bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does expression of estrogen receptor, progesterone receptor, and HER2 in atypical breast lesions predict a subsequent clinically significant event?
Authors: Tjoe Judy Angela , Neitzel Gary , Singh Maharaj , Last Brittany , Marx James , Kansra Sanjay 
Published: February 2017

34 Background: Atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH) increase breast cancer risk 3-5 fold. Risk reduction strategies include intense radiographic surveillance, medical, or surgical prophylaxis, all with associated side effects. Thus, identifying predictors of future breast cancer associated with atypia would limit aggressive treatment to only those patients at highest risk for disease progression. Given that lifetime estrogen exposure is a risk factor for breast cancer, and human epidermal growth factor receptor-2 (HER2) gene amplification is linked to breast pathogenesis, we tested whether expression patterns of estrogen receptor (ER), progesterone receptor (PR), and HER2 at initial diagnosis of atypia predicted a subsequent clinically significant event (SCSE), defined as another occurrence of atypia, in situ, or invasive carcinoma. Methods: Patients with an initial diagnosis of ADH and/or ALH were retrospectively identified. 19 women who developed a SCSE (cases) were matched to 45 women with no SCSE for at least 5 years after the diagnosis of atypia (controls). Archived tissue from cases and controls were subjected to ER, PR, and HER2 immunohistochemistry. ER and PR were reported using Allred score (0 to 8). HER2 was reported as negative (0-1+), equivocal (2+) or positive (3+). Atypia with HER2 (2+) or (3+) scores were subject to SISH to confirm gene amplification. Results: There was no significant difference in expression of ER (mean Allred: cases = 7.26 ± 0.35; controls = 6.91 ± 0.43) or PR (mean Allred: cases = 6.95 ± 0.43; controls = 6.57 ± 0.34). >90% of both cases and controls were HER2 negative (0-1+). Longitudinal assessment of ER, PR, and HER2 in patients who developed a SCSE revealed that three of 19 cases presented with HER2 overexpression; however SISH analysis revealed no gene amplification. Interestingly, ER/PR expression decreased in three of seven patients with atypia who later developed an invasive malignancy. Conclusions: ER and PR expression do not predict a SCSE after an initial diagnosis of breast atypia. HER2 does not appear to be a useful marker for risk prediction of a SCSE, as HER2 overexpression was not identified in any of our cases.
Breast cancer subtypes in Chinese Americans: A study from the Mount Sinai Health System.
Authors: Masias Camila , Shao Theresa H. 
Published: February 2017

39 Background: Breast cancer has been increasing in many Asian countries, as well as among Asian Americans. While many studies have examined breast cancer subtypes in African American and Caucasian populations, few have looked at tumor subtypes in the Asian population. We aimed to examine breast cancer subtypes in Chinese Americans. Methods: We identified all Chinese patients diagnosed with invasive breast cancers between 2005 and 2012 from the Cancer Registry of Mount Sinai Beth Israel, Mount Sinai St. Luke’s, and Roosevelt Hospitals. The following clinical data were collected for each patient: age at diagnosis, year of diagnosis, largest tumor size (cm), lymph node status, estrogen receptor (ER), progesterone receptor (PR) and HER2 status. Based on ER, PR, and HER2, patients were categorized into three molecular subtypes: 1) Hormone receptor (HR)+ (ER and/or PR positive, HER2 negative), HER2+ and triple negative (TN) (ER, PR, and HER2 negative). Descriptive variables were analyzed using one-way Anova test. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from logistic regression models. Results: There were 175 Chinese patients diagnosed with invasive breast cancers from 2005 to 2012. Median age at diagnosis was 54 (range 27-90). One hundred fourteen (65%) were HR+, 41 (23%) were HER2+, and 20 (11%) were TN. There were 59 (34%) patients diagnosed at age ≤ 50 and twelve patients (7%) were diagnosed at age < 40. There were more HER2+ and TN breast cancers diagnosed in women age ≤ 50 compared to age > 50, but the difference was not statistically significant. Women in the HR+ group were diagnosed at an older age compared to the other two subgroups (57 ± 12, 52 ± 8, and 52 ± 10 for HR+, HER2+, and TN, respectively, p = 0.036). Patients with TN breast cancers were more likely to have lymph node involvement compared to HR+ or HER2+ patients (p = 0.02). There was a trend of increasing prevalence of HER2+ breast cancer observed in recent years: 18.5% in 2005-2006, 23.8% in 2007-2008, 18.4% in 2009-2010, and 29.8% in 2011-2012. Conclusions: We observed a high proportion of breast cancer among young Chinese Americans as well as an increasing prevalence of HER2+ breast cancer in this population in recent years. Further studies are warranted.
Predictors that influence contralateral prophylactic mastectomy election among women with ductal carcinoma in situ who tested negative for a BRCA mutation.
Authors: Elsayegh Nisreen , Lin Heather Y. , Gutierrez-Barrera Angelica M. , Profato Jessica , Litton Jennifer Keating , Kuerer Henry Mark , Hortobagyi Gabriel N. , Arun Banu 
Published: February 2017

