bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing participation in breast cancer research: (INSPIRE-BrC).
Authors: Robinson Brandi , Swain Sandra M. 
Published: February 2017

53 Background: Increasing black patients’ participation in cancer clinical trials is particularly important because of the population’s lower survival rate. Accrual to clinical trials remains low among the general population (1 to 3%), with recruitment of blacks the lowest of all groups at 0.5 to 1.5%. Clinical trials are key to developing new methods to prevent, detect, and treat cancer. INSPIRE-BrC aims to increase trial participation rates among black patients with breast cancer and examine the relationship between the intervention and attitudes/beliefs on the decision to participate. Methods: A sample size of 123 black patients with breast cancer at five MedStar sites will view a 15 minute, culturally tailored video about clinical trials, which targets six cultural and attitudinal barriers to participation. A pre-test/post-test method is used to determine the impact of the video on three variables — likely participation in therapeutic clinical trials; attitudes toward therapeutic clinical trials (assessed based on the 6 barriers); and actual trial enrollment. Expected Findings: We hypothesize that the intervention will increase clinical trial enrollment compared to our 2012 clinical trial enrollment baseline rate of 6% (22/384) for black patients with breast cancer in five MedStar hospitals. The primary outcome measure is the proportion of black patients with breast cancer who agree to participate in a therapeutic clinical trial among those who sign consent to INSPIRE-BrC. Study findings have the potential to increase patient recruitment as a promising tool for rapid dissemination of a theory-driven, evidence-based model to enhance clinical trial accrual among black patients with cancer. [Table: see text]
Racial/ethnic disparities in estrogen and progesterone receptor phenotype and survival outcomes.
Authors: Shameem Raji , Hamid Muhammad S , Sonpal Niket , Pudusseri Anita , Graham Robert , Sullivan Kevin M. 
Published: February 2017

54 Background: The incidence of estrogen receptor (ER) and progesterone receptor (PR) phenotypes varies among different racial/ethnic groups. However, the prognostic significance of specific ER/PR phenotypes on survival in racial/ethnic groups including Asians has not been reported. Methods: The Surveillance Epidemiology and End Results (SEER) database was used to identify invasive breast cancer cases from 1988 to 2009. Groups included were: “Non-Hispanic Whites (NHW)”, “Blacks”, “Filipinos”, “Chinese”, “Japanese”, “Koreans”, “Vietnamese”, and “Asian Indian/Pakistanis (AIP)”. Cases were grouped according to ER/PR phenotype (ER+/PR+, ER-/PR-, ER+/PR-, ER-/PR+). The Kruskall-Wallis test, and the Z test were employed to examine for differences between racial/ethnic groups. Multivariate Cox proportional analyses were used to establish the weight of the age adjusted ER/PR phenotype on the prognostic significance contributing to survival. Results: In comparison to NHW, ER+/PR+ status was associated with poor outcomes in blacks (HR: 1.814, p < 0.01), however improved outcomes were seen in Chinese (HR: 0.759, p <0.01), Vietnamese (HR: 0.755, p < 0.01), AIP (HR: 0.751; p < 0.01), Koreans (HR: 0.661, p < 0.01) and Japanese (HR: 0.608, p < 0.01). ER-/PR- status also was associated with decreased survival in blacks (HR: 1.391, p < 0.01), but improved survival in Chinese (HR: 0.793, p < 0.01), Filipinos (HR: 0.787, p < 0.01), Japanese (HR: 0.757, p <0.01), AIP (HR: 0.751, p < 0.01), Vietnamese (HR: 0.736, p < 0.01), and Koreans (HR: 0.705, p < 0.01). Compared to the referent NHW, ER+/PR- status in Chinese (HR: 0.765, p < 0.01), Japanese (HR: 0.794, p < 0.01), Filipinos (HR: 0.711, p < 0.01), and Koreans (HR: 0.662, p < 0.05) there was improved survival, while blacks (HR: 1.612, p < 0.01) had decreased survival. Regarding ER-/PR+ status, blacks (HR: 1.464, p < 0.01) had decrease survival, while only Japanese women exhibited improved outcomes (HR: 0.586, p < 0.01) compared to NHW. Conclusions: For ER/PR phenotypes including ER-/PR- tumors, Asian subgroups showed favorable survival outcomes compared to NHW, while poor outcomes were seen in blacks.
