bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparities in utilization of breast-conserving therapy among breast cancer patients.
Authors: Lautner Meeghan Ann , Lin Heather Y. , Shen Yu , Parker Catherine , Kuerer Henry Mark , Shaitelman Simona Flora , Babiera Gildy , Bedrosian Isabelle 
Published: February 2017

104 Background: Since 1990 breast conserving therapy (BCT) has become a widely accepted modality in the treatment of breast cancer. However, many women continue to undergo mastectomy over BCT. The objective of this study was to provide a comprehensive population based review of the factors that influence utilization of BCT. Methods: Using the National Cancer Database (NCDB), we evaluated women who underwent a mastectomy or BCT for T1/T2, any N breast cancer between 1998 and 2011. We conducted a retrospective review of patient and facility variables associated with undergoing BCT and the trends over time. Logistic regression analysis was used to assess the multivariate relationship between these variables and the probability of undergoing BCT. Results: Among the 727,927 patients who met study criteria, BCT rates increased from 54% in 1998 to 59% in 2006 and then stabilized. After adjusting for demographic and clinical characteristics, BCT utilization was more likely in patients aged 52-61 compared to younger patients (odds ratio (OR) 1.14 {95% CI 1.12-1.15}) and in those with the highest education level (OR 1.16 {95% CI 1.14-1.19}). BCT rates were higher in patients with private insurance compared to the uninsured (OR 1.33 {95% CI 1.28-1.38}) and in those with the highest median income (OR 1.09 {95% CI 1.06-1.11}) (all p < 0.0001). Academic Cancer Programs, facilities in the Northeast and patients who lived within 17 miles of a treatment facility had higher utilization of BCT than Community Cancer Programs (OR 1.13 {95% CI 1.11-1.15}), facilities located in the South (OR 1.50 {95% CI 1.48-1.52}) and those who lived further from a treatment facility (OR 1.25 {95% CI 1.23-1.27}) (all p<0.0001). When comparing BCT utilization in 1998 and 2011, increases were seen across age groups, in community cancer programs and in facilities located in the South; however, disparities by insurance status, income level and travel greater than 17 miles to a treatment facility persist. Conclusions: BCT rates have increased during the last two decades. Disparities based on age, geographic location and type of cancer program have improved. However, socio-economic status and travel distance to treatment facilities persist as key barriers to BCT utilization.
Barriers and facilitators for clinical trial participation among diverse Asian patients with breast cancer.
Authors: Lee Guek Eng , Ow Mandy Y.L. , Lie Desiree , Dent Rebecca Alexandra 
Published: February 2017

108 Background: Recruitment rates for breast cancer trials are low for racial/ethnic minorities. Little is known about factors influencing trial recruitment in Asian patients. Our aim is to examine the barriers and facilitators for participation in trials among multi-ethnic Asian women with breast cancer. Methods: We recruited a convenience sample from consecutive women seen at a National Cancer Centre. Two experienced bilingual (English and Chinese) moderators conducted focus groups to theme saturation. The question guide incorporated open-ended questions soliciting opinions about trial participation and knowledge. Women were first asked if they were willing, unwilling, or still open to participate in future trials. Sessions were audiotaped and transcribed. Transcripts were independently coded for emergent themes. Results: Sixteen of 103 women approached participated in five focus groups. Chinese, Malay and Indian participants aged 29 to 69 represented different cancer stages. Five had no prior knowledge of trials. We identified three major areas consisting of 24 minor themes for barriers and facilitators. Major themes fell into: 1) individual- or patient-related, 2) trial-related and and 3) sociocultural factors. When analysis was stratified by willingness to join trials, we found that women willing to join trials expressed themes representing facilitators (better test therapy, cost-effective profile, or trust in doctors and local systems). Women unwilling to participate expressed themes associated with barriers, while women still open to participation expressed themes representing both facilitators and barriers. Malay women were more likely to express themes related to ‘fatalism’ as a barrier. Conclusions: We found that facilitators and barriers to trial participation among Asian women were similar to those previously reported in Western women. Knowledge of trials is limited among women receiving breast cancer treatment. Unique sociocultural factors suggest that approaches customised to local and community beliefs are needed to improve trial participation in minority groups.
Secondary nonbreast malignancies (SNBM) after primary breast cancer (BC).
Authors: Habib Joyce Georges , Espirito Janet L. , Harrell Robyn K. , Turnwald Brian , O'Shaughnessy Joyce , Patt Debra A. 
Published: February 2017

