Developing a utility decision framework to evaluate predictive models in breast cancer risk estimation.

Combining imaging and genetic information to predict disease presence and progression is being codified into an emerging discipline called "radiogenomics." Optimal evaluation methodologies for radiogenomics have not been well established. We aim to develop a decision framework based on utility analysis to assess predictive models for breast cancer diagnosis.

Comparing Mammography Abnormality Features to Genetic Variants in the Prediction of Breast Cancer in Women Recommended for Breast Biopsy.

Rationale And Objectives: The discovery of germline genetic variants associated with breast cancer has engendered interest in risk stratification for improved, targeted detection and diagnosis. However, there has yet to be a comparison of the predictive ability of these genetic variants with mammography abnormality descriptors.

Materials And Methods: Our institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study utilized a personalized medicine registry in which participants consented to provide a DNA sample and to participate in longitudinal follow-up.

Prognostic significance of full-length estrogen receptor beta expression in stage I-III triple negative breast cancer.

Triple negative breast cancer (TNBC) is an aggressive breast cancer subtype for which there is a need to identify new therapeutic targets. Full-length estrogen receptor beta (ERβ1) may be a possible target given its antiproliferative effects on breast cancer cells. The prognostic significance of ERβ in breast cancer subtypes has remained elusive, and disparate results observed across previously published reports might be due to the detection of multiple ERβ isoforms, the lack of specific antibodies and the use of different cutoffs to define ERβpositivity.

Leveraging Interaction between Genetic Variants and Mammographic Findings for Personalized Breast Cancer Diagnosis.

Recent large-scale genome-wide association studies (GWAS) have identified a number of genetic variants associated with breast cancer which showed great potential for clinical translation, especially in breast cancer diagnosis via mammograms. However, the amount of interaction between these genetic variants and mammographic features that can be leveraged for personalized diagnosis remains unknown. Our study utilizes germline genetic variants and mammographic features that we collected in a breast cancer case-control study.

Validation of the CoRE Questionnaire for a Medical Journal Peer Review.

If a peer review instrument asks concrete questions (defined as items that can only generate disagreement if reviewers have different degrees of expertise), then questionnaires could become more meaningful in terms of resolving subjectivity thus leading to more reviewer agreement. A concrete item questionnaire with well-chosen questions can also help resolve disagreement when reviewers have the same level of expertise. We have recently created the core-item reviewer evaluation (CoRE) questionnaire for which decision-threshold score levels have been created, but which have not been validated.

Navigating the Needs of Rural Women with Breast Cancer: A Breast Care Program.

We describe the development and establishment of a breast care program (BCP) with service for rural breast cancer patients. Our program is a comprehensive program serving rural communities in Wisconsin. Our BCP is committed to breast health throughout the continuum from breast cancer risk assessment and prevention, advanced diagnostics, and screening tools to genetic testing and state-of-the-art surgical techniques.

Treatment differences between urban and rural women with hormone receptor-positive early-stage breast cancer based on 21-gene assay recurrence score result.

Background: Women who live in rural and urban settings have different outcomes for breast cancer. A 21-gene assay predicts 10-year distant recurrence risk and potential benefit of chemotherapy for women with hormone receptor-positive (HR+) breast cancer.

Objective: To assess differences in scores and cancer therapies received by rural versus urban residence.

New genetic variants improve personalized breast cancer diagnosis.

Recent large-scale genome-wide association studies (GWAS) have identified a number of new genetic variants associated with breast cancer. However, the degree to which these genetic variants improve breast cancer diagnosis in concert with mammography remains unknown. We conducted a case-control study and collected mammography features and 77 genetic variants which reflect the state of the art GWAS findings on breast cancer.

Developing a clinical utility framework to evaluate prediction models in radiogenomics.

Combining imaging and genetic information to predict disease presence and behavior is being codified into an emerging discipline called "radiogenomics." Optimal evaluation methodologies for radiogenomics techniques have not been established. We aim to develop a clinical decision framework based on utility analysis to assess prediction models for breast cancer.

