bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of reconstruction on satisfaction with contralateral prophylactic mastectomy.
Authors: Boughey J. C. , Hoskin T. L. , Hartmann L. C. , Johnson J. L. , Jacobson S. R. , Degnim A. C. , Frost M. H. 
Published: February 2017

240 Background: Contralateral prophylactic mastectomy (CPM) is increasingly chosen by patients with breast cancer. Satisfaction after CPM is high. However, decreased satisfaction has been associated with reoperation after reconstruction. This study’s aim was to examine the adverse aspects patients attribute to reconstruction and the subsequent effect on psychosocial consequences and satisfaction with CPM. Methods: 487 unilateral breast cancer patients with a family history of breast cancer who underwent CPM between 1960 and 1993 were mailed a questionnaire evaluating QOL and satisfaction with CPM. Results: Of 269 respondents, 210 (78%) underwent reconstruction and 59 (22%) did not. Mean age at CPM was 46 and 50 years respectively (p=0.01). Mean follow-up was 20.2 years. Reconstruction was immediate in 96%, 98% with implants and 2% with tissue flap. Reconstruction was associated with lower satisfaction with CPM (p=0.03), but still only 7% (vs 2% in those without reconstruction) said they were dissatisfied. Most (83%) of those with reconstruction said they would choose reconstruction again while 7% were unsure and 10% said they would not. In those who did not undergo reconstruction, 18% said they would choose reconstruction if able to make the choice again while 5% were unsure and 77% said they still would not. 95 patients (45%) of those that underwent reconstruction required one or more reoperations for complications. Those with reoperation reported poorer responses for satisfaction with CPM (p=0.04), choice to have CPM again (p=0.008), and choice to have reconstruction again (p=0.004) when compared to patients with reconstruction and no reoperation. Those with and without reconstruction did not differ significantly with respect to femininity, sexual relationships or emotional stability, but those without reconstruction reported significantly poorer effects related to self esteem (p=0.04) and body appearance (p=0.002). Conclusions: In patients who undergo CPM, many years after surgery satisfaction with CPM is higher in those choosing not to have reconstruction than those with reconstruction although it was high in both groups. Reoperation is common after reconstruction and is associated with lower satisfaction.
Pregnancy-associated breast cancer: Review of the literature.
Authors: Bjelic-Radisic V. , Retussnig C. P. N. 
Published: February 2017

245 Background: Overall, 0.2%-3.8% of all breast cancer cases are diagnosed during the pregnancy. It is to be expected that the incidences of pregnancy-associated breast cancer (PABCS) will likely increase. Therapy of PABCS is the challenge and requests team play of different experts in this area. The aim of this study was to review the actual therapy of PABCS. Methods: Publications relevant to PABCS and their therapy were identified by searching Pubmed database for the period between 1960 and 2010. We used the keywords “cancer”, “pregnancy”, “chemotherapy”, and “systemic treatment”. Search results were adjusted by references from relevant articles. 221 relevant articles and abstracts were found. Articles describing the same patient cohort and articles without data of the kind of drug, trimester of application and without size of patient cohort were excluded from analyses. 79 articles matched the search criteria and were included in analyses. Results: The use of anthracycline-based chemotherapy has been documented in 320 cases, congenital malformation (CM) occurred in 3.75% of the reported cases (similar to the standard population). 14 publications described a methotrexate-containing therapy during pregnancy, CM occurred in 6.67%. Use of taxanes has been documented in 29 cases, CMs were observed in 3.45%. 9 articles (20 cases) published the effects of vinca alkaloids-containing treatment, in 1 cases occur missed abortion. Tamoxifen use during pregnancy is described in 9 publications, 30% of the exposed newborns showed CM. The application of target-agent-trastuzumab during pregnancy is described in 16 case reports with developing of oligo- or anhydramnion, IUGR, pulmonal hypoplasia. Conclusions: Anthracyclines are regarded the safest chemotherapeutic agents during pregnancy and can be given with minimal fetal risk after the first trimester. The routine use of newer agents like taxanes or vinca alkaloids are with high possibility safe in 2. And 3. Trimenom, but because of limited data are not recommended so far. Methotrexate should be avoided during pregnancy. Tamoxifen, aromatase inhibitor and target agents are contraindicated during the pregnancy. Target agents can not be recommended for the use in the pregnancy.
Male breast cancer: An institution’s 25-year experience.
Authors: Scow J. S. , Degnim A. C. , Jakub J. W. , Shah S. , Jimenez R. E. , Boughey J. C. 
Published: February 2017

