bluuebunny/crossref_metadata_2025_split huggingface dataset:
Behavior of breast cancer in young women: A Surveillance Epidemiology and End Results (SEER) database review.
Authors: Tesfaye Anteneh A. , Mozayen Mohammad , Morariu Ioana , Eilender David S. 
Published: February 2017

6 Background: Advanced age is a major risk factor for breast cancer in women. Small sized studies have reported variable outcome of breast cancer in young women. Our study was done to evaluate tumor characteristic and cancer specific survival among young women. Methods: The 1973-2009 SEER database was reviewed for women with breast cancer diagnosed between 2004 and 2009. Patients were grouped by age into: A (≤35 years), B (36-50 years) and C (>50 years). Age, ethnicity, staging, lymph nodes status, micrometastasis in negative lymph nodes, tumor size, tumor grade, hormone receptor status were extracted. Data and survival were analyzed using chi square, Kaplan-Meier, Life table, and Cox proportional hazard model. The primary outcome was 5-year cancer-specific survival. Results: A total of 248,280 patients were included in the study, group A, B and C making 2.8%, 25.5% and 71.7% of study subjects respectively. The median tumor size was 2.4, 1.9, and 1.6 cm in groups A, B and C respectively (p=0.0001). Positive lymph nodes were seen in 52.5%, 43% and 34% in groups A, B and C respectively (p=0.0001). Regional disease was seen in 47.5%, 39.5% and 29.9% in groups A, B and C respectively (p=0.0001). Higher Grade histology was seen in 63.5%, 44.3% and 33.8% in groups A, B and C respectively (p=0.0001). ER-PR negative were found in 42.1%,26.4%, 22.6% of Groups A, B and C respectively (p=0.0001). Five year cancer specific survival was 82%, 89%, 86% in groups A, B and C respectively (p=0.0001). Independent prognostic factors are given in the table. Conclusions: Breast cancer is uncommon among young women (age <35). Compared to other age groups, breast cancer in young women presents with bigger tumor, higher nodal positivity, an advanced stage, higher tumor grade, higher hormone receptor negativity, and worse 5-year cancer-specific survival. [Table: see text]
Socioeconomic and geographic disparities in immediate reconstruction after mastectomy in the United States.
Authors: Wexelman Barbara A. , Ma Xiangji , Estabrook Alison , Ma Ayemoethu 
Published: February 2017

63 Background: Disparities are found in breast cancer diagnosis, treatment, and outcomes. We seek to determine if socioeconomic and geographic disparities exist nationally in immediate reconstruction type after mastectomy. Methods: This retrospective study compares socioeconomic and geographic features for 14,986 women who underwent mastectomy in 2008 using the Nationwide Inpatient Sample (NIS), an all-payer stratified statistical sample of all US hospital discharges. Statistical analysis was performed to understand variations between three groups: patients without reconstruction (NR), patients who underwent breast implant/ tissue expander reconstruction (TE), and patients with advanced reconstruction techniques such as free or pedicled flaps (FLAP). Results: The majority of women (63%) had no reconstruction (NR), while 25.3% had TE and 12% underwent FLAP. Compared to patients with NR, women with TE or FLAP were younger (64.9 years vs. 51.3 & 51.1 years, p<0.001), had fewer chronic conditions (3.85 NR vs. 2.60 TE & 2.54 FLAP conditions, p<0.001), and higher mean hospital charges ($22,300 NR vs. $42,850 TE and $48.680 FLAP, p<0.001). The length of stay was longest for FLAP patients (3.62 days) compared to the NR group (2.02 days) and the TE group (1.90 days), p<0.001. Caucasians were disproportionately more likely to undergo both TE and FLAP compared to Black and Hispanic women. Patients with FLAP reconstruction were more likely to have private insurance (81.1%), than TE (80.1%) and NR (35.2%) while women without reconstruction were more likely to have Medicare and Medicaid insurance. Compared to NR, those undergoing reconstructions were more likely to live in zip codes with higher average incomes and more likely to live in or near a major city (>1 million people). The states with the highest rates of FLAP reconstruction are New Hampshire (52.9%), Kansas (22.6%), New York (20.9%), and New Jersey (20.0%). Conclusions: This is the first national study analyzing patients of all insurance types and regions of the US to show statistically significant disparities in the type of immediate reconstruction after mastectomy based on age, race, insurance type, and geographic location.
Vascular toxicities of endocrine therapy in early-stage breast cancer: Encouraging observations in a nontrial setting.
Authors: Dent Susan Faye , Crawley Freya L. , Graham Nadine A. , Campbell Michelle M. 
Published: February 2017

