bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relationship of breast density, BMI, and menopausal status in mammography and MRI.
Authors: Chun Jennifer , Refinetti Ana Paula , Leite Ana Klautau , Schnabel Freya Ruth , Hochman Tsivia , Moy Linda ,   The Breast Surgery Section of NYULMC
Published: February 2017

36 Background: Mammographic breast density (BD) is associated with a 4- to 6-fold increased risk for developing breast cancer. A previous study has shown that background parenchymal enhancement (BPE) as measured on MRI can be correlated with breast cancer risk. Being overweight or obese is also an established risk factor for breast cancer. The purpose of this study was to evaluate the relationship between BD, BPE, FGT (assessment of fibroglandular tissue with contiguous MR images), and BMI in pre- and post-menopausal women. Methods: The Breast Cancer Database at NYU Langone Medical Center was queried and a total of 187 women had completed both screening mammograms and MRIs. Variables of interest included BD, BPE, FGT, BMI, and menopausal status. BD was defined by ACR classifications 1-4. FGT was assessed on a similar scale 1-4. BPE was categorized as minimal, mild, moderate, or marked. BMI (kg/m2) was grouped as underweight (≤18), normal (19-24), overweight (25-29), and obese (≥30). Statistical analyses were performed using Spearman Correlation Coefficients and Cochran Mantel Haenszel tests. Results: The median age in our cohort was 51 years (range 22-87 years). The majority were Caucasian (71%) with early stage breast cancers (75%). There was no correlation between BD and BPE (r=0.132) and a weak correlation between BPE and FGT (r=0.312). However, there was a strong positive correlation between BD and FGT (r=0.733). After adjusting for menopausal status, these correlations remained the same. When we stratified by BMI, we found the strongest positive association between BD and FGT among women with BMI≥25 (r=0.715). Conclusions: In our cohort of newly diagnosed breast cancer patients, BD and BPE were not correlated, even after adjusting for menopausal status. This implies that BD and BPE may represent different characteristics of breast tissue and may have different implications. We found a strong correlation between FGT and BD. This association was strongest in women who were overweight and obese. FGT is a more objective and quantitative measurement of breast density and may be more useful in quantitative breast cancer risk assessment.Further studies are necessary to determine if BPE and FGT are independent risk factors for breast cancer.
Prophylactic mastectomy: The role of risk aversion.
Authors: Kruper Laura , Bhatt Meghana , London Karin , Henderson Katherine , Vito Courtney , Yim John H. , Chen Steven L. 
Published: February 2017

39 Background: The rate of women undergoing contralateral prophylactic mastectomy (CPM) has increased significantly over the past decade. Large population studies have examined factors associated with the use of CPM. We studied the factors associated with CPM within our institution. Methods: A 30-question validated survey was mailed to all patients who underwent mastectomy from 1972 to 2011 and are currently receiving treatment or surveillance at our institution. Responses were analyzed to determine the factors predictive of CPM. Multivariate logistic regression methods were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for possible associations between exposures (including age at surgery, marital status, education, race, family history of breast cancer, and BRCA genetic mutation (BRCA mutation) and likelihood of CPM. Results: 368 of 691 surveys were returned. Younger age was statistically significantly associated with increased likelihood of CPM (p-trend < 0.001). Caucasian patients were 4 times as likely to undergo CPM compared to non-Caucasian patients (OR 3.95, 95%CI=1.89-8.23). Patients with a family history of breast cancer were 3 times as likely to undergo CPM as compared with those with no family history (OR 3.38, 95%CI=1.4-8.16). Married patients were also 3 times as likely to undergo CPM compared with unmarried patients (OR 3.00, 95%CI=1.39-6.52). Reporting a BRCA mutation was highly correlated with younger age, positive family history, higher level of education and marital status. Conclusions: When faced with the decision of whether to undergo a CPM, patients must assess both objective future risks and subjective feelings about those risks. These results suggest that the decision to undergo CPM is associated with known risk factors for the development of contralateral cancer such as younger age and positive breast cancer family history. In addition, multiple demographic factors including Caucasian race and married status increased the likelihood of choosing CPM. This may relate to social support as well socioeconomic status. Further exploration into societal factors that impact CPM use is warranted.
Incidence and survival among female breast cancer patients in the United States: An analysis from national registry data 2000-2009.
Authors: Huang Huan , Lang Kathy , Namjoshi Madhav , Federico Victoria , Menzin Joseph 
Published: February 2017

