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108s Cancer Prevention/Epidemiology 1592 General Poster Session (Board #8B), Sat, 1:15 PM-5:15 PM Secondary breast cancer (s-BC) after hematopoietic cell transplantation (HCT) for leukemia: Role of total body irradiation (TBI). Presenting Author: Can-Lan Sun, City of Hope, Duarte, CA Background: s-BC after conventional chest radiation for histologically distinct cancer is well-recognized, and has resulted in radiologic screening recommendations by American Cancer Society. However, risk of s-BC after TBI is not well-defined. Methods: We determined the risk of s-BC in 648 consecutive females transplanted for leukemia (ALL [19%], AML/MDS [57%], CML [24%]) between 1976 and 2008 with a post-HCT survival of �2 years. The study was restricted to leukemia to understand the role of TBI without the influence of pre-HCT chest radiation. Near-complete ascertainment of s-BC was assured by combining institutional follow-up with California Cancer Registry data. Results: Median age at HCT was 38 years (range, 0-71); 14% had received autologous HCT, 64% related and 22% unrelated donor HCT; 70% had received TBI for myeloablative conditioning. After 5,675 person-years of observation, 16 patients developed s-BC (14 after TBI). Median latency from HCT to s-BC was 16y (2-27). Median age at s-BC was 50y (29-66). Cumulative incidence of s-BC was 6% at 20y after HCT, contributed to largely by TBI (s-BC incidence after TBI: 5.7%). Among TBI-exposed, 8.6% were projected to develop s-BC by age 65y (1.6% among non-TBI-exposed, p�0.03). TBI-exposed patients were 2.4 times more likely to develop s-BC compared with general population (p�0.001); non-TBI exposed were not at increased risk (SIR�0.9, p�0.9). Multivariate analysis (adjusted for age at HCT, follow-up and primary diagnosis) revealed a 4.7-fold (p�0.068) increased risk of s-BC among TBI-exposed. Conclusions: Risk of s-BC after TBI as the sole source of radiation to breast is increased. Nearly 9% of those exposed to TBI will develop s-BC by age 65y. Identification of vulnerable subpopulations among the TBI-exposed patients is underway to create targeted screening strategies for early detection of s-BC. 1594 General Poster Session (Board #8D), Sat, 1:15 PM-5:15 PM Association of a history of autoimmunity or hypersensitivity with overall survival in breast cancer. Presenting Author: Hakan Lars Olsson, Departments of Oncology and Cancer Epidemiology, Lund University, Lund, Sweden Background: Antibody therapy of malignant melanoma with ipilimumab is associated with the development of an autoimmune disease. The aim was to investigate if preexisting autoimmune disorders or hypersensitivities, similar to the side effects of immunotherapy in malignant melanoma, gave a better overall survival for breast cancer (BC) patients, compared with patients without these disorders. Methods: A consecutive clinical material consisting of 1,705 breast cancer patients diagnosed between 1980 and 2010 was used. The patients were grouped according to preexisting autoimmune disease or hypersensitivities. The remaining BC patients were used as a reference group. All analyses were adjusted for age at diagnosis, T, N, M-status of the tumor, and ever-use of HRT simultaneously. A p value of less than 0.05 was considered significant. Results: One hundred and twenty-five (7.3%) patients had a history of autoimmunity and 72 (4.2%) patients had a history of hypersensitivity prior to BC diagnosis. Our main finding was that BC patients with a preexisting autoimmune disease or hypersensitivities with ER-negative tumors had a longer overall survival compared to patients without, HR 0.55, 95% CI 0.31-0.97. The risk was specifically low in BC patients with hypersensitivity and ER-negative tumors, HR 0.39, 95% CI 0.16-0.96. The risk was nonsignificantly lower in the autoimmune group, HR 0.78, 95% CI 0.37-1.61. Stratifying both on ER-status and menopausal status, similar results were seen in premenopausal BC patients with hypersensitivity. Postmenopausal BC patients with an ER-negative tumor and an autoimmune disease had a longer nonsignificant overall survival, HR 0.3, 95% CI 0.07-1.26. Conclusions: BC patients with an ER-negative tumor and/or diagnosed before menopause had a longer overall survival when previously diagnosed with hypersensitivity. For BC patients with an autoimmune disease, the prognostic benefit was seen when diagnosed postmenopausally with an ER-negative BC. Preexisting or induced autoimmunity or hypersensitivity may prolong life in breast cancer especially in young patients and those with ER-negative tumors. 