Overview of recent trends in diagnosis and management of leptomeningeal multiple myeloma.

Neurological complications related to multiple myeloma (MM) are not uncommon; however, direct involvement of the central nervous system (CNS) is extremely rare and represents a diagnostic and therapeutic challenge. Significant survival difference has been noted with the introduction of novel therapy in patients with MM, but their effect on the incidence and their use for management of leptomeningeal myeloma (LMM) is uncertain. Analysis of published data demonstrates its recent increased incidence, median time to CNS presentation, and slight improvement in median survival after diagnosis of LMM.

Survival Comparisons for Breast Conserving Surgery and Mastectomy Revisited: Community Experience and the Role of Radiation Therapy.

Objectives: Evidence suggests superiority of breast conserving surgery (BCS) plus radiation over mastectomy alone for treatment of early stage breast cancer. Whether the superiority of BCS plus radiation is related to the surgical approach itself or to the addition of adjuvant radiation therapy following BCS remains unclear.

Materials And Methods: We conducted a retrospective cohort study of women with breast cancer diagnosed from 1994-2012.

Diastolic function improves after resolution of takotsubo cardiomyopathy.

Background: Takotsubo cardiomyopathy (TTC) is a condition of reversible left ventricular (LV) systolic dysfunction. However, the diastolic function (DF) manifestations of TTC have not been widely investigated. We performed a bicentric study with retrospective analysis of DF in patients with TTC, during onset and at follow-up.

Cardiovascular toxicity associated with adjuvant trastuzumab therapy: prevalence, patient characteristics, and risk factors.

Before the advent of the human epidermal growth factor receptor 2 (HER2)-targeted monoclonal antibody trastuzumab, HER2-positive breast cancers were difficult to treat and had a poor prognosis. Adjuvant trastuzumab is now an important part of the treatment regimen for many women with HER2-positive breast cancer and has undoubtedly resulted in a significant improvement in prognosis, but it is associated with a risk for cardiotoxicity. In this review, we describe the prevalence, patient characteristics, and risk factors for cardiotoxicity associated with use of adjuvant trastuzumab.

Geographical and seasonal barriers to mammography services and breast cancer stage at diagnosis.

Introduction: Routine mammography screening and early detection are important prognostic indicators for breast cancer. Geographical and seasonal barriers to mammography services and relationship to breast cancer stage at diagnosis were examined.

Methods: Travel time to mammography center, seasonal distribution of mammogram use, mammography frequency, and stage of cancer were retrospectively examined in 1428 female patients diagnosed with primary breast cancer at a tertiary care clinic system in Wisconsin, USA, from 2002 to 2008.

Antithrombin levels are unaffected by warfarin use.

Context: The results of studies among patients with antithrombin deficiency have suggested that the use of warfarin will increase the level of antithrombin.

Objective: To reevaluate the effect of warfarin on antithrombin levels using an automated amidolytic method in current use.

Design: Antithrombin levels were measured in patients who were receiving warfarin for atrial fibrillation and were compared with antithrombin levels in preoperative patients who had not received warfarin.

A novel method for studying the temporal relationship between type 2 diabetes mellitus and cancer using the electronic medical record.

Background: We developed an algorithm for the identification of patients with type 2 diabetes and ascertainment of the date of diabetes onset for examination of the temporal relationship between diabetes and cancer using data in the electronic medical record (EMR).

Methods: The Marshfield Clinic EMR was searched for patients who developed type 2 diabetes between January 1, 1995 and December 31, 2009 using a combination of diagnostic codes and laboratory data. Subjects without diabetes were also identified and matched to subjects with diabetes by age, gender, smoking history, residence, and date of diabetes onset/reference date.

Does KRAS testing in metastatic colorectal cancer impact overall survival? A comparative effectiveness study in a population-based sample.

