Mining electronic health records: an additional perspective

Using the Utah Population Database to assess familial risk of primary open angle glaucoma

BACKGROUND Globally, breast cancer is the most commonly diagnosed cancer and the most common cause of cancer death for women. Access to high quality treatment and novel therapies vary significantly based on geographic regions and countries. Mortality rate is considerably higher women in developing and low-income regions compared to high income regions. While many factors contribute to disparities in breast cancer specific outcomes, access to clinical trials provide high quality and evidence-based cancer care. Therefore, we evaluated the availability of breast cancer treatment clinical trial among global regions with the highest breast cancer incidence and related mortality. METHODS In this study, we reviewed clinical trials registered with clinicaltrials.gov and published in 3 high impact journals: The New England Journal of Medicine, Lancet Oncology and the Journal of Clinical Oncology between January 2018 and May 2020. For each trial, the countries from which patients enrolled were captured and compared to the countries in the top 5 regions for highest breast cancer incidence and breast cancer related mortality globally per the GLOBOCAN 2018 estimates. RESULTS A total of 77 clinical trials meet this criteria and enrolled patients in 67 different countries. As most trials enrolled in multiple countries, the enrollment countries for every trial was recorded with a total of 697 enrolled countries in these 77 clinical trials. The global regions with the high breast cancer mortality are Melanesia, Micronesia and Polynesia (Hawaii excluded), Northern Africa, Caribbean and Western Africa. These regions together had only 8 clinical trials that accrued patients during this time frame: one trial in Egypt, 4 in New Zealand and 3 in Puerto Rico. This represents about 1% of country accruals in the trials analyzed (8 of 697). The most frequently enrolling countries were the United States, Canada, Belgium, United Kingdom, Italy, France, Germany, and Spain which have high incidence of breast cancer but lower mortality rates compared to other global regions. CONCLUSIONS High impact breast cancer trials currently enroll patients from areas with high incidence of breast cancer but not from areas with high mortality rates. Barriers that lead to these disparities have not been extensively explored and would be of interest in future studies. Exploring creative ways to bridge this gap, such as working with local governments to help develop clinical centers with ability to run clinical trials and train local medical staff, may be part of an effort to decrease global breast cancer mortality. Citation Format: Jean-Pierre A Blaize, Phillip P Acosta, Isiah Gonzalez, Kristen E Ott, Kate Lathrop. Exploring global clinical trial enrollment opportunities in high breast cancer mortality regions [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-17.

Background: Breast cancer is the most common cancer among women and one of the most important causes of death among them.Many of previous studies showed a strong association between ABO, Rh blood groups, and the occurrence of malignant tumors. Objectives:The present study aimed to determine the association between ABO blood groups and Rhesus factor with prevalence of the breast cancer. Methods:In this study, we identified 50 research documents from data based search engines.The research papers were selected by using the primary key-terms including breast cancer, ABO blood type, and Rhesus blood type.We reviewed the 36 papers that harmonized our criteria were comprised and remaining papers were excluded.The current study was included more than 847811 normal subjects as control and more than 19208 breast cancer patients for ABO blood groups and more than 251939 subjects as control and more than 11116 breast cancer patients for Rh factor. Results: Blood group (A) has high incidence of breast cancer (40.62%), blood group (O) has (33.46%); (B) (17.31%) and blood group (AB) has (8.091%) incidence of breast cancer. Blood group (A) has the highest and blood group (AB) has least association with breast cancer. Rhesus positive (Rh + ) blood group has high incidence of breast cancer (87.20%) and Rhesus negative (Rh-) blood group has least association with breast cancer (12.80%). Conclusion:It can be concluded that blood group (A) and Rh+ have a high risk of breast cancer, while blood type (AB) and Rh-are at low risk of breast cancer.So, physicians should carefully monitor the females with blood group (A) and Rh+ as these females are more prone to develop breast cancer.To reduce the prevalence of the breast cancer and its burden, screening, and preventive programs for breast cancer especially in young women are highly recommended.Further studies are necessary to determine the mechanisms by which ABO blood type may influence the risk of breast cancer.

IntroductionThe ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter.MethodsOf third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan.ResultsTraining SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p <.001.DiscussionThe EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.

