Carolyn Menendez

Positions:

Assistant Professor of Surgery

Surgical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.S. 1994

University of California - Irvine

M.D. 1998

Eastern Virginia Medical School

General Surgery Internship, Surgery

Eastern Virginia Medical School

General Surgery Residency, Surgery

University of California San Francisco at Fresno, School of Medicine

Publications:

Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study.

BACKGROUND: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. METHODS: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20-60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. FINDINGS: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. INTERPRETATION: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. FUNDING: National Institute for Health Research Global Health Research Unit, 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, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Authors
COVIDSurg Collaborative,
MLA Citation
COVIDSurg Collaborative, P. “Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study.Lancet Oncol, vol. 22, no. 11, Nov. 2021, pp. 1507–17. Pubmed, doi:10.1016/S1470-2045(21)00493-9.
URI
https://scholars.duke.edu/individual/pub1503792
PMID
34624250
Source
pubmed
Published In
Lancet Oncol
Volume
22
Published Date
Start Page
1507
End Page
1517
DOI
10.1016/S1470-2045(21)00493-9

The Influence of Body Mass Index on the Histopathology and Outcomes of Patients Diagnosed with Atypical Breast Lesions.

BACKGROUND: Multiple studies have demonstrated a link between obesity and breast cancer; however, the potential association between obesity and atypical high-risk breast lesions has not been well characterized. We sought to evaluate the characteristics and clinical outcomes of patients with breast atypia based on a woman's body mass index (BMI). METHODS: We retrospectively identified adult women diagnosed with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and/or lobular carcinoma in situ (LCIS) at a single institution from 2008 to 2017. BMI groups were defined as a BMI 18.5 to < 30 or BMI ≥ 30 (obese). Adjusted logistic regression was used to estimate the association of BMI group with the odds of (1) upstage to cancer after atypia on needle biopsy, and (2) subsequent diagnosis of breast cancer. RESULTS: Breast atypia was identified in 503 patients (most advanced atypia: 74.8% ADH, 4.6% ALH, 20.7% LCIS), and 41% of these patients were classified as obese. After adjustment, BMI group was not associated with upstage to breast cancer at surgical excision following needle biopsy (p = 0.16) or development of a subsequent breast cancer (p = 0.08). For those upstaged to breast cancer at the time of surgical excision, or those who developed a subsequent malignancy, tumor subtype, grade and stage were not associated with BMI group (p > 0.05). CONCLUSION: In a large cohort of patients diagnosed with atypical breast histology, the risk of upstaging and/or subsequent progression to a breast malignancy was not associated with BMI. Factors other than obesity may influence breast cancer risk.
Authors
Miller, KN; Thomas, SM; Sergesketter, AR; Rosenberger, LH; DiLalla, G; van den Bruele, AB; Hwang, ES; Plichta, JK
MLA Citation
Miller, Krislyn N., et al. “The Influence of Body Mass Index on the Histopathology and Outcomes of Patients Diagnosed with Atypical Breast Lesions.Ann Surg Oncol, vol. 29, no. 10, 2022, pp. 6484–94. Pubmed, doi:10.1245/s10434-022-12313-6.
URI
https://scholars.duke.edu/individual/pub1519551
PMID
35951136
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
29
Published Date
Start Page
6484
End Page
6494
DOI
10.1245/s10434-022-12313-6

Utilization of neoadjuvant chemotherapy in high-risk, node-negative early breast cancer.

BACKGROUND: Controversy exists regarding the optimal sequence of chemotherapy among women with operable node-negative breast cancers with high-risk tumor biology. We evaluated national patterns of neoadjuvant chemotherapy (NACT) use among women with early-stage HER2+, triple-negative (TNBC), and high-risk hormone receptor-positive (HR+) invasive breast cancers. METHODS: Women ≥18 years with cT1-2/cN0 HER2+, TNBC, or high recurrence risk score (≥31) HR+ invasive breast cancers who received chemotherapy were identified in the National Cancer Database (2010-2016). Cochran-Armitage and logistic regression examined temporal trends and likelihood of undergoing NACT versus adjuvant chemotherapy based on patient age and molecular subtype. RESULTS: Overall, 96,622 patients met study criteria; 25% received NACT and 75% underwent surgery first, with comparable 5-year estimates of overall survival (0.90, 95% CI 0.892-0.905 vs 0.91, 95% CI 0.907-0.913). During the study period, utilization of NACT increased from 14% to 36% and varied according to molecular subtype (year*molecular subtype p < 0.001, p-corrected < 0.001). Women with HER2+ (OR 4.17, 95% CI 3.70-4.60, p < 0.001, p-corrected < 0.001) and TNBC (OR 3.81, 95% CI 3.38-4.31, p < 0.001, p-corrected < 0.001) were more likely to receive NACT over time, without a change in use among those with HR+ disease (OR 1.58, 95% CI 0.88-2.87, p = 0.13, p-corrected = 0.17). CONCLUSION: Among women with early-stage triple-negative and HER2+ breast cancers, utilization of NACT increased over time, a trend that correlates with previously reported improved rates of pCR and options post-neoadjuvant treatment with residual disease. Future research is needed to better understand multidisciplinary decisions for NACT and implications for breast cancer patients.
MLA Citation
Prakash, Ipshita, et al. “Utilization of neoadjuvant chemotherapy in high-risk, node-negative early breast cancer.Cancer Med, vol. 11, no. 4, Feb. 2022, pp. 1099–108. Pubmed, doi:10.1002/cam4.4517.
URI
https://scholars.duke.edu/individual/pub1505844
PMID
34989142
Source
pubmed
Published In
Cancer Medicine
Volume
11
Published Date
Start Page
1099
End Page
1108
DOI
10.1002/cam4.4517

The breast life in BRCA: Imaging and biopsy burden for BRCA1/2 patients

Authors
Rooney, M; Ren, Y; Taylor-Cho, M; Menendez, C; Hwang, S; Plichta, J
MLA Citation
Rooney, Marguerite, et al. “The breast life in BRCA: Imaging and biopsy burden for BRCA1/2 patients.” Annals of Surgical Oncology, vol. 29, no. SUPPL 1, 2022, pp. 141–42.
URI
https://scholars.duke.edu/individual/pub1519565
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
29
Published Date
Start Page
141
End Page
142

ASO Visual Abstract: Mortality in Older Patients with Breast Cancer Undergoing Breast Surgery-How Low is "Low Risk"?

MLA Citation
Dillon, Jacquelyn, et al. “ASO Visual Abstract: Mortality in Older Patients with Breast Cancer Undergoing Breast Surgery-How Low is "Low Risk"?Ann Surg Oncol, vol. 28, no. Suppl 3, Dec. 2021, p. 645. Pubmed, doi:10.1245/s10434-021-10612-y.
URI
https://scholars.duke.edu/individual/pub1494138
PMID
34432191
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
28
Published Date
Start Page
645
DOI
10.1245/s10434-021-10612-y