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Greenup, Rachel Adams

Overview:

I am a breast cancer surgeon and health services researcher with a clinical practice entirely focused on the treatment of breast disease. My prior research has revolved around two major themes: 1) the doctor-patient relationship within oncology, and 2) high-value breast cancer care (i.e. evidence-based breast cancer treatment translating into high quality cancer care at lower health care costs). 


My long-standing interest in high value oncology care was initially sparked when I completed my Masters in Public Health degree at the University of Wisconsin.  My prior research has demonstrated that adherence to evidence-based practice leads to a “win-win” of providing the best care for patients while naturally reducing health care spending. Through the BIRCWH Scholar program, I am currently working on better understanding how knowledge of health care costs and burden may impact patients' and doctors' treatment decisions.


Positions:

Associate 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:

M.D. 2004

M.D. — Medical College of Wisconsin

M.P.H. 2009

M.P.H. — University of Wisconsin at Madison

Internship/General Surgery Residency

Medical College of Wisconsin

Breast Surgical Oncology Fellow

Massachusetts General Hospital

News:

Grants:

Building Interdisciplinary Research Careers in Women's Health

Administered By
Obstetrics and Gynecology
AwardedBy
National Institutes of Health
Role
Scholar
Start Date
September 26, 2002
End Date
July 31, 2022

Comparison of Operative to Medical Endocrine Therapy (COMET) for Low Risk DCIS

Administered By
Surgery, Advanced Oncologic and Gastrointestinal Surgery
AwardedBy
Alliance for Clinical Trials in Oncology Foundation
Role
Investigator
Start Date
June 01, 2016
End Date
December 01, 2021

TBCRC 029: Male Breast Cancer

Administered By
Duke Cancer Institute
AwardedBy
Johns Hopkins University
Role
Principal Investigator
Start Date
June 13, 2016
End Date
June 12, 2020

A novel strategy to see and treat breast cancer: translation to intra-operative breast margin assessment

Administered By
Biomedical Engineering
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 15, 2017
End Date
July 31, 2019

Comparing the Effectiveness of Guideline-concordant Care to Active Surveillance for DCIS: an Observational Study

Administered By
Surgery, Advanced Oncologic and Gastrointestinal Surgery
AwardedBy
Patient-Centered Outcomes Research Institute
Role
Investigator
Start Date
November 01, 2015
End Date
January 31, 2019

A Novel Optical Spectral Imaging System for Rapid Imaging of Breast Tumor Margins

Administered By
Biomedical Engineering
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
April 01, 2011
End Date
March 31, 2017
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Awards:

Duke SCORES Scholar. Duke Department of Surgery.

Type
School
Awarded By
Duke Department of Surgery
Date
October 01, 2017

Health Policy Scholars Award. American College of Surgeons and American Society of Breast Surgeons.

Type
National
Awarded By
American College of Surgeons and American Society of Breast Surgeons
Date
April 01, 2017

Publications:

Association Between Targeted HER-2 Therapy and Breast Reconstruction Outcomes: A Propensity Score-Matched Analysis.

Current treatment for HER-2+ breast cancer includes chemotherapy and targeted HER-2 therapy with trastuzumab and/or pertuzumab. Evidence is lacking on the safety of breast reconstructive operations in these patients. We hypothesized that targeted HER-2 therapy was not associated with post-mastectomy reconstructive outcomes.Women receiving chemotherapy and post-mastectomy reconstruction at Duke University Medical Center from 2006 to 2016 were retrospectively identified. Patients receiving targeted HER-2 therapy with trastuzumab and/or pertuzumab within 6 weeks before breast reconstruction were propensity score-matched 1:1 to patients who did not receive targeted HER-2 therapy, based on the following factors: age, obesity, diabetes, tobacco use, receipt of neoadjuvant chemotherapy, chemotherapy regimen, and radiation therapy. Primary study outcomes included the occurrence of hematoma, seroma, infection, wound breakdown, mastectomy skin flap necrosis, and postoperative flap thrombosis.A total of 481 women were identified, resulting in 107 propensity score-matched pairs. Administration of combined trastuzumab and pertuzumab therapy before breast reconstruction was independently associated with increased risk of postoperative wound breakdown requiring operative intervention for closure, compared with patients not undergoing targeted HER-2 therapy (odds ratio 65.29; 95% CI 1.63 to 2,611.50; p = 0.03). In addition, larger tumor size (2 to 5 cm) was significantly associated with a reduced risk of postoperative wound breakdown, compared with smaller tumors (<2 cm) (odds ratio 0.41; 95% CI 0.19 to 0.87; p = 0.02). Single-agent targeted HER-2 therapy with trastuzumab was not significantly associated with reconstructive complications.Our study suggests that trastuzumab therapy in conjunction with breast reconstructive operation is not associated with reconstructive complications, and breast reconstruction does not need to be delayed due to the administration of trastuzumab. Future studies are needed to evaluate the impact of pertuzumab on surgical outcomes.

Authors
Shammas, RL; Cho, EH; Glener, AD; Poveromo, LP; Mundy, LR; Greenup, RA; Blackwell, KL; Hollenbeck, ST
MLA Citation
Shammas, RL, Cho, EH, Glener, AD, Poveromo, LP, Mundy, LR, Greenup, RA, Blackwell, KL, and Hollenbeck, ST. "Association Between Targeted HER-2 Therapy and Breast Reconstruction Outcomes: A Propensity Score-Matched Analysis." Journal of the American College of Surgeons (September 26, 2017).
PMID
28985927
Source
epmc
Published In
Journal of The American College of Surgeons
Publish Date
2017
DOI
10.1016/j.jamcollsurg.2017.08.023

Oncologic Safety of Prophylactic Nipple-Sparing Mastectomy in a Population With BRCA Mutations: A Multi-institutional Study.

Nipple-sparing mastectomy (NSM) offers superior cosmetic outcomes and has been gaining wide acceptance; however, its role among patients with BRCA mutations remains controversial.To report on the oncologic safety of NSM and provide evidence-based data to patients and health care professionals regarding preservation of the nipple-areolar complex during a risk-reducing mastectomy in a population with BRCA mutations.We retrospectively reviewed the outcomes of 9 institutions' experience with prophylactic NSM from 1968 to 2013 in a cohort of patients with BRCA mutations. Patients with breast cancer were included if they underwent contralateral risk-reducing mastectomy; however, only the prophylactic side was considered in the analysis. Patients found to have an occult primary breast cancer at the time of risk-reducing mastectomy, those having variant(s) of unknown significance, and those undergoing free nipple grafts were excluded.The primary outcome measure was development of a new breast cancer after risk-reducing NSM. Three reference data sources were used to model the expected number of events, and this was compared with our observed number of events.A total of 548 risk-reducing NSMs in 346 patients were performed at 9 institutions. The median age at NSM was 41 years (interquartile range, 34.5-47.5 years). Bilateral prophylactic NSMs were performed in 202 patients (58.4%), and 144 patients (41.6%) underwent a unilateral risk-reducing NSM secondary to cancer in the contralateral breast. Overall, 201 patients with BRCA1 mutations and 145 with BRCA2 mutations were included. With median and mean follow-up of 34 and 56 months, respectively, no ipsilateral breast cancers occurred after prophylactic NSM. Breast cancer did not develop in any patients undergoing bilateral risk-reducing NSMs. Using risk models for BRCA1/2 mutation carriers, approximately 22 new primary breast cancers were expected without prophylactic NSM. Prophylactic NSM resulted in a significant reduction in breast cancer events (test of observed vs expected events, P < .001).Nipple-sparing mastectomies are highly preventive against breast cancer in a BRCA population. Although the follow-up remains relatively short, NSM should be offered as a breast cancer risk-reducing strategy to appropriate patients with BRCA mutations.

Authors
Jakub, JW; Peled, AW; Gray, RJ; Greenup, RA; Kiluk, JV; Sacchini, V; McLaughlin, SA; Tchou, JC; Vierkant, RA; Degnim, AC; Willey, S
MLA Citation
Jakub, JW, Peled, AW, Gray, RJ, Greenup, RA, Kiluk, JV, Sacchini, V, McLaughlin, SA, Tchou, JC, Vierkant, RA, Degnim, AC, and Willey, S. "Oncologic Safety of Prophylactic Nipple-Sparing Mastectomy in a Population With BRCA Mutations: A Multi-institutional Study." JAMA surgery (September 13, 2017).
PMID
28903167
Source
epmc
Published In
JAMA Surgery
Publish Date
2017
DOI
10.1001/jamasurg.2017.3422

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

The Financial Burden of Breast Cancer Treatment

Authors
Greenup, RA; Fish, L; Rushing, C; Peppercorn, J; Hyslop, T; Zafar, Y; Hwang, ES
MLA Citation
Greenup, RA, Fish, L, Rushing, C, Peppercorn, J, Hyslop, T, Zafar, Y, and Hwang, ES. "The Financial Burden of Breast Cancer Treatment." September 2017.
Source
wos-lite
Published In
Journal of Women's Health
Volume
26
Issue
9
Publish Date
2017
Start Page
1022
End Page
1022

Cost Effectiveness of Risk-Reducing Mastectomy versus Surveillance in BRCA Mutation Carriers with a History of Ovarian Cancer.

