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Fayanju, Oluwadamilola Motunrayo

Positions:

Assistant Professor of Surgery

Surgery, Advanced Oncologic and Gastrointestinal Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

A.B. 2001

A.B. — Harvard University

M.A. 2001

M.A. — Harvard University

M.D. 2007

M.D. — Washington University School of Medicine

MPHS 2011

MPHS — Washington University School of Medicine

General Surgery Resident, Surgery

Washington University School of Medicine

Breast Surgical Oncology Fellow, Surgery

University of Texas MD Anderson Cancer Center

Awards:

Duke CTSA KL2 Career Development Award. Clinical and Translational Science Awards (CTSA).

Type
University
Awarded By
Clinical and Translational Science Awards (CTSA)
Date
January 01, 2017

Duke Health Fellow. School of Medicine.

Type
University
Awarded By
School of Medicine
Date
January 01, 2017

Conquer Cancer Foundation Merit Award, Quality Care Symposium. American Society of Clinical Oncology (ASCO).

Type
National
Awarded By
American Society of Clinical Oncology (ASCO)
Date
January 01, 2016

1st prize, Resident/Fellow Competition, Commission on Cancer (CoC) Abstract Contest. Missouri Chapter of the American College of Surgeons (Missouri ACS).

Type
State
Awarded By
Missouri Chapter of the American College of Surgeons (Missouri ACS)
Date
January 01, 2012

Conquer Cancer Foundation Merit Award, Breast Cancer Symposium. American Society of Clinical Oncology (ASCO).

Type
National
Awarded By
American Society of Clinical Oncology (ASCO)
Date
January 01, 2012

Publications:

Body mass index mediates the prognostic significance of circulating tumor cells in inflammatory breast cancer.

Obesity (BMI≥30) may be an etiologic and prognostic factor in inflammatory breast cancer (IBC). We examined the relationship between BMI, pathologic complete response (pCR), and circulating-tumor-cell (CTC) levels in IBC.Cohort included IBC patients diagnosed 2005-2015 who had neoadjuvant chemotherapy during a prospective trial on CTCs and pathologic review describing pCR. Chi-square, logistic regression, and Cox proportional hazards models were used to identify clinicopathologic associations with event-free survival (EFS).Of 73 patients, 61 (84%) had CTC values, 22 (30%) achieved a pCR, and 39 (53%) were obese. There was no difference between obese and non-obese patients for pCR rates (31% vs. 29%, p = 0.90) or presence of CTCs (23% vs. 26%, p = 0.80). Among non-obese patients, CTCs were associated with worse EFS (HR 11.69, p < 0.01), but among obese patients, there was no difference in EFS between those with and without CTCs.BMI mediates CTCs' prognostic significance in IBC.

Authors
Fayanju, OM; Hall, CS; Bauldry, JB; Karhade, M; Valad, LM; Kuerer, HM; DeSnyder, SM; Barcenas, CH; Lucci, A
MLA Citation
Fayanju, OM, Hall, CS, Bauldry, JB, Karhade, M, Valad, LM, Kuerer, HM, DeSnyder, SM, Barcenas, CH, and Lucci, A. "Body mass index mediates the prognostic significance of circulating tumor cells in inflammatory breast cancer." American journal of surgery 214.4 (October 2017): 666-671.
PMID
28720217
Source
epmc
Published In
The American Journal of Surgery
Volume
214
Issue
4
Publish Date
2017
Start Page
666
End Page
671
DOI
10.1016/j.amjsurg.2017.06.005

The American Society of Breast Surgeons and Quality Payment Programs: Ranking, Defining, and Benchmarking More Than 1 Million Patient Quality Measure Encounters

Authors
Landercasper, J; Bailey, L; Buras, R; Clifford, E; Degnim, AC; Thanasoulis, L; Fayanju, OM; Tjoe, JA; Rao, R
MLA Citation
Landercasper, J, Bailey, L, Buras, R, Clifford, E, Degnim, AC, Thanasoulis, L, Fayanju, OM, Tjoe, JA, and Rao, R. "The American Society of Breast Surgeons and Quality Payment Programs: Ranking, Defining, and Benchmarking More Than 1 Million Patient Quality Measure Encounters." Annals of Surgical Oncology 24.10 (October 2017): 3093-3106.
Source
crossref
Published In
Annals of Surgical Oncology
Volume
24
Issue
10
Publish Date
2017
Start Page
3093
End Page
3106
DOI
10.1245/s10434-017-5940-1

Patient Age and Tumor Subtype Predict the Extent of Axillary Surgery Among Breast Cancer Patients Eligible for the American College of Surgeons Oncology Group Trial Z0011.

