Yihe G. Daida

Hispanic and Asian Pubertal Girls Have Higher Android/Gynoid Fat Ratio Than Whites

Objective: To examine differences in body size, composition, and distribution of body fat among Hispanic, white, and Asian adolescents.

Comparison of breast density measured by dual energy X-ray absorptiometry with mammographic density among adult women in Hawaii

BACKGROUND While use of mammography is limited, due to concerns related to radiation exposure, dual energy X-ray absorptiometry (DXA), commonly available in medical care settings, is characterized by low radiation exposure. METHODS In the current paper, we compared breast density measured by DXA with mammographic density in 101 adult women who had a screening mammogram during the last 2 years. DXA scans of both breasts were taken using a clinical DXA system calibrated to measure breast density. The total projected breast area was manually delineated on each image and percent fibroglandular volume density (%FGV), absolute fibroglandular volume, total breast area and volume were computed. After digitizing mammographic films, total breast area, dense area, and percent density (PD) were estimated using computer-assisted mammographic density assessment. RESULTS Both DXA and mammographic measures showed high correlations between left and right breasts ranging from 0.85 to 0.98 (p<0.0001). Mean %FGV was 38.8±14.3%, and mean percent density was 31.9±18.2% for craniocaudal views and 28.3±16.2% for mediolateral views. The correlation between the two measures was 0.76 for both views (p<0.0001). Associations with common risk factors showed similar patterns for DXA and mammographic densities; in particular, the inverse associations with BMI and age at menarche were evident for both methods. Multilinear regression with stepwise selection indicated an explained variance of 0.56 for %FGV alone and of 0.58 for %FGV plus number of children. CONCLUSION Despite some differences in methodology, the current comparison suggests that DXA may provide a low-radiation option in evaluating breast density.

Puberty, body fat, and breast density in girls of several ethnic groups.

We examined breast density by dual energy X‐ray absorptiometry (DXA) in relation to pubertal maturation and body fatness among girls of several ethnic groups, which may suggest important risk factors for future breast cancer.

KRAS Testing and Epidermal Growth Factor Receptor Inhibitor Treatment for Colorectal Cancer in Community Settings

Background: In metastatic colorectal cancer (mCRC), mutations in the KRAS gene predict poor response to EGF receptor (EGFR) inhibitors. Clinical treatment guidelines now recommend KRAS testing if EGFR inhibitors are considered. Our study investigates the clinical uptake and utilization of KRAS testing. Methods: We included 1,188 patients with mCRCs diagnosed from 2004 to 2009, from seven integrated health care delivery systems with a combined membership of 5.5 million. We used electronic medical records and targeted manual chart review to capture the complexity and breadth of real-world clinical oncology care. Results: Overall, 428 patients (36%) received KRAS testing during their clinical care, and 266 (22%) were treated with EGFR inhibitors. Age at diagnosis (P = 0.0034), comorbid conditions (P = 0.0316), and survival time from diagnosis (P < 0.0001) influence KRAS testing and EGFR inhibitor prescribing. The proportion who received KRAS testing increased from 7% to 97% for those treated in 2006 and 2010, respectively, and 83% of all treated patients had a KRAS wild-type genotype. Most patients with a KRAS mutation (86%) were not treated with EGFR inhibitors. The interval between mCRC diagnosis and receipt of KRAS testing decreased from 26 months (2006) to 10 months (2009). Conclusions: These findings show rapid uptake and incorporation of this predictive biomarker into clinical oncology care. Impact: In this delivery setting, KRAS testing is widely used to guide treatment decisions with EGFR inhibitors in patients with mCRCs. An important future research goal is to evaluate utilization of KRAS testing in other delivery settings in the United States. Cancer Epidemiol Biomarkers Prev; 22(1); 91–101. ©2012 AACR.

Epidemiology of Nontuberculous Mycobacterial Lung Disease and Tuberculosis, Hawaii, USA

Previous studies found Hawaiians and Asian-Americans/Pacific Islanders to be independently at increased risk for nontuberculous mycobacterial pulmonary disease (NTMPD) and tuberculosis (TB). To better understand NTM infection and TB risk patterns in Hawaii, USA, we evaluated data on a cohort of patients in Hawaii for 2005–2013. Period prevalence of NTMPD was highest among Japanese, Chinese, and Vietnamese patients (>300/100,000 persons) and lowest among Native Hawaiians and Other Pacific Islanders (50/100,000). Japanese patients were twice as likely as all other racial/ethnic groups to have Mycobacterium abscessus isolated (adjusted odds ratio 2.0, 95% CI 1.2–3.2) but were not at increased risk for infection with other mycobacteria species. In contrast, incidence of TB was stable and was lowest among Japanese patients (no cases) and highest among Filipino, Korean, and Vietnamese patients (>50/100,000). Substantial differences exist in the epidemiology of NTMPD by race/ethnicity, suggesting behavioral and biologic factors that affect disease susceptibility.