41 Background: This study evaluated incidence and survival among breast cancer (BC) patients in the United States during 2000-2009, by cancer stage. Methods: The Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat Database was used for this analysis. SEER is an epidemiologic surveillance system consisting of population-based tumor registries designed to track cancer incidence and survival in the US. The registries routinely collect information on incident cancer cases in areas that represent approximately 25% of the US population. We evaluated age-adjusted (to the 2000 US standard population) incidence (number of cases per 100,000 population), and survival among newly diagnosed female breast cancer patients during 2000-2009, by cancer stage (localized, regional, distant and unknown/unstaged). Results: A total of 547,086 cases of female BC were reported to SEER during 2000-2009. Localized BC (average incidence rate during 2000-2009 of 77.6 cases per 100,000 population) was the most common stage among newly diagnosed patients, followed by regional (39.7), distant (6.2), and unknown/unstaged BC (3.2). Incidence rates decreased for regional (average annual change -1.3%), localized (average annual change -0.2%), and unknown/unstaged (average annual change -7.2%) BC and increased for distant BC (1.4%). One-year (five-year) survival rates averaged over 2000-2009 (2000-2005 for five-year) were 100% (97%) for localized BC, 98% (82%) for regional BC, 65% (22%) for distant BC, and 80% (55%) for unknown/unstaged BC. Both one-year and five-year survival rates were steady during this period. Conclusions: Based on US population-based registry data, the incidence and survival for breast cancer were relatively steady for localized, regional and distant BC over the most recently-available 10-year period. There is considerable room to improve survival rates for patients with regional and distant BC. Further studies evaluating the survival experience of later-stage BC patients based on other key factors, such as age, race, treatment patterns, and tumor characteristics (e.g., ER/HER2 status) are warranted.
Uptake of surgical prophylaxis in underserved, ethnic minority BRCA mutation carriers.
Authors: Macdonald Heather R. , Ricker Charite , Opper Neisha , Wong Grace G. 
Published: February 2017

45 Background: Little data exist regarding uptake of surgical prophylaxis in the underserved clinical setting. This study describes acceptance of surgical prophylaxis amongst BRCA mutation carriers in a primarily Hispanic (60%) and Asian (15%) medically underserved population. Methods: An IRB-approved retrospective chart review of deleterious or suspected deleterious BRCA mutations carriers extracted clinicopathologic data, surgical history, and family cancer history. Patients younger than the recommended age of prophylaxis, undergoing active therapy, or with metastatic cancer were excluded. Results: Forty-six carriers of known or suspected deleterious BRCA mutations expressed decisions regarding prophylactic bilateral salpingo-oophorectomy and/or mastectomy. Thirty nine women identified themselves as Hispanic, 32 from Mexico. Three women were Asian, 2 African American and 1 Middle Eastern. Forty-two patients were previously affected by cancer, with a mean age at first cancer diagnosis of 42. Four patients were unaffected. Thirty-two women with a previous cancer diagnosis accepted prophylaxis: 11 RRM plus RRSO, 10 RRSO only, 11 RRM only. Three unaffected women underwent RRSO only. None of the unaffected patients chose RRM only. Presence of an affected family member younger than 35 at time of cancer diagnosis correlated with uptake of prophylactic surgery (18 accepted vs. 1 declined; p=0.01). There was a trend towards acceptance of prophylaxis among women with earlier TNM stage that did not reach statistical significance. Conclusions: More than 50% of eligible BRCA mutation carriers in this medically underserved population underwent RRM, RRSO, or both. Young family members affected with cancer positively influenced acceptance of surgical prophylaxis. [Table: see text]
Comparison of immunohistochemistry (IHC) and quantitative RT-PCR: ER, PR, and HER2 receptor status.
Authors: Christopherson Cindy , Chang Monica , Eberhard David A. , Sninsky John J. , Anderson Steven M. , Wang Alice M. , Kwok Shirley , Calhoun Benjamin 
Published: February 2017