The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial established the safety of omitting axillary lymph node dissection (ALND) for early-stage breast cancer patients with limited nodal disease undergoing lumpectomy. We examined the extent of axillary surgery among women eligible for Z0011 based on patient age and tumor subtype.Patients with cT1-2, cN0 breast cancers and one or two positive nodes diagnosed from 2009 to 2014 and treated with lumpectomy were identified in the National Cancer Data Base. Sentinel lymph node biopsy (SLNB) was defined as the removal of 1-5 nodes and ALND as the removal of 10 nodes or more. Tumor subtype was categorized as luminal, human epidermal growth factor 2-positive (HER2+), or triple-negative. Logistic regression was used to estimate the odds of receiving SLNB alone versus ALND.The inclusion criteria were met by 28,631 patients (21,029 SLNB-alone and 7602 ALND patients). Patients 70 years of age or older were more likely to undergo SLNB alone than ALND (27.0% vs 20.1%; p < 0.001). The radiation therapy use rate was 89.4% after SLNB alone and 89.7% after ALND. In the multivariate analysis, the uptake of Z0011 recommendations increased over time (2014 vs 2009: odds ratio [OR] 13.02; p < 0.001). Younger patients were less likely to undergo SLNB alone than older patients (age <40 vs ≥70: OR 0.59; p < 0.001). Patients with HER2+ (OR 0.89) or triple-negative disease (OR 0.79) (p < 0.001) were less likely to undergo SLNB alone than those with luminal subtypes.Among women potentially eligible for ACOSOG Z0011, the use of SLNB alone increased over time in all groups, but the extent of axillary surgery differed by patient age and tumor subtype.

Authors
Ong, CT; Thomas, SM; Blitzblau, RC; Fayanju, OM; Park, TS; Plichta, JK; Rosenberger, LH; Hyslop, T; Shelley Hwang, E; Greenup, RA
MLA Citation
Ong, CT, Thomas, SM, Blitzblau, RC, Fayanju, OM, Park, TS, Plichta, JK, Rosenberger, LH, Hyslop, T, Shelley Hwang, E, and Greenup, RA. "Patient Age and Tumor Subtype Predict the Extent of Axillary Surgery Among Breast Cancer Patients Eligible for the American College of Surgeons Oncology Group Trial Z0011." Annals of surgical oncology (September 6, 2017).
PMID
28879416
Source
epmc
Published In
Annals of Surgical Oncology
Publish Date
2017
DOI
10.1245/s10434-017-6075-0

Contralateral Prophylactic Mastectomy: Aligning Patient Preferences and Provider Recommendations.

Authors
Fayanju, OM; Hwang, ES
MLA Citation
Fayanju, OM, and Hwang, ES. "Contralateral Prophylactic Mastectomy: Aligning Patient Preferences and Provider Recommendations." JAMA surgery 152.3 (March 2017): 282-283.
PMID
28002558
Source
epmc
Published In
JAMA Surgery
Volume
152
Issue
3
Publish Date
2017
Start Page
282
End Page
283
DOI
10.1001/jamasurg.2016.4750

Surgical Education and Health Care Reform: Defining the Role and Value of Trainees in an Evolving Medical Landscape.

Health care reform and surgical education are often separated functionally. However, especially in surgery, where resident trainees often spend twice as much time in residency and fellowship than in undergraduate medical education, one must consider their contributions to health care.In this short commentary, we briefly review the status of health care in the United States as well as some of the recent and current changes in graduate medical education that pertain to surgical trainees.This is a perspective piece that draws on the interests and varied background of the multiinstitutional and international group of authors.The authors propose 3 main areas of focus for research and practice- (1) accurately quantifying the care provided currently by trainees, (2) determining impact to trainees and hospital systems of training parameters, focusing on long-term outcomes rather than short-term outcomes, and (3) determining practice models of education that work best for both health care delivery and trainees.The authors propose that surgical education must align itself with rather than separate itself from overall health care reform measures and even individual hospital financial pressures. This should not be seen as additional burden of service, but rather practical education in training as to the pressures trainees will face as future employees. Rethinking the contributions and training of residents and fellows may also synergistically work to impress to hospital administrators that providing better, more focused and applicable education to residents and fellows may have long-term, strategic, positive impacts on institutions.

