1
|
Jonsson H, Andersson A, Mao Z, Nyström L. Age-specific differences in breast cancer treatment between screen-detected and non-screen-detected breast cancers in women aged 40-74 years at diagnosis in Sweden 2008-2017. Acta Oncol 2024; 63:552-556. [PMID: 38967249 PMCID: PMC11332461 DOI: 10.2340/1651-226x.2024.40200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND AND PURPOSE We have recently demonstrated that screen-detected invasive breast cancers had more favourable tumour characteristics than non-screen-detected. The objective of the study was to analyse differences in breast cancer treatment between screen-detected and non-screen-detected cases by age at diagnosis, with and without adjustment for tumour (T) and nodal (N) status, within a nationwide, population-based mammography screening programme utilising register data. MATERIAL AND METHODS Data spanning 2008-2017 were collected from the National Quality Register for Breast Cancer. Multivariable logistic regression analysis was used to estimate odds ratios and 95% confidence intervals for treatment disparities between screen-detected and non-screen-detected breast cancer. RESULTS Among 46,481 women diagnosed with invasive breast cancer aged 40-74 and invited for mammography screening, significant differences in treatment were observed. Screen-detected cases showed higher likelihoods of partial mastectomy compared to mastectomy, endocrine therapy, and radiotherapy, whereas chemotherapy and antibody therapy were less likely compared to non-screen-detected cases. However, when adjusting for surgery type, screen-detected cases showed lower likelihoods of radiotherapy. Age at diagnosis significantly influenced treatment odds ratios, with interactions observed for all treatments except radiotherapy adjusted for surgery. Differences increased with age, except for endocrine therapy. Radiotherapy adjusted for surgery type showed no age-related interaction. Adjusting for T and N did not alter these patterns. INTERPRETATION In general, screen-detected cases received less aggressive treatment, such as mastectomy, chemotherapy, and antibody therapy, compared to non-screen-detected cases. Disparities increased with age, except for endocrine therapy and radiotherapy adjusted for surgery. Differences persisted after adjusting for T and N, suggesting that these factors cannot solely explain the results.
Collapse
Affiliation(s)
- Håkan Jonsson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Anne Andersson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Zheng Mao
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lennarth Nyström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| |
Collapse
|
2
|
McKee H, Brown MJ, Kim HHR, Doo FX, Panet H, Rockall AG, Omary RA, Hanneman K. Planetary Health and Radiology: Why We Should Care and What We Can Do. Radiology 2024; 311:e240219. [PMID: 38652030 DOI: 10.1148/radiol.240219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Climate change adversely affects the well-being of humans and the entire planet. A planetary health framework recognizes that sustaining a healthy planet is essential to achieving individual, community, and global health. Radiology contributes to the climate crisis by generating greenhouse gas (GHG) emissions during the production and use of medical imaging equipment and supplies. To promote planetary health, strategies that mitigate and adapt to climate change in radiology are needed. Mitigation strategies to reduce GHG emissions include switching to renewable energy sources, refurbishing rather than replacing imaging scanners, and powering down unused scanners. Radiology departments must also build resiliency to the now unavoidable impacts of the climate crisis. Adaptation strategies include education, upgrading building infrastructure, and developing departmental sustainability dashboards to track progress in achieving sustainability goals. Shifting practices to catalyze these necessary changes in radiology requires a coordinated approach. This includes partnering with key stakeholders, providing effective communication, and prioritizing high-impact interventions. This article reviews the intersection of planetary health and radiology. Its goals are to emphasize why we should care about sustainability, showcase actions we can take to mitigate our impact, and prepare us to adapt to the effects of climate change. © RSNA, 2024 Supplemental material is available for this article. See also the article by Ibrahim et al in this issue. See also the article by Lenkinski and Rofsky in this issue.
Collapse
Affiliation(s)
- Hayley McKee
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Maura J Brown
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Helen H R Kim
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Florence X Doo
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Hayley Panet
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Andrea G Rockall
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Reed A Omary
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Kate Hanneman
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| |
Collapse
|
3
|
López-Pérez MI, Molina-Rodríguez A, Harillo-Acevedo FD, Guillén-Martínez A, Palacio-Gaviria MP. Approach to the care process by nurse case managers in a breast unit. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:90-95. [PMID: 38484933 DOI: 10.1016/j.enfcle.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Breast units led by nurse case managers are being implemented to provide comprehensive care in the detection and treatment of breast cancer. However, their implementation is heterogeneous and the results of the care process with this professional have not been studied. The aim of the study is to describe the management in time and the approach of the process by a nurse case manager in the breast unit of women with suspected breast cancer pathology, derived from the breast cancer screening program. METHODS Descriptive, cross-sectional, retrospective study carried out in 2021. Women treated in a breast unit managed by a nurse case manager in a hospital in southern Spain were included. Sociodemographic, clinical and care process characteristics were analysed RESULTS: A total of 118 women of Spanish nationality (92%) participated, with a mean age of 59 years. The diagnosis of malignancy was made in 74.6% of them. Seventy-nine percent of the women had their first visit within 3 days. The mean time to diagnosis was 3.98 days (SD: ±3.93), 4.2 weeks (SD: ±1.84) to initiate treatment and a total in-hospital time of 33 days (SD: ±13.45). CONCLUSIONS The management of nurse case managers in breast units contributes to improving or speeding up times, in accordance with international guidelines, helping this approach in the continuity of the care process for women referred after screening for breast cancer detection.
