bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract PS7-84: Lymphovascular invasion among female patients diagnosed with breast cancer
Authors: Singh Maharaj , Konduri Santhi , Rovin Richard 
Published: February 2021

Abstract
Background The presence of carcinoma cells in either lymphatic vessels, blood vessels or both is defined as lymphovascular invasion (LVI). The presence of LVI is associated with an increased risk of axillary lymph node and distant metastases. LVI is also characterized as one of the significant prognostic factors for the patients diagnosed with breast cancer. Objective The objective of this study is to identify predictors of LVI among female patients diagnosed with breast cancer. Method From the Commission on Cancer’s National Cancer Database from 2010 through 2016, we identified 1,220,046 female patients diagnosed with breast cancer and with non-missing value for LVI. Patient demographics, tumor characteristics and biomarkers were analyzed using descriptive statistics. Odds ratios (OR) were computed using stepwise multivariate logistics regression. All statistical analysis was done using SAS version 9.4, SAS institute, Cary, NC and for all statistical tests alpha of 0.05 was used. Results The study population included 78% non-Hispanic white (NHW), 11% non-Hispanic black, (NHB), 5% Hispanic and 6% from ‘other’ race category. The median age of the patients at the time of diagnosis was 61 years. Of the total patients, only 16 % had LVI. Significant predictors of LVI include race (Hispanic vs NHW, OR=1.03, 1.01-1.06 p=0.008; NHB vs NHW OR=0.91,0.90-0.93, p&lt;0.001; ‘Other’ vs NHW OR=0.97, 0.95-1.00, p=0.018), insurance status (government vs no-insurance, OR=1.08,1.04-1.11, p&lt;0.001; private vs no-insurance, OR=1.08,1.05-1.12, p&lt;0.001), Charlson-Dayo Index (1 vs none, OR=1.08, 1.06 -1.09, p&lt;0.001, 2 vs none, OR=1.16, 1.12 -1.20, p&lt;0.001, 3 or more vs none, OR=1.16, 1.10 -1.22, p&lt;0.001), primary sequence (OR=1.03,1.01-1.04, p&lt;001), cancer stage (I vs 0, OR=2.99, 2.86-3.14, p &lt;0.0001, II vs 0, OR=9.40,8.97-9.86 p &lt;0.0001, III vs 0, OR=21.28, 20.25-22.36, p &lt;0.0001, and IV vs 0, OR=15.11,14.32-15.94, p &lt;0.001), ER (OR=1.02, 1.01-1.04 p=0.002), PR (OR=1.03, 1.01-1.05 p=0.002), HER2neu (equivocal vs negative OR=1.14, 1.10-1.18 p &lt;0.001, positive vs negative OR=1.28, 1.26 -1.30, p &lt;0.001), and 10 year increment in age at the time of diagnosis (OR=0.90, 0.89-0.90, p &lt;0.001). Conclusion The predictive factors for LVI includes Hispanic race, government or private insurance, higher Charlson-Dayo scores, primary sequence, cancer stages, ER, PR and HER2neu expression. The chances LVI decreases with increasing age. These finding might provide insights for clinicians for the treatment plan for the patients.
Citation Format: Maharaj Singh, Santhi Konduri, Richard Rovin. Lymphovascular invasion among female patients diagnosed with breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-84.
