Jane Fan

All Publications

• Breastfeeding Cessation Across Gestational Ages Among First-Time U.S. Mothers before and During the COVID-19 Pandemic, 2016-2021. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine Fan, J., Taylor, S., Shabanova, V. 2026: 15568253261494524

  Abstract

  The early COVID-19 pandemic period, with contact restrictions that affected in-hospital supports, provides a unique opportunity to examine changes in population-based breastfeeding cessation rates across the full spectrum of gestational age (GA) among first-time U.S. mothers.Using serial cross-sectional data from the Pregnancy Risk and Assessment Monitoring System (2016-2021), we included women from 19 U.S. jurisdictions who reported ever breastfeeding and cessation reasons (weighted N = 1,724,352). Weighted multivariable Cox regression compared cessation rates by GA between pre-COVID (2016-2019) and during-COVID (2020-2021) periods. Cessation reasons were assessed by prematurity using weighted Chi-square analysis (weighted N = 689,756).During pre-COVID years, cessation rates among mothers of extremely preterm (EP) infants were 31% lower (adjusted hazard ratio [aHR]: 0.69, 95% confidence interval [CI]: 0.53-0.89) compared to term mothers; very or moderately preterm (VMP) and late preterm (LP) mothers had higher cessation rates compared to term and EP mothers. Between periods, a 47% increase was observed among EP mothers (aHR: 1.47, 95% CI: 0.97-2.27). Only LP mothers had higher cessation rates relative to term mothers during COVID (aHR: 1.25, 95% CI: 1.06-1.46). Compared to mothers of EP (9.8%) and term (11.8%) infants, more mothers of VMP (16.2%) and LP (16.6%) infants reported too many household duties (p < 0.001).This study found that first-time U.S. mothers of VMP and LP infants breastfed for a shorter duration than their EP and term counterparts before COVID-19. The first two pandemic years were the most disruptive for EP mothers, highlighting the importance of in-hospital breastfeeding support.

  View details for DOI 10.1177/15568253261494524

  View details for PubMedID 42844698

• Personalized risk assessment of frailty in long-term cancer survivors JOURNAL OF GERIATRIC ONCOLOGY Forman, R., Westvold, S. J., Long, J. B., Fan, J., Hyslop, T., Conlin, K., Jacobson, S., Wang, S., Leapman, M. S., Cecchini, M., Leeds, I., Spees, L., Presley, C., Yasin, F., Taylor, M., Kwaramba, T., Gross, C. P., Oeffinger, K., Dinan, M. A. 2026; 17 (1): 102804

  Abstract

  Due to the growth of the cancer survivor population, strategies to facilitate efficient delivery of survivorship care are critical to reduce the risk of adverse events associated with frailty. The objective of this study was to develop a risk stratification tool to identify long-term survivors at the highest risk of becoming frail 5-10 years after cancer diagnosis.We used the Surveillance, Epidemiology, and End Results (SEER) dataset linked with Medicare data to identify patients with stage I-III breast, prostate, colon, or rectal cancers who lived at least five years from diagnosis and were not severely frail at year five post-diagnosis. Frailty was assessed using the claims-based Kim Frailty Index (FI) categorized by recommended thresholds. Restricted mean survival time (RMST) regression was used to identify clinical and demographic characteristics associated with frailty progression, defined as an increased category of the FI. Significant predictors were used to create clinical prediction rules and stratify survivors into low, intermediate, and high-risk groups.A total of 87,229 five-year survivors were included. At five years from diagnosis (time zero), 22 % of patients not frail at cancer diagnosis had new onset frailty and were mildly or moderately frail; at 10 years from diagnosis, 61 % had developed new or worsening frailty. Advanced age, comorbidities (RMST ratios ranging from 0.67 [95 % CI 0.65-0.70] to 0.80 [95 % CI 0.77-0.84], baseline moderate frailty at cancer diagnosis (RMST ratios ranging from 0.79 [95 % CI 0.76-0.83] to 0.86 [95 % CI 0.83-0.90]) and at five years post-diagnosis (RMST ratios ranging from 0.63 [95 % CI 0.62-0.64] to 0.71 [95 % CI 0.69-0.73]), living in a high poverty area (RMST ratios ranging from 0.91 [95 % CI 0.87-0.94] to 0.96, [95 % CI 0.93-0.99], and systemic treatments four to five years post-diagnosis (RMST ratios ranging from 0.77 [95 % CI: 0.70-0.84] to 0.86, [95 % CI: 0.84-0.89] were associated with less average time without frailty.Age, comorbidities, prior frailty, and late treatment were associated with frailty in older breast, prostate, colon, and rectal cancer survivors. This risk stratification model can be used by clinicians to assess cancer and age-related risk of frailty and facilitate timely intervention.

