bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract P3-01-06: Ultrasound as single mode of imaging may miss significant pathology in symptomatic women aged 35–39
Authors: Baker EL , Masudi T , Waterworth A 
Published: August 2014

Abstract
Recent guidelines in the UK stipulate that symptomatic women aged under 40 with clinically benign disease do not need mammography as a standard part of their assessment.1 Previous practice at the Calderdale and Huddersfield NHS Trust has been to perform mammography on all women over 35 years old. This study was undertaken to determine if there would be an increase in false negative assessment under the new guidelines.
All female patients 35–39 years old attending symptomatic breast clinic with benign clinical examination and undergoing both ultrasound and mammogram evaluation were eligible. Patients with previous breast cancer or a clinically suspicious lump mandating mammography were excluded. The information was gathered retrospectively using patient records. 96 women were included. Mammography and ultrasound results (including M and U valves) were compared for any discrepancy. If performed, biopsy results were also reviewed.
In 70% of patients there was no discrepancy between mammographic and ultrasonic evaluation (M = U). In 25% U score was one higher than M score. On further analysis this group mainly comprised of those with fibroadenomas or fibrocystic breast changes seen on ultrasound (U2) with a normal mammogram (M1).
In the remaining 5%, 3 patients had U score 2 greater than M score, 1 had M&gt;U by 1 and 1 had M&gt;U by 2. On further analysis of these discrepancies most patients had benign disease. In two patients with U5 scores and lower M scores malignancy was confirmed on biopsy. In one patient ultrasound showed benign disease (U2) but mammogram demonstrated suspicious calcifications (M4) that were confirmed as high grade DCIS on stereo-core biopsy.
In conclusion for the vast majority of patients in this group mammography does not add to the evaluation on presentation at symptomatic breast clinic. However this study identified a case (1 patient in 96) where significant disease could have been missed had a mammogram not been undertaken. The acceptable level of such false negative assessments with ultrasound only imaging in women under 40 must be further evaluated.
1Best practice diagnostic guidelines for patients presenting with breast symptoms Alexis M Willett, Michael J Michell, Martin J R Lee, November 2010
Printed by Breakthrough Breast Cancer, www.dh.gov.uk/publications
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-01-06.
Abstract P3-01-07: ESTIMATED RISK OF RADIATION-INDUCED BREAST CANCER FROM MAMMOGRAPHIC SCREENING
Authors: Freitas-Junior R , Correa RS , Peixoto J-E , Ferreira RS , Tanaka RMN 
Published: August 2014

Abstract
Objective: Estimate the benefit–risk balance of mammography, as number of lives saved/lost in an opportunistic screening in the state of Goiás, Brazil, in 2010, according to type of technology available and age group indicated for screening.
Methods: The number of lives saved was estimated considering the gross mortality rate for breast cancer, female population living in the state, estimated mortality rate reduction due to screening programs, and mammographic coverage in the state. For number of lives lost, the model adopted by the Biological Effects of Ionizing Radiation (BEIR VII) was used. Based on the mean glandular tissue dose (Dg), the following parameters were calculated: number of radiation-induced cancer cases with one exposure, with several exposures in screening programs and over the lifetime, number of deaths caused by radiation-induced cancer at a certain age and over the lifetime. Dg of each equipment was estimated according to the European protocol, using the incident air kerma (Ki) at the simulator entrance and the half-value layer (HVL) of the X-ray beam, and table values of coefficients to convert Ki into Dg. Ki and HVL were measured in 100 equipments in operation in the state. A standard breast simulator (5.3 cm thickness and 50% glandular tissue) was used. We considered a biannual mammographic screening with an exam routine composed of a cranio-caudal and a mediolateral oblique view and 40–70 and 50–70-year age groups.
Results: The mean Dg was 4.28 (±1.06) and 6.61 (±3.67) for conventional and digital equipments, respectively (p &lt; 0.001). A woman undergoing mammography at the age of 40 in a conventional equipment has a 0.243/100000 probability of radiation-induced cancer at the age of 60, whereas using a digital equipment, the probability is 0.375/100000. The number of cases of radiation-induced breast cancer over the lifetime and consequent deaths followed the differences in the doses employed according to type of technology (p &lt; 0.001). The balance between lives saved and lost was 75.5 (1253.8/16.6) and 166.5 (849.4/5.1) for women screened at 40–70 and 50–70 years, respectively.

