United States

Background:
Quadratus lumborum (QL) and transversus abdominis plane (TAP) blocks are frequently employed to manage perioperative pain in abdominal surgeries. Recent comparative analyses suggest that QL blocks may provide more effective and longer-lasting analgesia stemming from the spread of local anesthetic into the thoracolumbar fascia and paravertebral space, targeting both somatic and visceral nociception. However, existing studies often fail to account for the influence of adjunct analgesics, such as ketamine, which is known to reduce postoperative opioid needs by modulating central sensitization. This study aimed to (1) compare the effectiveness of QL versus TAP blocks on perioperative opioid use in abdominal surgery, (2) determine whether intraoperative adjunct analgesics mediates this relationship, and (3) determine whether block type moderated the relationship between pain intensity and opioid requirements.
Methods:
We retrospectively analyzed 111 adults who received either a QL (n = 57) or TAP (n = 54) block for abdominal surgery. Groups were matched on age, sex, ASA class, weight, and height. Primary outcomes included intraoperative ketamine dose, opioid requirements (intraoperative and PACU, measured in morphine milligram equivalents [MME]), pain scores (PACU and discharge), and recovery outcomes such as PACU duration, and length of stay. Between-group comparisons were performed using independent t-tests. Mediation and moderation analyses were conducted using PROCESS for SPSS (Models 4 and 1, respectively).
Results:
The TAP group received significantly more intraoperative ketamine [t (81.71) = −2.98, p = .004], while the QL group received significantly more opioids postoperatively in the PACU [t (87.70) = 2.55, p = .012] and overall [t (109) = 2.08, p = .040]. Mediation analysis indicated that intraoperative ketamine dose partially mediated the relationship between block type and total opioid consumption (indirect effect = 1.44 MME; 95% CI [0.03, 3.36]). Additionally, moderation analysis indicated that block type influenced the strength of the pain-opioid relationship (b = 2.86, SE = 1.27; t = 2.26, p = .026, 95% CI [0.35, 5.38]), such that average pain score was a significant positive predictor of total opioid requirements in the QL group [b = 2.45, p = .004], but not the TAP group [b = −0.41, p = .670].
Conclusion:
QL blocks were associated with greater postoperative opioid requirements, partially mediated by lower intraoperative ketamine administration. Moreover, pain intensity more strongly predicted opioid requirements among patients receiving QL blocks, suggesting differential analgesic mechanisms. These findings challenge the assumption that QL blocks are uniformly superior, highlighting the critical role of intraoperative adjuncts when designing individualized, opioid-

AMA Research Challenge 2025 

QL vs TAP Blocks in Abdominal Surgery: How Pain and Ketamine Influence Postoperative Opioid Use

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Background: Risk-stratified lung cancer screening programs identify high-risk smokers but do not account for underlying genetic susceptibility. Many polygenic scores (PGS) have been developed for lung cancer, but it is unclear which, if any, are suitable for identifying high-risk individuals in the general population. 

Methods: We used a systematic review to identify published lung cancer PGS, which were implemented and validated in the UK Biobank (UKB) cohort. Performance (discrimination and accuracy) was compared. Subgroup analyses by sex, ethnicity, and smoking status identified differences across the population. We also divided the cohort into percentiles to assess PGS accuracy at identifying cases across risk categories.

Results: We identified 60 lung cancer PGS published since 2012, most derived from a narrow set of genome-wide association studies (GWAS) with overlapping single nucleotide polymorphisms (SNPs) and limited ethnic diversity (only one included African ancestry). Most scores were associated with lung cancer risk in UKB. Of the 39 evaluated PGS, 33 had a hazard ratio per standard deviation greater than 1.1 and 22 had a C-index greater than 0.55. Discriminative performance did not differ by sex. However, most PGS performed better in smokers than never smokers, although for a few scores (n=8) the reverse is true. Risk threshold analysis showed modest case enrichment, with some PGS identifying more than 25% of cases among the top 20% of the distribution.

