bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of patients diagnosed with DCIS with isolated tumor cells or micrometastases on sentinel lymph node biopsy.
Authors: Moscol G. , Morginstin M. S. 
Published: February 2017

133 Background: Ductal carcinoma in situ of the breast (DCIS) is considered a precancerous condition. Nevertheless, 6 to 13% of cases will present cancerous cells in the sentinel lymph node biopsy (SNB) when analyzed using immunohistochemistry (IHC). Current guidelines do not specify if patients with isolated tumor cells (ITC, staged as N0[i+] for clusters <0.2mm) or with micrometastases (micromets, staged as N1mic for clusters between 0.2mm and 2 mm) would benefit from radiation or systemic therapy. We compared the clinical outcomes of patients diagnosed with DCIS and found to have ITC or micromets on SNB to those of patients diagnosed with DCIS without SNB analysis. Methods: Retrospective study. Medical records from patients diagnosed with DCIS at the Cancer Center of AEMC between 01/01/97 and 12/31/08 were reviewed and the SNB status assessed. Other pertinent data (receptor status, type of recurrence and time to recurrence) was collected. The primary outcomes were recurrence/distant metastasis rate (RR) confirmed by biopsy and the time to recurrence (TTR). Descriptive statistics, chi-square and Mann-Whitney U tests were used to analyze the data. Results: Of the patients diagnosed with DCIS between 1997 and 2008 (N=743), 145 were lost to follow up; 598 charts were analyzed. Only 22% of patients had a SNB. Those that underwent the SNB showed a higher RR as compared to those w/o a SNB (9.2% vs 3.6%, p=0.018). The average TTR between groups showed a wide distribution and no statistically significant difference (SNB mean= 2163 days, S.D=1664; w/o SNB mean= 1300 days, S.D. =819, p=0.180). Subgroup analysis in the SNB group showed that patients w/o IHC exam showed the highest rate of recurrence (6 cases, 13.6%), as compared to those with negative findings (5 cases, 7.6%), those with isolated tumor cells (1 case, 5.9%) and those with micromets (0 cases) (p=0.597). Conclusions: Patients with SNB had a higher RR when compared to those w/o SNB. Among patients with SNB, those w/o IHC had a higher RR as compared to those with SNB and IHC (although p > 0.05), possibly due to unidentified ITC/micromets. These results are limited due to the small number of cases with SNB and short follow up interval for patients with SNB and performed IHC.
Impact of dose intensity chemotherapy, in geriatric population with locally advanced breast cancer treated in neoadjuvant setting at the National Cancer Institute, Mexico City.
Authors: Arce Salinas H. C. , Ramirez-Morales R. , Aguila C. , Alvarado Miranda A. , Santamaria-Galicia J. , Cantu D. 
Published: February 2017

134 Background: Breast cancer in older women has a tendency to increase its incidence; the prevalence and their clinical course are not reported. This group of patients is usually considered to be fragile; they receive dose levels of chemotherapy below standards. Objective: To compare the association of dose intensity with complete pathological response (cPR) in older women. Methods: This is a retrospective analysis of patients treated with neoadjuvant anthracyclines, taxanes, or combination regimen from 2005 to 2008. Pathologic response was evaluated in the surgical specimen. Results: We analyzed 801 cases, 694 (86.6%) patients were younger than 65 years-old and 107 (13.3%) were older than 65 years-old. Clinical stage, histological type and HER2 status were similar in both groups. High-grade lesions were more common in the younger group (61% vs. 41% p>0.05). ER+/PR+ were more frequent for the group >65 years-old (57.5/47% vs. 79.5/50%) p=NS. Triple-negative were 154 cases (22%) for younger patients and 14 cases (13%) for elderly women (p=0.02). Optimal dose intensity was above 80% of planned dose. For anthracycline-based regimen, older patients had more dose reduction (27.8%) in comparison to the younger group 2.1% (p= 0.00001), for the taxane regimen dose intensity was less than the standard in 8.8% of young population vs. 17.6% for older women (p = 0.03). The rate of cPR in younger patients was 20.3% vs. 11.1% in the older group (p<0.001). Toxicity profile was statistically similar in both groups. Conclusions: Breast cancer has the same presentation in younger and in older patients. Older patients receive less dose intense chemotherapy. This is associated with a lesser rate of cPR. Therefore, older patient should be treated with full doses taking into account the toxicity profile of the chemotherapeutic regimens as well as the physical and medical conditions of the patient.
Survival after locoregional recurrence in patients after breast cancer surgery.
Authors: Osako T. , Nishimura R. , Okumura Y. , Tashima R. , Toyozumi Y. , Arima N. 
Published: February 2017