Collapse
|
4
|
Fancellu A, Deiana G, Sanna V, Rubino C, Cossu A, Cottu P, Giuliani G, Sant L, Norcia G, Porcu A. Rising age-specific rates of immediate breast reconstruction after mastectomy: Report from an Italian Breast Unit. J Surg Oncol 2023; 128:1227-1234. [PMID: 37592864 DOI: 10.1002/jso.27420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/29/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Immediate breast reconstruction (IBR) represents a fundamental part in the management of patients receiving mastectomy. In recent years, there has been an increasing trend in the use of IBR in all age groups. The study aims were to evaluate the age-specific trend of IBR, and to discuss its effects in work organization at an Italian Breast Unit. METHODS We searched for women diagnosed with breast cancer between 2010 and 2019, focusing on IBR rates in patients who received mastectomy. Age-specific trends were assessed using the Cochrane-Armitage test. Differences in operative times and hospital stay between women undergoing mastectomy + IBR (Ma + IBR) or mastectomy alone (Ma) were evaluated by Student's t test or χ2 test. RESULTS Among 1915 patients, 62.4% underwent breast conserving surgery (BCS), and 37.6% mastectomy. Overall, rates of Ma + IBR increased from 32% in 2010 to 58% in 2019 (p < 0.001). Although rates of IBR rose in all age groups, the trend was significantly increased among patients aged 50-59 (p < 0.001), 60-69 (p < 0.0001), and 70-79 (p < 0.05). CONCLUSIONS Rates of Ma + IBR have increased over years, especially among older women. Ma + IBR resulted in longer operative times and hospital stay than Ma alone. These findings imply that, in the near future, resources should be implemented to improve and strengthen the surgical activity of Breast Units, to support the increasing use of IBR in women of all age groups.
Collapse
Affiliation(s)
- Alessandro Fancellu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Giulia Deiana
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Valeria Sanna
- AOU Sassari, Department of Oncohematology, Unit of Medical Oncology, Sassari, Italy
| | - Corrado Rubino
- Department of Medicine, Surgery and Pharmacy, Unit of Plastic Surgery, University of Sassari, Sassari, Italy
| | - Antonio Cossu
- Department of Medicine, Surgery and Pharmacy, Unit of Pathology, University of Sassari, Sassari, Italy
| | - Pietrina Cottu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Giuliana Giuliani
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Lisa Sant
- Faculty of Medicine and Surgery, University of Sassari Medical School, Sassari, Italy
| | - Giuseppe Norcia
- Faculty of Medicine and Surgery, University of Sassari Medical School, Sassari, Italy
| | - Alberto Porcu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| |
Collapse
|
5
|
The Relationship between Histological Composition and Metabolic Profile in Breast Tumors and Peritumoral Tissue Determined with 1H HR-MAS NMR Spectroscopy. Cancers (Basel) 2023; 15:cancers15041283. [PMID: 36831625 PMCID: PMC9954108 DOI: 10.3390/cancers15041283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Breast tumors constitute the complex entities composed of cancer cells and stromal components. The compositional heterogeneity should be taken into account in bulk tissue metabolomics studies. The aim of this work was to find the relation between the histological content and 1H HR-MAS (high-resolution magic angle spinning nuclear magnetic resonance) metabolic profiles of the tissue samples excised from the breast tumors and the peritumoral areas in 39 patients diagnosed with invasive breast carcinoma. The total number of the histologically verified specimens was 140. The classification accuracy of the OPLS-DA (Orthogonal Partial Least Squares Discriminant Analysis) model differentiating the cancerous from non-involved samples was 87% (sensitivity of 72.2%, specificity of 92.3%). The metabolic contents of the epithelial and stromal compartments were determined from a linear regression analysis of the levels of the evaluated compounds against the cancer cell fraction in 39 samples composed mainly of cancer cells and intratumoral fibrosis. The correlation coefficients between the levels of several metabolites and a tumor purity were found to be dependent on the tumor grade (I vs II/III). The comparison of the levels of the metabolites in the intratumoral fibrosis (obtained from the extrapolation of the regression lines to 0% cancer content) to those levels in the fibrous connective tissue beyond the tumors revealed a profound metabolic reprogramming in the former tissue. The joint analysis of the metabolic profiles of the stromal and epithelial compartments in the breast tumors contributes to the increased understanding of breast cancer biology.
