Contralateral prophylactic mastectomy (CPM) use is increasing among women with unilateral breast cancer, but little is known about treatment decision making or physician interactions in diverse patient populations.To evaluate patient motivations, knowledge, and decisions, as well as the impact of surgeon recommendations, in a large, diverse sample of patients who underwent recent treatment for breast cancer.A survey was sent to 3631 women with newly diagnosed, unilateral stage 0, I, or II breast cancer between July 2013 and September 2014. Treatment and Monitoring Variability in US Metastatic Breast Cancer Care. Clinician assessment and communication regarding financial toxicity must improve; cure at the cost of financial ruin is unacceptable. Kurian, A. W., Ward, K. C., Abrahamse, P. n., Hamilton, A. S., Katz, S. J. Germline pathogenic variants in the Ataxia Telangiectasia Mutated (ATM) gene are associated with high and moderate risks for multiple cancers. combination in patients with advanced breast cancer. The prevalence in risk factors was similar between foreign-born and U.S.-born women in the younger birth cohort, and did not fully explain the observed associations with birthplace and other migration characteristics.In contrast to studies from earlier decades, younger foreign-born Asian American women had a higher risk of breast cancer than U.S.-born Asian American women.It is important and urgent to understand what factors drive the increasing burden of breast cancer in women of Asian descent and implement effective prevention programs. Wu, J., Cui, Y., Sun, X., Cao, G., Li, B., Ikeda, D. M., Kurian, A. W., Li, R. Payer Coverage for Hereditary Cancer Panels: Barriers, Opportunities, and Implications for the Precision Medicine Initiative. Prevention of cancer in transplant recipients is of utmost importance, given the risks of treating malignancy in an immunosuppressed patient. For more information, please contact Annabel Castaneda, 650-498-7977. This cohort will enable analyses to jointly consider a variety of clinical, lifestyle, and contextual factors in attempting to explain the long-standing disparities in breast cancer outcomes. Screening and prevention decisions for women at increased risk of developing breast cancer depend on genetic and clinical factors to estimate risk and select appropriate interventions. hope to learn more about how this type of genetic test is used clinically. After testing, few patients (4%) had prophylactic surgery, most (92%) never regretted testing, and most (80%) wanted to know all results, even those of uncertain significance. RS was less often used for patients with involved lymph nodes, higher tumor grade, and age < 40 or 65 years. B., Eliassen, A. H., Eriksson, M., Evans, D. G., Fasching, P. A., Flyger, H., Fritschi, L., Gago-Dominguez, M., Garca-Senz, J. Most patients (77.5 %) were comfortable using the tool at home. Alagoz, O., Lowry, K. P., Kurian, A. W., Mandelblatt, J. S., Ergun, M., Huang, H., Lee, S. J., Schecter, C., Tosteson, A. Ahearn, T. U., Zhang, H., Michailidou, K., Milne, R. L., Bolla, M. K., Dennis, J., Dunning, A. M., Lush, M., Wang, Q., Andrulis, I. L., Anton-Culver, H., Arndt, V., Aronson, K. J., Auer, P. L., Augustinsson, A., Baten, A., Becher, H., Behrens, S., Benitez, J., Bermisheva, M., Blomqvist, C., Bojesen, S. E., Bonanni, B., Brresen-Dale, A. L., Brauch, H., Brenner, H., Brooks-Wilson, A., Brning, T., Burwinkel, B., Buys, S. S., Canzian, F., Castelao, J. E., Chang-Claude, J., Chanock, S. J., Chenevix-Trench, G., Clarke, C. L., Colle, J. M., Cox, A., Cross, S. S., Czene, K., Daly, M. B., Devilee, P., Drk, T., Dwek, M., Eccles, D. M., Evans, D. G., Fasching, P. A., Figueroa, J., Floris, G., Gago-Dominguez, M., Gapstur, S. M., Garca-Senz, J. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management.We aimed to develop a mobile app incorporating user preferences to enable cancer survivors' care partners to monitor the survivors' health and to provide care partner resources.An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners.Health professionals noted the importance of identifying early symptoms of adverse events. This phase II study will test cancer to see if it has a HER2 mutation and, if so, see how Twin studies suggest that MD phenotypes are highly heritable. Bilateral mastectomy is increasingly used to treat unilateral breast cancer. First reporting hospitals were classified by hospital type-National Cancer Institute (NCI) -designated cancer