bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethnodrama: An innovative knowledge translation tool in the management of lymphedema.
Authors: Ahmed Shahid , Quinlan Elizabeth , McMullen Linda , Thomas Roanne , Fichtner Pam , Block Janice 
Published: February 2017

102 Background: Lymphedema can cause significant physical impairment and quality-of-life issues. Yet there is a gap in knowledge about lymphedema among breast cancer survivors (BCS), and health care professionals (HCP). Ethnodrama is an innovative knowledge translation strategy that uses theatrical performances for dissemination of research results. We evaluated the impact of live ethnodrama on HCP’ and BCS' awareness and attitudes in relation to impact of lymphedema on BCS’ lives. Methods: Ethnodrama performances were developed by script writers and a theatre director in collaboration with the investigators and BCS using data from published research and pre-performances workshops. The 25- minute performance follows a readers’ theatre model. Six interactive live performances were given to audiences of BCS, HCP, and community members in four cities across Canada. After watching these live performances, the audiences were asked to complete a survey regarding their knowledge, attitudes and practices toward lymphedema. Results: Of 238 survey participants, 55 (23%) were BCS and 85 (37.5%) were HCP. The mean age was 46±15 years & M:F was 1:4.8. Most members rated the performances as very effective in changing their (84%) or other people's (93%) understanding of lymphedema. Only 2.7% of respondents judged the performances as not effective at all in changing their understanding of lymphedema. Following the performances about 87% of respondents (95% HCP vs. 86.2% BCS, p = 0.10) reported being moderately to extremely motivated to seek additional information on lymphedema; 76% BCS reported interest in discussing arm morbidity issues with their HCP & 72% HCP anticipated changes in their practices related to arm morbidities screening. Overall no significant differences were noted in responses to ethnodrama between BCS and HCP. Open-ended responses were supportive of the findings from the closed-ended questions. One of the performances (The New Normal: Living with Lymphedema) is available on https://www.youtube.com/channel/UCewEVF6CcTlEKYlLNcc8FWQ . Conclusions: Our results indicate that ethnodrama performances effectively convey information and positively affecting changes in HCP’ and BCS’ attitudes toward lymphedema.
Racial disparities in breast cancer mortality among the regions of California.
Authors: Parise Carol , Caggiano Vincent 
Published: February 2017

106 Background: Racial/ethnic disparities in breast cancer mortality have been described. Geographic variation in breast cancer mortality has also been observed. The purpose of this study is to determine if there are racial disparities in breast cancer survival among eight regions in California, the most populous state in the U.S. Methods: Of 245,701 cases of first primary female invasive breast cancer from the California Cancer Registry (CCR) diagnosed in 2000-2011, we identified 143,184 with complete data. The regions of California were classified as North, Sacramento, San Francisco and Bay Area (SFBA), Central Valley, Tri-County, Desert Sierra, Los Angeles (LA), and San Diego/Orange. Cox Proportional Hazards was conducted to assess risk of mortality of African Americans, Hispanics, Asian/Pacific Islanders, and American Indians when compared with whites. The region X race interaction was tested. Analyses were adjusted for year of diagnosis, stage at diagnosis, grade, age, and socioeconomic status. Hazard ratios and 95% confidence intervals were reported. Results: The region X race/ethnicity interaction was statistically significant so separate models were fitted for each region. Blacks has increased mortality in SFBA (HR = 1.36; 1.20, 1.56), LA (HR = 1.37; 1.24, 1.51) and San Diego/Orange (HR = 1.31; 1.07, 1.60). American Indians had an increased risk of mortality in the Tri-County (HR = 3.90; 1.73, 8.78) and San Diego (HR = 1.93; 1.04, 3.64) regions. Hispanics had a reduced risk mortality only in the Tri County region (HR = 0.71; 0.55, 0.93). Asians had a lower risk of mortality in San Diego/Orange (HR = 0.81; 0.70. 0.94) and LA (HR = 0.78; 0.70; 0.87). Race was not a statistically significant factor for risk of mortality in the North, Sacramento, Central Valley, and Desert Sierra regions. Conclusions: Racial disparities in breast cancer mortality California vary by region and appear to be more prevalent in large urban areas.
Cancer team approach for prescreening and identifying breast cancer survivors as part of survivorship care plan implementation.
Authors: Danciu Oana Cristina , Bharadwaj Sushma , Hoskins Kent 
Published: February 2017

