bluuebunny/crossref_metadata_2025_split huggingface dataset:
CYP2D6 and ESR genotypes in adjuvant tamoxifen treatment for early breast cancer.
Authors: Kim K. , Jung K. H. , Ahn J. , Kim S. , Kim H. J. , Ko B. , Lee J. W. , Son B. H. , Ahn S. , Gong G. 
Published: February 2017

142 Background: The pharmacokinetics and pharmacodynamics of tamoxifen may influence the clinical outcome and tolerability of adjuvant treatment with tamoxifen in breast cancer. We investigated the effects of polymorphisms of CYP2D6, ESR1, and ESR2 for tamoxifen therapy in early stage breast cancer patients. Methods: Tissue DNA from 187 patients who received tamoxifen only as an adjuvant systemic therapy between 1997 and 2002 were extracted and genotyped for polymorphisms of CYP2D6 (*2A, *10, *14, *41) and estrogen receptor (ESR1, ESR2). While CYP2D6*10, *14 and *41 have been reported to be associated with decreased activation of tamoxifen, CYP2D6*2A, ESR1 PvuII CC and ESR2-02 GG have been associated with enhanced activity of tamoxifen. Statistical analyses include Fisher exact test, Chi-square and Kaplan-Meier analyses. Results: Median age was 43 years (range 25-49). Most of the patients (170/187) were stage I, while other patients were stage 0 (1/187) and stage II (17/187). None of the patients had nodal metastasis. Median follow-up was 100 months (7-166). Allele frequencies were as follows: CYP2D6*10, 0.69; *14, 0.02; *41, 0.01; *2A, 0.64; ESR1 PvuII C allele, 0.25; ESR2-02 G allele, 0.98. Each genotype group did not show significant differences in age, stage, pT, tumor size and follow up period. Twelve percent (24/187) had received tamoxifen therapy for less than 24 months. Of the 24 patients, 67% (16) discontinued tamoxifen therapy related to tolerability issues. Recurrence occurred in 12 patients (6.4%). There was no association between genotypes with either recurrence or tamoxifen duration < 2 years. Although statistically nonsignificant, patients with either CYP2D6*2A homozygote, ESR1 PvuII CC genotype, ESR2-02 GG genotype tended to have a longer DFS when compared concomitantly to wild-type (p=0.445). Conclusions: Polymorphsims for CYP2D6*2A,*10, *14, *41, ESR1 PvuII, ESR2-02 did not show significant associations with either recurrence or tamoxifen duration > 2 years. However, grouped analysis for CYP2D6*2A, ESR1 PvuII, ESR2-0210 genotypes need further evaluation regarding with tamoxifen outcome.
Relationship of recent pregnancy and cytologic atypia in the contralateral breast of patients with breast cancer.
Authors: Revesz E. , Zalles C. M. , Ivancic D. , Bethke K. P. , Hansen N. M. , Jeruss J. S. , Khan S. A. 
Published: February 2017

149 Background: Although early parity protects against breast cancer later in life, it is a risk factor in the years following pregnancy, particularly when child-bearing is delayed. In a separate study, we have reported that these pregnancy-associated breast cancers (PABC) are more likely to be hormone receptor (HR) negative; we have previously found that random fine needle aspiration (rFNA) of the contralateral breast (CB) frequently have atypia in women with HR negative breast cancer. We now report an analysis of the cytological features of contralateral rFNA in relation to recent parity, with the goal of assessing cytological features which may be risk factors for PABC. Methods: Women with breast cancer undergoing surgery between 2006 and 2008 were enrolled in a prospective study of rFNA of the CB. Cytological analysis was performed on all the samples, using two scoring systems, Masood and Zalles (M and Z). Linear regression analyses were performed relating each score to interval from last pregnancy, stratified for parity, and adjusted for age. Results: Eighty-two patients had rFNA and cytologic analysis. The parous group’s (n=52) interval since last pregnancy was inversely correlated with the overall M score (p=0.034); pleomorphism and (p=0.047 and p=0.013 respectively). M score was also related to age at last pregnancy (p=0.026) as were pleomorphism and chromatin pattern (p=0.044 and 0.035 respectively). In the nulliparous group (n=30), there were no significant relationships between any of the cytological parameters or age. Conclusions: The CB of women with recent parity display specific cytological abnormalities that are related to risk of breast cancer, particularly HR negative breast cancer. This observation affords the opportunity to further evaluate rFNA as a tool for breast cancer risk assessment following pregnancy, and to identify molecular correlates of nuclear cytological abnormalities that may serve as targets for prevention of ER negative breast cancer.
An international perspective: The role of nurse involvement in improving breast cancer control.
Authors: Blauvelt B. M. , Podder S. K. , Abulkhair O. , Barrios C. H. , Huang C. , Kim S. , Shockney L. D. 
Published: February 2017