112 Background: BC survivors are at higher risk of developing SNBM due to treatment effects and shared behavioral and genetic factors. Associations between histologic subtypes of primary BC and secondary endometrial or ovarian cancer have been reported. Less is known about subtype-specific associations with other secondary solid tumors. We aimed to determine the prevalence of SNBM across US Oncology practices and what subtype-specific associations, if any, exist between primary BC and SNBM. Methods: We conducted a retrospective database analysis identifying BC patients (pts) diagnosed between 01/2007 and 05/2013. SNBM were ascertained from codified fields in pts electronic records. Age at BC diagnosis, BC stage, estrogen receptor (ER), progesterone receptor (PR), HER2 status, BMI and smoking history were collected. Chi-square tests were used to compare categorical variables. Logistic regression was used to predict likelihood of secondary malignancies in separate multivariate models. Results: 105,795 pts with stage 0-IV BC were identified. 2,237 (2.1%) were diagnosed with ≥ 1 SNBM. Mean age at diagnosis and follow-up were 59.5 and 2.6 years respectively. Pts with SNBM were more likely to have: older age, ≥ stage I, HER-2 negative disease, BMI ≥25 and past/current smoking history. SNBM were most commonly: Non-small cell lung cancer (NSCLC) (n=346), colorectal (CRC) (n=250), uterine (n=192), ovarian (n=130), thyroid (n=106) and kidney cancer (n=73). No associations were found between BC subtypes and ovarian, uterine, thyroid or NSCLC. Significant positive and negative associations between triple-negative breast cancer (TNBC) and secondary CRC and kidney cancer, respectively, were noted. In multivariate analysis, TNBC was predictive of secondary kidney cancer (OR 2.00, p=0.019). TNBC (OR 0.47, p=0.009), age ≤55 (OR 0.27, p<0.0001) and BMI ≤30 (OR 0.64 for BMI 25-30, p=0.019) were negative predictors of secondary CRC. Conclusions: Our study is the first to report direct and inverse associations between primary TNBC and secondary kidney and CRC, respectively. The short follow-up precludes treatment-related effects. Results may potentially be attributed to genetic, environmental or lifestyle factors and warrant further research.
Circulating tumor cells during and beyond maintenance therapy with SERM or aromatase inhibitors for decision making in long-term survivorship.
Authors: Pachmann Katharina , Rabenstein Carola , Camara Oumar , Rengsberger Matthias , Runnebaum Ingo B. , Pachmann Ulrich A. 
Published: February 2017

119 Background: Although current guidelines still support 5 years of hormone blocking therapy after primary breast cancer due to earlier results showing no benefit of longer treatment, recent data have shown that longer treatment with tamoxifen can better reduce recurrence and death. However, side effects with this therapy can be considerable and compliance declines with time. We, here, report data on monitoring circulating epithelial tumor cells (CETC) beyond maintenance therapy showing that even if maintenance therapy with SERM or aromatase inhibitors had been effective in reducing tumor cells in blood, there can be a reincrease after the end of maintenance therapy and that this is highly correlated with relapse. Methods: 7.5ml of anti-coagulated blood was drawn before the start of chemotherapy, after each cycle and after the end of chemotherapy. Using a nondissipative approach with only red blood cell lysis the white blood cells including the tumor cells were stained with a fluorescent labelled anti-epithelial antibody, positive events counted using an automated image analysis microscope and calculated per volume blood. Results: 96 patients with nonmetastatic breat cancer were observed beyond maintenance treatment with hormone blocking therapy. Results on CETC were evaluable from 35 patients even after completion of therapy. Increasing cell numbers after the end of therapy were able to predict relapsing from long term relapse free survivors (p = 0.0001). Conclusions: In breast cancer, a debate has been reiinitated with respect to the length of maintenane treatment. Even if hormone blocking maintenance treatment is capable of reducing or even eliminating tumor cells circulating in peripheral blood and this is related to improved relapse free survival there may remain tumor cells in the body capable of re-growing and leading to late relapse. Monitoring of CETC in peripheral blood even after completion of maintenance therapy can early predict imminent relapse and help to decide whether to reinitiate hormone blocking therapy.
Uninsured utilization of the mobile mammography: 10-year analysis.
Authors: Riley Elizabeth Carloss , Rai Shesh , Pan Jainmin , Roland Lane , Barkley Laura , Mizuguchi Sarah 
Published: February 2017