Authors
Fayanju, OM; Aggarwal, R; Baucom, RB; Ferrone, CR; Massaro, D; Terhune, KP
MLA Citation
Fayanju, OM, Aggarwal, R, Baucom, RB, Ferrone, CR, Massaro, D, and Terhune, KP. "Surgical Education and Health Care Reform: Defining the Role and Value of Trainees in an Evolving Medical Landscape." Annals of surgery 265.3 (March 2017): 459-460.
PMID
27906761
Source
epmc
Published In
Annals of Surgery
Volume
265
Issue
3
Publish Date
2017
Start Page
459
End Page
460
DOI
10.1097/sla.0000000000002021

Measures of Appropriateness and Value for Breast Surgeons and Their Patients: The American Society of Breast Surgeons Choosing Wisely ® Initiative

Authors
Landercasper, J; Bailey, L; Berry, TS; Buras, RR; Degnim, AC; Fayanju, OM; Froman, J; Gass, J; Greenberg, C; Mautner, SK; Krontiras, H; Rao, R; Sowden, M; Tjoe, JA; Wexelman, B; Wilke, L; Chen, SL
MLA Citation
Landercasper, J, Bailey, L, Berry, TS, Buras, RR, Degnim, AC, Fayanju, OM, Froman, J, Gass, J, Greenberg, C, Mautner, SK, Krontiras, H, Rao, R, Sowden, M, Tjoe, JA, Wexelman, B, Wilke, L, and Chen, SL. "Measures of Appropriateness and Value for Breast Surgeons and Their Patients: The American Society of Breast Surgeons Choosing Wisely ® Initiative." Annals of Surgical Oncology 23.10 (October 2016): 3112-3118.
Source
crossref
Published In
Annals of Surgical Oncology
Volume
23
Issue
10
Publish Date
2016
Start Page
3112
End Page
3118
DOI
10.1245/s10434-016-5327-8

Value-Based Breast Cancer Care: A Multidisciplinary Approach for Defining Patient-Centered Outcomes

Authors
Fayanju, OM; Mayo, TL; Spinks, TE; Lee, S; Barcenas, CH; Smith, BD; Giordano, SH; Hwang, RF; Ehlers, RA; Selber, JC; Walters, R; Tripathy, D; Hunt, KK; Buchholz, TA; Feeley, TW; Kuerer, HM
MLA Citation
Fayanju, OM, Mayo, TL, Spinks, TE, Lee, S, Barcenas, CH, Smith, BD, Giordano, SH, Hwang, RF, Ehlers, RA, Selber, JC, Walters, R, Tripathy, D, Hunt, KK, Buchholz, TA, Feeley, TW, and Kuerer, HM. "Value-Based Breast Cancer Care: A Multidisciplinary Approach for Defining Patient-Centered Outcomes." Annals of Surgical Oncology 23.8 (August 2016): 2385-2390.
Source
crossref
Published In
Annals of Surgical Oncology
Volume
23
Issue
8
Publish Date
2016
Start Page
2385
End Page
2390
DOI
10.1245/s10434-016-5184-5

Postmastectomy Radiation Treatment Rates as a Quality Measure: An Opportunity for Compliance Through Collaboration

Authors
Fayanju, OM; Buchholz, TA; Hunt, KK
MLA Citation
Fayanju, OM, Buchholz, TA, and Hunt, KK. "Postmastectomy Radiation Treatment Rates as a Quality Measure: An Opportunity for Compliance Through Collaboration." Annals of Surgical Oncology 23.8 (August 2016): 2377-2379.
Source
crossref
Published In
Annals of Surgical Oncology
Volume
23
Issue
8
Publish Date
2016
Start Page
2377
End Page
2379
DOI
10.1245/s10434-016-5258-4

Influence of tumour stage at breast cancer detection on survival in modern times: Population based study in 173-797 patients Saadatmand S, Bretveld R, Siesling S, et al (Erasmus Univ Med Centre - Cancer Inst, Rotterdam, Netherlands; Netherlands Comprehensive Cancer Organization, Utrecht; Et al) BMJ 351:h4901, 2015

