Eun-Sil Hwang

Positions:

Mary and Deryl Hart Distinguished Professor of Surgery, in the School of Medicine

Surgical Oncology
School of Medicine

Professor of Surgery

Surgical Oncology
School of Medicine

Vice-Chair of Research in the Department of Surgery

Surgery
School of Medicine

Professor of Radiology

Radiology
School of Medicine

Core Faculty Member, Duke-Margolis Center for Health Policy

Duke - Margolis Center For Health Policy
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1991

University of California - Los Angeles

M.P.H. 2006

University of California - Berkeley

Intern, General Surgery

Kaiser Foundation Hospital

Resident, General Surgery

Cornell University

Fellow, Breast Surgical Oncology

Memorial Sloan-Kettering Cancer Center

Senior Reigstrar, General Surgical Oncology

Singapore General Hospital (Singapore)

Assistant Professor in Residence, Surgery

University of California San Francisco, School of Medicine

Associate Professor in Residence, Surgery

University of California San Francisco, School of Medicine

Chief, Division Of Breast Surgery Oncology

University of California San Francisco, School of Medicine

Professor in Residence, Surgery

University of California San Francisco, School of Medicine

Surgeon-in-Chief, Ucsf Helen Diller Family Cancer Center

University of California San Francisco, School of Medicine

Grants:

Genomic Diversity and the Microenvironment as Drivers of Progression in DCIS

Administered By
Surgical Oncology
Awarded By
Department of Defense
Role
Principal Investigator
Start Date
End Date

Preoperative Breast Radiotherapy: A Tool to Provide Individualized and Biologically-Based Radiation Therapy

Administered By
Radiation Oncology
Awarded By
Gateway for Cancer Research
Role
Collaborator
Start Date
End Date

(PQC3) Genomic Diversity and the Microenvironment as Drivers of Metastasis in DCIS

Administered By
Surgical Oncology
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

NCI National Clinical Trials Network U10 (Year 5)

Administered By
Duke Cancer Institute
Awarded By
National Institutes of Health
Role
Co-Principal Investigator
Start Date
End Date

Regional Oncolytic Poliovirus Immunotherapy for Breast Cancer

Administered By
Surgery, Surgical Sciences
Awarded By
Department of Defense
Role
Co Investigator
Start Date
End Date

Publications:

Inferring the evolutionary dynamics of ductal carcinoma in situ through multi-regional sequencing and mathematical modeling.

Authors
Ryser, MD; Sorribes, IC; Greenwald, M; Wu, E; Hall, A; Mallo, D; King, LM; Hardman, T; Simpson, L; Maley, CC; Marks, JR; Shibata, D; Hwang, ES
MLA Citation
URI
https://scholars.duke.edu/individual/pub1467191
Source
wos-lite
Published In
Cancer Research
Volume
80
Published Date

A medicare-based comparative mortality analysis of active surveillance in older women with DCIS.

Over 97% of individuals diagnosed with ductal carcinoma in situ (DCIS) will choose to receive guideline concordant care (GCC), which was originally designed to treat invasive cancers and is associated with treatment related morbidity. An alternative to GCC is active surveillance (AS) where therapy is delayed until medically necessary. Differences in mortality risk between the two approaches in women age 65+ are analyzed in this study. SEER and Medicare information on treatment during the first year after diagnosis was used to identify three cohorts based on treatment type and timing: GCC (N = 21,772; immediate consent for treatment), AS1 (N = 431; delayed treatment within 365 days), and AS2 (N = 205; no treatment/ongoing AS). A propensity score-based approach provided pseudorandomization between GCC and AS groups and survival was then compared. Strong influence of comorbidities on the treatment received was observed for all age-groups, with the greatest burden observed in the AS2 group. All-cause and breast-cancer-specific mortality hazard ratios (HR) for AS1 were not statistically different from the GCC group; AS2 was associated with notably higher risk for both all-cause (HR:3.54; CI:3.29, 3.82) and breast-cancer-specific (HR:10.73; CI:8.63,13.35) mortality. Cumulative mortality was substantially higher from other causes than from breast cancer, regardless of treatment group. Women managed with AS for DCIS had higher all-cause and breast-cancer-specific mortality. This effect declined after accounting for baseline comorbidities. Delays of up to 12 months in initiation of GCC did not underperform immediate surgery.
Authors
Akushevich, I; Yashkin, AP; Greenup, RA; Hwang, ES
MLA Citation
Akushevich, Igor, et al. “A medicare-based comparative mortality analysis of active surveillance in older women with DCIS.Npj Breast Cancer, vol. 6, no. 1, Oct. 2020, p. 57. Pubmed, doi:10.1038/s41523-020-00199-0.
URI
https://scholars.duke.edu/individual/pub1468769
PMID
33298917
Source
pubmed
Published In
Npj Breast Cancer
Volume
6
Published Date
Start Page
57
DOI
10.1038/s41523-020-00199-0

