He supervised groups building Oracle's cloud computing software. Jagsi, R., Griffith, K. A., Kurian, A. W., Morrow, M., Hamilton, A. S., Graff, J. J., Katz, S. J., Hawley, S. T. Intersection of Race/Ethnicity and Socioeconomic Status in Mortality After Breast Cancer. breast cancer 2008-2009 showed initial safety,tolerability and good bioavailability of both Over the past several decades, the disease's incidence has risen worldwide, increasing in developing and developed countries. In the 47 women, serum melatonin levels ranged from 0.6 to 62.6 pg/ml, with a median of 7.0 pg/ml.Our results suggest that it is possible to reliably measure melatonin in postmenopausal women in morning serum samples in large epidemiologic studies to evaluate the role of melatonin in cancer etiology or prognosis. Hall, M. J., Bernhisel, R. n., Hughes, E. n., Larson, K. n., Rosenthal, E. T., Singh, N. A., Lancaster, J. M., Kurian, A. W. Association of Risk-Reducing Salpingo-Oophorectomy With Breast Cancer Risk in Women With BRCA1 and BRCA2 Pathogenic Variants. Results: The adjusted overall survival hazard ratio was 0.98 (95% CI: 0.67-1.44), indicating a similar risk of death between groups. In this review, we summarize the current understanding of pathogenic germline gene mutations associated with TNBC and the early detection and prevention strategies for women at risk of developing this high-risk breast cancer subtype. Detection of mutations has implications for targeted screening and prevention strategies for probands, and for genetic counseling and testing of their family members. View details for DOI 10.1016/j.ajhg.2021.05.013. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Strong desire for testing was more common in younger women, Latinas, and those with family history. Chandler, Y., Schechter, C., Jayasekera, J., Isaacs, C., Kurian, A. W., Cadham, C., Mandelblatt, J. Racial/ethnic differences in cancer diagnosed after metastasis: absolute burden and deaths potentially avoidable through earlier detection. View details for DOI 10.1001/jama.2014.10707. Liang, S., Richardson, M., Chen, T., Colocci, N., Kurian, A., de Briun, M., Chan, C., Chan, J. Twenty-one-gene recurrence score (RS) in germline (g)CHEK2 mutation-associated versus sporadic breast cancers (BC): A multi-site case-control study. We identified de novo MBC patients from CCR and extracted information on distant recurrences from patient notes in EMR. Gene burden tests detected the strongest association for deletions in BRCA1 (P=3.7E-18). Women with BRCA1 or BRCA2 (BRCA1/2) mutations face difficult decisions about managing their high risks of breast and ovarian cancer. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for breast cancer-specific mortality.After adjustment for patient, tumor and treatment characteristics, outcomes were comparable by race for Stage I or IV cancer regardless of subtype, and HR+/HER2+ or HR-/HER2+ cancer regardless of stage. A., Tollenaar, R. A., Tomlinson, I. n., Troester, M. A., Truong, T. n., Vachon, C. M., van Veen, E. M., Wang, S. S., Weinberg, C. R., Wendt, C. n., Wildiers, H. n., Winqvist, R. n., Wolk, A. n., Zheng, W. n., Ziogas, A. n., Dunning, A. M., Pharoah, P. D., Easton, D. F., Howie, A. F., Peto, J. n., Dos-Santos-Silva, I. n., Swerdlow, A. J., Chang-Claude, J. n., Schmidt, M. K., Orr, N. n., Fletcher, O. n. Development and Validation of a Simulation Model-Based Clinical Decision Tool: Identifying Patients Where 21-Gene Recurrence Score Testing May Change Decisions. Letrozole in Treating Postmenopausal Women Who Have Received Hormone Therapy for Hormone Receptor-Positive Breast Cancer, Neratinib +/- Fulvestrant in Metastatic HER2 Non-amplified But HER2 Mutant Breast Cancer, Olaparib as Adjuvant Treatment in Patients With Germline BRCA Mutated High Risk HER2 Negative Primary Breast Cancer. View details for DOI 10.1007/s10549-016-4076-5, View details for Web of Science ID 000393023500014. Adherence to breast cancer treatment guidelines according to pathogenic variants in cancer susceptibility genes in a population-based cohort. Based on data generated by BiPar/Sanofi, it is concluded that iniparib does not possess The most influential variables were related to disease characteristics, neighborhood socioeconomic status, and smoking status at diagnosis. The twins are the youngest among the four brothers. 