bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lymphatic and proinflammatory candidate gene variations and lymphedema.
Authors: Fu Mei R. , Axelrod Deborah M. , Guth Amber , Goldberg Judith D. , Li Xiaochun , Cartwright Francis , Haber Judith , Conley Yvette 
Published: February 2017

9 Background: Traditionally, breast cancer-related lymphedema is considered to be mainly due to the mechanical injury from cancer surgery. Recent research identified that inflammation-infection may be one of the important predictors for lymphedema. This pilot study aimed to explore the associations between lymphatic and pro-inflammatory candidate gene variations and lymphedema. Methods: A prospective, longitudinal, repeated-measure, and comparative design was used to recruit 178 breast cancer survivors. To ensure the accuracy of lymphedema phenotype, lymphedema was classified into lymphedema of arm and breast. Arm lymphedema must have been validated by infra-red perometer and a bioimpedance device. Breast lymphedema was validated by an observational scale since no objective measure is available. Saliva samples were collected for DNA extraction. Candidate Gene Association Research Method was used to examine the eight genes known for inflammation and lymphatic specific growth factors: cytokines (IL1A, IL6, IL8, IL10, IL13) and PTGS2 (COX2), and lymphatic specific growth factors [VEGF-C and D]. Descriptive statistics, Chi-Squared tests for contingency tables and one-way analysis of variance for continuous variables were used to compare the genotypes for each of these genes in patients with and without lymphedema. Odds ratios of developing lymphedema are estimated. Results: Among 178 survivors, 39 women were confirmed to have arm lymphedema and 43 women had breast lymphedema. Five genes were significantly associated with breast cancer-related lymphedema. Specific single nucleic polymorphisms (SNPs) for lymphatic specific growth factors VEGF-C (rs4604006) and cytokine IL13 (rs1800925) were related to arm lymphedema. Specific SNPs of cytokine IL1A (rs1800587) and PTGS2 (COX2) (rs20417) were associated with breast lymphedema. Conclusions: Our findings provided preliminary data on genetic susceptibility as a risk factor for breast cancer-related lymphedema. Findings of our study may serve as a preliminary foundation for a priori recognition of genetic risk that may facilitate lymphedema risk prediction prior to surgery and raises the potential for early intervention for a high-risk group.
How accurately can clinicians predict the Oncotype DX DCIS score?
Authors: Cate Sarah Patricia , Gillego Alyssa , Chadha Manjeet , Rescigno John , Gliedman Paul R. , Radzio Agnes , Boolbol Susan K. 
Published: February 2017

90 Background: The Oncoype DX DCIS Score was developed to assess the risk of recurrence for ductal carcinoma in situ, as well as an invasive breast cancer. It is a 12 gene assay performed on an individual patient’s tumor and is used to predict the ten year local recurrence risk of an ipsilateral breast event, which can be either an invasive breast cancer or ductal carcinoma in situ. It is also used to predict the 10 year risk of an invasive cancer. The DCIS Score was clinically validated using patients from ECOG 5194. The purpose of this study was to investigate how often clinicians, (medical oncologists, breast surgical oncologists, and radiation oncologists) can predict the DCIS Score. Methods: In this IRB approved study, we retrospectively reviewed the charts of 27 patients at our institution who underwent unilateral or bilateral partial mastectomy for DCIS from April 2012 to February 2013 and who had their pathology specimens submitted for DCIS Scores. Patient age range was 40-79 years old, with a mean of 56.8. All patients underwent consultation with radiation oncology. A chart was compiled to include the patient’s age and tumor histology. This included grade of DCIS, extent of DCIS, presence of necrosis, margin width, and hormone receptors. We then removed all identifying factors from the patients’ data, and surveyed our radiation oncologists, medical oncologists, and breast surgical oncologists on whether patients had a low, intermediate, or high DCIS Score. Results: Breast surgical oncologists accurately predicted the DCIS score 49% of the time. Medical oncologists predicted the DCIS score 35% of the time, while radiation oncologists were accurate 51% of the time. Conclusions: This study demonstrates the difficulty in predicting the DCIS Score. The information obtained from the DCIS Score is specific to the genetic behavior of each individual tumor, whereas traditional methods of predicting risk of recurrence and benefit of radiation are based on standard pathologic and clinical criteria. Further studies on larger patient populations need to be performed prior to wide scale acceptance of this genomic test. [Table: see text]
Does the Oncotype DCIS score impact treatment decisions?
Authors: Cate Sarah Patricia , Gillego Alyssa , Chadha Manjeet , Rescigno John , Gliedman Paul R. , Kats Ilana , Boolbol Susan K. 
Published: February 2017

