bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of Angelina Jolie's (AJ) story on genetic referral and testing at an academic cancer centre.
Authors: Raphael Jacques , Verma Sunil , Hewitt Paul , Eisen Andrea 
Published: February 2017

44 Background: In May 2013, AJ revealed to the media that she had undergone preventive double mastectomy. The actress had a family history of breast and ovarian cancer and tested positive for the BRCA1 gene mutation. Media coverage has been extensive, but it’s not clear what messages the public and professional medical staff took from this personal story that sometimes could be misleading. Methods: We conducted a retrospective review in our centre using data from the clinical database of the Familial Cancer Program in a tertiary care cancer centre. The impact of AJ’s story on genetic counseling referrals was assessed by comparing the number of referrals made 6 months before and after the story. In addition, the quality of referrals was reported by comparing the number of patients who qualified for genetic testing as defined by the Ontario Ministry of Health and Long Term Care and the ones who carried a BRCA1/2 mutation before and after the media release. Results: The number of women referred for genetic counseling increased by 85% after the release of AJ’s story (479 before versus 887 after). This translated to an increase of 99% in the number of women who qualified for a genetic testing (211 before versus 419 after). Among them, 120 and 254 women had a history of breast and ovarian cancer in their family, 16 and 37 women had a history of male breast cancer in their family, and 28 and 15 women were diagnosed with breast cancer at the age of 35 or less before and after AJ’s story respectively. Furthermore, the number of BRCA1/2 carriers identified increased by 107% (29 (14 BRCA1, 15 BRCA2) before and 60 (32 BRCA1, 28 BRCA2) after). Conclusions: This study clearly shows that the number of genetic referrals doubled after AJ’s story. Nevertheless, the quality of referral remained the same with nearly the same percentage of patients who qualified for genetic testing and who were identified as BRCA1/2 carriers. The challenge is to meet the increased demand for cancer genetic services including screening, counseling, testing, and preventive surgery. After AJ’s story the current model of genetic counseling may need to be revisited.
Comparison of the intermediate risk 21-gene recurrence score (RS) with the 70-gene signature (GS) as a continuous variable, Magee equations, and Adjuvant! Online (AOL).
Authors: Mai Hanh P. , Kliethermes Stephanie , McCroskey Zulfia , Ersahin Cagatay , Gaynor Ellen R. , Robinson Patricia A. , Albain Kathy S. , Lo Shelly S. 
Published: February 2017

47 Background: Multigene assays and risk-prediction models are used to provide prognostic information in the management of patients with estrogen receptor positive (ER+) lymph node negative (LN-) breast cancer (BC). Some have predictive utility in determining the value of chemotherapy added to endocrine therapy. We previously reported a mix of high and low risk 70-GS within the intermediate risk 21-gene RS. The Magee equations provide an estimate of the 21-gene RS using standard pathological findings. AOL provides a 10-year risk of BC recurrence or death. The objective of this study is to evaluate correlations between the 70-GS as a nondichotomous continuous variable, the Magee equations, and AOL within patients (pts) with 21-gene intermediate RS. Methods: The 70-GS as a continuous variable (highest risk of -1 to lowest risk of +1) was obtained on all consecutive ER+LN- BC cases with an intermediate 21-gene RS at Loyola U Med Ctr from 1/2005 to 9/2012. AOL recurrence risk and the Magee equations were calculated from clinical-pathologic findings. Pearson pairwise correlations among all four recurrence measures were generated. Results: Results of the 70-GS as a continuous variable and the 21-gene RS were available in 89 cases. A higher risk 70-GS correlates with a higher 21-gene RS (r = -0.31; p = 0.003). A higher risk of recurrence as estimated by AOL is associated with a higher 21-gene RS (r = 0.22; p = 0.036), higher Magee equation 1 (r = 0.36; p = 0.001) and 2 (r = 0.32; p = 0.004), and a higher risk 70-GS (r = -0.40; p < 0.001). Magee equations 1 and 2 are statistically correlated to the 21-gene RS (r = 0.24; p = 0.028 and r = 0.23; p = 0.036 respectively), but not to the 70-GS (p = 0.064 and p = 0.057 respectively). Magee equation 3 is not statistically correlated with 70-GS, 21-gene RS or AOL. Conclusions: There is a continuum of highest to lowest risk 70-GS among LN- ER+ BC within intermediate risk RS. The prospective PROMIS study will assess if the 70-GS adds clinical utility regarding adjuvant therapy choice for these pts.
Incidence and survival of patients with T0N1 breast cancers.
Authors: Abe Shoko Emily , Carpenter Kendall W. , Han Yimei , Flippo Teresa , Sarantou Terry , Hill Joshua S. , White Richard L. 
Published: February 2017

