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Purpose: We reviewed the impact of a community based participatory process (CBPP) addressing cancer education, prevention, and screening in two ethnic/minority populations to determine their impact on personal health related decisions. Materials and Methods: From 2005 – 2008, 2,281 community members participated in CBPP outreach efforts (cancer education, prevention and screening forums) conducted by the Beaumont Cancer Institute in cooperation with the Arab American and Chaldean Council, the National Cancer Institute and the American Cancer Society. The study population consisted of 1,067 (46.7%) individuals completing a post-cancer forum survey: 642 (60.2%) from the African American (AA) and 425 (39.8%) from the Arab American & Chaldean (AAC) communities. Data were collected on behavioral intent and knowledge including: (1) forum content, (2) participants' cancer screening history, (3) symposium logistics (4) educational materials and (5) participation in subsequent cancer screening tests. Results: After attending at least one cancer education forum, 329 (30.8%) of the 1,067 participant respondents (14.4% of all attendees) underwent some type of cancer screening: 108 women (10.1%) underwent a screening mammogram, and 94 (8.8%) a pap smear. Thirty-eight men underwent (3.6%) a screening PSA, and 89 (8.3%) had other forms of cancer screenings (e.g. colonoscopy). Overall, 60.2% of AA versus 35% of ACC attendees completed a post-survey and 19.6% of AA versus 10% of AAC attendees underwent some type of cancer screening. Conclusions: The results of this study suggest that CBPP's based around perceived and/or serious diseases negatively affecting a target population can positively impact their personal health related decisions. Citation Information: Cancer Res 2009;69(23 Suppl):C61.

Background: Chemotherapy induced alopecia (CIA) is considered the most distressing side effect of chemotherapy for breast cancer patients. Scalp hypothermia offers hope to minimize chemotherapy induced alopecia (CIA) for breast cancer patients. We present data from a pilot study of scalp hypothermia with the Penguin Cold Cap System™ in patients receiving a combination chemotherapy regimen. Patients and Methods: Stage I-IIIC breast cancer patients, receiving adjuvant chemotherapy regimens with or without (A) were consented. Standard dose regimens included doxorubicin-cyclophosphamide (AC) x 4 cycles, dose dense, doxorubicin-cyclophosphamide followed by taxol (AC-T) x 8 cycles, taxotere-doxorubicin-cyclophosphamide (TAC) x 6 cycles, taxotere-cyclophosphamide (TC) x 4 cycles and taxotere-carboplatnium-trastuzumab (TCH) x 6 cycles. Photos were taken before and with each cycle and 3 weeks post chemotherapy, Dean's alopecia scale was used for grading. Caps were cooled to 8oC. Caps 1-2 were 20 minutes each prior to infusion, following caps were changed q 30 minutes throughout chemotherapy and for 3 hours post-chemotherapy. Results: See tables 1 and 2 for patient data. We enrolled 34 patients (22 (A) containing; 12 non (A) containing) after informed consent. Of patients withdrawn, 1 patient (AC-T) had metastatic disease at the time of registration and did not start scalp hypothermia,1 patient (TC) had scalp discoloration; 2 patients (AC and TAC) withdrew due to discomfort of cooling; 1 patient (TC) withdrew prior to start of therapy due to fear of discomfort and 1 patient (AC) was withdrawn for coloring hair at time of treatment. The mean percent of CIA in the (A) containing group was 52% (SD: 17 CI: 40-70) and the mean percent CIA in non (A) containing group was 25% (SD: 36 CI: 5-100). A comparison of the means yielded a p-value of 0.0003 in favor of non (A) containing regimens. Of the 12 patients in the non (A) containing regimen 83% (3 TCH, 7 TC) did not require a prostheses and of the patients receiving an (A) containing regimen 47% (8 AC) did not require a prostheses. For those patients who completed scalp hypothermia through chemotherapy, the median CIA for TC and TCH combined was 10% hair loss (5,25) and for AC, AC-T and TAC combined was 50% hair loss (45,70). Discussion: All patients who received TAC or AC-T had grade 4 CIA and needed a hair prostheses. Most AC patients preserved some of their hair. Hair thinning was even and not patchy in this group and most had no need for prostheses. Patients in the TC or TCH group, who were able to complete the scalp hypothermia therapy, retained 90% or better, of their hair and there was no need for prostheses in these groups. We found the scalp hypothermia technique used here reduces hair loss in AC patients and offers the possibility of CIA prevention for women with breast cancer receiving TC or TCH.Table 1. Data for all enrolled patientsRegimenEnrolledWithdrewCompletedAC1028AC-T716TAC514TC927TCH3-3 Table 2. Deans alopecia scale for all enrolled patientsRegimenGrade1 Excellent 75%AC2422AC-T---7TAC---5TC7--2TCH3--- Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5040.