91 Background: The Oncotype Dx DCIS Score has been developed and validated for risk recurrence in ductal carcinoma in situ. It is a 12 gene assay performed on an individual patient’s tumor. The results give information about the 10 year risk of any in-breast event and the 10 year risk of an invasive breast cancer. The clinical validation study was based on patients enrolled in ECOG 5194. The purpose of our study was to evaluate the impact of the DCIS Score on recommendations for adjuvant radiation therapy. Methods: In this IRB approved study, 27 patients at our institution underwent evaluation with the DCIS Score from April 2012 to February 2013. All patients had specimens submitted for DCIS Scores. 14 patients had margins of 3 mm or greater. 12 patients had margins of 1 mm to 2.5 mm, and 1 patient had margins that were less than 1 mm from the DCIS. The mean age was 56.8 years, with a range of 40-79 years old. The DCIS Score is reported on a scale of 0-100. All patients underwent consultation with radiation oncology. The radiation oncologists formulated their preliminary recommendation prior to reviewing the patients’ DCIS Scores. The final recommendation for radiation treatment was rendered after reviewing the DCIS Score. We then compared the pre-DCIS Score and post-DCIS score treatment recommendations. Results: 21 patients (78%) were advised to have adjuvant radiation therapy. 6 patients (22%) were advised not to undergo adjuvant radiation based on their clinical and pathologic features. Although the DCIS Score did not change treatment recommendations for any patient in this study group, it did confirm initial treatment recommendations. For the patients who were advised not to have radiation, their DCIS Scores were 0-31. Conclusions: The DCIS Score is a validated tool to assess the local risk of recurrence for ductal carcinoma in situ. In our study population, the results of the DCIS Score did not alter treatment in any patient. It is important to note that in the 6 patients who were advised not to have radiation, the low DCIS Score confirmed the radiation oncologist’s perceived low risk of recurrence. In order to increase confidence in results of the DCIS Score, further studies need to be performed.
Comparison of ultrasound with ultrasound-guided fine-needle aspiration biopsy and core needle biopsy for initial axillary staging of breast cancer patients.
Authors: Ahn Hye Shin , Kim Sun Mi , Jang Mijung , Yun Bo La 
Published: February 2017

96 Background: The sensitivity and specificity of FNAB and CNB performed in suspicious axillary LNs have ranged from 56% to 86% and from 91% to 100%, because FNAB and CNB are operator- and institution-dependent procedures. In addition, previous studies concerning the diagnostic accuracy of these procedures have reported results from only FNAB or CNB. So, the purpose of this study was to determine the diagnostic accuracy of axillary US and compare that of US-guided FNAB with CNB for axillary staging in the same breast cancer population. Methods: Of 220 breast cancer patients who underwent preoperative or prechemotherapy axillary US for axillary staging, 52 patients who underwent US-guided FNAB and CNB of cortical thickening and/or compressed hilum of lymph nodes on US were prospectively enrolled. US and FNAB/CNB findings were compared with final pathology from sentinel lymph node biopsy or axillary lymph node dissection. Results: Forty-eight patients met the final study criteria; we excluded 4 who had received primary systemic chemotherapy and showed negative FNAB/CNB results with negative final post-operative pathology. Positive predictive value (PPV) of axillary US was 54%. The sensitivity and specificity of FNAB were 73% and 100%, and those of CNB were 77% and 100%. Results did not significantly differ between US-guided CNB and FNAB. The complication rates of FNAB and CNB were 4%, and FNAB and CNB cost $180 and $350, respectively. Conclusions: Both US-guided CNB and FNAB were useful for axillary staging in breast cancer patients with high sensitivity. However, FNAB is recommended based on the advantages of low cost and minimal invasiveness.
Visualization rate of internal mammary sentinel lymph nodes with modified technique of radiotracer injection.
Authors: Wang Yong-sheng , Qiu Peng-fei , Yang Guo-ren , Liu Yan-bing , Cong Bin-bin , Zhao Tong , Chen Peng , Sun Xiao , Wang Chun-jian , Zhang Zhao-Peng , Yang Tao , Bi Xiang 
Published: February 2017