56 Background: As imaging modalities have improved, breast cancers are increasingly detected at earlier stages. Patients rarely present with axillary disease but no mammographically evident breast tumor. Based on analysis of Surveillance, Epidemiology and End Results (SEER) data, we determined that there has been an increase in incidence of T1aN1 breast cancers. In response, we hypothesize that T0N1 breast cancer incidence has decreased with increased MRI use. Moreover, SEER analysis showed that T1aN1 patients have worse survival than T1bN1 patients. We thus hypothesize that T0N1 patients have worse survival than T1N1 patients. Methods: We identified 36,093 female patients diagnosed with T0-1 N1 invasive breast cancer from the SEER database. We compared patient and tumor characteristics: age, race, histology, hormone receptor status, and diagnosis year group (1990-1994, 1995-1999, 2000-2005, 2006-2010) – by TN category (T0N1/T1aN1/T1bN1/T1cN1) using chi-square test and ANOVA. Kaplan-Meier method was used to estimate disease specific survival (DSS) for each TN category and diagnosis year group separately. Adjusted hazard ratios were estimated using Cox proportional hazards models. Results: Stage distribution was: T0N1=129, T1aN1=1294, T1bN1=6731, and T1cN1=27942 patients. Median ages were 59.6, 56.3, 59.1, and 58.1, respectively. Time trend analysis of T0N1 cancers showed an increase in incidence from 1990 to 1999 and stability after 2000. Five-year DSS was significantly worse for patients with T0N1 tumors than T1aN1 tumors (84.5% versus 94.1%, HR 0.513, p < 0.0001). T0N1 tumors were more likely to be ER negative than T1b-cN1 tumors (23% versus 16%, p < 0.0001). T0N1 tumors were also more likely to be ER negative than T1aN1 tumors, but did not reach statistical significance (23% vs. 20%, p = 0.09). The proportion of lobular cancers was significantly higher in T0N1 than T1aN1 or T1b-cN1 patients (18% versus 8%, p < 0.0001). Conclusions: Our analysis suggests that T0N1 tumors may differ biologically from T1N1 tumors. Although the incidence of T0N1 tumors did not decrease, it remained stable after 2000 when the use of MRI for occult breast cancers became widely accepted. Our second hypothesis that survival is worse in patients with T0N1 tumors was confirmed by our analysis.
Factors associated with increasing rates of contralateral prophylactic mastectomy.
Authors: Yakoub Danny , Avisar Eli , Koru-Sengul Tulay , Miao Feng , Tannenbaum Stacey L. , Byrne Margaret M , Moffat Frederick L. , Livingstone Alan S , Franceschi Dido 
Published: February 2017

57 Background: Contralateral prophylactic mastectomy (CPM) is an option increasingly used by women who wish to reduce their risk of breast cancer or its local recurrence. There is limited data on demographic differences among patients who choose to undergo this procedure. Methods: The population-based Florida cancer registry, Florida’s Agency for Health Care Administration (AHCA) data, and U.S. census data were linked and queried for patients diagnosed with invasive breast cancer from 1996 to 2009. The main outcome variable was the rate of CPM in those with a single unilateral cancer diagnosis. Primary predictors were race, ethnicity, socioeconomic status (SES), marital status, and insurance status. Results: The rates of CPM rose from 2% in 1996 to 4.8% in 2006 up to 8% in 2009. The population studied was 91.1% white and 7.5% black; 89.1% non-Hispanic and 10.9% Hispanic. Out of 21,608 included patients, 837 (3.9%) underwent CPM. Significantly more white than black (3.9 versus 2.8%; p < 0.001) and more Hispanic than non-Hispanic (4.5 versus 3.8%; p = 0.0909) underwent CPM. Those in the highest SES category had higher rates of CPM compared to the lowest SES category (5.3 versus 2.9%; p < 0.001). In multivariate analyses, Blacks and uninsured patients had significantly less CPM compared to whites and private patients (OR = 0.59, 95% CI 0.42- 0.83, p = 0.002) and (OR = 0.60, 95% CI 0.36- 0.98, p = 0.043), respectively. Conclusions: CPM rates are significantly increasing; these rates were significantly different among patients of different race, socioeconomic class, and insurance coverage. This observation is not accounted for by population distribution, incidence or disease stage. More in-depth study of the causes of this increase and the disparities in healthcare delivery is critically needed.
Racial/ethnic disparities in clinicopathologic features and treatment modalities of triple-negative breast cancer in black premenopausal women.
Authors: Hamid Muhammad S , Shameem Raji , Pudusseri Anita , Graham Robert , Shani Dana , Sullivan Kevin M. 
Published: February 2017

