bluuebunny/crossref_metadata_2025_split huggingface dataset:
What is the impact of reduction mammoplasty for women undergoing breast-conserving surgery for breast cancer?
Authors: Lin Jolinta Yin-Chu , Bluebond-Langner Rachel , Choi Enid , Cheston Sally B. , Nichols Elizabeth M. , Cohen Randi Jill , Bentzen Soren , Drogula Cynthia , Kesmodel Susan , Bellavance Emily Catherine , Rosenblatt Paula , Tkaczuk Katherine Hanna , Slezak Sheri , Feigenberg Steven J. 
Published: February 2017

49 Background: Reduction mammoplasty (RM) at time of breast conserving surgery (BCS) is an increasingly popular procedure that reduces redundant breast folds and skin toxicity from whole breast irradiation (WBI). However, the tissue manipulation may obscure the lumpectomy cavity (LC) and hinder the ability to deliver a radiation boost to the LC, potentially impacting local control. We studied the impact of RM on acute radiation side effects and the use of LC boost. Methods: From Jan 2012 to Dec 2014, 652 consecutive women with DCIS or Stage I-III invasive cancer were treated with curative intent BCS and WBI at an urban university and 2 community practices. We reviewed the charts on an IRB-approved study with the primary endpoint of ≥ grade 3 radiation dermatitis scored via the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Secondary endpoint was the use of LC boost. Tested variables included age, race, body mass index, menopausal status, multi-focal disease, stage, tumor grade, receptor status, chemotherapy administered, specimen volume, 3D or intensity modulated radiation, fractionation, nodal irradiation, and planning treatment volume (PTV). Student's t-tests and Pearson's chi-square tests were utilized. Results: Forty-three (7%) of 652 patients underwent RM. Larger volumes of tissue were removed from the RM patients (median 366.5 g v 35.3 g, P= 0.0001). No grade 4 toxicities and few (2-3%) grade 3 toxicities were seen, P= 1.00. Narcotic use was similar (4-5%), P= 0.70. A LC boost was used in 476 (73%) patients; RM significantly decreased the use of a boost [16/43 (37%) v 460/609 (76%)], P= 0.0001. RM patients were more likely to have neoadjuvant chemotherapy, stage III or multi-focal disease, higher BMI, nodal irradiation, and conventional fractionation (P< 0.05). Subgroup analysis of the patients with available PTVs (67%) revealed similar volumes (P= 0.16). Conclusions: RM was associated with a decrease in the use of LC boost without significant differences in acute toxicities; however, the result is not surprising given that PTVs were similar. Further investigation is needed to better delineate LCs in patients undergoing RM to increase the use of LC boosts.
Breast cancer in young women: Indian scenario.
Authors: Selvakumar Veda Padma Priya , Garg Shubha , Kumar Rajeev 
Published: February 2017

52 Background: Breast cancer in young women tends to be more advanced at presentation, more aggressive in nature with poorer survival. In this background we sought to study the clinicopathological profile of patients less than 40 years diagnosed with breast cancer at our institute. Methods: Out of the 1,330 patients who underwent surgery from December 2010 to December 2014 in the breast unit at our institute, 211 women were younger than 40. We retrospectively reviewed the clinic-pathological profile of these patients. SPSS 22 was used for statistical analysis and Kaplan Meier graphs plotted. Results: Mean age of patients was 35 years. The stage distribution was Stage 0: 2, Stage I: 9, Stage II: 81, Stage III: 95 and Stage 4: 2. 123 women underwent MRM and 85 breast conservation. On histopathological examination 202 were IDC, 1 ILC, 3 Mucinous Ca and 5 DCIS. 95(45 %) were Grade 3, 54 Grade 2 and 9 Grade 1. 55 patients were TNBC and 57 Her-2-neu positive. 57 underwent NACT while the rest underwent adjuvant chemotherapy, 170 received adjuvant radiation therapy and 122 adjuvant hormonal therapy. Overall survival is 98.9 % and DFS is 91.5 % at mean follow up of 17 months. Conclusions: In contrast to worldwide literature, around 15 % of women with breast cancer presenting to our institute were less than 40 years of age. They presented late with a higher stage, higher grade, and aggressive biology.
Preoperative breast MRI and MR-guided surgery of invasive breast cancers with and without DCIS components.
Authors: Kuhl Christiane K. , Bieling Heribert , Strobel Kevin , Wardelmann Eva , Kuhn Walter , Maass Nikolaus , Schrading Simone 
Published: February 2017

