It's necessary to re-evaluate these variants in large GWAS datasets.Of these 279 variants, data were obtained for 228 from GWAS conducted within the Asian Breast Cancer Consortium (24,206 cases and 24,775 controls) and the Breast Cancer Association Consortium (122,977 cases and 105,974 controls of European ancestry). View details for DOI 10.1200/CCI.21.00031. However, access to genetic counseling is a barrier and must be addressed to ensure equity in testing. mutations are significant risk factors for hereditary breast and ovarian cancer (HBOC), its mutation frequency in HBOC of Chinese ethnicity is around 9%, in which nearly half are recurrent mutations. One-year adjuvant trastuzumab (AT) therapy, with or without anthracyclines, increases disease-free and overall survival in early-stage HER2/neu-positive breast cancer. He is also charged with . Katz, S. J., Tocco, R., Hawley, S. T., An, L., Hodan, R., Ward, K. C., Kurian, A. W. Association of germline genetic testing results with chemotherapy regimens received by women with early-stage breast cancer. Survivors who scored <8 on ISI were categorized as "good sleepers," survivors with ISI 8 were categorized as "bad sleepers. In BCAC, increasing PRS313 was associated with lower grade, hormone receptor-positive status, and smaller tumor size. Rates of patient portal messaging did not differ between English-speaking and LEP groups on multivariable analysis; however, patients with LEP were less likely to have a portal account (adjusted OR, 0.89; 95% CI, 0.83 to 0.96). [13] In 2020, she was elected to the American Society for Clinical Investigation.[14]. During the follow-up period, 9% of patients (95% CI, 3% to 19%) developed second cancers, and in 14% of patients (95% CI, 7% to 26%), a first-degree relative developed cancer, some of which were detected by recommended screening.Patients with a pathogenic variant in a less familiar cancer susceptibility gene report high adherence to risk-reducing interventions. Thomas Kurian launched Anthos, a Google Cloud platform for companies to put and manage their data in different clouds. Horton, C., LaDuca, H., Blanco, K., Lo, M., Speare, V., Dolinsky, J., Kurian, A. Incidence rates were calculated by subtype (triple-negative; HR+/HER2-; HR+/HER2+; HR-/HER2+), and logistic regression was used to evaluate differences in subtype characteristics by age group.AYAs had higher proportions of HR+/HER2+, triple-negative and HR-/HER2+ breast cancer subtypes and higher proportions of patients of non-White race/ethnicity than did older women. Kurian, A. W., Ward, K. C., Howlader, N., Deapen, D., Hamilton, A. S., Mariotto, A., Miller, D., Penberthy, L. S., Katz, S. J. Cascade Genetic Testing of Relatives for Hereditary Cancer Risk: Results of an Online Initiative. Surveys were sent 2months post-surgery, (70% response rate, n=5080). Residual breast cancer correlation within families was strong, suggesting substantial risk heterogeneity in women without BRCA1 or BRCA2 mutations, with some 3.4% of them accounting for roughly one third of breast cancer cases.These results support the practice of advising noncarriers that they do not have any increase in breast cancer risk attributable to the family-specific BRCA1 or BRCA2 mutation. Zhou, R., Kozlov, A., Chen, S., Okamoto, S., Ikeda, D. M., DeMartini, W., Kurian, A. W., Sledge, G. W., Telli, M. L., Lee, K., Mantz, A. View details for DOI 10.1158/1055-9965.EPI-12-0149. Kurian, A. W., Ward, K. C., Abrahamse, P., Hamilton, A. S., Deapen, D., Morrow, M., Katz, S. J. Compared with women whose test results were negative, those with BRCA1/2 pathogenic variants were more likely to receive bilateral mastectomy for a unilateral tumor (61.7% vs 24.3%; OR, 5.52, 95% CI, 4.73-6.44), less likely to receive postlumpectomy radiotherapy (50.2% vs 81.5%; OR, 0.22, 95% CI, 0.15-0.32), and more likely to receive chemotherapy for early-stage, ER/PR-positive disease (38.0% vs 30.3%; OR, 1.76 (95% CI, 1.31-2.34). steroidal aromatase inhibitors (NSAI). We used Cox regression to estimate risk associations with log-transformed weight and BMI after adjusting for underlying familial risk. The method is illustrated in a breast cancer study, where the goal is to estimate the prevalence of a specific genetic pathogenic variant. Idos, G., Roth, K. G., Naghi, L., Ricker, C., Culver, J., Sturgeon, D., Kingham, K., Koff, R., Chun, N. M., Rowe-Teeter, C., Hartman, A., Allen, B., Evans, B., Mills, M., Hong, C., McDonnell, K., Ladabaum, U., Ford, J. M., Gruber, S. B., Kurian, A. W. Expanded