bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of fatigue and insomnia with inflammatory cytokine and hematopoetic stem cell levels in breast cancer patients undergoing adjuvant radiation therapy.
Authors: Liu Fei-Fei , Shi Willa Wei , McCusker M , Li Madeline , Su Jie , Williams Justin , Spence Tara , Xu Wei , Han Kathy Chai-Zung , Bratman Scott Victor , Yip Kenneth 
Published: September 2018

e12048 Background: Fatigue and insomnia are frequent conditions experienced by breast cancer patients during adjuvant radiation therapy (RT). Our group reported that fatigue correlates with reduced CD34+ circulating hematopoetic stem cell (HSC) levels. Our current study examined the role of inflammatory cytokines in mediating fatigue and insomnia following adjuvant RT. Methods: Phlebotomies were conducted on 148 breast cancer patients undergoing adjuvant RT at five time points: prior to RT (D1), after two (D2) and five (D5) days of treatment, during the final week of RT (Df), and one month post-RT completion (M1). CD34+, CD45+, circulating blood cell (CBC), and 17 inflammatory cytokine levels were assessed. Patients also completed questionnaires at each time point, including the multidimensional fatigue inventory (MIF-21), insomnia severity index (ISI), and hospital anxiety and depression scale (HADS). Results: CD34+, CD45+ and CBC levels decreased during treatment with adjuvant RT, with the lowest levels observed at Df (p<0.001). General fatigue significantly worsened throughout treatment from D1 to Df, returning to baseline at M1, (p<0.001; adjusted for insomnia, depression and anxiety). General fatigue worsened as CD34+ counts, hemoglobin and CBCs increased (p<0.001). Insomnia increased with reduced CD34+, CD45+ and CBCs (p<0.05). TGF-β1, MCP-1, MMP-2, IL-1ra and IFN-α2a cytokine expression varied throughout RT (p<0.01), most significantly at Df. Elevated MCP-1, TNF-RII and TNF-a levels correlated with worsening general fatigue, increased insomnia, and reduced activity and motivation (p<0.001). MMP-2 increased as IL-1ra, CD34+, CD45+ and CBC counts decreased (p<0.001). Further, the 52 patients who received prior adjuvant chemotherapy had elevated levels of fatigue, insomnia and anxiety, which correlated with high HSCs levels. Conclusions: Our findings demonstrate that fatigue and insomnia are associated with reduced HSCs and increased MCP-1, TNF-RII and TNF-a pro-inflammatory cytokines. This examination of the effect of RT on fatigue and insomnia is one of the most comprehensive longitudinal clinical evaluations of its kind.
Impact of Oncotype-DX testing on choice of chemotherapy.
Authors: Yip Walter , Dobosz Krzysztof , Illmann Caroline , Willemsma Kaylie , Simmons Christine E. 
Published: September 2018

e12049 Background: The Oncotype DX test has been shown to change treatment plans in ~30% of cases, but it is unclear if it changes the type of chemotherapy offered. We sought to determine if the availability of Oncotype DX testing in BC resulted in a change in the type of chemotherapy regimens used on early stage breast cancer pts. Methods: This was a cohort study in which pts treated in the 2 years prior to the availability of Oncotype Dx testing were compared to pts treated in the 2 years after it became available in BC. Charts were audited and divided into pre- and post- availability of Oncotype DX testing. The groups were compared for differences in length of chemotherapy (12 vs > 12 weeks), type of agents used (anthracycline vs non-anthracycline) and myelosuppressive potential of regimen chosen. Results: A total of 831 pts fulfilled enrollment criteria; 360 were seen in the pre Oncotype era and 471 were seen in the post Oncotype era. A total of 250 (30.1%) pts were treated with chemotherapy in both cohorts with a median age of 59 for both groups (range of 29-80 and 24-80 respectively, p = NS). There was a decrease of 11.5% in pts receiving chemotherapy from 36.6% to 25.1% (p = 0.0003). Of the pts who received chemotherapy, there was a shift away from regimens containing anthracycline (49.2% vs 32.2%, p = 0.0070) and a shift towards more myelosuppressive chemotherapy regimens (p = 0.0344). There was a significant difference in the duration of chemotherapy regimens chosen with post Oncotype era pts receiving short course chemotherapy 69.5% of the time, compared to only 56.8% in the pre Oncotype era (p = 0.0491). Conclusions: The availability of Oncotype DX testing has resulted in a shift towards use of shorter, more myelosuppressive, non-anthracycline containing chemotherapy protocols. Since being publicly available, fewer pts are receiving chemotherapy but our data suggests a 10% change in treatment plan compared to the 30% change seen in other literature. Further study is warranted to ensure long term outcomes are not negatively impacted by the move towards shorter chemotherapy regimens.
The effect of aromatase inhibitors use on endothelial function among postmenopausal women with breast cancer.
Authors: Maor Ronny , Maor Elad , Wanous Amanda , Pruthi Sandhya , Lerman Amir , Sandhu Nicole 
Published: September 2018

