Publications by authors named "Chelsea Salyer"

7 Publications

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Abnormal Pap Follow-Up among Criminal-Legal Involved Women in Three U.S. Cities.

Int J Environ Res Public Health 2021 06 18;18(12). Epub 2021 Jun 18.

Department of Population Health, University of Kansas, Kansas City, KS 66160, USA.

Criminal-legal involved women experience significant barriers to preventive cervical care, and consequently there is a higher incidence of cervical cancer in this population. The purpose of this study is to identify variables that may facilitate abnormal Pap follow-up among criminal-legal involved women living in community settings. The study included = 510 women with criminal-legal histories, from three U.S. cities-Birmingham, AL; Kansas City, KS/MO; Oakland, CA. Participants completed a 288-item survey, with questions related to demographics, social advantages, provider communication, and reasons for missing follow-up care. There were = 58 women who reported abnormal Pap testing, and = 40 (69%) received follow-up care. Most women received either repeat Pap/HPV testing ( = 15, 38%), or colposcopy and/or biopsy ( = 14, 35%). Women who did not follow-up ( = 15, 26%) cited that they forgot ( = 8, 53%), were uninsured ( = 3, 20%), or were reincarcerated ( = 3, 20%). In a multivariate analysis, both having a primary care provider (OR 4.6, 95% CI 1.3-16.0) and receiving specific provider communication about follow-up (OR 3.8, 95% CI 1.1-13.2) were independent predictors for abnormal Pap follow-up. Interventions that offer linkages to providers in the community or ensure abnormal Pap care plans are communicated effectively may mitigate the disparate incidence of cervical cancer among criminal-legal involved women.
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http://dx.doi.org/10.3390/ijerph18126556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296431PMC
June 2021

Variation in physician-directed immunohistochemistry screening among women with endometrial cancer.

Int J Gynecol Cancer 2020 09 7;30(9):1356-1365. Epub 2020 Jul 7.

Kaiser Permanente Division of Research, Oakland, California, USA

Objective: Immunohistochemistry screening is a reliable method for identifying women with endometrial cancer who are at risk for Lynch syndrome, but clinical workflows used to implement immunohistochemistry screening protocols can vary by institution. The goal of this study was to investigate variation in performance of immunohistochemistry screening when a physician order is required.

Methods: Retrospective study from an integrated healthcare system with a risk-based immunohistochemistry screening policy for Lynch syndrome from January 2015 to December 2016. Immunohistochemistry screening was indicated for all women with endometrial cancer aged <60 years and women with endometrial cancer aged ≥60 years who had a personal/family history suggestive of Lynch syndrome. However, a physician order was needed to have immunohistochemistry screening performed on the tumor specimen as our health system did not have reflex screening in the clinical workflow. Demographics and tumor characteristics were reviewed, and patients were stratified by immunohistochemistry screening status. Multivariable regression was performed to identify factors associated with immunohistochemistry performance and reported as odds ratios (ORs) with 95% confidence intervals (CIs).

Results: There were 1399 eligible patients in the study. With a required physician order, immunohistochemistry screening rates (20% overall, 34% aged <60 years) were significantly lower than previous reports (36% overall, 90% aged <60 years, p≤0.0001 for both comparisons). Significant factors associated with immunohistochemistry screening performance identified by multivariable analysis included age, race, body mass index, personal/family cancer history, diabetes, endometrioid histology, and tumor grade. Asian women were most likely to have immunohistochemistry screening (OR 1.58, 95% CI 1.07 to 2.34) whereas black women were least likely (OR 0.43, 95% CI 0.22 to 0.91).

Conclusions: Immunohistochemistry screening rates in women with endometrial cancer were lower in our health system compared with prior reports in the literature, and there were variations in screening performance according to patient age, race, and body mass index. Requiring a physician order for immunohistochemistry screening likely creates a barrier in screening uptake, therefore automated immunohistochemistry screening is recommended.
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http://dx.doi.org/10.1136/ijgc-2020-001449DOI Listing
September 2020

Comparison of two Lynch screening strategies in endometrial cancer in a California health system.

Gynecol Oncol 2020 07 6;158(1):158-166. Epub 2020 May 6.

Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States of America; Northern California Gynecologic Cancer Program, San Francisco, CA, United States of America. Electronic address:

Objective: Compare detection of Lynch syndrome in endometrial cancer between regions of a health care system with different screening strategies.