  View details for DOI 10.1016/j.jgo.2025.102804

  View details for Web of Science ID 001632311500001

  View details for PubMedID 41319472

• Cardiovascular risk in long-term survivors of breast, prostate, colon, and rectal cancer JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE Westvold, S. J., Long, J. B., Fan, J., Kc, M., Hyslop, T., Conlin, K., Jacobson, S., Silber, A., Wang, S., Leapman, M. S., Leeds, I., Spees, L., Wheeler, S. B., Gross, C. P., Oeffinger, K., Dinan, M. A. 2026; 118 (1): 130-140

  Abstract

  Cardiovascular disease (CVD) is the leading cause of noncancer mortality in long-term cancer survivors. Population-level assessment of cancer-related exposures is limited with respect to long-term cardiovascular risk in older survivors who have additional aging-related risks.This was a Surveillance, Epidemiology, and End Results-Medicare retrospective cohort study of long-term (5-year) survivors of breast, prostate, colon, and rectal cancers who were aged 66 years and older, diagnosed from 2003 to 2012, and received definitive treatment. The primary endpoint was late CVD, defined as myocardial infarction, stroke, congestive heart failure, or cardiomyopathy on an inpatient administrative claim or as Surveillance, Epidemiology, and End Results cause of death occurring 5-15 years postdiagnosis. Restricted mean survival time regression was used to assess predictors of shorter average time without CVD and develop a prediction rule for risk stratification. Survivors were assigned a risk score and stratified into tertiles.Included were 95 100 survivors with a mean age of 74 (6) years at diagnosis. Late CVD occurred in 23.2% of survivors. Older age, comorbidities, and prior CVD were associated with a shorter time without CVD. In contrast, cancer-related factors were not associated, except for stage III breast cancer, and radiation plus androgen deprivation therapy for prostate cancer. Across all cohorts, the high-risk strata had a three- to fourfold higher risk of CVD compared with the low-risk strata.In this cohort of older, long-term cancer survivors, cancer-related exposures were not independently associated with onset of CVD 5-15 years after diagnosis but may still contribute to latent cardiovascular risk. Given the limited impact of cancer-specific factors, cancer-agnostic risk prediction may be adequate to predict individual cardiovascular risk.

  View details for DOI 10.1093/jnci/djaf243

  View details for Web of Science ID 001616927400001

  View details for PubMedID 41069232

• Trajectories of Major Depression and Generalized Anxiety Symptoms Among People With Disabilities During the COVID-19 Pandemic AMERICAN JOURNAL OF ORTHOPSYCHIATRY Lowe, S. R., Fan, J., Michel, C., Manning III, R. B., Adler, J. M., Bogart, K. R., Nario-Redmond, M. R., Ostrove, J. M., Wang, K. 2026; 96 (4): 471-487

  Abstract

  People with disabilities (PWD) have reported higher major depression (MD) and generalized anxiety disorder (GAD) symptoms during the COVID-19 pandemic than others in the general population, with social isolation and disability stigma as key predictors of heightened symptomatology. However, the nature and predictors of PWD's MD and GAD symptom trajectories during the pandemic and after other potentially traumatic events remain largely unknown. The present study aimed to (a) document PWD's MD and GAD symptom trajectories during the pandemic and (b) examine social isolation and disability stigma as predictors of trajectory membership. A convenience sample of PWD recruited from disability-focused social media groups and Listserv (N = 200) completed a longitudinal study, with surveys in October-December 2020 (Time 1), November-December 2021 (Time 2), and October-December 2022 (Time 3). Participants reported on social isolation, disability stigma, demographic and disability characteristics, and pandemic-related stressors at Time 1, and MD and GAD symptoms at each wave. Latent class growth analysis detected three MD symptom trajectories (Mild-Decreasing: 40.5%; Moderate-Decreasing: 43.0%; Moderately Severe-Stable: 16.5%), and three GAD trajectories (Mild-Decreasing: 40.5%; Moderate-Decreasing: 41.5%; Severe-Stable: 18.0%). In adjusted models, higher social isolation was associated with higher odds of membership in the Moderately Severe-Stable MD trajectory versus the Mild- and Moderate-Decreasing MD trajectories, and higher odds of membership in the Moderate-Decreasing GAD trajectory versus the Mild-Decreasing GAD trajectory. The results demonstrate the persistent MD and GAD symptoms experienced by many PWD during the pandemic and the importance of interventions to address PWD's social isolation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

