bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sentinel lymph node biopsy following neoadjuvant chemotherapy in clinically node-negative breast cancer patients.
Authors: Enokido K. , Nakamura S. , Tsugawa K. , Kojima Y. , Iwata H. , Ohno S. , Akiyama F. , Motomura K. 
Published: February 2017

15 Background: Sentinel lymph node biopsy (SLNB) is a widely accepted staging method for patients with early breast cancer. But SLNB following neoadjuvant chemotherapy (NAC) is also controversial because of insufficient evidence to recommend as a standard procedure. The aim of our study was to demonstrate the feasibility of SNLB following NAC. Methods: The clinical study of SLNB for clinically node-negative breast cancer patient was conducted as a large cohort study to confirm the identification rate and safety of this procedure. It was investigated by The Japanese Breast Cancer Society and was accomplished between the years March 2008 and October 2009. In this study 11,228 cases are registered before SLNB from 64 institutions. Of the 11,228 eligible cases, analysis was conducted among 489 cases that were introduced neoadjuvant chemotherapy. Results: SLNB was performed in 110 cases before NAC, 379 cases after NAC. The sentinel node identification rate before NAC was 106/110 cases (96.4%), after NAC was 373/379 cases (98.4%). Intraoperative frozen section analysis was performed in 280 cases, 71 cases were positive. The remaining 219 patients displayed no metastasis in the intraoperative examination, and 6 of these 219 (2.7%) were positive in the final pathological analysis. Conclusions: The identification rate of SLNB following NAC is not inferior to the result of major clinical studies previously reported in the world. There is insufficient evidence to recommend this as a standard procedure. Further research with subgroup analysis is necessary to identify whether SLNB following NAC is feasible or not (planned study). The primary end point for Group A is local relapse rate, Group B is not only the accuracy and false negative rate also the utility of One-step Nucleic Acid Amplification (OSNA).
Treatment patterns and costs following metastatic breast cancer diagnosis in U.S. women: A SEER-Medicare analysis.
Authors: Taylor D. C. A. , Sanon M. , Clements K. , Balu S. , Faria C. , Teitelbaum A. 
Published: February 2017

150 Background: To use SEER-Medicare data to evaluate treatment (tx) patterns and health care costs in U.S. women with metastatic breast cancer (MBC). Methods: Key inclusion criteria included women diagnosed (dx) with breast cancer in 2001-2005 with 1) enrollment in Medicare 12 mo prior to dx through follow-up (2008) or death; 2) initial dx of “distant” disease or 2 indications of secondary malignancy >2 mo after initial dx; and 3) indication of tx with injectable hormonal, chemotherapy (chemo) or targeted/biologic therapies. Lines of tx were designated as: 1st-line if 1st agent (or agents, if on same day) after dx of MBC; new agents administered > 42 d after the previous agent are a new line, as well as an agent administered > 60 d after last dose of the same agent. Oral medication data were not available. Kaplan-Meier techniques estimated lifetime total health costs by partitioning data into 30-d intervals starting with MBC dx date and then summing the product of mean cost in each interval by the probability of survival to the start of the interval. Bootstrapping methods were used to generate 95% confidence intervals (CI). Results: The table lists the top 5 injectable tx for first, second, and third line, with associated mean lifetime costs. Conclusions: In this population, the injectable fulvestrant was the most commonly used first-line tx, with vinorelbine most frequently used in second- and third-line settings for MBC. Mean lifetime cost of MBC was $110,000. [Table: see text]
Physician experience and challenges obtaining unfunded oral chemotherapy across Canada.
Authors: Han D. , Hogeveen S. , Trinkaus M. , Mamdani M. , Berry S. R. , Jang R. W. , Hoch J. , Simmons C. E. 
Published: February 2017