Collapse
|
6
|
Mert T. Evaluation of knowledge and practice regarding mammography among a group of Turkish women attending a tertiary hospital. Turk J Surg 2022; 38:230-236. [PMID: 36846069 PMCID: PMC9948670 DOI: 10.47717/turkjsurg.2022.5672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/17/2022] [Indexed: 03/01/2023]
Abstract
Objectives Early detection is the most important cornerstone of breast cancer in determining treatment outcome and survival. In this study, it was aimed to investigate the level of knowledge, attitude, and practice of mammography in the early diagnosis of breast cancer in a group of women. Material and Methods Data of this descriptive study were collected under observation with the help of a questionnaire. Female patients over 40 years of age or over 30 years of age with a family history of breast cancer admitted to our general surgery outpatient clinic for a health problem other than breast were included. Results A total of 300 female patients with a mean age of 48.7 ± 10.9 years (min-max, 33-83 years) were included. Median frequency of correct answers among the women participating in the study was 83.7% (76.0-92.0). Mean score obtained by the participants from the questionnaire was 75.7 ± 15.8 (the median score 80; 25th-75th centiles, 73.3-86.7). Slightly more than half of the patients (159 patients, 53%) had at least one mammography scan before. The level of mammography knowledge was negatively correlated with age and the number of previous mammographies, and positively correlated with education level (r= -0.700, p <0.001; r= -0.419, p <0.001 and r= 0.643, p <0.001, respectively). Conclusion Although the level of knowledge about breast cancer and early diagnosis methods in women was at a satisfactory level, it is obvious that mammography screening practice of women without any breast symptoms is very low. Therefore, it should be aimed to increase women's awareness of cancer prevention and compliance with early diagnosis methods and to promote participation in mammography screening.
Collapse
Affiliation(s)
- Tuba Mert
- Department of General Surgery, Pendik Medipol University Faculty of Medicine, İstanbul, Türkiye
| |
Collapse
|
7
|
Sanna V, Fedele P, Deiana G, Alicicco MG, Ninniri C, Santoro AN, Pazzola A, Fancellu A. Edmonton Symptom Assessment Scale may reduce medical visits in patients undergoing chemotherapy for breast cancer. World J Clin Oncol 2022; 13:577-586. [PMID: 36157162 PMCID: PMC9346425 DOI: 10.5306/wjco.v13.i7.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/05/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adjuvant chemotherapy is recommended in high-risk breast cancer. However, no universally accepted guidelines exist on pre-chemotherapy assessment. In particular, the number and frequency of medical visits vary according to each institution’s policy. We hypothesised that the Edmonton Symptom Assessment Scale (ESAS) may have a favourable impact on the pre-treatment assessment in candidates for adjuvant chemotherapy.
AIM To investigate whether the ESAS can be used to safely reduce the number of medical visits in women with breast cancer undergoing adjuvant chemotherapy.
METHODS In a retrospectively prospective matched-pair analysis, 100 patients who completed the ESAS questionnaire before administration of adjuvant chemotherapy (ESAS Group) were compared with 100 patients who underwent chemotherapy according to the traditional modality, without ESAS (no-ESAS Group). Patients of the ESAS Group received additional visits before treatment if their ESAS score was > 3. The primary endpoint was the total number of medical visits during the entire duration of the chemotherapy period. The secondary endpoints were the occurrence of severe complications (grade 3-4) and the number of unplanned visits during the chemotherapy period.
RESULTS The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group (age P = 0.880; breast cancer stage P = 0.56; cancer histology P = 0.415; tumour size P = 0.258; lymph node status P = 0.883; immunohistochemical classification P = 0.754; type of surgery P = 0.157), except for premenopausal status (P = 0.015). The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group regarding age, cancer stage, histology, tumour size, lymph node status, immunohistochemical classification, and type of surgery. Unplanned visits during the entire duration of chemotherapy were 8 in the ESAS Group and 18 in the no-ESAS Group visits (P = 0.035). Grade 3-4 toxicity did not differ between the study groups (P = 0.652). Forty-eight patients of the ESAS Group received additional visits due to an ESAS score > 3. The mean number of medical visits was 4.38 ± 0.51 in the ESAS Group and 16.18 ± 1.82 in the no-ESAS group (P < 0.001). With multivariate analysis, women of the ESAS group were more likely to undergo additional visits for an ESAS score > 3 if they were aged 60 or older, received a mastectomy, or had tumour stage II/III.