107 Background: Recommendations from the Institute of Medicine are that cancer patients receive individualized survivorship care plan (SCP)and treatment summary.SCP includes guidelines for monitoring and maintaining health and is a communication tool shared with families and health care providers. Offering SCP and treatment summary to cancer survivors remains challenging due to time and resource limitations, inadequate reimbursement and survivor access. Methods: Survivorship starts when completing the initial treatment (surgery, chemotherapy or radiation therapy). A team of medical oncologists, nurse practitioner and patient navigator created a process of pre-screening and identifying breast cancer (BC) survivors. SCP and treatment summary were pre-populated, individualized for each patient, then finalized and discussed with the patients during their medical oncology clinic visit.Pre intervention data was retrospectively collected, including all BC cases from March 2014 to March 2015. Post intervention data was prospectively collected over eight weeks. Pre and post intervention SCP completion rates were compared with chi square analysis. Results: A baseline one year review of 1124 encounters noted 23 of 90 (25%) BC survivors received SCP. Ninety-six encounters occurred during the 8 week pilot period. Sixteen (16.6%) cases met the definition of BC survivor. During the pilot period, 15 out of 16 (93.7%) survivors received the SCP and treatment summary (p < 0.0001). Conclusions: We successfully piloted the implementation of SCP for BC survivors. Our team found that using clinic visit screening and pre-identifying patients that transition into the survivorship program resulted in improvement of compliance with survivorship measures. We plan to open a BC survivorship clinic to address survivorship issues and to review SCP and treatment summary.
St. Joseph Mercy Oakland Pink Ribbon Mammogram Program designed to address health-care disparities.
Authors: Sell Rachel Norianne , Muhleman Mitchel , Kirby Amy 
Published: February 2017

11 Background: Despite ongoing national efforts to promote state-mandated health care, such as the Affordable Health Care Act, many regions still struggle with high rates of uninsured and under-insured residents. Over 500,000 people have enrolled in the Healthy Michigan Plan, but premium payments are often prohibitively higher than the penalties for failing to obtain insurance. In Oakland County, 15% of adults remain uninsured and only 66.4% receive access to mammography screening. Developed in 2009, the St Joseph Mercy Oakland Pink Ribbon Mammogram Program takes a unique approach to addressing this issue, providing free breast cancer screening for women in Oakland County. Methods: Since its inception six years ago, the SJMO Pink Ribbon Program has served 806 Oakland County uninsured and under-insured women. This was made possible through the coordination of funding from the Pink Ribbon Trailblazers, a local grass-roots organization led by a breast cancer survivor, and St Joseph Mercy Oakland Hospital. Our program is unique, as women not only receive a free screening mammogram, but also a personalized breast cancer risk assessment and a clinical breast exam by a breast surgeon. The program also covers diagnostic mammogram and ultrasound if necessary. Women who need biopsy meet with the oncology financial navigator. Most women are enrolled in either the State of Michigan Title XV program/BCCCP, or Mercy Support, a charitable financial assistance program through the hospital. Women diagnosed with breast cancer either continue in Mercy Support or are enrolled in Medicaid. Results: We have found that despite the recent Affordable Health Care Act, demand for our program continues to increase annually. There continues to be a need for local communities to address health care disparities amongst lower income populations in Oakland County and throughout the nation. Conclusions: The purpose of this article is to describe the way that a local charitable organization, physician, and the hospital can come together to fund and provide continuity of care from screening, diagnosis, to treatment for low income women.
Male breast cancer: Risk factors, treatment, and survival.
Authors: Arobelidze Salome , Haddad Abdo S. , Spiro Timothy Peter , Daw Hamed 
Published: February 2017

