Jaya M. Satagopan

Supplemental Table 1 shows Hazard ratios and 95% confidence intervals for racial and ethnic disparities in all-cause mortality among 37,566 ovarian cancer patients diagnosed with stage III/IV disease in the National Cancer Database (2004–2017) stratified by treatment sequence

Supplemental Table 2 shows Hazard ratios and 95% confidence intervals for racial and ethnic disparities in all-cause mortality of ovarian cancer patients diagnosed with stage III/IV disease in the National Cancer Database (2004–2017) using the cut-off points of 30, 60, and 90 days after surgery as the start of time for follow-up in landmark analysis

Background:We investigated racial and ethnic disparities in treatment sequence [i.e., neoadjuvant chemotherapy (NACT) plus interval debulking surgery (IDS) versus primary debulking surgery (PDS) plus adjuvant chemotherapy] among patients with ovarian cancer and its contribution to disparities in mortality.Methods:Study included 37,566 women ages ≥18 years, diagnosed with stage III/IV ovarian cancer from the National Cancer Database (2004–2017). Logistic regression was used to compute ORs and 95% confidence intervals (CI) for racial and ethnic disparities in treatment sequence. Cox proportional hazards regression was used to estimate HRs and 95% CI for racial and ethnic disparities in all-cause mortality.Results:Non-Hispanic Black (NHB) and Asian women were more likely to receive NACT plus IDS relative to PDS plus adjuvant chemotherapy than non-Hispanic White (NHW) women (OR: 1.12; 95% CI: 1.02–1.22 and OR: 1.12; 95% CI: 0.99–1.28, respectively). Compared with NHW women, NHB women had increased hazard of all-cause mortality (HR: 1.14; 95% CI: 1.09–1.20), whereas Asian and Hispanic women had a lower hazard of all-cause mortality (HR: 0.81; 95% CI: 0.74–0.88 and HR: 0.83; 95% CI: 0.77–0.88, respectively), which did not change after accounting for treatment sequence.Conclusions:NHB women were more likely to receive NACT plus IDS and experience a higher all-cause mortality rates than NHW women.Impact:Differences in treatment sequence did not explain racial disparities in all-cause mortality. Further evaluation of racial and ethnic differences in treatment and survival in a cohort of patients with detailed treatment information is warranted.

Breast cancer, the most common cancer in women worldwide, is linked to microbiome imbalances. This suggests the potential for microbiome-based breast cancer management. However, a comprehensive and reproducible understanding of the microbiome’s role in breast cancer is lacking. We conducted a systematic literature review to explore microbiome signatures and specific genera associated with breast cancer development, subtypes, and outcomes. We searched PubMed, Embase, Scopus, and Web of Science using the terms “microbiome” and “breast cancer”, limiting to publications of human studies in English language between January 2011 and January 2025, and adhering to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. We extracted the study characteristics and results and summarized our findings. From 2536 articles, we identified 48 eligible studies – 22 case-control, 13 cohorts without any intervention, and 13 cohorts with an intervention. These studies included 3735 women with and 2023 without a diagnosis of breast cancer. Most studies used fecal (29) or breast tissue (14) samples. The genera Clostridium, Lcatobacillus, Prevotella were most commonly associated with breast cancer. However, no genus was consistently linked to the same outcome across studies, rendering meta-analysis unfeasible. Overall, we observed heterogenous methods for data generation and computational analysis leading to challenges in comparative analysis. While several genera are linked to breast cancer, the findings lack consistency across studies. Future studies should employ standardized outcomes, data collection, and processing methods to establish reproducible microbial markers to develop effective microbiome-based breast cancer management strategies.