Effect of hormone receptor status and local treatment on overall survival for early-stage breast cancer.
Authors: Parker Catherine , Lin Heather Y. , Shen Yu , Li Liang , Lautner Meeghan Ann , Kuerer Henry Mark , Shaitelman Simona Flora , Babiera Gildy , Bedrosian Isabelle 
Published: February 2017

60 Background: Mastectomy and breast conserving therapy (BCT) have been established as interventions with equivalent survival for early stage breast cancer. However, trials comparing these approaches pre-date the understanding of breast cancer heterogeneity. We hypothesized that if heterogeneity is considered, the surgical approach may impact survival. Methods: Using the National Cancer Database (NCDB) from 2004 to 2005, we evaluated the overall survival (OS) of women with Stage I breast cancer who underwent mastectomy, BCT (surgery with radiation), or breast conserving surgery (BCS, surgery without radiation). Since only ER and PR data were available, we categorized tumors as ER and/or PR positive (HR+) or ER and PR negative (HR-). We performed propensity score-matched analysis using the covariates associated with the choice of surgical therapy. We used the Cox proportional hazards model for analyses of OS in pre-matched and matched cohorts. Double robust estimation under the Cox model was used in the analyses of the matched cohort. Results: A total of 16,646 female patients met study criteria: 1,845 (11%) received BCS, 11,214 (67%) received BCT, and 3,587 (22%) underwent mastectomy. Patients undergoing BCT had superior survival outcomes compared to those undergoing mastectomy or BCS (5-year OS was 96% vs 90% vs 87% respectively, p<0.001). After adjusting for other risk factors, BCT remained significantly associated with OS (HR 0.57 [95% CI 0.50, 0.66] for BCT vs BCS; HR 0.67 [95% CI 0.6, 0.76] for BCT vs mastectomy). In the matched cohort (1706 patients in each treatment group), comparison of OS in multivariate analysis confirmed the survival benefit associated with BCT over mastectomy (HR 0.73 [95% CI, 0.59, 0.89]) in the HR+ subset but not in the HR- subset (HR 0.91 [95%CI 0.62, 1.34]) of patients. BCT showed better OS than BCS in both HR+ and HR- subsets (HR 0.63 [95% CI, 0.52, 0.77], HR 0.67 [95%CI 0.46, 0.98] respectively). No differences were seen in OS between mastectomy and BCS in either HR+ or HR- cohorts (HR 0.87 [95%CI. 0.73, 1.03]), HR 0.73 [95%CI 0.51, 1.06] respectively). Conclusions: When tumor heterogeneity is considered, type of local therapy appears to impact the survival of women with Stage I breast cancer.
Outcomes after local recurrence following breast-conserving therapy for early-stage breast cancer.
Authors: Jawad Maha Saada , Wobb Jessica , Wallace Michelle , Grills Inga S. , Pietron Arielle , Marvin Kimberly , Dilworth Joshua T. , Chen Peter Y. 