Authors
Fayanju, OM; Thompson, AM
MLA Citation
Fayanju, OM, and Thompson, AM. "Influence of tumour stage at breast cancer detection on survival in modern times: Population based study in 173-797 patients Saadatmand S, Bretveld R, Siesling S, et al (Erasmus Univ Med Centre - Cancer Inst, Rotterdam, Netherlands; Netherlands Comprehensive Cancer Organization, Utrecht; Et al) BMJ 351:h4901, 2015." Breast Diseases 27.2 (January 1, 2016): 120-121.
Source
scopus
Published In
Breast Diseases: A Year Book Quarterly
Volume
27
Issue
2
Publish Date
2016
Start Page
120
End Page
121
DOI
10.1016/j.breastdis.2016.04.021

Occult metastases in node-negative breast cancer: A Surveillance, Epidemiology, and End Results–based analysis

Authors
Fayanju, OM; Lucci, A
MLA Citation
Fayanju, OM, and Lucci, A. "Occult metastases in node-negative breast cancer: A Surveillance, Epidemiology, and End Results–based analysis." Breast Diseases: A Year Book Quarterly 27.1 (2016): 34-36.
Source
crossref
Published In
Breast Diseases: A Year Book Quarterly
Volume
27
Issue
1
Publish Date
2016
Start Page
34
End Page
36
DOI
10.1016/j.breastdis.2016.01.028

Predictors of pathological complete response to neoadjuvant chemotherapy in stage II and III breast cancer: The impact of chemotherapeutic regimen

Authors
NWAOGU, IHEOMAY; FAYANJU, OLUWADAMILOLAM; JEFFE, DONNAB; MARGENTHALER, JULIEA
MLA Citation
NWAOGU, IHEOMAY, FAYANJU, OLUWADAMILOLAM, JEFFE, DONNAB, and MARGENTHALER, JULIEA. "Predictors of pathological complete response to neoadjuvant chemotherapy in stage II and III breast cancer: The impact of chemotherapeutic regimen." Molecular and Clinical Oncology 3.5 (September 2015): 1117-1122.
Source
crossref
Published In
Molecular and Clinical Oncology
Volume
3
Issue
5
Publish Date
2015
Start Page
1117
End Page
1122
DOI
10.3892/mco.2015.579

Pathological complete response in breast cancer patients following neoadjuvant chemotherapy at a Comprehensive Cancer Center: The natural history of an elusive prognosticator

Authors
FAYANJU, OLUWADAMILOLAM; NWAOGU, IHEOMA; JEFFE, DONNAB; MARGENTHALER, JULIEA
MLA Citation
FAYANJU, OLUWADAMILOLAM, NWAOGU, IHEOMA, JEFFE, DONNAB, and MARGENTHALER, JULIEA. "Pathological complete response in breast cancer patients following neoadjuvant chemotherapy at a Comprehensive Cancer Center: The natural history of an elusive prognosticator." Molecular and Clinical Oncology 3.4 (July 2015): 775-780.
Source
crossref
Published In
Molecular and Clinical Oncology
Volume
3
Issue
4
Publish Date
2015
Start Page
775
End Page
780
DOI
10.3892/mco.2015.535

Contralateral prophylactic mastectomy after unilateral breast cancer: a systematic review and meta-analysis.

To examine whether contralateral prophylactic mastectomy (CPM) is associated with improved survival, incidence of contralateral breast cancer (CBC), and recurrence in patients with unilateral breast cancer (UBC).Despite conflicting data, CPM rates continue to increase. Here we present the first meta-analysis to assess post-CPM outcomes in women with UBC.We searched 5 databases and retrieved papers' bibliographies for relevant studies published through March 2012. Fixed- and random-effects meta-analyses were conducted on the basis of tests of study heterogeneity. We examined potential confounding via stratification and meta-regression. We report pooled relative risks (RRs) and risk differences (RDs) with 95% confidence intervals (CIs) at 2-tailed P < 0.05 significance.Of 93 studies reviewed, 14 were included in meta-analyses. Compared with nonrecipients, CPM recipients had higher rates of overall survival [OS; RR = 1.09 (95% CI: 1.06, 1.11)] and lower rates of breast cancer-specific mortality [BCM; RR = 0.69 (95% CI: 0.56, 0.85)] but saw no absolute reduction in risk of metachronous CBC (MCBC). Among patients with elevated familial/genetic risk (FGR, ie, BRCA carrier status and/or family history of breast cancer), both relative and absolute risks of MCBC were significantly decreased among CPM recipients [RR = 0.04 (95% CI: 0.02, 0.09); RD = -24.0% (95% CI: -35.6%, -12.4%)], but there was no improvement in OS or BCM.CPM is associated with decreased MCBC incidence but not improved survival among patients with elevated FGR. The superior outcomes observed when comparing CPM recipients with nonrecipients in the general population are likely not attributable to a CPM-derived decrease in MCBC incidence. UBC patients without known FGR should not be advised to undergo CPM.