152 Background: Non-Western, non-Caucasian populations comprise 90% of the world’s estimated 3.2 billion women, living mostly in low and middle income nations. While medical advances have greatly reduced breast cancer morbidity and mortality in developed nations, those are on the rise in many low and middle income nations. The purpose of the study was to identify emerging needs and challenges observed by breast cancer thought leaders in diverse regions of the world consisting mainly of lesser developed nations to identify strategies for improving breast cancer control. Methods: 225 breast cancer medical, advocacy and policy leaders from 30 countries in Latin America, Asia, the Middle East/North and South Africa, Canada and Australia participated in this study. The study sample was composed of 203 breast cancer specialists, 12 patient advocates and 10 policy makers. Results: The most salient needs and challenges identified were to: (1) develop nurses trained in breast cancer patient and family care, management, education and clinical research (48%); (2) individualize breast cancer therapy (47%); and (3) improve understanding of the reasons for apparently higher proportions of younger women presenting with more aggressive tumors among these predominantly non-Caucasian populations (45%). Analysis of these and other needs identified evolved into 4 key themes and sub-dimensions involving nurses to improve breast cancer control: Capacity, Research, Advocacy and Access. Conclusions: The most significant need identified by this study was to increase both the capacity and capability of breast cancer nurses. A comprehensive approach to doing this would include: (1) increasing capacity to educate nurses in breast cancer patient education and related care issues in nursing schools and teaching hospitals; (2) working with local medical societies, educational institutions and governmental authorities to enable nurses to work as primary care practitioners; and (3) increasing participation of nurses in breast cancer clinical research, working with clinicians and in collaboration with breast cancer research centers of excellence from around the world.
The impact of ethnicity and insurance status on stage of cancer at diagnosis and overall survival of breast cancer.
Authors: Omaira M. , Mozayen M. , Mushtaq R. , Katato K. 
Published: February 2017

154 Background: Major advances in early diagnosis and treatment of breast cancer (BC) have been achieved with significant declines in mortality. However, not all segments of the United States population have experienced equal benefits from this progress. Though ethnic disparities in BC outcome have been attributed to lack of adequate health insurance, the differences in outcome when insurance and socioeconomic status are similar still exist. We elected to examine the effect of insurance status at diagnosis, and whether race is an independent risk of poor outcome in a population from a community-based cancer database. Methods: A retrospective study on BC among patients aged 18 to 64 years were identified, between 1993 and 2005, using data from the Tumor Registry at Hurley Medical Center in Flint, Michigan. Patient’s characteristics included age, race, stage at diagnosis, and primary payer. Insurance status was classified as uninsured/Medicaid, private insurance, and Medicare disability (Medicare under age 65). The 5-year overall survival (OS) was calculated, in respect to patient ethnicity, and compared between the three insurance groups using Fisher’s exact test. Results: A total of 779 patients have been identified with diagnosis of BC. 147 patients were excluded due to incomplete data. 632 patients were analyzed. African Americans were 228 (36%), Caucasians 391 (62%), and other ethnicities 13 (2%). Mean age at diagnosis was (49.21) for African Americans versus (51.35) for Caucasians (p = 0.002). African Americans were more likely to present at advanced stage (III, IV) than Caucasians (17% versus 10%, p = 0.017). However, this difference was not statistically significant when adjusting for insurance status. Although both ethnicities had similar OS in respect of their insurance group, patients with Medicaid/uninsured had significantly lower OS compared to patients with Medicare disability (p = 0.006) and private insurance (p < 0.0001) respectively. Conclusions: Uninsured/Medicaid patients with breast cancer have worse outcome when compared to patients with Medicare or private insurance. Ethnicity is not an independent risk factor of advanced stage at diagnosis and poorer outcome.
Relationship between differences in RNA or protein expression and the effects of race/ethnicity on breast cancer outcomes.
Authors: Chavez-MacGregor M. , Liu S. , Chen H. , Do K. , Pusztai L. , Symmans W. F. , Hortobagyi G. N. , Mills G. B. , Meric-Bernstam F. , Gonzalez-Angulo A. M. 
Published: February 2017

