A Partnership in Health-Related Social Media for Young Breast Cancer Survivors.

In the United States, about 11% (26,393) of those diagnosed with breast cancer in 2016 will be young or less than 45 years old. Young breast cancer survivors, compared to older cancer survivors, are a disparate group that experience higher incidence of advanced disease, greater mortality, and poorer quality of life, and are often faced with difficulty locating support that meet the unique needs of young women. The Gulf States Young Breast Cancer Survivor Network, composed of three sister networks, formed a partnership aimed at harnessing the power of social media to reach and impact the lives of young women with breast cancer. The collaborative partnership framework and the power of synergy are shown in merging two existing programs and incorporating a third new program.

Cervical Human Papillomavirus Testing With Two Home Self-Collection Methods Compared With a Standard Clinically Collected Sampling Method.

BACKGROUND: The purpose of this study was to compare the outcomes of 2 self-collection methods to detect cervical human papillomavirus (HPV) DNA with outcomes from a standard clinical method. The standard method samples were collected by a clinician at a routine pelvic examination. Self-samples were taken at home and mailed to the clinical laboratory. METHODS: The 2 self-collection methods were a tampon-based method and a swab-based method using a commercial device, an Eve Medical HerSwab. All HPV samples were processed by a clinical laboratory using the Food and Drugs Administration approved Roche Cobase HPV method, which specifically identifies HPV 16, HPV 18, and a set of 12 other high-risk subtypes. Patients were recruited from 2 cancer screening clinics 2015 to 2017. All patients signed an informed consent. Screening outcomes, such as prevalence, percent agreement with standard, sensitivity, and specificity, were calculated for each self-collection method. Measures of similarity between self and standard collection outcomes, Cohen's κ, percent concordance, McNemar equivalence, and others were tested statistically. RESULTS: One hundred seventy-four patients were randomized. The prevalence of 1 or more positive HPV high-risk subtypes from the standard clinical specimens was 13.5%. All clinical specimens were sufficient for valid HPV detection. For the tampon method, 15 (27%) of the specimens were insufficient quality. Only 1 (2%) swab specimen was insufficient. Only the swab self-collection method was found to be statistically noninferior to the clinical method. The tampon method had an unacceptably high rate of insufficient quality specimens and also failed the equivalency tests. CONCLUSIONS: The swab home collection samples were equivalent to the clinical samples, but the tampon method had an unacceptably high rate of specimens insufficient for HPV detection.

Assessing patient navigation as a tool to address equity in cancer early detection.

BACKGROUND: The Louisiana Breast and Cervical Health Program (LBCHP) provides breast and cervical cancer screenings at no cost to about 5,000 low-income women per year. LBCHP was designed to increase access to cancer screenings for low-income women, a traditionally underserved population. A main program component is the provision of patient navigation services. Patient navigation provides extra layers of patient-centered education and resources to assist with screening completion. Both rural and racial/ethnic minority populations are underserved and have benefited from patient navigation. The purpose of this study was to establish estimates of LBCHP's eligible population and to measure the effect of patient navigation in reducing racial/ethnic and geographic (e.g., rural) inequities in cancer early detection. METHODS: This study analyzed program data from patients who received navigation services resulting in cervical and breast cancer screenings between July 01, 2016 and June 30, 2018. We used the combination of U.S. Census Bureau's Small Area Health Insurance Estimates 2016 and the American Community Survey 2017 to calculate the number of eligible women by race/ethnicity and by parish (county). We used the 2010 Census to estimate the distribution of the rural population by city and parish. Using patient addresses, residences were categorized into urban, suburban and rural. RESULTS: The population of women ages 21-64 years in Louisiana is 1.3 million and almost half (46.7%) live at or under 250% of the federal poverty level (FPL). The poverty rate is much higher among LBCHP's racial/ethnic minorities: 65.1% among Blacks and 58.5% among Latinx as compared to 35.5% among Whites. To be racially/ethnically equitable, LBCHP would aim to have the following client distribution: at least 47% Black and 5% Latinx. The population LBCHP served was 47% Black and 18% Latinx. While 27% of Louisiana is rural, only 17% of LBCHP's women served are from rural areas. In contrast, 61% of the state is urban, while 72% of LBCHP's women served live in urban areas. LBCHP's clients had excellent follow-up rates after abnormal screening test results with well over 95% of all racial/ethnic groups having completed follow-up. Latinxs had a higher percentage of abnormal results than Blacks and Whites. CONCLUSIONS: This study showed that LBCHP is achieving racial/ethnic equity in the client population that is served through patient navigation with LBCHP's largest reach among the Latinx population. In addition, once clients receive screening, they have excellent follow-up rates for any abnormalities. Because LBCHP's program goals include serving a high number of women, an unintended consequence is that LBCHP's rural population is underserved.

Louisiana Physicians Are Increasing HPV Vaccination Rates.

