Faculty Bibliography

BACKGROUND:Patients have immediate access to their diagnostic reports but these reports exceed the recommended reading level for patient-facing materials. Generative artificial intelligence may be a tool for improving patient comprehension of health information. This study assessed the readability and accuracy of ChatGPT-simplified breast pathology reports. METHODS:Ten de-identified patient breast pathology reports were simplified by ChatGPT-4.0 using three different prompts. Prompt 1 requested simplification, Prompt 2 added a 6th-grade-level specification, and Prompt 3 requested essential information. The Flesch-Kincaid Reading Level (FKRL) and Flesch Reading Ease Score (FRES) were utilized to quantify readability and ease of reading, respectively. Five physicians used a four-point scale to assess factual correctness, relevancy, and fabrications to determine overall accuracy. Mean scores and standard deviations for FKRL, FRES, and accuracy scores were compared using analysis of variance (ANOVA) and t-tests. RESULTS:Prompt 2 demonstrated a reduction in FKRL (p < 0.001) and an increase in FRES (p < 0.001), demonstrating improved readability and ease of reading. ChatGPT-simplified reports received an overall accuracy score of 3.59/4 (standard deviation [SD] ± 0.17). The scores by rubric category were 3.62 (SD ± 0.31) for factual correctness (4 = completely correct), 3.27 (SD ± 0.44) for relevancy (4 = completely relevant), and 3.89 (SD ± 0.11) for fabricated information (4 = no fabricated information). CONCLUSIONS:ChatGPT simplified breast pathology reports to the reading level recommended for patient-facing materials when given a grade-level specification while mostly maintaining accuracy. To minimize the risk of medically inaccurate and/or misleading information, ChatGPT-simplified reports should be reviewed before dissemination.

BACKGROUND:Health literacy is a critical factor in patient engagement and outcomes during cancer survivorship. With the 21st Century Cures Act, patients now receive immediate access to radiology and pathology reports, yet these documents often exceed the 6th-grade reading level recommended by the American Medical Association. While prior studies have examined general breast cancer materials, the readability of individualized clinical reports remains unexplored. METHODS:In this multi-institutional retrospective study, 120 de-identified breast radiology and pathology reports from the University of Colorado and the University of Miami were analyzed across six report types. Readability was assessed using six validated indices. Additionally, 98 MedEd definitions and 96 MedEd-directed online patient education materials (OPEMs) were evaluated. MedEd is a Chrome plug-in designed to highlight key breast health terms and provide physician-curated definitions with links to vetted educational content. RESULTS:Across institutions, most clinical reports exceeded a high school reading level, with surgical pathology reports being the least accessible. MedEd definitions and OPEMs demonstrated better readability but still surpassed the recommended 6th-grade level. CONCLUSIONS:Breast cancer-related reports and educational materials remain difficult for many survivors to comprehend. Improved design of patient-facing tools-potentially through AI integration and patient co-development-may enhance accessibility, empowerment, and shared decision-making. IMPLICATIONS FOR CANCER SURVIVORS/CONCLUSIONS:This study underscores a critical gap between the readability of breast radiology and pathology reports and the literacy levels of many cancer survivors. As patients gain immediate access to these documents through electronic portals, the complexity of medical language can lead to confusion, anxiety, and disengagement from care. Survivors may be particularly vulnerable during post-treatment surveillance when understanding follow-up imaging and pathology is vital for shared decision-making. Tools like MedEd-while promising-must continue to evolve to meet national literacy standards. Simplifying medical reports and integrating patient-centered, Al-supported education tools can enhance survivors' comprehension, foster autonomy, and ultimately improve their confidence and outcomes throughout survivorship.

Patient-to-patient variability in breast cancer progression complicates clinical treatment decisions. Of women undergoing prophylactic mastectomies, many may not have progressed to indolent forms of disease and could have benefited from milder, localized therapy. Tumor associated macrophages contribute significantly to tumor invasion and metastasis, with cysteine cathepsin proteases as important contributors. Here, a method is demonstrated by which variability in macrophage expression of cysteine cathepsins, their inhibitor cystatin C, and kinase activation can be used to train a multivariate model and score patients for invasion risk. These enzymatic profiles were used to predict macrophage-assisted MCF-7 breast cancer cell invasion in the trained computational model. To test these predictions, a priori, signals from monocytes isolated from women undergoing mastectomies were input to score their cancer invasion potential in a patient-specific manner, and successfully predicted that patient monocytes with highest predicted invasion indices matched those with more invasive initial diagnoses of the nine patients tested. Together this establishes proof-of-principle that personalized information acquired from minimally invasive blood draws may provide useful information to inform oncologists and patients of invasive/metastatic risk, helping to make decisions regarding radical mastectomy or milder, conservative treatments to save patients from hardship and surgical recovery.

Abstract Drosophila ash2 is a member of the trxG gene super family, some human homologues of which are involved in hematopoiesis and leukemia. We report here the identification of the human homologue of Drosophila ash2 and its alternative splicing isoform, ASH2L1 and ASH2L2. ASH2L proteins are 60% homologous to Drosophila ash2. ASH2L also has a zinc finger motif (C2C2) although it is not identical to that in ASH2. Expression profile analysis showed that the amount of ASH2L transcripts is extremely high in fetal liver, testis, and leukemia cell lines with erythroid and megakaryocytic potential such as K562, Hel, and Dami. We treated these cells with differentiation inducers phorbol ester and hemin. We found that ASH2L is downregulated rapidly and dramatically in K562, Hel, and Dami cells during phorbol ester induced differentiation with megakaryocytic features. However, its expression is maintained at a high level during erythroid differentiation of K562 cells induced with hemin. These results suggest that ASH2L plays a role in hematopoiesis and is associated with some special kinds of leukemia.