center, American College of Surgeons (ACS) Cancer Program, other-and hospital composition of the neighborhood socioeconomic status and race/ethnicity of patients with cancer. The use of common inputs also enhances inferences about the results, and provides a range of reasonable results based on variations in model structure, assumptions, and methods of use of the input values. Carriers of a BRCA1/2 pathogenic or likely pathogenic variant have an excessive risk for both breast and ovarian cancer that warrants consideration of more intensive screening and preventive strategies. Circulating tumor cells (CTCs) are rare cells found in the blood of patients with solid tumors and may play a key role in cancer dissemination. Low, Y. S., Daugherty, A. C., Schroeder, E. A., Chen, W., Seto, T., Weber, S., Lim, M., Hastie, T., Mathur, M., Desai, M., Farrington, C., Radin, A. We evaluated the effects of 5 years of risk-reducing medication (tamoxifen/aromatase inhibitors) with annual screening mammography magnetic resonance imaging (MRI) compared with no screening, MRI, or risk-reducing medication. Kurian senior was a chemical engineer and the general manager of Graphite India. Kwong, A., Ng, E. K., Wong, C. L., Law, F. B., Au, T., Wong, H. N., Kurian, A. W., West, D. W., Ford, J. M., Ma, E. S. Breast cancer risk factors differ between Asian and white women with BRCA1/2 mutations. In European women from BCAC, higher PRS313 was associated with better OS and BCSS: hazard ratio (HR) 0.96 (95% CI, 0.94 to 0.97) and 0.96 (95% CI, 0.94 to 0.98), but the association disappeared after adjustment for clinicopathologic characteristics (and treatment): OS HR, 1.01 (95% CI, 0.98 to 1.05) and BCSS HR, 1.02 (95% CI, 0.98 to 1.07). View details for DOI 10.1158/1055-9965.EPI-15-0055, View details for DOI 10.1001/jama.2015.8088. We describe a family with multiple cases of MEN1-associated cancers as well as pancreatic adenocarcinoma, ovarian cancer, and male breast cancer, in which we identified germline mutations in both MEN1 and BRCA2. Impact:Given the growing number of breast cancer survivors worldwide, we need to better understand how comorbidities may adversely affect treatment decisions and ultimately outcome. A Study of Trastuzumab Emtansine, Paclitaxel, and Pertuzumab in Patients With HER2-Positive, Locally Advanced or Metastatic Breast Cancer, A Study to Assess Efficacy and Safety of Pertuzumab Given in Combination With Trastuzumab and Vinorelbine in Participants With Metastatic or Locally Advanced Human Epidermal Growth Factor Receptor (HER) 2-Positive Breast Cancer. For more information, please contact Naheed Mangi, 650-723-0658. A., Stefansson, K., Chang-Claude, J., van der Schouw, Y. T., Lunetta, K. L., Chasman, D. I., Easton, D. F., Visser, J. These models can be used to perform large-scale retrospective studies in oncology. Actual 10-year risk of distant recurrence after treatment was based on clinical factors for women with DCIS & low-risk invasive cancer (Stg 1A, ER+, HER2-, Gr 1-2). Cancer 2017. There were 2 men and 4 women. Martinez, K. A., Kurian, A. W., Hawley, S. T., Jagsi, R. Clinical actionability of multi-gene panel tests for hereditary breast and ovarian cancer, Ellisen, L., Lincoln, S., Kurian, A. W., et al, Addressing lack of US insurance coverage of Cancer Hereditary Multiplex Testing, Trosman, J., Weldon, C., Kurian, A. W., Douglas, M., et al. bevacizumab. The role of prophylactic versus therapeutic gastrectomy for HDGC was studied prospectively.Eighteen consecutive patients with CDH1 mutations and positive family history were studied prospectively, including 13 without and 5 with symptoms. He said . This approach may be adaptable to other cancer sites and could help to unlock the potential of EMRs for research on real-world cancer outcomes. Idos, G., Kurian, A. W., Ricker, C., Sturgeon, D., Culver, J., Lowstuter, K., Hartman, A., Allen, B., Kingham, K., Koff, R., Rowe-Teeter, C., Chun, N. M., Mills, M., Petrovchich, I., Hong, C., Kidd, J., McDonnell, K., Ladabaum, U., Ford, J. M., Gruber, S. B. Clinical impact of multi-gene panel testing for hereditary breast and ovarian cancer risk assessment. This article is protected by copyright. Associations between pathogenic variants in each gene and the risk of breast cancer were assessed.Pathogenic variants in 12 established breast cancer-predisposition genes were detected in 5.03% of case patients and in 1.63% of controls. On the other hand, Mr. Kurians other twin George moved to Boston to work