Six hundred ninety-seven histologically confirmed cases of cancer were seen in the three-year period, 1987 to 1989, at Asir Central Hospital in Abha, Saudi Arabia. Percentage (crude relative) frequencies of cancer at various sites were determined. The most common cancer sites among males were skin, liver, lymphoid tissue (i.e., non-Hodgkin's lymphomas), bladder,, blood (leukemias), stomach, colon, esophagus, central nervous system, and prostate. Skin cancer was also the most common cancer among females, followed by breast, lymphoid tissue (non-Hodgkin's lymphomas), blood (leukemias), thyroid, stomach, colon, oral cavity, esophagus, and cervix.

While concerns remain regarding Electronic Medical Records (EMR) use impeding doctor-patient communication, resident and faculty patient perspectives post-widespread EMR adoption remain largely unexplored. We aimed to describe patient perspectives of outpatient resident and faculty EMR use and identify positive and negative EMR use examples to promote optimal utilization. This was a prospective mixed-methods study. Internal medicine faculty and resident patients at the University of Chicago's primary care clinic participated in the study. In 2013, one year after EMR implementation, telephone interviews were conducted with patients using open-ended and Likert style questions to elicit positive and negative perceptions of EMR use by physicians. Interview transcripts were analyzed qualitatively to develop a coding classification. Satisfaction with physician EMR use was examined using bivariate statistics. In total, 108 interviews were completed and analyzed. Two major themes were noted: (1) Clinical Functions of EMR and (2) Communication Functions of EMR; as well as six subthemes: (1a) Clinical Care (i.e., clinical efficiency), (1b) Documentation (i.e., proper record keeping and access), (1c) Information Access, (1d) Educational Resource, (2a) Patient Engagement and (2b) Physical Focus (i.e., body positioning). Overall, 85% (979/1154) of patient perceptions of EMR use were positive, with the majority within the "Clinical Care" subtheme (n = 218). Of negative perceptions, 66% (115/175) related to the "Communication Functions" theme, and the majority of those related to the "Physical Focus" subtheme (n = 71). The majority of patients (90%, 95/106) were satisfied with physician EMR use: 59% (63/107) reported the computer had a positive effect on their relationship and only 7% (8/108) reported the EMR made it harder to talk with their doctors. Despite concerns regarding EMRs impeding doctor-patient communication, patients reported largely positive perceptions of the EMR with many patients reporting high levels of satisfaction. Future work should focus on improving doctors "physical focus" when using the EMR to redirect towards the patient.

Despite the high incidence of breast cancer, there are few pharmacological strategies for chemoprevention, and their serious adverse effects, result in low adherence. Retinoids are capable of inhibiting mammary tumors development due to regulation of cell growth and differentiation, and, among them, fenretinide is considered promising for breast cancer chemoprevention for its ability to accumulate in breast tissue. However, the drug presents serious adverse effects, and its high lipophilicity results in low oral bioavailability. To overcome these limitations and enable its use in chemoprevention, the present study aimed at developing bioresponsive microemulsions capable of uptaking in situ fluids after subcutaneous administration and transforming into a liquid crystalline phase that provides prolonged and local fenretinide release. Several microemulsions were prepared, and those composed of [phosphatidylcholine]:[monoolein:tricaprylin]-propylene glycol in the proportions 1:1-30% and 9:1-50% were selected. They presented diameters below 230 nm, originated liquid-crystalline phase when added 1% or more of water, and prolonged Alexa Fluor 647 release in vivo for more than 30 days; however, the microemulsion 1:1-30% caused local irritation and the formation of a fibrous capsule. Fenretinide was incorporated at a concentration of 1% (m/m), and its release followed pseudo-first order kinetics, Treatment of MCF-7 and T47D cells with the formulation 9:1-50% loaded with fenretinide was more cytotoxic compared to 1:1-30%, leading to its the selection for subsequent studies. Treatment with the fenretinide-loaded 9:1-50% formulation reduced cell migration by 65.2 and 75.9% when used in concentrations equivalent to IC5 and IC15 (concentrations required to reduce viability by 5 or 15%) compared to untreated cells, respectively. In 3D models, treatment with 9:1-50% at a concentration equivalent to IC30 reduced the viability of spheroids by 28.8% compared to the untreated control. In the animal model of chemically induced carcinogenesis, the 9:1-50% formulation was safe and effective, inhibiting the development of breast tumors.