1593 General Poster Session (Board #8C), Sat, 1:15 PM-5:15 PM Effect of sunlight exposure on survival in patients with lymphoma: Results from the prospective Singapore Lymphoma Study. Presenting Author: Yin Leng Lee, National Cancer Center, Singapore Background: Recently, several studies evaluating the effect of ultraviolet light exposure on the risk of developing lymphoma have yielded conflicting results, in part due to seasonal and latitude variation. Further, most of these studies also lack long term follow up and could not systemically address the influence of sunlight exposure on survival. In this prospective, epidemiological study, we explored the relationship between past sunlight exposure and survival in lymphoma patients in tropical Singapore, where sunlight exposure is constant throughout the year. Methods: Singapore Lymphoma Study was established in 2005. A total of 384 patients with histologically confirmed lymphoma were followed from date of diagnosis through November 2011. Interviewers were trained to conduct in-person interviews to collect detailed information, including every occupational period that lasted at least 1 year and number of hours worked outdoor from 9am to 5pm using a structured questionnaire. Descriptive, multivariate and survival analysis (Kaplan Meier; age, gender, race and education level adjusted) were performed. Results: Among all lymphoma subtypes, the most prevalent was diffuse large B cell lymphoma, 47.7%, followed by Hodgkin lymphoma, 14.6%, follicular lymphoma, 12.2% and T cell lymphoma, 6.5%. 97.1% had black or brown eye color and 49.6% had fair skin. Overall survival of lymphoma and NHL subtype decreased significantly with increasing lifetime occupational hours (ptrend�0.01 and 0.03). Chinese was associated with longer survival with increasing daily sunlight exposure during childhood and adolescent years, whether at school or outdoor leisure (ptrend�0.04) and there were no evidence for non-Chinese (Malays or Indians). Patients with lighter eye color results in shorter survival (HR�2.91, 95% CI: 1.15-7.34, p�0.02). Conclusions: We found leisure sunlight exposure during childhood and adolescent years to be beneficial to the survival of Chinese lymphoma patients and increasing lifetime cumulative occupational exposure is associated with increasing risk of death. This data contributes to the growing research on the effects of sunlight exposure on lymphoma patients. 1595 General Poster Session (Board #8E), Sat, 1:15 PM-5:15 PM The evolution of breast cancer screening in the Medicare population: Clinical and economic implications. Presenting Author: Brigid K. Killelea, Yale University School of Medicine, Yale Comprehensive Cancer Center, New Haven, CT Background: Breast screening has evolved as newer approaches to mammography, ultrasound, and MRI have diffused into clinical practice. The use of these technologies and their impact on screening-related costs and outcomes remain undefined, particularly among older women. Methods: Using the Surveillance Epidemiology and End Results – Medicare linked database, we identified women aged 66 and older without a diagnosis of breast cancer. We constructed two cohorts (2001 vs. 2006) and followed each for two years. We assessed changes in imaging technology, screeningrelated costs (defined as costs for screening and subsequent imaging and testing, adjusted to 2009 USD), and stage at diagnosis between the two cohorts. Results: There were 136,845 women in the 2001-2002 (earlier) cohort and 137,733 in the 2006-2007 (later) cohort. The mean age was 76.9 and 77.2 respectively, (p�.001). The proportion of women receiving any screening mammogram was 42.5% in the earlier cohort and 43.4% in the later cohort, (p�.001). The use of digital mammography for screening increased from 2.2% to 15.0%, (p�.001). The use of any computer aided detection (CAD) increased from 3.2% to 29.3% (p�.001). MRI use increased from 0.03% to 0.2%, and ultrasound use from 4.0% to 4.5% (p �.001 for both). Average screening-related cost increased 31%, from $101 to $132 (p�.001). There was no significant difference in early stage at diagnosis over time (58.1% of women were in situ/stage I in early period vs. 57.2% in later period, p�.65). Conclusions: The use of digital mammography and CAD increased substantially between 2001 and 2007, contributing to a 31% increase in screening-related costs for women in the Medicare program. The increased cost of screening and downstream testing must be evaluated in context of an absence of benefit in terms of stage at diagnosis. Visit abstract.asco.org and search by abstract for the full list of abstract authors and their disclosure information.