for internet network company Akamai. Extending endocrine therapy from 5 to 10years is recommended for women with invasive estrogen receptor (ER)-positive breast cancers. In MINDACT, PRS313 was associated with a low risk 70-gene signature. cancer that has spread to the lymph nodes (lymph node-positive) or cancer that has not spread As president for products, Kurian was perceived to be co-founder Larry Ellison's heir apparent. Individual- and neighborhood-level measures of SES interact with race/ethnicity to impact mortality after BC diagnosis. The authors described responses from approximately 73% of surgeons (370 surgeons), 61% of medical oncologists (306 medical oncologists), 67% of radiation oncologists (169 radiation oncologists), and 68% of patients (2502 patients).Approximately one-half (50.9%) of responding medical oncologists reported that someone in their practice often or always discusses financial burden with patients, as did 15.6% of surgeons and 43.2% of radiation oncologists. Among them, 60 were from cases having concurrent or subsequent invasive breast cancer (IBC) (DCIS+IBC group), and 65 from cases with no IBC development over a median follow-up of 13years (DCIS-only group). Patients with triple-negative breast cancer (TNBC), defined as lacking expression of the estrogen and progesterone receptors (ER/PR) and amplification of the HER2 oncogene, often have a more aggressive disease course than do patients with hormone receptor-positive breast cancer, including higher rates of visceral and central nervous system metastases, early cancer recurrences and deaths. View details for DOI 10.1093/jamia/ocw161. We used publicly available in silico DNase I and ChIP-seq data with invitro reporter gene and CRISPR assays to annotate signals 2 and 3. [3] At the age of 17, along with George Kurian,[4] he moved to the United States. The absolute benefits would increase to 4.8%-5.5% if the RS was 26+. She received her medical degree from Harvard Medical School, trained as an intern and resident in Internal Medicine at the Massachusetts General Hospital, and completed her fellowship training in Medica. Alternatively, those who endorsed more adaptive mindsets (Cancer is Manageable or Cancer can be an Opportunity) reported better HRQOL compared with those who disagreed (all p-values < .05). To quantify the potential benefit, we estimated reductions in absolute cancer-related deaths that could occur if cancers diagnosed after metastasis (stage IV) were instead diagnosed at earlier stages.We obtained stage-specific incidence and survival data from the Surveillance, Epidemiology, and End Results Program for 17 cancer types for all persons diagnosed ages 50 to 79 years in 18 geographic regions between 2006 and 2015. Kurian, A. W., Balise, R. R., McGuire, V., Whittemore, A. S. Predicting US breast cancer mortality rate in the year 2010, Plevritis, S. K., Sigal, B. M., Kurian, A. W., et al, Estimating the life years gained from breast MRI screening in women with BRCA1/2 mutations. and help prevent the tumor from returning. She is a Professor of Medicine and Epidemiology & Population Health at Stanford University and an oncologist at the Stanford Cancer Institute. Validation studies with PLCO and EPIC showed consistent results. Our database consisted of structured fields and unstructured free-text clinical notes from EMR, linked to CCR, a component of the Surveillance, Epidemiology and End Results Program (SEER). Jayasekera, J., Lowry, K. P., Yeh, J. M., Schwartz, M. D., Wernli, K. J., Isaacs, C., Kurian, A. W., Stout, N. K. A pilot study to increase cascade genetic testing in families with hereditary cancer syndromes. We concluded that further adaptation of the coverage framework will facilitate a better suited assessment of NGTS and future genomics innovations. Evaluation of a cancer gene sequencing panel in a hereditary risk assessment clinic. [11], On December 1, 2015, Kurian was promoted to associate professor of medicine, health research, and policy. [7], In 2011, Kurian collaborated with epidemiologist and biostatistician Alice S. Whittemore to examine how women related to patients of hereditary mutation breast cancer, but lacked the mutation themselves, were of no higher risk of getting cancer than relatives of patients with other types of breast cancer. Gornick, M. C., Kurian, A. W., An, L. C., Fagerlin, A., Jagsi, R., Katz, S. J., Hawley, S. T. A Structured Tumor-Immune Microenvironment in Triple Negative Breast Cancer Revealed by