The use of deodorants/antiperspirants does not constitute a risk factor for breast cancer

Since mutagens produce an extraordinary diversity of mutational patterns, differential mutational exposures among populations are expected to produce different patterns of mutation. Classical epidemiological methods have been successful in implicating specific mutagens in cancers such as those of lung and skin in which one mutagen predominates. In breast cancer, however, no mutagens have been implicated in an unequivocal manner. In an attempt to facilitate epidemiological studies, we have been studying the pattern of p53 gene mutations in breast cancers from multiple populations with high and low breast cancer incidences. We previously reported that breast cancers from Midwest United States, predominantly rural Caucasian women, have a different pattern of p53 gene mutation from populations of Western European women. Herein, we analyze patterns of p53 mutations from Graz, Austria, another population with a high incidence of breast cancer. Among the 60 Austrian breast cancers analyzed, 14 (23%) have a p53 gene mutation in exons 5-9 or in adjacent splice junctions. Analysis of the patterns of mutation shows differences between the "Western European" profile and the Austrian and Midwest United States groups (P = 0.027 and 0.024, respectively). The Austrian pattern is characterized by a high frequency of A:T-->T:A transversions (P = 0.006). The presence of distinct patterns of mutation among the limited number of analyzed populations of Western European origin supports the idea that differential mutagenic exposure and/or genetic differences contribute to breast cancer mutagenesis among geographically distinct Caucasians of Western European origin.

Consumption of dietary fat has been linked to the high incidence of breast cancer. The in vitro effects of palmitate, oleate, linoleate, and eicosapentaenoate at supraphysiological concentrations [1.8-4.8 mM; endogenous (0.8) plus added (1-4)] on the binding of 17 beta-estradiol (E2) to sex hormone-binding globulin and albumin were evaluated in plasma, using centrifugal ultrafiltration. The E2-sex hormone-binding globulin complex was significantly dissociated by oleate, linoleate, eicosapentaenoate, and palmitate at 1.8 to 2.8-mM concentrations. The same FFA caused a significant increase in E2 binding to albumin at similar concentrations. However, only the unsaturated fatty acids at 3.8 to 4.8-mM concentrations (i.e. oleate, linoleate, and eicosapentaenoate) significantly increased the nonprotein-bound free E2 fraction. Thus, these results suggest that free E2 concentrations are not affected by physiological concentrations of FFA.

Although the proportion of triple-negative breast cancers (TNBCs) diagnosed among older women is low, the number of TNBC cases is substantial because of the high incidence of breast cancer after the age of 65 years. The molecular features of TNBC in this age group have not been well described. This study examined a population-based cohort of women with stage I to III TNBC diagnosed between the ages of 25 and 91 years with the PAM50 gene expression subtyping assay. The concordance between the TNBC classification by immunohistochemistry and the gene expression classification by PAM50, the expression of individual genes, and 5-year recurrence and breast cancer mortality in older women (≥65 years old) and younger women (<50 years old) was assessed. The molecular subtype distribution in TNBC was significantly different according to the age at diagnosis. TNBC was more likely to be classified as basal-like in women younger than 50 years (sensitivity, 0.91; 95% confidence interval, 0.77-0.97) than women 65 years old or older (sensitivity, 0.72; 95% confidence interval, 0.48-0.87); 35% of clinical TNBC cases in the latter group were the human epidermal growth factor receptor 2 (HER2)-enriched subtype by molecular classification. Older women with TNBC also had significantly higher expression of ERBB2 and lower expression of all 10 proliferation-associated genes tested (P < .01). The risk of breast cancer death within 5 years was significantly higher in women with TNBC in comparison with women with hormone receptor-positive cancers in all age groups. This study revealed differences in molecular subtypes among clinical TNBC cases based on patient age. A potentially targetable HER2-enriched group raises the possible need for intrinsic subtyping in older women with TNBC.