68 Background: Endocrine therapy (ET) is the standard of care for postmenopausal (PM) women with early stage breast cancer (EBC). Studies suggest higher risk of vascular toxicities (VT) on aromatase inhibitor (AI) therapy. We report incidence/discontinuation rates of VTs in a cardiac clinic. Methods: PM women with hormone receptor positive EBC treated with ET (tamoxifen (T) ± AI) at Ottawa Hospital Cancer Center 01/99-2/06. Data included: demographics, vascular co-morbidities (VCM), ET, duration, VTs. Results: 626 pts, median age 59 years (r: 30-92), median follow-up 98 months (m), stage: I (196 pts), II (341 pts) III (89 pts) EBC. Majority (52.5%) pts had VCM at ET initiation; hypertension (HTN) (36%), hyperlipidemia (HYLP) (17%), coronary disease (12%), thrombosis (9%), angina (6%) TIA (6%). Treatment discontinued due to VT 3x more with T vs. AI. Most common VTs: edema, arrhythmias (ARR), cardiovascular (CVS) event, and HYLP. With Letrozole and T, previous VCM significantly increased risk of developing VT (chi-square: P=0.022 and 0.009). Time to develop VT shortest for T and exemestane. Previous VCM did not affect this interval. Longer exposure to T correlated with higher VT rate (t-test: p=0.046) not seen with AIs. Exposure to multiple AIs associated with higher VT rate (t-test: p=0.009). Conclusions: This cohort study reports similar VT rates with AI therapy as reported in the literature. T was associated with higher discontinuation rates (10.5%) due to VTs compared to AIs (2.8-3.3%). Longer duration of AI therapy was not associated with increased risk of VTs. These encouraging results reflect the real-life experience of women exposed to ET. [Table: see text]
Contralateral breast cancer: Effect of stage on survival after unilateral breast cancer.
Authors: Uyeno Lori , Behrendt Carolyn E. , Kruper Laura , Chen Steven L. , Vito Courtney 
Published: February 2017

69 Background: Contralateral breast cancer (CBC) is the most common malignancy among breast cancer survivors. We investigated the impact of CBC on overall survival (OS) after unilateral primary breast cancer (UPBC) in women treated with mastectomy. Methods: Using the Surveillance Epidemiology End Results registry, we identified women age 25-80 diagnosed 1998-2006 with UPBC stage 0-III, treated with mastectomy and free of CBC at 1-year landmark. Subjects were split into test and validation samples. Follow-up continued until the earliest occurrence: death, end of 2008, or age 85. Primary risk factor was incident CBC, a time-dependent variable categorized as advanced-stage (IIB-IV), early-stage (0-IIA), or none. Proportional hazards regression adjusted for primary tumor characteristics, treatment including contralateral prophylactic mastectomy (CPM), demographics, and aging. Results: Subjects (n= 109,411, age 53.7[+12.7] years at UPBC diagnosis) were followed median 51 months. Most UPBC were early stage (63%), moderately/poorly differentiated (78%), ER+PR+ (52%). Few (9.8%) women underwent CPM at primary diagnosis. Incident CBC (n=867, 0.79%) was diagnosed median 23.5 (95% CI 1.2-72) months beyond the 1-year landmark. Test and validation samples did not differ. Only CBC of stage IIB-IV increased mortality; early stage CBC had no effect on OS. Among CBC cases, advanced stage was independently associated with aggressive UPBC (more positive nodes; larger tumor; greater extension), African-American race, and shorter time from UPBC. Conclusions: Among women who undergo mastectomy +/-CPM for UPBC, few develop CBC, which impacts survival only when diagnosed at advanced stage. Efforts to improve survival after UPBC should emphasize earlier detection and prevention of advanced-stage CBC, especially in African-American women and women with more aggressive UPBC. [Table: see text]
Web-based standard-regimen selection (SRS) and cancer-care registry (CCR) systems of a nationwide network in Japan: An attempt to improve breast cancer treatment.
Authors: Sato Kazuhiko , Shinozaki Nobuaki , Iwai Masaru , Mizuno Yoshio , Shimoyama Rai , Takahashi Noriyuki , Niitsu Yoshiro 
Published: February 2017