12 Background: Mobile Mammography Units (MMU) historically increase access breast cancer screening to uninsured patients. Our group previously reported insurance status predicts MMU repeat utilization (insured cohort most likely to repeat.) The purpose of this study is to examine the uninsured subset in multivariable analysis to understand the low repeat utilization by this group. Methods: From Jan 2001 to Dec 2010, 48,324 screening mammograms were performed in the largest county in KY. Of 21,587 unique subjects, 9,422 were uninsured (44%.) Demographic data was retrospectively reviewed to identify age, race/ethnicity, insurance status and location for each encounter. Utilization was defined as once or more than two times in a 10-year period. P-values were calculated using Chi-square test for comparison between the two groups. Odds ratio and its 95% confidence interval were provided. Logistics regression analysis is used to jointly model the effect of independent factors on repeat unitization of MMU. Results were declared significant at significance level of 5%. Results: Race, location, and age remain independent variables in likelihood of repeat utilization within a 10-year period (p value < .001.) The estimated OR are depicted in the table. We previously reported in the entire dataset (all insurance cohorts) and estimated OR of Whites (W) vs Blacks (B) of 0.897 (CI 0.843-0.955) and Hispanics (H) vs B 0.701 (CI 0.604-0.813.) Conclusions: Within the uninsured cohort, race and location remain independent predictors of repeat utilization of the MMU. However, the significance is weaker between W and B (p < .004 versus < .001) in the uninsured group than in the entire dataset which may suggest that insurance type becomes a stronger predictor of repeat utilization than race although further analysis will be necessary to confirm this trend.[Table: see text]
Comparing three methods for scoring late breast cosmesis in patients treated with lumpectomy and radiation therapy (RT).
Authors: Wong Andrew Thomas , Robertson-Parris Celina , Sura Sonal , White Carol , Chadha Manjeet 
Published: February 2017

128 Background: For intact breast, the Harvard and LENTSOMA criteria are widely used to report late cosmesis. These scales require clinician’s interpretation and thus may be subject to variation between evaluators. Computerized tools exempt from evaluator bias are available to assess cosmesis. The objective of this study was to perform a comparative review of late breast cosmesis using the Harvard, LENTSOMA, and BCCT.core scales (Cardoso JS. et al; doi:10.1016/j.artmed.2007.02.007). Methods: A frontal bilateral breast photograph was used for analysis. Late cosmesis was scored with reference to the baseline breast appearance, ~ 1 year from RT distant from the acute treatment effects. Cosmesis was graded as excellent, good, fair, or poor using the Harvard scale. For LENTSOMA, only atrophy/retraction was assessed from the frontal breast photographs. The BCCT.core software was used as a validated tool for objectively scoring cosmesis and computes a score based on symmetry, color, and scar visibility. All outcomes were assessed by the same investigator (AW). Results: A total of 33 patients had 1-year baseline and follow up photographs. All were treated on a 3-week hypofractionated RT schedule, and none received chemotherapy. One hundred photographs, 1 to 5.7 years from end of RT, were scored. Late cosmesis among patients with good/excellent scores at 1-year remained unchanged by all 3 methods. Among patients graded as fair at 1-year, there was improvement in late comesis detected by Harvard and BCCT.core scoring. Late cosmesis by LENTSOMA criteria remained unchanged from baseline. Conclusions: Our experience suggests easy applicability of BCCT.core for scoring cosmesis in clinical practice. We observed no significant differences in cosmetic score by the methods used. However, these observations were made on a small cohort of patients and evaluation on a larger cohort is needed. The role of objective user-independent grading of cosmesis might be helpful in large comparative studies of clinical outcomes. [Table: see text]
Secondary primary cancers in male breast cancer survivors.
Authors: Shameem Raji , Hamid Muhammad S , Mavani Gaurang P , Singhal Nakul , Shani Dana , Sullivan Kevin M. 
Published: February 2017