Abstract PS7-87: Incidence, treatment and survival of patients with brain metastases at initial metastatic breast cancer diagnosis: A real-world experience in national cancer center, China
Authors: Li Yiqun , Li Qiao , Mo Hongnan , Guan Xiuwen , Lin Shaoyan , Wang Zijing , Chen Yimeng , Zhang Ye , Zhang Dainan , Chen Shanshan , Cai Ruigang , Wang Jiayu , Luo Yang , Fan Ying , Yuan Peng , Zhang Pin , Li Qing , Ma Fei , Xu Binghe 
Published: February 2021

Abstract
Background: To characterize the incidence, treatment and survival of patients with brain metastases at initial diagnosis of metastatic breast cancer (MBC) in China. Methods: The China National Cancer Center database was used to identify 2087 MBC patients diagnosed between 2003 to 2015. Clinicopathological features, treatment and survival information were extracted. Multivariable logistic and Cox regression were performed to determine factors predictive of brain metastases at MBC diagnosis and survival, respectively. Results: Brain metastases occurred in ninety patients (4.3%) at MBC diagnosis, and in 27 patients (2.5%), 42 patients (7.2%) and 21 patients (5.2%) with hormone receptor positive, human epidermal growth factor receptor 2 negative (HR+HER2-), HER2-positive and triple negative breast cancer (TNBC), respectively. HER2-positive subtype (OR = 2.38; 95% CI 1.40 -4.04; p &lt;0.0001), TNBC subtype (OR = 1.89; 95% CI 1.02-3.51; p =0.005), and metastases to all three sites of bone, liver and lungs (OR = 3.23; 95% CI 1.52-6.87; p =0.002) were shown to increase the risk of BM at MBC diagnosis. Median survival after BM was 23.7 months. First-line tyrosine kinase inhibitors (TKI) improved survival compared to trastuzumab-based regimen (44.9 vs 35.4 months, p=0.09). Factors that independently decreased BM death risk were ECOG&lt;2, brain metastases only and multidisciplinary treatment. Conclusion: HER2-positive and TNBC subtypes have a higher incidence of BM at initial MBC diagnosis. Brain screening might be considered in patients with HER2-positive or triple-negative diseases or with extensive extracranial metastases. First-line TKI and multidisciplinary treatment helped to extend survival.
Citation Format: Yiqun Li, Qiao Li, Hongnan Mo, Xiuwen Guan, Shaoyan Lin, Zijing Wang, Yimeng Chen, Ye Zhang, Dainan Zhang, Shanshan Chen, Ruigang Cai, Jiayu Wang, Yang Luo, Ying Fan, Peng Yuan, Pin Zhang, Qing Li, Fei Ma, Binghe Xu. Incidence, treatment and survival of patients with brain metastases at initial metastatic breast cancer diagnosis: A real-world experience in national cancer center, China [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-87.
Abstract PS8-21: The impact of exogenous estrogen exposure on the characteristics of estrogen receptor (ER) positive, early-stage breast cancer (EBC)
Authors: Yariv Orly , Yerushalmi Rinat , Moore Assaf , Shohat Tzippy , Rotem Ofer , Ceder Yasmin Korzets , Goldvaser Hadar 
Published: February 2021

Abstract
Background: Oral contraceptives (OC) and hormone replacement therapy (HRT) are well-established risk factors for ER positive breast cancer. Infertility is associated with an increased breast cancer risk and there is conflicting data on the influence of fertility treatments on breast cancer risk. The impact of exogenous estrogen exposure on breast cancer characteristics is not well described. Methods: A single center retrospective cohort study comprising all women with ER positive, human epidermal growth factor receptor 2 (HER2) negative, EBC whose tumors were sent to OncotypeDX analysis and were treated in our institute between 2005 and 2012. Data on exogenous estrogen exposure were collected including: OC and HRT use and prior fertility treatments. The impact of these exposures was assessed on pre-specified histopathological features including: tumor size, nodal status, ER and progesterone receptor (PR) staining, grade, Oncotype recurrence score (RS), ki67, lymphovascular and perineural invasion.
Results: A total of 620 women were included, 79% (Num) were postmenopausal. Prior exposure to OC, HRT and fertility treatments was documented in 19% (103), 30% (136) and 11% (62), respectively. OC use was associated with smaller (≤1cm) tumors (30% vs. 20%, p=0.023) and were less likely to have grade 3 disease (10% vs. 19%, p=0.049). No other associations were found between exogenous estrogen exposures and tumor characteristics (Table).
Conclusions: Use of OC may be associated with breast cancer with a distinct features compared to women with luminal breast cancer without history of OC use. Large scale studies are needed to better characterize these findings.