Conclusions: Screening among 50–70-year-olds, performed biannually using conventional equipments, presented more benefits regarding radiation protection. The number of cases of radiation-induced breast cancer and consequent deaths reproduces the same ratio observed for the difference in the doses between the types of technology.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-01-07.
Abstract P3-01-08: Mammographic density and estrogen receptor α gene polymorphism in Javanese ethnic women
Authors: Choridah L , Aryandono T , Faisal A , Sadewa AH , Purnomosari D 
Published: August 2014

Abstract
Background: Mammography density reflects the number of stromal and epithelial and one of strongest risk of BC. Estrogen plays an important role in the occurrence of breast cancer through a mechanism of proliferation and genotoxic effects. Action of estrogen on breast tissue by binding to estrogen receptors. The main estrogen receptor α is coded as ESR1 gene. The most studied variants in this gene are the PvuII and XbaI polymorphisms, which have been associated to lower sensitivity to estrogen.
Objective: To determine the proportion of genetic variation ESR1 XbaI and PvuII in Javanese ethnic woman in Yogyakarta, Indonesia and to study the correlation between genetic variations in these genes with mammogram density based on quantitative methods. This reaserch to be used as preventive measures for the development of genetic marker breast cancer risk associated with the density of mammography for younger women who have not entered the age to undergo mammography and can be useful as a reference for evaluation of anti estrogen therapy.
Method: Conducted digitizer mammogram density assessment using quantitative rating system based on computer-assisted methods of measurement with cumulus program based on interactive thresholding. Polymorphism identification ESR1 XbaI and PvuII RFLP obtained through PCR process. The numbers of genotyped cases and controls for each marker were 50 cases and 58. Mean of density and frequencies of SNPs were compared between cases and controls to identify SNPs associated with cancer susceptibility. Using anova, independent t-test, cruskal wallis and mann whitney u test we calculated significant different between SNP genotype group.
Results: The mean of mammographic density is higher in cases (52%) than in controls (0,41%) (p &lt; 0,05). Means of mammographic density were compared by ESR1 genotypes and haplotypes. The percentage density was higher in women with one or two copies of the PvuII p allele (means for CT/Pp and TT/pp are 49 % and 48 %, respectively) than in those with the CC/PP genotype (39%), TT VS CC (P &gt;0,05). Women with one or two copies of the XbaI × allele had higher mean percentage density (AG/Xx and AA/xx, 49% and 47%, respectively) than those with the GG/XX genotype (32%,), AAVGG P &lt; 0,05. Persentage of TT genotype and mean of density is higher in cases (30%, 52%) than controls (10,2%, 40%).
Conclusion: Haplotype 2 (TG/PX) was associated with lower sensitivity to estrogen and reflects as decrease of mammographic density. The findings of this study support the view that ESR1 polymorphisms may affect breast cancer risk through differences in breast density.
Keywords: Breast Cancer, Mammogram Digitizer, DNA polymorphism ESR 1 PvuII, ESR1 XbaI, PCR RFLP
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-01-08.
Abstract P3-02-05: Subtypes of screen-detected invasive breast cancer and symptomatic invasive breast cancer and their impact on survival
Authors: Kobayashi N , Hikichi M , Miyajima S , Utsumi T 
Published: August 2014