157 Background: Race is associated with distinct outcomes for breast cancer patients. The purpose of this study was to evaluate whether there were differences in gene or protein expression patterns between breast cancers according to race/ethnicity and cancer subtype [(triple-negative (TN), estrogen receptor-positive/HER2-negative (HR+) and HER2-positive/with any ER status (HER2+)]. Methods: Fine needle aspirates from primary breast cancers were obtained under a prospective tissue collection protocol. Transcriptional profiling was performed using Affymetrix HG-U133A platform in 376 patients and reverse phase protein array analysis (RPPA) was done for 177 distinct proteins in 255 patients from a separate cohort. Unsupervised clustering was conducted, as well as supervised comparison by race and tumor subtype. BRB-Array tools and Ingenuity Pathways software packages were used to analyze the data. Results: Median age was 50 years in both cohorts. In the RPPA cohort 54.5% of the tumors were HR+, 20.7% HER2+ and 24.71% TN. One hundred and forty-seven (57.6%), 47 (18.43%), 46 (18.1%) of the patients were white, Hispanic, and black, respectively. Unsupervised hierarchal clustering of the protein expression data showed no distinct clusters by race (permutation p values were 0.492, 0.489 and 0.494 for the HR+, HER2+ and TN tumors respectively). In the gene expression cohort, 54.2% of the tumors were HR+, 16.5% HER2+ and 29.3% TN. Two hundred and sixteen (57.5%), 111 (29.52%), and 32 (8.52%) patients were white, Hispanic and black, respectively. No probe set with an FDR < 0.05 showed any association with race by breast cancer subtype; similar results were obtained using pathway and gene set enrichment analysis methods. Conclusions: These results indicate that there are no large scale gene and protein expression differences between breast cancers of different races. The study size is too small to confidently exclude small scale expression differences in a limited number of proteins or RNAs. This analysis also did not examine the potential differential distribution of DNA nucleic acid polymorphisms, somatic mutations, gene rearrangements or copy number aberrations by race-ethnicity.
Predictions for positive nodes in breast cancer using computerized modeling.
Authors: Gawlick U. , Hewitt K. , Tamayo P. , Mone M. C. , Hansen H. J. , Nelson E. W. 
Published: February 2017