Published: February 2017

66 Background: Limited data exist for patients who develop local recurrence (LR) following breast conserving therapy (BCT) for early stage breast cancer (ESBC). This study is to evaluate outcomes and predictors of failure following LR in patients treated with BCT. Methods: 1,654 women with ESBC underwent BCT from 1980 – 2013 at a single institution. All patients had breast-conserving surgery followed by whole breast irradiation (WBI) or accelerated partial breast irradiation (APBI). Subset analysis was performed for patients who developed LR as a first event. Clinical outcomes analyzed include contralateral breast failure (CLBF), regional recurrence (RR), distant metastases (DM), cause-specific survival (CSS), and overall survival (OS). Continuous variables were analyzed with an independent samples t-test and categorical variables with χ2. Univariate analysis was performed to determine factors predictive for events after LR. Results: 112 (7%) patients developed LR (87 WBI; 25 APBI), with median time to LR of 6.6 yrs (0.1-28). Median follow-up for the LR group was 14 yrs (0.7-31) overall; 10 (0.7-19) and 16 yrs (1.4-31) for APBI and WBI, respectively (p=0.01). A change from initial to LR pathology was seen for: ER status 21%, PR status 25%, HER2 status 13%, grade 38%, histology 40%, and LVSI 38%. Salvage treatment following LR was mastectomy ± chemotherapy (CHT) in 75%, wide local excision ± RT in 19%, CHT in 2%, and other in 4%. Outcomes following salvage treatment for LR are shown in the table. No differences were seen in outcomes between patients treated with APBI v WBI. Univariate analysis failed to demonstrate any factors predictive for events following LR. Conclusions: Patients who developed LR following BCT for ESBC had excellent clinical outcomes at 5 and 10 yrs, demonstrating effective salvage treatment in this cohort of patients. No differences were noted between patients undergoing APBI v WBI. Further identification of histopathologic patterns between first cancer and LR is currently underway. [Table: see text]
A phase II trial of once-weekly hypofractionated breast irradiation (WHBI): Interim analysis of cosmetic outcome and quality of life.
Authors: Dragun Anthony E. , Riley Elizabeth Carloss , Quillo Amy R. , Barry Parul Nafees , Hunter Allison M. , Rajeurs Akanksha A. , Roberts Teresa , Rai Shesh , Pan Jianmin , Jain Dharamvir , Scoggins Charles Raben , McMasters Kelly 
Published: February 2017

67 Background: A planned interim analysis of an institutional Phase II trial of once-weekly radiotherapy for patients undergoing breast-conserving surgery (BCS). Methods: Patients who underwent BCS for AJCC Stage 0, I or II breast cancer with negative surgical margins were eligible to receive whole-breast radiotherapy to a dose of 30Gy in 5 weekly fractions of 6 Gy with or without an additional boost. There were no restrictions on age, breast size or the use of cytotoxic chemotherapy for otherwise eligible patients. Patients were evaluated at baseline, 6 and 12 months with digital photography, physician assessment of cosmesis (Harvard Scale) and self-assessment (BCTOS). Results: Between January 2011 and January 2013, 82 eligible patients underwent WHBI immediately following BCS (82.7%) or at the conclusion of adjuvant cytotoxic chemotherapy (17.3%). The median age was 60 years (range: 30-80y) and the median followup was 33.1 months and all patients had at least 1 year followup. The rate of Excellent/Good vs. Fair/Poor cosmesis at 12 months was 77.3% vs. 22.7%. The rate of significant cosmetic change from baseline was 14.7%. The only factor predictive of significant cosmetic change was smoking status (OR: 6.94; p = 0.016). The median BCTOS score increased only slightly from baseline (31) to one year (32), with patient-reported breast size differences worsening but complaints of pain improving over the study period. Conclusions: Cosmetic outcome after WHBI compares well with reports of daily hypofractionated whole-breast irradiation. Further follow-up with continued accrual is needed to assess cosmetic stability and disease-specific outcomes. Clinical trial information: NCT01278212.
SPIO-enhanced MR imaging at 3T for accurate diagnosis of sentinel node metastases to avoid sentinel node biopsy in patients with breast cancer.