110 Background: We conducted a retrospective study to investigate male breast cancer risk factors, treatment and survival. Methods: All patients with male breast cancer diagnosed between 1985 and 2014 at the Cleveland Clinic were retrospectively reviewed. Results: 131 patients were enrolled in the study. The median age at diagnosis was 66. Most of the tumors were invasive ductal carcinomas (85%, 111/131) and most were intermediate grade (47%, 41/87). Most patients had localized disease – stage 0-1 (45%, 48/107); stage 2 (35%, 37/107). Among the patients with data, 93% (94/101) were ER+, 73% (74/101) were PR+, 12% (10/80) were HER2 positive, and 6% were triple negative. Estimated median survival was 20.2 years (95% C.I. 19.0-29.4), and estimated 2 and 5-year survival were 96% + 2% and 87% + 3%. Grade was associated with outcome (p=.07). Conclusions: In our study only age at diagnosis was associated with overall survival. Further research is required to understand the treatment outcomes of this rare cancer. [Table: see text]
Influence of taxanes (docetaxel, paclitaxel) on response assessment in DCE MRI.
Authors: Schrading Simone , Kuhl Christiane K. 
Published: February 2017

132 Background: To prospectively investigate the influence of taxane-containing (T-CTx) vs. non-taxane containing neoadjuvant chemotherapy (NT-CTx) on contrast-enhancement of breast-cancers, of benign-enhancing-lesions (BEL), and of background-parenchymal-enhancement (BPE) in DCE-MRI. Methods: Prospective study on 62 patients with invasive breast-cancer who received neoadjuvant multi-agent chemotherapy with (n = 49) or without (n = 13) taxanes between 2008 and 2011, with 3 years of follow-up. Written informed consent was obtained. Patients underwent DCE-MRI according to a standardized protocol before and 2 weeks after completing neoadjuvant-CTx. The percent reduction of enhancement of breast-cancers, of BEL and BPE was calculated for patients receiving NT-CTx vs. T-CTx. Final surgical-pathology served as standard-of-reference. Changes of mean enhancement of breast cancers, BEL and background enhancement in patients under T-CTx vs. NT-CTx were compared. Results: Similar rates of pCR were observed after T-CTx and NT-CTx (28/49; 57.2% vs. 8/13; 61.5%). T-CTx was associated with an almost complete suppression of enhancement not only of breast cancers, but also of BEL and of BPE in the same patients, with average reduction of enhancement by -89.9% ±9.3%, by -90.2%±11.8%, and by -91.2%±7.5 %, respectively. After T-CTx, cancers with partial (n = 21) or pCR (n = 28) exhibited a similar reduction of enhancement (-81.8% ± 17.5 % vs. -93.9% ± 2.3 %; p = 0.22). After NT-CTx, the reduction of enhancement of cancers was significantly less pronounced compared to T-CTx (-41.1%±22.8% versus 88.1± 13.9%; p < 0.0001), and effects on enhancement of BEL and BPE were significantly less pronounced compared to that of cancers in the same women (p < 0.0001). MRI overestimated response, i.e. was false-negative for residual disease, in 66.7% (14/21) patients after T-CTx, versus 20% (1/5) after NT-CTx. Conclusions: The reduction of enhancement observed in breast-cancers after T-CTx is, in part, unrelated to their oncological response. MRI-detectable effects of taxanes represent a combination of specific anti-mitotic, and non-specific, probably anti-angiogenic effects. This impacts the accuracy with which DCE-MRI predicts pCR to neoadjuvant T-Ctx.
Comparison of survival outcome of concurrent GnRH agonist plus tamoxifen to that of sequential adriamycin and cyclophosphamide chemotherapy plus tamoxifen in premenopausal, lymph node-negative, hormone-responsive, HER2-negative, T1-2 breast cancer patients.
Authors: Sohn Guiyun , Ahn Sei-Hyun , Kim Hee Jeong , Sohn Byung Ho , Lee jong Won , Ko Beom Seok , Yu Jong Han , Lee Yura , Lee Sae Byul , Baek Seunghee 
Published: February 2017