247 Background: There are no prospective and few large retrospective studies of male breast cancer (MBC). This study’s aim was to describe our institutional experience with MBC and evaluate the ability of the AJCC staging system to stratify survival. Methods: All MBC cases were identified from our institution’s cancer registry from 1984-2008. Data collected included tumor characteristics, lymph node status, treatment, age, and survival. Results: During the study period 166 MBC cases were identified. Median age at diagnosis was 62 years (range 27-87). Most common presentation was a palpable breast mass (77%). Stage at diagnosis was stage 0 (6%), stage 1 (27%), stage 2 (36%), stage 3 (17%), stage 4 (5%), and unknown (9%). Procedure performed was mastectomy in 148 patients (89%), lumpectomy in 10 patients (6%) and unknown in 8 patients (5%). Median tumor size was 2.0 cm (range 0.2-11.0 cm). Most common histology was invasive ductal carcinoma (91%). Estrogen and progesterone receptor status assessed at diagnosis was positive in 93% and 86% of cases tested respectively. HER2/neu status was positive in 6 of 47 cases tested (13%). Nodal staging was performed by axillary dissection (AD) (70%), sentinel node biopsy (SN) alone (11%), SN and AD (11%) and no axillary staging (8%); 43% were node positive, 47% node negative and 10% unknown. Adjuvant chemotherapy was given to 40 patients (24%), adjuvant hormonal therapy to 42 patients (25%) and adjuvant radiation therapy was used in 33 cases (20%). With a median follow-up of 5.5 years, 86 patients (52%) have died: 44 due to breast cancer, 23 due to causes unrelated to breast cancer, and in 19 the cause of death is unknown. Median overall survival was 9.3 years. Median cancer-specific survival was 16.0 years. For patients initially diagnosed at stage 2, 3, and 4 median cancer-specific survival was 12.9, 7.2, and 0.8 years respectively. Median cancer-specific survival was significantly different for stages 2 vs. 3 (p = 0.03) and 3 vs. 4 (p = 0.0006). Conclusions: MBC most commonly presents as a palpable mass, is hormone responsive, and is most commonly treated with mastectomy. The TNM system appropriately stratifies men with MBC by duration of survival.
Tolerance of docetaxel: Is obesity a risk factor for toxicity? A pilot study.
Authors: Parent D. , Rallet A. , Jovenin N. , Yazbek G. , Cure H. , Rey J. 
Published: February 2017

248 Background: Few data are available in the literature regarding chemotherapy dosage adjustment in obese patients. Docetaxel is a lipophilic substance, highly bound to albumin; obesity might result in an accumulation and may lead to a higher rate of toxicity. The objective of this study was to assess the tolerance to docetaxel in obese and non obese patients, according to their body mass index (BMI). Methods: A retrospective study was performed. Patients were divided according to their BMI, considering a limit of 30 kg/m2. All patients received docetaxel (100 mg/m2) as a part of adjuvant chemotherapy for breast carcinoma. Toxicity of docetaxel such as neutropenia, hand-foot syndrome (HFS), mucositis, and neuropathy were assessed in both groups. The included patients received docetaxel alone or in association with trastuzumab or bevacizumab. Qualitative data analysis was performed using Fisher's exact test. Quantitative data were studied using the Student test. Results: Among the 49 patients, 18 (37%) presented with a BMI greater than 30 kg/m2. The median age was 53 years in the group BMI greater than 30 and 55 years in the group BMI less than 30 (p = 0.9383). The median value for albumin was 75 g/L (59-86 g/L) in the BMI greater than 30 and 71 g/L (56-79 g/L) in the BMI less than 30 (p = 0.122). Toxicity in both groups is shown in the table below. No neuropathy was observed. Conclusions: Obese patients (BMI > 30 kg/m2) presented with more toxicities (p = 0.013). Hypoalbuminemia did not represent a risk factor for toxicity in this study. Obesity is a risk factor for toxicity in patients treated with docetaxel. Dosage calculation according to body surface area is not suitable for these patients. Toxicity in the group BMI < 30 seems to demonstrate greater susceptibility to the molecule for these patients. Further studies will try to identify the different mechanisms of toxicity of docetaxel involved obese patients, including the interaction between docetaxel and fats. Measures have also to be taken to obtain a favorable effectiveness/toxicity balance in obese patients. [Table: see text]
Breast cancer survivors’ motivation to perform preventive health behaviors: An application of the protection motivation theory.
Authors: Mohamed I. , Jordan T. , Coman M. 
Published: February 2017