42 Background: Patients with ductal carcinoma in situ (DCIS) are at increased risk for developing contralateral breast cancer (CBC). Consequently, more women with DCIS are electing to undergo contralateral prophylactic mastectomy (CPM). We previously reported a 27% CPM rate among patients with DCIS who were evaluated for BRCA genetic testing (positive, negative, not tested). In this specific cohort, we further evaluated factors associated with CPM in patients with DCIS who tested negative for a BRCA mutation. Specifically, we aimed to identify differences within BRCA-negative patients who underwent CPM and those who did not. Methods: This retrospective study from a prospective registry included 100 women with DCIS referred for genetic counseling between 2003 and 2011. Patient characteristics included: age, marital and educational status, tumor markers, nuclear grade, family history of breast cancer (BC) and ovarian cancer (OC), race, Ashkenazi Jewish ancestry, and BRCA results. Univariate and multivariate logistic regression analyses were used to determine predictive factors associated with CPM election. Results: Of 100 BRCA-negative patients, 31 (31%) underwent CPM. Univariate analysis revealed patients who had a first-degree relative with OC were more likely to elect CPM that those who did not (p = 0.0278). Patients who had a family history of OC (53.3%) were more likely to choose CPM than those with no family history (p = 0.0425). Married patients were more likely to elect CPM than those who were not married (p = 0.0235). In multivariate analysis, married patients were more likely to elect CPM than those who were not married (OR = 4.367; 95% CI, 1.198-15.924; p = 0.0255). Conclusions: The CPM rate among patients with DCIS who tested negative for a BRCA mutation is high. Factors associated with increased rate of CPM among this group include a family history of OC and being married. Further studies are needed to evaluate patients' perceptions of CBC risk and their role in the likelihood of CPM choice.
The use of breast MRI in early-stage breast cancer: Findings after implementation of an institutional protocol at a county hospital.
Authors: Whitney Stewart , Arita Nestor , LaCross Jessica , Lassinger Brian , Bonefas Elizabeth , Liscum Kathy , Silberfein Eric Jay 
Published: February 2017

5 Background: Breast MRI has recently become standard-of-care in many practices, however, its proper utility in the preoperative management of early-stage breast cancer has not been fully elucidated. Our program recently instituted a protocol to obtain breast MRI at the time of diagnosis of breast cancer. We report the outcomes of this new approach in patients with surgically resected, early-stage breast cancer. Methods: An institutional database was queried for all patients that underwent surgery after a new histopathologic diagnosis of either noninvasive or invasive breast cancer from November 2012, the time of protocol implementation, through March 2014. Patients that received neoadjuvant treatment and patients with stage IV disease were excluded. Demographic, diagnosti,c and clinical data were extracted and analyzed using summary statistics and student’s t-test. Results: Fifty-eight patients met criteria. The median size of the index lesion on mammogram, ultrasound, MRI, and final surgical pathology was 1.2, 1.4, 2.1, and 1.3 cm, respectively. MRI size was significantly larger than mammogram, ultrasound, and final surgical pathology size (p < 0.05). The median time between initial pathologic diagnosis and breast MRI was 16 days. MRI identified 20 additional lesions in 19 (33%) patients leading to 14 additional biopsies and the diagnosis of two additional invasive and two noninvasive cancers. The median time between initial pathologic diagnosis and final report of these 14 biopsies was 36 days. Nine (64%) of the 14 patients that underwent a second biopsy went on to have a partial mastectomy, all with negative margins. Of the remaining five patients that went on to have total mastectomy, all but one were offered partial mastectomy but desired reconstruction. Conclusions: In this cohort of patients with early-stage breast cancer, MRI overestimated the size of the index lesion when compared to other imaging modalities and final surgical pathologic size. The use of MRI did not alter the surgical management in the majority of cases and increased the time from initial diagnosis to definitive surgical management. More studies are needed to determine the role of breast MRI in early-stage breast cancer.
Locoregional recurrence risk for women with various molecular subtypes of breast cancer treated with multicatheter interstitial accelerated partial-breast irradiation: Results from Pooled Registry of Multicatheter Interstitial Sites (PROMIS).
Authors: Anderson Bethany Marie , Kamrava Mitchell , Wang Jason , Jeffrey Demanes D. , Snyder Margaret B. , Kuske Robert R. , Chen Peter Y. 
Published: February 2017