129 Background: Male Breast Cancer (MBC) survivors have an increased risk of developing secondary contralateral breast cancer. However, the risk of developing other solid tumors and hematological malignancies is not well understood. Methods: The Surveillance Epidemiology and End Results (SEER) database was used to detect MBC cases diagnosed up to 12/31/2011. The Standardized Incidence Ratio (SIR) was calculated as the ratio of observed to expected cases of second primary malignancy based on incidence data in the general United States population. The latency exclusion period from the date of diagnosis was 5 years. We also investigated for any modifying effects such as radiation therapy, age at diagnosis, and latency period after initial diagnosis (5-10 years and >10 years) that may have increased the risk for secondary cancer. Results: A total of 1,239 men with an initial diagnosis of primary breast cancer were included in our analysis. Overall, there was an increased SIR of secondary solid tumors of the pharynx (SIR: 8.39, P<0.05), hypopharynx (SIR: 15.77, P<0.05), and brain (SIR: 4.40, p<0.05), and Non-Hodgkin Lymphoma (NHL) (SIR: 2.49, P<0.05), that was also seen in MBC cases that received radiation (24.1%), (SIR: 4.51, P<0.05). For MBC diagnoses in patients >40 years, there was an increased incidence for these malignancies and for “all solid tumors” (SIR: 1.30, P<0.05) as well. In the period ranging from 5-10 years after initial breast cancer diagnosis increased incidence for tumors of the pharynx (SIR: 8.95, P<0.05) and hypopharynx (SIR: 16.70, P<0.05) were seen. In contrast, there was no significant increased incidence of secondary cancers >10 years after initial diagnosis. Conclusions: MBC survivors are at increased risk for secondary malignancies of the pharynx, hypopharynx, brain, and NHL. Older age at diagnosis and radiation treatment appear to be risk factors. Risk of secondary tumors of the pharynx and hypopharynx is greatest 5-10 years after initial breast cancer diagnosis but optimal surveillance for MBC survivors requires further clarification.
Combining serum autoantibody measurements with traditional serum biomarkers for the detection of invasive breast cancer.
Authors: Henderson Meredith C. , Reese David Emery , Borman Sherri , Yeh Susan , Hollingsworth Alan 
Published: February 2017

13 Background: The use of protein biomarkers for serum-based detection of invasive breast cancer has been problematic due in large part to intrinsic variability in the population as a whole. The Provista Biomarker Assay (PBA) has been shown previously to be highly sensitive across a wide spectrum of clinical signals. The detection of autoantibodies (AAb) holds great promise due to the inherent specificity these biomarkers provide. However, as a clinical-quality diagnostic, it is necessary to utilize a panel comprised of multiple autoantibodies, as individual sensitivity is general low. Our hypothesis was that combining serum protein and autoantibodies together in a panel would result in an increased ability to correctly identify breast cancer. Methods: To maximize clinical performance (sensitivity and specificity), we utilized the Meso Scale Discovery ELISA-based system to measure AAbs from patient sera. We analyzed 134 prospectively collected patient serum samples for a variety of autoantibody targets. These data, together with serum protein biomarker concentrations, produced an analytically robust test that is also highly specific. Results: Consistent with our hypothesis, the inclusion of autoantibodies with serum proteins in the Provista Biomarker Assay improved test specificity above that observed in serum protein biomarkers alone. Individual protein targets had limited ability to differentiate benign conditions from invasive breast cancer. However, factoring in autoantibody values resulted in improved overall accuracy to differentiate serum from benign and invasive breast cancer patients. Conclusions: In the novel approach of combining these two different classes of analytes, we exploit the specificity of AAbs while maintaining high sensitivity through the inclusion of more generalized cancer-associated protein biomarkers. The combination of these two approaches clearly offers unique performance benefits in the early detection of invasive breast cancer that is greater than either component alone.
Compliance with oral antiestrogens utilizing a bubble pack.
Authors: Riley Elizabeth Carloss , Dragun Anthony E. , McMasters Kelly , Scoggins Charles Raben , Quillo Amy R. , Rai Shesh , Wu Xiaoyong , Jain Dharamvir 
Published: February 2017