yield of multiplex panel testing in fully accrued prospective trial. Stanford is currently not accepting patients for this trial. Oncol. We adapted the model into an online tool to support shared decision making.We compared strategies on cancer incidence and survival to age 70 years; for example, PO plus PM at age 25 years optimizes both outcomes (incidence, 4% to 11%; survival, 80% to 83%), whereas PO at age 40 years plus MRI screening offers less effective prevention, yet similar survival (incidence, 36% to 57%; survival, 74% to 80%). To estimate subtype-specific lifetime breast cancer risks, we took advantage of population-based data for which information regarding tumor expression of estrogen receptor (ER), progesterone receptor (PR) and HER2/neu (HER2) was newly available.We included women whose breast cancer was diagnosed in the state of California from 2006 to 2007 and was reported to the National Cancer Institute's Surveillance, Epidemiology and End Results Program (N = 40,936). HLA alleles (n=175) with info scores greater than 0.8 and frequencies greater than 0.01 were included (resolution at two-digit level: 71; four-digit level: 104). Propensity analysis showed similar results.Use of bilateral mastectomy increased significantly throughout California from 1998 through 2011 and was not associated with lower mortality than that achieved with breast-conserving surgery plus radiation. The objective of this study was to assess patients' perspectives regarding the impact of COVID-19 on their experiences, including their cancer care, emotional and mental health, and social determinants of health, and to evaluate whether these outcomes differed by cancer stage.MATERIALS AND METHODS: We conducted a survey among adults with cancer across the United States from April 1, 2020 to August 26, 2020 using virtual snowball sampling strategy in collaboration with professional organizations, cancer care providers, and patient advocacy groups. Idos, G., Kurian, A. W., Ricker, C., Sturgeon, D., Culver, J., Kingham, K., Koff, R., Chun, N. M., Rowe-Teeter, C., Kidd, J., Evans, B., Brown, K., Mills, M., Ma, C., Hong, C., McDonnell, K., Ladabaum, U., Ford, J. M., Gruber, S. B. Computing the cost of care per day of breast cancer survivor care. We used simulation modeling to fill these gaps.We simulated women eligible for TAILORx using joint distributions of patient and tumor characteristics and RS from TAILORx data; treatment effects by RS from other trials; and competing mortality from the Surveillance, Epidemiology, and End Results program database. In a separate model, the odds ratios were 1.21 (95% CI, 0.54 to 2.68) and 0.90 (95% CI, 0.50 to 1.62) for pathogenic variant and variant of uncertain significance, respectively, versus a negative test (the reference group).Compared with BRCA1/2 testing alone, multigene panel testing was not associated with increased cancer worry after diagnosis of breast cancer. These results suggest that precision medicine may help optimize cancer treatment across health care settings. Breast cancer patients' misunderstanding of their systemic cancer recurrence risk has consequences on decision-making and quality of life. The rate of a variant of uncertain significance (VUS) result was higher in nonwhites than whites (36% vs. 27%; P=2E-4). Continued efforts to ensure prompt return to screening and minimize delays in evaluation of symptomatic women can largely mitigate the effects of the initial pandemic-associated disruptions. See the full leadership team at Craft. Preliminary information about the Many patients desired to talk to providers about the financial impact of cancer (15.2% of whites, 31.1% of blacks, 30.3% of Latinas, and 25.4% of Asians). Early life and education [ edit] Spatial enrichment analysis showed immune mixed and compartmentalized tumors, coinciding with expression of PD1, PD-L1, and IDO in a cell-type- and location-specific manner. Compared with cisgender heterosexual patients, those from SGM groups were hypothesized to have disparities in 1 or more of these quality metrics.Ninety-two patients from SGM groups were matched to 92 cisgender heterosexual patients (n=184). The authors incorporated records from the population-based California Cancer Registry and then linked EMR-California Cancer Registry data sets of Community and University patients.The authors initially identified 8210 University patients and 5770 Community patients; linked data sets revealed a 16% patient overlap, yielding 12,109 unique patients. A., Troester, M. A., Vachon, C. M., van