155 Background: Previous studies have shown hematologists and medical oncologists may not accept the financial limits set by governing agencies on access to oral chemotherapy for their patients. This requires increased time and effort on the clinician’s part to obtain funding. We captured physicians’ perceptions of barriers to obtaining unfunded chemotherapies and methods used to overcome these barriers. Methods: A total of 640 medical oncologists and hematologists were surveyed using a web-based survey tool. A thirteen-item survey was designed to assess the practice type along with time spent and methods used on obtaining unfunded oral chemotherapy. Results: Of the 640 invitees, 568 were delivered and 168 responded (response rate 30%). 91 respondents were medical oncologists, 44 were hematologists and 33 treated both solid and non-solid malignancies. 65% of physicians spent an average of 1-4 hours obtaining funding for oral drugs for patients per week. 62% indicated their institution has a drug access coordinator (DAC). Having a DAC did not impact the proportion of physicians spending >4 hrs/ week accessing oral drugs (38% vs 29%, p=NS). To overcome barriers to funding, physicians’ enrolled patients on clinical trials (91%), used compassionate access programs (96%) or special request forms to government (92%). Other methods included writing false claims on forms to fit funding criteria for a drug (36%) or use of leftover drug supplies (36%). The majority of physicians felt that their inability to obtain unfunded medications for their patients has negatively impacted patients’ clinical outcomes (56%) and psychosocial quality of life (74%). Of all respondents, only 28% of physicians contacted their governing body with concerns of funding for oral chemotherapy. Conclusions: Practicing hematologists and medical oncologists in Canada use numerous methods to obtain unfunded oral chemotherapies, including lying on access forms. Overall, the majority of physicians spend 1-4 hours a week on obtaining funding; this did not differ for physicians with or without a DAC at their practice. Despite the challenges in accessing oral chemotherapies, most physicians have not contacted governing bodies for legislative change.
A clinical trial with culturally appropriate video to increase participation of African Americans in cancer clinical trials.
Authors: Banda D. R. , Mete M. , Swain S. M. 
Published: February 2017

159 Background: There is a need to develop patient-level interventions to change attitudes and increase African American (AA) participation in breast cancer clinical trials (CT). This pilot study tested the efficacy of a 15 minute narrative-based video which we created in the first such intervention in AA patients. Methods: This single group study enrolled 88 breast cancer patients in active treatment at a large urban cancer institute. Eligible patients were self-identified AA, ≥ 21 years, and never participated in a CT. The primary outcome was self-reported likelihood to enroll in a therapeutic CT. Participants were interviewed at baseline using an instrument developed specifically to assess attitudes on six trial barriers. An immediate post-test was administered following the video. McNemar’s test for matched pairs was used to assess the change in likelihood to enroll in a CT. Stuart-Maxwell marginal homogeneity test for matched pairs with multi-category outcomes was used to evaluate which attitudes were impacted by the intervention. Results: Patients enrolled October 2010- February 2011 (n =108), 75% female. Age from 31-87 years, mean 61 (SD=12). Patients' likelihood of enrolling in a CT significantly increased post video [OR 19.5, 95% CI: 5.05 – 166.7, McNemar’s χ2 = 33.39, P <0.001]. Stuart-Maxwell tests showed significant changes in 28 of 30 attitudinal questions post video. Specifically, the video impacted attitudes associated with a concern about the ethical conduct of investigators; the fear of loss of autonomy after signing an informed consent form; worry about being treated poorly as a poor or minority patient; loss of privacy; and the lack of knowledge and awareness of clinical trials. Conclusions: These data demonstrate the overall efficacy of our video and can be extrapolated to a single disease focus. This should have particular benefit for large cooperative group studies including breast cancer trials.
Identifying genomic rearrangements in BRCA1 and BRCA2 in high-risk individuals for hereditary breast and ovarian cancer.
Authors: Jackson M. , Mattair D. , Lin H. , Gutierrez-Barrera A. M. , Elsayegh N. , Litton J. K. , Hortobagyi G. N. , Arun B. 
Published: February 2017