Authors: Motomura Kazuyoshi , Nakayama Takahiro , Tamaki Yasuhiro , Ito Yuri , Nakanishi Katsuyuki 
Published: February 2017

68 Background: We previously demonstrated the usefulness of SPIO-enhanced MR imaging at 1.5T for the detection of metastases in sentinel nodes identified by computed tomography lymphography (CT-LG) in patients with breast cancer (Ann Surg Oncol 2011, ASCO 2012). The aim of this study was to evaluate whether SPIO-enhanced MR imaging at 3T improved the diagnostic accuracy for the detection of metastases in sentinel nodes. Moreover, these results were compared with those of the diagnosis using CT-LG according to the size criteria. Methods: Seventy patients with breast cancer and clinically negative nodes were included. Sentinel nodes identified by CT-LG were evaluated prospectively using SPIO-enhanced MR imaging at 3T. Sentinel node size was measured on CT-LG and a node larger than 5 mm in short axis diameter was considered metastatic. Sentinel nodes localized by CT-LG were removed, and imaging results and histopathological findings were compared. Results: The mean patient age was 55 years (range, 29-78). Sentinel nodes were identified by CT-LG successfully in 69 (98.6%) of 70 patients. The mean number of sentinel nodes identified by CT-LG was 1.4 (range, 1-3). All 19 patients with positive sentinel nodes definitively diagnosed by pathology demonstrated metastases on SPIO-enhanced MR imaging. Forty-eight of 50 patients with negative sentinel nodes definitively diagnosed by pathology were non-metastatic on the imaging studies. The sensitivity, specificity and accuracy of MR imaging for the diagnosis of sentinel node metastases were 100%, 96.0%, and 97.1%, respectively, on a patient-by-patient basis. Those of CT-LG were 78.9%, 56.0%, 62.3%, respectively. The specificity and accuracy of MR imaging were superior to those of CT-LG (McNemar test; p < .0001 and = .0015, respectively). Conclusions: SPIO-enhanced MR imaging at 3T can accurately diagnose the sentinel node metastases, and therefore sentinel node biopsy may not be required for most patients with breast cancer.
Clinical efficacy of accelerated partial-breast irradiation in treatment of ER-negative breast cancer: Results of a matched pair analysis.
Authors: Chen Peter Y. , Wobb Jessica , Wallace Michelle , Grills Inga S. , Jawad Maha Saada , Pietron Arielle , Dilworth Joshua T. , Dekhne Nayana , Brabbins Donald S. 
Published: February 2017

70 Background: To assess outcomes of ER-negative breast CA pts treated with APBI, a matched-pair analysis was performed to determine efficacy of APBI vs whole breast RT (WBRT) from a single institution. Methods: From over 1650 pts treated with BCT from 1980-2013, a cohort of ER[-] pts treated with APBI or WBRT were investigated. Matched-pair analysis with a 1:1 ratio paired 79 APBI with 79 WBRT pts, all ER[-] (total:158). Match criteria included follow-up (FU) > 1.0 yr, stage, & age +/- 5 yrs. Outcomes analyzed included local recurrence (LR), true recurrence/marginal miss (TRMM), regional recurrence (RR), distant metastases (DM), disease-free (DFS), cause-specific (CSS), and overall survivals (OS). Results: As for clinical-pathological traits, no significant differences were noted for age (p=0.302), T-stage (p=1.000), tumor size (p=0.721), N-stage (p=0.062), use of chemoRx (p=0.747), endocrine Rx(p=0.408) or Herceptin (p=1.00). Per ASTRO Guidelines, no differences were seen in cautionary or unsuitable [UnS] groups between APBI & WBRT (p=0.333). With a mean FU of 8.0 yrs (10.1 yrs APBI; 8.4 yrs WBRT p<0.001), no differences were seen in the 10-yr actuarial rates of LR (9.3% vs 22.1% p=0.094), RR (1.3% vs 8.1% p=0.299), DM (7.1% vs 13.0% p=0.429), DFS (83.9% vs. 72.5% p=0.214), CSS (93.5% vs. 89.0 % p=0.677), or OS (79.6% vs. 80.1% p=0.573) between APBI & WBRT. Only TRMM was significantly different (0% APBI vs 12.5% p=0.011). In stratifying patients based on ER% (0%, 1-3%, 4-8%) no outcome differences were noted. Of the 158 ER[-] pts, 124 were cautionary with similar 10-yr outcomes except for TRMM (0% APBI;WBRT 14.4% p=0.017) & CLBF (0% APBI;WBRT17.1% p=0.019). For the 34 UnS patients, no endpoint differences were seen APBI vs WBRT. But, when the entire 158 ER[-] patients were analyzed for # of UnS factors, increasing UnS factors led to significant risk of RR (p<0.001) & DM (p=0.002). Conclusions: With 10-year FU of APBI for ER[-], the clinical results were equivalent to WBRT. No differences were noted based on ER%. Increasing number of unsuitable factors had more RR and DM. Maturation of randomized trial data will be needed to provide Class I evidence for equivalence of APBI to WBRT in ER[-] patients.