58 Background: DCIS-components of invasive breast-cancers are a major cause for positive margins and reoperations in women undergoing breast-conserving-surgery. We investigated whether breast-MRI, through improved diagnosis of such DCIS-components, combined with MR-guided needle biopsy and pre-operative MR-guided lesion bracketing where appropriate, would help reduce reoperation-rates for invasive breast cancers. Our hypothesis was that with improved diagnosis of local disease extent through MRI and MR-guided surgery, reoperation rates should be low, and should be independent of the presence or absence of a DCIS-component. Methods: Prospective study in two academic breast-centers on consecutive patients with newly-diagnosed invasive breast-cancer. Women underwent breast-MRI in addition to conventional imaging (CI; digital-mammography/breast-ultrasound), and MR-guided needle-biopsy and preoperative MR-guided lesion bracketing where appropriate. Accuracy of breast-MRI for diagnosing DCIS-components was compared with that of CI, stratified by nuclear-grade and relative size of DCIS-components. Surgical outcomes (reoperation and mastectomy-rates) were recorded, stratified by presence or absence of DCIS-components. Results: 593 women were included. Surgical-pathology documented DCIS-components in 139/593 (23.4%) women. Sensitivity of MRI (84.9%) for demonstrating DCIS-components was significantly higher than that of CI (36.7%) (p < 0.0001); over half (51.1%) of DCIS-components were only detected by MRI. The sensitivity advantage of MRI over CI increased significantly with increasing relative size and nuclear-grade of the DCIS-component. Reoperation-rates were equivalent for women with vs. without DCIS-components (10.1% vs. 9.9%); mastectomy rates were 10.8% and 8.1%, respectively. Similar Positive-Predictive-Values were achieved with CI and MRI. Conclusions: Breast-MRI significantly improves depiction of DCIS-components of invasive breast-cancers prior to surgery. Use of breast-MRI and MR-guided surgery translates into low reoperation rates for women with operable invasive breast-cancer, which were similar for women with or without DCIS-components.
The use of one-step nucleic acid amplification (OSNA) and tumor-related factors in the axillary management of breast cancer: A predictive model.
Authors: Banerjee Shramana Mitul , Williams Norman R. , Davidson Timothy Ian , El-Sheikh Soha , Tran-Dang My-annh , Davison Stephen , Keshtgar Mohammed R. 
Published: February 2017

61 Background: Recent trends in surgical practice advocate selective use of axillary nodal clearance (ANC) following sentinel lymph node biopsy (SNB) in the treatment of breast cancer. We aimed to determine the effectiveness of one-step nucleic acid amplification (OSNA) using CK19 mRNA copy number and tumor-related factors in predicting non-sentinel axillary nodal involvement, in order to formulate local guidelines for ANC. Methods: Patients due to have SNB at our institution for invasive breast cancer as well as selected patients with high grade ductal carcinoma in situ with negative assessment of the axilla on pre-operative imaging were included. Alternate slices of each node were sent for assessment by either OSNA or Histopathology. Immediate ANC was performed if OSNA was positive. The CK19 mRNA copy number, the total tumor load (summation of m RNA copy number of positive nodes,TTL), the total nodal status at ANC and tumor characteristics including grade, tumor size and lymphovascular invasion (LVI) for each patient were determined. A model of risk probability was constructed using TTL and tumor related factors. Results: 664 nodes were examined from 425 patients who had SNB performed between 2011 and 2014. After excluding 8 patients who did not meet the study criteria, 648 nodes from 417 patients were included for analysis. The concordance between OSNA and histology was 91.4%; positive predictive value (PPV) and negative predictive value (NPV) was 77% and 97% respectively. Patients with TTL less than 1400 did not have additional non sentinel lymph node involvement. TTL (p<0.01), and presence of LVI (p<0.05) were predictive for additional nodal involvement. The risk model identified all patients with more than 2 positive nodes as requiring ANC. All patients with non-sentinel node metastases at ANC were selected. Conclusions: OSNA is a sensitive and reliable intraoperative method for the detection of sentinel node metastases. Our study has shown it can also be used to predict the presence of non-sentinel metastases. Patients deemed high risk may be offered immediate ANC while axillary surgery in other groups may be omitted or be decision-based on risk stratification.
Impact of selected tumor and patient characteristics on outcome of lymph node-positive breast cancer patients.
Authors: Nagy Ahmed Aly , Ibrahim Hager , Eid Lamiaa , Sayed Fatma , Kelany Mohamed Reda , Jomaa Mona kamal 
Published: February 2017