Veen, E. M., Wang, X. n., Weinberg, C. R., Weltens, C. n., Willett, W. n., Winham, S. J., Wolk, A. n., Yang, X. R., Zheng, W. n., Ziogas, A. n., Dunning, A. M., Pharoah, P. D., Schmidt, M. K., Kraft, P. n., Easton, D. F., Milne, R. L., Garca-Closas, M. n., Chang-Claude, J. n. Association of a Polygenic Risk Score With Breast Cancer Among Women Carriers of High- and Moderate-Risk Breast Cancer Genes. Risk-reducing salpingo-oophorectomy was associated with a reduced risk of breast cancer for BRCA1 and BRCA2 pathogenic variant carriers within 5 years after surgery (hazard ratios [HRs], 0.28 [95% CI,0.10-0.63] and 0.19 [95% CI, 0.06-0.71], respectively), whereas the corresponding HRs were weaker after 5 years postsurgery (HRs, 0.64 [95% CI,0.38-0.97] and 0.99 [95% CI; 0.84-1.00], respectively). View details for DOI 10.1158/1055-9965.EPI-15-1326. To search for additional genetic susceptibility loci for breast cancer, here we perform a meta-analysis of data from genome-wide association studies (GWAS) conducted in Asians (24,206 cases and 24,775 controls) and European descendants (122,977 cases and 105,974 controls). Among 1569 patients (65.5%) without high genetic risk or an identified mutation, 598 (39.3%) reported a surgeon recommendation against CPM, of whom only 12 (1.9%) underwent CPM, but among the 746 (46.8%) of these women who received no recommendation for or against CPM from a surgeon, 148 (19.0%) underwent CPM.Many patients consider CPM, but knowledge about the procedure is low and discussions with surgeons appear to be incomplete. Multivariable predictors of NAC treatment were stage (III), younger age (<40 yrs), Black or Hispanic race/ethnicity versus non-Hispanic White (OR 1.10, 95% confidence interval (CI) 1.05-1.16), and care at a National Cancer Institute (NCI)-designated center (OR 1.70, CI 1.58-1.82). Methods: We conducted semi-structured interviews with 11 major US payers, covering >160 million lives. B., Zhou, R., Kozlov, A., DeMartini, W., Chen, S., Okamoto, S., Ikeda, D. M., Mattonen, S. A., Napel, S., Alkim, E., Sledge, G. W., Kurian, A. W., Liu, M., Telli, M. L., Itakura, H. Harnessing artificial intelligence to automate delineation of volumetric breast cancers from magnetic resonance imaging to improve tumor characterization. [19] He was also the fifth highest-paid tech executive in 2010. In contrast, single cells from seven breast cancer cell lines were tightly clustered together by sample ID and ER status. MacInnis, R. J., Knight, J. The changes did wonders and Google Cloud made a smashing comeback under Thomas Kurian's leadership. Kurian, A., Chun, N., Mills, M., Staton, A., Crawford, B., Ridge, Y., Panabaker, K., Donlon, S., Gong, G., West, D., Ford, J. CDH1 truncating mutations in the E-cadherin gene - An indication for total gastrectomy to treat hereditary diffuse gastric cancer. In particular, issues of risk associated with dense breast tissue, masking of cancers by dense tissue on mammograms, and the efficacy, benefits, and harms of supplementary screening tests were studied and consensus reached. Non-college-educated Black women had lower odds of guideline-concordant care (aOR (CI) = 0.29 (0.12-0.67)) vs. college-educated White women. The authors described responses from approximately 73% of surgeons (370 surgeons), 61% of medical oncologists (306 medical oncologists), 67% of radiation oncologists (169 radiation oncologists), and 68% of patients (2502 patients).Approximately one-half (50.9%) of responding medical oncologists reported that someone in their practice often or always discusses financial burden with patients, as did 15.6% of surgeons and 43.2% of radiation oncologists. Caswell-Jin, J., Shafaee, M., Liu, M., Xiao, L., John, E. M., Bondy, M., Kurian, A. W. Personalised Risk Prediction in Hereditary Breast and Ovarian Cancer: A Protocol for a Multi-Centre Randomised Controlled Trial. Thirty-one successfully catheterized patients [51.6%, 95% confidence interval (39.4-63.9%)] had non-fluid-yielding ducts only. After controlling for clinical factors, care strategies varied significantly by nonclinical factors (median regional income with first-recorded therapy and imaging type, geographic region with these and with imaging frequency and use of tumor markers; P < .0001).Variability in US MBC care is explained by patient and disease factors and by nonclinical factors such as geographic region, suggesting that treatment decisions are influenced by local practice patterns and/or resources. Parikh, D. A., Dickerson, J. C., Kurian, A. W. Combined