137 Background: The purpose of this study was to compare treatment outcomes between gonadotropin-releasing hormone (GnRH) agonist plus tamoxifen and adriamycin and cyclophosphamide (AC)-containing chemotherapy plus tamoxifen in hormone-responsive, premenopausal, node-negative, breast cancer patients. Methods: Among 7278 breast cancer patients who were diagnosed as breast cancer at Asan medical center, Seoul, Korea, 994 premenopausal women with node-negative, hormone receptor-positive, HER2-negative, T1-2 breast cancers were included in this retrospective cohort study: A median follow-up was 7.4 years (range, 0.5-11.4 years). 608 patients (61.2%) were treated with GnRH agonist together with tamoxifen, and 386 patients (38.8%) were treated with AC-containing chemotherapy with tamoxifen. The propensity score matching and inverse probability weighting was applied to original cohort based on patients’ age, operation method, nuclear and histologic grade, estrogen receptor and progesterone receptor positivity, T stage, Her2 positivity, and p53 positivity. In final analysis, 260 patients for each treatment arm were included. Results: In propensity matched cohorts (n = 520), a total of 34 patients had recurrence. There were 5 cancer-specific deaths and 12 overall deaths among total 520 patients. There were no survival differences for recurrence-free survival (p= 0.306), cancer-specific survival (p= 0.212), and overall survival (p= 0.102) between the two treatment groups. After applying inverse probability weighting, there were no survival differences for recurrence-free survival (p = 0.522), cancer-specific survival (p= 0.154). However, GnRH agonist with tamoxifen arm showed better overall survival than AC chemotherapy with tamoxifen arm (p= 0.021). Conclusions: Adding GnRH agonist to tamoxifen is a reasonable alternative to adding AC chemotherapy to tamoxifen in premenopausal, hormone-responsive, HER2-negative, lymph node-negative, T1-2, breast cancer patients.
Weekly nab-paclitaxel followed by FEC in patients with operable breast cancer: Phase II study.
Authors: Seki Hirohito , Asamuna Fumiki , Morinaga Shyoujiro , Suzuki Keiichi , Kaneda Munehisa , Kamiya Noriki , Ishii Yoshiyuki , Osaku Masayoshi , Ikeda Tadashi 
Published: February 2017