Abstract 3661 Poster Board III-597 Introduction BMB is frequently performed during the staging process of patients (pts) with HL. Previous data suggested routine use of this procedure may be unnecessary. The Ann Arbor classification is currently used to detect pts requiring BMB, despite sensitivity (sen) of 100%, specificity (spec) is only 40%. We sought to determine whether a modified IPS [Hasenclever and Diehl (1998)] would yield greater spec while maintaining good sen. Methods We retrospectively reviewed charts of 1215 histologically proven HL pts from Jan 2000-Dec 2008 at Cleveland Clinic Taussig and Moll Cancer Centers. Of 1215 pts, 1089 had BMB (90%). 876 pts were included in our study. 213 were excluded due tor un-interpretable BMB or missing data. Each component of IPS was equally weighted such that one point is assigned to each positive variable [male sex, age ≥45, albumin (alb) Result 88 pts (10%) had BMI, we used a modified IPS formally by calculating a score that uses “weights” based on the results of a multivariable model including all 7 factors and the relative magnitude of the associated regression coefficients (RC), [modified IPS= WBC+2x(sex+age+hem)+3x(stage+alb)+4xlymph]. This model suggests lymphopenia has a stronger impact on the presence of BMI, while leukocytosis has the least impact. The percentage of BMI was 0.1,17,48, and 87 % for pts with a score of 0-8, 9-10, 11-12, and >12 respectively. Using a score of >8 as a rule for BMI, sensitivity was 99% and specificity was 87%. The prevalence of BMI by histology was 4% lymphocyte-rich, 5% nodular sclerosis, 20% mixed-cellularity and 21% lymphocyte-depleted, further analysis showed using modified IPS, sensitivity and specificity were similar across all types of histologies. Conclusions Using a modified IPS of > 8 for predicting BMI in HL doubled the spec associated with Ann Arbor classification. The implementation of modified IPS is a practical and reliable tool that will allow physicians to predict BMI in HL pts. Therefore eliminate unnecessary painful procedure in many pts. Disclosures: No relevant conflicts of interest to declare.

e19531 Background: BMB is frequently performed during the staging of patients (pts) with HL. Previous data suggested routine use of this procedure may be unnecessary. The Ann Arbor classification is currently used to detect pts requiring BMB. Despite sensitivity (sen) of 100%, specificity (spec) is only 40%. We sought to determine whether IPS [as developed by Hasenclever and Diehl (1998)] would yield greater spec while maintaining good sen. Methods: We retrospectively reviewed charts of 1215 histologically proven HL pts from Jan 2000-Dec 2008 at Cleveland Clinic Taussig and Fairview Moll Cancer Centers. Of 1215 pts, 1089 had BMB (90%). 876 pts were included in our study. 213 were excluded due to un-interpretable BMB or missing data. The IPS is calculated as the number of poor risk features present based on male sex, age ≥45, albumin (alb) 3, lymphocyte (lymph) 3 and/or 3 to predict BMI, sen was 97% and spec 87%. BMI by histology was 4% lymphocyte-rich, 5% nodular sclerosis, 20% mixed-cellularity and 21% lymphocyte-depleted. Using the IPS>3 cutoff sen and spec were similar across all types of histologies; ranging from 94–100% and 86–89% respectively. Conclusions: using an IPS of >3 for predicting BMI in HL doubled the spec associated with Ann Arbor classification with little loss of sen. The implementation of IPS is a practical and reliable tool that will allow physicians to predict BMI in HL pts. It may, therefore eliminate painful BMB in many Pts. No significant financial relationships to disclose.

