UI study shows rise in primary breast lymphoma cases

A recent study from the University of Iowa shows that cases of primary breast lymphoma (PBL) have increased over the last four decades and continue to increase among younger women and for some subgroups.

According to the researchers, this is the largest contemporary study describing presentation, incidence, initial local therapy, and outcomes for women with PBL. The study, published in the Journal of the National Cancer Institute, looked at data spanning four decades.

Researchers found that the incidence of PBL increased from 0.66/1,000,000 women in 1975-1977 to 2.96 in 2011-2013. Overall, incidence of PBL has remained relatively stable in recent years, but continues to increase for women under 50 years of age.

Although reasons for this increase remain unclear, the study concedes that the advent of wide-spread breast imaging might have enhanced diagnostic sensitivity for PBL, even though most cases are not diagnosed in this way.

Researchers also note that the use of cosmetic implants increased 294.8% from 1997-2007, fell 21.9% from 2007-2009 (concurrent with the Great Recession), and has remained fairly stable from 2009-2015, generally reflecting the overall trends in PBL cases.

However, Mary Schroeder, assistant professor in the division of Health Services Research at the University of Iowa and the study’s senior author, cautions against correlating implant use with overall PBL trends.

“In 2011, the FDA identified a possible association between breast implants and the development of a particular type of PBL: anaplastic large cell lymphoma (ALCL),” Schroeder says. “Even so, ALCL comprises only a very small percentage of PBL, and thus do not explain the observed increases in PBL incidence overall.”

The study suggests that future work in this area should focus on confirming trends in the data and creating a better understanding of the underlying causes of PBL.

Co-authors include Paul Romitti, professor of epidemiology, and Brian Link, professor of internal medicine, both at the University of Iowa; Alexandra Thomas, formerly with the UI and currently professor of hematology and oncology at Wake Forest University; and Sean Altekruse, formerly with National Cancer Institute and currently with the National Heart, Blood, and Lung Institute.

This work was supported in part by the University of Iowa Holden Comprehensive Cancer Center Population Research Core, which is supported in part by the National Institutes of Health/National Cancer Institute grant P30 CA086862.

Bao receives FOE Diabetes Research Center grant

A portrait of Assistant Professor Wei Bao of the Department of Epidemiology in the University of Iowa College of Public Health.
Wei Bao

The Fraternal Order of Eagles (FOE) Diabetes Research Center is pleased to announce the results of its sixth round of pilot and feasibility research grants.  Three 2016-17 recipients were selected to receive $50,000 to support their research proposal, with the possibility of $100,000 over a two-year period.

The committee unanimously selected an additional proposal by Wei Bao, MD, PhD, CPH assistant professor of epidemiology, to receive $20,000 to support his research proposal, “Nontraditional glycemic markers in early pregnancy as predictors of gestational diabetes,” for one year.

Project Summary
Gestational diabetes mellitus (GDM) is a common pregnancy complication that affects ~9% of all pregnancies in the United States. GDM is usually diagnosed at 24-28 weeks of gestation by measuring fasting and post-load glucose in an oral glucose tolerance test (OGTT). Since GDM is associated with adverse health outcomes in the fetus and children, early prediction of GDM is imperative. However, the utility of glucose in early pregnancy for GDM prediction is limited because fasting glucose and OGTT are usually not available at that time. Using non-fasting blood glucose for GDM prediction is problematic due to the substantial glucose variability influenced by food intake. Nontraditional glycemic markers, including fructosamine, glycated albumin, and 1,5-anhydroglucitol (1,5-AG), do not require fasting; therefore they are perfect fit to the current clinical practice and can be measured in the same blood samples collected in early pregnancy for other routine lab tests.

We propose to conduct a nested case-control study in a prospective cohort of pregnant women. In this pilot study, we will measure nontraditional glycemic markers in first-trimester maternal plasma samples of pregnant women, and associate these markers with the risk of incident GDM. Moreover, we will assess the utility of these markers in the discrimination and prediction of GDM, as indicated by improved C-statistic and reclassification measures. Previous studies on the use of these markers for GDM prediction mainly used blood samples collected at the time of GDM diagnosis and the results have been conflicting. The proposed study is innovative because it represents a departure from the status quo by examining nontraditional glycemic markers in early pregnancy as early predictors for GDM. If successful, the proposed study may change the clinical paradigm in the screening and prediction of GDM. Findings from this study will be important to develop Specific Aims for subsequent NIH R01 projects that integrate multiple biochemical and genetic markers for improved GDM prediction in the era of “Precision Medicine.”

UI researcher finalist in challenge to improve maternal, newborn health

Atifa Begum with her new born baby at LAMB hospital.
Atifa Begum with her newborn baby at LAMB Hospital. Photo: GMB Akash

This July, creative thinkers from around the world will gather in Washington, D.C., to pitch their ideas for a chance to secure funding that will take their innovations to the next level. While it may sound like an episode of Shark Tank, the event, called the DevelopmentXChange, is dedicated to finding innovative ideas that address a pressing global health challenge: maternal and newborn mortality.