73 Background: This study was performed to determine in breast tumor recurrence (IBTR) and regional nodal recurrence (RNR) rates for women with different subtypes of invasive ductal breast cancer treated with multicatheter interstitial accelerated partial breast irradiation (mAPBI). Methods: Data from 5 institutions was collected for patients treated from 1992-2013. We report the outcomes of 821 women with 830 breast cancers, all with ≥ 1 year of follow-up after completion of mAPBI. Molecular subtype analysis was performed for 582 women in whom ER, PR, Her-2, and grade were known. The Kaplan-Meier method was used to calculate overall survival (OS), IBTR and RNR. A univariate proportional hazard model was performed to estimate the risk of IBTR based upon molecular subtype, age, grade, N-stage, T-stage, margin status, tumor size, dose rate, endocrine therapy, and chemotherapy. Results: The median age of our patient cohort was 60 years. 50.0% (n = 415) of women had luminal A, 6.9% (n = 57) luminal B, 5.7% (n = 47) luminal Her-2, 1.8% (n = 15) Her-2, and 5.8% (n = 48) triple negative breast cancer (TNBC); an additional 29.8% (n = 248) could not be subtyped. With a median follow-up time of 6.5 years, the 5-year OS of our patient cohort was 94.8%. The 5-year IBTR was 3.5% for luminal A, 4.1% for luminal B, 5.1% for luminal Her-2, 13.3% for Her-2, 11.3% for TNBC, and 1.7% for non-subtyped women. Positive surgical margins and high grade correlated with risk for IBTR; molecular subtype and other variables did not. The 5-year RNR rates were 0.3% for luminal A, 4.6% for luminal B, 2.6% for luminal Her-2, 34.5% for Her-2, and 2.3% for TNBC. RNR risk was significantly higher for women with Her-2 compared to the other 4 subtypes. In addition, risk of RNR was significantly higher for women with luminal B compared to those of luminal A. Conclusions: Women with Her-2 and luminal B breast cancer may have higher RNR but not IBTR risk after mAPBI, as compared with women with luminal A subtype. Further follow-up, correlation with use of trastuzumab, and comparison of outcomes with whole breast irradiation will be valuable.
Toxicity and cosmesis after oncoplastic surgery and interstitial brachytherapy.
Authors: Smith Linda A. , Kuske Robert R. 
Published: February 2017

89 Background: Oncoplastic surgery fuses breast cancer surgical and reconstructive techniques, both simple and complex. Following sculpting and removing the appropriate malignancy, tissue rearrangement is utilized to minimize the dead space. PBI with brachytherapy provides excellent tumor control in this population. This study investigates cosmetic outcome and toxicity in select stage 0, 1, and 2 breast cancers treated by a single breast surgeon and radiation oncologist. Methods: 140 women were treated between May 2010 and December 2013 with breast conservation, sentinel node biopsy (SNB), and interstitial brachytherapy. Selection criteria included women of any age, any subtype, tumor size less than < 3 cm, N0 or N1mic, with excision margins > 1 mm. Strict modified Harvard cosmesis scale was used by direct examination by the surgeon, not photos. Toxicity was judged by the surgeon at the time of each follow-up, using the CTCAE scale, version 4. Median follow-up is 2 years. Results: Two patients were lost to follow-up. There were no in-breast and 1 axillary recurrence. Grade 2 or higher toxicities were seen in 10 patients (7.2%, one of whom had Lupus), and only 1 lasted beyond a year. Toxicity included 1 transient breast edema, 1 late mastitis at one year, 1 grade 4 (0.7%), 0 grade 3, 5 grade 2 (3.6%), and 7 grade 1 fat necrosis, 3 grade 2 fibrosis (2.2%), and only 1 transient arm lymphedema (all patients had SNB). Cosmesis was judged as poor in 1 (0.7%), fair in 2 (1.4%), good in 19 (14%), and excellent in 116 (84%). Pockmarks were visible on casual examination in 8% after one year. Conclusions: Oncoplastic surgery combined with sentinel node mapping and interstitial brachytherapy has resulted in low toxicity (7.2%) and high rates of acceptable cosmesis (98% good/excellent), as scored by a single surgeon with strict criteria at each follow-up visit. No conclusions about tumor control will be made until this cohort has mature follow-up.
Recurrence patterns among T1-2N0 triple-negative breast cancer patients following mastectomy.
Authors: Young Rebekah , Gergelis Kimberly , Kalnicki Shalom , Fox Jana Lauren 
Published: February 2017