Conclusion: Lung cancer PGS remain relatively weak compared to those developed for other cancers, limiting their immediate clinical utility. The predominance of European-derived GWAS and overlapping SNP sources underscores limited diversity and innovation in current development. Selection of a suitable PGS is context-dependent and requires consideration of target population characteristics (such as ethnicity and smoking status). While unlikely to be useful as standalone tools, PGS may provide incremental value when combined with epidemiologic and clinical risk models.

The current state of polygenic scores for the development of lung cancer: a systematic review and validation in UK Biobank

Background:
Diabetic ketoacidosis (DKA) with concurrent COVID-19 has been associated with higher in-hospital mortality and complications. National trends of DKA outcomes across COVID-19 waves with dominant variants such as Wild type, Alpha, Delta, and Omicron remain poorly defined. Using NIS data, we evaluated the effect of concurrent COVID-19 infection on DKA-related mortality and outcomes from 2020–2022, assessing whether variant evolution and rising immunity improved mortality and complications over time.

Methods: 
We conducted a retrospective study using HCUP’s NIS (2020–2022) to estimate DKA hospitalizations in adults with type 1 and type 2 diabetes, weighted to national level estimates. DKA cases were identified using ICD-10-CM codes E08.1x, E09.1x, E10.1x, E11.1x, and E13.1x listed as the primary diagnosis. The annual incidence of DKA-related hospitalization was calculated using the CDC’s NHIS data from the corresponding year. We compared the in-hospital mortality, complications, and use of invasive mechanical ventilation (IMV) in DKA hospitalizations with and without concurrent COVID infection, stratified by quarter from 2020 to 2022. Trends in outcomes were further evaluated across the dominant COVID-19 variant waves. 

Results:
From April 2020 to December 2022, 626,400 DKA hospitalizations occurred in the U.S., including 327,665 in type 1 and 294,290 in type 2 diabetes. The annual incidence of DKA hospitalizations remained stable (8.5–8.8 per 1,000 diabetic patients), consistently higher in type 1 (47.6 - 49.4 per 1000) than type 2 diabetes (~5.0 per 1000). Among COVID-positive DKA patients, complications varied by SARS-CoV-2 waves. The Alpha wave (Q1–Q2 2021) had the highest respiratory failure (12.14%) and IMV use (3.50%), while Delta (Q3–Q4 2021) showed peak sepsis (4.47%), cardiac arrest (0.71%), and elevated respiratory failure (10.75%). Mortality was highest during the Wild-type wave (1.97%). AKI remained elevated across all waves, peaking during early Omicron (Q1 2022, 52.39%). We noticed that COVID-negative DKA outcomes were relatively stable over different waves. Overall, Alpha and Delta waves demonstrated the highest rate of complications, while Omicron was associated with higher hospitalizations but lower rate of complications.

Conclusion: DKA-related complications varied significantly by COVID-19 waves, highlighting the clinical impact of viral pathogenicity on acute metabolic crises. These findings emphasize the need for tailoring inpatient care strategies to the severity of variants during future infectious disease surges to mitigate adverse outcomes in DKA patients. 


Trends in DKA Hospitalizations and Outcomes During the COVID-19 Pandemic (2020–2022)

