bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in survival from metastatic breast cancer during the last twenty-years: A population based study in Northern Italy
Authors: Cortesi L. , Cirilli C. , Rashid I. , Artioli E. , Federico M. 
Published: August 2020

1125 Background: A significant improvement in overall survival was observed in the last two decades in patients with breast cancer due to early diagnosis and more effective therapies. However, a significant improvement in metastatic setting has been questioned. Our population based study was aimed to investigate the outcome of metastatic breast cancer from 1988 to 2005. Methods: Women with stage IV de novo or relapsed breast cancer diagnosed between 1988 and 2005 were identified by the Modena Cancer Registry (MCR). For all patients overall survival (OS) was measured from the date of first distant metastases to the date of death from any cause or last follow-up and compared across groups for four periods of similar duration time: 1988–1993 (A), 1994–1997(B), 1998–2001(C), 2002–2005(D). Results: Among 8,654 patients with breast cancer identified by the MCR, 409 had an initial metastatic disease (4.8%) and 693 (8.4%) had a distant recurrence. Median age at onset was 66 versus 59 years in de novo vs relapsed disease (p = 0.001). Significant differences for postmenopausal age (80% vs 71%) and for positive estrogen receptors (72% vs 63%) were registered in de novo and relapsed disease, respectively (p = 0.001). After a 27 months median follow-up for initial metastatic disease, the five-year OS was 12%, 14%, 9%, and 13% in the A, B, C, and D periods, respectively, (p = 0.5). Conversely, in relapsed breast cancer, after a 29 months median follow-up, a significant survival improvement was observed between the first and the other three periods, being the 5 year-survival rate after recurrence 10%, 22%, 30%, and 25%, respectively (p = 0.001). A survival improvement was seen in the last ten years for relapsed breast cancer using aromatase inhibitors (p < 0.0001) while for initial metastatic disease the same treatment provided a better outcome only in the last 4 years (p < 0.0001). Conclusions: Data from our study show that the outcome of initial metastatic breast cancer is still discouraging, despite the availability of several new drugs in recent years. A limited improvement was observed in relapsed breast cancer with the aromatase inhibitors introduction. In any case, the finish line is still far away, and robust investments in basic and translational research are still absolutely necessary. No significant financial relationships to disclose.
Contralateral risk-reducing mastectomy in BRCA1/2 mutation carriers and other high-risk women in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab)
Authors: Kiely B. E. , Jenkins M. A. , McKinley J. M. , Friedlander M. L. , Weideman P. C. , Milne R. , McLachlan S. , Hopper J. L. , Phillips K. 
Published: August 2020

1509 Background: Contralateral risk-reducing mastectomy (CRRM) reduces contralateral breast cancer (BC) risk by up to 97%. Few studies have examined the prevalence and predictors of CRRM in BC patients at high familial risk of a second primary BC. Methods: Participants were women with unilateral BC and a strong family history of the disease, including BRCA1 and BRCA2 mutation carriers. Data were collected by interview, self-administered questionnaire, and review of pathology and surgical reports. Associations between having CRRM and potential predictors were assessed using multivariate logistic regression. Results: Of 1018 study participants (median follow-up 5.5 years), 154 (15%) underwent CRRM. The median time from initial BC to CRRM was 1 year. More likely to undergo CRRM were women who were younger at the time of their BC diagnosis (odds ratio [OR] = 0.94 per year of age, p < 0.001), those diagnosed more recently (OR = 1.16 per calendar year, p < 0.001), those who underwent mastectomy rather than breast conservation as their initial definitive BC treatment (OR = 5.2, p < 0.001) and those who underwent risk-reducing salpingo-oophorectomy (OR = 3.4, p < 0.001). BRCA1/2 mutation status and tumor characteristics were not independently associated with CRRM uptake. A contralateral BC event occurred in 177 (20.5%) of the 864 women who did not have CRRM, compared with one chest wall event (0.6%) in the 154 women post-CRRM. Conclusions: Younger women with more recently diagnosed BC treated with mastectomy were most likely to elect CRRM. BRCA1/2 mutation status and the competing risk of BC recurrence and death did not appear to influence decision making. No significant financial relationships to disclose.
A study of lavender and tea tree oils on postmenopausal FSH levels and hot flash severity
Authors: Cohn R. D. , Bornhauser C. , MacManus D. , Sadakane M. , Read W. 
Published: August 2020

