separate cohort, mammography patients from the UC Irvine Athena Breast Health Network cohort were recruited to participate in a survey that included questions about their periodontal health. Diagnosis of invasive breast cancer, DCIS, and benign breast diseases was determined through data extraction from electronic medical records. There was no association between periodontal disease and DCIS or invasive breast cancer. However, there was a significant difference in the frequency of breast cysts among women with periodontal disease compared to women without periodontal disease (p Citation Format: Hannah Lui Park, Teofilia Acheampong, Kathleen Nguyen, Cindy Nguyen, Argyrios Ziogas, Richard Kelly, Andrea Alvarez, Kathryn M. Larsen, Deborah Goodman, Hoda Anton-Culver. Association of periodontal disease and breast health in women undergoing screening mammography. [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 2599.

Clinical Implementation of a Breast Cancer Risk Assessment Program in a Multiethnic Patient Population: Which Risk Model to Use?

Author(s): Park, Hannah Lui; Tran, Stephanie M; Lee, Jennifer; Goodman, Deborah; Ziogas, Argyrios; Kelly, Richard; Larsen, Kathryn M; Alvarez, Andrea; Tannous, Chris; Strope, Julie; Lynch, Wendy; Anton-Culver, Hoda | Abstract: The integration of risk assessment into clinical breast screening holds promise in decreasing breast cancer morbidity and mortality and increasing health care efficiency. Currently, clinical recommendations regarding risk counseling, screening, and chemoprevention are being made based on a woman’s personal risk. One of the criteria that can be used to categorize a woman as “increased risk” is her projected 5-year risk for invasive breast cancer as determined by one of various risk models which are heavily based on family history. We hypothesized that the frequency of screening mammography patients at our medical institution who would be considered at “increased risk” would be different according to different risk models and according to race/ethnicity, thus impacting the volume of patients who are targeted for risk-reducing intervention. Risk scores were calculated for 307 White, Hispanic, and Asian screening mammography patients according to the Gail, BCSC, and Tyrer-Cuzick models. Scores were compared within and between race/ethnicities, according to the different models, individually and in combination. As expected, White women had higher risk scores than Hispanic and Asian women according to all models tested (pl0.05), and a higher percent of White women were categorized as “increased risk” (pl0.0001). However, the correlations between models were moderate, resulting in inconsistencies of increased risk status for many women. Depending on the volume of patients undergoing risk assessment and the resources of staff and services providing the risk counseling and other downstream services, a prevention program may opt to use a combination of risk models suitable for their patient population instead of just one risk model.

Abstract 3243: A pilot study comparing breast cancer risk scores using models with and without breast density among women of different race/ethnicities undergoing breast screening in the University of California, Irvine Athena Breast Health Network cohort

Proceedings: AACR Annual Meeting 2014; April 5-9, 2014; San Diego, CA The USPSTF recommends that women who are at increased risk for breast cancer and at low risk for adverse medication effects should be offered risk-reducing medications, such as tamoxifen or raloxifene, by their clinicians. The NCCN also recommends risk counseling for women with a 5-year risk of ≥1.7% as calculated by the NCI-developed Breast Cancer Risk Assessment Tool (BCRAT, based on the Gail model) or other risk model. The integration of risk assessment into clinical breast screening holds promise in reducing breast cancer risk for many women; however, the criteria that contribute to elevated risk status are different according to different risk models. The University of California, Irvine (UCI) Athena Breast Health Network has integrated a computerized risk assessment largely based on the BCRAT into the screening mammography process at UCI mammography centers. Women identified to be at elevated risk are provided with personalized risk counseling by a Breast Health Specialist. In recent years, breast density has been increasingly recognized as a risk factor for breast cancer; however, it is not part of the BCRAT. In this pilot analysis, we sought to determine if incorporating breast density into the risk assessment program would affect the % of women in our cohort who have a 5-year risk of ≥1.7%. We hypothesized that an increased % of Asian women would reach this threshold since breast density is known to be higher in Asians. We used the BCSC model, which includes density as a variable, to calculate risk scores for a subset of our screening population (n=309), age-matched for three race/ethnic groups, and compared them to their scores according to the BCRAT. Our results showed that while Asians did exhibit significantly higher breast density (30.3% had BIRADS breast density classification 4, extremely dense) than White and Hispanic women (8.7% and 5.6%, respectively), their BCRAT and BCSC scores were significantly lower than in White women but higher than in Hispanic women, with 14.1% of Asians having a BCSC score ≥1.7% compared to 43.7% of Whites and 10.3% in Hispanics, and 17.2% of Asians having a BCRAT score of ≥1.7% compared to 34.0% of Whites and 6.5% of Hispanics. Interestingly, when differences were explored between BCRAT and BCSC scores within the same sub-group of women, the scores were not statistically different among White or Hispanic women but were approaching statistical significance in Asian women. Contrary to our hypothesis, in Asian women, BCSC-calculated risk was actually lower than according to the BCRAT. These findings suggest that, despite higher breast density, Asian women still exhibit lower breast cancer risk scores than White women; thus, a smaller proportion of Asian women in our cohort will be recommended for high risk counseling and chemoprevention. Citation Format: Hannah Lui Park, Stephanie M. Tran, Jennifer Lee, Deborah Goodman, Argyrios Ziogas, Richard Kelly, Kathryn M. Larsen, Andrea Alvarez, Chris Tannous, Julie Strope, Wendy Lynch, Hoda Anton-Culver. A pilot study comparing breast cancer risk scores using models with and without breast density among women of different race/ethnicities undergoing breast screening in the University of California, Irvine Athena Breast Health Network cohort. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3243. doi:10.1158/1538-7445.AM2014-3243