Background
Pigmented or paraganglioid carcinoid tumors (PCTs) of the lung are rare neuroendocrine neoplasms with morphologic and immunophenotypic features overlapping those of extra-adrenal paragangliomas (PGs), including zellballen architecture and expression of S100 and SOX-10. However, their precise classification remains ambiguous. This study aimed to define PCTs as a distinct pulmonary neuroendocrine tumor entity using a comprehensive spatial transcriptomic approach.
Methods
We retrospectively identified 38 tumors (20 typical carcinoids [TCs], 16 PGs, 2 PCTs) and analyzed them using immunohistochemistry (IHC) and spatial transcriptomic profiling via NanoString GeoMx® Digital Spatial Profiler. Regions of interest (ROIs) were segmented by PanCK, S100, and CD45 expression. Transcriptomic data were analyzed for differential gene expression (DE), immune cell deconvolution, and pathway enrichment, with false discovery rate (FDR) < 0.05 considered significant.
Results
All tumors expressed synaptophysin and INSM1. PCTs co-expressed cytokeratins and neural crest markers (S100, SOX-10), mimicking PGs but retaining some epithelial features. Spatial transcriptomics revealed PCTs shared transcriptional features with both TCs and PGs. Compared to TCs, PCTs showed significant upregulation of CST2 and CST4, and downregulation of FBXO22 and DPP8 in epithelial (PanCK+) compartments relative to TCs. In contrast to PGs, PCTs had 614 significantly differentially expressed genes, including upregulation of OTP, ELAPOR1, and FABP5. Pathway analysis indicated enrichment in immune response, MAPK, and integrin signaling. Spatial deconvolution showed PCTs had intermediate immune cell infiltrates, with elevated dendritic and monocyte populations compared to TCs.
Conclusion
PCTs of the lung exhibit a unique morphologic, immunophenotypic, and spatial transcriptomic profile that bridges typical carcinoids and extra-adrenal paragangliomas. Their hybrid molecular identity supports formal recognition as a distinct pulmonary neuroendocrine tumor subtype. Accurate diagnosis requires an integrated approach using IHC and spatial transcriptomics to avoid misclassification and guide appropriate clinical management.

Lung Paraganglioid Carcinoid Tumors: A Distinct Neuroendocrine Variant with Spatial Profiling

Background

A critical challenge after aneurysmal subarachnoid hemorrhage (aSAH) is early identification of delayed cerebral ischemia (DCI) and cerebral vasospasm (VSP). Transcranial doppler ultrasound (TCD) non-invasively records cerebral blood flow velocity (CBFV) and is used to identify DCI and VSP risk, but current methods extract mean CBFV velocity, ignoring CBFV shape and dynamics. We hypothesize early pathophysiologic changes are encoded in CBFV shape and dynamics but missed by current CBFV measures. By applying the attractor reconstruction method, we aim to transform qualitative features of CBFV waveforms into quantitative values that better predict DCI and VSP after aSAH.

Methods

Simultaneous EKG, arterial blood pressure (ABP), and bilateral CBFV recordings were collected from consecutive aSAH patients in the Neurological Intensive Care Unit. Angiographic VSP and DCI were adjudicated by neurointensivists. Artifact-free CBFV waveform segments were extracted manually. We used Takens’ theorem to generate attractors from the CBFV waveforms by means of a delay embedding. Features such as attractor concentration and width were calculated. Each patient’s latest recording prior to DCI/VSP or negative CT angiogram was included. Attractor features in patients with and without DCI/VSP were compared using two- tailed t-tests. To confirm the validity of our findings, we simulated CBFV waveforms and correlated attractor features with CBFV features.

Results

Fifty-three patients with aSAH from 2016-2019 were followed. Of these, 29 (54.7%) developed VSP, and 20 (37.7%) developed DCI. CBFV, but not ABP, attractor concentration was higher prior to DCI (DCI mean = 0.26±0.04, no DCI mean = 0.23±0.03, p=0.04) and VSP (VSP mean = 0.26±0.02, no VSP mean = 0.22±0.02, p≤0.01). Increasing upstroke convexity and heterogeneity of simulated CBFV recordings increased attractor concentration. CBFV, but not ABP, attractor width was increased before VSP (VSP mean = 66.93±15.65, no VSP mean = 49.37±14.46, p=0.01). Larger simulated CBFV amplitude increased attractor width. In these same recordings, there were no differences in number of patients with mean CBFV greater than 120 cm/s (DCI count = 1, no DCI count = 1, p=1.0, VSP count = 3, no VSP count = 1, p=0.32).