Authors
Fayanju, OM; Stoll, CRT; Fowler, S; Colditz, GA; Margenthaler, JA
MLA Citation
Fayanju, OM, Stoll, CRT, Fowler, S, Colditz, GA, and Margenthaler, JA. "Contralateral prophylactic mastectomy after unilateral breast cancer: a systematic review and meta-analysis." Annals of surgery 260.6 (December 2014): 1000-1010. (Review)
PMID
24950272
Source
epmc
Published In
Annals of Surgery
Volume
260
Issue
6
Publish Date
2014
Start Page
1000
End Page
1010
DOI
10.1097/sla.0000000000000769

Perceived barriers to mammography among underserved women in a Breast Health Center Outreach Program.

To investigate perceived barriers to mammography among underserved women, we asked participants in the Siteman Cancer Center Mammography Outreach Registry-developed in 2006 to evaluate mobile mammography's effectiveness among the underserved-why they believed women did not get mammograms.The responses of approximately 9,000 registrants were analyzed using multivariable logistic regression. We report adjusted odds ratios (OR) and 95% confidence intervals (CI) significant at 2-tailed P values less than .05.Fears of cost (40%), mammogram-related pain (13%), and bad news (13%) were the most commonly reported barriers. Having insurance was associated with not perceiving cost as a barrier (OR .44, 95% CI .40 to .49), but with perceiving fear of both mammogram-related pain (OR 1.39, 95% CI 1.21 to 1.60) and receiving bad news (OR 1.38, 95% CI 1.19 to 1.60) as barriers.Despite free services, underserved women continue to report experiential and psychological obstacles to mammography, suggesting the need for more targeted education and outreach in this population.

Authors
Fayanju, OM; Kraenzle, S; Drake, BF; Oka, M; Goodman, MS
MLA Citation
Fayanju, OM, Kraenzle, S, Drake, BF, Oka, M, and Goodman, MS. "Perceived barriers to mammography among underserved women in a Breast Health Center Outreach Program." American journal of surgery 208.3 (September 2014): 425-434.
PMID
24908357
Source
epmc
Published In
The American Journal of Surgery
Volume
208
Issue
3
Publish Date
2014
Start Page
425
End Page
434
DOI
10.1016/j.amjsurg.2014.03.005

Breast cancer patients' experiences within and outside the safety net.

Following reforms to the breast-cancer referral process for our city's health Safety Net (SN), we compared the experiences from first abnormality to definitive diagnosis of breast-cancer patients referred to Siteman Cancer Center from SN and non-SN (NSN) providers.SN-referred patients with any stage (0-IV) and NSN-referred patients with late-stage (IIB-IV) breast cancer were prospectively identified after diagnosis during cancer center consultations conducted between September 2008 and June 2010. Interviews were taped and transcribed verbatim; transcripts were independently coded by two raters using inductive methods to identify themes.Of 82 eligible patients, 57 completed interviews (33/47 SN [70%] and 24/35 NSN [69%]). Eighteen SN-referred patients (52%) had late-stage disease at diagnosis, as did all NSN patients (by design). A higher proportion of late-stage SN patients (67%) than either early-stage SN (47%) or NSN (33%) patients reported feelings of fear and avoidance that deterred them from pursuing care for concerning breast findings. A higher proportion of SN late-stage patients than NSN patient reported behaviors concerning for poor health knowledge or behavior (33% versus 8%), but reported receipt of timely, consistent communication from health care providers once they received care (50% versus 17%). Half of late-stage SN patients reported improper clinical or administrative conduct by health care workers that delayed referral and/or diagnosis.Although SN patients reported receipt of compassionate care once connected with health services, they presented with higher-than-expected rates of late-stage disease. Psychological barriers, life stressors, and provider or clinic delays affected access to and navigation of the health care system and represent opportunities for intervention.