Fertility treatmentHRT ≥ 2 yearsHRTOCPNo (%)Yes(%)PNo(%)Yes (%)PNo (%)Yes (%)PNo(%)Yes(%)0.1722254252165150.7002355222057240.7002255232456200.023205723304426T≤1 cm 1&lt;T≤2 T&gt;2 cm0.85917180.09815200.09815210.6671815Node positive0.06479138891100.29982126761590.29982135771590.207791488795IDC ILC Other0.1671864181473130.5001667181664190.5001667171762210.049186319187310Grade 1 230.18922078329680.70811781122770.70811781221780.7392227732275ER intensity≤1 1&lt;ER⇐2 ER&gt;20.1121470.67116150.67116140.103148PR Negative1.000530.455520.455530.28252PNI present0.772670.351780.351570.056105LVI present0.18620290.36222190.36223180.5282218Ki67 &gt;20%0.85917180.78718160.78717180.5701816Oncotype RS&gt;25
Citation Format: Orly Yariv, Rinat Yerushalmi, Assaf Moore, Tzippy Shohat, Ofer Rotem, Yasmin Korzets Ceder, Hadar Goldvaser. The impact of exogenous estrogen exposure on the characteristics of estrogen receptor (ER) positive, early-stage breast cancer (EBC) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-21.
Abstract PS8-24: Clinical and pathologic characteristics of Turkish breast cancer (BC) patients screened with BRCA1, BRCA2 or 26 - gene inherited cancer panel testing: Single institution experience
Authors: Isiklar Aysun , Soyder Aykut , Yararbas Kanay , Ekmekci Cumhur , Yazici Hulya , Basaran Gul 
Published: February 2021

Abstract
Background: BRCA1 and BRCA2 mutations are responsible for two thirds of hereditary BC. Germline genetic testing for BC susceptibility has evolved from a single-gene analysis to a multigene panel testing. Identification of a pathogenic mutation in BRCA and other panel represent a therapeutic opportunity today. Methods: We aimed to investigate clinical and pathologic characteristics of BC patients who were referred to our center between 2011-2019 and underwent BRCA1, BRCA2 or 26-gene inherited cancer panel testing based on NCCN criteria for hereditary breast/ovarian cancer testing. We analyzed the frequency of pathogenic mutations and its relationship with clinical and pathologic factors. Results: A total of 576 patients were identified. Among them 356 (63%) had their test in our university, 218 (38%) patients had their test at other centers. Sixty-six % (n:376) of patients had panel testing, 34% had only BRCA 1-2 mutation test. Median age was 42(22-87) and 5 patients were male. Ten % of patients had metastatic disease, 70% had early BC and 20% had locally advanced stage at the time of referral. The indication for genetic testing was family history in 169 (29%) patients, triple negative (TN) subtype in 100 (17%) patients and age &lt;45 years in 260 (45%) patients. Seventy-nine % of patients were premenopausal. A total of 114 (19%) patients had pathogenic mutations. The most commonly mutated genes were BRCA1 (n:38, 6%), BRCA2 (n:35, 6%), ATM (n:6), p53 (n:5), PALB2 (n:5), CHEK2 (n:5). Six patients had more than one pathogenic mutation. Among patients with pathogenic mutations 58% had ER positive, 27% had TN and 15 % had Her-2 positive disease. Thirty-four % of patients with TN tumors have pathogenic mutations, 23% of patients with TN tumors had BRCA mutations. TP53, PALB2 and CHEK2 mutations were more frequent in HR positive disease. Age &lt;35 (p:0.002), triple negative subtype (p: 0.005) and menopausal status (p:0.001) were significantly associated with having pathogenic mutations in multivariate analysis. Conclusion: Two thirds of BC patients &lt;35 years-old and one third of patients with TN tumors have pathogenic germline mutations in BC predisposing genes when they were screened in line with NCCN criteria.
Citation Format: Aysun Isiklar, Aykut Soyder, Kanay Yararbas, Cumhur Ekmekci, Hulya Yazici, Gul Basaran. Clinical and pathologic characteristics of Turkish breast cancer (BC) patients screened with BRCA1, BRCA2 or 26 - gene inherited cancer panel testing: Single institution experience [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-24.
