bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early evidence of increasing national mastectomy rates for the treatment of breast cancer.
Authors: Mahmood U. , Hanlon A. L. , Koshy M. , Buras R. , Chumsri S. , Tkaczuk K. H. , Cheston S. , Regine W. , Feigenberg S. J. 
Published: February 2017

136 Background: The use of mastectomy for the treatment of breast cancer has declined since initial randomized trials demonstrated equivalent survival with breast conservation therapy. Recent single institution series, however, have reported increasing mastectomy rates within the past decade. Methods: In order to verify these findings at the national level, we analyzed data from the Surveillance, Epidemiology, and End Results database, including women diagnosed with T1-2 N0-3 M0 breast cancer from 2000 to 2007. We evaluated therapeutic mastectomy rates by the year of diagnosis and performed a multivariable logistic regression analysis to determine predictors of mastectomy as the treatment choice. Results: A total of 228,240 patients met the entry criteria. The proportion of women treated with mastectomy decreased from 40.3% to 35.6% between 2000 and 2005. Subsequently, the mastectomy rate increased to 37.9% in 2007 (p < 0.0001). The mastectomy rate in 2007 was the highest since 2002 (38.6%). A reversal in previously declining mastectomy rates was noted in nearly all cohorts, but was most pronounced among younger women. Multivariable analysis found that age, race, marital status, geographic location, involvement of multiple regions of the breast, lobular histology, increasing tumor size, lymph node positivity, increasing grade, negative hormone receptor status, and synchronous diagnosis of an ipsilateral or contralateral breast cancer were independent predictors of mastectomy. Additionally, multivariable analysis confirmed that women diagnosed in 2007 were more likely to undergo mastectomy than women diagnosed in 2005 (HR = 1.14, CI: 1.09 to 1.18, p < 0.0001). Conclusions: There is evidence of a reversal in the previously declining national mastectomy rates, with the mastectomy rate reaching a nadir in 2005 and subsequently rising. Further follow-up to confirm this trend and investigation to determine the underlying cause of this trend and its impact on outcomes are warranted.
Prognostic classification of ipsilateral breast tumor recurrence (IBTR).
Authors: Eladoumikdachi F. G. , Jones M. , Shidfar A. , Helenowski I. B. , Franz J. M. , Scholtens D. , Sullivan M. E. , Bethke K. P. , Hansen N. M. , Jeruss J. S. , Khan S. A. 
Published: February 2017

137 Background: IBTR after breast conservation encompasses true recurrence (TR) and new primary cancer (NP). No clear criteria distinguish TR from NP, but there is agreement that NP tumors have better outcomes than TR. Prior studies have used distance of IBTR from index cancer (IC), time to IBTR, histological, immunohistochemical (IHC) and genetic differences, but all data are not often available. We have examined IBTR patterns with the goal of identifying the simplest, most robust determinants of outcomes following IBTR. Methods: We reviewed records of breast cancer patients diagnosed with IBTR at the Lynn Sage Breast Center from 8/1992 to 6/2010. Data for the IBTR and IC were reviewed for histology, IHC, location, time between IC and IBTR, follow-up status, and cause of death. Parameters were scored as 1 if IBTR and IC were similar, and 0 if different (location=1 if ≤3cm; IHC=1 if hormone receptors and HER2 similar; interval=1 if ≤ 4 years). Univariate and multivariate proportional hazard models were used to determine impact on overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), distant recurrence free survival (DRFS) and local recurrence (LR). The multivariate model included significant univariate parameters. Results: We identified 161 patients with IBTR and complete data on ≥3 parameters; post-IBTR median follow up was 25 months. Data were missing on location in 13%, histology in 9%, IHC in 26%, and time interval in 0%. In univariate analysis, short interval to IBTR significantly decreased OS (HR 2.56, p=0.04), DSS (HR 4.31, p=0.009), RFS (HR 2.25, p=0.01), DRFS (HR 2.53, p=0.02), LR (HR 2.28, p=0.02); close location of IBTR decreased OS (HR 2.68, p=0.04). Histology and receptor status had no significant impact on the outcomes. Multivariate analysis included time and location, time ≤ 4 years was shown to decrease DSS (HR 4.00, p= 0.04), RFS (HR 2.32, p=0.03) and LR (HR 2.41, p=0.03). Conclusions: A short time interval between IC and IBTR is the most important prognostic parameter; location of IBTR within 3 cm of the IC also increases HR of subsequent events. These are the most easily available parameters when evaluating patients with IBTR, and therefore the most useful for distinction of TR versus new primary.
A nomogram to predict nonsentinel lymph node involvement in breast cancer patients with sentinel lymph node metastases.
Authors: Kojima Y. , Tsugawa K. , Enokido K. , Iwata H. , Ohno S. , Akiyama F. , Motomura K. , Watanabe C. , Nakamura S. 
Published: February 2017