58 Background: Triple-negative breast cancer (TNBC) is a distinct breast cancer subtype associated with poor outcomes. Previous literature has reported an increased prevalence of TNBC in premenopausal black women. However, clinicopathologic features and treatment disparities of TNBC require further investigation. Methods: We used the Surveillance Epidemiology and End Results (SEER) database to collect data for premenopausal, estrogen receptor–negative, progesterone receptor–negative, and HER2 receptor–negative invasive breast-cancer cases diagnosed in 2010. Blacks were compared to the referent non-Hispanic white (NHW) cohort. Variables explored include: age at diagnosis, summary stage, tumor size, presence of metastasis at diagnosis, birth country, marital status, radiation, surgery (total and partial mastectomy), and radiation/surgery sequence. The Kruskall-Wallis test and the Z-test were used to investigate for any racial/ethnic disparities that may exist. Results: Compared to NHW, black patients had more regional disease (42.3% vs. 36.1%, p < 0.05) and distant metastasis (7.37% vs. 4.67%, p < 0.05) at the time of diagnosis, They were more likely to be single (44.0% vs. 17.1%, p < 0.05), born in the United States (39.4% vs. 32.5%, p < 0.05), have fewer cases in the “40-49 years” age range (68.6% vs. 73.0%, p < 0.05), and present with tumor size > 20 mm (26.1% vs. 36.6%, p < 0.05) compared to NHW. While black women received surgical intervention (11.5% vs. 6.8%, p < 0.05) more commonly, adjuvant radiation (41.0% vs. 33.3%, p < 0.05) was utilized less after segmental mastectomy compared to NHW. Conclusions: Poor prognostic tumor characteristics were significantly more likely to be present in black premenopausal women with TNBC compared with NHW patients. Black women were more likely to receive surgical intervention, however, adjuvant radiation was administered significantly less. Further research is necessary to clarify if these disparities have an impact on survival outcomes.
Nomogram for predicting the risk of locoregional recurrence in patients treated with accelerated partial-breast irradiation.
Authors: Wobb Jessica , Chen Peter Y. , Shah Chirag , Moran Meena S. , Shaitelman Simona Flora , Vicini Frank A. , Mbah Alfred K. , Lyden Maureen , Beitsch Peter D. 
Published: February 2017

59 Background: There are limited tools to guide clinicians regarding the risk of locoregional recurrence (LRR) in patients wishing to pursue APBI. The purpose of this study was to develop a nomogram taking into account clinicopathologic features to predict LRR in patients treated with APBI for early stage breast cancer. Methods: A total of 2,000 breasts (1,990 women) were treated with APBI at William Beaumont Hospital (N=551) or on the ASBrS MammoSite Registry Trial (N=1,449). Techniques included multiplanar interstitial catheters (N=98), balloon-based brachytherapy (N=1,689), and 3D conformal radiotherapy (N=213). Clinicopathologic variables were gathered prospectively. A nomogram was formulated utilizing the Cox Proportional Hazards Regression model to predict for LRR. This was validated by generating a bias-corrected index and cross-validated with a C-index. Results: Median follow-up was 5.5 years (0.9 to 18.3). Of the 2,000 cases, 435 were excluded due to missing data. Univariate analysis found that age <50, pre/perimenopausal status, close/positive margins, ER negativity, and high grade were associated with a higher frequency of LRR. These five independent covariates were used to create adjusted estimates, weighting each on a scale of 0 to 100. The total score is identified on a points scale to obtain the probability of an LRR over the study period. The model demonstrated good concordance for predicting LRR with a C-index of 0.641. Conclusions: The formulation of a practical, easy-to-use nomogram for calculating the risk of LRR in patients undergoing APBI will help guide the appropriate selection of patients for off-protocol utilization of APBI.
Locoregional recurrence (LRR) after neoadjuvant chemotherapy (NAC): Pooled-analysis results from the Collaborative Trials in Neoadjuvant Breast Cancer (CTNeoBC).
Authors: Mamounas Eleftherios P. , Cortazar Patricia , Zhang Lijun , Von Minckwitz Gunter , Mehta Keyur , Cameron David A. , Bonnefoi Herve R. , Gianni Luca , Valagussa Pinuccia , Wolmark Norman , Loibl Sibylle , Bogaerts Jan , Swain Sandra M. , Sridhara Rajeshwari , Costantino Joseph P. , Rastogi Priya , Geyer Charles E. , Eidtmann Holger , Gerber Bernd , Untch Michael 
Published: February 2017