Human papilloma virus (HPV) is a common virus that can cause genital warts and certain cancers. The HPV vaccine is effective in preventing many HPV-associated diseases, however, vaccination rates suggest many remain unprotected. This study examined successful strategies used by physicians to improve HPV vaccination rates. Providers with above average vaccination rates were identified. A representative from each provider participated in an interview to identify strategies used to boost HPV vaccination. Key strategies in ensuring vaccine completion were reminders, education, standing orders, and scheduling future vaccine appointments at time of first dose. Other successful strategies included coupling the HPV vaccine with adolescent vaccines, administering during well-visits, and recommending the vaccine as protection against cancer and genital warts. Findings suggest successful and widely used methods among high performing providers in Louisiana, the majority of which should be easily reproducible with minimal resources to improve HPV vaccination rates.

Parallel synthesis of cell-penetrating peptide conjugates of PMO toward exon skipping enhancement in Duchenne muscular dystrophy.

We describe two new methods of parallel chemical synthesis of libraries of peptide conjugates of phosphorodiamidate morpholino oligonucleotide (PMO) cargoes on a scale suitable for cell screening prior to in vivo analysis for therapeutic development. The methods represent an extension of the SELection of PEPtide CONjugates (SELPEPCON) approach previously developed for parallel peptide-peptide nucleic acid (PNA) synthesis. However, these new methods allow for the utilization of commercial PMO as cargo with both C- and N-termini unfunctionalized. The synthetic methods involve conjugation in solution phase, followed by rapid purification via biotin-streptavidin immobilization and subsequent reductive release into solution, avoiding the need for painstaking high-performance liquid chromatography purifications. The synthesis methods were applied for screening of PMO conjugates of a 16-member library of variants of a 10-residue ApoE peptide, which was suggested for blood-brain barrier crossing. In this work the conjugate library was tested in an exon skipping assay using skeletal mouse mdx cells, a model of Duchene's muscular dystrophy where higher activity peptide-PMO conjugates were identified compared with the starting peptide-PMO. The results demonstrate the power of the parallel synthesis methods for increasing the speed of optimization of peptide sequences in conjugates of PMO for therapeutic screening.

Parallel synthesis and splicing redirection activity of cell-penetrating peptide conjugate libraries of a PNA cargo.

A novel method for the parallel synthesis of peptide-biocargo conjugates was developed that utilizes affinity purification for fast isolation of the conjugates in order to avoid time consuming HPLC purification. The methodology was applied to create two libraries of cell-penetrating peptide (CPP)-PNA705 conjugates from parallel-synthesized peptide libraries. The conjugates were tested for their ability to induce splicing redirection in HeLa pLuc705 cells. The results demonstrate how the novel methodology can be applied for screening purposes in order to find suitable CPP-biocargo combinations and further optimization of CPPs.

Applying the Social Ecological Model to evaluate a demonstration colorectal cancer screening program in Louisiana.

OBJECTIVE: Lack of health insurance is correlated with noncompliance in colorectal cancer screening. Louisiana ranks 48th among all states in residents with health insurance. This paper describes initial results of Louisiana's first statewide colorectal cancer screening program. METHODS: The program enhanced screening capacity of state hospitals by providing fecal immunochemical tests (FITs), colonoscopes, and funded patient navigators. The Social Ecological Model (SEM) was used as the framework for the program. RESULTS: Patient navigators distributed 975 FITs to adults 50 to 64 years (21% men, 78% women).The overall return rate was 66%. There was no association among return rates, race, or gender. Participants who were previously screened (10.7%) were more likely to return their FIT. DISCUSSION: The combination of patient navigation and providing patients with an easy-to-use CRC screening option proved to be an effective method that potential colorectal cancer screening programs can deploy in similar populations of un- and under-insured adults.

Factors associated with delays to diagnosis and treatment of breast cancer in women in a Louisiana urban safety net hospital.

Only lung cancer surpasses breast cancer as a cause of death from cancer. However, the burden of cancer is not borne equally across racial and ethnic groups. In the United States, African American women have significantly higher mortality rates from breast cancer than white women. Delayed follow-up of breast abnormalities and delays from diagnosis to treatment may contribute to higher mortality. This study examined factors associated with delays to diagnosis and treatment of breast cancer in a group of white and African American women. Identified from tumor registry records were 247 women with pathology-confirmed first primary in situ and invasive breast carcinomas with no known previous cancer diagnosis. Factors associated with delays from provider recognition of abnormality to breast cancer diagnosis (diagnostic delays) and from diagnosis to treatment (treatment delays) were determined using chi-square tests and logistic regression. Factors that were considered included age, race, stage of disease at diagnosis, tumor size, type of abnormality, type of medical service at presentation, and prior mammogram within the past two years. The proportion of women experiencing diagnostic delays was high, with more African American women experiencing delays than white women (34% versus 17%, respectively). African American and white women did not differ in distribution of stage of cancer at diagnosis. Significantly smaller tumor sizes were found in women experiencing diagnostic delays compared to those not experiencing delays. Conversely, women experiencing treatment delays were significantly older and had larger tumor sizes compared to those not experiencing delays. More African American women experienced delays in diagnosis; however these delays did not appear to affect outcomes. Older age as a significant factor in treatment delays suggests that comorbidities as well as other possible barriers to treatment warrant further investigation in older women. The reasons for racial disparities in breast cancer outcomes remain and call for further study.