Abstract
Background: Breast cancer is a worldwide problem which urgently requires solution, in many countries still being the most common cause of malignancy associated death. The screening program aims to detect early breast cancer to improve survival. We investigated the clinicopathrogical characteristic including intrinsic subtypes and outcome of patients with screen-detected invasive breast cancer (S-DIBC) compared with those with symptomatic invasive breast cancer (SIBC).
Material and Methods: From January 2005 to December 2011 840 patients with invasive breast cancer who underwent surgery at our hospital were included. There were 195 S-DIBCs and 645 SIBCs. We retrospectively reviewed the clinical and pathologic data. Ki-67 LI was categorized as low (&lt;14%) and high (&gt; or = 15%). Tumors were classified into four groups based on the expression of ER, PgR, Ki-67 and HER2 as follows: luminal A (ER+ and/or PR+, and HER2− and Ki67 low), luminal B (ER+ and/or PR+, and HER2+ or Ki67 high), HER2 disease (ER−, PR−, HER2+), and triple negative (ER−, PR−, HER2−). Overall survival (OS) and relapse-free survival (RFS) curves were generated using the Kaplan- Meier method. Survival comparisons were made with the log-rank test, the level of significance was taken to be 0.05. SPSS 18.0 software package was used for statistical analysis.
Results: S-DIBC was associated with smaller tumor size, less lymph node involvement, and earlier stage compared with SIBC (P &lt; 0.001). Significantly more tumors were positive for hormone receptors in the S-DIBC group as compared to the SIBC group (ER+,83.5% vs.75.1%, p = 0.017; PgR+, 73.4% vs. 60.6%, P = 0.009), with a greater proportion of the luminal A subtype in the S-DIBC group (S-DIBC: Luminal A 59.0%, Luminal B 25.6%, HER2 disease 4.6%, triple negative 10.8%; SIBC group: Luminal A 46.5%, Luminal B 30.0%, HER2 disease 6.6%, triple negative 16.8%). Patients with S-DIBC had better prognosis [5-year OS: 100% (S-DIBC) vs. 95.5% (SIBC), p = 0.005, 5-year RFS: 98.5 vs. 92.1%, p = 0.004]. Tumors detected with screening generally had more favorable outcomes than symptomatic cancers regardless of subtypes [5-year OS: (S-DIBC) Luminal A 100%, Luminal B 100%, HER2 disease 100%, triple negative 100%; (SIBC) Luminal A 95.9%, Luminal B 93.3%, HER2 disease 95.5%, triple negative 84.1%)].
Conclusions: Our results suggest that subtype distribution of S-DIBC differs from that of SIBC.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-05.
Abstract P3-02-06: Survival impact of early detection of recurrence after surgery in early breast cancer patients
Authors: Hojo T , Tamura K , Masuda N , Inoue K , Kinoshita T , Fujisawa T , Hara F , Saji S , Asaga S , Anan K , Yamamoto N , Wada N , Takahashi M , Nakagami K , Kuroi K , Iwata H 
Published: August 2014

Abstract
Background and Object: Annual mammography and physical examination as the follow-up tests after surgery were recommended to early breast cancer patients based on the two randomized clinical trials (GIVIO and Rosselli Del Turco) which were reported in 1990s. Whereas, radiological imaging and blood test (serum tumor marker) for early detection of recurrence are not recommended due to the lack of evidence from clinical trial. However, the imaging techniques (helical CT, bone scan, PET/CT. MRI et al) to detect minute lesions and therapeutic options for metastatic breast cancer have been remarkably advanced since then. In fact, routine radiological examinations after surgery were performed in several Japanese hospitals for aiming early detection of recurrence as the clinical practice.
We here evaluate the possible benefit of early detection of recurrence by radiological and laboratory examinations during post-operative follow-up period.
Methods: Clinical information of breast cancer patients who were diagnosed as recurrence after surgery during 2005–2006 was collected from 30 hospitals in Japan. Clinical and pathological characteristics such as molecular subtype of breast cancer, survival time from initial therapy or 1st recurrence, detection methods and symptomatic information when they diagnosed as metastasis were analyzed retrospectively.
Results: As the routine examination of post-operative follow-up, serum tumor maker, chest x-ray/CT, abdominal US/CT and bone scan were done in 95%, 57%, 38%, 24% of 30 hospitals, respectively. Of the 698 patients individually evaluated in this analysis, 248 had loco-regional recurrences and 450 had distant metastases. The first distant metastatic site were 35% in bone, 30% in lung, 17% in liver and 11% in lymph node, respectively. All individual patients are divided into symptomatic (45.7%) or asymptomatic groups (54.3%) at the detection of metastases. Asymptomatic metastases were detected by serum tumor marker (26%), bone scan (18%), chest x-ray (17%), chest CT (17%), abdominal US (11%) and abdominal CT (5%), respectively. The median disease-free interval (DFI) was 3.0 years in both groups, but the median survival time after the diagnosis of recurrence to death were 3.7 years in asymptomatic patients and 3.0 years in symptomatic patients, respectively. In addition, asymptomatic group had significantly superior overall survival (from primary surgery to death) than symptomatic group with oligo-metastases such as limited organ disease (P &lt; 0.001).
Conclusions: Our data may support the hypothesis that early detection of breast cancer recurrences has beneficial impact on survival. Randomized clinical trial would be warranted to prove this hypothesis, and we are currently planning this.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-06.
Abstract P3-02-09: Cost-effectiveness of screening with additional MRI for women with familial risk for breast cancer without a genetic predisposition
Authors: Saadatmand S , Heijnsdijk EA , Rutgers EJ , Hoogerbrugge N , Oosterwijk JC , Tollenaar RA , Hooning M , Obdeijn I-M , de Koning HJ , Tilanus-Linthorst MM 
Published: August 2014