1596 General Poster Session (Board #8F), Sat, 1:15 PM-5:15 PM ABO blood group and the risk of lung cancer: Multicenter, case-control, observational study. Presenting Author: Gungor Utkan, Ankara University School of Medicine, Ankara, Turkey Background: The role of genetic factors in the development of cancer is widely accepted. Previous studies have observed an association between ABO blood group and risk of certain malignancies, including pancreatic and gastric cancer. The data on the role of ABO blood group and Rh factor in lung cancer is limited. Methods: All patients who had Lung cancer (LC) and treated between 2000-2011 at the involved centers with defined ABO/Rh were included in our retrospective reviews of tumor registry records. A group of volunteer healthy blood donors of Turkish Red Crescent between 2004 and 2011 were identified as a control group. The relationship of ABO/Rh with clinical features such as age at diagnosis, histological subtype and sex were evaluated. We compared the distributions of ABO/Rh among 1954 patients and 3,022,883 controls. Among LC patients, differences between each of aforementioned ABO/Rh groups with respect to various clinical features were explored, respectively. Results: Of these patients the median age was 62 (range: 17-90). The 84% of patients were male. Overall distributions of ABO blood groups as well as Rh factor were statistically different between patients (43.6% A, 8.3% AB, 17.3% B, 30.8% O, and 86.3% Rh�) and controls (42.2% A, 7.6% AB, 16.3% B, 33.9% O, and 87.7% Rh�) (p�0,03). In addition, there were statistically significant differences between patients and controls with respect to O vs. nonO (p�0.004) and marginal significance for A vs. nonA (p�0,065), B vs. nonB (p�0,076), and Rh� vs. Rh- (p�0,057). Among patients, there weren’t statistically significant differences between blood group with respect to sex and age. However there was statistically significant difference between blood group with respect to histology (p�0,001). Although the distribution of A and O were similar according to histology, patients with squamous histology had antigen B more frequently than other histological sub types (p�0,009). Conclusions: In the study populations, ABO blood type was statistically significantly associated with the LC and having blood type other than O increases the risk of LC. Further studies are necessary to define the mechanisms by which ABO blood type may influence breast cancer risk. 1598 General Poster Session (Board #8H), Sat, 1:15 PM-5:15 PM Analyzing excess mortality from cancer among individuals with mental illness. Presenting Author: Jackson S. Musuuza, Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI Background: Previous studies have documented higher cancer-related mortality in individuals with mental illness, compared to their healthier counterparts. The aim of this study was to identify the anatomic cancer sites for which mortality is higher in individuals with mental illness. Methods: We used a linked dataset comprised of death certificate data for the state of Ohio for the years—2004-2007 and data from the publicly funded mental health system in Ohio. Decedents with mental illness were those identified concomitantly in both data sets. We used age-adjusted standardized mortality ratios (SMRs) in race- and sex-specific strata to estimate excess deaths for each of the anatomic cancer sites. Results: Overall, there was excess mortality from cancer associated with having mental illness in Non-Black men and women (SMR: 1.14 (95% confidence interval [CI] � 1.05-1.22), and 1.13 (95% CI� 1.05-1.20, respectively), but lower mortality in Black men, likely due to premature mortality from other causes (0.71 (95% CI� 0.61-0.83). In Black women, we observed no excess mortality from cancer that was associated with having mental illness. There was excess mortality from hepatobiliary cancer in Non-Black men (SMR� 1.65; 95% CI �1.15-2.29), but not in any other sex- and race- stratum. In addition, we observed excess mortality from lung and laryngeal cancers among Non-Black men and women (SMRs for lung cancer of 1.28 (95% CI� 1.13-1.45), and 1.45 (95% CI� 1.29-1.62), respectively; and for laryngeal cancer (2.01 (95% CI� 1.19-3.18 for men, and 2.47 (95% CI� 1.08-4.89) for women). Black women experienced excess mortality from cancer of the kidney and renal pelvis (SMR� 2.91; 95% CI �1.53-5.06), while Non-Black women experienced excess mortality from urinary bladder cancers (SMR�1.89; 95% CI�1.15- 2.92). Conclusions: Compared to the general population in Ohio, individuals with mental illness experienced excess mortality from certain cancers. In part, this excess mortality may be mediated by a higher prevalence of smoking or substance abuse in individuals with mental illness. Further investigation is needed to explain the observed racial variation in cancer mortality, and to examine mortality for specific cancers based on severity of mental illness. Cancer Prevention/Epidemiology 109s 1597 General Poster Session (Board #8G), Sat, 1:15 PM-5:15 PM Association of p53 Arg72Pro polymorphism and HPV status with the initiation, progression, and development of cervical cancer (CC): A metaanalysis. Presenting Author: Steven Habbous, Princess Margaret Hospital, Toronto, ON, Canada Background: CC develops through progression from normal cervical epithelium through squamous intra-epithelial lesions (SILs) to cancer. CC is classically associated with oncogenic human papillomavirus (HPV). Yet, not all CC patients demonstrate HPV infection at diagnosis. HPV� and HPV– subsets of CC patients may thus represent distinct entities. HPV binds to P53, promoting its degradation; the Arg variant of p53 Arg72Pro binds more ardently to HPV than the Pro variant. Although there have been meta-analyses of Arg72Pro in CC risk, none has evaluated the relationship between Arg72Pro and HPV status together. We hypothesize that p53 Arg72Pro modifies aspects of the carcinogenic process in HPV� (but not HPV-) subsets of CC. Methods: Pubmed/Embase databases identified 1494 potential studies; 51 were eligible and included. Separate analyses were performed to evaluate CC risk (CC vs normal), initiation of cancer (SIL vs normal), and progression towards cancer (CC vs SIL), by HPV status. Pooled odds ratios (pOR) were generated using RevMan 5.1 software. Results: p53 Arg72Pro was not associated with CC risk in either HPV� or HPV- patient subsets (pORs 0.92; 95%CI, 0.6-1.3 and pORs 1.07; 95%CI, 0.7-1.7, respectively). Similarly, there was no association with the initiation of disease (SIL vs normal): pORs 0.96; 95%CI, 0.7-1.3 (HPV� subset); 1.11; 95%CI, 0.9-1.4 (HPV- subset). There was no association with disease progression from SIL to CC in the HPV- subset (pOR, 0.98; 95%CI, 0.7-1.4). However, in the HPV� subset, comparing the progression from SIL through to CC, there was strong and significant association: pOR, 1.37; 95%CI, 1.2-1.6 (p�4.0x10E-4), with no evidence of heterogeneity (I2 � 0%) or bias (by funnel plot). Sensitivity analyses demonstrated similarly significant results, even after taking into account differing quality of methodological designs and type of biological sample analyzed (tumour vs. blood) of the underlying studies. Associations were mainly restricted to Caucasian studies. Conclusions: In this meta-analysis, the Arg variant of p53 Arg72Pro was associated with progression of SIL to CC only in HPV� subsets, but not to disease initiation or risk of CC. 1599 General Poster Session (Board #9A), Sat, 1:15 PM-5:15 PM Analysis of KRAS and BRAF mutant colorectal cancers in a multiracial population. Presenting Author: Jared David Acoba, University of Hawaii Cancer Center, Honolulu, HI Background: We previously demonstrated racial disparities in colorectal cancer (CRC) survival despite adjustments for tumor and socioeconomic factors. Molecular differences in breast and lung tumors contribute to racial survival inequality, yet in CRC, molecular tumor characteristics have not been studied extensively in a racially diverse cohort. We performed a comprehensive evaluation of KRAS and BRAF mutations in a multiracial population to determine the prevalence in CRC and the degree to which these molecular traits impact survival. Methods: A retrospective cohort study of patients diagnosed with CRC between 2008 and 2011 from hospital tumor registries was performed. The prevalence of KRAS and BRAF mutations was determined for the study population and individual racial groups. Multivariable Cox proportional hazards regression models for survival were built for KRAS and BRAF mutation status while adjusting for age at diagnosis, race, and stage of disease. Results: Of 706 patients diagnosed with CRC, KRAS mutational analysis was performed on 148 subjects. 14% of subjects were white (W), 64% Asian (A), and 21% Native Hawaiian/Pacific Islander (NH). KRAS mutation was identified in 48 subjects (32%). The prevalence of mutant tumors among racial groups was W 33%, A 36%, and NH 30%. Analysis for KRAS G13D mutations revealed a prevalence of W 11%, A 9%, and NH 7%. When compared to published datasets of predominantly white patients, our multiracial cohort had a significantly higher rate of KRAS G13D mutant tumors, p�0.039. Of 74 subjects tested for the BRAF mutation, two mutant tumors were detected (3%). The prevalence of the BRAF mutation by race was 10% W, 3% A, and 0% NH (p�0.18). BRAF and KRAS G13D mutations were adverse prognostic factors in a multivariate analysis, although the odds ratios failed to meet statistical significance. Conclusions: The prevalence of BRAF and KRAS mutations in this multiracial cohort is similar to what has been previously reported. However the rates of KRAS G13D and BRAF mutant tumors in our cohort are higher than prior reports. Furthermore, KRAS G13D which has been postulated to be a favorable prognostic factor for CRC, may adversely impact survival of minority patients. Visit abstract.asco.org and search by abstract for the full list of abstract authors and their disclosure information.