The appropriate management of breast cancer risk in BRCA mutation carriers following ovarian cancer diagnosis remains unclear. We sought to determine the survival benefit and cost effectiveness of risk-reducing mastectomy (RRM) among women with BRCA1/2 mutations following stage II-IV ovarian cancer.We constructed a decision model from a third-party payer perspective to compare annual screening with magnetic resonance imaging (MRI) and mammography to annual screening followed by RRM with reconstruction following ovarian cancer diagnosis. Survival, overall costs, and cost effectiveness were determined by decade at diagnosis using 2015 US dollars. All inputs were obtained from the literature and public databases. Monte Carlo probabilistic sensitivity analysis was performed with a $100,000 willingness-to-pay threshold.The incremental cost-effectiveness ratio (ICER) per year of life saved (YLS) for RRM increased with age and BRCA2 mutation status, with greater survival benefit demonstrated in younger patients with BRCA1 mutations. RRM delayed 5 years in 40-year-old BRCA1 mutation carriers was associated with 5 months of life gained (ICER $72,739/YLS), and in 60-year-old BRCA2 mutation carriers was associated with 0.8 months of life gained (ICER $334,906/YLS). In all scenarios, $/YLS and mastectomies per breast cancer prevented were lowest with RRM performed 5-10 years after ovarian cancer diagnosis.For most BRCA1/2 mutation carriers following ovarian cancer diagnosis, RRM performed within 5 years is not cost effective when compared with breast cancer screening. Imaging surveillance should be advocated during the first several years after ovarian cancer diagnosis, after which point the benefits of RRM can be considered based on patient age and BRCA mutation status.

Authors
Gamble, C; Havrilesky, LJ; Myers, ER; Chino, JP; Hollenbeck, S; Plichta, JK; Kelly Marcom, P; Shelley Hwang, E; Kauff, ND; Greenup, RA
MLA Citation
Gamble, C, Havrilesky, LJ, Myers, ER, Chino, JP, Hollenbeck, S, Plichta, JK, Kelly Marcom, P, Shelley Hwang, E, Kauff, ND, and Greenup, RA. "Cost Effectiveness of Risk-Reducing Mastectomy versus Surveillance in BRCA Mutation Carriers with a History of Ovarian Cancer." Annals of surgical oncology (July 11, 2017).
PMID
28699130
Source
epmc
Published In
Annals of Surgical Oncology
Publish Date
2017
DOI
10.1245/s10434-017-5995-z

Breast Cancer after Augmentation: Oncologic and Reconstructive Considerations among Women Undergoing Mastectomy.

Breast augmentation with subglandular versus subpectoral implants may differentially impact the early detection of breast cancer and treatment recommendations. The authors assessed the impact of prior augmentation on the diagnosis and management of breast cancer in women undergoing mastectomy.Breast cancer diagnosis and management were retrospectively analyzed in all women with prior augmentation undergoing therapeutic mastectomy at the authors' institution from 1993 to 2014. Comparison was made to all women with no prior augmentation undergoing mastectomy in 2010. Subanalyses were performed according to prior implant placement.A total of 260 women with (n = 89) and without (n = 171) prior augmentation underwent mastectomy for 95 and 179 breast cancers, respectively. Prior implant placement was subglandular (n = 27) or subpectoral (n = 63) (For five breasts, the placement was unknown). Breast cancer stage at diagnosis (p = 0.19) and detection method (p = 0.48) did not differ for women with and without prior augmentation. Compared to subpectoral augmentation, subglandular augmentation was associated with the diagnosis of invasive breast cancer rather than ductal carcinoma in situ (p = 0.01) and detection by self-palpation rather than screening mammography (p = 0.03). Immediate two-stage implant reconstruction was the preferred reconstructive method in women with augmentation (p < 0.01).Breast cancer stage at diagnosis was similar for women with and without prior augmentation. Among women with augmentation, however, subglandular implants were associated with more advanced breast tumors commonly detected on palpation rather than mammography. Increased vigilance in breast cancer screening is recommended among women with subglandular augmentation.Therapeutic, III.

Authors
Cho, EH; Shammas, RL; Phillips, BT; Greenup, RA; Hwang, ES; Hollenbeck, ST
MLA Citation
Cho, EH, Shammas, RL, Phillips, BT, Greenup, RA, Hwang, ES, and Hollenbeck, ST. "Breast Cancer after Augmentation: Oncologic and Reconstructive Considerations among Women Undergoing Mastectomy." Plastic and reconstructive surgery 139.6 (June 2017): 1240e-1249e.
PMID
28538550
Source
epmc
Published In
Plastic and Reconstructive Surgery
Volume
139
Issue
6
Publish Date
2017
Start Page
1240e
End Page
1249e
DOI
10.1097/prs.0000000000003342

Cost Implications of an Evidence-Based Approach to Radiation Treatment After Lumpectomy for Early-Stage Breast Cancer.

Breast cancer treatment costs are rising, and identification of high-value oncology treatment strategies is increasingly needed. We sought to determine the potential cost savings associated with an evidence-based radiation treatment (RT) approach among women with early-stage breast cancer treated in the United States.Using the National Cancer Database, we identified women with T1-T2 N0 invasive breast cancers treated with lumpectomy during 2011. Adjuvant RT regimens were categorized as conventionally fractionated whole-breast irradiation, hypofractionated whole-breast irradiation, and omission of RT. National RT patterns were determined, and RT costs were estimated using the Medicare Physician Fee Schedule.Within the 43,247 patient cohort, 64% (n = 27,697) received conventional RT, 13.3% (n = 5,724) received hypofractionated RT, 1.1% (n = 477) received accelerated partial-breast irradiation, and 21.6% (n = 9,349) received no RT. Among patients who were eligible for shorter RT or omission of RT, 57% underwent treatment with longer, more costly regimens. Estimated RT expenditures of the national cohort approximated $420.2 million during 2011, compared with $256.2 million had women been treated with the least expensive regimens for which they were safely eligible. This demonstrated a potential annual savings of $164.0 million, a 39% reduction in associated treatment costs.Among women with early-stage breast cancer after lumpectomy, use of an evidence-based approach illustrates an example of high-value care within oncology. Identification of high-value cancer treatment strategies is critically important to maintaining excellence in cancer care while reducing health care expenditures.

Authors
Greenup, RA; Blitzblau, RC; Houck, KL; Sosa, JA; Horton, J; Peppercorn, JM; Taghian, AG; Smith, BL; Hwang, ES
MLA Citation
Greenup, RA, Blitzblau, RC, Houck, KL, Sosa, JA, Horton, J, Peppercorn, JM, Taghian, AG, Smith, BL, and Hwang, ES. "Cost Implications of an Evidence-Based Approach to Radiation Treatment After Lumpectomy for Early-Stage Breast Cancer." Journal of oncology practice 13.4 (April 2017): e283-e290.
PMID
28291382
Source
epmc
Published In
Journal of Oncology Practice
Volume
13
Issue
4
Publish Date
2017
Start Page
e283
End Page
e290
DOI
10.1200/jop.2016.016683

Miniature spectral imaging device for wide-field quantitative functional imaging of the morphological landscape of breast tumor margins.

We have developed a portable, breast margin assessment probe leveraging diffuse optical spectroscopy to quantify the morphological landscape of breast tumor margins during breast conserving surgery. The approach presented here leverages a custom-made 16-channel annular photodiode imaging array (arranged in a 4 × 4 grid), a raster-scanning imaging platform with precision pressure control, and compressive sensing with an optimized set of eight wavelengths in the visible spectral range. A scalable Monte-Carlo-based inverse model is used to generate optical property [ ? s ? ( ? ) and ? a ( ? ) ] measures for each of the 16 simultaneously captured diffuse reflectance spectra. Subpixel sampling (0.75 mm) is achieved through incremental x , y raster scanning of the imaging probe, providing detailed optical parameter maps of breast margins over a 2 × 2 ?? cm 2 area in ? 9 ?? min . The morphological landscape of a tumor margin is characterized using optical surrogates for the fat to fibroglandular content ratio, which has demonstrated diagnostic utility in delineating tissue subtypes in the breast.

Authors
Nichols, BS; Llopis, A; Palmer, GM; McCachren, SS; Senlik, O; Miller, D; Brooke, MA; Jokerst, NM; Geradts, J; Greenup, R; Ramanujam, N
MLA Citation
Nichols, BS, Llopis, A, Palmer, GM, McCachren, SS, Senlik, O, Miller, D, Brooke, MA, Jokerst, NM, Geradts, J, Greenup, R, and Ramanujam, N. "Miniature spectral imaging device for wide-field quantitative functional imaging of the morphological landscape of breast tumor margins." Journal of biomedical optics 22.2 (February 2017): 26007-.
PMID
28241273
Source
epmc
Published In
Journal of Biomedical Optics
Volume
22
Issue
2
Publish Date
2017
Start Page
26007
DOI
10.1117/1.jbo.22.2.026007

The Effect of Hospital Volume on Breast Cancer Mortality.