To determine what proportion of patients with acute myocardial infarction are not eligible for thrombolytic therapy and to assess their natural history.Retrospective chart review.A large community-based hospital.All patients with acute myocardial infarction hospitalized during a 27-month period.Of 1471 patients with acute myocardial infarction, 230 (16%) received thrombolytic therapy according to the protocol and an additional 97 (7%) received nonprotocol thrombolytic therapy, primary coronary balloon angioplasty, or both because of contraindications. The other 1144 patients (78%) did not receive reperfusion therapy.The patients who did not receive thrombolytic therapy were older, more likely to be women, and more likely to have a history of hypertension, previous myocardial infarction, or chronic angina (all comparisons, P less than 0.002). An average of 1.9 reasons for exclusion were identified per patient among the ineligible patients. Mortality was fivefold higher among ineligible patients (19%; Cl, 16% to 21%) than among protocol-treated patients (4%; Cl, 1% to 6%) (P less than 0.001). In-hospital mortality rates for excluded patients were 28% (Cl, 23% to 32%) in elderly patients (age, greater than 76 years; n = 396); 29% (Cl, 23% to 35%) in patients with stroke or bleeding risk (n = 209); 17% (Cl, 14% to 20%) in patients with delayed presentation (greater than 4 hours after the onset of chest pain; [n = 599]); 14% (Cl, 11% to 16%) in patients with an ineligible electrocardiogram (ECG) (n = 673); and 26% (Cl, 21% to 32%) in patients with a miscellaneous reason for exclusion (n = 243). Independent predictors of increased mortality were: age greater than 76 years, stroke or other bleeding risk, ineligible ECG, or the presence of two or more exclusion criteria.Thrombolytic therapy is currently used in the United States for only a minority of patients with acute myocardial infarction: those who have low-risk prognostic characteristics.

Introduction: MGUS is considered to be a pre-malignant condition, and previous studies have reported VTE as a marker for a subsequent malignancy. We conducted a retrospective study to evaluate the incidence of VTE among MGUS patients (pts) and to correlate this incidence with different risk groups for developing malignancy in MGUS pts. Methods: The complete medical records of all MGUS pts at Cleveland Clinic Cancer Center at Fairview hospital from Jun/2005–Jun/2008 were retrospectively reviewed. Of 237 pts diagnosed with MGUS, 112 pts (65 males, 47 females) were eligible for our study. These pts were divided into 2 risk groups: low risk (LR)/low-intermediate risk (LIR) group (78 pts.) and high intermediate risk (HIR)/high risk (HR) group (34 pts) based on the Risk Stratification Model using three adverse risk factors; serum M-protein level ≥ 3 gm/dL, non-IgG MGUS, and an abnormal kappa/lambda free light chain ratio. Only pts with ≥ 12 months follow up were included. Exclusion criteria included a personal history of inherited thrombophilia, previous episode of VTE or anticoagulant treatment, thrombocytosis, malignancy, and renal impairment. Risk factors (RF) for VTE were identified in each pt and categorized into four groups: no RF, 0; one RF, 1; two RF, 2; and > 2 RF, >2. RF included > 48 hours of immobilization, surgery in the past 3 months, current hospitalization at the time of VTE occurrence, oral contraceptive use, and congestive heart failure. Objectives: 1. To compare the proportion of pts with MGUS who developed VTE to the proportion of pts in the general population who developed VTE. 2. To compare VTE incidence between the two risk groups. Results: During the study period, 9 pts with MGUS experienced VTE. In the general population, the incidence of VTE is 117/100,000 persons/year (from literature). Therefore, the proportion of pts in the general population over 3 years was 117/100000 × 3 =0.0035. The proportion of VTE in MGUS pts, adjusted for 3 years, of 0.080 is significantly higher than that for the general population (p

7082 Background: The expression of LPL/ADAM-29 in the peripheral blood has been reported to correlate with IGVH (Immunoglobulin heavy chain) mutational status and survival in CLL (Chronic lymphocyt...

20716 Background: Methods of scalp cooling previously tested to prevent chemotherapy induced alopecia (CIA) have had variable efficacy. We present data from a pilot study of the Penguin Cold Cap system (PCC) (Medical Specialties of California) used to minimize CIA in breast cancer patients receiving a chemotherapy regimen with a combination of doxorubicin (A), cyclophosphamide (C), or taxane (T). Methods: Patients with a diagnosis of stage I-IIIC breast cancer, receiving a chemotherapy regimen containing A-C or T were recruited. The first 2 caps are placed 20 minutes each prior to infusion to begin scalp cooling process. Caps are changed every 30 minutes to maintain cooled scalp temperature throughout chemotherapy and for 3 hours after. Patients were given instructions on hair care and are followed during and 24 weeks post treatment. Grading was based on the World Health Organization and Dean’s grading scale for alopecia. Success was defined as no need for cosmetic devices (i.e. wig) due to CIA. Results: ...