1516 Background: Products containing lavender and tea tree oil have been linked to prepubertal male gynecomastia.(N Engl J Med 356:479–485) This implies that these products may be phytoestrogens, or plant products with estrogenic effects. Exogenous estrogens increase the risk of developing breast cancer and could counteract benefit from adjuvant hormonal manipulations in women with a history of breast cancer. We designed a study to determine the effects of lavender and tea tree oil on healthy postmenopausal women's FSH as a means to determine the estrogenic effect of both products. Hot flashes are a side effect of decreased endogenous estrogen, and in this study we used hot flash severity as an additional assay of estrogenic effect. Methods: Lavender lotion and tea tree oil products were generously donated by The Body Shop. Nine healthy postmenopausal women suffering from hot flashes were asked to apply lavender lotion and tea tree oil according to product directions for a week each, with a washout period in between. Participants were menopausal with baseline FSH > 26 IU/mL. Serum FSH was obtained at baseline, after each lotion and after the washout period. Participants also recorded daily hot flash number and severity. Average daily hot flash severity was calculated for each patient during each period, with lotion use periods compared to Paired, 2-tailed T-tests were used to compare average hot flash severity for each participant as well as FSH values as compared to the baseline obtained before it. Results: Compliance was excellent. No significant differences were seen between time periods with either product for either measure. In no case did FSH dip to premenopausal levels. No indication of improvement in hot flash frequency or severity was seen. Conclusions: In our population, the lavender and tea tree oil products showed no estrogenic effects. This is similar to clinical trials of phytoestrogens, which as used by humans are not potent enough to affect FSH or hot flash severity. Both lotions can probably be used without increasing the risk of recurrent or de novo breast cancer. We intend one more study period in which participants will use a large daily amount of lavender lotion, again tracking hot flash severity and FSH. No significant financial relationships to disclose.
Risk of noncompliance due to patient discomfort during screening mammogram
Authors: Mullai N. , Murugesan N. , Burton L. , Goodin V. , Stout A. 
Published: August 2020

1522 Background: There is enough evidence supporting the benefits of screening mammograms than any other screening procedure for the early detection of malignancy. Compliance to the screening method is very important to achieve this purpose. There is some concern about future trends in breast cancer mortality as a decline in rates of mammogram screening has been noticed. Pain during mammography has been recognized as a significant deterrent to breast screening. Hence this study was done to evaluate compliance in screening mammogram and to analyze major reasons for noncompliance. Methods: Randomly selected patients visiting the doctor's office for various reasons were asked about mammogram and their experience. Their responses were tabulated and analyzed statistically. Results: Out of 160 people questioned, 155 patients had mammogram regularly at 1–2 year interval and five patients did not. 50% of respondents were 51–70 years of age, 15% were 50 years or under, and 31% were over 70 years. Ninety patients (58%) reported their mammogram experience was unpleasant, causing pain and bruising. In spite of the discomforts reported, 132 (82.5%) patients said they would continue the screening as recommended. However, 28 patients (17.5%) indicated their intention not to get further mammograms based on their painful experience, unless the screening technology was improved. Conclusions: Breast cancer incidence after peaking in 1998 has decreased 9.8% since then with a 12% decline in women aged 50–60. The sharpest decline was noted from 2003 that could be due to the decrease in the hormone replacement therapy after the Women's Health Initiative report. However, it may also reflect some reduction in screening mammograms from 70% (in 2000) to 66% (in 2005) as estimated by National Health Interview Survey. Various causes were attributed for the decline in screening mammogram rate including the discomfort and pain caused by compression during film mammography. More than 1 in 6 patients refusing to undergo further screening is definitely a sign of concern. Better screening methods like patient controlled compression mammogram reported by Duke University Medical Center or other methods are worth investigating, to improve the compliance of the one of the effective preventive measures. No significant financial relationships to disclose.
Results of the first national public breast cancer screening program in the Kingdom of Saudi Arabia
Authors: Omalkhair A. , Tahan F. , Al Naeem A. , Young S. , Musaad S. , Jazieh A. 
Published: August 2020