Will Story, assistant professor of community and behavioral health at the University of Iowa College of Public Health, is among the participants invited to the DevelopmentXChange July 26-28. The event – an inspired mashup of tradeshow, networking opportunities, and mentoring workshops – brings together 50 finalists selected from nearly 650 applications submitted to Saving Lives at Birth: A Grand Challenge for Development.

Story, along with co-principal investigator Dr. Louise Day, a clinician-researcher practicing in Bangladesh, will be presenting their innovation, an illustration-based decision-making tool that helps pregnant, semi-literate women and their families in rural Bangladesh know how and when to seek skilled care for the safe delivery of their baby.

A Vulnerable Time

Every two minutes, a woman dies in childbirth worldwide, according to the Saving Lives at Birth website. The onset of labor marks the start of the highest-risk period for both mother and baby, which continues until at least 48 hours after birth. During this short period of time, 145,000 maternal deaths, 1.45 million neonatal deaths, and 1.2 million stillbirths occur each year, Saving Lives at Birth reports. The vast majority of these deaths occur in low- and middle-income countries.

Women with their infants sitting outside in Bangladesh
Women with their newborns. Photo: LAMB Hospital

The Saving Lives at Birth partnership, launched in 2011, includes the U.S. Agency for International Development, the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada (funded by the Government of Canada), the U.K’s Department for International Development, and the Korea International Cooperation Agency.

The partnership issues an annual global call for groundbreaking, scalable prevention and treatment approaches for pregnant women and newborns in poor, hard-to-reach communities around the time of delivery. From the hundreds of applications, the most promising ideas are selected to present as finalists at the DevelopmentXChange for a chance to receive additional funding.

Obstetric Care in Rural Bangladesh

In rural Bangladesh, where Story and Day’s research is taking place, only a third of women deliver their babies in a health facility where they have better access to life-saving interventions. One of the primary barriers to obtaining skilled obstetric care is a delay in care-seeking, which is caused by a lack of recognition of the risk during labor by the family and caregivers. Another factor is a lack of support for the mother from the decision makers, including the male family members.

The goal of the team’s project is to expedite obstetric care-seeking among semi-literate women and their families in rural Bangladesh by combining a new home-based, pictographic decision-making tool – also known as a “pictorial partograph” – with a novel approach to involving men during labor and delivery.

The team has already pre-tested a working draft of the pictorial partograph with a group of semi -literate family caregivers and community health workers, who gave it very positive feedback. The pictorial partograph is a two-page, color-printed decision tool with simple illustrations that depict mothers in low-risk, at-risk, and high-risk scenarios with guidance on caregiving, when to seek advanced care, and possible outcomes for mothers and babies.

“Right now, there’s no male-specific component to the tool,” explains Story. “We want to talk to men and women in rural Bangladesh to find out what is most helpful for men to do during labor and delivery, then integrate it into the pictorial partograph.”

Some possible tasks for the men are logistical, Story says, such as arranging for transportation to a qualified health care provider, negotiating any needed financial support, finding appropriate blood donors (since clinics in limited-resource settings typically don’t have blood banks), and offering social support during labor and delivery.

Next Steps

Outside of LAMB hospital in northwest Bangladesh
LAMB Hospital. Photo: GMB Akash

The researchers are seeking $250,000 in seed funding at the DevelopmentXChange event to further test, refine, and evaluate the pictorial partograph in a clinical setting before finalizing it for use at home by rural families and caregivers. The study would be conducted in LAMB Hospital located in Dinajpur, a rural district in northwest Bangladesh.

Currently, Story and Day are honing their elevator speeches about the pictorial partograph in preparation for the DevelopmentXChange event.

“It’s exciting, because our tool is low cost, low tech, and focused on behavior change,” says Story. “We’re different, because a lot of the finalists are more technology-driven.”

In addition to Story and Day, the research team includes co-investigators Shirajum Munira, a Bangladeshi researcher; Stacy Saha, director of the LAMB Management Information Systems- Research Department; and Kavita Singh, a research associate professor in the Department of Maternal and Child Health at the University of North Carolina.

Read more about the DevelopmentXChange finalists.


Study finds domestic violence doubles risk of premature birth

Domestic violence by a partner or ex-partner during pregnancy doubles the risk of pre-term birth and low birth weight, according to a study conducted by University of Iowa  researchers. The team also found that domestic violence slightly increased the risk of a baby being small for gestational age. The researchers  included first author Brittney Donovan, doctoral student in epidemiology, Audrey Saftlas, Cassie Spracklen, and Kelli Ryckman from the Department of Epidemiology, and Marin Schweitzer from the Department of Internal Medicine.

This story has been covered by several media outlets:

The Guardian

Huffington Post

Times of India

Business Standard