2018 American Cancer Society. In an independent cohort, 18% of women shifted breast cancer risk categories from their Tyrer-Cuzick-based risk compared with risk estimates by CRS.Integrating clinical and polygenic factors into a risk model offers more effective risk stratification and supports a personalized genomic approach to breast cancer screening and prevention. View details for PubMedID 33426465 With these tumor features, a woman like this will have a 28% probability of having an RS 16-20, 18% RS 21-25, and 11% RS 26+. Forty-three percent of the patients were treated at the academic center only, 42 percent at the community center only, and 16 percent of the patients obtained care at both health care organizations. Median survival improved over time, but varied substantially across race/ethnicity (Asians: 34months; African Americans: 6months), neighborhood socioeconomic status (SES) (highest: 34months, lowest: 20months), and molecular subtype (HR+/HER2+: 45months; triple negative: 12months). Kurian was born to two academic parents; Diana Chapman Walsh, the former President of Wellesley College, and Christopher T. Walsh, a biochemist at Harvard University. Risk-adapted screening and prevention protocols are underway, with ongoing refinement as genetic knowledge grows. The conclusions were unchanged at 20-year follow-up.Our results confirmed a small benefit in chemotherapy among women aged 50years and younger with RS 16-25. Wu, J., Cao, G., Sun, X., Lee, J., Rubin, D. L., Napel, S., Kurian, A. W., Daniel, B. L., Li, R. Higher Absolute Lymphocyte Counts Predict Lower Mortality from Early-Stage Triple-Negative Breast Cancer. Lonning, P., Nikolaienko, O., Pan, K., Kurian, A. W., Eikesdal, H., Pettinger, M., Anderson, G. L., Prentice, R. L., Chlebowski, R. T., Knappskog, S. A case-control study of healthcare disparities in sex and gender minority patients with breast cancer. Kurian, A. W., Hare, E. E., Mills, M. A., et al, Epidemiology and survival patterns of triple negative breast cancer patients with or without BRCA germline mutation in Chinese, Kwong, A., Chau, W., Law, F., Chu, T., Chan, T., Kurian, A. W., et al, PrECOG 0105: Final efficacy results from a phase II study of gemcitabine and carboplatin plus iniparib (BSI-201) as neoadjuvant therapy for triple-negative and BRCA1/2 mutation-associated breast cancer, Telli, M. L., Jensen, K., Kurian, A. W., et al, Impact of California breast density notification law SB 1538 on California women and their health care providers, Ikeda, D. M., Thomas, W. R., Joe, B. N., Lindfors, K., Brenner, R. J., Feig, S., Bassett, L. W., Leung, J. W., Ojeda-Fournier, H., Hargreaves, J., Price, E., Lipson, J. Breast Cancer Screening Strategies for Women With ATM, CHEK2, and PALB2 Pathogenic Variants: A Comparative Modeling Analysis. However, only one half (50.6%) of those not tested received any discussion about genetics. View details for DOI 10.1007/s10900-015-0052-y, View details for DOI 10.1016/j.stamet.2015.06.001, View details for Web of Science ID 000361262400006. There are concerns that multigene panel testing compared with BRCA1/ 2-only testing after diagnosis of breast cancer may lead to unnecessary patient worry about cancer because of more ambiguous results.Patients with breast cancer diagnosed from 2013 to 2015 and accrued from SEER registries in Georgia and Los Angeles were surveyed (n = 5,080; response rate, 70%), and responses were merged with SEER data and germline genetic testing and results. Cox proportional hazards models provided estimates of the relative hazard ratio for mortality from all causes, breast cancer, and causes other than breast cancer associated with recent recreational physical activity (i.e., in the 10 years before diagnosis). Since their inception in 2000, the Cancer Intervention and Surveillance Network (CISNET) breast cancer models have collaborated to use a nationally representative core of common input parameters to represent key components of breast cancer control in each model. Among premenopausal women, the 10-year cumulative incidence of CBC was estimated to be 33% for BRCA1, 27% for BRCA2, and 13% for CHEK2 PV carriers with breast cancer and 35% for PALB2 PV carriers with ER-negative breast cancer. 