Conclusion

Attractor analysis of CBFV recordings identifies brain-specific, morphological, and dynamic CBFV changes prior to DCI and VSP where conventional flow velocity analysis does not. These metrics provide non-invasive and quantitative predictors of DCI and VSP, unlocking a new paradigm for TCD clinical utility.

Early Identification of Delayed Cerebral Ischemia and Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage Through a Novel Dynamical Systems Approach

Background
Vulvovaginal diseases are under-reported and there is limited research on the nature of these conditions, the prevalence, and their impact patient on experience. Current estimates suggest 1 in 6 people with vulvas experience undiagnosed and untreated vulvovaginal discomfort over their lifetime. This may result from patient experiences of shame and stigma, lack of provider familiarity, or misunderstanding about these treatable conditions. Two of these conditions are vulvodynia and lichen sclerosus/lichen planus (LS/LP). Vulvodynia is a neuropathic pain condition and estimated to have a prevalence of 8% in the United States. LS/LP are chronic inflammatory and scarring disorders with a diagnosed prevalence of 0.05% in the United States, which is likely an underestimate.
Quality of life is a comprehensive method of evaluating physical and psychosexual aspects of vulvar disease. The Vulvar Quality of Life Index (VQLI) is a 15 question survey scored out of 45 with lower scores indicating lower quality of life. It has been validated to assess individual health and treatment response. This study aimed to better understand of how the quality of life differs for patients with LS/LP and vulvodynia compared to controls and how it changes over time with treatment. 

Methods
We are conducting a prospective cohort study using a baseline and follow-up surveys with the VQLI. Participants include adults in three groups: individuals with LS/LP, individuals with vulvodynia, and a control group without vulvar conditions (n=90). All participants completed an initial standardized questionnaire assessing vulvar quality of life. A follow-up survey was conducted five months later to evaluate changes over time. Comparative analyses were performed between groups to assess differences in baseline and follow-up outcomes. 

Results
Preliminary results include 51 participants: n=16 (control), n=23 (LS/LP), and n=12 (vulvodynia), with follow-up data from n=11, n=10, and n=4, respectively. Mean total scores differed significantly by group (ANOVA p=2.26×10⁷). Post hoc testing showed the greatest mean difference between vulvodynia and control, with additional significant differences between LS/LP and control and between vulvodynia and LS/LP. 

Conclusion
These findings demonstrate that vulvodynia and LS/LP severely impact quality of life compared to controls. As the study progresses, further data will clarify which variables most affect quality of life in vulvovaginal diseases. This may guide targeted counseling and follow-up. Treatment success may also be evaluated by its impact on quality of life.


Assessing the Impact of Vulvodynia and Lichen Sclerosus/Planus Using the Vulvar Quality of Life Index


Background
The Soong classification grades the prominence of volar locking plates used to treat distal radius fractures in relation to the volar rim. The basis of the classification scheme is that increasing plate prominence over the volar rim and distal radius watershed zone is associated with increased likelihood of flexor tendon irritation and need for plate removal. However, recent studies report mixed results on the predictive value of the Soong classification for these outcomes. We hypothesized that the decreased predictive accuracy of Soong classification is due to misclassification between Soong grades secondary to a suboptimal correlation between the Soong classification on radiographs (XR) and computed tomography (CT). 

Methods
Fifty volarly displaced distal radius fractures treated with a volar locking plate in the international and publicly available ICUC database were reviewed. All cases with a postoperative XR and CT were included. Soong classification of the volar locking plate in relation to the volar ulnar rim was determined on both XR and CT by two independent, fellowship-trained hand surgeons using CT imaging as the gold standard. The distribution of Soong grades on XR and CT was compared using Pearson’s chi-square test, and correlation was calculated using the Matthews’ correlation coefficient (MCC). A multi-class confusion matrix was used to calculate each grade's positive predictive value (PPV). 

Results
We found the interrater correlation coefficient (ICC) between the two observers to be 100% for the grades as determined separately on radiographs and CT imaging. The MCC was 0.65, indicating only moderate correlation between the two modalities. Per individual Soong grade, the PPV was the highest for grade 2 (0.96), with lower PPVs for grade 0 (0.63) and grade 1 (0.60). 