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Volume 30, Issue 15S, Part I of II
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Editor: Michael A. Carducci, MD Man
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Volume 30, Issue 15S Supplement to
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Letter from the Editor The 2012 ASC
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JOURNAL of CLINICAL ONCOLOGY ......
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ASCO Conflict of Interest Policy an
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2012 ASCO Annual Meeting Proceeding
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500 Oral Abstract Session, Sun, 8:0
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508 Clinical Science Symposium, Sat
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Author Index Note: Numerals refer t
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Alexanian, Raymond 8093 Alexeev, Bo
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Arkenau, Hendrik-Tobias 2540, 3000,
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Ballen, Karen K. 6606, 6617, 6618,
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Ben-Aharon, Irit 548, 2556, e13080
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Blancas, Isabel e11535, e11545, e21
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Brandes, Johann Christoph 7048, 106
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Cakir, Betul 9567 Calabek, Bernadet
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Ceraulo, Domenica 4017 Cerbone, Lin
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Chinen, Ludmilla T.D. e16046 Chinen
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Come, Steven E. 9071, 9100 Comis, S
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Dahlheimer, Tambra 2546 Dahmane, El
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DeLacure, Mark D. e16052 Delage, Ju
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Domingo, Gelenis 6568, 6575, 6588 D
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El Sherbeiny, Esam e15129 El-Deiry,
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Fayad, Luis 6501, 8067 Fayette, Jer
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Foroni, Chiara e11546 Foroni, Letiz
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Gang, Wu 7091, e14511 Gangaram, Anj
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Gimenez Capitan, Ana 4068, 10596, e
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Granowetter, Linda 9537 Grant, Barb
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Hainsworth, John D. 618, 1018, 1086
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Heerschap, Arend e13111 Heersink, M
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Hong, Seung-Mo 3568 Hong, Sook Hee
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Im, Young-Hyuck 598^, 644, TPS649,
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Ji, Yongling e17527 Jia, Jingquan e
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Kaparelou, Maria 583 Kapaun, Christ
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Kim, Chan Kyu e14688 Kim, Chang Won
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Komatsu, Yoshihiro e14689 Komatsu,
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Laack, Nadia N. 2032, e14507 Laadem
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Lee, Ji-Hyun TPS3114, 6100 Lee, Jih
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Lim, Kian-Huat e14584 Lim, Kiat Hon
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Loupakis, Fotios 3518, 3540, 3546,
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Man, Shan e11061, e15177^ Manaloor,
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Mathieu-Nicot, Florence e19623 Math
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Mergenthaler, Hans-Guenther e15026
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Molero, Xavier e21035 Moles-Moreau,
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Munoz-Sanchez, MM e19590 Munsell, M
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Ng, Daniel e15050 Ng, Dawn Marie e1
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Oguri, Senri 5556 Oh, Do Youn 1003
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Palassini, Elena 10026, 10053, 1006
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Peisker, Uwe 10600 Peker, Deniz e18
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Piwnica-Worms, Helen 3047 Pizzo, Fa
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Rabinowits, Guilherme 5501, 5582, 9
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Reyes-Rivera, Irmarie CRA3503 Reyna
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Rose, Steven C. 3590 Rosell, Rafael
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Sakata, Shinya e18059 Sakata, Yuh 3
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Schenkein, David P. 6606 Schepp, Wo
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Sha, Dan 3564 Sha, Huifang e13528 S
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Silva, Jose D. 5567 Silva, Milton J
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Tillmanns, Todd D. 5014, e15514 Til
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Uchiyama, Tomotaka e21108 Udovitsa,
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Videtic, Gregory M.M. e14611, e1466
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Wang, Yuan e15124 Wang, Yunfei 547
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Wischnewsky, Manfred 1078 Wischnik,
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Yasuda, Hiromi e14029 Yasuda, Hiroy
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Zhang, Xinmin e16022 Zhang, Xu Dong
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