CONCLUSION The ESAS score may safely reduce the number of medical visits in candidates for adjuvant chemotherapy for early breast cancer. Our results suggest that the ESAS score may be used for selecting a group of breast cancer patients for whom it is safe to reduce the number of medical visits in the setting of adjuvant chemotherapy. This may translate into several advantages, such as a more rational utilization of human resources and a possible reduction of coronavirus pandemic infection risk in oncologic patients.
Collapse
Affiliation(s)
- Valeria Sanna
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Palma Fedele
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Giulia Deiana
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | | | - Chiara Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Anna N Santoro
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Antonio Pazzola
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| |
Collapse
|
8
|
Heinig M, Heinze F, Schwarz S, Haug U. Initial and ten-year treatment patterns among 11,000 breast cancer patients undergoing breast surgery-an analysis of German claims data. BMC Cancer 2022; 22:130. [PMID: 35109813 PMCID: PMC8812022 DOI: 10.1186/s12885-022-09240-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to explore the potential of German claims data for describing initial and long-term treatment patterns of breast cancer patients undergoing surgery. METHODS Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population) we included patients with invasive breast cancer diagnosed in 2008 undergoing breast surgery and followed them until 2017. We described initial and long-term treatment patterns and deaths. Analyses were stratified by stage (as far as available in claims data), age at diagnosis, and mode of detection (screen-detected vs. interval vs. unscreened cases). RESULTS The cohort comprised 10,802 patients. The proportion with neoadjuvant therapy was highest in patients < 50 years (19% vs. ≤ 8% at older ages). The proportion initiating adjuvant chemotherapy within four months after diagnosis decreased with age (< 50 years: 63%, 50-69: 46%, 70-79: 27%, 80 + : 4%). Among women < 69 years, ~ 30% had two breast surgeries in year one (70-79: 21%, 80 + : 14%). Treatment intensity was lower for screen-detected compared to interval or unscreened cases, both in year one (e.g., proportion with mastectomy ~ 50% lower) and within 2-10 years after surgery (proportions with radiotherapy or chemotherapy about one third lower each). CONCLUSIONS This study illustrates the potential of routine data to describe breast cancer treatment and provided important insights into differences in initial and long-term treatment by mode of detection and age.
Collapse
Affiliation(s)
- Miriam Heinig
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.
| | - Franziska Heinze
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center On Inequality and Social Policy, University of Bremen, 28359, Bremen, Germany
| | - Sarina Schwarz
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.,Faculty of Human and Health Sciences, University of Bremen, Grazer Str. 2, 28359, Bremen, Germany
| |
Collapse
|
9
|
Fancellu A, Houssami N, Sanna V, Porcu A, Ninniri C, Marinovich ML. Outcomes after breast-conserving surgery or mastectomy in patients with triple-negative breast cancer: meta-analysis. Br J Surg 2021; 108:760-768. [PMID: 34057990 DOI: 10.1093/bjs/znab145] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND In patients with triple-negative breast cancer (TNBC), oncological and survival outcomes based on locoregional treatment are poorly understood. In particular, the safety of breast-conserving surgery (BCS) for TNBC has been questioned. METHODS A meta-analysis was performed to evaluate locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS) rates in patients with TNBC who had breast-conserving surgery versus mastectomy. Estimates were pooled in random-effects analysis. The effect of study-level co-variables was assessed by univariable metaregression. RESULTS Fourteen studies, including 19 819 patients operated for TNBC met the inclusion criteria; 9828 patients (49.6 per cent) underwent BCS and 9991 (50.4 per cent) had a mastectomy. Patients with smaller tumours were more likely to be selected for BCS (pooled odds ratio (OR) for T1 tumours 1.95, 95 per cent c.i. 1.64 to 2.32; P < 0.001). The pooled OR for LRR was 0.64 (0.48 to 0.85; P = 0.002), indicating a statistically significantly lower odds of LRR among women who had BCS relative to mastectomy. The pooled OR for DM was 0.70 (0.53 to 0.94; P = 0.02), indicating a lower odds of DM among women who had BCS; however, this difference diminished with increasing study-level age and follow-up time. A pooled hazard ratio of 0.78 (0.69 to 0.89; P < 0.001) showed a significantly lower hazard for all-cause mortality among women undergoing BCS versus mastectomy. CONCLUSION These results should be interpreted cautiously owing to likely differences in selection for BCS or mastectomy in the included studies. Patients with TNBC selected for BCS do not, however, have a worse prognosis than those treated with mastectomy, and breast conservation can be offered when feasible clinically.
