Ophira Ginsburg | National Cancer Institute (original) (raw)

Papers by Ophira Ginsburg

The Lancet Global Health, Feb 1, 2023

The Lancet

Women interact with cancer in complex ways, as healthy individuals participating in cancer preven... more Women interact with cancer in complex ways, as healthy individuals participating in cancer prevention, as patients, as health professionals, researchers, policymakers, and as unpaid caregivers. In all these domains, women often are subject to overlapping forms of discrimination, such as due to age, race, ethnicity and socio-economic status, that render them structurally marginalized. These myriad factors can restrict a woman’s rights and opportunities to avoid cancer risks, are a barrier to diagnosis and quality cancer care, maintain an unpaid caregiver workforce that is predominantly female, and hinder women’s professional advancement. The Lancet Commission on women, power and cancer was created to address urgent questions at the intersection of social inequality, cancer risk, and outcomes, and the status of women in society.

Asia-Pacific Journal of Oncology Nursing, Jul 1, 2023

Cancer Treatment Reviews, Mar 1, 2022

Breast cancer is the leading cause of cancer morbidity, disability and mortality in women, worldw... more Breast cancer is the leading cause of cancer morbidity, disability and mortality in women, worldwide. Overall, in 2020, it was the most diagnosed malignancy. Differences in breast cancer mortality have been historically evidenced, as a result of disparities in access to diagnosis, treatment and palliative care. Epidemiologic trends in the last decades display three main patterns of breast cancer mortality: some high-income countries report continuous substantial improvements exceeding 2% annual mortality reduction; however, many low- and middle-income countries (LMICs) have stagnant or even increasing mortality rates. Population-based studies show that investing in breast cancer control, based on a primary health care approach, and expanding the cancer treatment capacity can portend population health benefits, with positive changes of the epidemiological adverse trajectories. Framed as part of the political commitment to the Sustainable Development Goals Agenda, World Health Organization (WHO) has recently launched a global initiative to tackle disparities in breast cancer mortality. The WHO-led Global Breast Cancer Initiative (GBCI) is framed across 3 pillars, to address key determinants of the cancer-related outcomes: health promotion and early detection, timely access to diagnosis and treatment, comprehensive breast cancer treatment, palliative and survivorship care. GBCI is a systematized approach, with the goal to (i) increase the fraction of newly diagnosed invasive cancers being stage 1 or 2 at diagnosis (60% or more), (ii) ensure diagnostic work-up to be completed within 60 days from the first connection with the primary healthcare providers to avoid delays in diagnosis and treatment and (iii) assure 80% or more women with breast cancer to undergo and complete multimodal treatments. GBCI will pursue a comprehensive and multisectoral approach, to deliver population health, social and economic benefits, ultimately intended as an entry point for health system strengthening and for the broader cancer control.

International Journal of Radiation Oncology Biology Physics, Sep 1, 2019

Fertility and Sterility, Mar 1, 2016

Breast Cancer Research, Mar 9, 2012

Journal of Clinical Oncology, May 20, 2018

1537Background: Lynch syndrome (LS) accounts for most inherited endometrial cancers (EC). The ide... more 1537Background: Lynch syndrome (LS) accounts for most inherited endometrial cancers (EC). The identification of probands presents a chance to prevent other cancers and enable cascade testing. Professional organizations have released guidelines for genetic counseling referrals (GCR) based on high-risk (HR) criteria including loss of mismatch repair (MMR) protein expression on tumor immunohistochemistry (IHC). Methods: All women diagnosed with EC from 2012 to 2017 were retrospectively identified and evaluated. Comparative analyses were performed with appropriate two-sided statistical tests. HR criteria were defined as age ≥50 at diagnosis, significant family or personal histories of LS-related cancers or positive MMR IHC. Results: A total of 716 women were diagnosed with EC and of these, 230 (32%) had at least one HR criteria. Of the HR women, 51% were given GCR and 13 (19%) were found to have LS. Mid-2015, we implemented universal MMR IHC. GCR rates among HR women were higher after January 2016 (72% vs 52%...