Conclusions
Inter-observer Soong grading demonstrated an excellent correlation for radiographs and CT independently, though not between grades from XR and those using CT. This points to the Soong grading system being affected by imaging modality. Because of this, Soong grades based on radiographs should not be the only consideration for a physician when deciding whether to remove a VLP following the healing of distal radius fractures.


Soong Classification Using X-Rays Only Moderately Correlates with Distal Radius Plate Position on CT

Background: Women develop substance use disorders and seek treatment after fewer years of drug use compared to men, a pattern known as the telescoping effect. This phenomenon has been consistently demonstrated across epidemiological studies of cocaine, alcohol, opioids, and tobacco, and replicated in preclinical models with cocaine and opioids, strongly suggesting it is biologically driven. However, its underlying mechanisms remain unexplored. Using a rat model, we tested the hypothesis that calcium-permeable AMPA receptors (CP-AMPARs) in the nucleus accumbens core (NAc), which are critical for cocaine craving in males, also drive the development of enhanced drug motivation, another key addiction-like feature in rodents, and that this process is accelerated in females, providing a potential mechanism underlying the telescoping effect.

Methods: Motivation for cocaine was assessed under a progressive-ratio schedule before (Pre-ExA PR) and after (Post-ExA PR) extended-access cocaine self-administration (24 h/day, 96 infusions/day, 10 days) and a 7-day withdrawal period. During withdrawal, females received intraperitoneal injections of the mGluR1 positive allosteric modulator SYN119 (SYN; 0 or10 mg/kg), which has been shown to prevent the recruitment of CP-AMPAR in the NAc, while males received intraperitoneal injections of the mGluR1 antagonist JNJ16259685 (JNJ; 0 or 5 mg/kg), which has been shown to accelerate the recruitment of CP-AMPAR in the NAc. Once a stable level of motivation was established after the withdrawal period, the effect of intra-NAc infusions of the CP-AMPAR antagonist Naspm (40 µg/side) was examined. In a separate cohort, NAc GluA1 and GluA2 protein levels were quantified to assess receptor composition after 7-days of withdrawal relative non-addiction controls (0-day timepoint).

Results: Females, but not males, developed enhanced motivation for cocaine following the 7-day withdrawal period (defined as a greater than 15% increase from Pre- to Post-ExA PR testing), recapitulating the telescoping effect. As predicted, this motivational shift was blocked in SYN-treated females and induced in JNJ-treated males. Intra-NAc Naspm infusions reduced cocaine motivation only in JNJ-treated males, confirming the functional contribution of CP-AMPARs. Molecular analyses in untreated controls revealed that only females showed GluA1-specific increases after 7 days of withdrawal, consistent with the recruitment of GluA2-lacking CP-AMPARs.

Conclusion: Together, these findings extend the role of CP-AMPARs in the NAc to include the development of enhanced drug motivation and highlight their significance in mediating the accelerated trajectory toward addiction in females. This work underscores CP-AMPAR recruitment as a key mechanism underlying multiple addiction-like behaviors and a promising target for developing novel treatment strategies.

CP-AMPA Receptors Drive the Telescoping Effect in a Rat Model of Cocaine Addiction

Abstract Title: 
Spontaneous Coronary Artery Dissection with Elevated Homocysteine – A Call for Surveillance in Patients with the MTHFR Mutation 

Background:
Elevated homocysteine is a known risk factor for vascular events1. Patients with the methylenetetrahydrofolate reductase (MTHFR) mutation are at increased risk for hyperhomocysteinemia, particularly in the setting of nutritional deficiencies2. We present a case of spontaneous coronary artery dissection (SCAD) associated with hyperhomocysteinemia in a patient with chronic alcohol use, nutritional deficiencies, and known MTHFR mutation.