Utilization of breast preservation treatments in Hispanic patients with breast cancer: An analysis from the National Cancer Data Base (NCDB) from 2000 to 2011.
Authors: Martinez Alvaro , Arrojo Elisabeth E. , Vicini Frank A. 
Published: February 2017

76 Background: In contrast to mastectomy, radiotherapy (RT) treatments for breast cancer (BC) patients, allows for the benefits of breast preservation therapy and brachytherapy (BT) is a very convenient and short course of RT. BT use in BC has increased since FDA approval in 2002, however, has it been used evenly among races? Methods: Trends of treatment were analyzed for BC patients stages Tis to IV using the NCDB and 2.015.671 cases were found. Specific analysis of treatment differences between Black, White and Hispanic races, and the use of BT was performed. Results: The use of surgery as the only treatment in BC patients has decreased in stages 0 to IV (-7%, -11%, -8%, -6% and -6%; p<0.0001), while the use of RT has increased in stages 0 to III (+5%, +1%, +3%, +8%; p<0.0001). The use of chemotherapy has also increased in stages 0, I, III, IV (+3%, +4%, +7%, +5%; p<0.0001), while decreased in stage II (-3%; p<0.0001). Hispanic patients, received less RT in stages I to III (-4.11%, -5.46%, -4.84%; p<0.05), while White’s in stage I and III (58.11%, 65.98%), and Black’s in stage II (52.19%) received more RT (p<0.05). In addition, Hispanic’s received significantly more mastectomy in stages I, II and IV. BT as a type of RT was used mainly in stages 0 to II. In stages III and IV its use was <0.13%. 50.836 patients stage 0-II received BT. In this group of patients, BT increased from 0.35% in 2000 to 9,76% in 2008 (p<0,0001), and from then, decreased to 8.28% in 2011 (p<0.0001). There are also significant differences between races. In White’s BT increased 11.33% in 2008 which is 1.46 more times than in Black’s and 1.79 more than Hispanic, and then decreased to 9.52% in 2011 which is 1.61 more than in Black’s, and 1.64 more than Hispanic’s. Conclusions: The use of breast preservation RT has increased significantly in stages 0 to III from year 2000 to 2011. BT use increased until year 2008, when it begun to decrease until year 2009, stabilizing in 2010 and 2011 at around 8%. There are significant differences between races in the use of RT in general, and BT in particular, being Hispanic’s the ones which significantly received less breast preservation RT treatment. This finding raises important questions.
Cardiac dose evaluation in patients undergoing breast radiotherapy in the modern era.