99 Background: Even though the 2009 AJCC incorporated the internal mammary sentinel lymph node biopsy (IM-SLNB) concept, there has been limited change in surgeons practice patterns due to the low visualization rate of the internal mammary sentinel lymph nodes (IM-SLNs) with the conventional injection technique (average 13%, 0~37%). In this prospective study, different radiotracer injection techniques were evaluated to achieve a relative high visualization and detection rate of IM-SLNs (NCT01642511). Methods: The 190 patients enrolled in this study were divided into three groups according to the study period and radiotracer (99mTc-labeled sulfur colloid) injection technique. Group A: conventional technique (radiotracer injection only into the tumor quadrant) for the initial 58 cases; Group B: two-quadrant injection at the 6 and 12 o’clock positions, 2.0~3.0 cm from nipple in the latter 132 cases. Group B was then separated into two groups according to the radiotracer injection volume: Group B1, low volume (<0.5ml/point, n=41); Group B2, high volume (≥0.5ml/point, n=91). Radiotracer was injected into the parenchyma under the ultrasonographic guidance for all patients. IM-SLNB was performed for patients with IM-SLNs visualized on preoperative lymphoscintigraphy and/or detected by intraoperative gamma probe. Results: Group B was associated with a significantly higher IM-SLNs visualization rate (76.5%, 101/132) compared to Group A (15.5%, 9/58, P=0.000), and Group B2 with the highest visualization rate (86.8% vs. 53.7% Group B1, P=0.000). All techniques had the same visualization rate of the axillary SLNs (P=0.915). The visualization rate of IM-SLNs was related to the patient’s age (P=0.037) and injection volume (P=0.000). The successful rate of IM-SLNB was 92.3%, and arrived 100% after 20 cases learning curve. The postoperative IM-SLNB complications were 0. Conclusions: Modified technique of radiotracer injection (Qiu's injection technique: two-quadrant, high volume and ultrasonographic guidance) significantly improved the visualization rate of IM-SLNs, provided an effective technique to evaluate the status of internal mammary, and would promote research on the IM-SLNB.
Taking control of cancer: Women’s choice for mastectomy.
Authors: Covelli Andrea Marie , Baxter Nancy , Fitch Margaret , Wright Frances Catriona 
Published: February 2017

11 Background: Rates of both unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early stage breast cancer (ESBC) have been increasing since 2003. Studies suggest that the increase is due to women playing an active role in decision-making. We do not know what factors are influencing the choice for more extensive surgery. Methods: To identify these factors we completed a multi-method study; conducting a systematic review of quantitative literature and qualitative interviews. Decision-making literature was identified from 5 databases and underwent thematic analysis. Purposive sampling identified women across the Toronto Area (Ontario, Canada), who were suitable candidates for breast conserving surgery (BCS) but underwent UM or CPM. Data saturation was achieved after 29 in-person interviews. Constant comparative analysis identified key concepts and themes. Results: ‘Taking control of cancer’ was the dominant theme. Literature illustrated that patients markedly overestimate risk of local recurrence, contralateral cancer and particularly, mortality. Similarly, interviews revealed that fear of breast cancer was expressed at diagnosis and drives the decision-making process. Despite surgeons discussing survival equivalence of BCS and UM, patients chose UM due to fear of recurrence and an overestimated survival advantage. Similarly, patients chose CPM to eliminate contralateral cancer and a misperceived survival benefit. Women were actively trying to Control Outcomes, as more surgery was believed to offer greater survival and therefore greater control. Conclusions: Both the literature and our interviews have illustrated that women seek UM and CPM for treatment of their ESBC to manage their fear of cancer mortality by undergoing more extensive surgery; this in turn drives mastectomy rates. It is important to understand this process so that we may improve our ability to communicate issues of importance to women and facilitate informed decision-making.
Adherence to national quality guidelines for nodal staging and treatment of cutaneous melanoma.
Authors: Hieken Tina J. , Comfere Nneka I. , Grotz Travis Edward , Inselman Jonathan W. , Habermann Elizabeth B. 
Published: February 2017