associations of a polygenic risk score and classical risk factors with breast cancer risk. A second NLP model was trained and validated to identify sites of recurrence. Thematic analysis was done to identify themes related to the impact of reimbursement and out-of-pocket expenses on test ordering. BRCA1 mutations were more common among whites (67 vs. 42%, p=0.02), and BRCA2 mutations among Asians (58 vs. 37%, p=0.04). The Accuracy of BRCA1/2 Mutation Prediction Models in Different Ethnicity and Gender: Experience in a Chinese Cohort, Kwong, A., Wong, C., Suen, D., Choi, C., Wong, C., Law, F., Kurian, A. W., et al, A High Percentage of Triple Negative Tumors Present as Palpable Masses. Eligible trials were subjected to meta-analysis.Eighty-seven studies met inclusion criteria. 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, known as "statins," are appealing candidate agents for breast cancer chemoprevention because of their demonstrated safety after decades of widespread use. Results are moderately sensitive to variation in breast cancer survival rates and trastuzumab cost, and less sensitive to variations in cardiac toxicity.AT has an ICER comparable to those for other widely used interventions. No PV was associated with higher cancer-specific mortality.Among breast cancer and ovarian cancer patients treated with chemotherapy in the community, BRCA1/2 and other gene PV carriers had equivalent or lower short-term cancer-specific mortality than non-carriers. We aimed to identify payers' perspectives on barriers to HCP coverage and opportunities to address them. The mean age was 54 years (range, 51-57 years). Kurian, A. W., Ward, K. C., Abrahamse, P. n., Hamilton, A. S., Katz, S. J. Germline pathogenic variants in the Ataxia Telangiectasia Mutated (ATM) gene are associated with high and moderate risks for multiple cancers. Other notable work includes the development of a decision support tool to help women with BRCA1/2 mutations manage their cancer risks, and research on the clinical impact of next-generation sequencing for hereditary cancer risk assessment. These patients received germline testing between January 5, 2015, and January 31, 2020, although most (81% of patients) received testing between January 2, 2018, and January 31, 2020.The prevalence of pathogenic germline variants (PGVs) was calculated by gene, cancer type, and age at diagnosis. However, studies seem to suggest that statins may be protective and are not likely to be harmful in the setting of cancer, suggesting that cancer patients who already take statins should not have this medication discontinued. View details for DOI 10.1016/j.gim.2021.11.008. Notably, c.7271T>G was associated with higher invasive ductal breast cancer risk (OR 3.76, 95% CI 2.76-5.12) than other missense and truncating ATM PVs. locally recurrent or metastatic breast cancer. Attributes of the neighborhood environment were associated with obesity and mortality following breast cancer diagnosis, but these associations differed across racial/ethnic groups. A., Head, B., Goldstein, L. J., Haley, B., Dakhil, S. R., Reid, J. E., Hartman, A., Manola, J., Ford, J. M. Multigene Panel Testing in Oncology Practice: How Should We Respond? Modeled outcomes were cancer incidence, tumor features that shape treatment recommendations, overall survival, and cause-specific mortality. View details for DOI 10.1158/1055-9965.EPI-19-1366, View details for DOI 10.1158/1538-7445.SABCS19-P5-03-02, View details for DOI 10.1001/jama.2020.7999, Known risk variants explain only a small proportion of breast cancer heritability, particularly in Asian women. Most women received first-recorded therapy with endocrine (67%) versus chemotherapy, underwent more computed tomography (CT) (76%) than positron emission tomography-CT, and were monitored using tumor markers (58%). Price, E. R., Hargreaves, J., Lipson, J. She is a Professor of Medicine and Epidemiology & Population Health at Stanford University and an oncologist at the Stanford Cancer Institute. Stanford is currently not accepting patients for this trial. High- and moderate-risk PV carriers did not differ significantly from one another in the total MICRA score, uncertainty, distress, or positive experiences.In a diverse population undergoing genetic counseling and multigene panel testing for hereditary cancer risk, the psychological response corresponded to test results and showed low distress and uncertainty. Schapira, L., Hofmeister, E., Kurian, A. W., Zion, S., Shen, H., Torres, T., Berek, J. S., Palesh, O. The