138 Background: Nanoparticle albumin-bound paclitaxel (nab-PTX) has a high transitivity into tumor tissue compared to solvent-based paclitaxel (sb-PTX). In a phase III study in patients with metastatic breast cancer, nab–PTX demonstrated nearly double the response rate and significantly longer time to tumor progression than paclitaxel. However, the current problems are that nab-PTX is a higher rate of discontinuation and sensory neuropathy than sb-PTX. We sought to evaluate the efficacy and safety of nab-PTX followed by FEC. Methods: In this study, patients were received 4 cycles of nab-PTX (80 mg/m2) q1w (days 1, 8, and 15 of each 4-week cycle) followed by 4 cycles of FEC q3w. The primary endpoint was pCR rate (ypT0/is ypN0). The secondary endpoints included clinical response rate, disease-free survival, breast-conserving surgery rate, and safety. Results: Forty patients were enrolled; the median age was 53 (range 33-81), postmenopausal women were 62.5%. ER positivity, PgR positivity and HER2 positivity were 62.5%, 52.5% and 37.5%, respectively. Clinical stage for I, II and III were 30%, 62.5% and 7.5%, respectively. The pCR rate (ypT0/is ypN0) was 40% (16/40). In the subtype subset, pCR rates were Luminal A 20% (1/5), Luminal B (HER2 negative) 15.4% (2/13), Luminal B (HER2 positive) 60% (6/10), HER2 enrich 80% (4/5) and TNBC 42.9% (3/7). The breast-conserving surgery rate was 77.5% (31/40). The clinical response rates were cCR 20.0% (8/40), cPR 52.5% (21/40), cSD 25% (10/40) and cPD 2.5% (1/40) after 4 cycles of nab-PTX, cCR 32.5% (13/40), cPR 42.5% (17/40), cSD 20% (8/40) and cPD 5% (2/40) after nab-PTX followed by FEC. Ninety-eight percent patients completed 4 cycles of planned protocol dose of nab-PTX and 62.5% completed FEC. The Grade3/4 hematologic toxicity of nab-PTX was only neutropenia 2.5%. Grade1/2 non-hematologic toxicity were neuropathy 12.5%, arthralgia 7.5% and myalgia 7.5%. Grade3/4 non-hematologic toxicity was no reported. Conclusions: This is the first study to evaluate weekly nab-PTX (80 mg/m2) followed by FEC for operable breast cancer. Our results demonstrated that weekly nab-PTX (80 mg/m2) followed by FEC was well-tolerated and resulted in increased pCR rate than reported data of nab-PTX. Clinical trial information: UMIN000011048.
Tumor subtype and race in male breast cancer: A population-based cohort study.
Authors: Aydogan Fatih , Sagara Yasuaki , Mallory Melissa Anne , Tukenmez Mustafa , Golshan Mehra 
Published: February 2017

149 Background: Subtypes of female breast cancer have been shown to vary by race, however data on the significance of molecular profiling and the distribution of subtype according to race/ethnicity for male breast cancer is lacking and warrants research. We sought to investigate the differences in male breast cancer according to tumor subtypes and racial/ethnic profiles using the Surveillance, Epidemiology, and End Results Program (SEER) database. Methods: We used the SEER database (SEER 18 registries) to identify all cases of male breast cancer diagnosed between 2010 and 2012. The cases were classified based on estrogen receptor (ER), progesterone receptor (PR) and HER2 status as follows: ER and/or PR positive and HER2−; ER and/or PR and HER2 +; ER−, PR−, and HER2 +; and triple negative (ER−, PR−, and HER2−). We sought the association between the subtype and race, which is categorized as non-Hispanic (NH) white, NH black, NH Asian Pacific Islander (API) and Hispanic men. Results: We identified 1515 cases of male breast cancer diagnosed during the study period; 188 were excluded because of unknown race or subtype, and the remaining 1327 were included in our final cohort. 96.8% of cases were ER positive and less than 3.2% of cases were ER negative. 1145 patients (86.1%) were HR+/HER2-, 139 patients (10.0%) were HR+/HER2+, 12 patients (0.7%) were HR-,HER2+, and 31 patients (2.3%) were triple negative (Table 1).Tumor subtype did not vary by race/ethnicity (p = 0.08). Conclusions: Our results indicate that unlike female breast cancer that male breast cancer subtype does not vary by race/ethnicity. Further research is warranted to determine how these findings may impact the treatment and prognosis of male breast cancer. [Table: see text]
Breast cancer method of detection, stage at diagnosis, and delay in treatment in La Libertad province, Peru.
Authors: Romanoff Anya , Cedano Guadiamos Manuel , Hayes Constant Tara , Burga Vega Ana Maria , Zunt Joseph , Johnson Kay 
Published: February 2017

