Katherine C. Brooks, MD; Katie E. Raffel, MD; David Chia, MD; Abhishek Karwa, DO; Colin C. Hubbard, PhD; Andrew D. Auerbach, MD; Sumant R. Ranji, MD

The American Cancer Society (ACS) recently announced new lung cancer screening guidelines, updating its 2013 recommendations. Recent studies, including an analysis of the risk-benefit ratios of screening, supported the updated recommendations, according to an ACS statement.

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Despite previous observational research suggesting that blood from female donors resulted in worse outcomes among transfusion recipients, a recent randomized clinical trial involving 8719 patients showed that the sex of red blood cell donors did not influence outcomes.

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Black men in the US have a higher mortality rate after surgery than Black women as well as White women and men, based on the outcomes of more than 1.8 million Black and White patients aged 65 years or older who were covered by Medicare.

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Current cancer screening recommendations are based in part on estimated cancer risk, because cancer risk in the screened population affects the performance characteristics of the screening test—the higher the risk, the higher the positive predictive value of a screening test. Cancer results from a series of genetic or epigenetic changes that allows poorly controlled cell proliferation and invasion of normal tissue. Tumor suppressor genes are directly involved in cell growth and differentiation. Genetically inherited traits may be transmitted through Mendelian inheritance (e.g., autosomal-dominant, -recessive, or -codominant trait; X-linked trait) or non-Mendelian inheritance (e.g., uniparental disomy; expansion of trinucleotide repeats). Genetic segregation analysis is a statistical modeling approach to teasing out the effect of genes and shared environment. Genetics applications in health care are only going to increase; new genes are being discovered every day.

BACKGROUND:Few cross-sectional studies report iron deficiency (ID) prevalence in women of different race/ethnicity and ages in US or Canada. MATERIALS AND METHODS:We evaluated screening observations on women who participated between 2001-2003 in a cross-sectional, primary care-based sample of adults ages ≥25 y whose observations were complete: race/ethnicity; age; transferrin saturation; serum ferritin; and HFE p.C282Y and p.H63D alleles. We defined ID using a stringent criterion: combined transferrin saturation <10% and serum ferritin <33.7 pmol/L (<15 μg/L). We compared ID prevalence in women of different race/ethnicity subgrouped by age and determined associations of p.C282Y and p.H63D to ID overall, and to ID in women ages 25-44 y with or without self-reported pregnancy. RESULTS:These 62,685 women included 27,079 whites, 17,272 blacks, 8,566 Hispanics, 7,615 Asians, 449 Pacific Islanders, 441 Native Americans, and 1,263 participants of other race/ethnicity. Proportions of women with ID were higher in Hispanics and blacks than whites and Asians. Prevalence of ID was significantly greater in women ages 25-54 y of all race/ethnicity groups than women ages ≥55 y of corresponding race/ethnicity. In women ages ≥55 y, ID prevalence did not differ significantly across race/ethnicity. p.C282Y and p.H63D prevalence did not differ significantly in women with or without ID, regardless of race/ethnicity, age subgroup, or pregnancy. CONCLUSIONS:ID prevalence was greater in Hispanic and black than white and Asian women ages 25-54 y. p.C282Y and p.H63D prevalence did not differ significantly in women with or without ID, regardless of race/ethnicity, age subgroup, or pregnancy.

The Genetic Association Information Network (GAIN) Data Access Committee was established in June 2007 to provide prompt and fair access to data from six genome-wide association studies through the database of Genotypes and Phenotypes (dbGaP). Of 945 project requests received through 2011, 749 (79%) have been approved; median receipt-to-approval time decreased from 14 days in 2007 to 8 days in 2011. Over half (54%) of the proposed research uses were for GAIN-specific phenotypes; other uses were for method development (26%) and adding controls to other studies (17%). Eight data-management incidents, defined as compromises of any of the data-use conditions, occurred among nine approved users; most were procedural violations, and none violated participant confidentiality. Over 5 years of experience with GAIN data access has demonstrated substantial use of GAIN data by investigators from academic, nonprofit, and for-profit institutions with relatively few and contained policy violations. The availability of GAIN data has allowed for advances in both the understanding of the genetic underpinnings of mental-health disorders, diabetes, and psoriasis and the development and refinement of statistical methods for identifying genetic and environmental factors related to complex common diseases.