1524 Background: Despite the relatively low incidence in the Kingdom of Saudi Arabia (KSA) compared to Western countries, breast cancer (BC) is the most common cancer among Saudi females for the past 11 consecutive years (National Cancer Registry 1994–2004). The objective of this study is to report the results of the first public national BC screening program in KSA and to evaluate the relationship between imaging and pathological findings and known BC risk factors. Methods: Asymptomatic women 40 years of age or older underwent BC screening at Abdulatif Charitable Cancer Screening Center, Riyadh, KSA. Mammograms were scored using American College of Radiology Breast Imaging Reports and Data System (BIRADS). Correlations between imaging findings and risk factors, as well as pathological findings, were analyzed. Results: A total of 1,215 women were enrolled between September 2007 and April 2008. Median age was 45 years (19–91) and median body mass index (BMI) was 31.6 kg/m2 (16.7–58). A total of 16 cases of cancer were diagnosed (80% are less than stage IIB). No cancer was diagnosed in 942 women with R1/R2 scores and only one case of cancer was diagnosed in 228 women with R0/R3 scores. However, among 26 women with R4/R5 scores, 50% had malignant disease and 35% had benign lesions (odds ratio = 1.96; 95% confidence interval = 1.5, 2.6) (p < 0.0001). No correlation between known risk factors and imaging score or cancer diagnosis. Conclusions: The public acceptance of BC screening program was encouraging. Longitudinal follow-up and inclusion of more participants will help in better determining the risk factors relevant to our patient population. No significant financial relationships to disclose.
Frequency of late-stage breast cancer diagnoses despite high mammography screening rates in an HMO
Authors: Haque R. , Schottinger J. E. , Kanter M. H. , Avila C. C. , Contreras R. , Gordon M. A. , Quinn V. P. 
Published: August 2020

1526 Background: Kaiser Permanente Southern California (KPSC) led the nation in screening women for breast cancer (BCa) with a mammography rate of nearly 90% in 2007 according to 2008 Healthcare Effectiveness Data and Information Set (HEDIS) measures. Despite successes in improving screening rates in this health plan that serves 3+ million diverse members, the percentage of women diagnosed with late stage BCa (stage III, IV) remained stable, varying from 12.9% (N∼323) in 2003 to 10.8% (N∼270) in 2007. To identify patient and health care factors associated with late stage diagnosis and the impact of its enhanced screening implementation guidelines, KPSC undertook this study. Methods: This cross-sectional study included a cohort of 10,580 BCa patients from 2003–2007. We compared women diagnosed with late stage disease versus those with early stage disease (stages I, II). P values (2-sided) were based on the chi-square distribution. Adjusted odds ratios and 95% confidence intervals were estimated using unconditional logistic regression. Results: Factors that were positively associated with late stage diagnosis in the univariate analyses included age, lack of recent mammography screening, worse tumor features, 80+ years of age, minority race, lower geocoded household income, increased healthcare visits, and use of Pap testing (P < 0.01 for all variables). Factors significantly associated with late stage diagnosis in the multivariate model included only lack of recent mammography screening (OR = 1.35, 95% CI: 1.14–1.58) and worse tumor features including high grade (grade 3, OR = 2.58, 95% CI: 1.96–3.40), positive lymph nodes (OR = 53.49, 95% CI: 39.90–71.72), and HER-2+ tumors (OR = 1.40, 95% CI: 1.13–1.72). Conclusions: Targeting older women, those with lower utilization, and women who did not have a recent mammogram may help further lower the prevalence of late stage diagnoses. However, given the extent of the health plan's previous efforts to enhance BCa screening rates, a ceiling effect may limit additional benefit. Additional efforts to decrease the rate of advanced tumor stage at diagnosis may include improving interpretation of mammograms or earlier detection of aggressive tumors by enhanced BRCA genetic testing. No significant financial relationships to disclose.
Factors leading to the decision for contralateral prophylactic mastectomy in patients with breast cancer
Authors: Yi M. , Hunt K. K. , Arun B. K. , Bedrosian I. , Gutierrez Barrera A. M. , Kuerer H. M. , Babiera G. , Mittendorf E. A. , Meric-Bernstam F. 
Published: August 2020