76 Background: Tokushukai group has a nation-wide network of 67 affiliated hospitals, and has started an “oncology project” to improve the quality of cancer care using web-based SRS and CCR systems. Methods: Every institution has been introduced the same electric-medical-record (EMR) to share the unified code to order chemotherapy regimens, and patient data could be collected on a database in the central office. 141 recommended regimens for 15 types of solid tumor have been approved in the cancer committee consisting of working-group and program-evaluation members. In breast cancer, 31 recommended regimens (7 for adjuvant and 24 for metastatic settings) were selected from the NCCN guidelines and approved by the committee. Not only recommended but also non-recommended regimens have their own specific codes in EMR, and the patterns of care in the selection of chemotherapy regimen were examined. Results: In 2011, 21 of 67 hospitals utilized these systems. 71.8% of 2,676 patients with cancer including 753 with colorectal, 317 with breast, 273 with gastric, 144 with non-small cell lung, 123 with pancreatic, and 73 patients with esophageal cancer had received 97 types of recommended therapies (11,022 cycles). In terms of breast cancer, 86% of 388 patients had been treated with recommended regimens (1,994 cycles). Among 71 patients received non-recommend therapies, only 6 patients (1.5%) had been treated with three regimens which were not regarded as standard regimens. Conclusions: The introduction of web-based SRS and CCR systems in a large medical group could facilitate standard chemotherapy regimen by an accurate examination of current treatment patterns.
Using computerized decision support to improve compliance of cancer multidisciplinary meetings with evidence-based guidance.
Authors: Patkar Vivek , Acosta Dionisio , Davidson Tim , Jones Alison , Fox John , Keshtgar Mohammed R. 
Published: February 2017

79 Background: The cancer multidisciplinary team (MDT) meeting is regarded as the best platform to reduce unwarranted variation in cancer care through evidence-compliant management. However, MDT meetings are often overburdened with many different agendas, and hence struggle to achieve their full potential. Methods: We have developed an interactive computer system called MATE to facilitate explicit, evidence-based decision-making in MDT meetings for breast cancer care. MATE provides prognostication and risk assessment and also flags up patients eligible for recruiting into ongoing research trials. We describe the system; share our experience of implementing MATE and report initial audit and survey results. MATE was used to record the proceedings of breast MDT meetings between 2008-2009 to gather 1,295 cases discussed in the MDMs during this period and to audit the MDT decisions and MATE recommendations against NICE, NHSBSP, and NCCN guidelines. Results: MATE identified 61% more patients who were eligible for recruitment into clinical trials than the MDT and its recommendations demonstrated high concordance with MDT decisions (93.2 %). MATE is in routine use in breast MDT meetings at Royal Free Hospital, London, and deployment of the system in other NHS trusts is being explored. Conclusions: Sophisticated decision support systems can enhance the conduct of MDT meetings in a way that is acceptable to and valued by the clinical team. Further rigorous evaluations are required to examine cost-effectiveness, measure the impact on patient outcomes and test the generalizability of the system in different hospital setups and in different cancers.
Breast cancer patients' rights: How can they be respected in Iran?
Authors: Joulaee Azadeh , Joolaee Soodabeh , Bahrani Naser , Kadivar Maryam , Kalantari Mojgan 
Published: February 2017