18529 Background: Mantle cell lymphoma (MCL) is a mature B-cell non-Hodgkin’s lymphoma (NHL) with a variable clinical course ranging from indolent to aggressive. Treatment for MCL is complicated by this variability, as systemic chemotherapy for NHL is directed by the aggressiveness of the lymphoma. Previous attempts have been made to correlate clinical outcome in MCL with histologic features. More recently, measurement of metabolic activity using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) was found to be highly correlative with the aggressiveness of NHL. Given the clinical heterogeneity of MCL, the search for the true metabolic status in MCL is important in prognostication and management. We propose to study the metabolic activity in MCL by comparing the maximum SUV at the site of biopsy with the highest SUV in other MCL areas of the body. Methods: 12 patients with newly diagnosed MCL and having staging by FDG-PET were identified. PET(CT) body scans were obtained in the usual fashion. The SUVs, defined as tumor activity divided by dose injected per lean body mass, from the PET and PET-CT cameras were cross validated to produce the same value in a given phantom and patient. Maximum biopsy SUV was measured by searching the maximum value within a volume of interest over the known biopsy site, and highest body SUV was similarly searched in known tumor sites in other body areas. Results: One patient was excluded because the tumor at the biopsy site had been completely resected. The remaining 11 patients (M:F=8:3, age=63±8 yrs) were analyzed. The SUV at biopsy sites ranged from 2.1 to 9.8 (mean=5.2±2.3). The SUV in other tumor sites ranged from 4.8 to 18.6 (mean=8.9±4.1), which was significantly higher when compared to the respective biopsy site (p=0.0036). Conclusions: As the SUV of MCL at the biopsy site may not represent the highest SUV, it is important to search other tumor sites in the body for the highest SUV to help in grading, managing, and subsequent monitoring of MCL. Perhaps FDG-PET can direct biopsies to tumor sites with the highest SUV and subsequently provide useful histologic detail for predicting clinical course. Future study is needed to correlate the maximal SUV of MCL with histology and clinical course. No significant financial relationships to disclose.

OBJECTIVE To report sites of second primary cancer and the time to first diagnosis during routine follow-up after treatment for choroidal melanoma. DESIGN Prospective longitudinal follow-up of patients enrolled in 2 randomized trials conducted by the Collaborative Ocular Melanoma Study (COMS) Group. METHODS Baseline and annual or semiannual systemic and laboratory evaluations were performed according to a standard protocol for 2320 patients enrolled in the COMS without evidence of melanoma metastasis or other primary cancer at baseline. Deaths were coded by a mortality coding committee. RESULTS Subsequent to treatment for choroidal melanoma, a total of 222 patients were diagnosed with a second primary cancer other than basal or squamous cell skin cancer (5-year rate of 7.7% [95% confidence interval, 6.6%-9.0%]). The most common sites were prostate (23% of reported cases) and breast (17%); 12 of these 222 patients were diagnosed simultaneously with second primary cancers in 2 or more sites. Of these 222 patients, 113 died; 37 (33%) were coded as dead with melanoma metastasis, 33 (29%) as dead with a malignant tumor other than metastatic melanoma, and 13 (11%) as dead with a malignancy of uncertain origin. Radiotherapy did not significantly increase the development of second primary cancers. The rate of diagnosis of second primary cancer did not differ significantly by smoking status, although the rate in former smokers was increased vs that observed in either current smokers or those who never smoked. CONCLUSION Routine medical surveillance for development of second primary cancers among patients treated for choroidal melanoma is important, especially for those with a history of smoking, regardless of the size of choroidal melanoma at the time of treatment.