163 Background: Germline mutations in the BRCA1 and BRCA2 genes are responsible for the majority of hereditary breast and ovarian cancer (HBOC). Comprehensive gene sequencing detects ~87% of BRCA mutations, and large genomic rearrangement testing (BART) accounts for ~3%. Criteria have been established to capture individuals who most likely have a BART mutation, however, recent data shows that some individuals have BART mutations and do not meet the criteria. We conducted a single-institution study to evaluate the sufficiency of BART criteria to determine if new criteria are warranted. Methods: During 2006-2008, 172 individuals underwent BRCA sequencing and BART at M. D. Anderson Cancer Center. A retrospective, IRB-approved chart review of a prospectively maintained database was conducted to determine BART criteria eligibility, personal/family history of breast and ovarian cancer and tumor characteristics. Univariate and multivariate analysis was performed to test the significance of each variable in relation to BRCA1/BRCA2 positivity. Results: Of 172 individuals, 12/34 (35%) had BRCA1 BART mutations, and 7/11 (64%) had BRCA2 BART mutations. Of the 19 individuals who tested positive for BART mutations, only 8 (42%) met BART criteria and 11 (58%) did not and proceeded with BART for various reasons (family history, insurance covered, and patient request). Individuals who were BRCA1 positive (sequencing or BART) were more likely to have ER/PR negative breast cancer (p<0.0001) and a personal (p=0.0215)/family history of ovarian cancer (p=0.0001) compared to non-carriers and individuals who had no family history Individuals who were BRCA1 sequencing positive were more likely to meet BART criteria than BRCA1 BART positive (p=0.0151) individuals. Conclusions: Given that no significant differences in family history/tumor characteristics between individuals who have sequencing and BART mutations were identified, and a majority of individuals who were BART positive do not meet BART criteria, it appears that these criteria may be insufficient. BART testing should be considered for all individuals who undergo BRCA sequencing; however, large scale collaboration studies should be conducted.
Survival variation of the ER/PR/HER2 subtypes by race in a single institution.
Authors: Parise C. , Caggiano V. 
Published: February 2017

183 Background: We have investigated breast cancer in California noting variation in survival among race/ethnicity, age, and the ER/PR/HER2 subtypes. The purpose of this study is to determine if similar variation exists in a single institution in California. Methods: We indentified 994 cases of first primary invasive breast cancer between January 2004 and December 2007. Descriptive statistics were used to assess the distributions of race/ethnicity, ER/PR/HER2 subtype, age, and treatment status. Kaplan-Meier survival estimates were computed and the Log-Rank Test used to compare 5-year survival. Results: The most common subtype was ER+/PR+/HER2- (49.6%). There were 221 cases of the HER2-positive subtype; 25% of these were the HER2 over-expressed subtype (ER-/PR-/HER2+). There were 113 cases of ER-/PR-/HER2- (14.0%) and only 3 cases of the ER-positive/PR-positive subtype. The distributions of race and subtype were similar to statewide data for this region. Of the 994 cases, 81% were White, 5.9% Black, 6.5% Asian, 6.2% Hispanic, and 0.3% were American-Indian. For all subtypes and stages combined, 5-year survival was worse for African-Americans (70%) when compared with White patients (83%) Χ2 = 15.29, p < 0.001. There were no statistically significant differences in mean age of diagnosis among the eight subtypes. Of the 113 cases of ER-/PR-/HER2-, 80 were White, 15 Black, 8 Asian, and 8 Hispanic. Only one Black patient with ER-/PR-/HER2- was younger than age 45. African-American patients with ER+/PR+/HER2+ and ER+/PR-/HER2- were more often diagnosed in stages 3 and 4. The ER-/PR-/HER2- subtype had worse 5-year survival (64%) than both the ER+/PR+/HER2+ (88%) and the ER+/PR+/HER2- (85%) subtypes (p < 0.001). There was no difference in survival by race for the ER-/PR-/HER2- subtype. For ER-positive patients, African-Americans had worse 5-year survival than whites (66% versus 86%) Χ2 = 16.18, p < 0.001 despite comparable hormonal and chemotherapy regimens. Conclusions: The ER+/PR+/HER2+ subtype does not always mean poor survival. The triple-negative subtype has the worst survival for both Black and White patients. African-American patients with any ER-positive subtype fare poorly. Referral bias and small sample sizes are study limitations.
Learning from the lowest incidence rates in breast cancer: Health information from men, young women, and Native American/Alaskan native women.
Authors: Dedousi-Huebner V. , Chakravarti A. , Lautenschlaeger T. 
Published: February 2017