251 Background: Little is known about what motivates breast cancer survivors to engage in preventive health behaviors to prevent recurrence of breast cancer. The primary objective was to assess how survivors’ fear of recurrence, spirituality, and perceptions of risk and coping appraisal were associated with their motivation to perform healthy lifestyle and cancer screening behaviors. Methods: A reliable and valid questionnaire was developed. An a priori power analysis indicated that a minimum of 386 completed surveys were needed for adequate statistical power. Based on an estimated 50% return rate, the investigators randomly selected a state-wide sample of 800 survivors from Ohio. A 3-wave mailing was used to increase response rate. Results: 559 surveys were completed (72%). Respondents with higher perceived risks of recurrence were more motivated to perform healthy lifestyle behaviors than those with lower perceived risks (t=2.51, df=521, p=.039). Most (>70%) agreed that healthy lifestyle behaviors such as regular exercise reduce one’s risk of recurrence. Only 43% exercised regularly. Only 54% reported their doctor discussed how to reduce the risk of recurrence. Survivors who were satisfied with their physician’s communication exercised more regularly than those who were not satisfied (chi-square =13.09, p=.016, df=5). Cancer survivors with a high level of motivation and high level of behavioral intentions were more likely to be engaging in preventive health and cancer screening behaviors. Higher levels of spirituality were positively correlated with a higher level of motivation to engage in preventive health behaviors (r=.345, n=468, p<0.001). Conclusions: This study provides strong evidence that the Protection-Motivation Theory (PMT) helps to explain certain factors that impact survivors’ motivation and behavioral intentions to engage in healthy lifestyle behaviors and follow up screening tests. When developing programs for breast cancer survivors, health professionals should consider incorporating spirituality, fear of recurrence, and the constructs of the PMT.
Time spent in the lymphedema state: Area under the curve.
Authors: Armer J. M. , Stewart B. R. , Madsen R. 
Published: February 2017

252 Background: The experience of lymphedema (LE) is variable as related to the pattern of LE emergence, with characteristics related to time since diagnosis, duration of the LE episode, frequency of limb volume change (LVC) events, and overall time spent in the state defined as LE. Recognition of these characteristics, examination of trajectories, and application of the ability to quantify LE state through calculation of Area Under the Curve provide an opportunity to explore new ways to quantify LE occurrence to better examine the impact of LE on survivorship outcomes. Further, through these findings researchers and clinicians will better understand the potential variations in lymphedema experience, including patterns of emergence, duration of each episode, frequency of events, and time spent in the lymphedema state. Methods: Participants were enrolled following BC diagnosis and followed every 6 months through 60 months. The criterion of 10% LVC (LePCT) by perometry was chosen to demonstrate use of trajectories and utility of calculating Area Under the Curve (AUC). We examined times when a participant met the criterion as a means of following the trajectory of LE and quantified the proportion of (calendar) time that a participant appeared to have LE by looking at the AUC determined by the individual’s graph. As study time differed, rather than look at AUC alone, we looked at the percent of time that a participant met the LE criterion by dividing AUC by total study time. Results: Over the 60-month time-stamps of data collection points, we examined trajectories or patterns of events where participants met the LE criterion of interest. An individual may have a single LVC “spike” or may have multiple “spikes.” These cases may be acute, transient, or chronic. Further, individuals may experience the LVC early or late in the survivorship trajectory. These variations contribute to varying AUC and percent of the (calendar) time that a participant meets the LE criterion. Conclusions: These approaches provide an opportunity to further examine the association of LVC with psychosocial and functional outcomes of interest in cancer survivorship. They also provide preliminary data for exploring phenotypic differences in presentation and progression of post-breast cancer lymphedema.
Which benefit from subsequent chemotherapy lines beyond the second for women with metastatic breast cancer? Evidence from a single-center retrospective analysis of survivorship.
Authors: Bernardo G. , Palumbo R. , Bernardo A. , Teragni C. , Sottotetti F. , Tagliaferri B. , Strada M. R. 
Published: February 2017