Authors
Fayanju, OM; Jeffe, DB; Elmore, L; Ksiazek, DN; Margenthaler, JA
MLA Citation
Fayanju, OM, Jeffe, DB, Elmore, L, Ksiazek, DN, and Margenthaler, JA. "Breast cancer patients' experiences within and outside the safety net." The Journal of surgical research 190.1 (July 2014): 126-133.
PMID
24768022
Source
epmc
Published In
Journal of Surgical Research
Volume
190
Issue
1
Publish Date
2014
Start Page
126
End Page
133
DOI
10.1016/j.jss.2014.03.030

Under your nose.

Authors
Fayanju, O
MLA Citation
Fayanju, O. "Under your nose." Bulletin of the American College of Surgeons 99.1 Suppl (June 2014): 8-.
PMID
24956901
Source
epmc
Published In
Bulletin of the American College of Surgeons
Volume
99
Issue
1 Suppl
Publish Date
2014
Start Page
8

A method for achieving reciprocity of funding in community-based participatory research.

The St. Louis Komen Project was conceived to address disparities in breast cancer treatment and outcomes between African-American and White women in St. Louis, Missouri. Our goal was to apportion tasks and funding through a process to which all researcher partners had input and to which all could agree, thus eliminating institutionalized inequalities.This paper describes the collaborative process and resulting division of responsibilities, determination of costs, and ultimate allocation of funds and resources, as well as the documentation employed to achieve funding reciprocity and equal accountability.Both communication and documentation are critical. Although the Memoranda of Understanding employed are not a panacea, they codify roles and expectations and promote trust. The process of developing financial transparency set the tone for subsequent steps in the research process.The exhaustive planning process and project-specific procedures developed by its partners have helped the project foster reciprocity, facilitate participation, and equitably distribute resources.

Authors
Gehlert, S; Fayanju, OM; Jackson, S; Kenkel, S; McCullough, IC; Oliver, C; Sanford, M
MLA Citation
Gehlert, S, Fayanju, OM, Jackson, S, Kenkel, S, McCullough, IC, Oliver, C, and Sanford, M. "A method for achieving reciprocity of funding in community-based participatory research." Progress in community health partnerships : research, education, and action 8.4 (January 2014): 561-570.
PMID
25727989
Source
epmc
Published In
Progress in Community Health Partnerships: Research, Education, and Action
Volume
8
Issue
4
Publish Date
2014
Start Page
561
End Page
570
DOI
10.1353/cpr.2014.0054

Occult primary breast cancer at a comprehensive cancer center.

Management of occult primary breast cancer (OPBC), that is, breast cancer that first presents through regional nodal or distant disease without clinical or mammographic evidence of disease in the breast, has been controversial and inconsistent. Here, we review OPBC patients treated at our institution.We conducted a retrospective review of women diagnosed with a first primary breast cancer between March 1999 and September 2010 to identify patients who presented with isolated axillary lymphadenopathy proven to be histologically consistent with primary breast malignancy but had no evidence of a breast mass on physical examination, mammography, or ultrasound. Descriptions of treatments received, recurrence, morbidity, and mortality as of October 2012 are reported.Of 5533 patients reviewed, seven (0.1%) patients were identified. The median age was 65 y old (range, 40-72), and the median length of follow-up was 86 mo (range, 42-124). Four patients underwent modified radical mastectomy, one patient had a lumpectomy and axillary lymph node dissection, and two patients had axillary lymph node dissection without breast surgery. Four patients received adjuvant radiation therapy. All seven patients received chemotherapy. Three patients received endocrine therapy, and two patients received anti-HER2 therapy. At the last follow-up, all seven patients were alive with no evidence of disease.Although there was some variation in the management of OPBC at our institution, our patients had excellent outcomes after multimodal treatment. Our results support a curative intent approach to the treatment of OPBC and illustrate the need for individualized treatment algorithms based on tumor biology and extent of the disease at diagnosis.

Authors
Fayanju, OM; Jeffe, DB; Margenthaler, JA
MLA Citation
Fayanju, OM, Jeffe, DB, and Margenthaler, JA. "Occult primary breast cancer at a comprehensive cancer center." The Journal of surgical research 185.2 (December 2013): 684-689.
PMID
23890400
Source
epmc
Published In
Journal of Surgical Research
Volume
185
Issue
2
Publish Date
2013
Start Page
684
End Page
689
DOI
10.1016/j.jss.2013.06.020

Geographic and temporal trends in the management of occult primary breast cancer: a systematic review and meta-analysis.