Abstract
Background: To reduce mortality risk, women with a family history of breast cancer are often screened with mammography before 50 years of age. Additional Magnetic Resonance Imaging (MRI) can improve sensitivity. MRI screening is cost-effective for BRCA1/2 mutation carriers. However, for women with a family history of breast cancer without a proven mutation cost-effectiveness is not clear. We evaluated the cost-effectiveness of additional MRI for women with a familial risk in the largest prospective MRI screening study: the Dutch MRI Screening Study (MRISC).
Materials & Methods: Between 1999 and 2007 a total of 1597 women (8370 women years at risk) between 25–70 years, with an estimated cumulative lifetime risk of 15–50% for breast cancer participated in the MRISC. Women were screened with clinical breast examination (CBE) every six months and annual mammography and MRI. We calculated the costs per detected breast cancer. In addition, MRISC data were incorporated into a micro simulation screening analysis model: MISCAN. This model simulates screening programs with different screening modalities and time intervals. Different screening schemes were evaluated and the cost per life-year gained (CLYG) estimated.
Results: Forty-seven breast cancers, including 9 Ductal Carcinoma in Situ, were detected. Screening with additional MRI leads to a cost per detected breast cancer treated of €101,962. In increasing age-cohorts the cost decreased, probably due to the higher breast cancer incidence. The cost per detected and treated breast cancer in age group 40–50 years doubled in the age group &gt;60 years. We will demonstrate these results more extensively.
With MISCAN modeling we predicted that screening with this scheme from age 35 to 60 years reduces breast cancer mortality by 30% at a CLYG of €119,945 (3.5% discounting), compared to 21% estimated mortality reduction at €45,707 CLYG with mammography and CBE alone.
Conclusion: Screening with MRI may improve survival for women with familial risk for breast cancer, but is expensive. However, it may be cost-effective for a select group. We will discuss subgroups that may benefit from MRI screening and in which age category MRI was most effective in our study.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-09.
Abstract P3-03-02: The metastatic rate of IMLN, when IMLN metastasis is suspected with PET CT.
Authors: Lee J-H , Son G-T , Choi J-E , Kang S-H , Lee S-J 
Published: August 2014

Abstract
Background: Metastatic status of internal mammary lymph nodes (IMLNs) has a clinical importance in assessing stage and prognosis of breast cancer. But, when metastasis of IMLN is suspected, the management is controversial. We reviewed 29 breast cancer patients who had IMLN dissection, retrospectively, and investigated the pathologic status of IMLNs.
Methods: From August 2005 to December 2011, at Yeungnam University Hospital, 43 patients underwent IMLN biopsy or dissection for suspected IMLN metastasis on lymphoscintigraphy (7 patients), breast ultrasound (1 patient) or PET CT (29 patients), when diagnosed with primary or recurred breast cancer. 6 patients who had stage IV at diagnosis or had too obscure data to identify exact location of IMLN, were excluded. Among them, we reviewed clinicopathologic features of IMLN detected on PET CT and metastatic status of IMLNs was investigated.
Results: Total 29 patients were included in this study. 19 patients and 10 patients underwent IMLN dissection when diagnosed with primary or recurred breast cancer, respectively. Unlike conventional IMLN dissections, our IMLN biopsy or dissection was done during Radical mastectomy (in 2 pts.), modified radical mastectomy (in 14 pts.), using incision of breast conserving surgery (in 3 pts.) and separated incision (in 10 pts.), with or without resection of ribs.
The mean number of IMLNs was 2.76±2.15 and total metastatic rate of IMLN was 72.4% (21/29). The sensitivity, specificity, positive predictive value, and negative predictive value of PET CT was following: 91.3%, 42.8%, 72.4% and 27.6%. Mean standard uptake value (SUV) of metastatic and non-metastatic IMLN were 3.6±2.9 and 3.9±2.6 and there was no statistical difference (p-value=0.821).