81 Background: The revolutionary concept in breast cancer diagnosis and treatment has significantly changed many aspects of cancer treatment in favor of patients' rights. The best useful targeted treatment is offered to them with the least harm and invasion. As the most common cancer, breast cancer incidence is 24/100, 000 or one-fourth of all new cancers. The aim of this study is to compare the international rights for breast cancer patients with actual situation in Iran. Methods: All published data in Iran are reviewed since 2001 to 2012 to see the actual care in Iran. Codification of new radiology, surgical and pathologic procedure and insurance coverage are searched through available national references. These data are compared with international references. Results: Diagnosis is done by excisional/incisional biopsy or frozen section. Trucut biopsy is done in a low minority of cases. Insurance system does not cover vacuum assisted biopsy. Only mastectomy and axillary dissection are accepted by insurance. No codification exists for conservative surgery, oncoplastic surgery and sentinel node biopsy and the rate for these surgeries are low. Breast reconstruction, conservative surgery as bilateral mammoreduction, and symmetrization of controlateral breast are considered as cosmetic surgery with no coverage. The majority of cases are treated in general surgical wards. There are very few breast nurses and few centers for rehabilitation, lymphedema treatment, and psychological support of survivor. Conclusions: The ministry of health insists on full respection of the patient’s rights in medical practice. The new rights of breast cancer patients based on new treatment strategy are not highlighted in Iran. Valid evidence must be provided for policy makers about the rights of these vulnerable patients to consider them in Iranian health care delivery system. Specialized breast unit can improve significantly the quality of breast cancer care toward the patients' right. Pre-operative confirmation of cancer by trucut biopsy seems to be the key point. This gives the patient the opportunity to know more about the disease and to search for the best therapeutic plan according to international guideline.
Time trends in survival in young women with breast cancer in a population-based study: Are there estrogen receptor status differentials?
Authors: Ademuyiwa Foluso Olabisi , Groman Adrienne , Hong Chi-Chen , Kumar Shicha , Levine Ellis Glenn , Miller Austin , Ambrosone Christine B. 
Published: February 2017

85 Background: As mammography is not generally recommended to women under 40, it is reasonable to conclude that documented outcome improvements over time are attributable to treatment advances with screening playing a less important role. In order to determine the contribution of screening and treatment to improvements, we evaluated the odds of presenting with more advanced disease by time-period and examined the time-trends in outcome in a population-based cohort ≤50. We evaluated whether any outcomes differentials existed by ER status. Methods: Patients in SEER diagnosed with breast cancer were divided into 4 by year of diagnosis (1990-1994, 1995-1999, 2000-2004, 2005-2008). Patients were categorized into 2 age-groups: <40 and 40-50 years. Odds ratios for presenting with more advanced disease over the 4 time-periods were calculated for the 2 age-groups. Multivariate analysis was done to investigate the association of survival with time-period for the 2 age-groups by ER status. Results: 110,629 patient records were included. Patients 40-50 who were diagnosed in the 3 later time-periods (1995-1999, 2000-2004, 2005-2008) were more likely to have small tumors (≤2cm) compared with patients diagnosed in 1990-1994. Similarly, these patients were less likely to have larger tumors (≥3cm) comparing the 3 time-periods relative to 1990-1994. Conversely, patients <40 years had a higher odds of presenting with larger tumors (≥3cm) when the 3 later time-periods were compared to 1990-1994. In the ER positive patients, multivariate analysis showed that being diagnosed in the 3 later time-periods relative to 1990-1994 was associated with improved survival irrespective of age. In the ER negative cohort, those 40-50 years had a higher risk of death in the 3 later time-periods relative to 1990-1994; while there was a no effect of time-period on mortality for the younger age group of <40. Conclusions: Patients who are ER positive and between 40-50 years have had time-trend changes with improvements in breast cancer outcome and smaller tumors likely attributable to both screening and hormonal therapies. Patients who are <40 years and/or ER negative have not had improvements in breast cancer outcome.
Patient informational needs about breast reconstruction post-mastectomy.
Authors: Ahmed Ivy A. , Harvey Allison , Weiss Erica , Amsellem Marni 
Published: February 2017