Case Presentation:
A 52-year-old woman with a history of left subclavian deep vein thrombosis (18 years prior) and known MTHFR mutation presented with several months of exertional chest heaviness, accompanied by nausea, vomiting, and intermittent dizziness. A few days prior, an abnormal EKG (with baseline ST abnormalities) was noted during preoperative clearance for urethral sling surgery. An outpatient exercise stress test demonstrated markedly reduced functional capacity, though results were deemed equivocal due to baseline ST depression.

Initial workup in the ED revealed a normal cardiac exam, non-elevated troponins, and non-ischemic EKG. Transthoracic echocardiogram showed normal left ventricular systolic function without regional wall motion abnormalities. Given ongoing exertional symptoms, equivocal stress test results, and concern for unstable angina or SCAD, CT-derived fractional flow reserve imaging was acquired to minimize risk associated with coronary angiography. Imaging identified a type 3 SCAD in the mid-left anterior descending artery.

Laboratory studies revealed a markedly elevated homocysteine level (61 µmol/L; normal <14 µmol/L) and borderline folate (4.8 ng/mL). Although diagnosed with MTHFR mutation 13 years prior during prenatal testing, her homocysteine level had not been re-evaluated since. The patient endorsed longstanding alcohol use, intermittent bulimia nervosa, and poor nutritional intake. Notably, levels of vitamins B6, B9, and B12 had not been assessed within the past five years. She was managed conservatively with metoprolol, aspirin, and atorvastatin.

Discussion:
This case highlights an underrecognized intersection between genetic predisposition, nutritional status, and vascular risk. While SCAD is increasingly recognized as a non-atherosclerotic cause of myocardial ischemia, more commonly in younger women3, its association with hyperhomocysteinemia remains understudied. The MTHFR mutation alone does not typically result in hyperhomocysteinemia unless compounded by nutritional deficiencies. Current guidelines do not recommend routine homocysteine screening in patients with MTHFR mutations; however, this case illustrates the potential value of targeted surveillance in at-risk individuals. Periodic assessment of homocysteine and related cofactors (B6, B9, B12) may help identify modifiable contributors to vascular pathology before the development of irreversible events. Clinicians should maintain a high index of suspicion for hyperhomocysteinemia in patients with the MTHFR mutation and risk factors for nutritional deficiencies. 


Spontaneous Coronary Artery Dissection with Elevated Homocysteine – A Call for Surveillance in Patients with the MTHFR Mutation


Abstract Title:
A Diagnostic Challenge: Multi-System Serositis and Seropositivity in Adult-Onset Still’s Disease

Background: 
Adult-onset Still&#39;s disease (AOSD) is a rare, systemic autoinflammatory disorder of unknown etiology, which involves dysregulated innate immunity, with a central role for macrophage activation and overproduction of pro-inflammatory cytokines, particularly interleukin IL-1, IL-6, and IL-18. In AOSD, the absence of definitive diagnostic markers, and the requirement to exclude a broad range of mimicking conditions including infections, malignancies, and other rheumatological diseases, often leads to protracted diagnostic workups, and delayed delivery of care. 

Case Presentation: 
A 41-year-old previously healthy woman presented with high-grade fevers, headache, photophobia, sore throat, shortness of breath, and diffuse arthralgia. She was septic. Examination revealed cervical lymphadenopathy, and a maculopapular rash on her thighs. Initial laboratory studies were notable for leukocytosis, hyperferritinemia, transaminitis, and elevated troponins. Chest imaging (X-ray and CT) showed bilateral pleural effusions and pulmonary infiltrates. Blood and sputum cultures, along with a comprehensive infectious workup, were negative. An Echocardiogram showed myocardial edema suspicious of myocarditis. CT of abdomen revealed splenomegaly. Pleural fluid analysis showed an exudative effusion without organisms. A lumbar puncture showed aseptic meningitis. Broad-spectrum antibiotics were initiated but patient continued to be septic despite a 7-day course. Rheumatologic testing was positive for Rheumatoid Factor (RF), Antinuclear (ANA), Anti-Centromere, and Anti-Mitochondrial antibodies. Patient also developed odynophagia. Upper endoscopy revealed esophagitis and antral gastritis; biopsies showed non-infectious inflammation. Despite positive autoimmune antibodies corresponding with certain diseases, the lack of diagnostic clinical features and the rarity of widespread serosal inflammation in these conditions made an autoimmune cause unlikely. Subsequently, the patient met Yamaguchi criteria for AOSD, and a diagnosis was established after 2 weeks. (11) Antibiotics were discontinued, and the patient received intravenous Methylprednisolone for two days, then daily oral Prednisone. IL-6 inhibitor therapy was initiated. Sepsis rapidly resolved and remarkable recovery of symptoms was observed within 24 hours of steroid initiation.