66 Background: Axillary lymph node (ALN) involvement remains the most significant factor affecting long term survival in breast cancer (BC) patients, and the risk of treatment failure is increased with the higher the number of ALN involvement, The aim of this study was to determine the impact of tumor characteristics; tumor size and number of positive lymph nodes and, ER and HER-2, as well as patient characteristics on DFS of patients with Lymph node positive Breast Cancer Patients who received Adjuvant Treatment. Methods: We retrospectively reviewed data of 704 patients with BC and ALN involvement who received adjuvant treatment in the period between 2010 and 2012. DFS outcomes were estimated with the Kaplan-Meier method and compared using the log rank test to determine. The effect of prognostic factors on BC outcomes. Results: Median age was 50 years (SD±12.024, Range 21-88). About 83.7% of the tumors were IDC,. About 30.4%of the tumors were grade III. Median tumor size was 5 cm (SD± 1.3745, Range 1-7).Median number of positive axillary LN was 4 (SD± 4.987, Range 1-37). Regarding receptor expression; 21.2% were HER-2 +ve, 58.7% were ER +ve and about 30.4 were triple negative. Median DFS was 20 months (SD± 14.511, Range 1-60). Cox regression showed that age, positive ER status and more than 3 ALN involvement had a statistically significant impact on DFS ( p<0.001 for all ), however, Tumor size, HER-2 overexpression, patient menstrual status had no significant effect. ER positive age >50 years was associated with prolonged DFS of 23 months (95%CI=20.641-25.359) versus 19 months (95% CI=17.598-20.402) for age≤50 years (p<0.001). ER positive status was associated with prolonged DFS of 22 months (95%CI=20.290-23.710) versus 17 months (95% CI=14.049-19.951) for ER negative (p<0.001).The group of patients with ≤3 positive dissected LN was associated with statistically significant prolonged DFS of 25 months (95%CI=22.286-27.714) versus 15 months (95%CI = 12.353-17.647) for patients with>3 positive dissected LN (p<0.001). Conclusions: These study indicate that the age, ER status and more than 3 ALN involvement have impact on DFS in Lymph node positive Breast Cancer Patients.
Feasibility of a breast health educational program to increase breast cancer awareness among adolescents and their female relatives in low-income communities.
Authors: Soto Perez De Celis Enrique , Smith David D. , Baltazar-Avalos Edgar , Hurria Arti , Reyes-Bautista Martin A , Gitler-Weingarten Rina , Pavas-Vivas Alba M , Rojo-Castillo Patricia , Sirota-Toporek Max , Mohar Alejandro , Ayala-Gonzalez Mayte , Chaveste-Ramos Viridiana , Cosme-Gonzalez Brenda , Gallegos-Quintana Sofia N , Martinez-Aviles Ana FS , Melendez-Rosas Julia A , Salazar-Moreno Andrea , Chavarri Guerra Yanin 
Published: February 2017

76 Background: Delays in the diagnosis of breast cancer in developing countries are partially related to a lack of knowledge on breast health (BH), particularly in rural communities with poor access to education. We implemented a BH educational program for adolescents from a rural community in Mexico, aimed at increasing knowledge and promoting intergenerational transmission of information from adolescents to their female relatives. Here, we report the results of our feasibility aims, as well as the change in knowledge in the students after the intervention. Methods: In this pilot study, adolescents enrolled in a public rural Mexican middle school were invited to participate in the program. They received age-appropriate, culturally sensitive sessions from expert educators focused on transmitting BH knowledge in their household. Our primary outcome was satisfaction with the content, with 75% approval needed for the program to be considered acceptable. Pre and post true/false tests to evaluate the students’ knowledge were applied. Paired t-test was used to detect changes in knowledge. A p value of < 0.05 was considered significant. Acceptability of the program among the school teachers was assessed. Results: 238 students were invited to participate, of which 126 (53%) provided parental consent and completed the program. Median age was 13.5 years (12-16). 96% (n = 121) of the students considered the sessions very interesting and 99% (n = 124) thought they either learned “a lot” (66%; n = 83) or “some” (33%; n = 41). The pre- and post-test mean proportion of correct answers was 63% (12.5-100%, SD 0.2) and 89% (25-100%, SD 0.12) respectively. A statistically significant improvement in the proportion of correct answers was found for 5 out of 8 questions. 100% (n = 18) of the teachers thought the intervention was acceptable. Conclusions: Our results show that implementing a BH educational program for rural adolescents in low-income communities is feasible and acceptable, and that such a program can increase their knowledge on BH. Our next planned step is to assess intergenerational transmission of the information to the students’ female relatives.
Prognostic impact of tumor-infiltrating lymphocytes (TIL's) and stromal-infiltrating lymphocytes (SIL's) in triple-negative breast cancer.
Authors: Sherwell-Cabello Santiago , Maffuz-Aziz Antonio , Camacho-Ramírez Diego A , Bautista-Piña Verónica , Ríos-Luna Nina P , Labastida-Almendaro Sonia , Rodriguez-Cuevas Sergio 
Published: February 2017