The aim of this study was to determine whether hospital volume was associated with mortality in breast cancer, and what thresholds of case volume impacted survival.Prior literature has demonstrated improved survival with treatment at high volume centers among less common cancers requiring technically complex surgery.All adults (18 to 90 years) with stages 0-III unilateral breast cancer diagnosed from 2004 to 2012 were identified from the American College of Surgeons National Cancer Data Base (NCDB). A multivariable Cox proportional hazards model with restricted cubic splines was used to examine the association of annual hospital volume and overall survival, after adjusting for measured covariates. Intergroup comparisons of patient and treatment characteristics were conducted with X and analysis of variance (ANOVA). The log-rank test was used to test survival differences between groups. A multivariable Cox proportional hazards model was used to estimate hazard ratios (HRs) associated with each volume group.One million sixty-four thousand two hundred and fifty-one patients met inclusion criteria. The median age of the sample was 60 (interquartile range 50 to 70). Hospitals were categorized into 3 groups using restricted cubic spline analysis: low-volume (<148 cases/year), moderate-volume (148 to 298 cases/year), and high-volume (>298 cases/year). Treatment at high volume centers was associated with an 11% reduction in overall mortality for all patients (HR 0.89); those with stage 0-I, ER+/PR+ or ER+/PR- breast cancers derived the greatest benefit.Treatment at high volume centers is associated with improved survival for breast cancer patients regardless of stage. High case volume could serve as a proxy for the institutional infrastructure required to deliver complex multidisciplinary breast cancer treatment.

Authors
Greenup, RA; Obeng-Gyasi, S; Thomas, S; Houck, K; Lane, WO; Blitzblau, RC; Hyslop, T; Hwang, ES
MLA Citation
Greenup, RA, Obeng-Gyasi, S, Thomas, S, Houck, K, Lane, WO, Blitzblau, RC, Hyslop, T, and Hwang, ES. "The Effect of Hospital Volume on Breast Cancer Mortality." Annals of surgery (November 23, 2016).
PMID
27893532
Source
epmc
Published In
Annals of Surgery
Publish Date
2016

The Impact of the Affordable Care Act on North Carolinian Breast Cancer Patients Seeking Financial Support for Treatment.

The Affordable Care Act (ACA) was instated on 23 March 2010 to improve healthcare quality, reduce costs, and increase access. The Pretty in Pink Foundation (PIPF), a non-profit 501(C)(3) organization in North Carolina, provides financial assistance and in-kind support to individuals seeking help with breast cancer care. The objective of this study was to determine whether sociodemographic variables and treatment services varied among PIPF recipients since enactment of the ACA.North Carolinians who received financial assistance from the PIPF between 1 January 2013 and 31 December 2014 were included in the study, and the cohort was divided into two groups based on receipt of assistance before or after the enactment of the ACA. Descriptive statistics were tabulated as frequencies. Comparative univariate analysis between both groups was conducted using the χ (2) and Mann-Whitney U tests. All tests were two-sided and a p value <0.05 was considered statistically significant. All analyses were conducted using Stata.Overall, 1016 individuals fulfilled the inclusion criteria, and the median age of the cohort was 49 years (interquartile range 45-55). The ACA groups did not differ significantly by age, race, and sex; however, the groups varied with respect to income, employment, and clinical stage. In addition, the groups differed on the types of services for which they received financial assistance, but no difference was observed between groups with respect to insurance status.Since the enactment of the health insurance market component of the ACA, there has been a reduction in subjects receiving assistance from the PIPF; however, no change in their insurance status has been observed.

Authors
Obeng-Gyasi, S; Tolnitch, L; Greenup, RA; Shelley Hwang, E
MLA Citation
Obeng-Gyasi, S, Tolnitch, L, Greenup, RA, and Shelley Hwang, E. "The Impact of the Affordable Care Act on North Carolinian Breast Cancer Patients Seeking Financial Support for Treatment." Annals of surgical oncology 23.10 (October 2016): 3412-3417.
PMID
27411550
Source
epmc
Published In
Annals of Surgical Oncology
Volume
23
Issue
10
Publish Date
2016
Start Page
3412
End Page
3417
DOI
10.1245/s10434-016-5311-3

Self-Reported Factors Associated with Surgeon Comfort with Performing Contralateral Prophylactic Mastectomy

Authors
Bellavance, EC; Yao, K; Greenup, RA; Keune, JD; Lynch, J; Colyar, D; Tilburt, J; Hlubocky, F; Peppercorn, J
MLA Citation
Bellavance, EC, Yao, K, Greenup, RA, Keune, JD, Lynch, J, Colyar, D, Tilburt, J, Hlubocky, F, and Peppercorn, J. "Self-Reported Factors Associated with Surgeon Comfort with Performing Contralateral Prophylactic Mastectomy." October 2016.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
223
Issue
4
Publish Date
2016
Start Page
E16
End Page
E17

The promise and perils of shared decision-making in clinical practice

Authors
Greenup, RA; Peppercorn, J
MLA Citation
Greenup, RA, and Peppercorn, J. "The promise and perils of shared decision-making in clinical practice." Handbook of Health Decision Science. September 26, 2016. 293-305.
Source
scopus
Publish Date
2016
Start Page
293
End Page
305
DOI
10.1007/978-1-4939-3486-7_21

Surgeons’ Perspectives of Contralateral Prophylactic Mastectomy

Authors
Bellavance, E; Peppercorn, J; Kronsberg, S; Greenup, R; Keune, J; Lynch, J; Collyar, D; Magder, L; Tilburt, J; Hlubocky, F; Yao, K
MLA Citation
Bellavance, E, Peppercorn, J, Kronsberg, S, Greenup, R, Keune, J, Lynch, J, Collyar, D, Magder, L, Tilburt, J, Hlubocky, F, and Yao, K. "Surgeons’ Perspectives of Contralateral Prophylactic Mastectomy." Annals of Surgical Oncology 23.9 (September 2016): 2779-2787.
Source
crossref
Published In
Annals of Surgical Oncology
Volume
23
Issue
9
Publish Date
2016
Start Page
2779
End Page
2787
DOI
10.1245/s10434-016-5253-9

Can Vascular Patterns on Preoperative Magnetic Resonance Imaging Help Predict Skin Necrosis after Nipple-Sparing Mastectomy?

Nipple-areola complex (NAC) and skin flap ischemia and necrosis can occur after nipple-sparing mastectomy (NSM). The purpose of this study was to correlate vascular findings on MRI with outcomes in patients who underwent NSM.Female patients at a single institution who underwent NSM and had a preoperative breast MRI between 2010 and 2014 were identified. Medical records were reviewed for patient demographics, surgical factors, and complications. Magnetic resonance images were reviewed by 2 radiologists, blinded to outcomes, for the presence of dual vs single blood supply to the breast. The association between blood supply on MRI with ischemic and necrotic complications after NSM was analyzed.One hundred and sixty-four NSM procedures were performed in 105 patients (mean age 45.5 years, range 25 to 69 years) who had a preoperative MRI. The majority of procedures were performed for malignancy (89 of 164 [54.3%]) or prophylaxis (73 of 164 [44.5%]). Nipple-areola complex or skin flap ischemia or necrosis occurred in 40 (24.4%) breasts. Ischemia or necrosis after NSM was less likely to occur in breasts with dual compared with single blood supply (20.8% vs 38.2%; p = 0.03). There was no association between surgical complications and age, BMI, smoking history, previous radiation therapy, indication for NSM, surgical specimen weight, surgical incision type, reconstruction approach, or operating surgeon on univariate analysis.Preoperative MRI characterization of breast vascularity can be considered when planning NSM. The presence of a dual blood supply to the breast on MRI is associated with a decreased risk of nipple-areola complex and skin flap ischemia and necrosis after NSM.

Authors
Bahl, M; Pien, IJ; Buretta, KJ; Hwang, ES; Greenup, RA; Ghate, SV; Hollenbeck, ST
MLA Citation
Bahl, M, Pien, IJ, Buretta, KJ, Hwang, ES, Greenup, RA, Ghate, SV, and Hollenbeck, ST. "Can Vascular Patterns on Preoperative Magnetic Resonance Imaging Help Predict Skin Necrosis after Nipple-Sparing Mastectomy?." Journal of the American College of Surgeons 223.2 (August 2016): 279-285.
PMID
27182036
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
223
Issue
2
Publish Date
2016
Start Page
279
End Page
285
DOI
10.1016/j.jamcollsurg.2016.04.045

Physician Experience and Attitudes Toward Addressing the Cost of Cancer Care.