Collapse
Affiliation(s)
- A Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - N Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - V Sanna
- Azienda Ospedaliero-Universitaria di Sassari, Unit of Medical Oncology, Sassari, Italy
| | - A Porcu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - C Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - M L Marinovich
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
10
|
Molassiotis A, Tyrovolas S, Giné-Vázquez I, Yeo W, Aapro M, Herrstedt J. Organized breast cancer screening not only reduces mortality from breast cancer but also significantly decreases disability-adjusted life years: analysis of the Global Burden of Disease Study and screening programme availability in 130 countries. ESMO Open 2021; 6:100111. [PMID: 33892452 PMCID: PMC8085709 DOI: 10.1016/j.esmoop.2021.100111] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/06/2021] [Indexed: 01/28/2023] Open
Abstract
Background Multiple studies over the past 4 decades have shown the significant benefit of breast cancer screening (BCS) in reducing mortality rates from breast cancer (BC). However, significant debate exists about the role of BCS in this regard, with some studies also showing no benefit in terms of mortality along with issues such as overdiagnosis, health care utilisation costs, psychological distress or overtreatment. To date, no BCS study has focused on disability. Hence the aim of this study is to evaluate the relative contribution of BCS approaches to age-standardized mortality and disability-adjusted life years (DALYs) rates along with other related risk factors, from a country-level perspective. Patients and methods This study created a country-dataset by merging information from the Global Burden of Disease study regarding female age-standardized BC mortality, DALYs rates and other risk factors with the BCS programme availability at the national or regional level (versus no or only pilot such programme), BCS type (mammography, digital screening, breast self-examination and clinical breast examination) and other BCS-related information among 130 countries. Mixed-effect multilevel regression models were run to examine the associations of interest. Results The most important factor predictive of lower mortality was the more advanced type of BCS programme availability [mammography: −4.16, 95% CI −6.76 to −1.55; digital mammography/ultrasound: −3.64, 95% CI −6.59 to −0.70] when compared with self- or clinical breast examinations. High levels of low-density lipoprotein cholesterol (LDL-c) and smoking were also related to higher mortality and DALYs from BC. In terms of BC DALYs, BCS had a 21.9 to 22.3-fold increase in the magnitude of effect compared with that in terms of mortality. Data on mortality and DALYs in relation to BCS programmes were also calculated for high-, middle- and low-income countries. Conclusions These data further support the positive effects of BCS in relation to age-standardized BC mortality rates, and for the first time show the impact of BCS on DALYs too. Additional factors, such as diabetes, high levels of LDL-c or smoking seemed to be related to BC mortality and disability, and could be considered as additional components of possible interventions to be used alongside BCS to optimize the BCS benefit on patients. A key factor predictive of lower age-standardized BC mortality was breast cancer screening (BCS). This was the case with national-level BCS programmes as well as the availability of different types of BCS. LDL-c and smoking among others, were related to mortality and disability. BCS with mammography or digital screening was related to less age-standardized BC disability. These data support, for the first time, the relation of BCS on disability.
Collapse
Affiliation(s)
- A Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - S Tyrovolas
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - I Giné-Vázquez
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - W Yeo
- Department of Clinical Oncology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - M Aapro
- Centre du Sein, Genolier Cancer Center, Genolier, Switzerland
| | - J Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Denmark; University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
11
|
Parambil JV, Najim M, Mahmoud M, Abubeker IY, Kartha A, Calaud F, Al-Mohamed A, Al-Mohannadi D, Chandra P, A Yassin M. Breast Cancer Screening Practices in a Tertiary Care Center in the State of Qatar: A Cross-Sectional Survey. BREAST CANCER-TARGETS AND THERAPY 2021; 13:21-30. [PMID: 33447078 PMCID: PMC7802912 DOI: 10.2147/bctt.s285210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/01/2020] [Indexed: 12/24/2022]
Abstract
Introduction Breast cancer is the most common cancer in females. In Qatar, mortality related to breast cancer came in third after lung cancer and leukemia. In this study, we aim to comprehensively evaluate the rate of internal medicine residents and faculty compliance with breast cancer screening in Hamad Medical Corporation (Doha, Qatar), as well as to identify barriers and facilitators that could potentially augment changes to enhance physician-led cancer screening. Methods A cross-sectional web-based survey was distributed among internal medicine physicians between December 2018 and March 2019 at a tertiary medical centre. It focused on the knowledge, attitude, and practice of physicians regarding breast cancer screening guidelines and explored potential barriers and proposed solutions. Chi-square and t-test statistics were used to draw conclusions where appropriate. Results A total of 158 physicians responded to the survey, with a response rate of 61%. 75.9% were postgraduate trainees. Around three-quarters of the physicians mentioned that they would recommend breast cancer screening for their age-appropriate average-risk patients. There was a statistically significant difference between the trainees, consultants, and specialists regarding the modality of choice, where the majority of the trainees opted mammogram every 2 or 3 years while 44.4% of the consultants indicated yearly self-breast exam (p<0.001). The percentage of survey participants who rarely to never offer breast cancer screening in the outpatient settings was 37.8%. Unclear pathway (40%) and lack of time in clinic/ward rounds (26.5%) were the major reported barriers for cancer screening. Conclusion In the current era of personalized medicine, physicians should be more oriented to local guidelines to provide optimal care to their patients. While the attitude towards breast cancer screening is positive, the overall compliance with the national recommendations is sub-optimal. Further initiatives and intervention programs are required to promote the breast cancer screening in Qatar.