47 Background: IHC is the present standard for measuring estrogen (ER) and progesterone receptor (PR) expression for breast cancer. However, the lack of concordance between testing laboratories and the critical patient treatment decisions made with results prompted ASCO/CAP to recommend guidelines and proficiency testing requirements to ensure accuracy. Quantitative RT-PCR (qRT-PCR) is an alternative method for ER and PR testing and while concordance with IHC has been reported, additional testing is merited. This study compares ER, PR and HER2 status determined by IHC and qRT-PCR. Methods: FFPE tissues of ER(+) tumors collected and tested at the Blumenthal Cancer Center were studied. Expression levels of ESR1, PGR, and ERBB2 were determined by a multiplex qRT-PCR TaqMan assay and by the Oncotype Dx assay. Pre-established cutpoints were used to determine positivity. Only samples with qRT-PCR and corresponding IHC data were used, resulting in 144 ER, 128 PR, and 107 HER2 comparisons. ESR1 and PGR expression levels determined by the two qRT-PCR assays were also compared. Results: Of the144 IHC ER(+) samples, 142 were positive and 2 were negative by both qRT-PCR assays. All 120 IHC PR(+) samples were positive by both qRT-PCR assays. Of the 8 IHC PR(-) samples, 5 were negative and 3 were positive by both qRT-PCR assays. Of the 107 IHC HER2(-) samples, all but 2 were negative by qRT-PCR. One sample was positive by both qRT-PCR assays; one was positive by Oncotype Dx only. The expression levels determined by the qRT-PCR assays showed good correlation for ESR1 (r=0.85) and PGR (r=0.9). Conclusions: Concordance between qRT-PCR and IHC was 98.6% for ER and 97.7% for PR. Except for a single HER2 determination, there was 100% concordance between the two qRT-PCR assays. The discordant sample was HER2 (+) by multiplex qRT-PCR and “equivocal” by Oncotype Dx. Excellent correlation was also observed in the mRNA expression levels. The absence of HER2(+) and ER(-) samples are limitations of this study. These results suggest that qRT-PCR is a promising alternative method to IHC for determining hormone receptor status. Additional testing of samples with endocrine therapy outcomes including ER(-) samples would be beneficial.
The follow-up sought after diagnosis of a BRCA-1 or BRCA-2 mutation.
Authors: Chambers Karinn Marie , Armstrong Edward Joey , Flippo Teresa , Sarantou Terry , Greene Frederick L. , Brick Wendy , White Brook , Amacker-North Lisa , White Richard L. 
Published: February 2017

57 Background: A woman with a known BRCA mutation has a lifetime risk for the development of breast cancer of up to 80%. Carolinas Medical Center cares for approximately 600 breast cancer patients annually with genetic testing offered to those patients whose history meets commonly established criteria. This study seeks to document the follow-up patients with BRCA mutations most commonly undertake at our facility. Methods: This study is a retrospective review of all patients who underwent genetic testing at Carolinas Medical Center and who were found to be positive for a mutation in the BRCA gene. Since 1996 our genetics group has tested 2056 individuals, of these 246 (12%) carry a mutation of the BRCA-1 and/or BRCA-2 gene. 102 of these 246 patients (41%) had no evidence of cancer at the time of genetic testing. 144 of these 246 patients (59%) did carry a diagnosis of cancer at the time of genetic testing. Results: Of the 246 patients who tested positive for a deleterious mutation in the BRCA gene 204 (83%) had documented follow-up after their diagnosis. 140 of those 204 patients (69%) had documented initial follow-up appointments to discuss their diagnosis. 63 patients of the 140 (45%) who sought initial consultation met with a surgeon. 73 of these 140 patients (52%) had their initial consultation with a Gyn/Oncologist. 3 patients had their initial consultation with a medical oncologist and the remaining patient with their primary care physician. Documentation was available for 131 of the 204 patients (64%) in regards to follow up related to their risk of breast cancer development, 129 of those patients were being followed by a high risk breast provider. 126 of the 204 patients (62%) with long term follow-up were being followed by a Gyn/Oncologist secondary to their increased risk for ovarian cancer. This data includes all patients regardless of the decisions they made concerning surveillance or prophylactic surgery. Conclusions: The majority of the patients at Carolinas Medical Center who have tested positive for a BRCA mutation have sought long term follow-up with both a high risk breast provider and a Gyn/Oncologist in regards to their increased risk for the development of both breast and ovarian cancer.
Acute care utilization (ACU) among women receiving adjuvant chemotherapy for early breast cancer (EBC).
Authors: Enright Katherine , Grunfeld Eva , Yun Lingsong , Moineddin Rahim , Dent Susan Faye , Eisen Andrea , Trudeau Maureen E. , Kaizer Leonard , Earle Craig , Krzyzanowska Monika K. 
Published: February 2017