We surveyed US cancer doctors to examine current attitudes toward cost discussions and how they influence decision making and practice management.We conducted a self-administered, anonymous, electronic survey of randomly selected physician ASCO members to evaluate the frequency and nature of cost discussions reported by physicians, attitudes toward discussions of cost in clinics, and potential barriers.A total of 333 of 2,290 physicians responded (response rate [RR], 15%; adjusted RR after omitting nonpracticing physician ASCO members, 25%), Respondent practice settings were 45% academic and 55% community/private practice. Overall, 60% reported addressing costs frequently/always in clinic, whereas 40% addressed costs rarely/never. The largest reported barrier was lack of resources to guide discussions. Those who reported frequent discussions were significantly more likely to prioritize treatments in terms of cost and believed doctors should explain patient and societal costs. A total of 36%did not believe that doctors should discuss costs with patients. Academic practitioners were significantly less likely to discuss costs (odds ratio [OR], 0.41; P = .001) and felt less prepared for such discussions (OR, 0.492; P = .005) but were more likely to consider costs to the patient (OR, 2.68; P = .02) and society (OR, 1.822; P = .02).Although the majority of respondents believe it is important to consider out-of-pocket costs to patients, a substantial proportion do not discuss or consider costs of cancer care. Lack of consensus on the importance of such discussions and uncertainty regarding the optimal timing and content appear to be barriers to addressing costs of care with patients.

Authors
Altomare, I; Irwin, B; Zafar, SY; Houck, K; Maloney, B; Greenup, R; Peppercorn, J
MLA Citation
Altomare, I, Irwin, B, Zafar, SY, Houck, K, Maloney, B, Greenup, R, and Peppercorn, J. "Physician Experience and Attitudes Toward Addressing the Cost of Cancer Care." Journal of oncology practice 12.3 (March 2016): e281-248.
PMID
26883407
Source
epmc
Published In
Journal of Oncology Practice
Volume
12
Issue
3
Publish Date
2016
Start Page
e281
End Page
248
DOI
10.1200/jop.2015.007401

A mouse-human phase 1 co-clinical trial of a protease-activated fluorescent probe for imaging cancer.

Local recurrence is a common cause of treatment failure for patients with solid tumors. Intraoperative detection of microscopic residual cancer in the tumor bed could be used to decrease the risk of a positive surgical margin, reduce rates of reexcision, and tailor adjuvant therapy. We used a protease-activated fluorescent imaging probe, LUM015, to detect cancer in vivo in a mouse model of soft tissue sarcoma (STS) and ex vivo in a first-in-human phase 1 clinical trial. In mice, intravenous injection of LUM015 labeled tumor cells, and residual fluorescence within the tumor bed predicted local recurrence. In 15 patients with STS or breast cancer, intravenous injection of LUM015 before surgery was well tolerated. Imaging of resected human tissues showed that fluorescence from tumor was significantly higher than fluorescence from normal tissues. LUM015 biodistribution, pharmacokinetic profiles, and metabolism were similar in mouse and human subjects. Tissue concentrations of LUM015 and its metabolites, including fluorescently labeled lysine, demonstrated that LUM015 is selectively distributed to tumors where it is activated by proteases. Experiments in mice with a constitutively active PEGylated fluorescent imaging probe support a model where tumor-selective probe distribution is a determinant of increased fluorescence in cancer. These co-clinical studies suggest that the tumor specificity of protease-activated imaging probes, such as LUM015, is dependent on both biodistribution and enzyme activity. Our first-in-human data support future clinical trials of LUM015 and other protease-sensitive probes.

Authors
Whitley, MJ; Cardona, DM; Lazarides, AL; Spasojevic, I; Ferrer, JM; Cahill, J; Lee, C-L; Snuderl, M; Blazer, DG; Hwang, ES; Greenup, RA; Mosca, PJ; Mito, JK; Cuneo, KC; Larrier, NA; O'Reilly, EK; Riedel, RF; Eward, WC; Strasfeld, DB; Fukumura, D; Jain, RK; Lee, WD; Griffith, LG; Bawendi, MG; Kirsch, DG; Brigman, BE
MLA Citation
Whitley, MJ, Cardona, DM, Lazarides, AL, Spasojevic, I, Ferrer, JM, Cahill, J, Lee, C-L, Snuderl, M, Blazer, DG, Hwang, ES, Greenup, RA, Mosca, PJ, Mito, JK, Cuneo, KC, Larrier, NA, O'Reilly, EK, Riedel, RF, Eward, WC, Strasfeld, DB, Fukumura, D, Jain, RK, Lee, WD, Griffith, LG, Bawendi, MG, Kirsch, DG, and Brigman, BE. "A mouse-human phase 1 co-clinical trial of a protease-activated fluorescent probe for imaging cancer." Science translational medicine 8.320 (January 2016): 320ra4-.
PMID
26738797
Source
epmc
Published In
Science Translational Medicine
Volume
8
Issue
320
Publish Date
2016
Start Page
320ra4
DOI
10.1126/scitranslmed.aad0293

Evaluation of Pathologic Nipple Discharge: What is the Added Diagnostic Value of MRI?

To determine the diagnostic value of magnetic resonance imaging (MRI) for the evaluation of patients with pathologic nipple discharge.We performed a retrospective review of women with nipple discharge who underwent breast MRI between January 1, 2004, and December 31, 2013. Radiographic findings, pathology results, and clinical notes were reviewed. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI were calculated.Over a 10-year period, 103 women (mean age 46 years, range 25-72 years) underwent MRI for evaluation of nipple discharge. Ninety-one patients (88 %) underwent surgical excision or had clinical and/or radiographic follow-up at least 2 years after presentation and thus comprise the study population. Eleven (30 %) of 37 patients with MRIs coded as American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS) 4 of 5 were diagnosed with ductal carcinoma in situ (n = 6) or invasive adenocarcinoma (n = 5). Seven (64 %) of 11 patients diagnosed with malignancy had a negative mammographic and sonographic workup. None of the patients with MRIs coded as BI-RADS 1, 2, or 3 was diagnosed with malignancy immediately after presentation or during the 2-year follow-up period. The sensitivity and specificity of MRI for the detection of malignancy were 100 % (11 of 11) and 68 % (54 of 80), respectively. The positive predictive value and negative predictive value were 37 and 100 %, respectively.MRI is a valuable additional diagnostic tool for the evaluation of pathologic nipple discharge when conventional imaging is negative. A negative MRI in this symptomatic population may obviate the need for duct exploration and excision.

Authors
Bahl, M; Baker, JA; Greenup, RA; Ghate, SV
MLA Citation
Bahl, M, Baker, JA, Greenup, RA, and Ghate, SV. "Evaluation of Pathologic Nipple Discharge: What is the Added Diagnostic Value of MRI?." Annals of surgical oncology 22 Suppl 3 (December 2015): S435-S441.
PMID
26249144
Source
epmc
Published In
Annals of Surgical Oncology
Volume
22 Suppl 3
Publish Date
2015
Start Page
S435
End Page
S441
DOI
10.1245/s10434-015-4792-9

Trends in Treatment Patterns and Outcomes for Ductal Carcinoma In Situ.

Impact of contemporary treatment of pre-invasive breast cancer (ductal carcinoma in situ [DCIS]) on long-term outcomes remains poorly defined. We aimed to evaluate national treatment trends for DCIS and to determine their impact on disease-specific (DSS) and overall survival (OS).The Surveillance, Epidemiology, and End Results (SEER) registry was queried for patients diagnosed with DCIS from 1991 to 2010. Treatment pattern trends were analyzed using Cochran-Armitage trend test. Survival analyses were performed using inverse probability weights (IPW)-adjusted competing risk analyses for DSS and Cox proportional hazard regression for OS. All tests performed were two-sided.One hundred twenty-one thousand and eighty DCIS patients were identified. The greatest proportion of patients was treated with lumpectomy and radiation therapy (43.0%), followed by lumpectomy alone (26.5%) and unilateral (23.8%) or bilateral mastectomy (4.5%) with significant shifts over time. The rate of sentinel lymph node biopsy increased from 9.7% to 67.1% for mastectomy and from 1.4% to 17.8% for lumpectomy. Compared with mastectomy, OS was higher for lumpectomy with radiation (hazard ratio [HR] = 0.79, 95% confidence interval [CI] = 0.76 to 0.83, P < .001) and lower for lumpectomy alone (HR = 1.17, 95% CI = 1.13 to 1.23, P < .001). IPW-adjusted ten-year DSS was highest in lumpectomy with XRT (98.9%), followed by mastectomy (98.5%), and lumpectomy alone (98.4%).We identified substantial shifts in treatment patterns for DCIS from 1991 to 2010. When outcomes between locoregional treatment options were compared, we observed greater differences in OS than DSS, likely reflecting both a prevailing patient selection bias as well as clinically negligible differences in breast cancer outcomes between groups.

