Rachel Greenup

Overview:

Dr. Greenup is an Associate Professor of Surgery and Population Health Sciences at the Duke School of Medicine and Duke Cancer Institute. She is the founder and co-director of the Duke Breast Cancer Outcomes Research Group, and Core Faculty for the Duke Margolis Center for Health Policy.

She earned her undergraduate degrees in Zoology and Psychology at the University of Wisconsin, where she later completed a Masters in Public Health. She attended the Medical College of Wisconsin for Medical School and General Surgery Residency, and went on to complete a Breast Surgical Oncology Fellowship at the Massachusetts General Hospital, Dana Farber Cancer Institute, and Brigham and Women’s Hospital. In 2016, she received the National Institutes of Health Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Award to evaluate how financial costs and burden relate to preference-sensitive decisions for breast cancer surgery. In 2017, she was named the American College of Surgeons & American Society of Breast Surgeons Health Policy Scholar. More broadly, her research focuses on aligning patient-centered care with high quality, lower cost treatment.

Dr. Greenup serves on several national committees, including the Alliance in Clinical Oncology Ethics and Value Committees, the American College of Surgeons Cancer Care Delivery Task Force, the American Society of Breast Surgeons Legislative Committee, and the Editorial Board for the Annals of Surgical Oncology. 

Positions:

Associate Professor of Surgery

Surgical Oncology
School of Medicine

Associate Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2004

Medical College of Wisconsin

M.P.H. 2009

University of Wisconsin at Madison

Internship/General Surgery Residency

Medical College of Wisconsin

Breast Surgical Oncology Fellow

Massachusetts General Hospital

Grants:

TBCRC 029: Male Breast Cancer

Administered By
Duke Cancer Institute
Awarded By
Johns Hopkins University
Role
Principal Investigator
Start Date
End Date

Publications:

Nodal Response to Neoadjuvant Chemotherapy Predicts Receipt of Radiation Therapy after Breast Cancer Diagnosis.

BACKGROUND: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) is associated with improved overall survival (OS) in breast-cancer patients, but it is unclear how post-NACT response influences radiotherapy administration in patients presenting with node-positive disease. We sought to determine whether nodal pCR is associated with likelihood of receiving nodal radiation and whether radiotherapy among patients experiencing nodal pCR is associated with improved OS. METHODS: cN1 female breast cancer patients diagnosed 2010-2015 who were ypN0 (i.e., nodal pCR, n=12,341) or ypN1 (i.e., residual disease, n=13,668) post-NACT were identified in the National Cancer Database. Multivariate logistic regression was used to identify factors associated with receiving radiotherapy. Cox proportional hazards modeling was used to estimate the association between radiotherapy and adjusted OS. RESULTS: 26,009 patients were included. 43.9% (n=5,423) of ypN0 and 55.3% (n=7,556) of ypN1 patients received nodal radiation. Rates of nodal radiation remained the same over time among ypN0 patients (trend test p=0.29) but increased among ypN1 patients from 49% in 2010 to 59% in 2015 (trend test p<0.001). After adjusting for covariates, nodal pCR (vs no stage change) was associated with decreased likelihood of nodal radiation after mastectomy (∼20% decrease) and lumpectomy (∼30% decrease, both p<0.01). After mastectomy, nodal (vs no) radiation conferred no significant survival benefit in ypN0 patients but approached significance for ypN1 patients (hazard ratio [HR] 0.83, 95% CI 0.69-0.99, p=0.04, overall p-value=0.11). After lumpectomy, nodal radiation was associated with improved adjusted OS for ypN0 (HR 0.38, 95% CI 0.22-0.66) and ypN1 patients (HR 0.44, 95% CI 0.30-0.66, both p<0.001), but this improvement was not significantly greater than that associated with breast-only radiation. CONCLUSIONS: ypN0 patients were less likely to receive nodal radiation than ypN1 patients, suggesting that selective omission already occurs and, in the context of limited survival data, could potentially be appropriate for select patients.
MLA Citation
Fayanju, Oluwadamilola M., et al. “Nodal Response to Neoadjuvant Chemotherapy Predicts Receipt of Radiation Therapy after Breast Cancer Diagnosis..” Int J Radiat Oncol Biol Phys, Oct. 2019. Pubmed, doi:10.1016/j.ijrobp.2019.10.039.
URI
https://scholars.duke.edu/individual/pub1418091
PMID
31678225
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Published Date
DOI
10.1016/j.ijrobp.2019.10.039

Contralateral Prophylactic Mastectomy in the Era of Financial Toxicity: An Additional Point for Concern?