14 Background: Several nomograms have been described as predictors of non-sentinel axially lymph node (non-SN) metastases in breast cancer with positive sentinel nodes (SN). However, all these predicting models were based on data from western countries. The purpose of this study was to examine predictive factors of non-SN status among SN metastatic patients, in order to develop a nomogram based on Japanese large data set. Methods: This research was analyzed by using a clinical database of 11,228 Japanese breast cancer patients who registerd to cohort study as SN biopsy between March 2008 and Octover 2009 in Japan. We reviewed data retrospectively to extract patients with SN metastases who underwent complementary axillary lymph node dissection. In this cohort, we examined predictive factors of non-SN metastases. All clinical and pathologic features were analyzed to predict the non-SN status, by using univariate and multivariate logistic regression model. A receiver operating characteristic curve was constructed and the area under the curve (AUC) was calculated. Results: Among the database, SN metastases were found in 1,029 patients, and 345 (33.5%) were non-SN positive. Univariate analysis showed a significant association between non-SN involvement and primary tumor size (p<0.001), histologic grade (p=0.011), lymphatic invasion (p<0.001), venous invasion (p=0.005) and the number of involved SNs among all identified SNs (p<0.001). Tumor size (p<0.001), lymphatic invasion (p<0.001), and the size of SN metastasis (p<0.001) were associated with non-SN metastasis in multivariate analysis. Based on the multivariate analysis, we developed a scoring system to predict the likelihood of non-SN metastases in breast cancer patients with SN involvement. The discriminatory ability of our nomogram, as measured by the AUC, was 0.752. Conclusions: In patients with invasive breast cancer and a positive SN, primary tumor size, lymphatic invasion, and the size of SN metastases among all identified SNs were independently predictive of non-SN involvement, and used for a nomogram. Validation study will be performed in the future investigation.
Prognosis and non-sentinel lymph node status of the breast cancer patients with micrometastatic sentinel lymph nodes.
Authors: Takahashi M. , Jinno H. , Hayashida T. , Hirose S. , Mukai M. , Kitagawa Y. 
Published: February 2017

140 Background: Sentinel lymph node biopsy (SLNB) is a more sensitive and accurate nodal staging procedure than axillary lymph node dissection (ALND). Because of detailed pathologic evaluation in SLNs, more nodal micrometastases have been identified. However, it remains controversial whether to perform ALND for patients with micrometastases in SLNs and their prognostic significance is also a matter of debate. The purpose of this study is to determine the non-sentinel lymph node (NSLN) status and prognosis of the patients with micrometastatic SLNs. Methods: A prospective database of 1,012 clinically node-negative, T1-T2 breast cancer patients, who underwent SLNB from January 2002 to Dec 2010 at Keio University Hospital was analyzed. SLNs were detected using a combined method of isosulfun blue dye and small-sized technetium-99m-labeled tin colloid. Intraoperative frozen examination was performed with hematoxylin and eosin (HE) staining. SLNs, fixed and embedded in paraffin, were additionally diagnosed with HE staining and immunohistochemical (IHC) analysis. Results: Micrometastases in SLNs were found in 69 (6.8%) of 1,012 patients. Thirty eight (55.1%) of 69 patients with micrometastatic SLNs underwent immediate or delayed ALND and revealed no NSLN metastasis. Among 31 (44.9%) patients with micrometastatic SLNs who omitted ALND and axillary radiation therapy, no axillary lymph node recurrence has been observed after a median follow-up of 50 months, although 29 patients (93.5%) in these 31 patients received adjuvant systemic therapy. There is no significant difference in recurrence free survival between the patients with micrometastatic and negative SLNs (98.0% vs. 95.7%, respectively). Conclusions: These date suggested that it may not be necessary to perform ALND for the patients with micrometastatic SLNs and the presence of micrometastases in SLNs may not worsen prognosis with proper systemic therapy.
Utilizing BRCA1/2 mutation status to select patients for breast cancer clinical trials: Experience from a prospective phase II trial.
Authors: Schackmann E. A. , Vinayak S. , Kurian A. W. , Ford J. M. , Telli M. L. 
Published: February 2017