Authors
Worni, M; Akushevich, I; Greenup, R; Sarma, D; Ryser, MD; Myers, ER; Hwang, ES
MLA Citation
Worni, M, Akushevich, I, Greenup, R, Sarma, D, Ryser, MD, Myers, ER, and Hwang, ES. "Trends in Treatment Patterns and Outcomes for Ductal Carcinoma In Situ." Journal of the National Cancer Institute 107.12 (December 2015): djv263-.
PMID
26424776
Source
epmc
Published In
Journal of the National Cancer Institute
Volume
107
Issue
12
Publish Date
2015
Start Page
djv263
DOI
10.1093/jnci/djv263

Performance and Practice Guideline for the Use of Neoadjuvant Systemic Therapy in the Management of Breast Cancer.

The American Society of Breast Surgeons (ASBrS) sought to provide an evidence-based guideline on the use of neoadjuvant systemic therapy (NST) in the management of clinical stage II and III invasive breast cancer.A comprehensive nonsystematic review was performed of selected peer-reviewed literature published since 2000. The Education Committee of the ASBrS convened to develop guideline recommendations.A performance and practice guideline was prepared to outline the baseline assessment and perioperative management of patients with clinical stage II-III breast cancer under consideration for NST.Preoperative or NST is emerging as an important initial strategy for the management of invasive breast cancer. From the surgeon's perspective, the primary goal of NST is to increase the resectability of locally advanced breast cancer, increase the feasibility of breast-conserving surgery and sentinel node biopsy, and decrease surgical morbidity. To ensure optimal patient selection and efficient patient care, the guideline recommends: (1) baseline breast and axillary imaging; (2) minimally invasive biopsies of breast and axillary lesions; (3) determination of tumor biomarkers; (4) systemic staging; (5) care coordination, including referrals to medical oncology, radiation oncology, plastic surgery, social work, and genetic counseling, if indicated; (6) initiation of NST; (7) post-NST breast and axillary imaging; and (8) decision for surgery based on extent of disease at presentation, patient choice, clinical response to NST, and genetic testing results, if performed.

Authors
Holmes, D; Colfry, A; Czerniecki, B; Dickson-Witmer, D; Francisco Espinel, C; Feldman, E; Gallagher, K; Greenup, R; Herrmann, V; Kuerer, H; Malik, M; Manahan, E; O'Neill, J; Patel, M; Sebastian, M; Wheeler, A; Kass, R
MLA Citation
Holmes, D, Colfry, A, Czerniecki, B, Dickson-Witmer, D, Francisco Espinel, C, Feldman, E, Gallagher, K, Greenup, R, Herrmann, V, Kuerer, H, Malik, M, Manahan, E, O'Neill, J, Patel, M, Sebastian, M, Wheeler, A, and Kass, R. "Performance and Practice Guideline for the Use of Neoadjuvant Systemic Therapy in the Management of Breast Cancer." Annals of surgical oncology 22.10 (October 2015): 3184-3190. (Review)
PMID
26224406
Source
epmc
Published In
Annals of Surgical Oncology
Volume
22
Issue
10
Publish Date
2015
Start Page
3184
End Page
3190
DOI
10.1245/s10434-015-4753-3

Combining Prophylactic Oophorectomy with Mastectomy Does Not Adversely Affect Surgical Outcomes: Results from the NSQIP Database

Authors
Blau, J; Gamble, C; Anolik, RA; Havrilesky, L; Greenup, RA; Hollenbeck, ST
MLA Citation
Blau, J, Gamble, C, Anolik, RA, Havrilesky, L, Greenup, RA, and Hollenbeck, ST. "Combining Prophylactic Oophorectomy with Mastectomy Does Not Adversely Affect Surgical Outcomes: Results from the NSQIP Database." October 2015.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
221
Issue
4
Publish Date
2015
Start Page
S113
End Page
S113

Vascular Patterns on Preoperative Breast MRI Predict Ischemia and Necrosis after Nipple-Sparing Mastectomy

Authors
Pien, IJ; Bahl, M; Buretta, KJ; Greenup, RA; Ghate, SV; Hollenbeck, ST
MLA Citation
Pien, IJ, Bahl, M, Buretta, KJ, Greenup, RA, Ghate, SV, and Hollenbeck, ST. "Vascular Patterns on Preoperative Breast MRI Predict Ischemia and Necrosis after Nipple-Sparing Mastectomy." October 2015.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
221
Issue
4
Publish Date
2015
Start Page
S120
End Page
S120

Abstract SY36-03: Intraoperative molecular imaging with protease-activated fluorescent imaging agents

Authors
Whitley, MJ; Cardona, DM; Blazer, DG; Hwang, S; Greenup, RA; Mosca, PJ; Cahill, J; Mito, JK; Cuneo, KC; Larrier, N; O'Reilly, E; Spasojevic, I; Riedel, RF; Eward, WC; Griffith, LG; Bawendi, MG; Ferrer, J; Strasfeld, DB; Lee, WD; Brigman, B; Kirsch, DG
MLA Citation
Whitley, MJ, Cardona, DM, Blazer, DG, Hwang, S, Greenup, RA, Mosca, PJ, Cahill, J, Mito, JK, Cuneo, KC, Larrier, N, O'Reilly, E, Spasojevic, I, Riedel, RF, Eward, WC, Griffith, LG, Bawendi, MG, Ferrer, J, Strasfeld, DB, Lee, WD, Brigman, B, and Kirsch, DG. "Abstract SY36-03: Intraoperative molecular imaging with protease-activated fluorescent imaging agents." August 1, 2015.
Source
crossref
Published In
Cancer Research
Volume
75
Issue
15 Supplement
Publish Date
2015
Start Page
SY36-03
End Page
SY36-03
DOI
10.1158/1538-7445.AM2015-SY36-03

Diagnostic Value of Ultrasound in Female Patients With Nipple Discharge.

The purpose of this study was to assess the contribution of ultrasound to the evaluation of patients with pathologic nipple discharge.A retrospective review was conducted of the records of females who presented with nipple discharge between January 1, 2009, and December 31, 2011. Pathologic nipple discharge was defined as discharge with one or more of the following features: unilateral, clear or bloody, and spontaneous. Patients underwent bilateral mammography followed by ultrasound directed at the subareolar portion of the affected breast. Radiologic findings and pathologic results were reviewed.Over a 3-year period, 327 females (mean age, 48 years; range, 13-88 years) presented with nipple discharge. Among these patients, 273 (83%) underwent surgical excision or clinical or radiographic follow-up at least 2 years after presentation and composed the study population. Among the 273 patients, 262 (96%) underwent mammography and 246 (90%) underwent sonography. Among 252 patients who had at least one pathologic feature of nipple discharge and underwent surgical excision or at least 2 years of follow-up, a total of 20 (8%) cases of ductal carcinoma in situ (DCIS) or invasive adenocarcinoma were diagnosed. DCIS or invasive adenocarcinoma was diagnosed in eight patients with normal sonographic findings. For the detection of DCIS and invasive adenocarcinoma, the sensitivity and specificity of ultrasound were 56% (10/18) and 75% (170/228); the sensitivity and specificity of mammography were 15% (3/20) and 98% (237/242).For females presenting with pathologic nipple discharge, ultrasound is a useful diagnostic tool and may be worth including in the routine evaluation.

Authors
Bahl, M; Baker, JA; Greenup, RA; Ghate, SV
MLA Citation
Bahl, M, Baker, JA, Greenup, RA, and Ghate, SV. "Diagnostic Value of Ultrasound in Female Patients With Nipple Discharge." AJR. American journal of roentgenology 205.1 (July 2015): 203-208.
PMID
26102400
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
205
Issue
1
Publish Date
2015
Start Page
203
End Page
208
DOI
10.2214/ajr.14.13354

Abstract P1-15-10: Low utilization of hypofractionated radiotherapy for the treatment of early-stage breast cancer in the US

Authors
Mowery, YM; Greenup, RA; Houck, K; Palta, M; Horton, JK; Hwang, E-SS; Sosa, JA; Blitzblau, RC
MLA Citation
Mowery, YM, Greenup, RA, Houck, K, Palta, M, Horton, JK, Hwang, E-SS, Sosa, JA, and Blitzblau, RC. "Abstract P1-15-10: Low utilization of hypofractionated radiotherapy for the treatment of early-stage breast cancer in the US." May 1, 2015.
Source
crossref
Published In
Cancer Research
Volume
75
Issue
9 Supplement
Publish Date
2015
Start Page
P1-15-10
End Page
P1-15-10
DOI
10.1158/1538-7445.SABCS14-P1-15-10

Abstract P1-10-02: Adjuvant radiation after lumpectomy: A cost comparison of treatment patterns in 43,247 women from the National Cancer Data Base