Discussion:
This case illustrates the importance of maintaining a broad differential in patients with sepsis, atypical multisystemic inflammation, and negative cultures, especially when classic autoimmune criteria are not fully met. Additionally, while autoimmune serologies are typically negative in AOSD, their presence does not rule out the diagnosis. The pathogenesis involves innate and adaptive immunity, intersecting with autoimmune diseases. Nonetheless, overlap between AOSD and systemic autoimmune conditions is rare, primarily documented in isolated case reports. Current evidence refutes an increased risk of autoimmune disease in AOSD patients. This makes seropositivity a diagnostic challenge rather than an exclusion criterion.

A Diagnostic Challenge: Multi-System Serositis and Seropositivity 
In Adult-Onset Still’s Disease

Background:
Racial disparities in breast cancer incidence and outcomes remain a critical public health issue in the United States, with Black women experiencing earlier onset, more aggressive subtypes, and higher mortality rates than White women. Structural inequities in healthcare access are thought to drive these gaps, and more information is needed to characterize local cancer biorepositories.
This study leverages patient data from the Prisma Health Cancer Institute Biorepository in Upstate South Carolina for comparison with national data.
Methods:
We conducted a retrospective cohort analysis of 1,688 breast cancer cases treated at the Prisma Health Cancer Institute between January 2014 and December 2022. Demographic, lifestyle, and clinical variables—including age, race, BMI, presence of diabetes, smoking status, receptor (ER/PR/HER2) status, histology, and cancer stage—were extracted from the cancer patient records. Multiple correspondence analysis (MCA) of five categorical tumor markers (ER, PR, HER2, stage, histology) was followed by K-means clustering (optimal k=4) to identify biologically distinct patient subgroups. Odds ratios were calculated to explore associations between combined lifestyle factors and the likelihood of developing Triple Negative Breast Cancer (TNBC) versus Luminal A subtype. To provide the national context, comparative analyses were performed against the age-adjusted incidence and stage-at-diagnosis data from the 2018–2022 Surveillance, Epidemiology, and End Results (SEER) Program.
Results:
Black patients comprised 16.4% of the cohort but exhibited a higher proportion of TNBC (10.9% vs. 7.7% in White patients), higher obesity rates (mean BMI 32.9 vs. 29.4), and were more likely to be diagnosed before age 40 (5.7% vs. 4.8%). Clustering analysis confirmed four tumor biology–driven subgroups that differed significantly by stage and histology (p<0.05), but not by race, age, BMI, or menopausal status (all p>0.2). National SEER data show that non-Hispanic
Black women have roughly double the age-adjusted incidence of TNBC (25.3 vs. 12.6 per 100,000) and lower rates of localized-stage detection (55.3% vs. 63.8%) compared to White women. Our cohort mirrored these patterns with earlier onset and more advanced-stage presentation among Black patients. Lifestyle factor analyses yielded non-significant trends (e.g., diabetic overweight smokers had 0.45-fold odds of TNBC vs. non-smokers).
Conclusion:
Local breast cancer patterns among Black women align with national disparities in tumor subtype and stage at diagnosis. These findings underscore the need for culturally responsive screening strategies and targeted interventions to reduce inequities in breast cancer outcomes.

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