  View details for DOI 10.1037/ort0000855

  View details for Web of Science ID 001482960700001

  View details for PubMedID 40338598

• Screening History, Stage at Diagnosis, and Mortality in Screen-Detected Breast Cancer JAMA NETWORK OPEN Huang, S., Westvold, S. J., Soulos, P. R., Fan, J., Winer, E. P., Zhan, H., Lustberg, M. B., Lewin, J., Robinson, T. J., Dinan, M. A. 2025; 8 (4): e255322

  Abstract

  Screening mammography promotes early detection of breast cancer and is associated with reduced breast cancer mortality. Screening history prior to diagnosis may impact stage at diagnosis and breast cancer mortality but has not been comprehensively examined within a diverse US cohort.To determine whether having a prior screening is associated with earlier stage at breast cancer diagnosis and lower breast cancer-specific mortality.This cohort study used linked Surveillance, Epidemiology, and End Results-Medicare data of women aged at least 70 years, diagnosed with estrogen receptor-positive or human epidermal growth factor receptor 2-negative breast cancer from 2010 to 2017, and enrolled in fee-for-service Medicare Parts A and B from 5 years prior to through 1 year after diagnosis. Data were analyzed from March 1 to September 18, 2024.Presence of 1 or more screening mammograms during the 5 years prior to the mammogram at breast cancer diagnosis.Outcomes of interest were stage of breast cancer at diagnosis, dichotomized into very early (T1N0) vs later stage (T2+ or N1+) and breast cancer-specific mortality.Among 13 028 included women, most had at least 1 prior screening (10 094 women [77.5%]) and were aged between 70 and 79 years (9034 women [69.4%]) and not dual-eligible for Medicare and Medicaid (11 475 women [88.1%]). Additionally, 3812 women (29.3%) were diagnosed with later-stage disease (T2+ or N1+) at the time of diagnosis. In multivariable analyses, prior screening was associated with 54% lower odds of later-stage breast cancer diagnosis (adjusted odds ratio, 0.46; 95% CI, 0.42-0.50) and 36% lower hazard of breast cancer-specific death (adjusted hazard ratio, 0.63; 95% CI, 0.52-0.76) compared with no prior screenin. In the adjusted Cox proportional hazards model, having 3 or 4 prior screenings was associated with 37% reduced hazard of breast cancer-specific mortality compared with having 1 prior screening (adjusted hazard ratio, 0.63; 95% CI, 0.44-0.89).In this cohort study of older women with screen-detected estrogen receptor-positive or human epidermal growth factor receptor 2-negative breast cancer, prior screening mammography was associated with earlier stage at breast cancer diagnosis and lower breast cancer mortality. These findings support the potential for routine screening to improve breast cancer outcomes. As with all observational studies, this study is limited by the potential effects of other differences between the screening and nonscreening groups.

  View details for DOI 10.1001/jamanetworkopen.2025.5322

  View details for Web of Science ID 001470316000009

  View details for PubMedID 40232715

  View details for PubMedCentralID PMC12000969

• Predictors of late recurrence of colorectal cancer (CRC) among older long-term survivors using claims-based evidence. Yasin, F., Westvold, S., Long, J. B., Fan, J., Hyslop, T., Leeds, I. L., Cecchini, M., Gross, C., Dinan, M. LIPPINCOTT WILLIAMS & WILKINS. 2025: 66

  View details for DOI 10.1200/JCO.2025.43.4_suppl.66

  View details for Web of Science ID 001423525100044

• Personalized frailty risk assessment in long-term survivors of colorectal cancer Forman, R., Westvold, S., Long, J. B., Fan, J., Hyslop, T., Yasin, F., Conlin, K., Jacobson, S., Silber, A., Wang, S., Leapman, M., Leeds, I. L., Cecchini, M., Spees, L. P., Wheeler, S. B., Gross, C., Oeffinger, K. C., Dinan, M. LIPPINCOTT WILLIAMS & WILKINS. 2025: 65

