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Introduction Black women are more likely to be diagnosed with early-onset breast cancer, have triple negative disease, carry pathogenic variants in BRCA2, and are 41% more likely to die from the disease. The American College of Radiology recommends risk assessment for all Black women by age 30. Still, it remains unclear whether this population may benefit from earlier screening mammography. We evaluated women treated for breast cancer between ages 40 and 45 to determine the frequency of cancer detection on first mammogram for Black patients versus other racial/ethnic groups. We also analyzed risk factors associated with first mammogram-detected cancers. Methods Demographic, mammographic, and clinico-pathologic data were obtained from 724 women ages 40-45 who underwent oncologic surgery for breast cancer at our institution between 2010 and 2019. We defined first mammogram cancers as those with tissue diagnoses within three months of first mammogram. A logistic regression model was applied to assess the association of collected variables with cancer detection on baseline mammogram by racial/ethnic group. Results In the overall cohort of 724 patients, the mean age at breast cancer diagnosis was similar across ethnic groups (42.8 years, p=0.624). Black women were more likely to have a BMI greater than 30 (p= First Mammogram Cancers by RaceAllAsianBlackWhitep-valueN=712N=21N=80N=611Cancer on first mammogram, N (%):198 (27.8%) 7 (33.3%) 38 (47.5%) 153 (25.0%) Citation Format: Avia Wilkerson, Megan Obi, Camila Ortega Estrella, Chao Tu, Holly Pederson, Zahraa Al-Hilli. Breast cancer disparities through an imaging lens: Are black women more likely to have cancer detected on their first mammogram? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-09.

Current medical management of pulmonary embolism (PE) is driven by risk stratification, with thrombolytic treatment reserved for patients with hemodynamic instability. We describe a case of a man with acute submassive bilateral pulmonary emboli and a right popliteal deep vein thrombosis (DVT), who had persistent shortness of breath, tachycardia, and hypoxemia but remained normotensive and was therefore not treated with thrombolytics until he suffered a fatal cardiac arrest on hospital day six. We examine the indications, risks, and potential benefits of thrombolytic treatment in patients with submassive PE who exhibit signs of instability but do not meet current indications for thrombolytic treatment with persistent hypotension or shock.

Background Hyponatremia in the neonatal population is an uncommon occurrence and can be associated with significant increase in morbidity and mortality. In the neonatal population, it is typically associated with an excess of antidiuretic hormone and rarely has been found to be associated with hydrocephalus, short of being caused by the subsequent treatment of hydrocephalus. Case Description We present a case report of a patient with neonatal hydrocephalus, secondary to intraventricular hemorrhage in the setting of prematurity, treated at our institution, in whom sodium levels reached a nadir as head circumference peaked and subsequent treatment of hydrocephalus resolved the associated hyponatremia. Conclusions Hydrocephalus secondary to intraventricular hemorrhage is a notable complication in the premature neonatal population. Physicians should be aware of its potential association with hyponatremia and consider early neurosurgical intervention when other etiologies of the electrolyte disturbance cannot be identified.

INTRODUCTION: Nearly 50% of depressed primary care patients referred to mental health services do not initiate mental health treatment. The most promising interventions for increasing depression treatment initiation in primary care settings remain unclear. METHODS: We performed a systematic search of publicly available databases from inception through August 2017 to identify interventions designed to increase depression treatment initiation. Two authors independently selected, extracted data, and rated risk of bias from included studies. Eligible studies used a randomized or pre-post design and assessed depression treatment initiation (i.e., ≥ 1 mental health visit or antidepressant fill) among adults, the majority of whom met criteria for depression. Interventions were classified as simple or complex and sub-classified into intervention strategies that were graded for strength of evidence. RESULTS: Of 9516 articles identified, we included 14 unique studies representing 16 (4 simple and 12 complex) interventions and 8 treatment initiation strategies. We found low to moderate strength of evidence for collaborative/integrated care (3 studies), treatment preference matching (2 studies), and case management (2 studies) strategies. However, there was insufficient evidence to determine the benefit of cultural tailoring (2 studies), motivation (alone, with reminders or with cultural tailoring (5 studies)), education (1 study), and shared decision-making strategies (1 study). Overall, we found moderate strength of evidence for complex interventions (8 of 12 complex interventions demonstrated statistically significant effects on treatment initiation). DISCUSSION: Collaborative/integrated care, preference treatment matching, and case management strategies had the best evidence for improving depression treatment initiation, but none of the strategies had high strength of evidence. While primary care settings can consider using some of these strategies when referring depressed patients to treatment, our review highlights the need for further rigorous research in this area. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-018-4554-z) contains supplementary material, which is available to authorized users.