e12064 Background: Data on long-term cardiovascular effects and safety of aromatase inhibitors (AI) are limited and conflicting. The purpose of the current study was to evaluate the effect of AI on vascular injury as assessed by peripheral endothelial function among women with breast cancer. Methods: This is an observational, prospective study of 96 postmenopausal women with breast cancer at initiation of treatment, with or without AI. All participants underwent baseline and 6-12 months follow up non-invasive peripheral endothelial function measurement. Reactive hyperemia index (RHI) was measured using the EndoPAT test. The primary endpoint was endothelial function deterioration of at least 20% between baseline and follow-up. Results: Mean age of the study population was 66±7 years. There was no statistical difference in demographic data between the groups. Compared with the control group, more women in the treatment group demonstrated worsening of RHI (53% vs. 42%, p = 0.207) between baseline and 6-12 month follow up measurement. There was no statistical difference between the groups at baseline. When RHI deterioration was evaluated as a dichotomous variable, with a 20% cutoff, women in the AI group demonstrated higher rates of RHI deterioration (28% vs. 8%, p=0.020). The risk of AIs for endothelial dysfunction was correlated with burden of cardiovascular (CV) risk, such that in women with >3 CV risk factors, AIs were associated with increased risk of RHI deterioration (42% vs. 10%, p=0.016), whereas in women with <2 CV risk factors, rates of RHI deterioration were similar in AI and control groups (20% vs. 7%, p = 0.232). Conclusions: This study suggests that AI therapy may be associated with vascular injury as detected by deterioration in endothelial function. The effect is more pronounced among women with higher baseline CV risk factor burden. The results of this study have potentially important implications for patients with breast cancer being treated with AI and for women at increased lifetime risk of breast cancer who may use AI for breast cancer risk reduction. Clinical trial information: NCT00719966.
Detecting bone loss in early breast cancer survivors: The Arm-DXA method.
Authors: Al-Farhat Yousuf , Peter Auth 
Published: September 2018

e12066 Background: Breast cancer survivors who are on adjunct therapy with Aromatase Inhibitors (AIs) or premature menopause due to chemotherapy are known to have an increased risk of osteoporosis and bone fracture. Being at high risk for osteoporosis, these patients should be screened using with dual energy X-ray absorptiometry (DXA) to measure bone mineral density (BMD) according to national guidelines. This study screened the population of patients with early Breast cancer utilizing the Arm-DXA as a user friendly and efficient method. Methods: All Breast cancer patients at the Tolna County Cancer Center, Szekszárd who are diagnosis of early invasive breast cancer were scanned using Arm-DXA during their regular visit to the center. Cancer patients under hormone therapy were scanned annually. Patients who have metastatic disease or known to have osteoporosis were excluded from the study. A total of 431 patients were subject of an arm-DEXA scan for BMD during the period February 2015 to September 2016. Results: Out of the 431 patients, normal T score >-1,5 detected in 223 patients (51,7%), clinically significant osteopenia (CSO) T score -1,5- -2,5 detected in 129 patients (29,9%), and osteoporosis T score < -2,5 detected in 79 patients (18,3%). For the 224 Patients who were under hormone therapy or/and chemotherapy about 29,9% (n: 67) had a CSO, and 20,5% (n:46) had osteoporosis. Conclusions: This study highlights the fact that osteoporosis is under-detected in early breast cancer survivors who are on or after hormone and chemotherapy. About 48% of early breast cancer survivors found to have osteoporosis or clinically significant osteopenia in our study. Our BMD test results shows that half the 224 patients who were under hormone therapy need to take treatment (zoledronic -acid or denosumab ) to prevent bone fracture.
How well is interdependent care managed across specialties in breast cancer? Metrics and pre-implementation data from the 4R in Oncology Project.
Authors: Weldon Christine B. , Trosman Julia Rachel , Perez Claudia B. , Kulkarni Swati , Khan Seema Ahsan , Hansen Nora , Nelson Valerie , Stein Jennifer , Simon Melissa A. , Strauss Jonathan Blake , Benson Al Bowen , Espino Sasa M. , Bunce Mikele , Pan Wayne , Friedewald Sarah M. , Gradishar William John 
Published: September 2018