16 Background: The accuracy and consistency of sentinel lymph node (SLN) biopsy for axillary staging in breast cancer has been well established by multiple studies. Although the standard of care has been to perform a completion axillary lymph node dissection (ALND) on patients who have a positive sentinel node, recent data (ACOSG Z0010, Z0011 and NSABP B-32) suggests that an ALND may be avoided in certain subsets of patients. To further study this question, we used a Bayesian model to predict the probability of finding disease in the ALND for breast cancer. Methods: All SLN procedures performed by a single surgeon, for clinical T1-T2 N0 disease between September 2000 and March 2009 were retrospectively reviewed under an IRB approved protocol. Demographic, disease and surgical procedural variables were collected. Values are reported as mean ± standard deviation. A Bayesian model, a standard statistical model frequently used in medicine, was used to identify variables that could predict a positive ALND. Results: A total number of 235 SLN procedures were reviewed. The mean patient age was 58.6 ± 11.8 (range 28-88), tumor size was 1.8 ± 1.3 cm (range 0.2-7.4), and BMI was 28 ± 6.1. The number of SLN found was 3.6 ± 1.9 (range 0-10), and in 2 cases no SLN were found, for an overall failure rate of 0.85%. A total of 73 ALND were performed in this group; 27 cases had ALND as national study participants randomized to ALND, 44 cases for positive SLN, and 2 cases in which no SLN could be identified. The mean number of axillary lymph nodes removed was 14.8 ± 7 and the mean number of positive axillary nodes was 2.7 ± 4.1. Tumor size, tumor grade, number of positive SLN by hematoxylin and eosin staining, and a low technetium count of the first SLN were found to be significant predictors of positive axillary nodes during a completion ALND. There was also a trend for progesterone receptor expression as a predictor of axillary disease. Conclusions: A model to predict a positive ALND for breast cancer is presented. We found tumor characteristics, number of positive SLN and low technetium count for first SLN to be predictors for finding axillary disease. Further studies are needed to validate our model as a means of sparing women an ALND who have a low probability of finding additional breast disease.
Use of a meal replacement weight loss intervention in survivors of ER/PR-negative breast cancer.
Authors: Milliron B. , Hopkins J. O. , Fulmer A. , Case L. D. , Vitolins M. 
Published: February 2017

166 Background: The detrimental relationship between body mass index and recurrence has been more pronounced among women with estrogen receptor/progesterone receptor (ER/PR)-negative breast cancer. Although studies have reported that soy-based meal replacements can favorably impact weight and other metabolic risk factors, meal replacement strategies have not been tested in this population. The objectives of this pilot study were to determine the feasibility of a soy-based meal replacement intervention, to measure changes in anthropometrics and biomarkers, and to measure changes in health-related quality of life (QOL). Methods: The 3-month intervention included education sessions, meal replacement products, meal plans, and physical activity promotion. Anthropometrics, blood samples, and questionnaire data were collected. Paired t-tests assessed changes over time in continuous measures. Weights were measured weekly and a mixed model regression analysis assessed change in weight over time. Results: Nineteen women participated in the study (mean age 59 years). When comparing pre and post intervention weights, women lost ~7.5 ± 4.9 kg (p < 0.001) and had significant improvements in health-related QOL. Women lost 7.5% of their baseline weight which exceeded our study goal (5% reduction). There were significant reductions in waist circumference (-7.5 ± 4.9 cm, p = 0.001), % fat mass (-9.4 ± 8.3, p < 0.001), total cholesterol (p = 0.026), and triglycerides (p = 0.002). Conclusions: The use of this weight loss approach was well-received by the study participants. We are currently evaluating whether this approach had a long-term impact on the weight status and quality of life among the study participants. [Table: see text]
Adolescent intakes of alcohol and folate and risk of proliferative benign breast disease.
Authors: Liu Y. , Tamimi R. M. , Berkey C. S. , Willett W. C. , Collins L. C. , Schnitt S. J. , Colditz G. A. 
Published: February 2017

169 Background: Given the importance of exposure between menarche and first childbirth in breast cancer risk, adolescent alcohol consumption may influence the risk of proliferative benign breast disease (BBD). Folate may modify the adverse effect of alcohol on breast cancer. Methods: We used data from 29,329 women in the Nurses’ Health Study II who completed both adolescent alcohol consumption questions in 1989 and an adolescent diet questionnaire in 1998. A total of 666 women with proliferative BBD between 1991 and 2001 were confirmed by centralized pathology review. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for established risk factors of breast cancer. Results: Adolescent alcohol consumption was dose-dependently associated with an increased risk of proliferative BBD (HR = 1.12 per 10g/day consumption; 95% CI, 1.03-1.22). There was no significant association with adolescent folate intake. While the interaction between adolescent alcohol and folate intake was not statistically significant, among women with low folate intake (<279 mg/day) the BBD risk was significantly increased with moderate alcohol intake (HR = 1.62; 95% CI, 1.14-2.28) and with high alcohol intake (HR = 1.90; 95% CI, 0.98-3.70; Ptrend <0.01). Adolescent alcohol consumption was not associated with increased risk among women with higher adolescent folate intake. Conclusions: Adolescent alcohol consumption is associated with higher risk of proliferative BBD, especially in women with low adolescent folate intake.
Use of Blue Citrus, a Chinese herbal remedy, to reduce side effects of aromatase inhibitors.
Authors: Massimino K. , Glissmeyer M. , Wagie T. , Karamlou K. , Look R. M. , Sorenson L. , Turner C. , Johnson N. 
Published: February 2017