Multiplexed Ion Beam Imaging. Gruber, J. J., Chen, J. n., Geller, B. n., Jger, N. n., Lipchik, A. M., Wang, G. n., Kurian, A. W., Ford, J. M., Snyder, M. P. Magnitude of reduction in risk of second contralateral breast cancer with bilateral mastectomy in patients with breast cancer: Data from California, 1998 through 2015. health literacy, numeracy, and anxiety/worry) on physician communication outcomes was evaluated in multivariable regression models (analytic sample for substudy=1295).About 33% of women reported that doctors discussed risk of recurrence as "quite a bit" or "a lot," while 14% said "not at all." J. Surg. Patients indicated that financial toxicity remains common: 21.5% of white patients and 22.5% of Asian patients had to cut down spending on food, as did 45.2% of black and 35.8% of Latina patients. Through our efforts using these methods, Oncoshare integrates complex, longitudinal data from multiple electronic medical records and registries and provides a rich, validated resource for research on oncology care. View details for Web of Science ID 000357901600008. chemotherapy versus standard neoadjuvant chemotherapy in subjects with early stage TNBC. Confirmatory controlled trials are warranted. Other variables had negligible impact on disparity.While contextual, physical activity, body size, and comorbidity variables may influence breast cancer-specific mortality, they do not explain racial/ethnic mortality disparity.Other factors besides those investigated here may explain the existing racial/ethnic disparity in mortality. A., Head, B., Goldstein, L. J., Haley, B., Dakhil, S. R., Reid, J. E., Hartman, A., Manola, J., Ford, J. M. Multigene Panel Testing in Oncology Practice: How Should We Respond? Residual breast cancer correlation within families was strong, suggesting substantial risk heterogeneity in women without BRCA1 or BRCA2 mutations, with some 3.4% of them accounting for roughly one third of breast cancer cases.These results support the practice of advising noncarriers that they do not have any increase in breast cancer risk attributable to the family-specific BRCA1 or BRCA2 mutation. In a separate model, the odds ratios were 1.21 (95% CI, 0.54 to 2.68) and 0.90 (95% CI, 0.50 to 1.62) for pathogenic variant and variant of uncertain significance, respectively, versus a negative test (the reference group).Compared with BRCA1/2 testing alone, multigene panel testing was not associated with increased cancer worry after diagnosis of breast cancer. Cheng, I., Shariff-Marco, S., Koo, J., Monroe, K. R., Yang, J., John, E. M., Kurian, A. W., Kwan, M. L., Henderson, B. E., Bernstein, L., Lu, Y., Sposto, R., Vigen, C., Wu, A. H., Gomez, S. L., Keegan, T. H. Treatment Decision Making and Genetic Testing for Breast Cancer: Mainstreaming Mutations. For example, tamoxifen could increase the number of endometrial cancers up to 11 per 1,000 high-risk women. The investigators doctors plan treatment in which more patients are willing to choose chemoprevention to reduce The magnitude of breast and ovarian cancer risk associated with many clinically tested genes, and independent of family cancer history, remains to be quantified.We queried a commercial laboratory database of 95,561 women tested clinically for hereditary cancer risk with a 25-gene (APC, ATM, BARD1, BMPR1A, BRCA1, BRCA2, BRIP1, CDH1, CDK4, CHEK2, MLH2, MSH2, MSH6, MUTYH, NBN, P14ARF, P16, PALB2, PMS2, PTEN, RAD51C, RAD51D, SMAD4, STK11, and TP53) next-generation sequencing panel. Many patients with breast cancer work for pay at the time of their diagnosis, and the treatment plan may threaten their livelihood. View details for DOI 10.1200/JCO.2014.58.5885 To assist women who are at increased risk of developing breast cancer and their physicians in the application of individualized strategies to reduce breast cancer risk, NCCN has developed these guidelines for breast cancer risk reduction. Non-European populations are under-represented in genetics studies, hindering clinical implementation of breast cancer polygenic risk scores (PRSs). All P values are two-sided.We did not observe an age-related black-white crossover in incidence for any molecular subtype of breast cancer. We calculated frequencies of breast cancer subtypes among Asian ethnic groups and evaluated their associations with clinical and demographic factors. Development of a Mobile Health App (TOGETHERCare) to Reduce Cancer Care Partner Burden: Product Design Study. Women with BRCA1 or BRCA2 (BRCA1/2) mutations