93 Background: Women with early-stage TN breast cancers are at increased risk for recurrence (RR) compared to other molecular subtypes, and are often treated with mastectomy without local adjuvant therapy. We wish to evaluate the RR for these women. Methods: In this single institution retrospective study, women with T1-2N0 TN breast cancer who underwent mastectomy between 2008-12 were identified from tumor registry. Adjuvant chemotherapy was allowed, but adjuvant radiotherapy (RT) was excluded. Of 3,000 cases reviewed, 52 women were identified. Median age was 58.5 (30–90). Lesions were high-grade (83%), and T1-2 (47%, 53%). 21 women (42%) had at least 1 risk factor. 5 women were BRCA+. Women underwent total mastectomy or modified radical mastectomy, and the majority (84%) had adjuvant chemotherapy. Results: At a median follow-up of 3.5 years (6-71 months), there were 8 recurrences (15.4%). 3 (5.8% of cohort) were locoregional (LR) only (2 chest wall (CW) and 1 ipsilateral axilla), 6 (11.5%) involved a concurrent LR and distant recurrence, and 2 (3.8%) were distant only. Median time to recurrence was 17.3 months. The isolated LR recurrences (LRR) were at 14, 15.6 and 15.1 months. Most women (41, 78.8%) were alive with NED. 3 were alive with disease, underdoing treatment, and 1 woman was disease free after treatment for CW recurrence. 8 patients (15.4%) are deceased, half from their cancer. On univariate analysis, there was no significant correlation (p>0.05) between age or high-risk features and RR (STATA v 11). Conclusions: T1-2N0 breast cancer patients are believed to have a low RR following mastectomy. TN disease, however, is more aggressive, and the question of irradiating early stage disease after mastectomy has arisen. A single institution, retrospective study found women with T1-2N0 TN disease fare better with BCT that includes RT, compared to mastectomy alone. Other studies have shown no statistical difference in RR between these 2 groups. We found an isolated LRR rate at 3.5 years of 5.8%. Follow-up and ultimately prospective data is needed to determine whether the isolated LRR warrants a change in treatment recommendations for this pt subset.
External beam radiation therapy evaluated in patients with breast cancer with cutaneous mastocytosis.
Authors: Chaiken Lisa , Yonemoto Les , Ziegner Ulrike , Kuhn Gilbert , DiNome Maggie Lee , Slates Randal , Juillard Guy 
Published: February 2017

95 Background: Mastocytosis is a rare disease characterized by an excess of mast cells. The most common presentation is cutaneous mastocytosis (CM) presenting with skin lesions of urticaria pigmentosa (UP). There is concern of anaphylactic shock from the interaction of ionizing therapeutic radiation and mast cell activation in these patients. There is very little if anything published regarding radiation treatment of patients with cutaneous mastocytosis. Literature has ranged from radiation possibly causing mastocytosis in breast cancer patients to radiation treating canine mast cell tumors. Two patients are reported in order to explore and document the tolerance and safety of breast radiation in patients with cutaneous mastocytosis. Methods: Two patients with CM presented with early stage breast cancer for radiation treatment. Three dimensional conformal radiation to the breast was given. Epinephrine injection was kept at the patient’s side during treatment. With the initiation of radiation, a steroid and additional anti-inflammatory medicine or antihistamine were taken with the baseline medication, prior to each treatment. Monitoring was performed after treatment. To minimize potential toxicity, radiation started with the boost field to confirm acceptable tolerance. Results: Both patients tolerated the radiation without any unusual acute or late toxicities. There was no anaphylaxis. Both patients showed a decrease in the UP rash in the radiated field. Tryptase levels, a marker for CM, remained stable or decreased. Conclusions: Two patients with cutaneous mastocytosis showed excellent tolerance of breast radiation therapy. In the radiation field, UP improved and may be indicative of mast cells being sensitive to radiation in small volumes. Breast radiation avoids more extensive surgery and anesthesia, which are known to exacerbate CM. Radiation therapy to the breast appears to be safe for patients with cutaneous mastocytosis. Precautions of starting with the boost field, monitoring the patients, and maximizing medical treatment, should be taken given the limited data. This report is the first to document the safety of breast radiation in patients with cutaneous mastocytosis.
Ensuring head and neck oncology patients receive recommended pretreatment dental evaluations.
Authors: Margalit Danielle Nina , Losi Stephanie , Tishler Roy B. , Schoenfeld Jonathan Daniel , Fugazzotto JoAnn , Stephens Josie , Cebulski Amy , Hammerstrand Elizabeth , Ma Laura , Lopes Holly , Haddad Robert I. , Treister Nathaniel S. , Frustino Jennifer L. 
Published: February 2017