Authors
Offodile, AC; Hwang, ES; Greenup, RA
MLA Citation
Offodile, Anaeze C., et al. “Contralateral Prophylactic Mastectomy in the Era of Financial Toxicity: An Additional Point for Concern?.” Ann Surg, Oct. 2019. Pubmed, doi:10.1097/SLA.0000000000003629.
URI
https://scholars.duke.edu/individual/pub1415524
PMID
31592896
Source
pubmed
Published In
Ann Surg
Published Date
DOI
10.1097/SLA.0000000000003629

Cost of Reconstruction: A Qualitative Study of Women after Breast Cancer

Authors
Lane, WO; Rushing, C; Mundy, LR; Shammas, R; Hollenbeck, ST; Fish, LJ; Greenup, RA
MLA Citation
Lane, Whitney O., et al. “Cost of Reconstruction: A Qualitative Study of Women after Breast Cancer.” Journal of the American College of Surgeons, vol. 229, no. 4, ELSEVIER SCIENCE INC, 2019, pp. S147–S147.
URI
https://scholars.duke.edu/individual/pub1421710
Source
wos
Published In
Journal of the American College of Surgeons
Volume
229
Published Date
Start Page
S147
End Page
S147

Immediate Breast Reconstruction Allows for the Timely Initiation of Postmastectomy Radiation Therapy.

BACKGROUND: Complications from breast reconstruction may delay postmastectomy radiation therapy and impact breast cancer outcomes. The authors hypothesized that immediate breast reconstruction may be associated with delays in the initiation of radiation, but that this delay would not significantly impact overall patient survival. METHODS: Using the National Cancer Database, the authors identified women with breast cancer who underwent mastectomy and received postmastectomy radiation therapy. Delayed radiation was defined as treatment initiated 6 months or more after surgery in patients who received adjuvant chemotherapy or 12 weeks or more after surgery in patients who received neoadjuvant or no chemotherapy. RESULTS: Women undergoing breast reconstruction had an increased time to postmastectomy radiation therapy, 154 days versus 132 days (p < 0.001), and were more likely to experience a delay in initiating radiation (OR, 1.25; 95 percent CI, 1.188 to 1.314). Other factors associated with delayed radiation included increased Charlson/Deyo scores, neoadjuvant chemotherapy, nonprivate insurance, and black race. Cox proportional hazards models revealed no evidence of a reduced adjusted overall survival in the immediate breast reconstruction group (hazard ratio, 0.836; 95 percent CI, 0.802 to 0.871; p < 0.001). Restricted cubic spline analysis identified the threshold number of days at which the start of radiation began to impact survival at 169 days (95 percent CI, 160 to 190 days), 75 days (95 percent CI, 42 to 90 days), and 71 days (95 percent CI, 41 to 90 days) in patients undergoing adjuvant, neoadjuvant, and no chemotherapy, respectively. CONCLUSION: Immediate breast reconstruction is associated with a modest delay in initiating postmastectomy radiation therapy but does not impact overall survival. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Authors
Shammas, RL; Ren, Y; Thomas, SM; Hollenbeck, ST; Greenup, RA; Blitzblau, RC
MLA Citation
Shammas, Ronnie L., et al. “Immediate Breast Reconstruction Allows for the Timely Initiation of Postmastectomy Radiation Therapy..” Plast Reconstr Surg, vol. 144, no. 3, Sept. 2019, pp. 347e-357e. Pubmed, doi:10.1097/PRS.0000000000005899.
URI
https://scholars.duke.edu/individual/pub1406361
PMID
31460998
Source
pubmed
Published In
Plast Reconstr Surg
Volume
144
Published Date
Start Page
347e
End Page
357e
DOI
10.1097/PRS.0000000000005899

Abstract PD6-08: Medicare costs for women after breast cancer: Preparing for survivorship

Authors
Greenup, RA; Yashkin, A; Gorbunova, G; Akusevich, I; Hwang, ES
MLA Citation
Greenup, R. A., et al. “Abstract PD6-08: Medicare costs for women after breast cancer: Preparing for survivorship.” Poster Discussion Abstracts, American Association for Cancer Research, 2019. Crossref, doi:10.1158/1538-7445.sabcs18-pd6-08.
URI
https://scholars.duke.edu/individual/pub1404096
Source
crossref
Published In
Poster Discussion Abstracts
Published Date
DOI
10.1158/1538-7445.sabcs18-pd6-08