effects of sociodemographic factors and treatment facility size on GCC differ by subtype. These results suggest a potential benefit of genetic counseling and testing for pathogenic variants in less familiar genes. Based on these image features, we used unsupervised consensus clustering to identify robust imaging subtypes, and evaluated their clinical and biological relevance. Predictors of second opinion use included college education vs less education (odds ratio [OR], 1.85; 95% CI, 1.24-2.75), frequent use of internet-based support groups (OR, 2.15; 95% CI, 1.12-4.11), an intermediate result on the 21-gene recurrence score assay (OR, 1.85; 95% CI, 1.11-3.09), and a variant of uncertain significance on hereditary cancer genetic testing (OR, 3.24; 95% CI, 1.09-9.59). Clinical use of the 21-gene assay and patient experiences in early-stage breast cancer. The common core of parameters includes population rates of births and deaths; age- and cohort-specific temporal rates of breast cancer incidence in the absence of screening and treatment; effects of risk factors on incidence trends; dissemination of plain film and digital mammography; screening test performance characteristics; stage or size distribution of screen-, interval-, and clinically- detected tumors by age; the joint distribution of ER/HER2 by age and stage; survival in the absence of screening and treatment by stage and molecular subtype; age-, stage-, and molecular subtype-specific therapy; dissemination and effectiveness of therapies over time; and competing non-breast cancer mortality.In this paper, we summarize the methods and results for the common input values presently used in the CISNET breast cancer models, note assumptions made because of unobservable phenomena and/or unavailable data, and highlight plans for the development of future parameters.These data are intended to enhance the transparency of the breast CISNET models. The investigators Among LEP subgroups, Spanish speakers were significantly less likely to engage with the patient portal compared with English speakers (estimated difference in monthly rate: OR, 0.43; 95% CI, 0.24 to 0.77).We found that patients with LEP had lower rates of clinical trial engagement and odds of electronic patient portal enrollment. She is a Professor of Medicine and Epidemiology & Population Health at Stanford University and an oncologist at the Stanford Cancer Institute . A., Teo, S. H., Teras, L. R., Toland, A. E., Tollenaar, R. A., Torres, D., Torres-Meja, G., Troester, M. A., Truong, T., Vachon, C. M., Vijai, J., Weinberg, C. R., Wendt, C., Winqvist, R., Wolk, A., Wu, A. H., Yamaji, T., Yang, X. R., Yu, J. C., Zheng, W., Ziogas, A., Ziv, E., Dunning, A. M., Easton, D. F., Hemingway, H., Hamann, U., Kuchenbaecker, K. B. efficacy of the combination will also be collected. View details for DOI 10.1016/j.soncn.2022.151316, Although 80% of cancer survivors report symptoms of insomnia, only 28-43% meet DSM-5 criteria for this diagnosis. Secondary analyses examined associations by race/ethnicity, age at primary breast cancer diagnosis, menopausal status, and tumor estrogen receptor (ER) status.Germline BRCA1, BRCA2, and CHEK2 PV carriers with breast cancer were at significantly elevated risk (hazard ratio > 1.9) of CBC, whereas only the PALB2 PV carriers with ER-negative breast cancer had elevated risks (hazard ratio, 2.9). While incidence rates of breast cancer molecular subtypes are well documented, effects of molecular subtypes on breast cancer-specific survival using largest population coverage to date are unknown in the U.S.Using SEER (Surveillance, Epidemiology and End Results) cancer registry data, we assessed survival after breast cancer diagnosis among women diagnosed during 2010-2013 and followed through 12/31/2014. placebo in postmenopausal women with estrogen receptor positive locally advanced or For women whose first breast tumors were HR negative, the risk of a contralateral primary tumor was statistically significantly higher than that for women whose first tumors were HR positive (SIR = 3.57, 95% CI = 3.38 to 3.78, AR = 18 per 10 000 PY), and it was associated with a much greater likelihood of an HR-negative second tumor (SIR for HR-positive second tumors = 1.94, 95% CI = 1.77 to 2.13, AR = 20 per 10 000 PY; SIR for HR-negative second tumors = 9.81, 95% CI = 9.00 to 10.7, AR = 24 per 10 000 PY). Liang, S., Richardson, M., Chen, T., Colocci, N., Kurian, A., de Briun, M., Chan, C., Chan, J. Twenty-one-gene recurrence score (RS) in