Disparities at the Intersection of Race and Ethnicity: Examining Trends and Outcomes in Hispanic Women With Breast Cancer.

PURPOSE: We sought to examine tumor subtype, stage at diagnosis, time to surgery (TTS), and overall survival (OS) among Hispanic patients of different races and among Hispanic and non-Hispanic (NH) women of the same race. METHODS: Women 18 years of age or older who had been diagnosed with stage 0-IV breast cancer and who had undergone lumpectomy or mastectomy were identified in the National Cancer Database (2004-2014). Tumor subtype and stage at diagnosis were compared by race/ethnicity. Multivariable linear regression and Cox proportional hazards modeling were used to estimate associations between race/ethnicity and adjusted TTS and OS, respectively. RESULTS: A total of 44,374 Hispanic (American Indian [AI]: 79 [0.2%]; Black: 1,011 [2.3%]; White: 41,126 [92.7%]; Other: 2,158 [4.9%]) and 858,634 NH women (AI: 2,319 [0.3%]; Black: 97,206 [11.3%]; White: 727,270 [84.7%]; Other: 31,839 [3.7%]) were included. Hispanic Black women had lower rates of triple-negative disease (16.2%) than did NH Black women (23.5%) but higher rates than did Hispanic White women (13.9%; P < .001). Hispanic White women had higher rates of node-positive disease (23.2%) versus NH White women (14.4%) but slightly lower rates than Hispanic (24.6%) and NH Black women (24.5%; P < .001). Hispanic White women had longer TTS versus NH White women regardless of treatment sequence (adjusted means: adjuvant chemotherapy, 42.71 v 38.60 days; neoadjuvant chemotherapy, 208.55 v 201.14 days; both P < .001), but there were no significant racial differences in TTS among Hispanic patients. After adjustment, Hispanic White women (hazard ratio, 0.77 [95% CI, 0.74 to 0.81]) and Black women (hazard ratio, 0.75 [95% CI, 0.58 to 0.96]) had improved OS versus NH White women (reference) and Black women (hazard ratio, 1.15 [95% CI, 1.12 to 1.18]; all P < .05). CONCLUSION: Hispanic women had improved OS versus NH women, but racial differences in tumor subtype and nodal stage among Hispanic women highlight the importance of disaggregating racial/ethnic data in breast cancer research.
Authors
Champion, CD; Thomas, SM; Plichta, JK; Parrilla Castellar, E; Rosenberger, LH; Greenup, RA; Hyslop, T; Hwang, ES; Fayanju, OM
MLA Citation
Champion, Cosette D., et al. “Disparities at the Intersection of Race and Ethnicity: Examining Trends and Outcomes in Hispanic Women With Breast Cancer.Jco Oncol Pract, Oct. 2020, p. OP2000381. Pubmed, doi:10.1200/OP.20.00381.
URI
https://scholars.duke.edu/individual/pub1462132
PMID
33026950
Source
pubmed
Published In
Jco Oncol Pract
Published Date
Start Page
OP2000381
DOI
10.1200/OP.20.00381

Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline.