132 Background: Adherence to endocrine therapy in breast cancer has been a long recognized problem despite efficacy to these drugs. Most of our knowledge of noncompliance has been largely observational and retrospective. Although multifactorial, extremes of age and race are risk factors for noncompliance. This report is an interim analysis of a well-designed study prospectively measuring compliance rates of “bubble” packaging of oral anti-estrogens Methods: A total of 88 patients were enrolled between August 2012 and April 2014. Out of 88 patients, 1 declined participation and 1 was deemed ineligible based on metastatic disease. Of the remaining 86, 53 continued participation and were included in this analysis. Demographic and clinical data were collected prospectively including age, race, insurance, duration of therapy, stage, and comorbidities. Duration of therapy was divided into 3 cohorts: early (less than 12 months), middle ( 12-36 months,) or late (37-60 months.) Comorbidities were defined as none, moderate (1-3) or significant (>3.) All patients received anti-estrogens in a “bubble”pack. All used bubble packs and missed dose diaries were returned at follow up appointments for review. Results: The majority of patients were white (77%)) and stage I/II (74%.) The overall compliance rate was 97%; however only 61% of enrolled patients were continued in the analysis. None of the variables examined race, age, insurance status and/ or stage had an impact on compliance. Only duration of therapy had a marginal effect on compliance (p value = 0.06.) The late cohort was least likely to be compliant at 89.53%, although only represented 9% of the included patients. Conclusions: The compliance rate of bubble packaging is higher than expected however should be interpreted with caution given the 39% withdrawal. Interestingly there was no difference in compliance rate among race, insurance status or age which contradicts our current knowledge on high risk groups. However duration of therapy did have a negative impact on compliance and may become increasingly important as duration of anti-estrogen therapy extends. However given the small number of patient in this cohort this will need to be confirmed at final analysis with larger involvement within this group. Clinical trial information: NCT01694225.
Factors influencing survival in inflammatory breast cancer.
Authors: Cupp Julie A. , Liu Diane , Shen Yu , Ueno Naoto T. , Alvarez Ricardo H. , Chavez-Mac Gregor Mariana , Woodward Wendy A. , Kogawa Takahiro , Babiera Gildy 
Published: February 2017

136 Background: Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer associated with poor prognosis, characterized by rapidly growing mass, skin changes, and regional adenopathy. The objective of this study was to determine if delay in treatment influenced survival in IBC patients. Methods: A prospective IBC database identified 93 women with stage III IBC who received care at MD Anderson from 2007 - 2012 and were retrospectively reviewed. All patients received neoadjuvant chemotherapy followed by surgery, unless progression of disease was noted, and postmastectomy radiation. Impact of time from onset of symptoms to chemotherapy or to surgery on overall survival (OS) and progression free survival (PFS) were evaluated after adjusting for the baseline covariates in the Cox model. Results: A majority of patients were white (77.4%) with an average age of 54 years. Average days from onset of symptoms to first chemo is 95 (range 16 – 387) and to surgery is 283 (range 184 – 585). Four patients had progression while on chemo. There were 14 deaths with median follow up of 2.6 years from diagnosis. In univariate analysis, delay in treatment, > 90 days from onset of symptoms to chemo, did not affect OS or PFS. Obtaining negative margins was statistically significant for OS and PFS measured from first chemo (p=0.005 and p=0.007). Positive HER-2 status was associated with longer PFS time from chemo (p=0.02, log-rank test) and from surgery (p=0.009). Positive progesterone receptor (PR) was found to be statistically significantly associated with longer OS time from chemo (p=0.01) and from surgery (p=0.03). Clinical and imaging response to chemo were associated with better OS (p=0.007 and p=0.005) and pathologic response was marginally associated with improved OS and PFS (p=0.07 and p=0.06), both measured from surgery. In multivariate Cox model, adjusting for PR or HER2, days from onset of symptoms to chemo or surgery did not have significant impact on OS or PFS. Conclusions: While traditionally delay diagnosis and treatment is considered one of the factors associated with poor prognosis, our study suggests otherwise. However, due to such rapid progression of disease, early diagnosis is still important in the overall management of patients diagnosed with IBC.