The high incidence of breast cancer and the physical and emotional consequences of its treatment reinforce the need for comprehensive rehabilitation strategies. This study analyzed the effects of physical activity (PA) on the physical and emotional quality of life of women post-breast cancer treatment. A literature review methodology was adopted, with a qualitative approach and narrative analysis, selecting 16 highly relevant articles published between 2020 and 2025 from databases such as SciELO and PUBMED. The analysis demonstrated that the inclusion of physical exercise is a safe and effective strategy, promoting measurable physical benefits, such as the restoration of functionality, strength recovery, and the reduction of limitations such as cancer fatigue. Regarding the emotional impact, regular exercise has proven to be a powerful resource for reducing anxiety and depression and strengthening psychological and social well-being. It is concluded that the evidence provides a solid basis for recommending supervised PA as an essential resource in the complete and lasting care of survivors, although it highlights the need for investment in public policies to expand access to structured programs.

The high incidence of breast cancer in women has increased significantly in the recent years. Breast MRI involves the use of magnetic resonance imaging to look specifically at the breast. Contrast-enhanced breast MRIs acquired by contrast injection have been shown to be very sensitive in the detection of breast cancer, but are also time-consuming and cause waste of medical resources. This paper utilizes the use of type-II fuzzy sets to enhance the contrast of the breast MRI image. To evaluate the performance of our approach, we run tests over different MRI breast images and show that the overall accuracy offered by the employed approach is high.KeywordsBreast CancerMagnetic Resonance ImagingMembership FunctionSpike Neural NetworkBreast MRIsThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Swiss women show, together with women from the Netherlands, France, Belgium, Sweden, Finland, England and Germany, a very high incidence of breast cancer in Europe. Whilst the evidence for primary cancer prevention is slowly growing, its strategies can not yet be implemented in clinical prevention programmes. Therefore, secondary prevention, early detection of cancer, remains the main focus for reducing breast cancer mortality. This is especially true because of the proven relationship between mortality and size of the primary tumour as well as the status of the axilla. Despite these facts, in contrast to the French part of Switzerland, breast cancer screening has not yet been implemented in the German and Italian part of Switzerland. It was the aim of this study to identify prevention measures used by women living in the German-, Italian- and French-speaking part of Switzerland and to explore their attitude towards breast cancer prevention measures. It was asked what these women knew about breast cancer prevention, what type of secondary prevention they used and who motivated them to do so. The investigation included 1721 women from three language regions of Switzerland. Data were collected with a postal survey questionnaire. Descriptive, uni- and multivariate methods were used for data analysis. The response rate was 34%. Statistically significant differences in breast self-examination were observed between the three regions (p = < 0.001) and defined age-groups (p = < or = 0.001). In all three regions of the country, 90% of women age 50-59 had mammograms, whereas in comparison to the other regions, fewer women from the German part of Switzerland, aged 60-69, had undergone mammography screening. Significant differences in mammography screening again were observed between language regions (p = < or = 0.001) and age-groups (p = < or = 0.001). Eighty-four percent of women were motivated by the gynaecologist to have a mammography, 11% by the family doctor and 10% of the women decided by themselves. More than half of this female Swiss study population wished to see a health policy providing mammography-screening in Switzerland and about one third wished to be more informed about the intervention. An increased need for information and education about prevention and early detection was observed in individuals who had a relative with cancer. The majority of women in this study wished to see a health policy in Switzerland which includes a mammography screening programme. Opportunistic mammography screening, lacking systematic quality control and data collection for epidemiological purposes, was widely used in the Italian and in the German speaking region. Data show that there is a need for public and professional information and education about prevention and early detection of breast cancer to prevent misconceptions regarding the effect of breast self-examination and mammography-screening. Womens' organisations and nurses may be in a good position to take up a leading role in breast cancer prevention.

It has been shown that some breast cancers may have a long preclinic al existence. A host reaction may play a part in determining when preclinical becomes clinical cancer and on the subsequent course of the cancer. A study of breast cancer in mice has shown that it is a systemic disease produced by genetic factors hormones environmental factors and viruses. The virus B particle transmitted by mothers milk is the causative factor if other factors are also present. The virus is present in most organs of the mice including the blood mammary glands and milk long before clinical symptoms of cancer are found. The virus can be found in tumor cells grown in tissue culture but not in other cultured cells. Although the type B particle is regarded as the causative agent in mouse breast cancer its presence does not necessarily indicate future cancer development. However a correlation exists between high numbers of type B particles in milk of mice and a high incidence of breast cancer. Testicular tissues and spermatic fluid also contain virus and may infect the females. The type B particles are known as oncogenic or oncorna viruses. Breast cancers in mice have similarities as well as differences between the findings of neoplasia in women.