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

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:

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

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

To estimate the mean change in MRI tumor volume from pretreatment to completion of preoperative endocrine therapy in ER(+) DCIS, as well as to determine whether 3-month change in volume correlates with 6-month change.

Administered By
Surgical Oncology
Awarded By
Alliance for Clinical Trials in Oncology Foundation
Role
Principal Investigator
Start Date
End Date

Publications:

Tumour-associated macrophages drive stromal cell-dependent collagen crosslinking and stiffening to promote breast cancer aggression.

Stromal stiffening accompanies malignancy, compromises treatment and promotes tumour aggression. Clarifying the molecular nature and the factors that regulate stromal stiffening in tumours should identify biomarkers to stratify patients for therapy and interventions to improve outcome. We profiled lysyl hydroxylase-mediated and lysyl oxidase-mediated collagen crosslinks and quantified the greatest abundance of total and complex collagen crosslinks in aggressive human breast cancer subtypes with the stiffest stroma. These tissues harbour the highest number of tumour-associated macrophages, whose therapeutic ablation in experimental models reduced metastasis, and decreased collagen crosslinks and stromal stiffening. Epithelial-targeted expression of the crosslinking enzyme, lysyl oxidase, had no impact on collagen crosslinking in PyMT mammary tumours, whereas stromal cell targeting did. Stromal cells in microdissected human tumours expressed the highest level of collagen crosslinking enzymes. Immunohistochemical analysis of biopsies from a cohort of patients with breast cancer revealed that stromal expression of lysyl hydroxylase 2, an enzyme that induces hydroxylysine aldehyde-derived collagen crosslinks and stromal stiffening, correlated significantly with disease specific mortality. The findings link tissue inflammation, stromal cell-mediated collagen crosslinking and stiffening to tumour aggression and identify lysyl hydroxylase 2 as a stromal biomarker.
Authors
Maller, O; Drain, AP; Barrett, AS; Borgquist, S; Ruffell, B; Zakharevich, I; Pham, TT; Gruosso, T; Kuasne, H; Lakins, JN; Acerbi, I; Barnes, JM; Nemkov, T; Chauhan, A; Gruenberg, J; Nasir, A; Bjarnadottir, O; Werb, Z; Kabos, P; Chen, Y-Y; Hwang, ES; Park, M; Coussens, LM; Nelson, AC; Hansen, KC; Weaver, VM
MLA Citation
Maller, Ori, et al. “Tumour-associated macrophages drive stromal cell-dependent collagen crosslinking and stiffening to promote breast cancer aggression.Nat Mater, vol. 20, no. 4, Apr. 2021, pp. 548–59. Pubmed, doi:10.1038/s41563-020-00849-5.
URI
https://scholars.duke.edu/individual/pub1466321
PMID
33257795
Source
pubmed
Published In
Nature Materials
Volume
20
Published Date
Start Page
548
End Page
559
DOI
10.1038/s41563-020-00849-5

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study.

BACKGROUND: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. METHODS: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. FINDINGS: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28-2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65-3·22], p<0·0001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (2·35 [1·57-3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01-2·39], p=0·046), emergency versus elective surgery (1·67 [1·06-2·63], p=0·026), and major versus minor surgery (1·52 [1·01-2·31], p=0·047). INTERPRETATION: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. FUNDING: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Authors
COVIDSurg Collaborative,
MLA Citation
COVIDSurg Collaborative, David C. “Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study.Lancet, vol. 396, no. 10243, July 2020, pp. 27–38. Pubmed, doi:10.1016/S0140-6736(20)31182-X.
URI
https://scholars.duke.edu/individual/pub1452990
PMID
32479829
Source
pubmed
Published In
Lancet
Volume
396
Published Date
Start Page
27
End Page
38
DOI
10.1016/S0140-6736(20)31182-X

Patient-reported causes of distress predict disparities in time to evaluation and time to treatment after breast cancer diagnosis.

BACKGROUND: We examined whether the National Comprehensive Cancer Network distress thermometer (DT), a patient-reported outcome measure, could be used to identify levels and causes of distress associated with racial/ethnic disparities in time to care among patients with breast cancer. METHODS: We identified women aged ≥18 years with stage 0-IV breast cancer who were diagnosed in a single health system between January 2014 and July 2016. The baseline visit was defined as the first postdiagnosis, pretreatment clinical evaluation. Zero-inflated negative binomial (ZINB) regression (modeling non-zero DT scores and DT scores = 0) and logistic regression (modeling DT score ≥ 4, threshold for social services referral) were used to examine associations between baseline score (0 = none to 10 = extreme) and types of stressors (emotional, familial, practical, physical, spiritual) after adjustment for race/ethnicity and other characteristics. Linear regression with log transformation was used to identify predictors of time to evaluation and time to treatment. RESULTS: A total of 1029 women were included (median baseline DT score = 4). Emotional, physical, and practical stressors were associated with distress in both the ZINB and logistic models (all P < .05). Black patients (n = 258) were more likely to report no distress than Whites (n = 675; ZINB zero model odds ratio, 2.72; 95% CI, 1.68-4.40; P < .001) despite reporting a similar number of stressors (P = .07). Higher DT scores were associated with shorter time to evaluation and time to treatment while being Black and having physical or practical stressors were associated with delays in both (all P < .05). CONCLUSIONS: Patient-reported stressors predicted delays in time to care, but patient-reported levels of distress did not, with Black patients having delayed time to care despite reporting low levels of distress. We describe anticipatory, culturally responsive strategies for using patient-reported outcomes to address observed disparities.
Authors
Fayanju, OM; Ren, Y; Stashko, I; Power, S; Thornton, MJ; Marcom, PK; Hyslop, T; Hwang, ES
MLA Citation
Fayanju, Oluwadamilola M., et al. “Patient-reported causes of distress predict disparities in time to evaluation and time to treatment after breast cancer diagnosis.Cancer, vol. 127, no. 5, Mar. 2021, pp. 757–68. Pubmed, doi:10.1002/cncr.33310.
URI
https://scholars.duke.edu/individual/pub1464167
PMID
33175437
Source
pubmed
Published In
Cancer
Volume
127
Published Date
Start Page
757
End Page
768
DOI
10.1002/cncr.33310

Electronic Health Record Use by Sex Among Physicians in an Academic Health Care System.

Authors
Tait, SD; Oshima, SM; Ren, Y; Fenn, AE; Boazak, M; Hinz, EM; Hwang, ES
MLA Citation
Tait, Sarah D., et al. “Electronic Health Record Use by Sex Among Physicians in an Academic Health Care System.Jama Intern Med, vol. 181, no. 2, Feb. 2021, pp. 288–90. Pubmed, doi:10.1001/jamainternmed.2020.5036.
URI
https://scholars.duke.edu/individual/pub1468770
PMID
33284311
Source
pubmed
Published In
Jama Internal Medicine
Volume
181
Published Date
Start Page
288
End Page
290
DOI
10.1001/jamainternmed.2020.5036

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