Collapse
Affiliation(s)
| | - Mostafa Najim
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Mahmoud
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Anand Kartha
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Francois Calaud
- Department of Medical Oncology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Al-Mohamed
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Dabia Al-Mohannadi
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Department of Medical Oncology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
12
|
Fancellu A, Zhao XY, Cottu P, Sanna V, Li YP, Zhu Q, Tanda C, Zhang YY, Lai YM, Ginesu GC, Dai SQ, Porcu A. Comparing Clinicopathologic Features and Surgical Treatment of Premenopausal Breast Cancer across Italy and China: Report from a Medical Exchange Program. Breast Care (Basel) 2020; 15:511-518. [PMID: 33223995 DOI: 10.1159/000505448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 12/16/2019] [Indexed: 02/05/2023] Open
Abstract
Background This study investigated the differences in clinicopathologic features and surgical treatment between an Italian and a Chinese cohort of premenopausal women with breast cancer, and highlighted the potential advantages of international medical exchange projects. Methods Premenopausal women who underwent surgical treatment between 2012 and 2016 at one Italian and one Chinese institution participating in a medical exchange program were compared. Factors associated with the probability to receive mastectomy were determined via logistic analysis. Changes in surgical management at the Chinese institution in the period 2018-2019, after the exchange program, were also evaluated. Results A total of 505 patients, 318 from Italy and 187 from China, were evaluated. The Chinese patients had more frequently advanced-stage tumours, large tumour size (30.9 vs. 18.1 mm, p < 0.01), invasive carcinoma (92.5 vs. 83.3%, p < 0.01), positive axillary lymph nodes (54.5 vs. 27.4%, p < 0.01), Her-2 positivity (36.4 vs. 22.0%, p < 0.01), and high proliferative index (55.1 vs. 30.2%, p < 0.01). Positive oestrogen receptor status and rates of triple-negative breast cancer did not differ (77.0 vs. 69.5%, p = 0.09 and 14.2 vs. 16%, p = 0.56, respectively). Mastectomy rates were higher among Chinese women (85 vs. 41%, p < 0.001), whereas use of sentinel node biopsy was more frequent among Italian women (77 vs. 33%, p < 0.001). Chinese women had more than 4-fold higher risk of receiving mastectomy. In the last 2 years, the rates of breast-conserving surgery and sentinel node biopsy at the Chinese institution increased from 15 to 23%, and from 33 to 42%, respectively. Conclusions Tumour features and surgical strategies for premenopausal breast cancer may differ significantly between Italy and China. Since the international exchange program, patients from the Chinese institution have been offered more frequently less invasive surgery. International exchange programs can help in designing epidemiological studies which may be useful for strategies to improve breast cancer management and control.