170 Background: Aromatase inhibitors are widely used in treatment of estrogen receptor positive breast cancer. Many patients experience significant arthralgias, which may lead to early cessation of therapy. Blue Citrus, a mix of Chinese herbs formulated in our community, had anecdotal reports of success in alleviating these symptoms. We objectively evaluated its activity in symptomatic patients. Methods: Breast cancer patients with significant arthralgia on aromatase inhibitors were enrolled in a prospective fashion to a double blind crossover placebo controlled trial. Each patient received either Blue Citrus (BC+P) or a placebo (P+BC) for three months and then crossed over to the opposite treatment for an additional three months. Symptoms were measured over the course of treatment. Results: A total of 37 patients enrolled on the study. There were 6 early withdrawals, which left 31 evaluable patients. Visual Analogue Score (VAS) for both groups was similar at baseline at 4.9 and 5.1 for the BC+P and P+BC groups, respectively. At 30 days the BC+P score was 3.4 vs. the P+BC of 4.7 showing clearly improved symptom control in the BC+P group. The P+BC group did however approach the BC+P group by 90 days. At crossover the BC+P group experienced a spike in symptomology when changed to placebo that didn’t appear for the P+BC group. When compared to baseline, mean VAS score on Blue Citrus was 2.98 (p=0.001) versus mean VAS score on placebo 3.92 (p=0.0203). By study end (180 days) the VAS scores for both groups were closer at 2.6 BC+P vs. 3.0 for P+BC but BC+P still maintained lower VAS scores. Conclusions: Blue Citrus improved symptoms associated with aromatase inhibitor use. Patients who received Blue Citrus in the first arm had rapid improvement in symptoms and experienced return of symptoms when converted to placebo. All patients averaged lower VAS scores on Blue Citrus however at 6 months the difference between the arms became less pronounced.
Change of serum vitamin D according to the breast cancer treatment.
Authors: Kim H. J. , Ahn S. 
Published: February 2017

172 Background: Vitamin D deficiency is associated with increased breast cancer risk and decreased breast cancer survival. The purpose of this study was to determine the effect of breast cancer adjuvant treatment to the vitamin D status, as measured by the serum hydroxyvitamin D (25OHD) in breast cancer patients. Methods: For 589 patients who was diagnosed as a non metastatic breast cancer in 2009 at the asan medical center, blood was prospectively analyzed in batches for serum 25 OHD level at basal and at 6 and 12month. We excluded the patients who took a vitamin D supplementation and got a neoadjuvant chemotherapy. Vitamin D sufficiency was defined as serum as 30ng/ml or greater, insufficiency as 20 to 29 ng/ml and insufficiency as less than 20ng/ml. Results: At baseline, mean serum 25OHD was greater in summer (April to Oct) than Winter (Nov to May ) (28.2ng/ml vs 32.9ng/ml respectively, p=0.000). The patients who did not get a chemotherapy and anti-hormonal therapy as baseline, the patient with chemotherapy showed decreased serum 25OHD level than who without chemotherapy in 6 month but not in 12 month (p=0.003, vs p=0.156 respectively). The patients who had taken anti-hormonal therapy showed significant increasing serum 25OHD in 6 month and 12 months (p=0.000 both). For the patients who got both chemotherapy and anti-hormonal therapy, the changes of serum 25OHD level is smaller than the patients who got a chemotherapy only. For the patients who got a chemotherapy, 57% of patients were vitamin D sufficient at baseline, but 27% of patients in 6 month and 49% in 12 month (p=0.001). Conclusions: Vitamin D status was worse during chemotherapy but recovered after chemotherapy. Antihormonal therapy make the serum vitamin D level increased. The translational research about the effect of chemotherapy and antihormonal therapy to the vitamin D status should be warranted.