88 Background: For many women, receiving a breast cancer diagnosis is further complicated by decisions they will face about breast reconstruction post-mastectomy. While women are typically provided with some information about reconstruction options, little is known about the perceived value of this information and how it might ultimately affect their decision about reconstruction. The Cancer Support Community investigated these questions in a national sample of women with breast cancer to better understand their information-seeking experiences, knowledge, and decision-making about reconstruction. Methods: In 2011, 439 participants attending Frankly Speaking about Cancer: Spotlight on Breast Reconstruction, a national educational workshop, completed a post-workshop survey (56.4% response rate). 76.2% of respondents were women diagnosed with breast cancer, who reported their decisions about reconstruction as well as their experience receiving information about reconstruction. Results: Respondents were Caucasian (74.8%), black (11.4%), and Hispanic (10.1%), and the mean age was 48.9. Nearly half (42%) of respondents reported low levels of knowledge about breast reconstruction prior to the workshop. Of those eligible for breast reconstruction, 18.2% reported they had decided against reconstruction, 40.7% were considering their options, and 41.1% planned to undergo or had undergone reconstructive procedures. Women reported they would have liked to have had more information prior to reconstruction about a variety of topics, including more information about the procedure (43.6%), how they would look (31.1%) and feel (29.7%) after reconstruction, and information about their future breast health (31.8%). No differences were found in unmet informational needs based on their reconstruction decisional status with one exception: those who decided against reconstruction were more likely to endorse that they would have wanted more information about when to make their decision about reconstruction than the other two groups (chi square=24.6, p <.01). Conclusions: Findings suggest women facing breast reconstruction often are not equipped with comprehensive information about procedures, options, outcomes, and recovery.
The use of bioelectrical impedance spectroscopy (BIS) to detect subclinical changes potentially associated with the development of breast cancer-related lymphedema.
Authors: Vicini Frank , Arthur Douglas W. , Lyden Maureen , Shah Chirag 
Published: February 2017

89 Background: The purpose of the study was to evaluate bioelectrical impedance spectroscopy's (BIS) ability to detect and monitor extracellular fluid accumulation of the upper limb as it relates to the extent of locoregional therapy for patients with breast cancer. Methods: A total of 125 patients from 4 clinical practices, with newly diagnosed breast cancer were evaluated at baseline and following locoregional procedures that could potentially affect fluid accumulation in the arm and signal the possible development of early lymphedema. In order to assess the ability of BIS to detect sub-clinical changes by treatment modality, the change in L-Dex score from baseline to measurements taken within 180 days following surgery were calculated. Results: Fifty-one patients (40.8%) underwent lumpectomy and 74 (59.2%) mastectomy; 68 patients (54.4%) underwent sentinel lymph node (SLN) sampling. Sixty-five patients underwent radiation therapy (RT) with RT patients being more likely to have undergone lumpectomy (66.2% v. 3.2%, p<0.001) and axillary dissection (41.5% v. 19.4%, p=0.04) compared with patients not receiving RT. However, no difference in the mean number of nodes sampled (7.7 v. 5.4, p=0.14) was noted for patients receiving RT compared with those not receiving RT. Patients receiving RT had a significantly increased change in L-Dex score (0.8 v. -2.5, p=0.03) compared with those patients not receiving RT. For all patients, ALND was associated with a significantly increased change in L-Dex score (5.0 v. 0.3, p=0.003) compared with SLN. When stratifying by the number of nodes removed, a statistically significant increase in the change in L-Dex score was noted (0.4 v. 0.4 v. 4.3 v. 6.4, p=0.04) for 0-3, 4-6, 7-10, and greater than 10 lymph nodes removed. Conclusions: In this limited analysis, L-Dex scores paralleled the extent of axillary sampling and the addition of radiation therapy; these results suggest that BIS can be used to monitor patients for the early onset of edema as differences emerged within 180 days of surgery.