e12067 Background: The “NCI ASCO Teams” Project emphasized management of interdependent cancer care across specialties as crucial to teamwork, yet a considerable challenge (Taplin JOP 2015). Interdependent care requires well-managed timing and sequencing of events across specialties. We developed the 4R model (Right Information / Care / Patient / Time) to manage interdependent care and facilitate teamwork (Trosman JOP 2016). 4R is being implemented at 3 centers: academic, community and safety net. Pre-implementation, we identified guideline recommended interdependent care whose timing / sequencing is challenging, developed relevant adherence metrics and gathered current state data. Methods: Interviews with 42 clinicians across breast cancer (BC) specialties at the 3 sites, using theme analysis to identify challenging interdependent care. Guidelines and literature were used to define adherence metrics. Clinical data were reviewed for 216 Stage I-III patients at 3 sites to measure adherence. Results: We identified 7 BC interdependent care events for which timing / sequencing is a challenge - Table. Adherence ranged from 0% to 100%, and was < 50% for 5 of the 7 care events. Preoperative BRCA 1/2 results and neoadjuvant consult showed highest adherence, yet were most frequently noted as a challenge: interviewees reported substantial ad-hoc efforts applied to managing timeliness of these events. Conclusions: Identified challenges and adherence gaps support the need for the 4R implementation for systematic, consistent and timely delivery of interdependent care. Established metrics will allow pre / post 4R implementation comparison and may inform broader adoption of the 4R model. [Table: see text]
Dual-imaging assessment of ultrasonography and mammography in nipple discharge patients: A cohort study.
Authors: Li Bo , Yang Yihe 
Published: September 2018

e12079 Background: Nipple discharge (ND) is a common complaint of women. There is no consensus on clinical approach in these patients. We investigated the diagnostic ability of combination of ultrasound (US) and mammogram (MG) in Chinese ND patients without palpable mass. Methods: 827 patients with ND as only chief complaint presented in the First Hospital of China Medical University (Shenyang, China) between 2008 and 2015 were included. Palpable mass, physiological NP and/or elevated PRL were excluded. All patients underwent dual-imaging examinations of US and MG. Indication of surgical excision included 1) BI-RADS categories 4b, 4c, 5 in either US or MG, and/or 2) US suspected papilloma. Patients met surgical indications served as study arm (N = 742). Patients did not meet surgical indications but underwent surgery served as control arm (N = 85). Reason of surgery in the control group were patients’ choices and surgeons’ clinical judgment. Histological diagnosis provided by surgery were analyzed. In our institution, breast cancer, papilloma, and/or papilloma with atypical dysplasia were regarded as histological indication of surgery. Chi-square tests were applied. Results: Histology revealed 88 (11.9%) breast cancer in the study arm and 0 breast cancer in the control arm ( p= 0.0008); 167 (22.5%) papilloma with atypical dysplasia in the study arm and 12 (13.6%) papilloma with atypical dysplasia in the control arm ( p= 0.08); 335 (45.1%) papilloma without atypical dysplasia in the study arm and 27 (30.7%) papilloma without atypical dysplasia in the control arm ( p= 0.02). A total of 590 (79.5%) in the study arm and 39 (44.3%) in the control arm met histological indication of surgical intervention ( p< 0.00001). Conclusions: This dual-imaging assessment of US and MG is sensitive in detecting breast cancer in ND without palpable mass patients. It showed diagnostic ability in detecting papilloma with/without atypical dysplasia, but needs further improvement.
Diagnostic accuracy of core needle biopsy by image guidance and vacuum assistance.
Authors: Dabbous Firas M , Friedewald Sarah M. , O'Meara Ellen , Weaver Donald L. , Wernli Karen , Ray Kimberly , Rauscher Garth H 
Published: September 2018