Authors
Greenup, RA; Blitzblau, R; Houck, K; Horton, J; Howie, L; Palta, M; Mackey, A; Scheri, R; Sosa, JA; Taghian, AG; Peppercorn, J; Smith, BL; Hwang, ES
MLA Citation
Greenup, RA, Blitzblau, R, Houck, K, Horton, J, Howie, L, Palta, M, Mackey, A, Scheri, R, Sosa, JA, Taghian, AG, Peppercorn, J, Smith, BL, and Hwang, ES. "Abstract P1-10-02: Adjuvant radiation after lumpectomy: A cost comparison of treatment patterns in 43,247 women from the National Cancer Data Base." May 1, 2015.
Source
crossref
Published In
Cancer Research
Volume
75
Issue
9 Supplement
Publish Date
2015
Start Page
P1-10-02
End Page
P1-10-02
DOI
10.1158/1538-7445.SABCS14-P1-10-02

Data for manuscript "A Quantitative Diffuse Reflectance Imaging (QDRI) System for Comprehensive Surveillance of the Morphological Landscape in Breast Tumor Margins"

This repository contains the clinical patient data, along with representative images and mat files, of the data for the manuscript submitted to PLOS ONE entitled "A Quantitative Diffuse Reflectance Imaging (QDRI) System for Comprehensive Surveillance of the Morphological Landscape in Breast Tumor Margins"

Authors
Nichols, B; Brown, JQ; Schindler, CE; Wilke, LG; Mulvey, CS; Krieger, MS; Gallagher, J; Greenup, R; Geradts, J; von Windheim, J; Ramanujam, N
MLA Citation
Nichols, B, Brown, JQ, Schindler, CE, Wilke, LG, Mulvey, CS, Krieger, MS, Gallagher, J, Greenup, R, Geradts, J, von Windheim, J, and Ramanujam, N. "Data for manuscript "A Quantitative Diffuse Reflectance Imaging (QDRI) System for Comprehensive Surveillance of the Morphological Landscape in Breast Tumor Margins"." (March 3, 2015).
Website
http://hdl.handle.net/10161/9504
Source
manual
Publish Date
2015

Importance of Hospital Volume and Treatment Facility on Early-stage Breast Cancer

Authors
Greenup, RA; Houck, K; Sarma, D; Mackey, A; Sosa, JA; Peppercorn, J; Blitzblau, R; Hwang, E
MLA Citation
Greenup, RA, Houck, K, Sarma, D, Mackey, A, Sosa, JA, Peppercorn, J, Blitzblau, R, and Hwang, E. "Importance of Hospital Volume and Treatment Facility on Early-stage Breast Cancer." February 2015.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
22
Publish Date
2015
Start Page
S52
End Page
S52

A Phase I Clinical Trial of LUM015: A Protease-activated Fluorescent Imaging Agent to Detect Cancer during Surgery

Authors
Whitley, MJ; Cardona, DM; Blazer, DG; Hwang, E; Greenup, RA; Mosca, PJ; Cahill, J; Mito, JK; Cuneo, KC; Larrier, N; O'Reilly, E; Spasojevic, I; Riedel, RF; Eward, WC; Griffith, LG; Bawendi, MG; Kirsch, DG; Brigman, BE
MLA Citation
Whitley, MJ, Cardona, DM, Blazer, DG, Hwang, E, Greenup, RA, Mosca, PJ, Cahill, J, Mito, JK, Cuneo, KC, Larrier, N, O'Reilly, E, Spasojevic, I, Riedel, RF, Eward, WC, Griffith, LG, Bawendi, MG, Kirsch, DG, and Brigman, BE. "A Phase I Clinical Trial of LUM015: A Protease-activated Fluorescent Imaging Agent to Detect Cancer during Surgery." February 2015.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
22
Publish Date
2015
Start Page
S11
End Page
S12

The Impact of Socioeconomic and Geographic Factors on Ductal Carcinoma in situ Treatment

Authors
Sarma, D; Worni, M; Greenup, RA; Ryser, MD; Hwang, E
MLA Citation
Sarma, D, Worni, M, Greenup, RA, Ryser, MD, and Hwang, E. "The Impact of Socioeconomic and Geographic Factors on Ductal Carcinoma in situ Treatment." February 2015.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
22
Publish Date
2015
Start Page
S55
End Page
S55

Trends in Tumor Characteristics among DCIS Patients: A Population-based Analysis of 130,229 Patients

Authors
Worni, M; Ryser, MD; Guller, U; Greenup, RA; Hwang, SE
MLA Citation
Worni, M, Ryser, MD, Guller, U, Greenup, RA, and Hwang, SE. "Trends in Tumor Characteristics among DCIS Patients: A Population-based Analysis of 130,229 Patients." February 2015.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
22
Publish Date
2015
Start Page
S49
End Page
S49

A Quantitative Diffuse Reflectance Imaging (QDRI) System for Comprehensive Surveillance of the Morphological Landscape in Breast Tumor Margins.

In an ongoing effort to address the clear clinical unmet needs surrounding breast conserving surgery (BCS), our group has developed a next-generation multiplexed optical-fiber-based tool to assess breast tumor margin status during initial surgeries. Specifically detailed in this work is the performance and clinical validation of a research-grade intra-operative tool for margin assessment based on diffuse optical spectroscopy. Previous work published by our group has illustrated the proof-of-concept generations of this device; here we incorporate a highly optimized quantitative diffuse reflectance imaging (QDRI) system utilizing a wide-field (imaging area = 17 cm(2)) 49-channel multiplexed fiber optic probe, a custom raster-scanning imaging platform, a custom dual-channel white LED source, and an astronomy grade imaging CCD and spectrograph. The system signal to noise ratio (SNR) was found to be greater than 40 dB for all channels. Optical property estimation error was found to be less than 10%, on average, over a wide range of absorption (μa = 0-8.9 cm(-1)) and scattering (μs' = 7.0-9.7 cm(-1)) coefficients. Very low inter-channel and CCD crosstalk was observed (2% max) when used on turbid media (including breast tissue). A raster-scanning mechanism was developed to achieve sub-pixel resolution and was found to be optimally performed at an upsample factor of 8, affording 0.75 mm spatially resolved diffuse reflectance images (λ = 450-600 nm) of an entire margin (area = 17 cm(2)) in 13.8 minutes (1.23 cm(2)/min). Moreover, controlled pressure application at the probe-tissue interface afforded by the imaging platform reduces repeated scan variability, providing <1% variation across repeated scans of clinical specimens. We demonstrate the clinical utility of this device through a pilot 20-patient study of high-resolution optical parameter maps of the ratio of the β-carotene concentration to the reduced scattering coefficient. An empirical cumulative distribution function (eCDF) analysis is used to reduce optical property maps to quantitative distributions representing the morphological landscape of breast tumor margins. The optimizations presented in this work provide an avenue to rapidly survey large tissue areas on intra-operative time scales with improved sensitivity to regions of focal disease that may otherwise be overlooked.

Authors
Nichols, BS; Schindler, CE; Brown, JQ; Wilke, LG; Mulvey, CS; Krieger, MS; Gallagher, J; Geradts, J; Greenup, RA; Von Windheim, JA; Ramanujam, N
MLA Citation
Nichols, BS, Schindler, CE, Brown, JQ, Wilke, LG, Mulvey, CS, Krieger, MS, Gallagher, J, Geradts, J, Greenup, RA, Von Windheim, JA, and Ramanujam, N. "A Quantitative Diffuse Reflectance Imaging (QDRI) System for Comprehensive Surveillance of the Morphological Landscape in Breast Tumor Margins." PloS one 10.6 (January 2015): e0127525-.
PMID
26076123
Source
epmc
Published In
PloS one
Volume
10
Issue
6
Publish Date
2015
Start Page
e0127525
DOI
10.1371/journal.pone.0127525

Management of positive sub-areolar/nipple duct margins in nipple-sparing mastectomies.

We evaluated management of positive sub-areolar/nipple duct margins in nipple-sparing mastectomies (NSM) at our institution. Retrospective chart review of all NSM from January 2007 to April 2012 was performed and patient, tumor, and treatment information was collected. Sub-areolar/nipple duct margins included ductal tissue from within the nipple. Of 438 NSM, 22 (5%) had positive sub-areolar/nipple duct margins; 21 of 220 cancer-bearing breasts (10%) and 1 of 218 prophylactic mastectomies (0.5%). Positive margins included four with invasive lobular carcinoma and 18 with ductal carcinoma in situ (DCIS). Management included removal of eight nipples and nine nipple areola complexes (NAC). Four of 17 nipple/NAC specimens had evidence of residual DCIS and none had residual invasive cancer. The majority of nipple/NAC specimens excised for a positive margin had no residual malignancy. Future studies are needed to determine the extent of NAC tissue removal required for positive margins.

Authors
Camp, MS; Coopey, SB; Tang, R; Colwell, A; Specht, M; Greenup, RA; Gadd, MA; Brachtel, E; Austen, WG; Smith, BL
MLA Citation
Camp, MS, Coopey, SB, Tang, R, Colwell, A, Specht, M, Greenup, RA, Gadd, MA, Brachtel, E, Austen, WG, and Smith, BL. "Management of positive sub-areolar/nipple duct margins in nipple-sparing mastectomies." The breast journal 20.4 (July 2014): 402-407.
PMID
24890641
Source
epmc
Published In
The Breast Journal
Volume
20
Issue
4
Publish Date
2014
Start Page
402
End Page
407
DOI
10.1111/tbj.12279

Trends in treatment patterns and outcomes for DCIS patients: A SEER population-based analysis.