141 Background: The purpose of this study was to investigate factors for survival after locoregional recurrence in patients who underwent mastectomy or breast-conserving therapy (BCT) for primary breast cancer in our hospital. Methods: Out of 3,332 patients operated on from 1989 to 2008, 50 patients had chest wall recurrences after mastectomy (CWR), 40 patients had regional nodal recurrences (RNR), and 24 patients had ipsilateral breast tumor recurrences (IBTR) from 1997 to 2008. To investigate the prognostic factors for survival after locoregional recurrence, we conducted uni- and multivariate analyses of these cases. Results: The median follow-up time was 49.2 months. The 5-year survivals after recurrence of the patients with CWR, RNR and IBRT were 52%, 28%, and 68%, respectively. And the 10-year survivals were 15%, 0%, and 62%, respectively. Furthermore, the 5-year distant metastasis-free survivals were 24%, 13%, and 59%, respectively. In a multivariate analysis of the patients with CWR, type of recurrent nodules (diffuse/single, RR 21.0, p= 0.001), pT (T3 or 4 /T1, RR 11.4, p=0.01), pN (N3/N0, RR 15.5, p= 0.03), Ki67 of primary tumor (>50%/<20%, RR6.7, p=0.02) and ER of the primary tumor (+ / -, RR 2.6, p = 0.02) were independent prognostic factors. In a multivariate analysis of RNR, the method of first line salvage therapy (local /local + systemic, RR 16.1, p = 0.01) was only an independent prognostic factor. In the cases of IBTR, there were no independent prognostic factors for survival after recurrence. Conclusions: Although CWR developed distant metastases within 5 years, the survival depended upon the several biological factors. RNR developed distant metastases within a few years and provided poor prognosis. These suggested that RNR would be the first appearance of systemic metastasis not local disease. In contrast, IBTR provided better prognosis and a salvage treatment cured about 60% of the patients.
Patterns of reconstruction after unilateral and bilateral mastectomies.
Authors: Erb K. M. , Julian T. B. 
Published: February 2017

143 Background: A trend for the increased usage of mastectomy to treat breast cancer and for prophylaxis has been reported. Postmastectomy reconstruction (PMR) may improve body image and quality of life for breast cancer survivors. This prompted an investigation of the current pattern of PMR in our breast surgery practice. Methods: An IRB-approved retrospective chart review of women who had mastectomies performed by dedicated breast surgeons from 2006 through 2009 was completed. Data collected included age, unilateral (ULM) or bilateral mastectomy (BLM), type and timing of reconstruction, BRCA status, presence of an in-breast tumor recurrence (IBTR). Two-sided Fisher exact test and t-test were used in comparing groups. Results: From 2006 to 2009, 231 patients ranging in age from 27 to 91 years had ULM (n=155) or BLM (n=76). 38% of the patients had PMR. Patients <50 years old were more likely to undergo PMR than those >50 (67.5% versus 22.7%, p< 0.0001). 4 patients >70 years old had PMR. PMR followed ULM 27.7% of the time and BM 57.9% (p < 0.0001). Only 6 patients underwent delayed PMR. 30 patients had mastectomies after IBTR with 36.7% having PMR and 36.7% opting for BLM. These rates were not significantly different from women with a unilateral de novo breast cancer (33.1% and 21.3%, respectively). In 15 patients with a BRCA mutation, one had ULM. The 14 having BLM were more likely to have BMR than BLM patients without a mutation (92.9% versus 50.0%, respectively, p=0.0029) and were younger (44.6 versus 52.3 years, respectively, p=0.0166). Types of reconstructions were divided between tissue expander/implant (TE/I)(70%) and autologous tissue flaps (AT) techniques. After BLM, TE/I was employed more frequently than after UM (84% versus 56%, respectively, p=0.005). From 2006 to 2009, there was no significant change in type or frequency of PMR. Conclusions: From this data it appears that a majority of women do not have PMR and few women return for a delayed PMR. Fewer women seek PMR after ULM. Rates and types of PMR have not changed over this time period. Further investigation to determine if women feel informed about PRM and to identify factors influencing their choices may be helpful in improving a PMR program.
Should palpable DCIS be treated as IDC? A retrospective audit.
Authors: Nair N. S. , Pandey N. , Vanmali V. , Shet T. , Hawaldar R. , Parmar V. , Badwe R. A. 
Published: February 2017