Purpose: Epidermal growth factor receptor (EGFR) inhibitors are approved for treating metastatic colorectal cancer (CRC); KRAS mutation testing is recommended prior to treatment. We conducted a non-inferiority analysis to examine whether KRAS testing has impacted survival in CRC patients.

Patients And Methods: We included 1186 metastatic CRC cases from seven health plans.

Genetic variants improve breast cancer risk prediction on mammograms.

Several recent genome-wide association studies have identified genetic variants associated with breast cancer. However, how much these genetic variants may help advance breast cancer risk prediction based on other clinical features, like mammographic findings, is unknown. We conducted a retrospective case-control study, collecting mammographic findings and high-frequency/low-penetrance genetic variants from an existing personalized medicine data repository.

Comparing the value of mammographic features and genetic variants in breast cancer risk prediction.

The goal of this study was to compare the value of mammographic features and genetic variants for breast cancer risk prediction with Bayesian reasoning and information theory. We conducted a retrospective case-control study, collecting mammographic findings and high-frequency/low-penetrance genetic variants from an existing personalized medicine data repository. We trained and tested Bayesian networks for mammographic findings and genetic variants respectively.

Breast cancer biomarkers: risk assessment, diagnosis, prognosis, prediction of treatment efficacy and toxicity, and recurrence.

Breast cancer is the most common cancer amongst women in the United States and around the world. Although widespread use of adjuvant chemotherapeutic and hormonal agents has improved mortality from breast cancer, it remains challenging to determine on an individual basis who will benefit from such treatments and who will be likely to encounter toxicities. With the rising costs of healthcare and the introduction of new targeted therapies, use of biomarkers has emerged as a method of assisting with breast cancer diagnosis, prognosis, prediction of therapeutic response, and surveillance of disease during and after treatment.

Peripancreatic cystic lymphangioma diagnosed by endoscopic ultrasound/fine-needle aspiration: a rare mesenchymal tumour.

A 73-year-old man presented with a 5-month history of intermittent nausea, vomiting, central abdominal discomfort and a 17-pound weight loss over the past year. Laboratory testing, including a complete blood count with differential, liver function testing, amylase and lipase studies were normal. A CT scan showed a bilobed cystic lesion inferior to the body of the pancreas.

Type 2 diabetes mellitus, glycemic control, and cancer risk.

Type 2 diabetes mellitus is characterized by prolonged hyperinsulinemia, insulin resistance, and progressive hyperglycemia. Disease management relies on glycemic control through diet, exercise, and pharmacological intervention. The goal of the present study was to examine the effects of glycemic control and the use of glucose-lowering medication on the risk of breast, prostate, and colon cancer.

Mammography utilization: patient characteristics and breast cancer stage at diagnosis.

Objective: Missed mammograms represent missed opportunities for earlier breast cancer diagnosis. The purposes of this study were to identify patient characteristics associated with missed mammograms and to examine the association between missed mammograms and breast cancer stage at diagnosis.

Materials And Methods: Mammography frequency and cancer stage were retrospectively examined in 1368 cases of primary breast cancer diagnosed at our clinic from 2002 to 2008.

Increased risk of colon cancer in men in the pre-diabetes phase.

Background: Historically, studies exploring the association between type 2 diabetes mellitus (DM) and cancer lack accurate definition of date of DM onset, limiting temporal analyses. We examined the temporal relationship between colon cancer risk and DM using an electronic algorithm and clinical, administrative, and laboratory data to pinpoint date of DM onset.

Methods: Subjects diagnosed with DM (N = 11,236) between January 1, 1995 and December 31, 2009 were identified and matched at a 5∶1 ratio with 54 365 non-diabetic subjects by age, gender, smoking history, residence, and diagnosis reference date.

Reliability of reviewer ratings in the manuscript peer review process: an opportunity for improvement.

Accountability to authors and readers cannot exist without proper peer review practices. Thus, the information a journal seeks from its peer reviewers and how it makes use of this information is paramount. Disagreement amongst peer reviewers can be considerable, resulting in very diverse comments to authors.