Collapse
Affiliation(s)
- Alessandro Fancellu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Xue Yun Zhao
- Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China
| | - Pietrina Cottu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Valeria Sanna
- Division of Medical Oncology, AOU Sassari, Sassari, Italy
| | - Yuan Ping Li
- Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China
| | - Qin Zhu
- Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China
| | - Cinzia Tanda
- Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Ying Yi Zhang
- Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China
| | - Yan Mei Lai
- Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China
| | - Giorgio Carlo Ginesu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Shu Qin Dai
- Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China
| | - Alberto Porcu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| |
Collapse
|
13
|
Al-Mousa DS, Alakhras M, Hossain SZ, Al-Sa'di AG, Al Hasan M, Al-Hayek Y, Brennan PC. Knowledge, Attitude and Practice Around Breast Cancer and Mammography Screening Among Jordanian Women. BREAST CANCER (DOVE MEDICAL PRESS) 2020; 12:231-242. [PMID: 33204150 PMCID: PMC7666976 DOI: 10.2147/bctt.s275445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/07/2020] [Indexed: 01/28/2023]
Abstract
Background Breast cancer is the most common occurring cancer in women worldwide. To guide current breast cancer screening program, the level of knowledge about breast cancer should be evaluated. This study aims to ascertain the level of breast cancer knowledge including risk factors, signs and symptoms, and early detection methods, especially mammography screening. Methods The study was conducted among 1353 Jordanian women from the public using a self-administered questionnaire. Responses to the knowledge test were summed for an overall knowledge score. Comparisons between socio-demographics and knowledge, attitude and practice were also measured using a Chi-square test. Results About 76% of participants were aware that breast cancer is the most common cancer among women in Jordan. About 53.7% of our participants were rated as having an intermediate level of knowledge regarding risk factors, and 44% were rated as having a good to an excellent level of knowledge about breast cancer signs and symptoms. The participants' level of education was the main factor identified as influencing the participants' knowledge of the risk factors, signs and symptoms, and knowledge of early detection methods of breast cancer. The study sample was rated as having an intermediate level of knowledge regarding mammography screening; however, their participation in this screening method was low. Conclusion Although Jordanian women had an acceptable level of knowledge of breast cancer, the screening rates for mammography were low. These findings suggest that there is a need to provide extra awareness programs for Jordanian women to improve their breast cancer knowledge and practice.
Collapse
Affiliation(s)
- Dana S Al-Mousa
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Maram Alakhras
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Syeda Z Hossain
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Amani G Al-Sa'di
- Technical Coordination and Consumer Education Section of the Jordanian Food and Drug Administration, Irbid 22110, Jordan
| | - Marwa Al Hasan
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Yazan Al-Hayek
- Medical Radiation Science, School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia.,Faculty of Applied Health Sciences, The Hashemite University, Zarqa 13133, Jordan
| | - Patrick C Brennan
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
14
|
The COVID-19 Outbreak May Be Associated to a Reduced Level of Care for Breast Cancer. A Comparative Study with the Pre-COVID Era in an Italian Breast Unit. Healthcare (Basel) 2020; 8:healthcare8040474. [PMID: 33187343 PMCID: PMC7712282 DOI: 10.3390/healthcare8040474] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
The recent COVID-19 pandemic has caused profound changes to healthcare systems as well as had deleterious repercussions on the care of cancer patients. In this comparative study, we sought to evaluate the effects of the COVID-19 pandemic on the surgical management of breast cancer in a breast unit in an Italian region with a low incidence of COVID-19 infection. Eighty-three patients were included, of whom 41 received surgery during the height of the pandemic (Group A, operated on between March and April 2020), and 42 during the same period of the year in 2019 (Group B). Clinicopathological characteristics and surgical outcomes were compared between the two groups. There were no significant differences in the baseline characteristics of the two groups with regard to age (p = 0.62), tumour size (p = 0.25), grade (p = 0.27), histology (p = 0.43), positive lymph node status (p = 0.35), and ER positive status (0.35). Waiting time for surgery was slightly longer in Group A (49.11 vs. 46.39 days, p = 0.38). Patients receiving immediate breast reconstruction were significantly less in Group A (p < 0.001). The use of sentinel node biopsy was similar in the two groups (p = 0.84). Hospital stay was longer in patients of Group B (p = 0.008). The use of regional nerve blocks was lower in Group A (p < 0.001). Patients operated on during the height of the pandemic were less likely to receive immediate reconstruction and regional nerve blocks during surgery. These features configure a situation of reduced level of care for patients with breast cancer. Efforts should be taken by the healthcare systems to maintain standard of care, even in case of a new peak in the coronavirus outbreak.
Collapse
|
15
|
Fancellu A, Perra T, Ninniri C, Cottu P, Deiana G, Feo CF, Porcu A. The emerging role of pectoral nerve block (PECS block) in breast surgery: A case-matched analysis. Breast J 2020; 26:1784-1787. [PMID: 32564408 DOI: 10.1111/tbj.13939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 02/05/2023]
Abstract
To evaluate the benefits of pectoral nerve block (PECS block) in breast cancer surgery, we compared outcomes of 100 patients receiving PECS vs 107 without PECS. Intraoperative use of fentanyl (P < .001) acetaminophen (P = .02), morphine (P < .01), and nonsteroidal anti-inflammatory drugs (NSAIDS) (P < .01) was lower in the PECS group. Occurrence of postoperative nausea and vomiting (PONV) was lower in the PECS group (P = .04). On postoperative day 1, the use of acetaminophen (P = .23), morphine (P = .83), and NSAIDS (P = .4) did not differ. Twenty-one patients received surgery with PECS block plus sedation alone. PECS block can reduce intraoperative use of opioids and analgesic drugs, and is associated with reduced occurrence of PONV. Selected patients can receive breast-conserving surgery with PECS plus sedation, avoiding general anesthesia.