<h4>Purpose</h4>To develop guideline recommendations concerning optimal neoadjuvant therapy for breast cancer.<h4>Methods</h4>ASCO convened an Expert Panel to conduct a systematic review of the literature on neoadjuvant therapy for breast cancer and provide recommended care options.<h4>Results</h4>A total of 41 articles met eligibility criteria and form the evidentiary basis for the guideline recommendations.<h4>Recommendations</h4>Patients undergoing neoadjuvant therapy should be managed by a multidisciplinary care team. Appropriate candidates for neoadjuvant therapy include patients with inflammatory breast cancer and those in whom residual disease may prompt a change in therapy. Neoadjuvant therapy can also be used to reduce the extent of local therapy or reduce delays in initiating therapy. Although tumor histology, grade, stage, and estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2) expression should routinely be used to guide clinical decisions, there is insufficient evidence to support the use of other markers or genomic profiles. Patients with triple-negative breast cancer (TNBC) who have clinically node-positive and/or at least T1c disease should be offered an anthracycline- and taxane-containing regimen; those with cT1a or cT1bN0 TNBC should not routinely be offered neoadjuvant therapy. Carboplatin may be offered to patients with TNBC to increase pathologic complete response. There is currently insufficient evidence to support adding immune checkpoint inhibitors to standard chemotherapy. In patients with hormone receptor (HR)-positive (HR-positive), HER2-negative tumors, neoadjuvant chemotherapy can be used when a treatment decision can be made without surgical information. Among postmenopausal patients with HR-positive, HER2-negative disease, hormone therapy can be used to downstage disease. Patients with node-positive or high-risk node-negative, HER2-positive disease should be offered neoadjuvant therapy in combination with anti-HER2-positive therapy. Patients with T1aN0 and T1bN0, HER2-positive disease should not be routinely offered neoadjuvant therapy.Additional information is available at www.asco.org/breast-cancer-guidelines.
Authors
Korde, LA; Somerfield, MR; Carey, LA; Crews, JR; Denduluri, N; Hwang, ES; Khan, SA; Loibl, S; Morris, EA; Perez, A; Regan, MM; Spears, PA; Sudheendra, PK; Symmans, WF; Yung, RL; Harvey, BE; Hershman, DL
MLA Citation
Korde, Larissa A., et al. “Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline.Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 39, no. 13, May 2021, pp. 1485–505. Epmc, doi:10.1200/jco.20.03399.
URI
https://scholars.duke.edu/individual/pub1473067
PMID
33507815
Source
epmc
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
39
Published Date
Start Page
1485
End Page
1505
DOI
10.1200/jco.20.03399

Outcomes and Costs for Women After Breast Cancer: Preparing for Improved Survivorship of Medicare Beneficiaries.

<h4>Purpose</h4>Increasing health care costs, longer life expectancy, improved breast cancer (BC) survival, and higher levels of complex comorbidities have important implications for future Medicare expenditures.<h4>Methods</h4>Data from the SEER program linked to Medicare claims records were used. Women with BC (cases) were categorized into 3 groups on the basis of their year of diagnosis (1998, 2003, or 2008) and were propensity score matched to women without a BC diagnosis (controls). All stage and stage-specific longitudinal changes in survival, morbidity levels using the Elixhauser index, and Medicare expenditures in 2018 dollars were calculated and compared.<h4>Results</h4>More than 15% of BC cases were diagnosed in patients over the age of 85 years. The prevalence of most comorbidities increased over time. Costs among cases increased between 1998 and 2008. Spending directly correlated with the stage of disease at diagnosis, with the lowest per-patient costs in the ductal carcinoma in situ (DCIS) subgroup ($14,792 in 1998 and $19,652 in 2008) and the highest in those with distant cancer ($37,667 in 1998 and $43,675 in 2008). Assuming no significant changes in the distribution of BC stage or age at diagnosis, the total annual costs of caring for patients with BC in women 65 years of age or older at diagnosis increased by at least $1.1 billion between 1998 and 2008.<h4>Conclusion</h4>Improvements in BC survivorship are associated with intensive use of health care resources and substantially higher downstream costs among Medicare beneficiaries. Appropriate planning, in both the fiscal and the oncology care infrastructure, is required to prepare the health system for these emerging health care trends.
Authors
Yashkin, AP; Greenup, RA; Gorbunova, G; Akushevich, I; Oeffinger, KC; Hwang, ES
MLA Citation
Yashkin, Arseniy P., et al. “Outcomes and Costs for Women After Breast Cancer: Preparing for Improved Survivorship of Medicare Beneficiaries.Jco Oncology Practice, vol. 17, no. 4, Apr. 2021, pp. e469–78. Epmc, doi:10.1200/op.20.00155.
URI
https://scholars.duke.edu/individual/pub1452594
PMID
32692618
Source
epmc
Published In
Jco Oncology Practice
Volume
17
Published Date
Start Page
e469
End Page
e478
DOI
10.1200/op.20.00155