110 Background: Assessment of compliance with national quality guidelines for the management of melanoma may be complicated by controversy about selection of patients for nodal surgery and limited by a lack of data on quality metrics. Previous reports suggest suboptimal overall compliance, with sentinel lymph node biopsy (SLNB) not performed for many suitable patients and completion lymph node dissection (CLND) omitted in many biopsy-proven node-positive (LN+) cases. The purpose of this study was to assess compliance with national ASCO/SSO guidelines for lymph node (LN) surgery for T2 and T3 (intermediate thickness, 1.01-4.00 mm) primary cutaneous melanoma patients and elucidate factors associated with non-compliance. Methods: All cases of T2 and T3, M0 melanoma were identified from 2004-2010 SEER data. Multivariable logistic regression was utilized to identify independent predictors of compliance. Five-year cancer specific survival (CSS) was estimated using the Kaplan-Meier method. Results: Overall, 75.3% (6,609/8,782) of T2-T3 primary cutaneous melanoma patients underwent LN staging including SLNB in 6,330 (74.5%) of 8,492 clinically LN negative patients. Among these 6,609 patients, 1,279 (19.4%) had one or more LN+. 940 LN+ patients (73.4%) underwent CLND with removal of a mean (median, IQR) of 20.7 (18, 11-27) LNs. Compliance with LN staging and management guidelines was associated with truncal primary site (for SLNB), p<0.001 and with patient age <65 yrs and increasing number of metastatic LNs (for CLND), both p<0.0001. Compliance with CLND for LN+ patients was associated with improved 5 year CSS: 70.0% vs 64.6%, p<0.001. Conclusions: Compliance with guidelines for LN surgery in T2 and T3 melanoma is poor despite the well-defined benefit for this group of patients. These data suggest that non-compliance is multifactorial and not simply due to practice differences arising from the controversial aspects of melanoma management. Room for improvement exists. Assessment of modifiable factors associated with poor compliance, design of strategies to improve compliance and the development of performance measures around appropriate LN staging and management of T2 and T3 melanoma deserve further investigation.
Resource utilization, costs, and quality of end-of-life cancer care: A systematic review of retrospective cohort studies based on routinely collected data (1990-2011).
Authors: Langton Julia M. , Blanch Bianca , Drew Annabelle , Haas Marion , Ingham Jane M. , Pearson Sallie 
Published: February 2017

111 Background: The last year of life is one of the most resource intensive periods in cancer care. The aim of this systematic review is to synthesize retrospective observational studies examining resource utilization and costs at the end-of-life period in adult cancer patients. The purpose is to examine study methodology and outcomes, with a particular focus on studies using quality indicators. Methods: We searched Medline, Embase, CINAHL, and York Centre for Research and Dissemination (1990-2011). Two reviewers screened titles and abstracts of 14,424 articles and 835 full-text, potentially relevant articles. Inclusion criteria were: English-language; at least one resource utilization or cost outcome in adult cancer decedents with solid tumors; outcomes derived from health administrative data; and an exclusive end-of-life or palliative focus. Results: We reviewed 78 studies examining end-of-life care in over 3.7 million cancer decedents; 55 were from the North America; and 33 published since 2008. We observed exponential increases in service use and costs as death approached. Hospital services were the main cost driver. Palliative services were relatively underutilized, and associated with lower expenditures than hospital-based care. The 15 studies using quality of care indicators demonstrated significant proportions of up to 33% of patients receive chemotherapy or life sustaining treatments in the last month of life; up to 66% do not receive hospice/palliative services. Conclusions: Observational studies using routinely collected health administrative data have the potential to drive evidence-based palliative care practice and policy. Further refinement of quality of care markers will enhance benchmarking activities across health care jurisdictions, providers, and patient populations.
The impact of screening mammography in women age 40-49 as a function of tumor biology.
Authors: Ruckdeschel John C. , Rees William V. , Parkinson Brett T , Belnap Thomas , Rowley Braden D. , Pena Kenneth 
Published: February 2017