During IMLN dissection, besides initial approach intercostals space (ICS), some metastatic IMLN was also found in upper or lower level ICS (42.9%, 6/14). Only IMLN metastasis without axillary nodes metastasis were found in 3 patients and the tumor location of these patients was all inner or central quadrant. Chest X-ray was done postoperatively as routine procedure, and there were no other specific complications such as pneumothorax or hemothorax.
Conclusion: IMLN dissection without radical mastectomy can be done safely without complications due to recent advance in diagnostic and surgical skills. If SUV on IMLN is shown on the PET-CT, IMLN dissection is needed, regardless of SUV. If breast cancer is located at inner quadrant, more aggressive dissection of IMLN is needed. Further follow-up and studies are needed to assess locoregional recurrence and to compare improvement in overall survival and disease free survival.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-03-02.
Abstract P3-05-02: Pathological assessment of discordant cases for molecular (BluePrint and MammaPrint) versus clinical subtypes for breast cancer among 621 patients from the EORTC 10041/BIG 3–04 (MINDACT) trial
Authors: Viale G , Slaets L , de Snoo F , van't Veer L , Rutgers E , Piccart M , Bogaerts J , van den Akker J , Stork-Sloots L , Engelen K , Russo L , Dell'Orto P , Cardoso F 
Published: August 2014

Abstract
Background: Biology has become the main driver of breast cancer therapy. Intrinsic biological subtypes by gene expression profiling have been identified. Pathology can be used to define surrogates of these subtypes but these are not always concordant, which may lead to different treatment plans. We investigated the concordance between BluePrint and MammaPrint (microarray-based) breast cancer subtypes and pathological surrogates (based on ER, PR, HER2 & Ki67).
Methods: Using available data (centrally assessed pathology and genomics) from the MINDACT pilot phase [Rutgers et al. EJC 2011] 621 tumors were analyzed. Patients were classified according to 4-category based pathology (ER, PR, HER2 and Ki67); additionally, classification was performed adhering to the recent St. Gallen recommendations [Goldhirsch et al. 2011], which recognizes an additional category (Luminal B HER2+). Based on BluePrint and MammaPrint 4 subtypes are formed: Luminal A (Luminal-type/MammaPrint Low Risk); Luminal B (Luminal-type/MammaPrint High Risk); HER2-type; and Basal-type. This study is an analysis of discordant patient groups (i.e. clinical HER2+/BluePrint Luminal-type; clinical Hormone Receptor (HR)-positive/BluePrint Basal-type) providing comparison of centrally assessed tumor heterogeneity as well as comparison of quantified ER, PR and HER2 results.
Results: Ki67 is often used as biomarker to distinguish Luminal A from Luminal B subgroups. The concordance between MammaPrint and centrally assessed Ki67 in Luminal-type patients is 71%, with a κ score of 0.35 (95% CI 0.26–0.45) indicating that Ki67 and MammaPrint cannot reliably substitute for each other. There is a relatively large group of clinical HER2+ cases that are BluePrint Luminal-type (29 out of 76; 38%) indicating that tumor expression of the Luminal profile is dominant compared with expression of the HER2 profile. These patients have high IHC ER results and fall into the group that St Gallen separately defines as Luminal B HER2-type. These patients may have lower response to trastuzumab [von Minckwitz et al. JCO 2012]. 12 out of 76 BluePrint Basal-type patients are clinical HR+. These patients have low centrally assessed IHC ER and PR expression (≥1% and &lt;10%).
Conclusions: Marked differences are observed between BluePrint and MammaPrint (microarray based) breast cancer subtypes and centrally re-assessed pathological surrogates (based on ER, PR, HER2 & Ki67). The greatest discordance is seen in the sub-stratification of Luminal patients, and in the HR+/HER2+ patients. The observed subtype discrepancies may have an important impact on treatment decision making.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-05-02.