Methods: A retrospective study of endometrial cancer (EC) cases from 2 regions of an integrated health care system (Kaiser Permanente Northern (KPNC) and Southern (KPSC) California). Within KPNC, immunohistochemistry tumor screening (IHC) was physician ordered and risk-based; within KPSC, IHC was universal and automated. Clinical risk factors associated with abnormal IHC and Lynch Syndrome (LS) were identified.

Results: During the study, there were 2045 endometrial cancers: 1399 in the physician-order group and 646 in the universal testing group. In the physician-order group: among women < age 60, 34% underwent IHC; 9.6% were abnormal, and 3% were possible LS after methylation testing; among women ≥60, 11% underwent IHC, 3% were abnormal and <1% were possible LS. In the universal group, 87% of women age <60 had IHC, 19.4% were abnormal, and 6% were possible LS; Among women age ≥60, 82% underwent IHC, 26% were abnormal, and 2% were possible LS. There were no differences in LS cases between the physician-order group and the universal group in either age strata (<60: 3% vs. 3.6%, p=0.62; ≥60: <1% vs. 1%, p=0.63) Factors associated with LS were younger age (odds ratio (OR) 0.11, 95% confidence interval (CI) 0.04-0.29) and lower body mass index (BMI), (OR 0.38 95% CI 0.18-0.80).

Conclusions: Universal IHC screening did not result in increased LS detection in EC.
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http://dx.doi.org/10.1016/j.ygyno.2020.04.692DOI Listing
July 2020

Clinical characteristics and outcomes in elderly women with BRCA1 and BRCA2 mutations.

Gynecol Oncol 2019 08 31;154(2):374-378. Epub 2019 May 31.

Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America; Kaiser Permanente Genetics Department, San Francisco, CA, United States of America; Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America; Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America; Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America; Division of Research, Kaiser Permanente Northern California, Oakland CA, United States of America. Electronic address:

Objective: Describe clinical characteristics and risk reducing strategies utilized among women with a BRCA mutation who lived to age 75 and above.

Methods: A retrospective study of women with BRCA mutations identified from 1995 to 2015 in a California health care system. From a database of 1189 women, 69 participants were identified who lived to age 75 or older. Demographic and clinical characteristics were recorded, as well as cancer history and risk-reducing strategies utilized. Descriptive and bivariate analyses were used to analyze the cohort.

Results: The median age of the cohort at study entry was 78 (IQR: 76-84) and the median age at time of genetic testing was 73 (IQR 68-79). Fifty (72%) women had a prior history of breast cancer and 27 (39%) had a history of ovarian cancer. Three of 19 (16%) women with no history of breast cancer elected to undergo a risk-reducing mastectomy (RRM) after their positive genetic test. Among 30 women with ovaries still in place, 14 (47%) underwent a risk-reducing salpingo-oophorectomy (RRSO); six were age 70 or older at the time of surgery. Four (6%) women in the cohort developed BRCA-related cancer after testing, one developed breast cancer and three developed pancreatic cancer.

Conclusions: Most women with BRCA mutations surviving beyond age 75 received their genetic test result at an older age and had a history of BRCA-related cancer. Women continued surveillance and risk reducing surgeries at an older age. Pancreatic cancer was the most common new cancer diagnosed in older BRCA mutation carriers.
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http://dx.doi.org/10.1016/j.ygyno.2019.05.017DOI Listing
August 2019

Alternative Treatment Utilization Before Hysterectomy for Benign Gynecologic Conditions at a Large Integrated Health System.

J Minim Invasive Gynecol 2019 Jul - Aug;26(5):847-855. Epub 2018 Aug 28.

Department of Obstetrics and Gynecology (Drs. Nguyen, Salyer, and Zaritsky), Kaiser Permanente Northern California, Oakland, California. Electronic address:

Study Objective: To investigate rates of utilization of alternative treatments before hysterectomy for benign gynecologic indications within a large integrated health care system.

Design: Retrospective cohort study of patients who underwent hysterectomies for benign gynecologic conditions between 2012 and 2014 (Canadian Task Force classification II-2).

Setting: Kaiser Permanente Northern California, a community-based integrated health system.

Patients: Women who underwent hysterectomy for a benign gynecologic condition between 2012 and 2014.

Interventions: From an eligible cohort of 6892 patients who underwent hysterectomy, a stratified random sample of 1050 patients were selected for chart review. Stratification was based on the proportion of indications for hysterectomy.