Authors
Womi, M; Greenup, RA; Mackey, AM; Akushevich, I; Hwang, SE
MLA Citation
Womi, M, Greenup, RA, Mackey, AM, Akushevich, I, and Hwang, SE. "Trends in treatment patterns and outcomes for DCIS patients: A SEER population-based analysis." May 20, 2014.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
32
Issue
15
Publish Date
2014

Physician experience and attitudes toward addressing the cost of cancer care.

Authors
Altomare, I; Irwin, BB; Zafar, Y; Houck, K; Maloney, B; Greenup, RA; Peppercorn, JM
MLA Citation
Altomare, I, Irwin, BB, Zafar, Y, Houck, K, Maloney, B, Greenup, RA, and Peppercorn, JM. "Physician experience and attitudes toward addressing the cost of cancer care." May 20, 2014.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
32
Issue
15
Publish Date
2014

Cost implications of the SSO-ASTRO consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stage I and II invasive breast cancer.

Authors
Greenup, RA; Peppercorn, J; Worni, M; Hwang, ES
MLA Citation
Greenup, RA, Peppercorn, J, Worni, M, and Hwang, ES. "Cost implications of the SSO-ASTRO consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stage I and II invasive breast cancer." Annals of surgical oncology 21.5 (May 2014): 1512-1514.
PMID
24577813
Source
epmc
Published In
Annals of Surgical Oncology
Volume
21
Issue
5
Publish Date
2014
Start Page
1512
End Page
1514
DOI
10.1245/s10434-014-3605-x

Incidence Patterns of Breast Cancer among Women 35 and Younger at Diagnosis

Authors
Greenup, RA; Arbeev, K; Akushevich, I; Mackey, A; Tolnitch, L; Hwang, ES
MLA Citation
Greenup, RA, Arbeev, K, Akushevich, I, Mackey, A, Tolnitch, L, and Hwang, ES. "Incidence Patterns of Breast Cancer among Women 35 and Younger at Diagnosis." February 2014.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
21
Publish Date
2014
Start Page
S56
End Page
S57

Application of ACOSOG Z0011 criteria reduces perioperative costs.

BACKGROUND: The ACOSOG Z0011 (Z0011) trial concluded that sentinel lymph node biopsy (SLNB) without completion axillary lymph node dissection (ALND) provides excellent regional control in women with T1-T2 sentinel lymph node (SLN) positive breast cancers receiving breast conservation therapy. We determined whether application of Z0011 guidelines would reduce costs. METHODS: A retrospective chart review of patients with invasive breast cancer treated with lumpectomy and SLNB at our institution during 2009 was performed. We determined the number of overnight hospital admissions following ALND and estimated costs pertaining to the perioperative surgical management of the axilla patients actually received, and compared those to the estimated number of inpatient days and perioperative costs if Z0011 guidelines had been followed for eligible patients. The 2011 Medicare Fee Schedule was used to estimate costs for procedures, and costs for OR time were estimated using procedure length and cost of OR time per minute. RESULTS: A total of 71 patients underwent lumpectomy with SLNB and had at least 1 positive SLN. Estimated costs related to perioperative surgical management of the axilla were $322,775, and there were 36 overnight admissions. Applying Z0011 criteria, 51 patients (72%) would have been eligible to forego completion ALND. Estimated costs would have been $264,513 with 13 overnight admissions, translating into a cost savings of $58,262 and 23 fewer overnight admissions. CONCLUSION: Application of Z0011 guidelines resulted in cost savings, with a 64% reduction in inpatient hospital days and an 18% reduction in early perioperative costs.

Authors
Camp, MS; Greenup, RA; Taghian, A; Coopey, SB; Specht, M; Gadd, M; Hughes, K; Smith, BL
MLA Citation
Camp, MS, Greenup, RA, Taghian, A, Coopey, SB, Specht, M, Gadd, M, Hughes, K, and Smith, BL. "Application of ACOSOG Z0011 criteria reduces perioperative costs." Ann Surg Oncol 20.3 (March 2013): 836-841.
PMID
23010735
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
20
Issue
3
Publish Date
2013
Start Page
836
End Page
841
DOI
10.1245/s10434-012-2664-0

Outcomes after Mastectomy for Node-positive Breast Cancer: Comparison of Women Treated With and Without Completion Axillary Dissection at NCCN Cancer Centers

Authors
Greenup, RA; Breslin, T; Edge, SB; Hughes, ME; Hwang, ES; Laronga, C; Marcom, P; Moy, B; Otteson, RA; Rugo, H; Wilson, JL; Wong, Y; Weeks, JC
MLA Citation
Greenup, RA, Breslin, T, Edge, SB, Hughes, ME, Hwang, ES, Laronga, C, Marcom, P, Moy, B, Otteson, RA, Rugo, H, Wilson, JL, Wong, Y, and Weeks, JC. "Outcomes after Mastectomy for Node-positive Breast Cancer: Comparison of Women Treated With and Without Completion Axillary Dissection at NCCN Cancer Centers." February 2013.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
20
Publish Date
2013
Start Page
S9
End Page
S9

Prevalence of BRCA mutations among women with triple-negative breast cancer (TNBC) in a genetic counseling cohort

Background: Revised NCCN guidelines recommend that women ≤60 years with triple-negative breast cancer (TNBC) be referred for consideration of genetic counseling. Small, homogeneous samples have limited evaluation of BRCA mutation prevalence among different ethnicities affected by TNBC subtype. We sought to determine whether the prevalence of BRCA mutations within a TNBC cohort differs by demographic factors. Methods: We performed a retrospective review of patients with TNBC referred for genetic counseling at two academic Hereditary Cancer Clinics between 2000 and 2012. Demographic data were collected, including age at diagnosis and race/ethnicity. Race was categorized as African American (AA), Ashkenazi Jewish (AJ), Asian, Caucasian, Hispanic, or other. Primary outcome was BRCA mutation status, analyzed by race/ethnicity and age at diagnosis. Results: A total of 469 patients with TNBC who underwent testing for BRCA genetic mutations were identified, of which 450 patients had evaluable BRCA testing results; 139 (30.8 %) had confirmed BRCA1 (n = 106) or BRCA2 (n = 32) mutations. BRCA mutation prevalence differed by ethnicity and race: AA (20.4 %), AJ (50 %), Asian (28.5 %), Caucasian (33.3 %), and Hispanic (20 %). The prevalence of genetic mutations also differed by age at diagnosis: <40 years (43.8 %), 40-49 years (27.4 %), 50-59 years (25.3 %), 60-69 years (12.5 %), and >70 years (16.6 %). Conclusions: The prevalence of genetic mutations among women with TNBC referred for genetic counseling is high and differs significantly by ethnicity/race and age. This data helps to refine mutation risk estimates among women with TNBC, allowing for more personalized genetic counseling potentially aiding in improved patient decision-making. © 2013 Society of Surgical Oncology.

Authors
Greenup, R; Buchanan, A; Lorizio, W; Rhoads, K; Chan, S; Leedom, T; King, R; McLennan, J; Crawford, B; Marcom, PK; al, E
MLA Citation
Greenup, R, Buchanan, A, Lorizio, W, Rhoads, K, Chan, S, Leedom, T, King, R, McLennan, J, Crawford, B, Marcom, PK, and al, E. "Prevalence of BRCA mutations among women with triple-negative breast cancer (TNBC) in a genetic counseling cohort." Annals of Surgical Oncology 20.10 (2013): 3254-3258.
Source
scival
Published In
Annals of Surgical Oncology
Volume
20
Issue
10
Publish Date
2013
Start Page
3254
End Page
3258
DOI
10.1245/s10434-013-3205-1

New treatment paradigms for patients with ductal carcinoma in situ

One of the most poorly understood clinical diagnoses in breast cancer is ductal carcinoma in situ (DCIS), which now accounts for almost one third of all mammographically detected malignancies. Detection and diagnosis of DCIS have improved, and mature data from randomized controlled trials of lumpectomy for DCIS have provided some measure of the magnitude of benefit to be derived from adjuvant treatments. The past 5 years have seen the emergence of molecular prognostic tools, which together with clinical factors have the potential to allow better selection of individualized therapies for these heterogeneous lesions. Ongoing and future research to identify which patients with DCIS can be safely managed with active surveillance are underway and will create opportunities to better understand the biology of this disease, thereby informing treatment strategies that are more closely aligned with the invasive potential of specific DCIS subtypes. © 2013 Springer Science+Business Media New York.