113 Background: Mammographic screening for women 40-49 years of age remains controversial based on results from earlier large scale, controlled mammography trials. Methods: From 2002-2006, 871 women aged 40-49 were diagnosed with breast cancer at Intermountain. The charts of all patients without a record of a screening mammogram at Intermountain (n= 436) were reviewed to confirm that they had not had a screening mammogram in the prior two years at any facility (Interval Cancers) and their survival was compared to 435 women who had their cancer diagnosed on a screening exam (Screen Detected). All patients were followed for at least 5 years via the tumor registry. Results: Stage distribution for Screen Detected/Interval cancers was 25.3/6.4% stage 0, 36.8/24.8% stage I, 24.6/35.6% stage II, 6.9/20.4% stage III and 0.5/3.4% stage IV. Overall, 67 patients (7.7%) did not have complete staging data. Overall survival was significantly better (p<.0001) for 40-49 year old women with Screen Detected compared to those with Interval cancers. 702 (79.6%) had ER/PR status recorded (83.5% ER/PR positive). Women with DCIS or LCIS did not have tissue sent for markers. 679 patients (76.9%) had HER2 status recorded (78.8% HER2 neg). Of the patients with both HER2 and ER/PR status recorded 10.4% were “triple negative.” Survival following screening mammography was significantly enhanced for women who were ER/PR positive (p<0.0001), HER2 negative (p=0.0065), or HER2 positive (p=0.0013). Survival was not improved by screening mammography for women who were ER/PR negative (p=0.3818) or for women who were triple negative (p=0.416). Conclusions: A minority of women age 40-49 who develop breast cancer (13%) have biologic features suggestive of aggressive disease and, after 5 years of follow up, they are not benefitted by screening mammography. The remaining 87% are clearly benefitted by screening mammography. Our results suggest that the discrepancies noted in the screening mammography trials in 40-49 year old women may have resulted from population variations in the proportion of women with unfavorable biology. Based in part on these results, we continue to recommend regular screening in the 40-49 year old cohort.
Identifying opportunities to improve quality of cancer care: An evaluation of the use of routine surveillance imaging scans in women with early breast cancer (EBC) treated in Ontario, Canada.
Authors: Enright Katherine , Ghannam Mohammed , Yun Lingsong , Taback Nathan , Booth Christopher M. , Trudeau Maureen E. , Krzyzanowska Monika K. 
Published: February 2017

115 Background: Over use of routine surveillance imaging to detect recurrence in women with EBC was recently identified as one of the top five opportunities to improve the quality of cancer care by the American Society of Clinical Oncology. We undertook a population level assessment of the current practice of surveillance imaging in EBC women treated in Ontario Canada. Methods: Incident EBC patients diagnosed 01/07 – 12/09 in Ontario, Canada were identified from the Ontario Cancer Registry. Patient records were linked deterministically to provincial health care databases to provide comprehensive medical follow-up. Basic (chest x-ray, abdominal x-ray and abdominal ultrasound) and advanced (computed tomography [CT] or bone scans) surveillance imaging scans completed during the first and second year of follow-up (starting 6 months after surgery or upon completion of chemotherapy) were identified. Logistic regression models were used to identify covariates associated with advanced surveillance imaging. Results: 16,981 EBC patients were included in the analysis of which 7,907(46.6%) received chemotherapy. In the first year of follow up care, 8,311 (48.9%) had at least 1 basic imaging test, while 4,916 (29.0%) had advanced imaging. This fell to 45.7% (basic) and 25.1% (advanced) in the second year of follow-up. Bone scans were the most common advanced imaging test (14.5%), followed by CT thorax (10.8%). On multivariable analysis age, stage, the use of chemotherapy and comorbidity were associated with increased use of advanced surveillance imaging (Table). Conclusions: Surveillance imaging was common in the first two years of follow-up for EBC patients. While appropriate for symptom driven investigation, the high rate of advanced imaging scans suggests an opportunity for improvement with the Ontario cancer system. [Table: see text]