The use of hormone replacement therapy (HRT) in postmenopausal breast cancer survivors is controversial. This report describes the symptomatic benefit of HRT and the subsequent risk of recurrent breast cancer in a group of postmenopausal women with a prior history of locally treated breast cancer. One-hundred and fourteen disease-free patients received HRT to control estrogen deficiency problems after local breast cancer therapy. Thirty-three had American Joint Committee on Cancer (AJCC) stage O at diagnosis, 43 stage 1, 24 stage 2A, 12 stage 2B, 1 stage 3A, and 1 stage 3B. Pathology was infiltrating carcinoma in 81, ductal carcinoma in situ (DCIS) 29, and lobular carcinoma in situ 4. Fifty-six were receiving HRT at the time of breast cancer diagnosis with 20 continuing HRT. One-hundred and eight patients received either an estrogen or an estrogen/progestin combination with 6 receiving vaginal estrogens. The time from breast cancer diagnosis to initiation of HRT ranged from .0 to 23.9, mean 3.7 years. HRT was administered for hot flashes in 77%, dyspareunia/vaginal dryness 53.5%, reactive depression/anxiety 34%. The duration of replacement therapy ranged from .10–17.5, mean 2.5 years. Hot flashes were relieved in 98%, dyspareunia/vaginal dryness 95%, and reactive depression/anxiety 95%. One new primary or ipsilateral breast recurrence (DCIS with microinvasion) 1.8%, (1/56, 95% confidence interval [Cl], .045–9.6%) was observed. One patient developed DCIS within breast tissue left on the chest wall after a modified mastectomy. Two new contralateral primaries, 2.0%, (2/103, 95% Cl, .24-6.8%) were observed. One occurred in the contralateral breast during therapy for an ipsilateral chest wall and systemic recurrence. Three patients, 3.0% (3/114, 95% Cl, .55–7.5%) have experienced systemic relapse with two deaths. In this selected group of postmenopausal women survivors, HRT dramatically relieved estrogen deficiency symptoms and did not appear to increase the risk of an ipsilateral, contralateral, or systemic recurrence.

Abstract 5098 Introduction: Follicular Lymphoma (FL) comprises of 20–30% of Non-Hodgkin's Lymphomas. It is the most common lymphoma with varied clinical aggressiveness, depending on morphological grading on histology. The prognosis of FL is heterogeneous. Therefore therapeutic options for FL are increasingly becoming more risk-adopted. Pathologically, FL has been graded into grade 1–2 (FL1–2) and grade 3 (FL3) by visual counting or estimating the absolute number of centroblasts in neoplastic follicles. Recent studies found that the average tumor cell size of FL is highly variable, but is consistently reproducible, achieved by an objective measurement using flow cytometry. A significant variation in metabolic activity has also been observed in FL studied by PET scan. The purpose of this study was to investigate a new risk stratification method for FL using a combined criterion of Flow cytometry based cell size of FL cells and metabolic activity based on FDG PET scan to further evaluate their prognostic values. Materials and Methods: Retrospective study of 64 patients (25 males and 39 females with median age of 61 years), diagnosed with FL between 2006 –2010 in Beaumont Health System with proper HIC approval was performed. 44 cases were graded morphologically into low risk (FL 1–2) and 20 into high risk (FL 3), based on current WHO classification. The average tumor cell size was measured based flow cytometric analysis of the relative forward scatters (FSC) of tumor cells relative to that of internal T-cells in the lymphoma tissue. The metabolic activity was measured as in maximal standardized uptake value (SUV max) of the involved lymph node by PET scan based F-18 FDG uptake. The SUV was normalized to a glucose level of 100 using the formula: SUV100={[100 mg/dl]/[glc]}g where g=[-0. 5] from our prior publication and [Glc] was the glucose level of the patient recorded at the time of PET scan. The difference of average lymphoma cell size between grade 1–2 (FL 1–2, indolent) and grade 3 (FL 3, aggressive) was compared with Student t test. The difference of size distribution between FL with low SUV100 and FL with high SUV100 were compared with Chi square and Kappa tests. A two-tail p-value less than 0. 05 was considered significant in all tests. FSC and Metabolic activity were cross tabbed and correlated using cut off values determined by discriminant analysis. Results: The FSC of B-cells were significantly lower in low grade FL than that in high grade FL (p=0. 00002). In contrast, FSC of residual T-cells in low grade FL and high grade FL were about the same (p=0. 2). Average lymphoma cell size of the low risk group (relative FSC of −15, range of −83 to 153) was significantly smaller than that of high risk group(relative FSC of 92, range of −32 to 243), (P Conclusion: The significance of average lymphoma cell size identified by FSC in this study between FL grade 3 and grade 1–2 validate potential utility of flow cytometry in grading FL in refining the grading because the measurement of average lymphoma cell size by flow cytometry it is more reproducible, objective, and easy to use than manual counting centroblasts microscopically. Since increased metabolic activity is often associated with more aggressive clinical behavior, combining tumor cell size by flow cytometry and metabolic activity by FDG PET imaging can potentially serve as an independent criterion in risk stratification and better grading of FL. Further clinical correlation is in progress. Disclosures: No relevant conflicts of interest to declare.