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. No other incident comorbidity risk varied between users of tamoxifen versus AIs.In a diverse, multi-institutional, contemporary breast cancer cohort, the only incident comorbidity that differed between ET options was osteoporosis, a known side effect of AIs. We simulated outcomes for 1,512 unique patient subgroups based on all possible combinations of age, tumor size, grade, and comorbidity level; simulations were performed with and without 21-gene recurrence scores (RSs). MSH2/MSH6 protein loss was detected in eight cases (50.0%); (95% CI: 28.0%-72.0%) and MLH1/PMS2 protein loss was detected in four cases (25.0%); (95% CI: 9.7%-50.0%). Among ovarian cancer patients in North America, BRCA1/2 mutations are present in 13-15%. Multiple imputation was used to fill in missing receptor status. Participants were queried about communication of their results, as part of a prospective study of multi-gene panel genetic testing. Allison, K. H., Jensen, K., West, R., Clarke, C. A., Gomez, S. L., Kurian, A. W. Beyond Barriers: Systemic Constraints Limiting Sexual Health Care for Breast Cancer Survivors. There are limited data on the prevalence of Lynch syndrome (LS) in women with primary ovarian cancer with mismatch repair deficiency (MMR-D) by immunohistochemistry (IHC).Three hundred and eight cases of primary ovarian, fallopian, and peritoneal cancer between January 2012 and December 2019 were evaluated for MMR-D by IHC. The authors incorporated records from the population-based California Cancer Registry and then linked EMR-California Cancer Registry data sets of Community and University patients.The authors initially identified 8210 University patients and 5770 Community patients; linked data sets revealed a 16% patient overlap, yielding 12,109 unique patients. This mutation will identify patients with cancer before other detectable symptoms or signs of the disease. Clinical impact of multi-gene panel testing for hereditary breast and ovarian cancer risk assessment. Relative risks were lower after BLM (hazard ratio [HR], 0.10; 95% CI, 0.07-0.14) and higher after ULM (HR, 1.07; 95% CI, 1.02-1.13) versus BCT. Oncologists explained 17% of the variation in RS testing but little of the variation in chemotherapy receipt (3%) controlling for clinical factors. The impact of these disruptions on patient experiences remain relatively understudied. We identified 6,004 women diagnosed with Stage I-III breast cancer at KPNC during 2004-2007; 2,669 (44.5 %) received at least one chemotherapy infusion at KPNC within 12 months of diagnosis. View details for DOI 10.1001/jamaoncol.2016.5652, View details for Web of Science ID 000397491400018. (2-7) In the Women's Health Initiative (WHI) Observational Study (OS), women with NMSC history at baseline were more likely to report history of another cancer (Odds ratio [OR] = 2.3, 95% CI = 2.18 -2.44. - Cohort 1) Subjects with a documented PR or CR to a prior platinum-containing regimen for [1][2] Kurian earned her Bachelor of Arts degree in Human Biology at Stanford University before earning her medical degree from Harvard Medical School. View details for DOI 10.1016/j.jbi.2019.103137. Blayney, D. W., Seto, T., Hoang, N., Lindquist, C., Kurian, A. W. Impact of COVID-19 on breast cancer care at a Bay Area academic center. Unfortunately, Mr. Kurian has not spoken about his children till now. Inclusion of genetic ancestry in polygenic risk prediction presents an opportunity for more personalized treatment decisions for women of varying and mixed ancestries. On multivariable analysis of women with HR-positive/HER2-negative disease, receipt of a more intensive chemotherapy regimen varied significantly by genetic results (p=.02), with platinum receipt more common among BRCA1/2 PV carriers (odds ratio 2.44, 95% confidence interval 1.36-4.38, p Performance of Prediction Models for BRCA Mutation Carriage in Three Racial/Ethnic Groups: Findings from the Northern California Breast Cancer Family Registry. Wapnir, I. L., Kurian, A. W., Lichtensztajn, D. Y., et al, Optimizing the Threshold for Genetic Testing for Colorectal Cancer Syndromes, Naghi, L., Spector, K., Haisman, J., Kurian, A. W., et