83 Background: Immune response seems to improve outcome in women with Triple-Negative Breast Cancer (TNBC). Recent data suggests that the presence of Tumor-Infiltrating Lymphocytes is an independent factor associated with better prognosis. In this study, we evaluate the prognostic impact of both TIL´s and SIL´s in patients with TNBC. Methods: Data on women diagnosed with TNBC between 2005 and 2013, was collected by retrospectively reviewing at our institute. The rate of intratumoral and/or stromal lymphocytes was evaluated in all hematoxylin and eosin-stained histopathologic sections according to Denkert et al. The five-year disease-free survival (DFS) and overall survival (OS) were compared between groups with the presence or absence of TIL´s or SIL´s. Demographic and clinical characteristics were assessed, variables with a statistical significance between groups were analyzed in a multivariate analysis. Results: A total of 172 patients with TNBC treated at this institution were included with a mean age of 49.8 years. A complete absence of tumor lymphocytes was found in 88 patients while the presence of intratumoral, stromal or both was found in 84 (48.8%). A mean follow-up of 46.12 months showed significantly higher rates of both DFS and OS in women with SIL´s and TIL´s (p = 0.014 and 0.042 respectively) in locally advanced stages (LAS), regardless the rate of infiltrating lymphocytes found [Table 1]. SIL´s are correlated with a better prognosis compared with TIL´s (p = 0.028 and 0.091 respectively). Non-significant differences were found in early stages (p= 0.255). Conclusions: These results show that the presence of SIL´s or TIL´s are strongly associated with higher rates of DFS and OS in LAS, especially when SIL´s are found, suggesting that immunity seems to play a key role regarding the outcome in women with TNBC. Independent of the rate of lymphocytic infiltrate, its presence has a statistical significance. Because it is a feasible and inexpensive test that can be used as a prognostic predictor, we suggest assessing both SIL's and TIL's in histopathologic biopsies of patients with TNBC. [Table: see text]
Documenting the impact of alopecia in breast cancer: Assessing the performance of the alopecia patient assessment (APA) questionnaire.
Authors: Piault-Louis Elisabeth , Petersen Jennifer , Gable Jonathon , Hudgens Stacie 
Published: February 2017

84 Background: The APA questionnaire was developed to document the emotional and social burden of alopecia experienced by breast cancer patients undergoing therapy. Content, clarity, and relevance of the measure were assessed by patients undergoing chemotherapy; the instructions, recall and APA items were found to be clear and relevant (Mathias et al., 2013). The next phase consists of documenting the performance of the APA measure as an evaluative tool for use in clinical research. Methods: The APA was implemented in a US observational multicentre, prospective, longitudinal cohort of 497 patients with HER2+ metastatic breast cancer (SystHERs) with a mixed modality for data collection (first paper and then transition to ePRO). The APA was collected at baseline and every 90 (± 15) days. The psychometric analysis was adapted based on the study design and on the manifestation of alopecia (onset, duration) in this population. The select set of psychometric tests included quality and pattern of completion, construct validity and reliability. Results: Quality of completion as measured by correct scale use was 85.2% (compliance was 95.6%). Discrimination indices were above the 0.3 threshold for each item on the APA and ranged from 0.59 to 0.82 at baseline. The scale demonstrated good internal consistency as assessed by 0.88 Cronbach alpha. Weighted kappa agreement of 0.49 was observed between the APA and the ‘I am bothered by hair loss’ item (B5) of the Functional Assessment of Cancer Therapy-Breast (FACT-B) measure. Conclusions: The APA is a valid and reliable measure able to discriminate change in patients’ daily functioning resulting from an alopecia event related to treatment for breast cancer. Results support the use of the APA in clinical research to better characterize the impact of alopecia on patients’ lives.
A novel breast cancer screening platform: An epitope-based biomarker coupled to electrochemical sensor.
Authors: Paiva Maia Yara Cristina , Araújo Thaise Gonçalves , Franco Diego Leoni , Capparelli Fausto Emilio , Ribeiro Vanesssa Silva , Fujimura Patrícia Tieme , Calábria Luanda , Paiva Carlos Eduardo , Santos Donizeti Wilian , Franco Juliana Almeida , Madurro João Marcos , Brito-Madurro Ana Graci , Freitas Renata Nascimento , Goulart Luiz R. 
Published: February 2017