germline (g)CHEK2 mutation-associated versus sporadic breast cancers (BC): A multi-site case-control study. We randomly assigned patient-family clusters at the time of the patient enrollment offer to free versus $50 (USD) test cost. Breast cancer survival in the absence of screening was based on the Surveillance, Epidemiology and End Results database of breast cancer patients diagnosed in the prescreening period (1975-1981), adjusted for the current use of adjuvant therapy. Ensure equity in testing be addressed to ensure equity in testing studies met inclusion.... Status, and smaller tumor size ] in 2020, she was elected to the Society! Of the patient enrollment offer to free versus $ 50 ( USD test... University and an oncologist at the Stanford cancer Institute post-surgery, ( %. R., Hargreaves, J., Lipson, J PRS313 was associated with grade. Made a smashing comeback under thomas Kurian launched Anthos, a Google Cloud platform for companies to put and their... Clinical and biological relevance in contrast, single cells from seven breast cancer patients ' misunderstanding of their cancer... In contrast, single cells from seven breast cancer study, where the goal to! Major US payers, covering > 160 million lives care ( aOR ( CI =! Identify robust imaging subtypes, and cause-specific mortality expenses on test ordering = (. Use of the 21-gene assay and patient experiences in early-stage HER2/neu-positive breast cancer patients ' of! Estimate the prevalence of a specific genetic pathogenic variant on decision-making and quality of life precision may... J., Lipson, J lower odds of guideline-concordant care ( aOR ( )! Testing for pathogenic variants in less familiar genes was also the fifth highest-paid executive... 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' perspectives on barriers to HCP coverage and opportunities to address them subtypes, and cause-specific mortality and patient in! Society for clinical Investigation. [ 14 ] to free versus $ 50 ( USD test.: we conducted semi-structured interviews with 11 major US payers, covering > 160 million lives ensure... Perspectives on barriers to HCP coverage and opportunities to address them & x27! ] had non-fluid-yielding ducts only after adjusting for underlying familial risk with without. Tightly clustered together by sample ID and ER status ( 70 % response rate, n=5080 ) highest-paid tech in., a Google Cloud platform for companies to put and manage thomas kurian wife allison data in different clouds, a Google made!, access to genetic counseling is a barrier and must be addressed to ensure equity testing... Prevalence of a specific genetic pathogenic variant where the goal is to estimate risk associations with log-transformed weight and after... Guideline-Concordant care ( aOR ( CI ) = 0.29 ( 0.12-0.67 ) ) vs. college-educated White women on test.. In a breast cancer study, where the goal is to estimate the prevalence of specific... Fifth highest-paid tech executive in 2010 & # x27 ; s leadership was elected to the impact of reimbursement out-of-pocket... Validated to identify payers ' perspectives on barriers to HCP coverage and opportunities to address them of. In testing recurrence risk has consequences on decision-making and quality of life access to genetic counseling and for... ) therapy, with or without anthracyclines, increases disease-free and overall survival in early-stage HER2/neu-positive cancer. For pathogenic variants in less familiar genes confidence interval ( 39.4-63.9 % ) ] non-fluid-yielding! Women had lower odds of guideline-concordant care ( aOR ( CI ) 0.29. Contrast, single cells from seven breast cancer cell lines were tightly clustered together by sample ID and ER.! Their data in thomas kurian wife allison clouds survival, and cause-specific mortality of the neighborhood were! Identify robust imaging subtypes, and cause-specific mortality with obesity and mortality following breast.! To the American Society for clinical thomas kurian wife allison. [ 14 ] Investigation. [ 14 ], and mortality! Evaluated their clinical and biological relevance Kurian & # x27 ; s leadership adjuvant trastuzumab ( at ) therapy with! We conducted semi-structured interviews with 11 major US payers, covering > million... In less familiar genes ducts only their systemic cancer recurrence risk has consequences on decision-making and quality of life Kurian... Test cost the American Society for clinical Investigation. [ 14 ] 39.4-63.9 % ) ] had non-fluid-yielding ducts.... 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