65 Background: Adjuvant chemotherapy is considered standard care for patients with lymph node (LN) positive and high risk LN negative EBC. While toxicities of chemotherapy are documented in clinical trials, the impact of toxicities on ACU at a population level is unknown. We undertook a population based study of ACU in patients undergoing adjuvant chemotherapy for EBC compared with controls. Methods: All EBC patients diagnosed 01/07 – 12/09 in Ontario, Canada, were identified from the Ontario Cancer Registry. Pt records were linked deterministically to provincial healthcare databases. All patients received ≥1 cycle of adjuvant chemotherapy. EBC cases (n = 4,718) were matched to non-cancer controls (n = 4,718) on age and geographic location. ACUs (emergency room or hospitalizations) within 30 days of chemotherapy were identified. If the primary reason for visit was a common toxicity of chemotherapy, the visit was considered chemotherapy associated (CA). All cause and CA visits were compared between cases and controls. Logistic regression models were used to identify covariates associated with ACU. Results: ACU was significantly higher in EBC pts compared with controls for both all cause (42.1% vs 9.1%, p<.001) and CA (30.7% vs 2.4%, p<.001) visits. Fever was the most common CA toxicity (22.9% vs 1.2%, p<.001). Taxanes were significantly associated with increased ACU compared with anthracycline only. Conclusions: ACU is common among EBC receiving chemotherapy and significantly higher than among controls. Interventions aimed at mitigating CA toxicity, particularly with the use of taxanes may reduce ACUs. [Table: see text]
An overview of breast medical oncology documentation through the Florida Initiative on Quality Cancer Care (FIQCC): The Phase II 2009 results.
Authors: Gray Jhanelle Elaine , Laronga Christine , Siegel Erin , Lee Ji-Hyun , Fulp William J. , Fletcher Michelle , Jacobsen Paul B. 
Published: February 2017

73 Background: Following feedback provided to each site of their 2006 compliance results and enactment of improvement plans, the FIQCC re-evaluated the quality of documentation of specific quality indicators for breast cancer in the medical records of 11 participating FIQCC sites in 2009. Quality indicators were based upon ASCO, ACOS, NCCN, and expert-consensus panel recommendations. The findings were compared with 2006 results. Methods: Chart reviews from the same 2006 FIQCC sites for pre-specified Breast Medical Oncology quality indicators were performed by trained abstractors on patients first seen in 2009. The indicators included: clinical trial decisions, consent for treatment, definitive surgery after neo-adjuvant chemotherapy, published regimen dose plan, and chemotherapy selected from a published list. Statistical comparisons of 2006 and 2009 data were performed using the Pearson chi-square exact test based on Monte Carlo estimation. Results: 636 pts (99% female) [average age of 60.7 years (range 24-94)] were evaluated, with the 2009 number of cases per site ranging from 59 to 97. Significant improvements in treatment planning and administration were seen over time when comparing 2006 (n=602) to 2009 charts. This included signed chemotherapy consent (2006: 74%; 2009: 81% p=0.047), definitive surgery after neo-adjuvant chemotherapy (2006: 88%; 2009:100% p=0.017), and the planned dose being from a published list (2006: 74%;200: 84% p=0.020). Strides were also made in documenting that patients were evaluated for clinical trial enrollment (2006:13%; 2009: 21% p=0.001). Declines were seen in chemotherapy selections from an approved list (2006:94%; 2009: 82% p<0.001). Further investigations into this finding are underway and will be presented at the meeting. Conclusions: With the adoption of specific quality indicators, evaluation of a specified number of cases across multiple practices, and then providing feedback on documentation to providers and medical teams, here we demonstrate that significant improvements in medical charting and thus quality cancer care can be made.
Indirect costs associated with metastatic breast cancer.
Authors: Wan Yin , Gao Xin , Mehta Sonam , Wang Zhixiao , Faria Claudio , Schwartzberg Lee Steven 
Published: February 2017