A comparison of breast density measures between mothers and adolescent daughters

BackgroundBased on the importance of breast density as a predictor of breast cancer risk, we examined the heritable component of breast measures in mothers and daughters using Dual Energy X-ray Absorptiometry (DXA).MethodsWe recruited 101 mothers ≥30 years and their daughters aged 10-16 years through Kaiser Permanente Hawaii. Scans of both breasts were taken using a DXA system in research mode, calibrated to distinguish fibroglandular and fatty breast tissue. We calculated correlation coefficients between mothers and daughters for breast volume, absolute fibroglandular volume (FGV), and %FGV and performed multiple linear regression to include relevant covariates.ResultsBreast volume and absolute FGV in daughters were lower than in mothers and were positively associated with % total body fat and Tanner breast stage. In contrast, %FGV in daughters was higher than in mothers and was inversely associated with % total body fat. Although unadjusted correlations between mothers and daughters were significant for breast volume and absolute FGV (r = 0.28 and p < 0.01 for both), models adjusted for demographic variables, Tanner stage, and % total body fat indicated significant associations only among the more mature girls (Tanner stages 4&5). There was no significant association between %FGV of mothers and daughters.ConclusionsThese results indicate that the heritability of breast volume and amount of dense tissue is measurable in adolescence, but percent breast density shows no relation between mothers and daughters at that time. Further study of breast tissue composition during adolescence and in young women may enhance understanding of breast cancer risk later in life.

Uptake of and Factors Associated With Direct-acting Antiviral Therapy Among Patients in the Chronic Hepatitis Cohort Study, 2014 to 2015

Background: Limited information is available describing the uptake of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection among patients in general US health care settings. We determined the proportion of HCV-infected patients in the Chronic Hepatitis Cohort Study prescribed DAAs in 2014, who initiated treatment and identified characteristics associated with treatment initiation. Methods: Uptake was defined as the proportion of HCV-infected patients with at least 1 clinical encounter in 2013 who were prescribed a DAA regimen during 2014 and initiated the regimen by August 2015. Using multivariable analysis, we examined demographic and clinical characteristics associated with receipt of DAAs. Results: The cohort comprised 9508 patients; 544 (5.7%) started a DAA regimen. Higher annual income [adjusted odds ratios (aOR) 2.3 for income>

Factors Associated With Prevalence and Treatment of Primary Biliary Cholangitis in United States Health Systems

50K vs. <

Changing trends in complications of chronic hepatitis C

30K], higher Fibrosis-4 score (aORs, 2.1, 2.0, and 1.4 for Fibrosis-4, >5.88, 3.25 to 5.88, 2.0 to 3.25, respectively, vs. <2.0), genotype 2 infection (aOR 2.2 vs. genotype 1), pre-2014 treatment failure (aOR 2.0 vs. treatment-naive), and human immunodeficiency virus (HIV) coinfection (aOR 1.8 vs. HCV monoinfection) were associated with DAA initiation. Black race/ethnicity (aOR 0.7 vs. whites) and Medicaid coverage (aOR 0.5 vs. private insurance) were associated with noninitiation. Sex, age, comorbidity, previous liver transplant, and duration of follow-up were not associated with receipt of DAAs. Conclusions: Among patients in these general US health care settings, uptake of DAA therapy was low in 2014, and especially so among minority and Medicaid patients. Systemic efforts to improve access to DAAs for all patients are essential to reduce morbidity and mortality from HCV infection.

Race, Age, and Geography Impact Hepatitis C Genotype Distribution in the United States

BACKGROUND & AIMS Reported prevalence of primary biliary cholangitis (PBC) varies widely. Demographic features and treatment patterns are not well characterized in the United States (US). We analyzed data from the Fibrotic Liver Disease (FOLD) Consortium, drawn from 11 geographically diverse health systems, to investigate epidemiologic factors and treatment of PBC in the US. METHODS We developed a validated electronic health record‐based classification model to identify patients with PBC in the FOLD database from 2003 through 2014. We used multivariable modeling to assess the effects of factors associated with PBC prevalence and treatment with ursodeoxycholic acid (UDCA). RESULTS We identified 4241 PBC cases among over 14.5 million patients in FOLD health systems; median follow‐up was 5 years. Accuracy of the classification model was excellent, with an area under the receiver operating characteristic curve value of 93%, 94% sensitivity, and 87% specificity. The average patient age at diagnosis was 60 years; 21% were Hispanic, 8% were African American, and 7% were Asian American/American Indian/Pacific Islander. Half of the cohort (49%) had elevated levels of alkaline phosphatase, and overall, 70% were treated with UDCA. The estimated 12‐year prevalence of PBC was 29.3 per 100,000 persons. Adjusted prevalence values were highest among women (42.8 per 100,000), White patients (29.6 per 100,000), and patients 60–70 years old (44.7 per 100,000). Prevalence was significantly lower among men and African Americans (10.7 and 19.7 per 100,000, respectively) than women and whites; men and African Americans were also less likely to receive UDCA treatment (odds ratios, 0.6 and 0.5, respectively; P < .05). CONCLUSIONS In an analysis of a large cohort of patients with PBC receiving routine clinical care, we observed significant differences in PBC prevalence and treatment by gender, race, and age.