255 Background: Although the true impact of chemotherapy (CT) in metastatic breast cancer (MBC) is still debated, in the routine clinical practice an increasing number of women asking for further treatment after progression receive subsequent CT lines. This study aimed to assess which benefit could be brought by the succession of CT lines in patients treated for MBC and to identify women who benefit from these treatments. Methods: This retrospective analysis included 980 women treated with CT for MBC at our Institution over a 7-year period (May 1999-July 2006). With overall survival (OS) data updated at December 1, 2008, the median follow-up was 125 months (range 48-192), OS and time to treatment failure (TTF) were calculated according to the Kaplan-Meyer method for each CT line. Cox proportional hazards model was used to identify factors that could influence TTF and OS. Results: Median OS evaluated from day 1 of each CT line decreased with the line number from 34.8 months (980 patients, 1st line, range 4-208) to 22.6 months (838 patients, 2nd line), 14.6 months (684 patients, 3rd line), 12.4 months (302 patients, 4th line), 9.4 months (88 patients, 5th line), 8.2 months (45 patients, seven or more lines). Median TTF ranged from 9.2 months to 7.8 and 6.4 months for the first, second and third line, respectively, with no significant decrease observed beyond the 3rd line (median 5.2 months, range 4.8-6.2). In univariate analysis factors positively linked to a longer duration of TTF for each CT line were positive hormonal receptor status, absence of liver metastasis, adjuvant CT exposure, response to CT for the metastatic disease; in the multivariate analysis the duration of TTF for each CT line was the only one factor with significant impact on survival benefit for subsequent treatments (p<0.001). Conclusions: CT beyond the 2nd line may be beneficial in a significant subset of women treated for MBC, with improved TTF and OS. These findings could help physician in planning an appropriate strategy of subsequent schedules for women with symptomatic MBC who responded to their 1st line CT, while non responder patients should be considered for clinical trials.
The use of complementary and alternative medicine (CAM) by Irish patients with breast cancer.
Authors: Graham D. M. , O'Connor N. A. , McCaffrey J. , Carney D. N. 
Published: February 2017

259 Background: Worldwide, the use of complementary and alternative medicine (CAM) has greatly increased over the last decade. CAM use has been shown to be higher in cancer patients than among the general population and is known to be prevalent in patients with breast cancer. The aim of this study was to investigate the prevalence of CAM use among Irish breast cancer patients; something which has not previously been examined. Methods: An anonymous cross-sectional survey was offered to all patients attending for treatment of malignancy or cancer-care follow-up at a single Irish Cancer Centre over an 8-week period. The reasons for CAM use and those factors that increase the likelihood of CAM use were also investigated. A subset analysis of patients with a diagnosis of breast cancer was performed. Results: A total of 230 questionnaires were distributed. 193 patients responded. Of these, 5 were excluded due to lack of demographic data. Of the 188 surveys available for analysis, 91 respondents (49%) had a diagnosis of breast cancer. Thirty-five breast cancer patients (39%) reported having used CAM. This was not significantly different from other cancer types. Of those patients with breast cancer who used CAM, 11 (12%) commenced CAM use following their cancer diagnosis. Respondents who were under 40 (p=0.005), single (p=0.023) and currently in employment (p=0.001) were more likely to use CAM. The most common reason cited for CAM use was to improve physical well-being (46%) and 78% reported a benefit. No patients reported adverse effects from CAM use. The most commonly used therapies were massage/reflexology (58%), relaxation therapy (61%) and herbal teas (58%). CAM medication therapies were used by 31% CAM users, of whom 32% had not informed their doctor. Conclusions: CAM use is prevalent among Irish breast cancer patients. Use of CAM is more common in young, single, employed patients, in keeping with similar studies in other countries. A significant proportion use CAM medications, which may potentially interact with prescribed treatment. Of note, almost one third of these patients do not inform their doctor. This underlines the need for physicians to ask about CAM use in all patients being treated for breast cancer.
Relationship between implementation of the American Society of Clinical Oncology/College of American Pathologists guideline recommendations for breast core-needle biopsies and delay in therapy for patients with breast cancer.
Authors: Rosen D. , Quraishi M. A. , Middleton L. P. , Yang W. T. , Sahin A. A. 
Published: February 2017

