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:

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

Derivation of a nuclear heterogeneity image index to grade DCIS.

Abnormalities in cell nuclear morphology are a hallmark of cancer. Histological assessment of cell nuclear morphology is frequently used by pathologists to grade ductal carcinoma in situ (DCIS). Objective methods that allow standardization and reproducibility of cell nuclear morphology assessment have potential to improve the criteria needed to predict DCIS progression and recurrence. Aggressive cancers are highly heterogeneous. We asked whether cell nuclear morphology heterogeneity could be incorporated into a metric to classify DCIS. We developed a nuclear heterogeneity image index to objectively, and quantitatively grade DCIS. A whole-tissue cell nuclear morphological analysis, that classified tumors by the worst ten percent in a duct-by-duct manner, identified nuclear size ranges associated with each DCIS grade. Digital image analysis further revealed increasing heterogeneity within ducts or between ducts in tissues of worsening DCIS grade. The findings illustrate how digital image analysis comprises a supplemental tool for pathologists to objectively classify DCIS and in the future, may provide a method to predict patient outcome through analysis of nuclear heterogeneity.
Authors
Hayward, M-K; Louise Jones, J; Hall, A; King, L; Ironside, AJ; Nelson, AC; Shelley Hwang, E; Weaver, VM
MLA Citation
Hayward, Mary-Kate, et al. “Derivation of a nuclear heterogeneity image index to grade DCIS.Comput Struct Biotechnol J, vol. 18, 2020, pp. 4063–70. Pubmed, doi:10.1016/j.csbj.2020.11.040.
URI
https://scholars.duke.edu/individual/pub1469320
PMID
33363702
Source
pubmed
Published In
Computational and Structural Biotechnology Journal
Volume
18
Published Date
Start Page
4063
End Page
4070
DOI
10.1016/j.csbj.2020.11.040

It's not you, It's me: The influence of patient and surgeon gender on patient satisfaction scores.

BACKGROUND: Surgeons face the unique challenge of being responsible for both clinical encounters and surgical outcomes. We aim to explore how patient evaluations of surgeons may be influenced by patient and provider factors. METHODS: Patient responses from the 2016 CGCAHPS survey at a single institution were identified. A Poisson regression model was used to identify patient/provider factors associated with ratings. RESULTS: 11,007 surveys of 134 surgeons were included. After adjustment, higher overall surgeon ratings were associated with older patient age (p < 0.001) and male patient gender (p = 0.001). Lower ratings were associated with higher patient education (p < 0.001) and lower patient self-health ratings (p < 0.001). Although female surgeons tended to have higher communication scores, overall scores did not differ based on any surgeon factors. CONCLUSIONS: Patient satisfaction scores of surgeons are more closely correlated with patient variables than surgeon factors. This may have implications for physician performance evaluation in value-based care models.
Authors
Plichta, JK; Williamson, H; Sergesketter, AR; Grimm, LJ; Thomas, SM; DiLalla, G; Zwischenberger, BA; Hwang, ES; Plichta, RP
MLA Citation
Plichta, Jennifer K., et al. “It's not you, It's me: The influence of patient and surgeon gender on patient satisfaction scores.Am J Surg, vol. 220, no. 5, Nov. 2020, pp. 1179–88. Pubmed, doi:10.1016/j.amjsurg.2020.07.036.
URI
https://scholars.duke.edu/individual/pub1457142
PMID
32847689
Source
pubmed
Published In
Am J Surg
Volume
220
Published Date
Start Page
1179
End Page
1188
DOI
10.1016/j.amjsurg.2020.07.036

Nucleic-Acid Scavengers Mitigate Breast Cancer Induced Inflammation, Invasion, and Metastasis

Authors
Eteshola, EOU; Landa, K; Rempel, RE; Naqvi, IA; Hwang, ES; Nair, SK; Sullenger, BA
URI
https://scholars.duke.edu/individual/pub1471025
Source
ssrn