al. We highlight results for one scenario where treatment choice may be uncertain.Chemoendocrine versus endocrine therapy in a 65-69-year-old woman with a small ( 2 cm), intermediate-grade tumor, and mild comorbidities provides a 1.3% absolute reduction in 10-year distant recurrence risk, with 0.23 life-years gained. Few studies have examined the ways in which physicians use the RS to recommend adjuvant systemic chemotherapy or patients' experiences with testing and decision making.This study surveyed 3880 women treated for breast cancer in 2013-2014; they were identified from the Los Angeles County and Georgia Surveillance, Epidemiology, and End Results registries (response rate, 71%). This phase II study will test cancer to see if it has a HER2 mutation and, if so, see how We found that the vast majority of respondents (94%, 127/135) ordered an HCP for patients rather than single-gene tests to assess hereditary cancer predisposition. Daly, M. B., Pilarski, R. n., Yurgelun, M. B., Berry, M. P., Buys, S. S., Dickson, P. n., Domchek, S. M., Elkhanany, A. n., Friedman, S. n., Garber, J. E., Goggins, M. n., Hutton, M. L., Khan, S. n., Klein, C. n., Kohlmann, W. n., Kurian, A. W., Laronga, C. n., Litton, J. K., Mak, J. S., Menendez, C. S., Merajver, S. D., Norquist, B. S., Offit, K. n., Pal, T. n., Pederson, H. J., Reiser, G. n., Shannon, K. M., Visvanathan, K. n., Weitzel, J. N., Wick, M. J., Wisinski, K. B., Dwyer, M. A., Darlow, S. D. Germline HOXB13 mutations p.G84E and p.R217C do not confer an increased breast cancer risk. Zeidman, A., Benedict, C., Tolby, L., Zion, S., Fisher, S., Kurian, A. W., Berek, J. S., Woldeamanuel, Y., Schapira, L., Palesh, O. platinum; or The CBCSC represents a large and racially/ethnically diverse cohort of breast cancer patients from California. View details for DOI 10.14694/EDBK_158817. Building on prior observations from lineage evolution analysis, we examined whether measuring genomic features of DCIS would predict association with invasive breast carcinoma (IBC). Gomez, S., Yao, S., Kushi, L. H., Kurian, A. W. Simulation Modeling to Extend Clinical Trials of Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Early Breast Cancer. The mean (SD) age was 61.8 (12) years at the time of the survey. View details for Web of Science ID 000304771800030, View details for PubMedCentralID PMC3446389. Responses were evaluated according to patient characteristics, including type of study-prompted interventions, BRCA mutation status, and prior history of cancer, via univariate analysis.Most patients [85.3% (68.9-95.1%)] were more opposed or unchanged in their attitudes towards PM after study participation, with only 14.7% (5.0-31.1%) less opposed (P = 0.017) despite a short-interval follow-up MRI rate of 71.7% and a biopsy rate of 37%. A., Ham, C. M., Van Dam, J., Jeffrey, R. B., Longacre, T. A., Huntsman, D. G., Chun, N., Kurian, A. W., Ford, J. M. Ductal pattern enhancement on magnetic resonance imaging of the breast due to ductal lavage. Howlader, N. n., Cronin, K. A., Kurian, A. W., Andridge, R. n. Patient Experiences and Clinician Views on the Role of Radiation Therapy for Ductal Carcinoma In Situ. We assumed 100% use of therapy. Relative to screening with mammography alone, the cost per QALY gained by adding MRI from ages 35 to 54 years is 55,420 dollars for BRCA1 mutation carriers, 130,695 dollars for BRCA2 mutation carriers, and 98,454 dollars for BRCA2 mutation carriers who have mammographically dense breasts.Breast MRI screening is more cost-effective for BRCA1 than BRCA2 mutation carriers. for hormone receptor-positive breast cancer. Of 523 women who desired to talk to providers regarding the impact of breast cancer on employment or finances, 283 (55.4%) reported no relevant discussion.Many patients report inadequate clinician engagement in the management of financial toxicity, even though many providers believe that they make services available. Lifetime risk of triple-negative breast cancer is highest in black women (1.98%, 1.80-2.17%), compared to 0.77% (0.67-0.88%) for Asians, 1.04% (0.96-1.13%) for Hispanics and 1.25% (1.20-1.30%) for whites. Both germline genetic testing and tumor DNA sequencing are increasingly used in cancer care. While free-text clinic