  View details for DOI 10.1200/JCO.2025.43.4_suppl.65

  View details for Web of Science ID 001423525100012

• Relative Burden of Cancer and Noncancer Mortality Among Long-Term Survivors of Breast, Prostate, and Colorectal Cancer in the US JAMA NETWORK OPEN Madhav, K. C., Fan, J., Hyslop, T., Hassan, S., Cecchini, M., Wang, S., Silber, A., Leapman, M. S., Leeds, I., Wheeler, S. B., Spees, L. P., Gross, C. P., Lustberg, M., Greenup, R. A., Justice, A. C., Oeffinger, K. C., Dinan, M. A. 2023; 6 (7): e2323115

  Abstract

  Improvements in cancer outcomes have led to a need to better understand long-term oncologic and nononcologic outcomes and quantify cancer-specific vs noncancer-specific mortality risks among long-term survivors.To assess absolute and relative cancer-specific vs noncancer-specific mortality rates among long-term survivors of cancer, as well as associated risk factors.This cohort study included 627 702 patients in the Surveillance, Epidemiology, and End Results cancer registry with breast, prostate, or colorectal cancer who received a diagnosis between January 1, 2003, and December 31, 2014, who received definitive treatment for localized disease and who were alive 5 years after their initial diagnosis (ie, long-term survivors of cancer). Statistical analysis was conducted from November 2022 to January 2023.Survival time ratios (TRs) were calculated using accelerated failure time models, and the primary outcome of interest examined was death from index cancer vs alternative (nonindex cancer) mortality across breast, prostate, colon, and rectal cancer cohorts. Secondary outcomes included subgroup mortality in cancer-specific risk groups, categorized based on prognostic factors, and proportion of deaths due to cancer-specific vs noncancer-specific causes. Independent variables included age, sex, race and ethnicity, income, residence, stage, grade, estrogen receptor status, progesterone receptor status, prostate-specific antigen level, and Gleason score. Follow-up ended in 2019.The study included 627 702 patients (mean [SD] age, 61.1 [12.3] years; 434 848 women [69.3%]): 364 230 with breast cancer, 118 839 with prostate cancer, and 144 633 with colorectal cancer who survived 5 years or more from an initial diagnosis of early-stage cancer. Factors associated with shorter median cancer-specific survival included stage III disease for breast cancer (TR, 0.54; 95% CI, 0.53-0.55) and colorectal cancer (colon: TR, 0.60; 95% CI, 0.58-0.62; rectal: TR, 0.71; 95% CI, 0.69-0.74), as well as a Gleason score of 8 or higher for prostate cancer (TR, 0.61; 95% CI, 0.58-0.63). For all cancer cohorts, patients at low risk had at least a 3-fold higher noncancer-specific mortality compared with cancer-specific mortality at 10 years of diagnosis. Patients at high risk had a higher cumulative incidence of cancer-specific mortality than noncancer-specific mortality in all cancer cohorts except prostate.This study is the first to date to examine competing oncologic and nononcologic risks focusing on long-term adult survivors of cancer. Knowledge of the relative risks facing long-term survivors may help provide pragmatic guidance to patients and clinicians regarding the importance of ongoing primary and oncologic-focused care.

  View details for DOI 10.1001/jamanetworkopen.2023.23115

  View details for Web of Science ID 001059371500008

  View details for PubMedID 37436746

  View details for PubMedCentralID PMC10339147

• Demographic and clinical factors associated with cardiovascular events in elderly longterm survivors of breast cancer Westvold, S., Madhav, K. C., Fan, J., Hyslop, T., Spees, L., Wang, S., Silber, A., Oeffinger, K. C., Dinan, M. LIPPINCOTT WILLIAMS & WILKINS. 2023

  View details for Web of Science ID 001053772005248

• Demographic and clinical factors associated with cardiovascular events in elderly long-term survivors of breast cancer. Westvold, S., Madhav, K. C., Fan, J., Hyslop, T., Spees, L., Wang, S., Silber, A., Oeffinger, K. C., Dinan, M. LIPPINCOTT WILLIAMS & WILKINS. 2023: e24105

  View details for DOI 10.1200/JCO.2023.41.16_suppl.e24105

  View details for Web of Science ID 001555504800008