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)

Chief, Division Of Breast Surgery Oncology

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:

Comparing the Effectiveness of Guideline-concordant Care to Active Surveillance for DCIS: an Observational Study

Awarded By
Patient Centered Outcomes Research Institute
Role
Principal Investigator
Start Date
End Date

Prevent Ductal Carcinoma in Situ Invasive Overtreatment Now - PRECISION

Administered By
Surgical Oncology
Awarded By
MD Anderson Cancer Center
Role
Principal Investigator
Start Date
End Date

Breast Pre-Cancer Atlas Center

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

TBCRC 034: The Incidence of Adjacent Synchronous Ipsilateral Infiltrating Carcinoma and/or DCIS in Patients Diagnosed with Intraductal Papilloma without Atypia or Flat Epithelial Atypia by Core Needle Biopsy

Administered By
Duke Cancer Institute
Awarded By
Johns Hopkins University
Role
Principal Investigator
Start Date
End Date

Tissue tension, RANK and Breast Cancer Risk

Administered By
Surgical Oncology
Awarded By
University of California, San Francisco
Role
Principal Investigator
Start Date
End Date

Publications:

Pain Control in Breast Surgery: Survey of Current Practice and Recommendations for Optimizing Management-American Society of Breast Surgeons Opioid/Pain Control Workgroup.

INTRODUCTION: The opioid epidemic in the United States is a public health crisis. Breast surgeons are obligated to provide good pain control for their patients after surgery but also must minimize administration of narcotics to prevent a surgical episode of care from becoming a patient's gateway into opioid dependence. METHODS: A survey to ascertain pain management practice patterns after breast surgery was performed. A review of currently available literature that was specific to breast surgery was performed to create recommendations regarding pain management strategies. RESULTS: A total of 609 surgeons completed the survey and demonstrated significant variations in pain management practices, specifically within regards to utilization of regional anesthesia (e.g., nerve blocks), and quantity of prescribed narcotics. There is excellent data to guide the use of local and regional anesthesia. There are, however, fewer studies to guide narcotic recommendations; thus, these recommendations were guided by prevailing practice patterns. CONCLUSIONS: Pain management practices after breast surgery have significant variation and represent an opportunity to improve patient safety and quality of care. Multimodality approaches in conjunction with standardized quantities of narcotics are recommended.
Authors
Rao, R; Jackson, RS; Rosen, B; Brenin, D; Cornett, W; Fayanju, OM; Chen, SL; Golesorkhi, N; Ludwig, K; Ma, A; Mautner, SK; Sowden, M; Wilke, L; Wexelman, B; Blair, S; Gary, M; Grobmyer, S; Hwang, ES; James, T; Kapoor, NS; Lewis, J; Lizarraga, I; Miller, M; Neuman, H; Showalter, S; Smith, L; Froman, J; American Society of Breast Surgeons: Patient Safety & Quality Committee, Research Committee,
MLA Citation
Rao, Roshni, et al. “Pain Control in Breast Surgery: Survey of Current Practice and Recommendations for Optimizing Management-American Society of Breast Surgeons Opioid/Pain Control Workgroup.Ann Surg Oncol, vol. 27, no. 4, Apr. 2020, pp. 985–90. Pubmed, doi:10.1245/s10434-020-08197-z.
URI
https://scholars.duke.edu/individual/pub1428312
PMID
31965373
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
27
Published Date
Start Page
985
End Page
990
DOI
10.1245/s10434-020-08197-z

Molecular classification and biomarkers of clinical outcome in breast ductal carcinoma in situ: Analysis of TBCRC 038 and RAHBT cohorts.