Management of occult primary breast cancer (OPBC), including the role of magnetic resonance imaging (MRI), is controversial. We conducted a pooled analysis of OPBC patients and a meta-analysis of MRI accuracy in OPBC in order to elucidate current practices.A literature search yielded 201 studies. Patient-level data for clinically/mammographically OPBC from studies published after 1993 and from our institution were pooled; logistic regression examined associations between patient/study data and outcomes, including treatments and recurrence. We report adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI) significant at 2-tailed p < 0.05. Meta-analysis included data for patients who received MRIs for workup of clinically/mammographically OPBC. We report pooled sensitivity and specificity with 95 % CIs.The pooled analysis included 92 patients (15 studies [n = 85] plus our institution [n = 7]). Patients from Asia were more likely to receive breast surgery (OR = 5.98, 95 % CI = 2.02-17.65) but not chemotherapy (OR = 0.32, 95 % CI = 0.13-0.82); patients from the United States were more likely to receive chemotherapy (OR = 13.08, 95 % CI = 2.64-64.78). Patients from studies published after 2003 were more likely to receive radiotherapy (OR = 3.86, 95 % CI = 1.41-10.55). Chemotherapy recipients were more likely to have distant recurrence (OR = 9.77, 95 % CI = 1.10-87.21). More patients with positive MRIs received chemotherapy than patients with negative MRIs (10 of 12 [83.3 %] vs 5 of 13 [38.5 %]; p = 0.0414). In the MRI-accuracy meta-analysis (10 studies, n = 262), pooled sensitivity and specificity were 96 % (95 % CI = 91-98 %) and 63 % (95 % CI = 42-81 %), respectively.OPBC management varied geographically and over time. We recommend establishing an international OPBC patient registry to facilitate longitudinal study and develop global treatment standards.

Authors
Fayanju, OM; Stoll, CRT; Fowler, S; Colditz, GA; Jeffe, DB; Margenthaler, JA
MLA Citation
Fayanju, OM, Stoll, CRT, Fowler, S, Colditz, GA, Jeffe, DB, and Margenthaler, JA. "Geographic and temporal trends in the management of occult primary breast cancer: a systematic review and meta-analysis." Annals of surgical oncology 20.10 (October 2013): 3308-3316. (Review)
PMID
23975301
Source
epmc
Published In
Annals of Surgical Oncology
Volume
20
Issue
10
Publish Date
2013
Start Page
3308
End Page
3316
DOI
10.1245/s10434-013-3157-5

Patient and process factors associated with late-stage breast cancer diagnosis in Safety-Net patients: a pilot prospective study.

Following reforms to our city's Safety-Net (SN) breast cancer referral process, we investigated whether factors often associated with late-stage diagnosis would differ by referral source--SN versus non-Safety-Net (NSN)--or, among SN patients, by stage at diagnosis.From September 2008 to June 2010, SN patients with any-stage (0-IV) and NSN patients with late-stage (IIB-IV) breast cancer were identified prospectively during initial cancer-center consultations. Data were analyzed using logistic regression, chi-square, and t tests; two-tailed P < 0.05 was considered significant.Fifty-seven women completed interviews (33 SN, 24 NSN); 52% of SN-referred patients were diagnosed with late-stage disease. Compared with NSN late-stage patients, SN late-stage patients were more likely to be African-American (83% vs. 21%, P < 0.001), to have an annual household income <$25,000 (89% vs. 38%, P < 0.001), and to report having a health problem in the preceding year but not being able to see a doctor because of cost (67% vs. 25%, P = 0.012); they were less likely to be married/partnered (22% vs. 79%, P < 0.001) and to have post-college education (0% vs. 25%, P < 0.03), any insurance (61% vs. 96%, P < 0.005), and to have sought medical attention within 1 week of realizing they had concerning breast findings (50% vs. 79%, P = 0.047). Married/partnered patients were more likely to delay medical care by >1 week (odds ratio = 9.9, P = 0.038).SN patients presented with higher-than-expected rates of late-stage disease despite improvements in mammography rates and the referral process. Efforts to further facilitate access to care for this vulnerable SN patient population are needed.