1528 Background: Women with breast cancer have an increased risk of developing contralateral breast cancer in their lifetime. Thus increasing numbers of women have been electing to undergo contralateral prophylactic mastectomy (CPM) at the time of their initial breast cancer treatment. The objective of this study was to identify factors that determine the decision for CPM in patients at a major cancer center. Methods: 2,544 women with Stage 0-III unilateral primary breast cancer who underwent surgery to the breast at our institution from January 2000 to August 2006 were identified from a prospectively maintained database. Patient and tumor characteristics were evaluated and comparisons were made between patients who did or did not undergo CPM using logistic regression. Results: Of the 2,544 patients, 1254 (49.3%) underwent total mastectomy for their known cancer; 282 (22.5%) of these patients underwent immediate or delayed CPM. Overall, 171 patients (6.7%) had genetic testing; and the use of testing increased in the latter years of the study (3.% in 2000–2002 vs. 8.2% in 2003–2006, p<.0001). 49 of 171 patients had genetic testing prior to surgery. 10 had a deleterious BRCA1/2 mutation, 9 of whom had a CPM (p=.002). 14 patients without a mutation also had a CPM. Multivariate analysis revealed factors associated with use of CPM were: age younger than 50, white race, family history of breast cancer, higher clinical tumor stage, invasive lobular histology, and use of reconstruction (Table). Conclusions: Both patient and tumor characteristics influence selection of CPM. Although the use of genetic testing is increasing, most women elect to undergo CPM without having genetic testing. Evidence-driven models are needed to better inform women of their absolute risk of contralateral breast cancer as well as competing risk from their primary breast cancer in order to empower them in their active-decision-making. [Table: see text] No significant financial relationships to disclose.
Evaluation of known risk factors for breast cancer in Venezuelan patients with breast cancer, benign breast diseases, and without breast pathology
Authors: Hernandez D. E. , Hernandez A. E. , Garcia G. C. 
Published: August 2020

1531 Background: Breast cancer (BC) represents the second cause of death from cancer in Venezuelan women, therefore, it is important to study the known risk factors for developing BC in Venezuelan patients. Also, little is known about the importance of these risk factors in patients with benign breast diseases (BBD). Due to this we carried out a prospective case-control study of known risk factors for developing BC in a group of female patients with BC and BBD with the purpose of defining clinical criteria which can be used to orient physicians and patients about the conducts to be followed not only by the patients, but also by their family group. Methods: We included 515 patients with BC, 507 with BBD, and 505 without breast pathology.The following risk factors were identified through a personal interview with each patient: family history of breast and ovary cancer, exposure to female hormones (exogenous and endogenous), and previous history of BBD. Results: The significant results when comparing the BC group with the BBD group were the following: strong family history of BC (p = 0.004), ingestion of oral contraceptives (p = 0.035), lactation (p = 0.00013), hormone replacement therapy (p = 0.000001), and previous history of BBD (p = 0.0000032). The significant results when comparing the BC group with the group without breast pathology were the following: family history of BC (p = 0.0000001), family history of ovary cancer (p = 0.0000001), nulliparity (p = 0.00009), age of first terminal pregnancy (p = 0.000001), number of abortion (p = 0.024), lactation (p = 0.03), and previous history of BBD (p = 0.0000001). A logistic regression model showed that the variables with the highest impact were lactation (p = 0.0001), family history of breast cancer (p = 0.0001), and family history of ovary cancer (p = 0.0001). Conclusions: Even though several hormonal factors were important, lactation and family history of breast and ovary cancer were the most important risk factors. No significant financial relationships to disclose.
Willingness of breast cancer survivors to participate in a randomized controlled trial (RCT) of digital mammography with or without magnetic resonance imaging (MRI) as breast cancer (BC) surveillance: A feasiblity study
Authors: Warner E. , Tsoi D. , Bordeleau L. , Brezden C. , Holloway C. 
Published: August 2020