Ductal carcinoma in situ (DCIS) is the most common precursor of invasive breast cancer (IBC), with variable propensity for progression. We perform multiscale, integrated molecular profiling of DCIS with clinical outcomes by analyzing 774 DCIS samples from 542 patients with 7.3 years median follow-up from the Translational Breast Cancer Research Consortium 038 study and the Resource of Archival Breast Tissue cohorts. We identify 812 genes associated with ipsilateral recurrence within 5 years from treatment and develop a classifier that predicts DCIS or IBC recurrence in both cohorts. Pathways associated with recurrence include proliferation, immune response, and metabolism. Distinct stromal expression patterns and immune cell compositions are identified. Our multiscale approach employed in situ methods to generate a spatially resolved atlas of breast precancers, where complementary modalities can be directly compared and correlated with conventional pathology findings, disease states, and clinical outcome.
Authors
Strand, SH; Rivero-Gutiérrez, B; Houlahan, KE; Seoane, JA; King, LM; Risom, T; Simpson, LA; Vennam, S; Khan, A; Cisneros, L; Hardman, T; Harmon, B; Couch, F; Gallagher, K; Kilgore, M; Wei, S; DeMichele, A; King, T; McAuliffe, PF; Nangia, J; Lee, J; Tseng, J; Storniolo, AM; Thompson, AM; Gupta, GP; Burns, R; Veis, DJ; DeSchryver, K; Zhu, C; Matusiak, M; Wang, J; Zhu, SX; Tappenden, J; Ding, DY; Zhang, D; Luo, J; Jiang, S; Varma, S; Anderson, L; Straub, C; Srivastava, S; Curtis, C; Tibshirani, R; Angelo, RM; Hall, A; Owzar, K; Polyak, K; Maley, C; Marks, JR; Colditz, GA; Hwang, ES; West, RB
MLA Citation
Strand, Siri H., et al. “Molecular classification and biomarkers of clinical outcome in breast ductal carcinoma in situ: Analysis of TBCRC 038 and RAHBT cohorts.Cancer Cell, vol. 40, no. 12, Dec. 2022, pp. 1521-1536.e7. Pubmed, doi:10.1016/j.ccell.2022.10.021.
URI
https://scholars.duke.edu/individual/pub1556629
PMID
36400020
Source
pubmed
Published In
Cancer Cell
Volume
40
Published Date
Start Page
1521
End Page
1536.e7
DOI
10.1016/j.ccell.2022.10.021

Impact of adjuvant trastuzumab on locoregional failure rates in a randomized clinical trial: North Central Cancer Treatment Group N9831 (alliance) study.

BACKGROUND: The goal of this study was to assess the impact of trastuzumab on locoregional failure. METHODS: The analysis included 2763 patients with HER2-positive (HER2+) breast cancer who were randomly assigned to adjuvant doxorubicin (A), cyclophosphamide (C), paclitaxel (T) and trastuzumab (H) (arm A, AC→T [n = 922]; arm B, AC→T→H [n = 988]; arm C, AC→T+H→H [n = 853]). Radiotherapy was given after AC→T concurrently with H. Radiotherapy was given after lumpectomy (L) or after mastectomy (M) with ≥4 positive lymph nodes but was optional for 1 to 3 positive lymph nodes. Locoregional failures at 10 years (LFR10) as first events were compared using competing risk analysis. RESULTS: The median follow-up was 13.0 years. The first site of failure was local-only in 96 cases, locoregional in 16 cases, regional in 32 cases, and not specified in 2 cases; LFR10 was 4.8% (95% CI 4.1%-5.7%). LFR10 was 5.5% (95% CI 4.3%-7.2%), 4.9% (95% CI 3.7%-6.4%), and 2.8% (95% CI 1.9%-4.1%) in arms A, B, and C (B vs A: hazard ratio [HR] 0.91, P = .62; C vs A: HR 0.72, P = .12). For estrogen receptor-positive patients, LFR10 was 3.7% (95% CI 2.8%-4.8%) and for estrogen receptor-negative patients, it was 6.1% (95% CI 5.0%-7.4%; HR 0.61, P = .004). Local treatment included L+RT (n = 1044 [38%]), M+RT (n = 1025 [37%]), and M (n = 694 [25%]). LFR10 was 6.% (95% CI 5.0%-7.8%), 3.0% (95% CI 2.1%-4.3%), and 5.5% (95% CI 4.0%-7.4%) for L+RT, M+RT, and M, respectively (M+RT vs L+RT: HR 0.43, P < .001; M vs L+RT: HR 0.88, P = .57). For 1 to 3 positive lymph nodes, LFR10 was 6.5% (95% CI 4.8%-8.9%), 4.1% (95% CI 2.4%-7.0%), and 4.3% (95% CI 2.9%-6.5%) in L+RT, M+RT, and M, respectively (M vs L+RT: HR 0.68, P = .14; M vs M+RT: HR 1.2, P = .6). CONCLUSION: Low 10-year LFRs were seen regardless of trastuzumab use. Differences in local therapy in patients with 1 to 3 positive lymph nodes did not appear to improve local control. Local therapy studies for HER2+ and other tumor characteristics are important as the role of local therapies continues to evolve.
Authors
Vargas, CE; Thorpe, CS; Dueck, AC; Tenner, KS; Davidson, NE; Martino, S; Pisansky, TM; Hwang, ES; Halyard, MY; Pockaj, BA; Perez, EA
MLA Citation
Vargas, Carlos E., et al. “Impact of adjuvant trastuzumab on locoregional failure rates in a randomized clinical trial: North Central Cancer Treatment Group N9831 (alliance) study.Cancer, vol. 126, no. 24, Dec. 2020, pp. 5239–46. Pubmed, doi:10.1002/cncr.33154.
URI
https://scholars.duke.edu/individual/pub1461082
PMID
32931029
Source
pubmed
Published In
Cancer
Volume
126
Published Date
Start Page
5239
End Page
5246
DOI
10.1002/cncr.33154