notes may offer the greatest nuance and detail about a patient's clinical status, they are largely excluded in previous predictive models due to the increase in processing complexity and need for a complex modeling framework. test the tolerability and efficacy of AZD0530 (also called saracatinib) when used together By using data from The Cancer Genome Atlas (TCGA), a radiogenomic map for the tumor-adjacent parenchymal tissue was created and molecular pathways associated with prognostic parenchymal imaging features were identified. Caswell-Jin, J. L., Plevritis, S. K., Tian, L., Cadham, C. J., Xu, C., Stout, N. K., Sledge, G. W., Mandelblatt, J. S., Kurian, A. W. Association of Germline Genetic Test Type and Results With Patient Cancer Worry After Diagnosis of Breast Cancer. However, studies seem to suggest that statins may be protective and are not likely to be harmful in the setting of cancer, suggesting that cancer patients who already take statins should not have this medication discontinued. We compare three different approximate methods to solve our analytical model against standard medical practice and show significant potential benefit of the computed dynamic strategies to limit tumor growth and to reduce the number of time periods patients are given chemotherapy, with its attendant side effects. Wapnir, I. L., Kingham, K. E., Mills, M., Ford, J. M., Kurian, A. W. Screening for founder and recurrent BRCA mutations in Hong Kong and US Chinese populations. O'Mara, A. E., Benedict, C., Kurian, A. W., Wagner, S. K., Diver, E. J. Polygenic risk modeling for prediction of epithelial ovarian cancer risk. We conducted an inductive thematic analysis of open-ended responses about why women chose their risk estimates in a uniquely large sub-sample ( N = 1,754). There is a need for industry-independent decision tools that integrate clinicopathologic features, comorbidities, and genomic information for women with node-negative, invasive, hormone receptor-positive, human epidermal growth factor receptor-2-negative (early-stage) breast cancer.We adapted an extant Cancer Intervention and Surveillance Modeling Network simulation model to estimate the 10-year risk of distant recurrence, breast cancer-specific mortality, other-cause mortality, and life-years gained with chemoendocrine versus endocrine therapy. Gallagher, S., Hughes, E., Rosenthal, E., Kurian, A. W., Domchek, S., Garber, J., Probst, B., Morris, B., Tshiaba, P., Roa, B., Slavin, T. P., Wagner, S., Weitzel, J. N., Gutin, A., Lanchbury, J. S., Robson, M. E. Triple-negative breast cancer (TNBC) risk with pathogenic variants (PV) in hereditary cancer predisposition genes. Most had Stage 4 disease (n=80; 25.6%). Background:The role of comorbidities in survival of breast cancer patients has not been well studied, particularly in non-white populations. The primary objective of the study is to assess the progression-free survival (PFS) of oral View details for DOI 10.1136/bjsports-2021-105132, View details for Web of Science ID 000891944700374, View details for Web of Science ID 000892333600112, About 25% of all triple-negative breast cancers (TNBCs) and 10% to 20% of high-grade serous ovarian cancers (HGSOCs) harbor BRCA1 promoter methylation. For more information, please contact Pei Jen Chang, 650-725-0866. Estimated decline in chemotherapy use was from 26.6% (95% CI=23.0% to 30.7%) to 14.1% (95% CI=12.0% to 16.3%) for node-negative/micrometastasis patients and from 81.1% (95% CI=76.6% to 85.0%) to 64.2% (95% CI=58.6% to 69.6%) for node-positive patients. performed in the laboratory, iniparib is a novel investigational anti-cancer agent that View details for DOI 10.1097/GCO.0000000000000141. My research employs methods from the population sciences, in collaboration the Surveillance, Epidemiology and End Results (SEER) Program. Respondents often recalled clinicians informing them about inheritance patterns (65%; 95% CI, 62% to 67%), surgical implications (65%; 95% CI, 63% to 68%), and other cancer risks (66%; 95% CI, 63% to 68%) but less often that results could have potential implications for clinical trial eligibility (38%; 95% CI, 36% to 42%) or targeted therapies (14%; 95% CI, 12% to 16%). We trained the NLP models using 894 randomly selected patient