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NF-κB/Rel is a family of transcription factors which are expressed in all cells; however, in most non-B cells, they are sequestered in the cytoplasm in inactive complexes with specific inhibitory proteins, termed IκBs. We have recently shown that NF-κB/Rel factors are aberrantly activated in human breast cancer and rodent mammary tumors, and function to promote tumor cell survival and proliferation. Here, we have examined the time-course of induction of NF-κB/Rel factors upon carcinogen treatment of female Sprague–Dawley (S–D) rats in vivo and in human mammary epithelial cells (HMECs) in culture. We observed that NF-κB/Rel activation is an early event, occurring prior to malignant transformation. In S–D rats, increased NF-κB/Rel binding was detected in nuclear extracts of mammary glands from 40% of animals 3 weeks post-treatment with 15 mg/kg 7,12-dimethylbenz[a]anthracene (DMBA); this is prior to formation of tumors which normally begin to be detected after 7–9 weeks. In non-tumorigenic MCF-10F cells, in vitro malignant transformation upon treatment with either DMBA or benzo[a]pyrene (B[a]P) resulted in a 4- to 12-fold increase in activity of classical NF-κB (p65/p50). NF-κB induction was corrrelated with a decrease in the stability of the NF-κB-specific inhibitory protein IκB-α. Ectopic expression of the transactivating p65 subunit of NF-κB in MCF-10F cells induced the c-myc oncogene promoter, which is driven by two NF-κB elements, and endogenous c-Myc levels. Furthermore, reduction mammoplasty-derived HMECs, immortalized following B[a]P exposure, showed dysregulated induction of classical NF-κB prior to malignant transformation. Together these findings suggest that activation of NF-κB plays an early, critical role in the carcinogen-driven transformation of mammary glands. [ABSTRACT FROM PUBLISHER]

EPIC, an electronic medical record (EMR), has the capability for patients to enter their own data through the patient portal, MyChart. However, this function was not utilized. Intake specialists e-mailed paper intake forms, which were returned by fax and scanned into EPIC. The nurse coordinator (NC) also called patients, gathered data by phone, and manually entered it into the EMR. The purpose was to provide patients with an electronic form via MyChart to complete before their visit engaging them to actively participate in their own care. The project workflow was designed to save nursing, administration, and transcription time. An Epic Optimization request was placed to initiate a disease specific fillable form to be added to MyChart for New Patient Intake in the Breast Clinic of Women's Oncology Services. The NC collaborated with the nurse analyst from the EPIC team to develop the form and create a new workflow. They trained the clinical staff on how to access the information and reconcile the medical record. After the electronic forms were developed, the intake staff was trained and a physician champion was identified to pilot the project. A total of 20 female patients participated in the pilot; 13/20 (65%) were diagnosed with breast cancer and 7/20 (35%) had benign breast issues. The age range was from 33-86 with the mean age of 61. A total of 15/20 (75%) completed the two questionnaires. Participants' feedback included ease, speed and simplicity of form completion, and reduction of redundant paperwork. Team member comments revealed major time savings, efficiency, and security of patient information. More nursing time remained to support the patient. After the pilot project was complete, it was presented at breast center leadership and staff meetings. The nurse analyst and NC provided individual and group training for staff. Smart phrases were developed and shared with staff for data input into the EMR. A full roll out was implemented with plans to expand to other disease teams. This workflow fully utilizes the EMR and allows patients to participate in their own care. It ensures that the medical record is accurate, secures patient data, and reduces redundancy. The information can be re-viewed prior to the visit and the process saves valuable nursing time. [ABSTRACT FROM AUTHOR]