146 Background: Ductal carcinoma in situ (DCIS) identified by screening mammography accounts for 20% of breast cancer diagnoses, and microinvasion (DCIS-M) is found in 5%-10%. There are no defined treatment guidelines for palpable DCIS or DCIS-M. In the developing world wherein screening mammography is controversial due to a predominantly premenopausal population, most women with DCIS present with a palpable lump in the breast. The objective of this study was to evaluate whether disease in these patients with palpable DCIS have been treated differently from screen detected DCIS. Methods: Annually we register 3,000 new cases of breast cancer of which DCIS constitute a small fraction. Over a period of 12 years (1998-2010) we registered 71 cases of DCIS for treatment. A retrospective analysis of these was performed. Results: Of the 71 patients reviewed, 35 (49.2%) had foci of microinvasion. The median age of presentation was 49 years and mean tumor size was 2.3 cm; all presented with palpable breast lumps. Of the 36 women with DCIS alone Tsize was > 2 cm in 26 (72.2%), 14 (38.9%) had presence of comedo necrosis and 1 (2.7%) had positive lymph nodes on histopathology. Adjuvant chemotherapy was given to 4 (11.11%). Of the 35 women with DCIS-M Tsize was > 2 cm in 23 (66%), 10 (29%) had comedo necrosis (compared to 38.9% in pure DCIS p=0.45), 3 (8.5%) had positive lymph nodes, and 17 (48.6%) received chemotherapy. We compared this data to that of women treated for invasive ductal carcinoma with pTsize <2cm, at a median follow-up of 60 months, DFS for the women with DCIS was 82% (95% CI 0. 67- 0.98), for DCIS-M was 78% (95% CI 0. 59 -0.98), and that for IDC < 2cm was 83% (95% CI 0.70-0.95). Conclusions: DCIS presenting in these palpable lesions poses a clinical dilemma for the use of adjuvant therapy. Over 49.2% of the palpable DCIS showed evidence of microinvasion. We thus need to consider the role of adjuvant chemotherapy when treating women with palpable DCIS.
Treatment patterns of breast cancer patients in Georgia Medicaid: Are patterns different for BCCPTA women?
Authors: Adams E. K. , Gabram S. G. A. , Chien L. 
Published: February 2017

153 Background: The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) of 2000 allowed states to cover women diagnosed with breast, cervical, or pre-cancerous cervical conditions under Medicaid upon diagnosis and while “under treatment”. We investigate breast cancer treatment of patients enrolled under BCCPTA in Georgia. Methods: Georgia Comprehensive Cancer Registry were linked to Medicaid enrollment files to identify 2,048 enrollees with a primary cancer of breast, of whom 1,046 were BCCPTA, 674 were disabled, and 328 were in ‘other’ Medicaid eligibility groups. Logistic regressions were used to estimate the odds of receiving: (1) lumpectomy, (2) mastectomy, and (3) other surgery in addition to (4) any drug regimen (hormonal or chemotherapy) and (5) radiation. Results: Using descriptive data and after controlling for covariates, BCCPTA women are more likely to receive any treatment (OR = 4.71, [CI] = 2.48, 8.96), any drug regimen (OR = 3.58, [CI] =2.32, 5.51), any radiation (OR = 1.61, [CI] = 1.15, 2.24), and any ‘definitive’ surgery (OR = 2.52, [CI] = 1.74, 3.66) than the ‘other’ eligibility group. There are no significant differences in the receipt of a lumpectomy versus a mastectomy by eligibility group but BCCPTA women are more likely to receive more adjuvant follow-up. Conclusions: The BCCPTA program in Georgia appears to create a quicker pathway for previously low-income uninsured women with breast cancer to access services and in turn, receive more treatment than women enrolled in more traditional, Medicaid eligibility groups. Yet, the overall rate of adjuvant therapy, whether radiation or hormonal/chemotherapy, appears to fall short of national criteria. [Table: see text]
The effect of molecular subtype on survival in a racially diverse cohort of patients with high-risk breast cancer receiving trimodality therapy.
Authors: Wright J. L. , Takita C. , Panoff J. E. , Reis I. M. , Zhao W. , Sujoy V. , Fernandez C. G. , Jorda M. , Franceschi D. , Hurley J. 
Published: February 2017