185 Background: Breast cancer rates by the NCI show the lowest incidence for young women under 30, Native American/Alaskan Native women and males overall. Using the National Health Interview Survey we set out to investigate what these three very heterogeneous appearing groups seem to have in common in order to possibly detect preventive factors for breast cancer. Methods: The NHIS is a continuous national survey of the US civilian population. The data are collected yearly through in-person computer assisted household interviews. All members of the household 17 years of age and over who are at home at the time of the interview were invited to participate and respond for themselves. Using the data from this survey provided by the Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, we controlled for gender, race/ethnicity, poverty level and age. Results: Over 29.5% of all questioned Native American/Alaskan Native women responded to be in good health while only 17.8% of all white women responded the same. The difference in reported health status between white women and white men was not statistically different. For the health status of women in different age groups we found a picture that is reverse to the incidence trend of breast cancer. The older the women, the more likely they were to respond that they were in good health. Conclusions: As can be expected from such heterogeneous groups they did not have one variable in common that might have a preventive effect on breast cancer. The higher estimate of positively reported health status in association with the low incidence of breast cancer of Native American/Alaskan Native women certainly makes it worth investigating the positive attributes associated with this group’s health behavior. Another more unsettling interpretation of the low incidence rate in this population may be attributed to health insurance coverage, 32.5%—more than double the rate of the population of Caucasian females—do not have health insurance coverage which might lead to a lower rate of reported cancer cases.
Ductal carcinoma in situ (DCIS) of the breast: Race- and treatment-adjusted specific disease-free probability.
Authors: Stark A. , Yan X. \(. , Stapp R. , Raghunathan A. , Kirchner L. , Griggs J. , Newman L. A. , Dick A. W. , Chitale D. 
Published: February 2017

186 Background: Findings of DCIS outcome between African-American (AA) and White-American (WA) women are inconclusive. Methods: We conducted a retrospective longitudinal study with the objective of comparing the risk of any second breast cancer after the first primary DCIS, adjusting for pathologic prognostic indicators, treatment, age, and the established epidemiologic risk factors. Women were diagnosed and treated in one institution between 1990-1999. Diagnostic slides were reviewed and prognostic indicators documented; demographic, clinical and method of detection, screening mammography vs. palpation, were collected from medical records. We applied Accelerated Failure Time Modeling (AFTM) to determine the variables that were best associated with the risk of a second cancer. Results: 335 women, 29.6% (n=100) AA with mean age of 60 (±13) and 70.4% (n=235) WA with mean age of 57 (±12.4), contributed to this study. Distributions of some of the prognostic indicators and final treatment are presented. (Table) During the 10 years of follow-up 12.0% (n=12) of AA and 3.0% (n=7) WA experienced second cancer in ipsilateral breasts; 5.0% (n=5) of AA and 3.8% (n=9) WA in their contralateral breasts and 2 women, 1 AA and 1 WA, in both breasts. Results from the AFTM yielded race as the only variable associated with the risk of a second cancer but only in ipsilateral breasts (HR= 4.11, 95% CI=1.6-10.5 p=0.003). Conclusions: No difference in the risk of a second cancer in contralateral breast between AA and WA women support the notion of equal access and equal treatment in comparable treatment outcome. Reasons for increased risk of a second cancer in ipsilateral breast in AA women are being evaluated. [Table: see text]
Racial and ethnic disparities in presenting stage and overall survival in women treated for breast cancer.
Authors: Salner A. L. , Staff I. 
Published: February 2017