26 Background: Recently the ASCO/CAP suggested new guideline recommendations for immunohistochemical (IHC) testing of biomarkers in breast cancer. An algorithm that relies on accurate, reproducible assay performance was proposed and preanalytical, analytical and postanalytical standards suggested. One such recommendation is to have appropriate internal controls when assessing hormone expression. In this retrospective study we evaluated 242 breast core biopsy specimens to assess the impact of the recently proposed ASCO/CAP guideline recommendations and its possible impact on routine daily practice. In addition, we explore the impact of blindly selecting a random core for potential future studies. Methods: A total 988 cores from 242 specimens corresponding to 224 patients diagnosed between 2008 and 2009 were examined. Each core was examined for the presence of normal glands, percentage of tumor involvement, biomarker status, and diagnostic adequacy. Results: Absence of normal glands was found on 61/242 specimens (25%). Of these, expression of ER, PR and HER2 was seen in 44 (72%), 28 (46%), and 21 specimens (35%) respectively. Negative staining for ER, PR and HER2 was observed in 7 specimens (12%). A total of 148 cores (15%) showed absence of tumor and 275 cores (28%) had <25% of tumor in them. 18 cores (2%) were insufficient for diagnosis due to either scant tumor present or crush artifact present. Conclusions: Although the presence of internal control glands is optimal, its presence may be unnecessary if proper IHC batch run controls are utilized and histologic/IHC concordance is performed. Tumor histology and IHC profile concordance is imperative specially in triple negative cases. The impact on patient health care of an “receptor uninterpretable” biopsy is yet to be determined, but likely would include assessment of the delay in care due to a repeat biopsy with procurement of additional tissue, additional heath care costs, and anxiety to the patient. Adequacy check using frozen section could be done to assess for the presence of tumor during the procedure.
Compliance with consensus recommendations for systemic therapy, breast cancer intrinsic subtype, and clinical outcome.
Authors: Takayama S. , Matsui J. , Ando N. 
Published: February 2017

262 Background: Consensus recommendations for breast cancer are come into wide use, and we believe clinical guidelines leads our patients to improved outcome. Recently, gene profiling can be available, and immunohistochemical surrogates for molecular subtyping can provide much of prognostic and predictive factors. We investigated the relationship between compliance with consensus recommendations and clinical outcome of each subtype on the hypothesis that conformity with consensus recommendations is associated with increased survival among all intrinsic subtypes. Methods: We investigated breast cancer patients operated in our hospital from 2002 to 2004. DCIS, Stage 4 and male breast cancer were excluded. Patients were divided into luminal A (ER+ and/or PgR+, HER2-, low nuclear grade (NG)), luminal B (ER+ and/or PgR+, HER2-, high NG), luminal-HER2 (ER+ and/or PgR+, HER2+), HER2 (ER-, PgR-, HER2+) and triple negative (TN), (ER-, PgR-, HER2-). All patients were divided into compliance group or non-compliance group according to their conformity with consensus recommendations. Kaplan-Meier analysis was used in statistical studies. Results: 121 breast cancer patients were eligible and investigated in this study. Median follow-up period was 6.7 years. Fifteen relapse cases (12.4%) were identified. Among luminal A patients, compliance group was significantly associated with better recurrence free survival compared with non-compliance group with Kaplan-Meier analysis (p<0.001). In contrast, there was no difference between compliance group and non-compliance group among the other subtypes. Median time to recurrence (4.2 year) in non-compliance group among luminal A was apparently longer than that (1.7 year) in compliance group among the other subtypes. Conclusions: Compliance group was significantly associated with better clinical outcome compared with non-compliance group among luminal A. This study suggests that cautious follow-up is required against non-compliance patients among luminal A, because time to recurrence of them was longer than that of both compliance and non-compliance subgroups among the other subtypes.