Abstract PS8-34: High rates of BRCA1 and BRCA2 germline mutations among Arab patients with triple-negative breast cancer
Authors: Abdel-Razeq Hikmat , Abujamous Lama , Bater Rayan 
Published: February 2021

Abstract
Background: Patients with triple-negative (TN) disease, which represent 10-15% of all breast cancer cases, is associated with the worst prognosis among all breast cancer subtypes. Because of higher risk for BRCA mutation, patients diagnosed at age ≤60 years with triple-negative disease should undergo genetic testing. Identification of BRCA1 or BRCA2 mutation has clinical impact on breast and ovarian cancer prevention and treatment. Many drugs were recently approved for patients with BRCA mutation carriers. We here investigate the patterns and prevalence of BRCA1 and BRCA2 mutations among Arab patients diagnosed with this breast cancer subtypes and treated at our institution. Patients and Methods: We utilized our database of all breast cancer patients, from Jordan and neighboring Arab countries, tested for BRCA mutations (n=1302) as per the NCCN guidelines. Patients with no expression of estrogen (ER) or progesterone (PR) receptors and negative for HER2 (triple-negative) were enrolled regardless of their age or family history. Following a detailed genetic counselling in a clinic established for this purpose, BRCA testing was then performed at 3 reference labs in UK and USA. BRCA1 and BRCA2 mutations were classified as pathogenic/likely pathogenic and variant of uncertain significance (VUS). Results: During the three-year study period, a total of 171 (13.1%) of all patients in database fulfilled our inclusion criteria. Twenty-two (12.9%) patients were from Palestine, Syria and Iraq. Median age was 41 (range, 19-77) years and all were females. Among this group, a total of 45 (26.3%) were tested positive for BRCA1 (n=32, 18.7%) or BRCA2 (n=13, 7.6%) while 12 (7.0%) others had VUS. Mutations were detected in 26 (31.7%) of 82 patients who were triple-negative and diagnosed at age 40 years or younger. Additionally, 26 (36.6%) of 71 patients with triple-negative disease who had one or more close relatives with breast, pancreatic, or prostate cancer (Gleason score ≥7) had positive BRCA1 or BRCA2 mutation, too. In multivariate analysis, the impact of younger age on mutation rates was considered insignificant (OR: 1.86; 95%CI: 0.89-3.91; p=0.10). However, breast cancer diagnosis at any age with 2 or more close relatives with breast cancer have is associated with a significantly higher BRCA mutation rate (OR: 2.76; 95%CI: 1.13, 6.71; p = 0.03). Conclusions: Arab patients with triple-negative breast cancer subtype have very high BRCA1 or BRCA2 mutation rates. Family history of breast cancer in close relatives further increase this risk.
Citation Format: Hikmat Abdel-Razeq, Lama Abujamous, Rayan Bater. High rates of BRCA1 and BRCA2 germline mutations among Arab patients with triple-negative breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-34.
Abstract PS9-44: Breaking the silent struggles: Development of a cancer caregiver support program
Authors: Koerber Joyce Marie , Solti Magdolna 
Published: February 2021

Abstract
Background/Purpose: 4.6 million Americans serve as unpaid caregivers for someone with cancer. The burden of caregiving poses challenges to one’s physical, psychological, financial and spiritual health. Our project aimed to explore caregiver needs and provide comprehensive information and practical guidance to enhance coping during and after treatment. Methods: We conducted targeted interviews with 50 caregivers of patients with high risk cancers (brain, head and neck, lung, gastrointestinal, gynecologic, breast and hematologic cancers) to prioritize and discuss their most pressing concerns. Caregiver quality of life and well-being was assessed using validated tools that were measured at baseline and 6 months later. A Caregiver Resource Manual was developed with a list of tangible resources and provided to all families. Supportive interventions included counseling, palliative care, referral to nutrition and support groups.
Results: The interviewed caregivers included spouses, children, friends and parents. At baseline, 55% of patients had stage IV disease. Within 6-months, 38% of patients expired or progressed, 59% stayed in remission or remained stable on treatment. At baseline, 65% of caregivers reported moderate/high distress, 39% scored moderately/high in feeling their life was imposed upon, and 58% scored moderately/high in difficulty meeting their own medical needs. After intervention, moderate/high scores improved by 25% in distress, 18% in feeling life was imposed upon and 12% in attending to medical needs. The well-being survey found an 8% increase in all aspects assessed.Conclusion: Our project recognized patients and caregivers as one unit of care with information and support needed for both. The interventions improved caregiver stress and overall well-being. We found a gap in adequately preparing families for progressive nature of disease highlighting the need for proactive palliative care in the future.