1534 Background: Although no RCT of MRI screening has ever been performed, and thus its impact on survival is unknown, MRI (plus mammography) has become the standard of care for screening women at very high risk for BC due to its superior sensitivity. The current ASCO guideline for surveillance of women with a past history of BC patients for ipsilateral recurrence or contralateral BC is annual mammography; however, MRI is often being ordered as well. A RCT for this population is still theoretically feasible assuming one could recruit a sufficient number of patients. We conducted a study to evaluate the willingness of BC survivors to participate in a RCT of digital mammography with or without MRI. Methods: In this multi-center, cross-sectional cohort survey, consecutive women ages 20 to 59 with invasive BC who had completed all primary therapy (except hormonal therapy), had at least one remaining breast and no evidence of metastatic disease, were consented in clinic to complete a self-administered questionnaire. Results: 348 women at four study sites across Toronto, Canada, were enrolled over 10 months. Median age 51 years, 76% Caucasian, 69% had BC within the last 5 years, 37% had previous mastectomy. At diagnosis, 71% BC had been visible on mammogram; 45% had undergone diagnostic MRI. 22% continued to have MRI as part of surveillance imaging, especially women younger than 40 years. 58% agreed to consider participating in the proposed RCT, and 16% remained neutral. Women who had undergone mastectomy were more likely to consider the trial (71% vs. 52%). The most common reason for not considering the trial was that they were already getting surveillance MRI. Other reasons were additional false positive tests and biopsies (34%), discomfort associated with MRI (28%), and fear that their anxiety about cancer recurrence would increase (16%). Conclusions: A RCT of MRI surveillance for BC survivors younger than age 60 is still feasible at centers where annual MRI is not yet routinely recommended for this population. No significant financial relationships to disclose.
The Love/Avon Army of Women: A “just in time” resource to encourage research in women
Authors: Love S. M. , Mills D. , Eraklis E. , Hurlbert M. 
Published: August 2020

1535 Background: One of the barriers to finding the cause of breast cancer is the difficulty basic scientists have in involving healthy women and obtaining human tissues, fluids, and information processed according to their needs. The Dr. Susan Love Research Foundation has collaborated with basic scientists successfully recruiting community women for studies. These efforts led to the Love/Avon Army of Women (AOW), a new “just in time” resource seeking to partner women with scientists to find the cause and prevention of breast cancer. Methods: The AOW is a pool of volunteers who have registered online ( www.armyofwomen.org ) that they are willing to participate in research. Peer-reviewed, funded projects submitted by researchers are reviewed by the AOW Scientific Advisory Committee for eligibility. An eBlast is sent to all AOW volunteers describing the study, and eligible women RSVP to the AOW for a secondary screen. The list is then sent to the researcher. If needed, referrals are made to a regional AOW Center for specimen collection, processing, and shipment. All scientists participate in a webcast with the eligible volunteers to explain the research before the study and describe the overall results at the end, ensuring a partnership between the women and the investigators. Results: AOW recruitment was initiated October 1, 2008, by Dr. Love on national media with the goal of creating a resource of 1,000,000 women available for researchers. To date over 260,000 women have joined. All ethnicities, ages (18–89), and states are represented. The first eBlast was sent out in mid-October for the Sister Study to accrue the last 5,000 women needed from diverse backgrounds. In 48 hours, 1,600 women had responded and qualified, and in 2 months, 2,500 had signed up with a 90% enrollment rate. The second study required women who were breastfeeding and scheduled for a breast biopsy. In one week, 30 eligible women were identified. Conclusions: The Love/Avon Army of Women is a just in time resource for breast cancer scientists to obtain exactly the specimens: breast or adipose tissue, ductal fluid, urine, saliva, blood, or information processed exactly as needed. This new partnership between women and scientists promises to revolutionize research and accelerate efforts to find the cause and prevention of breast cancer. No significant financial relationships to disclose.