must choose between prophylactic surgeries and screening to manage their high risks of breast and ovarian cancer, comparing options in terms of cancer incidence, survival, and quality of life. Lebensohn, A. P., Kingham, K. E., Chun, N. M., Kurian, A. W. A Time to Decide: Patient Perspectives on Breast Cancer Treatment Decision Making. Katz, S. J., Ward, K. C., Hamilton, A. S., Abrahamse, P. n., Hawley, S. T., Kurian, A. W. Unmet Need for Clinician Engagement Regarding Financial Toxicity After Diagnosis of Breast Cancer. Gomez, S. L., Press, D. J., Lichtensztajn, D., Keegan, T. H., Shema, S. J., Le, G. M., Kurian, A. W. Accuracy of BRCA1/2 Mutation Prediction Models for Different Ethnicities and Genders: Experience in a Southern Chinese Cohort. We examined racial differences in outcome according to subtype and stage in a diverse, population-based series of 103,498 patients.We obtained data for all invasive breast cancers diagnosed 1/1/2005-12/31/2012 and followed through 12/31/2012 among 93,760 non-Hispanic white and 9,738 African-American women in California. Baxter, J. S., Johnson, N., Tomczyk, K., Gillespie, A., Maguire, S., Brough, R., Fachal, L., Michailidou, K., Bolla, M. K., Wang, Q., Dennis, J., Ahearn, T. U., Andrulis, I. L., Anton-Culver, H., Antonenkova, N. N., Arndt, V., Aronson, K. J., Augustinsson, A., Becher, H., Beckmann, M. W., Behrens, S., Benitez, J., Bermisheva, M., Bogdanova, N. V., Bojesen, S. E., Brenner, H., Brucker, S. Y., Cai, Q., Campa, D., Canzian, F., Castelao, J. E., Chan, T. L., Chang-Claude, J., Chanock, S. J., Chenevix-Trench, G., Choi, J. Y., Clarke, C. L., Colonna, S., Conroy, D. M., Couch, F. J., Cox, A., Cross, S. S., Czene, K., Daly, M. B., Devilee, P., Drk, T., Dossus, L., Dwek, M., Eccles, D. M., Ekici, A. We further identified one of the five credible causal variants at signal 2, a 1.4 kb deletion (esv3594306), as the likely causal variant; the deletion allele of this variant was associated with an average additional increase in IGFBP5 expression of 1.3-fold (MCF-7) and 2.2-fold (T-47D). We used simulation modeling to fill these gaps.We simulated women eligible for TAILORx using joint distributions of patient and tumor characteristics and RS from TAILORx data; treatment effects by RS from other trials; and competing mortality from the Surveillance, Epidemiology, and End Results program database. View details for DOI 10.1080/13691058.2014.939227, View details for Web of Science ID 000342208800012. The increasing use of germline genetic testing may have unintended consequences on treatment. The study was performed in the Mohn Cancer Research Laboratory (Bergen, Norway) between 2019 and 2022.Associations between BRCA1 methylation and incident TNBC and incident HGSOC were analyzed by Cox proportional hazards regression.Of 2478 cases and controls in the TNBC group and 3493 cases and controls in the HGSOC group, respectively, 7 (0.3%) and 3 (0.1%) were American Indian or Alaska Native, 46 (1.9%) and 30 (0.9%) were Asian, 1 (0.04%) and 1 (0.03%) was Native Hawaiian or Pacific Islander, 326 (13.2%) and 125 (3.6%) were Black or African, 56 (2.3%) and 116 (3.3%) were Hispanic, 2046 (82.6%) and 3257 (93.2%) were White, and 35 (1.4%) and 35 (1.0%) were multiracial. Physical inactivity and sedentary behaviour are associated with higher breast cancer risk in observational studies, but ascribing causality is difficult. The NCCN panel meets at least annually to review comments, examine relevant new data, and reevaluate and update recommendations. These PRSs were evaluated in 89,898 women from 3 prospective studies (1592 incident cases).The best performing PRS (genome-wide set of single-nucleotide variations [formerly single-nucleotide polymorphism]) had a hazard ratio per unit SD of 1.62 (95% CI= 1.46-1.80) and an area under the receiver operating curve of 0.635 (95% CI= 0.622-0.649). Clinician estimates of systemic recurrence risk were provided for patient sub-groups with DCIS and with low-, intermediate-, and high-risk invasive disease. Up to 11 per 1,000 high-risk women be used to treat unilateral breast cancer work for pay at the thomas kurian wife allison! Patient sub-groups with DCIS and with low-, intermediate-, and age < 40 or 65 years gene. % -5.5 % if the rs was 26+ cancer subtypes among Asian ethnic groups evaluated. Breast cancer risk assessment per 1,000 high-risk women cure at the Stanford cancer Institute Web of Science 000342208800012. 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