161 Background: Information from BRCA1/2 mutation testing is used to guide cancer screening and risk reduction strategies. More recently, BRCA1/2 mutation status is being used to select patients for breast cancer (BC) clinical trials employing new targeted therapies, such as PARP inhibitors. There is concern that current testing practices do not produce results within the timeframe necessary for clinical trial eligibility assessment. Methods: We analyzed BRCA1/2 mutation testing patterns in the context of a prospective phase II neoadjuvant study of gemcitabine, carboplatin and BSI-201 (iniparib) for women with Stage I-IIIA triple-negative or BRCA1/2 mutation-associated BC. Specifically, we analyzed: 1) the proportion of participants who met BRCA1/2 mutation testing criteria per NCCN Guidelines v1.2011 and 2) the proportion who had the Myriad Genetics Single Site, Multisite 3 (Ashkenazi Panel), BRACAnalysis and Comprehensive Rearrangement tests performed and their results. For patients without a known BRCA1/2 mutation prior to BC diagnosis who met testing criteria, we assessed the length of time from BC diagnosis to receipt of test results. Results: Sixty-four patients between the ages of 26 and 73 were enrolled. Results are summarized below. For patients who had BRCA1/2 testing after BC diagnosis, the median number of days from BC diagnosis to receipt of results was 42. Conclusions: The frequency of BRCA1/2 mutations in this cohort is high (20%), though nearly half of these mutations were found after patients provided trial consent. Current standard processes for testing women with newly diagnosed BC for BRCA1/2 mutations do not occur expeditiously enough for many to guide clinical trial selection. [Table: see text]
Comparison of hypnotherapy versus gabapentin in the treatment of hot flashes: A pilot study.
Authors: MacLaughlan S. , Salzillo S. , Bowe P. , Scuncio S. , Malit B. , Raker C. , Gass J. S. , Granai C. O. , Dizon D. S. 
Published: February 2017

168 Background: The purpose of this study is to compare the efficacy of hypnotherapy versus gabapentin for the treatment of hot flashes in women with an increased risk or personal history of breast cancer. Methods: In a prospective trial, eligible women were randomized to receive gabapentin (control arm) or hypnotherapy (experimental arm). Eligibility was defined by a personal history of breast cancer or an increased risk of developing breast cancer in women who reported at least one daily hot flash. The duration of participation was eight weeks, and women were asked to keep a daily journal of the number and severity of their hot flashes. The primary endpoints were number of daily hot flashes and hot flash severity score (HFSS). The secondary endpoint was quality of life, measured using the Hot Flash Related Daily Interference Score (HFRDIS). Results: Twenty-seven women were enrolled (n=14 gabapentin, n=13 hypnotherapy) and 15 (56%) were considered evaluable for the primary endpoint (n=8 gabapentin, n=7 hypnotherapy). The median number of daily hot flashes at enrollment was 4.5 in the gabapentin arm, and 5 in the hypnotherapy arm. HFSS scores were 7.5 in the gabapentin arm and 10 in the hypnotherapy arm. After eight weeks, the median number of daily hot flashes was reduced by 33.3% among women in the gabapentin arm, and 80% in the hypnotherapy arm. The median HFSS was reduced by 33.3% in the gabapentin arm, and 85% in the hypnotherapy arm. HFRDIS scores improved by 51.6% in the gabapentin group and 55.2% in the hypnotherapy group. Conclusions: Hypnotherapy and gabapentin both demonstrate efficacy in improving hot flashes in women with an increased risk or personal history of breast cancer. Complementary and alternative medicine (CAM) therapies are preferable to many women over hormone therapy due to the perceived risk of breast cancer, but objective data have been lacking comparing its use to conventional therapies. This pilot study provides evidence supporting the use of hypnotherapy for the treatment of hot flashes and emphasizes the need to perform further studies aimed at defining evidence-based recommendations for CAM.
Risk factor for axillary lymph node metastases in microinvasive breast cancer.
Authors: Ahn S. 
Published: February 2017