61 Background: There is limited information on LRR rates in pts treated with NAC. Methods: 12 large NAC BC trials (11,955 pts) with pCR information and long-term F/U for LRR, EFS and OS were included. Primary aims were to assess LRR rates by pCR, tumor subtype, surgery type and other clinico-pathologic factors. Main definition of pCR was ypT0/is ypN0. Results: Median F/U: 5.4 years. Median age: 49, T2 tumors: 61%, Inflammatory BC: 4%; Clinically(+) nodes: 47%. Overall LRR: 6.8% (95% CI: 6.3, 7.2). LRR was 5.5% with pCR (ypT0/isypN0) vs. 7.1% without. After lumpectomy, LRR rates were similar with pCR (6.0%) vs. without (6.3%). After mastectomy, LRR rates were lower with pCR (3.8%) vs. without (8.1%), irrespective of XRT use. In HR(+)/HER2(-) BC, LRR rates were low with pCR (1.9%) or without (3.3%) with similarly low LRR rates in grade 1/2 tumors (pCR: 2%, no-pCR: 2.6%). In HR(+)/HER2(-)/grade 3 BC LRR rates were lower with pCR (1%) vs. without (5.3%). In HER2(+) BC LRR rates were similar with pCR (5.1%) or without (7.3%), mainly seen in HER2(+)/HR(+) BC (5.7% vs. 5.5%). In contrast, in HER2(+)/HR(-) BC LRR rates were lower with pCR (4.9%) vs. without (9.8%). Also, in HR(-) /HER2(-) BC LRR rates were lower with pCR (4.9%) vs. without (8.6%). LRR varied with path nodal status and TNM stage at surgery: node(-): 5.6% vs. node(+) 8.9%; stage 0: 5.3%; stage 1: 5.2%; stage 2: 7.3%; stage 3: 10.1%. Conclusions: LRR rates after NAC are low and vary by pCR status, tumor subtype, type of surgery, stage and path nodal status. This information may have clinical implications on selecting appropriate candidates for XRT. [Table: see text]
Late axillary recurrence after negative SLNB.
Authors: Matsen Cindy Brown , Villegas Kristine , Eaton Anne , Stempel Michelle , Manning Aidan , Morrow Monica , Heerdt Alexandra S. 
Published: February 2017

63 Background: SLNB is the standard axillary evaluation method for clinically node-negative patients with invasive breast cancer. While axillary recurrence (AR) in the early years after negative SLNB is <2%, studies with longer (>8 yrs) follow-up on large patient numbers are lacking. With concern that current multimodality therapy may delay time to AR, we reviewed long-term SLNB patient outcomes. Methods: We identified patients with invasive cancer from a prospective, single-institution database who had a negative SLNB without additional axillary surgery from 1/97-12/00. Cancer, demographic, and treatment data were obtained for all patients. Primary outcome was AR. Overall survival (OS) and distant disease-free survival (DDFS) after AR were secondary endpoints. Results: 1529 eligible patients were identified. See table for patient and tumor characteristics. At 10.8 yrs (0-16) median follow-up, overall incidence of AR as a first event was low, n= 13. Median OS after AR was 4.6 yrs and median DDFS after AR was 3.8 yrs. The cumulative incidence of AR was 1.0% (CI 0.5-1.6) overall; cumulative incidence of 0.6% (CI 0.2-0.9) in the first 5 years, 0.4% years 5-10. Late AR (>5 yrs) occurred in 5 patients: 4 ER+, 1 HER2+. In comparison, in a group of contemporaneous SLNB-positive patients undergoing axillary dissection (n=902), overall cumulative incidence of AR was 0.8% (CI 0.2-1.5) at over 10 yrs follow-up. On univariate analysis of AR in SLNB-negative patients, high nuclear grade was the only significant predictor of AR (p=0.01). Conclusions: Late AR was an infrequent event after negative SLNB alone emphasizing its long-term safety as a staging procedure. AR after SLNB, like AR after ALND, portends a poor prognosis.[Table: see text]
Trends in breast cancer treatment in United States from 2000 to 2011: Consequences of 2004 National Comprehensive Cancer Network (NCCN) guidelines change.
Authors: Arrojo Elisabeth E. , Martinez Alvaro , Vicini Frank A. 
Published: February 2017