15 Background: The majority of breast cancer deaths occur in low- and middle-income countries, as a result of late stage disease presentation and inadequate access to diagnosis and treatment. Delay from development of symptomatology to initiation of treatment is associated with more advanced breast cancer, and delays greater than three months have been associated with reduced survival. We investigated method of detection, disease stage, and time to diagnosis and treatment in breast cancer patients in Peru. Methods: This investigation was conducted at the Instituto Regional de Enfermedades Neoplasicas del Norte, in Trujillo, Peru. All women with a pathologic or clinical diagnosis of breast cancer who visited a breast surgeon from February-May 2015 were eligible to participate. Trained personnel conducted individual patient interviews in Spanish, utilizing a validated breast cancer delays questionnaire. Results: Of the 159 women who qualified for inclusion, 113 (71%) agreed to participate in the study. Mean age was 54 years (range 30-85). Patients lived an average of 3 hours from the oncology institute (range 0-36). Most households earned less than minimum wage, and most (66%) were covered by Seguro Integral de Salud, the government-funded medical insurance for citizens with limited financial resources. One hundred and five (93%) participants reported initially detecting their breast cancer as a result of symptoms. One cancer (1%) was detected during screening clinical breast examination, and 7 (6%) by screening mammography. Ninety-three patients had available stage at time of diagnosis, with the following distribution: stage 0- 2%, stage 1-3%, stage 2-44%, stage 3-48%, and stage 4-3%. Based on patient report, mean patient delay (symptom development to first medical visit at any facility) was 211 days. Mean provider delay (first medical visit until treatment initiation) was 241 days. Mean total delay (symptom development to treatment initiation) was 407 days. Conclusions: Almost all study participants initially detected their breast cancer as a result of symptoms. More than half presented with stage 3 or 4 disease. Average delay from symptom onset to start of treatment was greater than one year.
Frequency and predictors of insufficient chemotherapy use among stage I-III breast cancer patients by molecular subtype.
Authors: Zhang Lu , Ferguson Tekeda Freeman , Wu Xiao-cheng , Hsieh Mei-Chin , Fontham Elizabeth , Loch Michelle Marie , Yu Qingzhao , Chen Vivien 
Published: February 2017

154 Background: Identification of distinct molecular subtypes has expanded the treatment options for breast cancer, however, chemotherapy remains the common and effective treatment for each subtype. The objective is to compare the frequency and predictors of insufficient chemotherapy use among two subtypes of stage I-III breast cancer patients: luminal A and triple negative breast cancer (TNBC). Methods: We analyzed data from a CDC funded project - Enhancing Cancer Registry Data for Comparative Effectiveness Research (CER) collected by Louisiana Tumor Registry. Women aged < = 70 years, diagnosed in 2011 with stage I-III luminal A or TNBC breast cancer, tumor size > 1cm, were included (N = 1,189). Insufficient chemotherapy (i.e. no chemotherapy use, nonstandard regimen use, and low relative dose intensity (RDI < 85%)) was evaluated respectively. Potential predictors included age, race, insurance, marital status, census tract-poverty, AJCC stage, grade, tumor size, lymph node status, and Charlson comorbidity. Stepwise model selection with p-value for entry at 0.2 and for stay at 0.25 was used to select the most relevant predictors. Results: The frequencies of no chemotherapy use were significantly different (p < .0001) between luminal A (42%, N = 913) and TNBC patients (9%, N = 241). Older age, white race, no insurance, lower stage or grade, and without lymph node involvement were related with no chemotherapy for luminal A patients; older age, not married, and high poverty for TNBC. There were 36% of luminal A and 40% of TNBC patients receiving nonstandard regimen (p = 0.27). Predictors of nonstandard regimen use were increased age, insurance, stage, and grade for luminal A and high poverty level and stage for TNBC. Reduced RDI occurred in 9% luminal A and 10% TNBC patients (p = 0.61). Small cases precluded the prediction model for low RDI. Conclusions: Luminal A patients are less likely to receive chemotherapy than TNBC patients. Low social economic status factors are associated with no chemotherapy use and nonstandard regimens use, especially for TNBC patients.