Authors
Fayanju, OM; Jeffe, DB; Elmore, L; Ksiazek, DN; Margenthaler, JA
MLA Citation
Fayanju, OM, Jeffe, DB, Elmore, L, Ksiazek, DN, and Margenthaler, JA. "Patient and process factors associated with late-stage breast cancer diagnosis in Safety-Net patients: a pilot prospective study." Annals of surgical oncology 20.3 (March 2013): 723-732.
PMID
23070783
Source
epmc
Published In
Annals of Surgical Oncology
Volume
20
Issue
3
Publish Date
2013
Start Page
723
End Page
732
DOI
10.1245/s10434-012-2558-1

Breast cancer presentation in an urban health care Safety Net system.

We examined the Safety-Net referral process for breast diseases to identify factors contributing to delays within it. Each record was mapped to a time line beginning with first abnormality and concluding with definitive diagnosis/treatment. The median interval between first sign and definitive diagnosis/treatment was 93 days. Need for repeat imaging and missed visits prolonged the interval. System- and patient-specific factors were associated with delayed diagnosis/ treatment in breast patients referred through the Safety-Net specialty clinic.

Authors
Fayanju, OM; Jeffe, DB; Tappenden, JR; Beers, CE; Drake, BF; Gao, F; Margenthaler, JA
MLA Citation
Fayanju, OM, Jeffe, DB, Tappenden, JR, Beers, CE, Drake, BF, Gao, F, and Margenthaler, JA. "Breast cancer presentation in an urban health care Safety Net system." Missouri medicine 109.5 (September 2012): 405-411.
PMID
23097949
Source
epmc
Published In
Missouri Medicine
Volume
109
Issue
5
Publish Date
2012
Start Page
405
End Page
411

Withdrawal of care in a potentially curable patient.

Authors
Murphy, J; Fayanju, O; Brown, D; Kodner, IJ
MLA Citation
Murphy, J, Fayanju, O, Brown, D, and Kodner, IJ. "Withdrawal of care in a potentially curable patient." Surgery 147.3 (March 2010): 441-445. (Review)
PMID
20176245
Source
epmc
Published In
Surgery
Volume
147
Issue
3
Publish Date
2010
Start Page
441
End Page
445
DOI
10.1016/j.surg.2010.01.012

Therapeutic management of intracystic papillary carcinoma of the breast: the roles of radiation and endocrine therapy.

BACKGROUND: The role of radiation and endocrine therapy in the treatment of intracystic papillary carcinoma (IPC) remains unclear. The aim of the current study was to review the management of IPC in order to determine factors associated with use of adjuvant therapies. METHODS: A retrospective review of our surgical and pathology databases from 1995-2006 identified 45 women with IPC. These patients were further divided into those with pure IPC (n = 21), IPC with associated ductal carcinoma in situ (DCIS) (n = 18), and IPC with associated microinvasion with or without DCIS (n = 6). Patient characteristics were compared between groups using the chi-square test. RESULTS: Patients with IPC and microinvasion were more likely to undergo an axillary staging procedure (6/6, 100%) compared to patients with pure IPC (6/21, 29%) or IPC with DCIS (5/18, 28%) (P < .001). Patients with pure IPC were less likely to have radiation therapy than patients with IPC and DCIS or microinvasion (P < .001). However, within the subset of patients with pure IPC, women less than 50 years of age were more likely to have radiation therapy than those older than 50 years (P < .001). Patients with IPC and DCIS or microinvasion had significantly increased use of endocrine therapy versus patients with pure IPC (P < .01). CONCLUSIONS: In our patient population, those patients with IPC and associated DCIS or microinvasion are treated with adjuvant radiation and endocrine therapy on the basis of this associated pathology. The use of adjuvant radiation and/or endocrine therapy should be considered in patients with pure IPC who are of young age (<50 years).

Authors
Fayanju, OM; Ritter, J; Gillanders, WE; Eberlein, TJ; Dietz, JR; Aft, R; Margenthaler, JA
MLA Citation
Fayanju, OM, Ritter, J, Gillanders, WE, Eberlein, TJ, Dietz, JR, Aft, R, and Margenthaler, JA. "Therapeutic management of intracystic papillary carcinoma of the breast: the roles of radiation and endocrine therapy." American journal of surgery 194.4 (October 2007): 497-500.
PMID
17826064
Source
manual
Published In
The American Journal of Surgery
Volume
194
Issue
4
Publish Date
2007
Start Page
497
End Page
500
DOI
10.1016/j.amjsurg.2007.06.016
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