74 Background: To estimate indirect costs (sick leave [SL]/short-term disability [STDI]) associated with metastatic breast cancer (MBC) compared to early stage breast cancer (EBC)/a general population without cancer (controls). Methods: The MarketScan Health and Productivity Management database (2005-2009) was used. Adult BC patients eligible for employee benefits of sick leave and/or STDI were identified. Difference in SL and STDI days was calculated between MBC patients and their propensity score matched EBC cohort or controls during a 12-month follow-up period. Indirect costs due to SL/ STDI were estimated by multiplying leave days with daily wages (2011 Bureau of Labor Statistics). Generalized linear model was used to examine the impact of MBC on indirect costs and potential cost drivers. Results: A total of 139 MBC/432 EBC/820 controls and 432 MBC/1,552 EBC/4,682 controls were eligible for SL and STDI respectively (not mutually exclusive), with a mean age of 49/51/50 years. After matching by age, payer type, region, index year and comorbidities, no difference was found in SL days between MBC and EBC cohorts. MBC patients had more STDI days and related cost than EBC patients and controls, with higher total indirect costs (SL + STDI). MBC patients also had more SL days/cost than controls (Table). Controlling for covariates, MBC patients incurred 47% more STDI cost vs. EBC patients (p=.009). Older patients (p=.002), non-HMO payers (p<.05), or patients not receiving chemotherapy during follow-up (p<.001) were associated with lower STDI cost. MBC patients also incurred 56% (p=.01) more SL cost and 11.6 times (p<.001) more STDI cost than controls. Conclusions: Productivity loss and associated costs in MBC patients are substantially higher than EBC patients or general population. These findings underscore the economic burden of MBC from US societal perspective. [Table: see text]
The impact of 5HT3RA antiemetics on the incidence of chemotherapy-induced nausea and vomiting (CINV), treatment adherence, and delay of therapy in early-stage breast cancer (BC) patients treated with moderately/highly emetogenic chemotherapy (MEC/HEC).
Authors: Rugo Hope S. , Palli Swetha , Grabner Michael , Quimbo Ralph A. , Knoth Russell L. 
Published: February 2017

75 Background: The effectiveness of 5-HT3receptor antagonists (5HTs) for the prevention of CINV is well established. Less is known about the impact of these drugs on chemotherapy adherence (AD) and preventing delayed therapy (DT). We examined the impact of palonosetron (PAL) vs. other 5HTs on CINV incidence, treatment AD and DT in early-stage BC. Methods: An observational nested case-control study was conducted using the HealthCore Integrated Research Database (HIRD). Female patients (pts) were identified by their first claim for IV MEC/HEC between 1/1/02 and 10/31/10 (index). Inclusion criteria were: ≥ 12 months health plan eligibility pre-index (baseline) and ≥ 6 months post-index (follow-up); ≥ 1 baseline claim for BC; no claim for secondary or multiple primary neoplasms; and ≥ 1 claim for 5HT during follow-up. CINV was defined using ICD-9 codes for nausea, vomiting, or related events, and use of rescue medications for 5 days after MEC/HEC. AD was defined as receiving the requisite number of cycles within the recommended NCCN timeframe. DT was defined as exceeding 2x the NCCN-recommended cycle length between MEC/HEC claims. Outcomes were assessed using descriptive analysis and multivariate logistic regression, controlling for demographics, baseline medical conditions, and index therapy. Results: We identified 682/696 [MEC] and 1,782/3,103 [HEC] pts who received PAL or other 5HTs, respectively. For PAL vs. 5HT, 33.7% vs. 49.7% (OR: 0.51; 95% CI 0.41-0.65; p<0.01) had CINV (mean 0.27 vs. 0.61 events/cycle) in the MEC group; in the HEC group, 27.3% vs. 35.7% (OR: 0.61; 95% CI 0.53-0.7; p<0.01) had CINV (mean 0.21 vs. 0.34 events/cycle). PAL users delayed MEC at a lower rate than those using other 5HTs (2.6% vs. 8.2%; OR: 0.37; CI 0.21-0.65; p<0.01) but had similar AD (41.8% vs. 37.2%; OR: 1.2; CI 0.95-1.5; p=0.12). No differences in AD or DT were found among pts on HEC. Conclusions: Among early-stage BC pts initiating a MEC or HEC agent, PAL was associated with fewer CINV events, a lower (MEC) or equal (HEC) rate of delayed therapy, and equal adherence compared to other 5HTs.