Introduction: Breast cancer-related pain significantly affects quality of life and is well-docume... more Introduction: Breast cancer-related pain significantly affects quality of life and is well-documented in developed countries. However, little is known about the extent of breast cancer-related pain in developing countries. A study at the National Cancer Institute of Vietnam reported that 44% of breast cancer patients experienced moderate to severe pain. However, this study did not include breast cancer survivors, and little is known about the prevalence of pain and its management in this patient population. Objectives: Determine the prevalence of pain, adequacy of pain management, and barriers to care in breast cancer survivors in Vietnam. Methods: We administered previously validated and published symptom assessment tools (the BPI and MDASI) to 160 unselected Vietnamese women diagnosed and treated for breast cancer in 2007. Here we present a preliminary description of the results for the first 40 breast cancer survivors enrolled in this study. Results: The most frequently reported symptoms were pain (62.5%, with 40% reporting the pain as severe), memory loss (50%), numbness/tingling (50%), sleep disturbance (45%), and appetite loss (32.5%). Only 23% reported adequate symptom management, with the costs of treatment and the false belief that no treatments existed for the pain being frequently cited as barriers to care. Discussion: Cancer-related pain is highly prevalent in breast cancer survivors treated at the largest cancer hospital in Vietnam. The majority of patients report inadequate management of pain, often attributable to costs and false beliefs regarding pain management. Initiatives aimed at patient education and improving accessibility to pain management could significantly improve the quality of life in this patient population. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-10-04.

Journal of Medical Genetics, Jul 17, 2015

Routledge eBooks, Jan 18, 2023

Nature Medicine

Despite women being disproportionally affected by cancer deaths at young ages, there are no globa... more Despite women being disproportionally affected by cancer deaths at young ages, there are no global estimates of the resulting maternal orphans, who experience health and education disadvantages throughout their lives. We estimated the number of children who became maternal orphans in 2020 due to their mother dying from cancer in that year, for 185 countries worldwide and by cause of cancer-related death. Female cancer deaths—by country, cancer type and age (derived from GLOBOCAN estimates)—were multiplied by each woman’s estimated number of children under the age of 18 years at the time of her death (fertility data were derived from United Nations World Population Prospects for birth cohort), accounting for child mortality and parity-cancer risk associations. Globally, there were 1,047,000 such orphans. Over half of these were orphans due to maternal deaths from breast (258,000, 25%), cervix (210,000, 20%) and upper-gastrointestinal cancers (136,000, 13%), and most occurred in Asia ...

BMJ Global Health

IntroductionResearch is a critical pillar in national cancer control planning. However, there is ... more IntroductionResearch is a critical pillar in national cancer control planning. However, there is a dearth of evidence for countries to implement affordable strategies. The WHO and various Commissions have recommended developing stakeholder-based needs assessments based on objective data to generate evidence to inform national and regional prioritisation of cancer research needs and goals.MethodologyBibliometric algorithms (macros) were developed and validated to assess cancer research outputs of all 54 African countries over a 12-year period (2009–2020). Subanalysis included collaboration patterns, site and domain-specific focus of research and understanding authorship dynamics by both position and sex. Detailed subanalysis was performed to understand multiple impact metrics and context relative outputs in comparison with the disease burden as well as the application of a funding thesaurus to determine funding resources.ResultsAfrican countries in total published 23 679 cancer resea...

JCO Global Oncology, 2022

PURPOSE Global Oncology is the movement to improve equitable access to cancer control and care, r... more PURPOSE Global Oncology is the movement to improve equitable access to cancer control and care, recognizing challenges because of economic and social factors between high-, middle-, and low-income countries (HIC, MIC, and LIC, respectively). The JCO Global Oncology ( JCO GO) is a major platform dedicated to publishing peer-reviewed research relevant to populations with limited resources. To assess the success of its goals of encouraging global interaction and increasing MIC and LIC engagement, we analyzed authorship and readership patterns. METHODS Metadata of logged views between January 1, 2018, and June 30, 2019, of articles published in 2018 by JCO GO were identified using Google Analytics. The country of origin of each author and those who accessed the journal were categorized according to the 2019 income group World Bank Classification (WBC). RESULTS One hundred thirty-two articles were published in JCO GO in 2018. Corresponding authors came from 34 nations: 35% HIC, 47% MIC, ...

JCO Global Oncology, 2021

Diagnosing cancer earlier can enable timely treatment and optimize outcomes. Worldwide, national ... more Diagnosing cancer earlier can enable timely treatment and optimize outcomes. Worldwide, national cancer control plans increasingly encompass early diagnosis programs for symptomatic patients, commonly comprising awareness campaigns to encourage prompt help-seeking for possible cancer symptoms and health system policies to support prompt diagnostic assessment and access to treatment. By their nature, early diagnosis programs involve complex public health interventions aiming to address unmet health needs by acting on patient, clinical, and system factors. However, there is uncertainty regarding how to optimize the design and evaluation of such interventions. We propose that decisions about early diagnosis programs should consider four interrelated components: first, the conduct of a needs assessment (based on cancer-site–specific statistics) to identify the cancers that may benefit most from early diagnosis in the target population; second, the consideration of symptom epidemiology t...