e12081 Background: Half of the women in the US undergoing annual screening mammography over 10 years require at least one additional imaging study. Of these women, 7%-17% undergo biopsies, the majority of which (77%) are benign. We sought to estimate the accuracy of core needle biopsy (CNB) by method of imaging guidance and use of vacuum assistance (VA). Methods: Data were pooled from four registries participating in the Breast Cancer Surveillance Consortium (bcsc-research.org) including facilities that perform both VA and non-VA CNB. Each registry collects data on screening mammography and breast pathology reports linked to their state cancer registries or regional Surveillance, Epidemiology and End Results registry. Sensitivity was defined as the proportion of positive biopsies among all cancers diagnosed within 12 months of biopsy. PPV3 was defined as the percentage of all biopsies performed that were positive for cancer. We estimated the adjusted average population risks/rates by modality using marginal standardization with logistic regression in STATA.Results: : Among the 37,270 CNBs, breast malignancy was found in 9,241 women (28.6%), of which 2,276 (25%) were ductal carcinoma in-situ. Sensitivity was 90.5% (95% CI 82.6-98.4) for non-VA Stereotactic (n = 415), 95.4% (95% CI 94.7-96.1) for VA Stereotactic (n = 18,733), 96.1% (95% CI 95.4-96.7) for non-VA ultrasound (n = 14,803), 95.1% (95% CI 93.7-96.5) for VA Ultrasound (n = 3,271) and 82.3% (95% CI 59.9-104.6) for non-VA MRI (n = 48). PPV3 was 12.2% (95% CI 9.0, 15.3), 17.7% (95% CI 17.2, 18.3), 28.6% (95% CI 27.8-29.4), 32.1% (95% CI 30.4-33.8) and 16.9% (95% CI 5.3, 28.5), respectively. For stereotactic biopsies, VA was associated with improved PPV3 (p = 0.01) without any change in sensitivity compared to non-VA Stereotactic biopsies.Conclusions: Our multicenter data confirm that VA-stereotactic CNB and ultrasound CNB with or without VA have high sensitivity and thus represent effective alternatives to open surgical biopsy.
Comparison of terminal duct lobular units in the nipple areolar complex by tumor subtypes-the implication for nipple sparing mastectomy.
Authors: Schnarr Kenna , Fan Fang , Amin Amanda Leigh , Balanoff Christa , Mammen Joshua , Wagner Jamie Lynn 
Published: September 2018

e12082 Background: Nipple-sparing mastectomy (NSM) has gained popularity for surgical treatment of breast cancer. Terminal duct lobular units (TDLU) have been shown to be present in 25% of nipple areolar complex (NAC). Pathologic tumor subtype influence on presence of TDLU in the NAC has not been assessed. In addition, criteria for technically performing the dissection below the NAC have not been established. We sought to evaluate TDLU characteristics by tumor subtype and determine NSM dissection criteria below the NAC. Methods: A retrospective review was performed of 120 total and skin sparing mastectomies, 30 of each breast cancer subtype, from 1/2013 to 1/2015. The NAC of each mastectomy was assessed for number of TDLU and distance from TDLU to the skin. Results: Thirty of the 120 mastectomies (25%) had TDLU present below the NAC. Of the 30 with TDLU, there was no statistically significant difference in number of TDLU present based on tumor grade (gd) (gd 1 vs 2, p = .67; gd 1 vs 3, p = .24). Compared to luminal A, luminal B showed statistical significance (p < .05) for number of TDLU at the NAC whereas Her 2 and triple negative breast cancer (TNBC) were not statistically significant (p = .09 and .10). In mastectomies with TDLU present, gd 2 (p < .05) and gd 3 (p = .05) had a closer skin distance than gd 1. When compared by tumor subtype, there was no difference in TDLU to skin distance (table). Conclusions: NSM has been adopted as a safe oncologic approach to breast cancer treatment. Although presence of TDLU in luminal B subtype was statistically significant, this may not be clinically significant, as there were only 2 of 30 cases with TDLU. Our study indicates that a careful dissection at the level of the dermis below the NAC is necessary, as 25% of women will have TDLU present. This will provide an appropriate oncologic outcome similar to total and skin sparing mastectomy. Tumor subtype does not appear to be exclusion criteria for NSM. However, more aggressive dissection may be necessary to clear all TDLU from below the NAC in higher gd cancers. [Table: see text]
Homogeneity of variance of measures associated with objective assessment of esthetic outcome after treatment with radiation therapy in early breast cancer.
Authors: Williams Norman R. 
Published: September 2018