Citation Format: Joyce Marie Koerber, Magdolna Solti. Breaking the silent struggles: Development of a cancer caregiver support program [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-44.
Abstract PS9-56: High compliance with choosing wisely breast procedures at a safety net hospital
Authors: Tang Annie , Mooney Colin , Ugarte Shannon , Knopf Kevin , Khoury Amal 
Published: February 2021

Abstract
The Choosing Wisely campaign has emerged recently in setting guidelines for surgical procedures of low utility and cost-ineffectiveness. Hospitals caring for underserved medical populations represent a unique opportunity to assess for quality of care and adherence to these guidelines. The Choosing Wisely campaign for breast surgery has highlighted: avoiding surgical re-excision for invasive cancer close to margins of excised breast tissue, avoiding double mastectomy in patients who have a single breast with cancer, avoidance of axillary lymph node dissection in women undergoing lumpectomy with limited nodal disease, and avoiding sentinel lymph node biopsy in patients ≥ 70 years of age with early stage breast cancer. Recent studies have shown variable adherence to these recommendations. In order to evaluate cost-effective surgery at our hospital serving a poorer patient population, we retrospectively analyzed patients who underwent surgery for breast cancer from 2015-2020. A total of 231 patients were identified. There were no patients who underwent re-excision for close margins of invasive cancer. Only 0.9% of patients (2/231) received contralateral mastectomy and only 1.6% of eligible patients (3/191) received axillary lymph node dissection instead of sentinel lymph node biopsy. Although 77.7% of patients ≥ 70 years of age with stage 1 hormone positive breast cancer (14/18) received sentinel lymph node biopsy, there was a downward trend during 2015 to 2020 from 100% to 50% of eligible patients receiving sentinel lymph node biopsy. De-implementation of traditional surgical practices, deemed as low-value care, towards newer cost-effective guidelines are achievable even at community hospitals serving a low socioeconomic community while preserving patient outcome and avoiding overtreatment. By avoiding overtreatment, cost savings can be achieved which allow for social distributive justice amongst breast cancer patients by ensuring careful utilization of scarce health economic resources.
Citation Format: Annie Tang, Colin Mooney, Shannon Ugarte, Kevin Knopf, Amal Khoury. High compliance with choosing wisely breast procedures at a safety net hospital [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-56.
Abstract SP114: Body Image and Sexual Health
Authors: Partridge A 
Published: February 2021

Abstract
Attention to body image and sexual health after breast cancer are important components of treatment decisions, support through treatment and survivorship care. A high proportion of breast cancer survivors report dissatisfaction with their physical appearance. Body image issues are particularly common among women who undergo mastectomy with or without reconstructive surgery and those who experience weight gain, hair loss from chemotherapy, and other psychosocial issues. Scalp cooling, proactive counseling about potential effects of treatment on weight and physical activity, and psychosocial support through treatment may help to prevent some of these negative effects. Weight loss and subsequent weight maintenance are notoriously difficult to achieve through diet alone, and exercise plays an important role in energy balance through and after treatment. Sexual health is frequently a concern for breast cancer survivors as well, with up to 40% of women reporting issues with sexual interest and 60% with physical sexual function. Issues may arise in the short term following both surgery and chemotherapy, due to factors including lower perceived attractiveness and vaginal dryness. Endocrine therapy with tamoxifen, aromatase inhibitors, and treatment-related amenorrhea or ovarian suppression treatment in premenopausal women are associated with sexual dysfunction. However, a multi-prong approach has been shown to improve such problems. Providers should actively monitor for and manage the consequences of diagnosis and treatment on body image and sexual health in survivors, using psychosocial, behavioral, and pharmacologic tools as needed.
Citation Format: A Partridge. Body Image and Sexual Health [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SP114.