The Lancet Global Health, Feb 1, 2023

The Lancet

Women interact with cancer in complex ways, as healthy individuals participating in cancer preven... more Women interact with cancer in complex ways, as healthy individuals participating in cancer prevention, as patients, as health professionals, researchers, policymakers, and as unpaid caregivers. In all these domains, women often are subject to overlapping forms of discrimination, such as due to age, race, ethnicity and socio-economic status, that render them structurally marginalized. These myriad factors can restrict a woman’s rights and opportunities to avoid cancer risks, are a barrier to diagnosis and quality cancer care, maintain an unpaid caregiver workforce that is predominantly female, and hinder women’s professional advancement. The Lancet Commission on women, power and cancer was created to address urgent questions at the intersection of social inequality, cancer risk, and outcomes, and the status of women in society.

Asia-Pacific Journal of Oncology Nursing, Jul 1, 2023

Cancer Treatment Reviews, Mar 1, 2022

Breast cancer is the leading cause of cancer morbidity, disability and mortality in women, worldw... more Breast cancer is the leading cause of cancer morbidity, disability and mortality in women, worldwide. Overall, in 2020, it was the most diagnosed malignancy. Differences in breast cancer mortality have been historically evidenced, as a result of disparities in access to diagnosis, treatment and palliative care. Epidemiologic trends in the last decades display three main patterns of breast cancer mortality: some high-income countries report continuous substantial improvements exceeding 2% annual mortality reduction; however, many low- and middle-income countries (LMICs) have stagnant or even increasing mortality rates. Population-based studies show that investing in breast cancer control, based on a primary health care approach, and expanding the cancer treatment capacity can portend population health benefits, with positive changes of the epidemiological adverse trajectories. Framed as part of the political commitment to the Sustainable Development Goals Agenda, World Health Organization (WHO) has recently launched a global initiative to tackle disparities in breast cancer mortality. The WHO-led Global Breast Cancer Initiative (GBCI) is framed across 3 pillars, to address key determinants of the cancer-related outcomes: health promotion and early detection, timely access to diagnosis and treatment, comprehensive breast cancer treatment, palliative and survivorship care. GBCI is a systematized approach, with the goal to (i) increase the fraction of newly diagnosed invasive cancers being stage 1 or 2 at diagnosis (60% or more), (ii) ensure diagnostic work-up to be completed within 60 days from the first connection with the primary healthcare providers to avoid delays in diagnosis and treatment and (iii) assure 80% or more women with breast cancer to undergo and complete multimodal treatments. GBCI will pursue a comprehensive and multisectoral approach, to deliver population health, social and economic benefits, ultimately intended as an entry point for health system strengthening and for the broader cancer control.

International Journal of Radiation Oncology Biology Physics, Sep 1, 2019

Fertility and Sterility, Mar 1, 2016

Breast Cancer Research, Mar 9, 2012

Journal of Clinical Oncology, May 20, 2018

1537Background: Lynch syndrome (LS) accounts for most inherited endometrial cancers (EC). The ide... more 1537Background: Lynch syndrome (LS) accounts for most inherited endometrial cancers (EC). The identification of probands presents a chance to prevent other cancers and enable cascade testing. Professional organizations have released guidelines for genetic counseling referrals (GCR) based on high-risk (HR) criteria including loss of mismatch repair (MMR) protein expression on tumor immunohistochemistry (IHC). Methods: All women diagnosed with EC from 2012 to 2017 were retrospectively identified and evaluated. Comparative analyses were performed with appropriate two-sided statistical tests. HR criteria were defined as age ≥50 at diagnosis, significant family or personal histories of LS-related cancers or positive MMR IHC. Results: A total of 716 women were diagnosed with EC and of these, 230 (32%) had at least one HR criteria. Of the HR women, 51% were given GCR and 13 (19%) were found to have LS. Mid-2015, we implemented universal MMR IHC. GCR rates among HR women were higher after January 2016 (72% vs 52%...