100 Background: Pre-treatment dental evaluations are recommended for head and neck (H&N) cancer patients (pts) prior to radiation therapy (RT) to minimize the risk of acute and long-term side effects of treatment. We previously created a dental instructional guide (DIG) outlining the necessary components of the pre-radiation dental evaluation for pts undergoing community-based dental evaluation. Yet our program did not have a system for documenting which pts received the DIG. We aimed to create a system to ensure that pts are given the DIG early in their care-plan and that such pts are readily identifiable so we can follow-up and confirm that the recommended dental care is complete prior to starting RT. Methods: Chart review was performed to determine the percentage of eligible pts with documented provision of the DIG. A diagnostic survey of H&N oncology clinicians was analyzed with a Pareto chart to determine common barriers to DIG provision and documentation. Clinicians were surveyed on potential ways to document DIG provision to eligible pts. The Model for Improvement and DMAIC (Six Sigma) methodologies were used and multiple Plan-Do-Study-Act (PDSA) cycles were performed to implement the intervention and monitor change. Change data was analyzed using a P-chart, 3-sigma. Results: We used a process map to identify 3 potential care-plans within the H&N oncology program and assist in defining which providers had primary responsibility for providing the DIG. We then designed and implemented a template within the electronic medical record that documents the clinician who gave the DIG and the date it was given. There was an improvement in the rate of DIG documentation from a baseline of 0% (range 0-0%) to a mean of 40% (range 0-100%) over 3-months (p<0.01). This improvement was sustained through last follow-up at 5 months. Conclusions: Through a multidisciplinary approach, we implemented an intervention to identify pts undergoing community-based dental evaluation prior to RT for H&N cancer. Further efforts are focused on increasing the DIG documentation rate and increasing our interaction with community dentists to promote expeditious pre-radiation dental care.
Quality of febrile neutropenia management in a regional cancer center emergency department.
Authors: Kapil Priyanka , Enright Katherine 
Published: February 2017

104 Background: ASCO's current guidelines for febrile neutropenia (FN) management support antibiotic administration within one hour of presentation to the emergency department (ED). Prompt initiation of antibiotic therapy is vital to decrease the likelihood of adverse outcomes. Many studies, however, have reported significant delays in antibiotic initiation with mean wait times far exceeding ASCO's guidelines. We aimed to assess the quality of FN management at a regional cancer centre ED. Methods: Patients undergoing chemotherapy who visited the ED at the Peel Regional Cancer Center in Ontario, Canada between 04/12 - 03/13 were identified using electronic medical records. Patients were excluded if there was no record of chemotherapy delivery within 30 days prior to ED visit. ICD-10 codes and chart data were used to identify patients who had presented for either fever or infection. The primary outcome measures were three major quality of health indicators; time to assessment by a physician, Canadian Triage and Acuity Scale (CTAS) score, and time to initiation of intravenous antibiotics. Results: In total 239 records were included in the analysis. CTAS score was concordant with recommendation for FN (level 1-2) in 85% of patients and did not vary based on primary cancer site (p = 0.17). The mean time to physician assessment was 97.2 min and the mean time to initiation of IV antibiotics was 194.7 min. Overall, 14.6% of patients received their first dose of antibiotic therapy within the recommended 1 hour window. Conclusions: Our audit identified a large margin for improvement in the time to initiation of antibiotic therapy for chemotherapy patients with suspected FN. Prompt recognition and initiation of standardized treatment pathways for FN in the ED may improve the time to initiation of antibiotic therapy. In an attempt to address this gap in quality we have developed and distributed a standardized wallet-sized fever card to all patients receiving cytotoxic chemotherapy within our regional cancer program. This card contains information pertaining to the current chemotherapy treatment and recommended ED treatment protocols for FN. An evaluation of the impact of these cards is ongoing.