Stiff stroma increases breast cancer risk by inducing the oncogene ZNF217.

Women with dense breasts have an increased lifetime risk of malignancy that has been attributed to a higher epithelial density. Quantitative proteomics, collagen analysis, and mechanical measurements in normal tissue revealed that stroma in the high-density breast contains more oriented, fibrillar collagen that is stiffer and correlates with higher epithelial cell density. microRNA (miR) profiling of breast tissue identified miR-203 as a matrix stiffness-repressed transcript that is downregulated by collagen density and reduced in the breast epithelium of women with high mammographic density. Culture studies demonstrated that ZNF217 mediates a matrix stiffness- and collagen density-induced increase in Akt activity and mammary epithelial cell proliferation. Manipulation of the epithelium in a mouse model of mammographic density supported a causal relationship between stromal stiffness, reduced miR-203, higher levels of the murine homolog Zfp217, and increased Akt activity and mammary epithelial proliferation. ZNF217 was also increased in the normal breast epithelium of women with high mammographic density, correlated positively with epithelial proliferation and density, and inversely with miR-203. The findings identify ZNF217 as a potential target toward which preexisting therapies, such as the Akt inhibitor triciribine, could be used as a chemopreventive agent to reduce cancer risk in women with high mammographic density.
Authors
Northey, JJ; Barrett, AS; Acerbi, I; Hayward, M-K; Talamantes, S; Dean, IS; Mouw, JK; Ponik, SM; Lakins, JN; Huang, P-J; Wu, J; Shi, Q; Samson, S; Keely, PJ; Mukhtar, RA; Liphardt, JT; Shepherd, JA; Hwang, ES; Chen, Y-Y; Hansen, KC; Littlepage, LE; Weaver, VM
MLA Citation
Northey, Jason J., et al. “Stiff stroma increases breast cancer risk by inducing the oncogene ZNF217.J Clin Invest, vol. 130, no. 11, Nov. 2020, pp. 5721–37. Pubmed, doi:10.1172/JCI129249.
URI
https://scholars.duke.edu/individual/pub1454390
PMID
32721948
Source
pubmed
Published In
J Clin Invest
Volume
130
Published Date
Start Page
5721
End Page
5737
DOI
10.1172/JCI129249

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, 2020, p. 57. Pubmed, doi:10.1038/s41523-020-00199-0.
URI
https://scholars.duke.edu/individual/pub1464414
PMID
33145400
Source
pubmed
Published In
Npj Breast Cancer
Volume
6
Published Date
Start Page
57
DOI
10.1038/s41523-020-00199-0