Breast cancer incidence is increasing among South Asian women in the United States (US). This qualitative study explored breast cancer beliefs, behaviors, and experiences among South Asian immigrant women in New Jersey (NJ). We conducted four online focus groups with South Asian women from NJ, aged ≥ 25 years with no prior history of cancer, in English, between June 2021 and July 2022. Thematic content analysis was guided by the Social Contextual Framework. We recruited 22 participants, average age 52 (standard deviation (SD) = 8.4) years, all born in South Asia, and living in the US for an average of 26 (SD = 11.7) years. Low perceived individual risk of breast cancer was influenced by no family history and healthy lifestyles. Despite diet changes since immigrating and misconceptions held by some, women understood the benefits of mammography. Interpersonal and cultural barriers included family responsibilities and norms deprioritizing women’s health and health-seeking behaviors. Access to care may be limited by structural factors including immigration status, insurance, and language barriers. Social norms regarding stigma, modesty, and self-disclosure may vary by generation and context. Despite low perceived breast cancer risk and some cultural and structural barriers to screening, South Asian immigrant women generally understood mammography’s early detection benefits. Culturally appropriate interventions leveraging family ties and social networks are needed to dispel misconceptions, promote health-seeking behaviors, and address structural barriers.

OBJECTIVES: Instilling the principles of ethical and responsible medical research is critical for educating the next generation of clinical researchers. We developed a responsible conduct of research (RCR) workshop and associated curriculum for undergraduate trainees in a quantitative clinical research program. METHODS: Topics in this 7-module RCR workshop are relevant to undergraduate trainees in quantitative fields, many of whom are learning about these concepts for the first time. These topics include: (1) research collaboration and mentoring, (2) human subjects and privacy, (3) rigor, reproducibility, and responsibility in data analysis, (4) data safety, security, and sharing, (5) responsible authorship, peer reviews, and conflicts of interest, (6) research misconduct and whistleblowing, and (7) social responsibility and contemporary ethical issues. The workshop adopts an active learning approach and is intended to encourage peer-to-peer learning through a critical review of case studies and contemporary media reports. Workshop materials and discussions are designed to address experiences relevant to undergraduate trainees. For example, for the discussion on human subject protection, trainees are asked to review their own university's policies for engaging students as research subjects. Student perceived knowledge and understanding of research ethics were obtained from pre- and post-workshop surveys, with responses ranging from 1 (low level of understanding) to 5 (high level of understanding). RESULTS: Survey responses from 38 trainees across 4 years demonstrated marked increase in perceived knowledge and understanding of research ethics, from 64% in pre- to 96% in post-workshop responses with scores of 3 and up. Trainees noted the effectiveness of the active learning format of the workshop and relevance of the topics on their own research projects. CONCLUSION: Intentional instruction is vital to help trainees discern between good and bad science in research. The presented RCR curriculum can be adapted by other programs designed for trainees engaged in medical research and education.

Somatic changes like copy number aberrations (CNAs) and epigenetic alterations like methylation have pivotal effects on disease outcomes and prognosis in cancer, by regulating gene expressions, that drive critical biological processes. To identify potential biomarkers and molecular targets and understand how they impact disease outcomes, it is important to identify key groups of CNAs, the associated methylation, and the gene expressions they impact, through a joint integrative analysis. Here, we propose a novel analysis pipeline, the joint sparse canonical correlation analysis (jsCCA), an extension of sCCA, to effectively identify an ensemble of CNAs, methylation sites and gene (expression) components in the context of disease endpoints, especially tumor characteristics. Our approach detects potentially orthogonal gene components that are highly correlated with sets of methylation sites which in turn are correlated with sets of CNA sites. It then identifies the genes within these components that are associated with the outcome. Further, we aggregate the effect of each gene expression set on tumor stage by constructing “gene component scores” and test its interaction with traditional risk factors. Analyzing clinical and genomic data on 515 renal clear cell carcinoma (ccRCC) patients from the TCGA‐KIRC, we found eight gene components to be associated with methylation sites, regulated by groups of proximally located CNA sites. Association analysis with tumor stage at diagnosis identified a novel association of expression of ASAH1 gene trans‐regulated by methylation of several genes including SIX5 and by CNAs in the 10q25 region including TCF7L2. Further analysis to quantify the overall effect of gene sets on tumor stage, revealed that two of the eight gene components have significant interaction with smoking in relation to tumor stage. These gene components represent distinct biological functions including immune function, inflammatory responses, and hypoxia‐regulated pathways. Our findings suggest that jsCCA analysis can identify interpretable and important genes, regulatory structures, and clinically consequential pathways. Such methods are warranted for comprehensive analysis of multimodal data especially in cancer genomics.