187 Background: Over the past 20 years, we have recognized racial/ethnic disparities in breast cancer outcomes, and have attempted to develop outreach, screening, and care strategies to address these. This study explored changes in these disparities over twenty years in presenting stage and overall survival at a single large urban teaching and community hospital with an active cancer outreach program, a member of the NCI Community Cancer Centers Program. Methods: Between 1990 and 2009, 9733 women were diagnosed and treated with breast cancer at our institution. 8918 women with complete race/ethnicity and clinical data were analyzed. The women were grouped into four five-year cohorts, and 3 subgroups-Caucasian, African American, and Latina. All four cohorts were compared for stage migration, while only the initial three cohorts were compared for 5 year overall survival to allow follow-up. Chi-Square tests of proportions were utilized to compare subgroups. Results: Of the 8918 women analyzed, 91.5% are Caucasian, 4.5% African American, and 4% Latina. Over the 20 years of the study, significant stage migration occurred; the total number of women diagnosed with early stage disease(in-situ and localized) increased from 71.7% to 78.7%. Significant stage migration was found for all subgroups of women. Stronger trends were found focusing only on in-situ disease—an overall increase from 14.4% to 30.8%. Five year overall survival of the entire group improved from 78.7% to 85.4%, and also improved for each of the subgroups. Caucasian women were significantly older (60 vs. 54) but the cohort and ethnic findings remained in multivariate analysis. Significant disparities between Caucasians and Latinas for stage and between Caucasians and African American for 5 year survival gradually diminished. Conclusions: Significant improvements are seen in earlier stage presentation and five year overall survival amongst women treated for breast cancer between 1990 and 2009, as well as in subgroups of Caucasian, African American and Latina women. Differences between subgroups diminish and in many cases disappear by the end of the study period, suggesting that strategies may have helped reduce breast cancer disparities.
Locoregional lymphatic recurrence following axillary dissection for breast cancer.
Authors: Lim S. M. L. , Lam F. L. , Remulla S. J. N. 
Published: February 2017

19 Background: The risk of locoregional recurrence is of concern for women following breast cancer surgery. We report a single surgeon’s experience of locoregional lymphatic recurrence following axillary dissection (AD) in women with breast cancer. Methods: The aim of this study is to identify risk factors for locoregional lymphatic recurrence in women who have undergone breast surgery and AD for T1, T2 tumours. 14 women were identified over 10 years with documented recurrence in the regional lymphatic basin; ipsilateral, contralateral, supraclavicular and internal mammary lymph nodes. One patient presented with bilateral breast cancer. Patient characteristics as well as the tumour grade, ER, PR, HER2 reactivity and presence of lymphovascular invasion (LVI) were analysed. Results: Between 1996 and 2006, 756 women underwent primary surgery for breast cancer in our practice. We identified 14 women who relapsed with locoregional lymphatic recurrence and underwent further surgical management after a median follow-up of 4.5 years. 13/14 had undergone primary breast surgery at our centre, of which 73% underwent total mastectomy and AD. The median age was 48 years, 14% were nulliparous, and 50% were premenopausal. The mean tumour size was 2.48 cm and 7% had a contralateral cancer. The median axillary lymph node (LN) yield was 11.5 of which 57% (8/14) were node negative at primary surgery. In those 8 patients with negative AD, 50% recurred in the ipsilateral axillary LNs, 37.5% recurred in the ipsilateral supraclavicular LNs in the absence of axillary relapse, and 12.5% recurred in the contralateral axillary LNs in the absence of ipsilateral axillary relapse. Of the primary tumour characteristics, 13% were low grade, 43% had LVI, 57% were ER+, 64% PR+, 43% HER2+, and 14% triple negative. None of the patients had distant metastases at the time of relapse in the locoregional lymphatic basin. Conclusions: An axillary dissection did not prevent locoregional lymphatic recurrence in 14 women in our small series. On retrospective analysis, there was no dominant risk factor which could help to identify this group at high risk of relapse, although at least 50% who relapsed locoregionally were less than 50 years, premenopausal with a high tumour grade.