Measurements And Main Results: The primary outcome was the use of alternative treatments before hysterectomy. Alternative treatments included oral hormone treatment, leuprolide, medroxyprogesterone intramuscular injections, a levonorgestrel intrauterine device, hormonal subdermal implants, endometrial ablation, uterine artery embolization, hysteroscopy, and myomectomy. Of the 1050 charts reviewed, 979 (93.2%) met the criteria for inclusion in this study. The predominant indication for hysterectomy was symptomatic myomas (54.4%), followed by abnormal uterine bleeding (29.0%), endometriosis (5.8%), pelvic pain (3.1%), dysmenorrhea (3.4%), and other (4.3%). The major routes of hysterectomy were laparoscopy (68.7%) and vaginal hysterectomy (13.4%). Before hysterectomy, 81.2% of patients tried at least 1 type of alternative treatment (33.8% with 1 treatment and 47.4% with at least 2 treatments), and 99.3% of patients were counseled regarding alternative treatments. Compared with younger women age <40 years, women age 45 to 49 years were less likely to use alternative treatments before hysterectomy (adjusted odds ratio, 0.41; 95% confidence interval, 0.21-0.76). There were no variations in treatment rates by socioeconomic status or between major racial and ethnic groups. The final pathological analysis identified myomas as the most common pathology (n = 637; 65.1%); 96 patients (9.8%) had normal uterine pathology.

Conclusion: More than 80% of patients received alternative treatments before undergoing hysterectomy for a benign gynecologic condition. Additional investigation is warranted to assess alternative treatment use as it relates to preventing unnecessary hysterectomies.
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http://dx.doi.org/10.1016/j.jmig.2018.08.013DOI Listing
January 2020

Bone loss in women with BRCA1 and BRCA2 mutations.

Gynecol Oncol 2018 03;148(3):535-539

Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA.

Objective: Estimate the prevalence and identify risk factors for bone loss in women with BRCA mutations.

Methods: Women, age 40 and older, with BRCA mutations identified from the Breast Cancer Surveillance database at Kaiser Permanente Northern California were invited to participate and undergo a dual-energy x-ray absorptiometry scan to assess for bone loss (osteopenia or osteoporosis). Multivariable logistic regression analysis was performed to assess clinical factors associated with bone loss.

Results: Of the 238 women in the final cohort, 20 women had intact ovaries (median age 54.5years) and 218 had undergone risk reducing salpingo-oophorectomy (RRSO) (median age 57). The prevalence of bone loss was 55% in the no RRSO group and 72.5% in the RRSO group (P=0.10). In multivariable analysis, only higher body mass index (OR 0.6 per 5kg/m, 95% CI: 0.4-0.7) and nonwhite race compared to white (OR 0.5, 95% CI: 0.2-0.9) were protective for bone loss while older age (OR 1.5 per 10years, 95% CI: 1.1-2.1) and selective estrogen receptor modulator use (3.1, 95% CI: 1.2-10.1) were associated with increased odds of bone loss. Among women with RRSO, bone loss was more frequent in women who had postmenopausal (n=106) compared to women who had premenopausal RRSO (n=112), (82.1% and 63.4% respectively, P=0.002). In multivariable analysis, only BMI was protective of bone loss (OR 0.5, 95%, CI: 0.4-0.7) but neither age nor menopausal status at RRSO were associated with bone loss.

Conclusion: Bone loss is common in women with BRCA mutations who undergo RRSO.
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http://dx.doi.org/10.1016/j.ygyno.2018.01.013DOI Listing
March 2018

The seasonality of abortion in Kentucky.

Contraception 2017 Feb 1;95(2):181-185. Epub 2016 Sep 1.

University of Louisville School of Public Health and Information Sciences, 485 E Gray St., Louisville, KY 40202, USA. Electronic address:

Objectives: Abortion incidence is correlated with seasonal trends in conceptions and births. This retrospective review looks at monthly abortion incidence to detect a seasonal trend.

Study Design: Data on abortion incidence in 2012 were obtained from the Kentucky Department of Vital Statistics. A regression analysis was performed to detect differences in abortion annualized rates by month.

Results: A total of 3810 abortions analyzed showed a trend in abortion incidence peaking in February and March with 444 and 378 abortions per month, respectively, compared to a mean of 299 in other months (p<.001). This trend persisted for second-trimester abortions with 64 and 56 abortions per month in February and March, respectively, compared to a mean of 30 in other months (p<.001).

Conclusion: The peak in first-trimester abortions correlate with the expected peaks of December conceptions. However, the same trend in second-trimester abortions suggests that women are delaying care.
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http://dx.doi.org/10.1016/j.contraception.2016.08.019DOI Listing
February 2017
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