Authors: Peters Christopher A. , Kaleda Andrew , Manfredo Anthony , Tapen Elizabeth , Koutcher Lawrence 
Published: February 2017

78 Background: Breast radiotherapy (RT) after conservative surgery improves overall survival and minimizes locoregional recurrence. The therapeutic ratio of adjuvant RT continues to improve with time. Cardiac toxicity from breast cancer treatment remains a concern, and can result from chemotherapy, biologic therapy, or RT in a dose-dependent fashion. Dose to avoidance structures can be minimized as technological improvements in radiotherapy evolve. We sought to investigate heart and coronary artery dose using modern RT techniques. Methods: We reviewed 164 consecutive non-metastatic breast cancer patients treated with adjuvant breast RT, from 3/2011 to 12/2013. 8 patients were excluded because they did not complete the prescribed dose. Patients were treated on 3 different machines, at 2 centers. Data was extracted using both the treatment planning system and electronic medical records. Univariate analysis was done using t-test and one way ANOVA for variables predicting higher mean heart dose (MHD). Multivariate analysis was performed using multiple linear regression. p values ≤0.05 were considered significant. Results: The median age of our cohort was 63 (range 33-85), and 90% had ≤ stage 2 disease. 53% had left sided RT, 45% right, and 2% had bilateral RT. 18% had breast/chest wall and nodal RT, with 2% dedicated IMN targeting. 22% of patients were treated prone. The median dose, including boost, was 60.4 Gy (range 42.4-66.4). 35% received cytotoxic chemotherapy and 10% received trastuzumab. Mean heart dose was 1.4Gy (SD 2.2), and mean LAD dose was 4.9Gy (SD 4.4). MHD were lower in the prone position compared to supine, but did not reach statistical significance p=0.3. Advanced AJCC stage grouping, left sided or bilateral treatment, breast/nodal target volume, and helical treatment were associated with significantly higher MHD on univariate analysis. On multivariate analysis, only breast/nodal volume and helical technique remained significant, both p<0.001. Conclusions: Modern techniques result in low heart and LAD doses in our series. Because adjuvant breast RT plays a critical role in the definitive management of breast cancer, these data are reassuring to patients, physicians, and payers.
The effects of hormonal replacement therapy (HRT) on mammographic breast density and abnormal mammograms prompting further investigation.
Authors: Barda Liran , Nevler Avinoam , Shabtai Esther L , Gutman Mordechai , Shabtai Moshe 
Published: February 2017

8 Background: Mammographic density has been associated with higher risk of breast cancer and lower sensitivity. HRT has been implicated with increased density and is also a risk factor. The relationship between HRT, breast density, and mammographic findings requiring investigation has not been fully investigated. We aimed at analyzing this correlation. Methods: 2,758 consecutive, single-center screening mammograms performed during 1 year were analyzed. Mammograms were supplemented by ultrasound. Density was measured by a semiquantitative, 5-grade scale, and grouped into low (1-3) (LDM) and high density (4-5) (HDM). Demographic and obstetric data, personal and family history of breast cancer, and the use of HRT were entered into database. These parameters were correlated with breast density and any abnormality detected. Univariate and multivariate analysis as well as multivariate logistic regression were performed on SAS 9.2. Results: Mean overall age was 48 (SD = 10.8, range 27-78), mean ages of LDM and HDM groups were 59 ± 10.5 and 50.9 ± 9.3 respectively (p = 0.001). Of 2,758 tests, 2,094 (76%) were LDM and 664 (24%) were HDM. 1,962 women (71%) were postmenopausal and 592 (30%) were on HRT. A difference in density between pre- and postmenopausal women was observed (p = 0.0001). HRT was not associated with higher rate of HDM (18%, n = 105/582) vs.15% n = 211/1370 (p = n.s) without HRT. Abnormality was more likely in postmenopausal HRT-less (52% n = 711/1370) vs. (30% n = 226/582) HRT (p = 0.0001) including solid lump (p = 0.0001), tissue irregularity (p = 0.016) and calcifications (p = 0.0005). Menopause was associated with 48% of any finding vs. 41.4% in pre-menopause women (p = 0.0017). 104 malignant lesions were found in 267 with mammographic findings prompting histological assessment. HRT was associated with lower incidence (28%) of malignancy compared to 50% without HRT. Conclusions: HRT was not associated with increased density nor with higher risk of malignancy; moreover, a lower rate of mammographic abnormality was noted. Albeit further studies are required, the results of this study do not support the notion that HRT increases the likelihood of malignancy or affects breast density.