e12085 Background: Breast cancer is an increasingly treatable disease which means that many women will live a long time with the esthetic consequences of their treatment. The majority of women with early breast cancer are given whole breast external beam radiation therapy (EBRT) after lumpectomy (breast conservation). It has been demonstrated, using an objective assessment of esthetic outcome in patients from a randomized trial that “redness”, a surrogate for radiation induced erythema grade I or II, is significantly greater after one year in patients receiving EBRT compared with those receiving intraoperative radiation therapy (IORT). However, it has been observed that not all women given EBRT have detectable erythema, which implies that there is a greater variability in this group. In order to test this hypothesis a test of unequal group variances was performed. Methods: 991 frontal digital photographs were analyzed from women participating in the TARGIT A Trial (NCT00983684) at four sites (Lublin, Mannheim, Copenhagen and Perth). Photographs taken at baseline (before surgery), 1 and 2 years (after surgery and EBRT or IORT) were objectively assessed, blinded to treatment received, by BCCT.core software which produces overall Harris scores, and scores for various measures of symmetry, color and scar. The scores for color were analyzed in SAS v9.4 using PROC GLM. Results: cEMDL, a color score associated with "lightness", showed significant heterogeneity of variance (using Levene's and Welch's Tests, p < 0.0001) in the women treated with EBRT, but not in those treated with IORT (p = 0.4). However, cX2b (associated with "redness") showed significant heterogeneity of variance in both the EBRT and IORT treated groups (p < 0.0001), although the point estimates moved in different directions. Conclusions: This study demonstrates that there are complex changes in skin color following radiation therapy to the breast, and assumptions regarding homogeneity of variance should be checked if required by the statistical analysis.
Does tumor size in T1-T2 early breast cancer (EBC) still have a prognostic role?
Authors: Kasangian Anaid Anna , Moretti Anna , Biagioli Elena , Bernardin Elena , Cordovana Andrea , Gherardi Giorgio , Farina Gabriella , Bramati Annalisa , Piva Sheila , Dazzani Maria Chiara , Paterno Emanuela , La Verde Nicla Maria 
Published: September 2018

e12087 Background: Theprognosis of EBC patients (pts) depends on pts characteristics and tumor biological/ histopathological features. The correlation between tumor size, expressed as the largest diameter in TNM staging, and overall survival (OS) and disease free survival (DFS) is well recognized. According to TNM, tumors classified as T2, could have different volumes (V); e.g. a tumor of 2,1 cm has a V of 4500 mm3, while a tumor of 4,9 cm has a V of 60000 mm3. Despite belonging to the same class, the two different V may have a different prognosis. The aim of the study is to establish if the role of tumor size has been surpassed by other factors. Methods: The purpose is to evaluate the correlation between V and DFS/OS, in a T1-T2 population, who underwent breast surgery and sentinel lymph node biopsy, in our institution from 01.01.2005 to 30.09.2013. V was evaluated with the measurement of three half-diameters of the tumor (a, b and c), and calculated with this formula: 4/3 * π * a * b * c. Results: 341 pts with T1-T2 EBC who underwent surgery were included. 86,5% were treated with conservative surgery. 85,1% had a luminal subtype, 9,1% triple negative (TN) and 7,4% Her2 positive (+). Median V was 942 mm3 (range 0,52-31651,2). 44 pts (12,9%) relapsed and 23 pts died. With a median follow-up of 6,5 years, the univariate analysis for DFS showed a correlation between age (p 0,016), tumor size (p 0,032), V (p 0,078), histological grading (p 0,001), molecular subtype (p < 0,001). The multivariate analysis confirmed the statistically significant correlation only for molecular subtype (p 0,005), showing a worse prognosis for TN and Her2+ subtypes. Regarding OS, a statistically significant correlation was shown by the univariate analysis both for histological grading (p 0,018) and molecular subtype (p 0,001). The multivariate analysis confirmed that TN and Her2+ subtypes negatively influence OS (p 0,005). Conclusions: In our study neither V nor tumor diameter seem to correlate with DFS and OS in T1-T2 tumors; the only parameter that strongly influences DFS and OS, is molecular subtype, confirming the worse prognosis of TN and Her2+ versus luminal tumors. These findings encourage clinics to choose adjuvant treatment not based on dimensional criteria but on biological features.