156 Background: To understand the origins of racial disparities in breast cancer outcomes, the relative importance of race must be examined in the context of molecular subtype. We assessed racial differences in progression-free survival (PFS) and overall survival (OS) in relation to subtype in a cohort of uniformly treated stage II-III breast cancer patients. Methods: We reviewed records of 582 consecutive patients receiving post-mastectomy radiation (PMRT) between 1/1999 and 12/2009 and evaluated the effect of demographic, tumor, and treatment characteristics on PFS and OS. Results: Median follow-up 44.7 months. Patients: 24% black, 76% white, 55% pre/peri-menopausal. Disease: stage II 30%, stage III 70%. Treatment: all had mastectomy and PMRT; 98% had chemotherapy. All ER+ patients received endocrine therapy. Black and non-black patients were similar in age, menopause status, stage, and completion of trimodality therapy. Black patients were more likely to be ER- (56% vs 38%, p=0.0001), PR- (69% vs 54%, p=0.002), and triple negative (TN) (46% vs 24%, p<.0001). Among ER+, there were no differences in menopause or PR status by race. Black patients had worse PFS (60.6% vs 78.3%, p=.001) and OS (72.8% vs 87.7%, p<.0001). There was no racial difference in PFS (p=0.229 and 0.273 respectively) or OS (p=0.113 and 0.097 respectively) among ER- or TN. Among ER+, black patients had worse PFS (55% vs 81%, p<.001) and OS (73% vs 91%, p<.0001). The difference in PFS was seen in the ER+/PR+/HER2- (“luminal A”) subgroup (p=.002) but not ER+/PR-/HER2- (“luminal B”) (p=0.129), and in the post-menopausal ER+/HER2- subgroup (p=.004) but not pre/perimenopausal ER+/HER2- (p=.150). On multivariate analysis, racial differences in PFS (p=.055) and OS (p=.052) were maintained in the luminal A postmenopausal subgroup. Conclusions: In a cohort of breast cancer patients black women had worse survival. This disparity was driven by (1) a higher proportion of ER- and TN tumors in the black women and (2) worse outcome of similarly treated post-menopausal black women with luminal A breast cancer. The efficacy of various types of endocrine therapy must be examined in the setting of racial diversity.
Identifying women at increased risk of breast cancer: Can we use genotyping at low penetrance loci?
Authors: Merrick C. , Dunlop J. , Baker L. , Gellatly E. , Martin A. , Quinlan P. , Tavendale R. , Thompson A. M. , Palmer C. , Reis M. , Berg J. N. 
Published: February 2017

162 Background: Most inherited predisposition to breast cancer is attributable to low penetrance susceptibility loci, a number of which have been identified through genome-wide association studies. Although individually each locus has a small effect, combining data from multiple loci would be expected to provide more risk information. We investigated the size of risk determination that can be achieved using genotyping at 18 loci. We then calculated its effect when combined with risk estimated from family history alone in terms of management under UK guidelines, where a woman who has a 10 year risk of 3% or greater requires additional breast screening from a younger age. Methods: Genotyping for 18 loci was carried out in 253 women at increased risk of breast cancer due to a positive family history and 118 matched controls. The relative risks conferred by genotype at the 18 loci were combined under a log-additive model and transformed into a log-polygenic risk. The BOADICEA risk estimation tool was used to calculate breast cancer risk due to family history. Results: Both the increased risk and control groups demonstrated a normal distribution of log-polygenic risk with similar variance. There was a significantly higher mean in the increased risk compared to the control group (mean = 0.1313 and 0.0874 respectively, p = 0.007). No significant correlation was found between polygenic risk calculated from genotype data and the family history risk estimated using BOADICEA. When polygenic risk was combined with family history risk there was significant reclassification of risk for those with a family history. 36.76% moved into a higher risk category while 3.68% moved into a lower risk category. Conclusions: Our data suggests that genotyping will be clinically relevant for estimating breast cancer risk. Individuals with a family history overall have a higher genotype risk than the population. The lack of correlation of genotype risk with BOADICEA risk suggests that the two risk estimates can be considered independently. By combining genotype with family history data, we demonstrated a significant reclassification of risk for individuals with a family history, with better identification of women in this group requiring intervention.
Treatment-related changes in neurobehavioral symptoms.
Authors: Patel S. K. , Beier E. , Davtyan A. , Meier A. , Palomares M. R. , Hurria A. , Bhatia S. 
Published: February 2017