69 Background: In 2004, the NCCN, changed the guidelines for the treatment of stage 1, HR+, > 70 years(y) breast cancer patients, based mainly on the CALGB/RTOG trial, which showed that in these patients, the addition of radiotherapy (RT) to surgery and tamoxifen did not improve overall survival, but significantly decreased local relapse at 5 y. Methods: Retrospective analysis about trends in breast cancer treatment in USA from years 2000 to 2011, searching the National Cancer Data Base, reviewing 458.386 cases of breast cancer stage I, HR+, with special focus in patients >70y. Chi square test was used. Results: Between years 2000-2011, in the group reviewed, mastectomy (MT) increased in women <40y (+25%) and between 40-69y (+13%), while RT decreased in both groups (-20%, -3%). In women >70y, MT decreased (-27%) progressively along these years, but radiotherapy increased until year 2003 (+3%), and begun to decrease in 2004 (-4%), with a final difference between 2003 and 2011 of -9%. In patients >70 y, chemotherapy (CH) treatments, increased progressively (+3%) from year 2000 to 2011 (p<0.001). Conclusions: Changes in NCCN breast cancer guidelines made in 2004, seem to have changed trends of breast cancer treatment in USA in patients > 70y, stage I, HR+. Since then, less aggressive “local” treatments (-4% for MT and -9% for RT) are been performed. Despite this trend for less local therapy chemotherapy utilization has increased even though the risk of systemic disease is very low. The main risk for these patients is local failure with the associated physical, psychological and family impact as well as cost of re-staging. Local RT has demonstrated a significant reduction of this risk. Today's life expectancy for a 70 y/o woman is >10y consequently local relapses and its consequences are expected. New RT techniques, such as partial breast irradiation delivered in few days are convenient and associated with very low toxicity and no mortality. Perhaps a re-look of the NCCN guidelines might be in order. [Table: see text]
A retrospective comparison of contrast enhanced spectral mammography (CESM) to breast MRI in breast cancer detection: An initial study for sensitivity analysis.
Authors: Li Luna , Brill Kristin , Germaine Pauline , Tinney Elizabeth , Hendershott Karen , Liao Lydia 
Published: February 2017

7 Background: CESM is a new study using contrast and dual energy digital mammographic technology to detect contrast enhanced cancer that may be invisible on conventional mammogram. Limited studies have shown that adding CESM to diagnostic workup adjunct with mammogram and breast ultrasound does increase sensitivity for breast cancer detection. More studies are needed to compare the sensitivity of CESM to BMRI to further define the role of CESM in breast cancer diagnosis. Methods: This study involved 50 malignant breasts in 48 women retrospectively chosen from of 960 patients in our institution during the period of October 2012 to March 2014. Both CESM and BMRI were done for each patient within 30 days. The cancer diagnoses were confirmed by tissue diagnoses. The size of lesions was classified into three categories based on standard of breast cancer stages: 1 (0.2cm - < = 2 cm), 2 (2 cm < lesion < = 5 cm), 3 (> 5 cm). The enhancement intensity of both lesions and background has been quantified based on a scale of 0-3. Statistical significance was analyzed using T test for mean size of index cancer and mean score of enhancement intensity of background and lesions on CESM and BMRI. Sensitivity and positive predictive value (PPV) were calculated for both CESM and BMRI. Morphology consistence was calculated on both studies. Results: Both CESM and BMRI have sensitivity of 100% for breast cancer detection. CESM has a PPV of 98% versus 93% for BMRI. No statistical significance was identified on mean size of index cancer. The enhancement intensity of background and lesions is significantly higher on CESM than on BMRI (p < 0.01). The smallest cancer can be detected by both CESM and BMRI is less than 0.5 cm. Morphology consistence was 46/50 (92%). Conclusions: Our study indicates that CESM and BMRI have comparable high sensitivity on breast cancer detection. CESM has a higher PPV than BMRI that may indicate a better specificity (no significant difference due to the small sample size). Significantly less background enhancement intensity on CESM than on BMRI reflect an increased specificity. More studies need to be conducted for further evaluation.