Introduction: Breast cancer-related pain significantly affects quality of life and is well-docume... more Introduction: Breast cancer-related pain significantly affects quality of life and is well-documented in developed countries. However, little is known about the extent of breast cancer-related pain in developing countries. A study at the National Cancer Institute of Vietnam reported that 44% of breast cancer patients experienced moderate to severe pain. However, this study did not include breast cancer survivors, and little is known about the prevalence of pain and its management in this patient population. Objectives: Determine the prevalence of pain, adequacy of pain management, and barriers to care in breast cancer survivors in Vietnam. Methods: We administered previously validated and published symptom assessment tools (the BPI and MDASI) to 160 unselected Vietnamese women diagnosed and treated for breast cancer in 2007. Here we present a preliminary description of the results for the first 40 breast cancer survivors enrolled in this study. Results: The most frequently reported symptoms were pain (62.5%, with 40% reporting the pain as severe), memory loss (50%), numbness/tingling (50%), sleep disturbance (45%), and appetite loss (32.5%). Only 23% reported adequate symptom management, with the costs of treatment and the false belief that no treatments existed for the pain being frequently cited as barriers to care. Discussion: Cancer-related pain is highly prevalent in breast cancer survivors treated at the largest cancer hospital in Vietnam. The majority of patients report inadequate management of pain, often attributable to costs and false beliefs regarding pain management. Initiatives aimed at patient education and improving accessibility to pain management could significantly improve the quality of life in this patient population. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-10-04.

Journal of Medical Genetics, Jul 17, 2015

Routledge eBooks, Jan 18, 2023

Nature Medicine

Despite women being disproportionally affected by cancer deaths at young ages, there are no globa... more Despite women being disproportionally affected by cancer deaths at young ages, there are no global estimates of the resulting maternal orphans, who experience health and education disadvantages throughout their lives. We estimated the number of children who became maternal orphans in 2020 due to their mother dying from cancer in that year, for 185 countries worldwide and by cause of cancer-related death. Female cancer deaths—by country, cancer type and age (derived from GLOBOCAN estimates)—were multiplied by each woman’s estimated number of children under the age of 18 years at the time of her death (fertility data were derived from United Nations World Population Prospects for birth cohort), accounting for child mortality and parity-cancer risk associations. Globally, there were 1,047,000 such orphans. Over half of these were orphans due to maternal deaths from breast (258,000, 25%), cervix (210,000, 20%) and upper-gastrointestinal cancers (136,000, 13%), and most occurred in Asia ...

BMJ Global Health

IntroductionResearch is a critical pillar in national cancer control planning. However, there is ... more IntroductionResearch is a critical pillar in national cancer control planning. However, there is a dearth of evidence for countries to implement affordable strategies. The WHO and various Commissions have recommended developing stakeholder-based needs assessments based on objective data to generate evidence to inform national and regional prioritisation of cancer research needs and goals.MethodologyBibliometric algorithms (macros) were developed and validated to assess cancer research outputs of all 54 African countries over a 12-year period (2009–2020). Subanalysis included collaboration patterns, site and domain-specific focus of research and understanding authorship dynamics by both position and sex. Detailed subanalysis was performed to understand multiple impact metrics and context relative outputs in comparison with the disease burden as well as the application of a funding thesaurus to determine funding resources.ResultsAfrican countries in total published 23 679 cancer resea...

JCO Global Oncology, 2022

PURPOSE Global Oncology is the movement to improve equitable access to cancer control and care, r... more PURPOSE Global Oncology is the movement to improve equitable access to cancer control and care, recognizing challenges because of economic and social factors between high-, middle-, and low-income countries (HIC, MIC, and LIC, respectively). The JCO Global Oncology ( JCO GO) is a major platform dedicated to publishing peer-reviewed research relevant to populations with limited resources. To assess the success of its goals of encouraging global interaction and increasing MIC and LIC engagement, we analyzed authorship and readership patterns. METHODS Metadata of logged views between January 1, 2018, and June 30, 2019, of articles published in 2018 by JCO GO were identified using Google Analytics. The country of origin of each author and those who accessed the journal were categorized according to the 2019 income group World Bank Classification (WBC). RESULTS One hundred thirty-two articles were published in JCO GO in 2018. Corresponding authors came from 34 nations: 35% HIC, 47% MIC, ...

JCO Global Oncology, 2021

Diagnosing cancer earlier can enable timely treatment and optimize outcomes. Worldwide, national ... more Diagnosing cancer earlier can enable timely treatment and optimize outcomes. Worldwide, national cancer control plans increasingly encompass early diagnosis programs for symptomatic patients, commonly comprising awareness campaigns to encourage prompt help-seeking for possible cancer symptoms and health system policies to support prompt diagnostic assessment and access to treatment. By their nature, early diagnosis programs involve complex public health interventions aiming to address unmet health needs by acting on patient, clinical, and system factors. However, there is uncertainty regarding how to optimize the design and evaluation of such interventions. We propose that decisions about early diagnosis programs should consider four interrelated components: first, the conduct of a needs assessment (based on cancer-site–specific statistics) to identify the cancers that may benefit most from early diagnosis in the target population; second, the consideration of symptom epidemiology t...