167 Background: Neurobehavioral outcomes, such as fatigue and neurocognitive dysfunction, are disabling side effects in a subgroup of breast cancer (BC) patients. Longitudinal studies with appropriate controls to dissociate treatment-related effects from those experienced by healthy post-menopausal women are sparse, and virtually all define “pre-treatment” baseline as prior to adjuvant therapy, but following surgery. Given the phenomenon of “postoperative cognitive dysfunction” reported in older patients undergoing major surgery, we are evaluating treatment-related impact using pre-surgery assessment as the baseline. Methods: Eligible post-menopausal BC patients are assessed prior to any local or systemic treatment and one month after completion of treatment (surgery, radiation and/or chemotherapy). Healthy controls (HC) are age-matched 1:2-3 and tested at similar time intervals. Currently 130 BC and 60 HC are enrolled; results for 80 BC and 30 HC who have reached Time 2 are available (Mean time between assessments = 143 days, SD = 93). Results: Interim analyses using repeated measures ANOVA, controlling for age and education differences, show that the BC group declined in verbal memory functioning post-treatment relative to baseline, while the HC group improved due to practice effects (F(1, 102) = 3.43, p = .061). A similar interaction effect is observed for executive functioning, where the BC group failed to benefit from practice effects to the same degree as did HC (F(1, 102) = 6.04, p = .016). Anxiety but not depression was significantly elevated at baseline and decreased post treatment in BC patients treated with and without chemotherapy (F (1, 102) = 6.85, p = .010). Fatigue did not significantly change for the BC group; however, it was significantly higher than HC at baseline (t =2.77, p = .01) and remained high at the post-treatment measurement. Conclusions: Significant declines in neurocognitive functioning soon after completion of BC treatment were observed compared to healthy post-menopausal women. This observation did not appear to be due to mood disturbance, as anxiety and depression decreased following treatment. Our data also suggest that fatigue is present even prior to any cancer treatment.
Factors associated with mortality after breast cancer metastasis.
Authors: Jung S. Y. , Rosenzweig M. Q. , Sereika S. M. , Linkov F. , Brufsky A. , Weissfeld J. L. 
Published: February 2017

174 Background: It is generally accepted that patients with breast cancer metastases have poor survival. Metastatic breast cancer patients can be considered a heterogeneous population with a varied clinical course, which underscores the need for accurate prediction of survival based on prognostic factors. The purpose of the present study was to identify factors related to survival in breast cancer patients after diagnosis with metastatic disease. Methods: A total of 557 patients with breast cancer metastasis diagnosis seen at one large urban practice have been followed up between January 1, 1999 and June 30, 2008. Demographic, tumor characteristics, clinical factors as predictors of survival were analyzed using Cox regression model. Results: The median survival length was 40 months (range 1-114 months) with 269 (48.3%) alive and 288 (51.7%) dead. This study demonstrated that hypertension, estrogen receptor (ER) and/or progesterone receptor (PR) status, human epidermal growth factor receptor-2 (HER2) status, number of metastatic sites, and body mass index (BMI) at diagnosis with metastatic breast cancer were the most relevant prognostic factors for survival after metastasis. Conclusions: Findings of this study may form a foundation for the corpus of knowledge explaining the outcome differences in treatment of patients with metastatic breast cancer, potentially helping to create tailored counseling and personalized treatment approaches for this vulnerable group. [Table: see text]