Aims: United States South Asians constitute a fast-growing ethnic group with high prevalence of type 2 diabetes (T2D) despite lower mean BMI and other traditional risk factors compared to other races/ethnicities. Bilirubin has gained attention as a potential antioxidant, cardio-protective marker. Hence we sought to determine whether total bilirubin was associated with prevalent and incident T2D in U.S. South Asians. Methods: We conducted a cross-sectional and prospective analysis of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Total bilirubin was categorized into gender-specific quartiles (Men: 0.8; Women: 0.6 mg/dl). We estimated odds of type 2 diabetes as well as other cardiovascular (CV) risk factors using multivariable logistic regression. Results: Among a total 1,149 participants (48% female, mean [SD] age of 57 [9] years), 38% had metabolic syndrome and 24% had T2D. Men and women in the lowest bilirubin quartile had 0.55% and 0.17% higher HbA1c than the highest quartile. Men, but not women, in the lowest bilirubin quartile had higher odds of T2D compared to the highest quartile (aOR [95% CI]; Men: 3.00 [1.72,5.23], Women: 1.15 [0.57,2.31]). There was no association between bilirubin and other CV risk factors. Conclusion: Total bilirubin was inversely associated with T2D in SA men but not women. Longitudinal studies are needed to understand temporality of association.

Background: South Asians are a rapidly growing population in the United States. Breast cancer is a major concern among South Asian American women, who are an understudied population. We established the South Asian Breast Cancer (SABCa) study in New Jersey during early 2020 to gain insights into their breast cancer-related health attitudes. Shortly after we started planning for the study, the COVID-19 disease spread throughout the world. In this paper, we describe our experiences and lessons learned from recruiting study participants by partnering with New Jersey’s community organizations during the COVID-19 pandemic. Methods: We used a cross-sectional design. We contacted 12 community organizations and 7 (58%) disseminated our study information. However, these organizations became considerably busy with pandemic-related needs. Therefore, we had to pivot to alternative recruitment strategies through community radio, Rutgers Cancer Institute of New Jersey’s Community Outreach and Engagement Program, and Rutgers Cooperative Extension’s community health programs. We recruited participants through these alternative strategies, obtained written informed consent, and collected demographic information using a structured survey. Results: Twenty five women expressed interest in the study, of which 22 (88%) participated. Nine (41%) participants learned about the study through the radio, 5 (23%) through these participants, 1 (4.5%) through a non-radio community organization, and 7 (32%) through community health programs. Two (9%) participants heard about the study from their spouse. All participants were born outside the US, their average age was 52.4 years (range: 39–72 years), and they have lived in the US for an average of 26 years (range: 5–51 years). Conclusion: Pivoting to alternative strategies were crucial for successful recruitment. Findings suggest the significant potential of broadcast media for community-based recruitment. Family dynamics and the community’s trust in our partners also encouraged participation. Such strategies must be considered when working with understudied populations.

Understanding the social and environmental causes of cancer in the United States, particularly in marginalized communities, is a major research priority. Population-based cancer registries are essential for advancing this research, given their nearly complete capture of incident cases within their catchment areas. Most registries limit the release of address-level geocodes linked to cancer outcomes to comply with state health departmental regulations. These policies ensure patient privacy, uphold data confidentiality, and enhance trust in research. However, these restrictions also limit the conduct of high-quality epidemiologic studies on social and environmental factors that may contribute to cancer burden. Geomasking refers to computational algorithms that distort locational data to attain a balance between effectively “masking” the original address location while faithfully maintaining the spatial structure in the data. We propose that the systematic deployment of scalable geomasking algorithms could accelerate research on social and environmental contributions across the cancer continuum by reducing measurement error bias while also protecting privacy. We encourage multidisciplinary teams of registry officials, geospatial analysts, cancer researchers, and others engaged in this form of research to evaluate and apply geomasking procedures based on feasibility of implementation, accuracy, and privacy protection to accelerate population-based research on social and environmental causes of cancer.