records that were manually reviewed by clinical experts and evaluated model performance using 179 hold-out patients (20%) as a test set.The median follow-up time was 19 quarters (5 years) for the training set and 15 quarters (4 years) for the test set. Performance of BRCA1/2 mutation prediction models in Asian Americans. Compared with the patient-mediated approach, direct relative contact resulted in significantly higher uptake of genetic counseling for all relatives (63% [95% CI, 49 to 75] v 35% [95% CI, 24 to 48]) and genetic testing for first-degree relatives (62% [95% CI, 49 to 73] v 40% [95% CI, 32 to 48]). The adjusted percentage treated and adjusted odds ratio (OR) are reported based on multivariable modeling for each treatment-eligible group.A total of 20568 women (17.3%) of 119198 were eligible (mean [SD] age, 51.4 [12.2]). We compared the ability of each NLP model to identify the presence, timing, and site of recurrence, when compared against manual chart review and International Classification of Diseases coding.A total of 1,273 patients were included in the development and validation of the two models. Jayasekera, J., Sparano, J. While these tests may identify 40% to 50% more individuals with hereditary cancer gene mutations than does testing for BRCA1/2 alone, whether finding such mutations will alter clinical management is unknown.To define the potential clinical effect of multigene panel testing for HBOC in a clinically representative cohort.Observational study of patients seen between 2001 and 2014 in 3 large academic medical centers. View details for DOI 10.1001/jamaoncol.2019.6400, View details for DOI 10.1001/jama.2020.0229, View details for DOI 10.1200/JCO.18.01854, View details for Web of Science ID 000468868300006, View details for Web of Science ID 000460623800016, View details for DOI 10.1001/jamaoncol.2018.0644, View details for Web of Science ID 000441190200011. We examined oncologists' influence on use of recurrence score (RS) testing and chemotherapy in the community.We identified 7810 women with stages 0-II breast cancer treated in 2013-15 through the SEER registries of Georgia and Los Angeles County. To our knowledge, this is the first report of a patient with both MEN1 and BRCA2 mutations and with a personal history of hyperparathyroidism and pancreatic neuroendocrine tumors. This randomised control trial (registration number to follow), based in genetic centres in the UK and US, will randomise participants on a 1:1 basis to either receive conventional cancer risk estimates, as per routine clinical practice, or to receive a personalised risk estimate. In 1996, the brothers switched companies when George was hired by McKinsey, and Thomas, by Oracle [7]. Consideration of prophylactic mastectomy surgery following transplantation requires complex medical decision-making, and bias against elective surgery exists because of concern for post-operative complications. A cox proportional hazards model was used to evaluate survival while controlling for clinical and demographic factors.The best survival pattern was observed among women with HR+/HER2- subtype (survival rate of 92.5% at four years), followed by HR+/HER2+ (90.3%), HR-/HER2+ (82.7%), and finally worst survival for triple-negative subtype (77.0%). This regulatory element increases cell-type-specific expression of the tumor suppressor gene IGFBP5 and, thereby, reduces risk of estrogen receptor-positive breast cancer (odds ratio = 0.77, 95% CI 0.74-0.81, p = 3.1 10-31). In the multivariable model, when clinical and SES variables were controlled for, racial differences in test uptake were no longer observed. View details for DOI 10.1158/1055-9965.EPI-22-1128, Low-frequency variants play an important role in breast cancer (BC) susceptibility. Kurian, A. W., Ward, K. C., Hamilton, A. S., Deapen, D. M., Abrahamse, P., Bondarenko, I., Li, Y., Hawley, S. T., Morrow, M., Jagsi, R., Katz, S. J. Mr. Kurians other twin George speaks of his mother for being both loving and strict. Years at the time of the survey tested received any discussion about.. Cancer before other detectable symptoms or signs of the survey to breast cancer treatment guidelines according to pathogenic variants a. 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