Authors
Mackey, A; Greenup, R; Hwang, ES
MLA Citation
Mackey, A, Greenup, R, and Hwang, ES. "New treatment paradigms for patients with ductal carcinoma in situ." Current Breast Cancer Reports 5.2 (2013): 86-98.
Source
scival
Published In
Current Breast Cancer Reports
Volume
5
Issue
2
Publish Date
2013
Start Page
86
End Page
98
DOI
10.1007/s12609-013-0109-9

Cost comparison of radiation treatment options after lumpectomy for breast cancer.

BACKGROUND: Radiation therapy (RT) after lumpectomy for breast cancer can be delivered with several different regimens. We evaluated a cost-minimization strategy to select among RT options. METHODS: An institutional review board (IRB)-approved retrospective review identified a sample of 100 women who underwent lumpectomy for invasive or in situ breast cancer during 2009. Post lumpectomy RT options included: no radiation in women ≥70 years [T1N0, estrogen receptor (ER)+] per Cancer and Leukemia Group B (CALGB) 9343 (no-RT), accelerated external-beam partial-breast irradiation (APBI), and Canadian fractionation (C-RT), as alternatives to standard whole-breast radiation therapy (WBRT). Eligibility for RT regimens was based on published criteria. RT costs were estimated using the 2011 US Medicare Physician Fee Schedule and average Current Procedural Terminology (CPT) codes billed per regimen at our institution. Costs were modeled in a 1,000-patient theoretical cohort. RESULTS: Median patient age was 56.5 years (range 32-93 years). Tumor histology included invasive ductal cancer (78 %), ductal carcinoma in situ (DCIS) (15 %), invasive lobular cancer (6 %), and mixed histology (1 %). Median tumor size was 1 cm (range 0.2-5 cm). Estimated per-patient cost of radiation was US$5,341.81 for APBI, US$9,121.98 for C-RT, and US$13,358.37 for WBRT. When patients received the least expensive radiation regimen for which they were eligible, 14 % received no-RT, 44 % received APBI, 7 % received C-RT, and 35 % defaulted to WBRT. Using a cost-minimization strategy, estimated RT costs were US$7.67 million, versus US$13.36 million had all patients received WBRT, representing cost savings of US$5.69 million per 1,000 patients treated. CONCLUSIONS: A cost-minimization strategy results in a 43 % reduction in estimated radiation costs among women undergoing breast conservation.

Authors
Greenup, RA; Camp, MS; Taghian, AG; Buckley, J; Coopey, SB; Gadd, M; Hughes, K; Specht, M; Smith, BL
MLA Citation
Greenup, RA, Camp, MS, Taghian, AG, Buckley, J, Coopey, SB, Gadd, M, Hughes, K, Specht, M, and Smith, BL. "Cost comparison of radiation treatment options after lumpectomy for breast cancer." Ann Surg Oncol 19.10 (October 2012): 3275-3281.
PMID
22851048
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
19
Issue
10
Publish Date
2012
Start Page
3275
End Page
3281
DOI
10.1245/s10434-012-2546-5

Association of pathologic complete response following neoadjuvant chemotherapy with survival among young women with breast cancer

Authors
Greenup, RA; Bardia, A; Buckley, JM; Niemierko, A; Camp, M; Coopey, S; Gadd, M; Schapira, L; Taghian, AG; Smith, BL; Specht, MC
MLA Citation
Greenup, RA, Bardia, A, Buckley, JM, Niemierko, A, Camp, M, Coopey, S, Gadd, M, Schapira, L, Taghian, AG, Smith, BL, and Specht, MC. "Association of pathologic complete response following neoadjuvant chemotherapy with survival among young women with breast cancer." May 20, 2012.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
15
Publish Date
2012

Clinical Utility and Effectiveness of Neoadjuvant Chemotherapy for Young Women with Breast Cancer

Authors
Greenup, RA; Bardia, A; Buckley, J; Camp, MS; Gadd, MA; Hughes, K; Coopey, SB; Niemierko, A; Isakoff, SJ; Taghian, AG; Specht, MC; Smith, BL
MLA Citation
Greenup, RA, Bardia, A, Buckley, J, Camp, MS, Gadd, MA, Hughes, K, Coopey, SB, Niemierko, A, Isakoff, SJ, Taghian, AG, Specht, MC, and Smith, BL. "Clinical Utility and Effectiveness of Neoadjuvant Chemotherapy for Young Women with Breast Cancer." February 2012.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
19
Publish Date
2012
Start Page
S58
End Page
S58

Evaluation of “other” neuroendocrine tumors of the pancreas

Authors
Greenup, RA; Wang, TS; Evans, DB
MLA Citation
Greenup, RA, Wang, TS, and Evans, DB. "Evaluation of “other” neuroendocrine tumors of the pancreas." The Handbook of Endocrine Surgery. January 1, 2011. 397-404.
Source
scopus
Publish Date
2011
Start Page
397
End Page
404
DOI
10.1142/9789814293204_0033

Organ Donation after Traumatic Cardiopulmonary Arrest among Pediatric Donors

Authors
Greenup, RA; Calkins, CM; Sato, TT; Cassidy, L; Shames, BD
MLA Citation
Greenup, RA, Calkins, CM, Sato, TT, Cassidy, L, and Shames, BD. "Organ Donation after Traumatic Cardiopulmonary Arrest among Pediatric Donors." April 2010.
Source
wos-lite
Published In
American Journal of Transplantation
Volume
10
Publish Date
2010
Start Page
366
End Page
366

Incidence and risk factors for venous thromboembolism in critically ill children after trauma.

BACKGROUND: Venous thromboembolism (VTE) causes major morbidity in adults after trauma, occurring in up to 50% of patients without prophylaxis. The incidence of VTE after trauma is lower in children. No study has measured the incidence of and risk factors for VTE in critically ill children after trauma. METHODS: Nested case-control study of children, younger than 18 years, admitted to the pediatric intensive care unit at a level I trauma center. Three controls were selected for each identified VTE case. RESULTS: Nine of 144 children admitted to the pediatric intensive care unit after trauma developed VTE (incidence 6.2%, 95% confidence interval [CI] 2.3-10.2), with a median age of 8.6 years (range, 2.3-17.9). VTE was diagnosed at a median of 9 days after admission, with 67% of VTE located at the site of previous or existing central venous line (CVL). Significant risk factors for thrombosis included parenteral nutrition (odds ratio [OR] 20, 95% CI 1.9-227), CVL (OR 19, 95% CI 2-178), deep sedation (OR 13, 95% CI 1.6-48), neuromuscular blockade (OR 10, 95% CI 1.4-70), inotropic support (OR 10, 95% CI 1.7-59), and recombinant factor VIIa administration (p = 0.012, OR not calculable). Logistic analysis found a 7.9-fold increase in the odds of developing VTE for each additional CVL (p = 0.005), a threefold increase with each additional risk factor present (p = 0.009), and a 1.3-fold increase for an increase in injury severity (p = 0.03). VTE was not associated with sepsis, spinal cord injury, fracture, or elevated D-dimer level. CONCLUSIONS: VTE is not a rare event in critically ill children after trauma. Most patients developing thrombosis have multiple risk factors, including poor perfusion, immobility, and presence of a CVL.

Authors
Hanson, SJ; Punzalan, RC; Greenup, RA; Liu, H; Sato, TT; Havens, PL
MLA Citation
Hanson, SJ, Punzalan, RC, Greenup, RA, Liu, H, Sato, TT, and Havens, PL. "Incidence and risk factors for venous thromboembolism in critically ill children after trauma." J Trauma 68.1 (January 2010): 52-56.
PMID
20065757
Source
pubmed
Published In
Journal of Trauma - Injury, Infection and Critical Care
Volume
68
Issue
1
Publish Date
2010
Start Page
52
End Page
56
DOI
10.1097/TA.0b013e3181a74652

Quality of life in cancer survivors: The surgeon's role

Authors
Greenup, RA; Lal, A; Walsh, MC; Pappas, S; Trentham-Dietz, A
MLA Citation
Greenup, RA, Lal, A, Walsh, MC, Pappas, S, and Trentham-Dietz, A. "Quality of life in cancer survivors: The surgeon's role." September 2009.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
209
Issue
3
Publish Date
2009
Start Page
S106
End Page
S106

The other side of the stethoscope.

Authors
Greenup, RA
MLA Citation
Greenup, RA. "The other side of the stethoscope." Acad Psychiatry 32.1 (January 2008): 1-2.
PMID
18270273
Source
pubmed
Published In
Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry
Volume
32
Issue
1
Publish Date
2008
Start Page
1
End Page
2
DOI
10.1176/appi.ap.32.1.1

Perspectives on Being a Mom and a Surgical Trainee. Juggling these Roles?

Authors
Greenup, R
MLA Citation
Greenup, R. "Perspectives on Being a Mom and a Surgical Trainee. Juggling these Roles?." Current Surgery 63.4 (2006): 297-298.
PMID
16843785
Source
scival
Published In
Current Surgery
Volume
63
Issue
4
Publish Date
2006
Start Page
297
End Page
298
DOI
10.1016/j.cursur.2006.04.002
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