Malaria is hyper-endemic in Ghana, accounting for 44% of outpatient attendance, 13% of all hospital deaths, and 22% of mortality among children less than five years of age. The paper analyzed the risk factors of malaria mortality among children using a logistic regression model and also assessed the interaction effect between age and treatment of malaria patient. S econdary data was obtained from the inpatient morbidity and mortality returns register at Tamale Teaching Hospital, from 1 st January 2008 to 31 st December 2010. The results showed that risk factors such as referral status, age, distance, treatment and length of stay on admission were important predictors of malaria mortality. However, it was found that the risk factors; sex and season were not good predictors of malaria mortality. Finally, the interaction effect between age and treatment was found to be significant. It was recommended, among other things, that the government should provide more assessable roads and expand ambulance services to the various Districts/communities in and around the Tamale metropolis to facilitate referral cases.

BACKGROUNDHFEC282Y homozygotes have an increased risk for developing increased iron stores and related disorders. It is controversial whether dietary iron restrictions should be recommended to such individuals.OBJECTIVETo determine whether dietary iron content influences iron stores in HFEC282Y homozygotes as assessed by serum ferritin concentration.DESIGNSerum ferritin concentration was measured and a dietary iron questionnaire was completed as part of the evaluation of 213 HFEC282Y homozygotes who were identified through screening of >100,000 primary care patients at five HEmochromatosis and IRon Overload Screening (HEIRS) Study Field Centers in the United States and Canada.RESULTSNo significant relationships between serum ferritin concentration and dietary heme iron content, dietary nonheme iron content or reports of supplemental iron use were found.CONCLUSIONThese results do not support recommending dietary heme or nonheme iron restrictions for HFEC282Y homozygotes diagnosed through screening in North America.

Background TARGIT-A, an international phase 3 randomised trial (Lancet 2010;376:91–102) compared outcomes in patients undergoing breast conserving surgery followed by either whole breast external beam radiotherapy (EBRT) over several weeks, or a risk-adaptive approach using single dose targeted intra-operative radiotherapy (TARGIT). Risk-adaptive approach meant that if the final pathology report demonstrated unpredicted pre-specified adverse features, then EBRT was to be added to TARGIT. Method 3451 women aged 45 years or older with invasive ductal carcinoma were enrolled from 33 centres in 10 countries between 2000 and 2012. Randomisation to TARGIT or EBRT arm was done either before lumpectomy (pre-pathology) or after lumpectomy (postpathology). If allocated to TARGIT, patients in the pre-pathology group received it immediately after surgical excision under the same anaesthesia; patients in the post-pathology group received it as a subsequent procedure. We pre-specified that analysis would be performed overall as the primary analysis and for these groups separately as a secondary analysis. The primary outcome was ipsilateral within breast recurrence (IBR) with an absolute non-inferiority margin of 2.5% at 5 years and secondary outcome was survival. We performed exploratory analyses for loco-regional recurrence, ‘all recurrence’ (ipsilateral or contralateral breast, axilla or distant), distant recurrence, and causes of death. Results 1721 patients were randomly allocated to receive TARGIT and 1730 to EBRT. 1010 patients have a minimum 4 years follow up and 611 patients have minimum 5 years follow up. Primary events have increased from 13 to 34 since 2010. For the primary outcome of ipsilateral breast recurrence, the absolute difference at 5-years was 2.0%, which was higher with TARGIT and reached the conventional levels of statistical significance (p = 0.042), but was within the pre-specified non-inferiority margin; in prepathology the absolute difference in 5-year IBR was 1%; in postpathology it was 3.7%. For the secondary outcome, there was a non-significant trend for improved overall survival with TARGIT (HR = 0.70(0.46–1.07)) due to fewer non-breast cancer deaths (17 vs. 35, HR 0.47 (0.26–0.84)). Cardiovascular deaths were 1 vs. 10 and deaths from cancers other than breast were 7 vs.16. Conclusion The risk-adapted approach using single dose TARGIT has a slightly higher local recurrence rate than EBRT for the primary endpoint of IBR, but was within the preset non-inferiority boundary, with the prepathology apparently performing better than the postpathology stratum. In addition there was a trend for improved overall survival in the TARGIT arm due to fewer non-breast cancer deaths. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr S4-2.