Abstract B88: Breast cancer risk factors and Gail risk score distribution in a heavily Hispanic population.

Background: The Athena Breast Health Network is a collaborative University of California (UC) initiative, focused on providing evidence-based innovations in the screening, diagnosis and treatment of cancer, as well as changing the way patients and providers interact to prevent and manage the disease. An initial goal of the Athena project is to integrate standardized risk assessment into breast cancer screening. Women at highest cancer risk are identified and offered personalized counseling and referrals for prevention services. Previous studies have shown a difference in breast cancer risk factor distribution between Hispanics and non-Hispanic whites. This current study will describe these factors in the UC Irvine Athena cohort, a heavily Hispanic population. Methods: Between March, 2011 and July, 2012, 1,407 patients completed an electronic questionnaire at the time of their screening mammography and consented to enroll in the UC Irvine Athena Breast Health Network as a research participant. The questionnaire collected data on the womans medical, reproductive, and family cancer history. Body mass index (BMI) was calculated using self-reported weight and height [BMI=weight (kg)/height (m)2]. NCI-Gail breast cancer scores were calculated using age, age at menarche, age at first full-term pregnancy, family history of breast cancer (mother, sister, daughter), number of biopsies, number of biopsies with atypia, and race/ethnicity. Elevated breast cancer risk was defined as a Gail score > 1.67. Our screening cohort was composed of 63.8% Hispanic (n=903), 19.6% non-Hispanic white (n=277), 10.5% Asian (n=148), 1.4% African American (n=20), and 4.2% who were unable to be classified (n=59). This analysis was limited to women who were Hispanic or non-Hispanic whites. Results: Mean ± SD ages of the Hispanic and non-Hispanic white groups were 53.9 ± 9.9 years and 60.6 ± 11.3 years (p 29.9) compared to non-Hispanic whites (42.0% vs 29.9%; p 1.67 compared to 33.7% of non-Hispanic whites (p<0.0001). Overall, those with an elevated Gail score were more likely to have reported Jewish ancestry (p<0.002), have a higher educational level (p<0.0001), a history of breast biopsy and atypia (p<0.0001), or a history of a first- or second- degree relative with breast cancer (p<0.0001) and were less likely to be married (p<0.0001). Conclusion: In the UC Irvine Athena population, breast cancer risk factors and Gail scores differed significantly between Hispanics and non-Hispanic whites. Recognition of racial disparities is critical for implementing a personalized breast cancer screening and prevention program in the community. For example, our study suggests that in a heavily Hispanic population, screening and prevention programs should target obesity reduction, while greater risk reduction in a non-Hispanic white population may be achieved through genetic counseling. Citation Format: Deborah Goodman, Hannah Lui Park, Argyrios Ziogas, Chris Tannous, Kathryn Larsen, Hoda Anton-Culver. Breast cancer risk factors and Gail risk score distribution in a heavily Hispanic population. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B88.

Abortion and Common Sense. By Ruth Dixon-Mueller and Paul KB Dagg. 298 pp. Philadelphia, Xlibris Corporation, 2002.

The abortion debate is often characterized by a passionate defense of rather narrowly focused moral, religious, and political beliefs. Broader social and health issues surrounding the abortion issue have typically received less attention despite that an estimated 600,000 women die annually from the