17 Background: Sentinel lymph node biopsy (SLNB) in patients with ductal carcinoma in situ (DCIS) was controversial. Usually we didn’t SLNB when we performed conserving operation with small sized DCIS. But sometimes we can find DCIS with microinvasive breast cancer (MIC) after operation. Must do reoperation in all patients? We determined the incidence of positive axillary lymph node (ALN) in patients with MIC and the predictive factors of ALN metastases in these patients. Methods: Between July 1989 and December 2008, 9.635 patients had operation on invasive breast cancer in Asan Medical Center. Among these patients 319 patients had MIC. The research conducted on the 293 patients except who didn’t performed axillary lymph node dissection or SLN biopsy. We retrospectively checked clinical and pathologic variables. Results: There were 22 cases of ALN metastases identified in this group of patients (7.5%). Lymphatic invasion (p<0.001) and positive estrogen receptor status (p=0.03) were independent significant predictors of axillary metastases. Conclusions: Microinvasive breast cancer is associated with a low rate of lymph node metastases. Some breast cancer patients with MIC at low likelihood of lymph node metastases may be spared lymph node evaluation.
Do younger women with early breast cancer have a higher recurrence risk?
Authors: Yap K. K. L. , Efiom-Ekaha D. N. 
Published: February 2017

178 Background: There has been conflicting evidence in the literature regarding the association between age and breast cancer recurrence risk. Cancer Research UK reported a better survival among patients aged 50 to 69 compared to younger women. The National Cancer Institute had reported the same, but only in women with stage 1 cancer. Fox Chase Cancer Center and Lyman et al had however suggested that there is no association between breast cancer recurrence and age at diagnosis. Our objective is to investigate the association between breast cancer recurrence and age at diagnosis. Methods: An IRB-exempted restrospective chart review of female patients at Wellspan Group who had Oncotype DX analysis in 2008 and 2009. Data collected included Oncotype DX score and age at diagnosis. Data was analyzed to determine the correlation between Oncotype DX score and age at diagnosis. The patients were divided into three groups: age less than 45 years, age 45 to 59 years, and age 60 or more. Oncotype DX score was used because it has been clinically validated as a reliable predictor of breast cancer recurrence for node-negative breast cancer. Results: A total of 125 patients were identified. The Pearson Correlation score for Oncotype DX score and age at diagnosis was -0.064 (p = 0.478). The mean score was 18.36 for those aged less than 45 years, 22.04 for those aged 45 to 59 years, and 19.16 for those age 60 or more. The difference between these groups was not significant (p = 0.340). Conclusions: There was neither significant correlation between breast recurrence and age, nor difference between the three age groups. Our study shows that age at diagnosis is not an independent predictor of breast cancer recurrence risk.
Features of recurrence of triple-negative (TN), non-metastatic breast cancer (NMBC) patients: A single institution study.
Authors: Alarcon-Rozas A. E. , Cueva M. R. , Galarreta J. , Torres J. , Gonzales E. , Ramirez J. 
Published: February 2017

180 Background: The TN BC is the most agressive subtype. Previous studies suggested that DFS of women with TN-BC is shorter than any other subtype and they demonstrated racial differences. The behaviour of these tumours are characterised by poor prognosis affecting mostly African American young obese women. Our goal is to determine the incidence of TN in non metastatic (NM) BC, the recurrence rate (RR), the patterns of recurrence by anatomic region and the DFS. Methods: We reviewed the medical records of patients with BC diagnosed between Jan/2000 to Dec/2005 at Almenara Hospital in Lima, Peru. There were a total of 1042 patients with BC; of them 215 were identified as TN NM BC according to IHC ER, PR, and Her2/neu negatives. We collected the clinical data including age, menopausal status, staging, hormone receptor status as well as Her2/neu status. The data were analized by statistic software SPSS v. 17.0. Results: The incidence of TN NM BC were 20.6% (215); of them 18.6% (40) patients had recurrences. The median age of recurrence were 52.5 years (31-93); the median DFS were 27 months, with a median follow-up of 64 months. According to inicial staging the recurrences were 7.5% (3); 32.5% (13); and 60% (24) respectively for patients with stages I, II and III. Almost one third (35%) of patients with recurrences were lymphatic node negative at diagnosis after mastectomy. The most frequent involved organs were visceral (lung=12, liver=3) 37.5% (15); bone 25% (10); skin 20% (8); CNS 12.5% (5) and contralateral breast 5% (2). There were four nuliparus women two of them had skin recurrence and the others two had bone metastasis. Conclusions: TN NM BC constitutes 20.6% of all BC in our institution; the majority of relapses were stage III (60%). The median DFS for recurrence were 27 months and the most frequent sites involved were visceral (37%) and bone (25%). 12.5% of recurrences were to CNS and one third of the patients were lymph node negatives. This is to our knowledge the first study of patterns of recurrence in TN nonmetastatic BC in a Latino population. The incidence of TN-BC which is close to African-American population (25%).
Are we seeing more obese breast cancer patients in Brooklyn?
Authors: Sultana R. , Thwin M. , Villani G. M. , Grand M. A. , Tun N. M. 
Published: February 2017