9 Background: The subtractive proteomic selection technology called Phage Display (PD) has been extensively used by our group in the discovery of high affinity ligands to target tissues and molecules. We have selected specific ligands against IgG purified from BC tissues, which was successfully coupled to an electrochemical sensor to detect the tumor-specific immune response. Methods: After PD selections, all immunoreactive peptide ligands were further characterized by DNA sequencing, in vitro translated and submitted to bioinformatic analyses. Further validations were performed by ELISA. We then used one synthetic peptide (SF4) for the construction of an immunosensor, which was applied to patients and control samples for final validation. Electrochemical impedance spectroscopy (EIS) was performed. Results: We have selected the F4 peptide for final validation and sensor construction due to its capability of detecting IgG in the peripheral blood and the excellent ELISA ratio BC:BBD, discriminating more than 70% of BC patients. The synthetic peptide reached a good precision in BC diagnosis (68%), but surprisingly, the selected F4 clone presented the highest sensitivity and specificity, (77.8% and 85.7%, respectively), suggesting that it can be used as a diagnostic reagent for early BC screening prior to imaging and pathological analyses. The electrochemical sensor that was built with the epitope-based peptide discriminated all IgG from BC and healthy individuals. Results with the EIS sensor demonstrated that the presence of (SF4) peptide IgG generated higher resistivity (-Z ') compared to the system containing only the peptide or the control sera. This is justified by the fact that with the immobilized biological peptide layer was correctly conjugated with the IgG forming an antigen: antibody complex that led to an increased resistance to the charge transfer system, producing a decrease in electron transfer between the iron-coupled / ferricyanide redox and the electrode surface. Conclusions: An electrochemical sensor using an epitope-based biomarker was developed, which allows for the first time BC screening using a very simple platform that could be an important auxiliary tool to mammography imaging.
Retrospective review of symptoms and palliative care interventions in women with advanced cervical cancer.
Authors: Kim YuJung , Munsell Mark F. , Park Ji Chan , Meyer Larissa , Sun Charlotte C. , Brown Alaina J. , Bodurka Diane C. , Williams Janet L. , Chase Dana Meredith , Bruera Eduardo , Ramondetta Lois M. 
Published: February 2017

104 Background: Symptoms reported by women with cervical cancer (CCx) include pain, fatigue, lymphedema, sexual dysfunction, proctitis, cystitis, constipation and diarrhea. The objective of this study was to delineate and measure the symptom distress experienced by patients with advanced CCx at the time of palliative care (PC) referral. Methods: A total of 156 advanced CCx patients were referred to PC from 2010 to 2012. Of these, 88 patients had completed the Edmonton Symptom Assessment System (ESAS) and were included in the analysis. Descriptive statistics were used to summarize the data. Results: At the time of presentation mean age was 45 (25-76), 47% were Caucasian, 18% African American, and 33% Hispanic. Fifty-one percent were married; 64% had no advance directives; 75% had recurrent disease. Clinically significant symptoms (defined as ESAS scores ≥ 4) were pain (81%), anorexia (72%), a poor feeling of well-being (70%), fatigue (69%), and insomnia (54%). The chief complaint was pain in 94% of patients. According to the PC specialists’ assessment, pain (96%), emotional distress (77%), and constipation (50%) were predominant symptoms. Various palliative care interventions including opioids, laxatives, and expressive supportive counseling were provided. The median time from advanced cervical diagnosis to PC consultation was 6.0 months (95% CI 5.0-7.8) and the median survival after first PC visit was 4.8 months (95% CI 3.4-6.2). Clinically significant symptoms including nausea, depression, anxiety, and feeling of well-being showed significant improvements at follow-up visits. Conclusions: More than half of patients with advanced CCx were significantly burdened with pain, anorexia, poor feeling of well-being, fatigue, insomnia, and constipation at the time of PC referral. Clinically significant symptoms showed improvements at follow-up visits. In patients with significant symptom distress, early PC involvement may be important to improve quality of life.