Breast and cervical cancer receive far less funding, advocacy, and public and political attention... more Breast and cervical cancer receive far less funding, advocacy, and public and political attention in low-income and middle-income countries than in high-income countries. This situation is despite the fact that women in these settings have higher burdens of these diseases, poorer access to care, present with more advanced stages of disease, and have a higher chance of dying from their disease than women in resource-rich settings. Why the discrepancy? A new Lancet Series on Health, equity, and women's cancers explores this neglected issue in global health. It covers the burden of breast and cervical cancer worldwide and inequities in incidence, survival, and mortality; feasible, cost-effect interventions for these cancers that could close the divide between low-income and middle-income countries and high-income nations; and changes to global policy that are needed to deliver safe, equitable, and affordable care for women.

J Cancer Policy, 2022

Background: Early reports suggested that COVID-19 patients with cancer were at higher risk of COV... more Background: Early reports suggested that COVID-19 patients with cancer were at higher risk of COVID-19-related death. We conducted a systematic review with risk of bias assessment and synthesis of the early evidence on the risk of COVID-19-related death for COVID-19 patients with and without cancer. Methods and findings: We searched Medline/Embase/BioRxiv/MedRxiv/SSRN databases to 1 July 2020. We included cohort or case-control studies published in English that reported on the risk of dying after developing COVID-19 for people with a pre-existing diagnosis of any cancer, lung cancer, or haematological cancers. We assessed risk of bias using tools adapted from the Newcastle-Ottawa Scale. We used the generic inverse-variance random-effects method for meta-analysis. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated separately. Of 96 included studies, 54 had sufficient non-overlapping data to be included in meta-analyses (>500,000 people with COVID-19, >8000 with cancer; 52 studies of any cancer, three of lung and six of haematological cancers). All studies had high risk of bias. Accounting for at least age consistently led to lower estimated ORs and HRs for COVID-19-related death in cancer patients (e.g. any cancer versus no cancer; six studies, unadjusted OR=3.30,95%CI:2.59-4.20, adjusted OR=1.37,95%CI:1.16-1.61). Adjusted effect estimates were not reported for people with lung or haematological cancers. Of 18 studies that adjusted for at least age, 17 reported positive associations between pre-existing cancer diagnosis and COVID-19-related death (e.g. any cancer versus no cancer; nine studies, adjusted OR=1.66,95%CI:1.33-2.08; five studies, adjusted HR=1.19,95%CI:1.02-1.38).

Journal of Cancer Policy, 2022

Background: The early COVID-19 literature suggested that people with cancer may be more likely to... more Background: The early COVID-19 literature suggested that people with cancer may be more likely to be infected with SARS-CoV-2 or develop COVID-19 than people without cancer, due to increased health services contact and/or immunocompromise. While some studies were criticised due to small patient numbers and methodological limitations, they created or reinforced concerns of clinicians and people with cancer. These risks are also important in COVID-19 vaccine prioritisation decisions. We performed a systematic review to critically assess and summarise the early literature. Methods and findings: We conducted a systematic search of Medline/Embase/BioRxiv/MedRxiv/SSRN databases including peer-reviewed journal articles, letters/commentaries, and non-peer-reviewed pre-print articles for 1 January-1 July 2020. The primary endpoints were diagnosis of COVID-19 and positive SARS-CoV-2 test. We assessed risk of bias using a tool adapted from the Newcastle-Ottawa Scale. Twelve studies were included in the quantitative synthesis. All four studies of COVID-19 incidence (including 24,181,727 individuals, 125,649 with pre-existing cancer) reported that people with cancer had higher COVID-19 incidence rates. Eight studies reported SARS-CoV-2 test positivity for > 472,000 individuals, 48,370 with preexisting cancer. Seven of these studies comparing people with any and without cancer, were pooled using random effects [pooled odds ratio 0.91, 95 %CI: 0.57-1.47; unadjusted for age, sex, or comorbidities]. Two studies suggested people with active or haematological cancer had lower risk of a positive test. All 12 studies had high risk of bias; none included universal or random COVID-19/SARS-CoV-2 testing.