182 Background: Breast cancer is the most common female cancer in the US and the second most common cause of cancer death in women. Obesity has become a significant health challenge. The prevalence of obesity among non-Hispanic black women is reported to be approximately 50% with a prevalence of Class lll obesity of 5.2%. The objective of this study was to evaluate the severity of obesity in female breast cancer patients at our facility over the last three years. Methods: A retrospective study was conducted on 191 patients treated between January 2008 and December 2010 for breast cancer. Prevalence of obesity by class (Class I = BMI from 30 to 34.99 kg/m2, Class II = BMI from 35 to 39.99 kg/m2, Class IIl= BMI greater than 39.99 kg/m2) was calculated. Pearson chi-square statistic was used to investigate the relation between classes of obesity and stages of breast cancer (early stage = CIS to stage 2, advanced stage = stage 3 and 4). Results: Data from 191 breast cancer patients with BMI of 30 or more were analyzed. Class I constituted 39.3%, Class II 34% and class III 26.7%. The majority (75.9%) were diagnosed at an early stage, 24.1% diagnosed with advanced stage. Severity of obesity was not associated with the stage of breast cancer at diagnosis (c2= 0.004, df = 2, n = 191, p > 0.5). African American women constituted the majority (78.5%) of our study population. Conclusions: Our study reveals an alarming rate of class lll obesity among our breast cancer patients. It does not show a correlation among obesity and stage of disease, The majority of patients have early stage, potentially curable breast cancer. Given the fact that obesity has been associated with an increase in mortality (cardiovascular mortality is 50% greater in obese people and 90% greater in severely obese persons in comparison with that for people of average weight) our study suggests that treatment of obesity may play an equally important role in achieving long term outcomes as treatment of breast cancer itself.
Association of a common genetic variant of the IGF1 gene with clinical outcome in patients with HER2-positive breast cancer.
Authors: Lang A. , Muendlein A. , Hartmann B. L. , Drexel H. , Decker T. , Fricke H. , Hofmann W. , Mueller-Holzner E. , Marth C. , Hubalek M. 
Published: February 2017

193 Background: Insulin-like growth factor 1 (IGF1) stimulates mitosis and inhibits apoptosis. Circulating IGF1 levels may be linked with an increased risk of colorectal and breast cancer. Further, IGF1 single nucleotide polymorphisms (SNPs), especially variant rs2946834, recently have been associated with a poor clinical outcome in patients with colorectal cancer. However, the influence of IGF1 SNPs on the prognosis of patients with breast cancer is unknown. Therefore, we aimed at investigating the influence of IGF1 tagging polymorphisms associated with IGF1 levels on event-free survival in patients with HER2-positive breast cancer. Methods: The present study included 161 consecutive white patients with HER2-positive breast cancer treated between 2000 and 2010 at the Department of Gynecology and Obstetrics, Medical University of Innsbruck, Austria. Event-free survival was calculated as the time from cancer diagnosis to either relapse or death from any cause. Genomic DNA was extracted from archived formalin-fixed paraffin embedded tumor tissue samples; five IGF1 tagging polymorphisms (rs2946834, rs6220, rs1520220, rs5742694, and rs5742678) were genotyped by SNaPshot assays. Results: Mean follow up period was 4.3 (± 2.5) years. Kaplan-Meier analysis showed a poorer clinical outcome for carriers of the rare allele of SNP rs2946834 (log-rank test, p = 0.029). Concordantly, in univariate Cox regression analyses the rare allele of SNP rs2946834 was significantly associated with a decreased event-free survival (HR = 2.87 [1.07 –7.70]; p = 0.036). Multivariate analysis adjusted for age and tumor stage confirmed this result (HR = 2.86 [1.06 –7.71]; p = 0.038). Thus, our results are in concordance with a recent report that the same SNP is associated with poorer clinical outcome in colorectal cancer patients. Other investigated genetic variants of the IGF1 gene were not significantly associated with event-free survival (all p-values > 0.05). Conclusions: For the first time, our study investigates the influence of IGF1 tagging polymorphisms on the clinical outcome of HER2-positive breast cancer patients suggesting SNP rs2946834 as a predictor for reduced event-free survival.