Collapse
Affiliation(s)
- Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| | - Teresa Perra
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| | - Chiara Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| | - Pietrina Cottu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| | - Giulia Deiana
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| | - Claudio F Feo
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, University of Sassari, Sassari, Italy
| |
Collapse
|
16
|
Doval DC, Radhakrishna S, Tripathi R, Kashinath RI, Talwar V, Batra U, Mullapudi NA, Kumar K, Dewan AK, Chaturvedi H, Tayal J, Mehta A, Gupta S, Nimmagadda RBV. A multi-institutional real world data study from India of 3453 non-metastatic breast cancer patients undergoing upfront surgery. Sci Rep 2020; 10:5886. [PMID: 32246015 PMCID: PMC7125186 DOI: 10.1038/s41598-020-62618-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/16/2020] [Indexed: 12/27/2022] Open
Abstract
The present analysis reports the clinical, pathological, treatment profile and overall survival (OS) and disease-free survival (DFS) outcomes of consecutive breast cancer patients from three Indian centres, who underwent curative surgery as their first treatment. Among the 3453 patients, stage I, II, and III cases were 11.75%, 66.79%, and 21.64%, respectively while hormone receptor positive/HER2 negative, triple negative (TNBC) and hormone receptor any/HER2 positive cases were 55.2%, 24.2% and 20.6%, respectively. The five-year OS in the entire cohort, node-negative and node-positive patients were 94.1% (93.25–94.98), 96.17% (95.2–97.15) and 91.83% (90.36–93.31), respectively, and the corresponding DFS were 88.1% (86.96–89.31), 92.0% (90.64–93.39) and 83.93% (82.03–85.89), respectively. The five-year OS in hormone receptor positive/HER2 negative, TNBC and HER2 subgroups were 96.11% (95.12–97.1), 92.74% (90.73–94.8) and 90.62% (88.17–93.15), respectively, and the corresponding DFS were 91.59% (90.19–93.02), 85.46% (82.79–88.22) and 81.29% (78.11–84.61), respectively. This is the largest dataset of early breast cancer patients from India with survival outcome analysis and can therefore serve as a benchmark for future studies.
Collapse
Affiliation(s)
- Dinesh Chandra Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India.
| | - Selvi Radhakrishna
- Department of Surgical Oncology, Chennai Breast Centre, Chennai, Tamil Nadu, India
| | - Rupal Tripathi
- Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Renu Iyer Kashinath
- Department of Medical Oncology, Apollo Cancer Institutes, Chennai, Tamil Nadu, India
| | - Vineet Talwar
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | | | - Kapil Kumar
- Department of Surgical Oncology, Fortis Hospital, Delhi, India
| | - Ajay Kumar Dewan
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | | | - Juhi Tayal
- Department of Research (Biorepository), Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Anurag Mehta
- Department of Laboratory and Transfusion Services, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ramesh B V Nimmagadda
- Department of Medical Oncology, Apollo Cancer Institutes, Chennai, Tamil Nadu, India.
| |
Collapse
|
17
|
Nikpour M, Hajian-Tilaki K, Bakhtiari A. Risk Assessment for Breast Cancer Development and Its Clinical Impact on Screening Performance in Iranian Women. Cancer Manag Res 2019; 11:10073-10082. [PMID: 31819640 PMCID: PMC6890170 DOI: 10.2147/cmar.s229585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/16/2019] [Indexed: 01/28/2023] Open
Abstract
Introduction The aim of this study is to estimate the objective and subjective risk and to examine their associations with three forms of breast cancer screening. Methods This cross-sectional study was conducted with a sample of 800 women aged 35–85 years from the community setting and outpatient clinic in Babol, the north of Iran. The demographic, socio-economic characteristics and the risk factor profiles were collected through in-person interview. The health belief model (HBM) and visual analog scales were used to assess the women’s perceived risk of breast cancer. The practice of women regarding breast self-examination (BSE), breast clinical examination (BCE), and mammography were measured. We used the Gail model in estimating 5-year and lifetime risk. The logistic regression model was applied to determine the relationship of calculated and perceived risk on screening behaviors. Results The mean of estimated 5-year and lifetime risk were 0.89 ±0.89 and 8.87 ±3.84 percent respectively while the perceived personal risk on visual scale perception was much greater than the calculated risk. The high 5-year calculated risk was a predictor of mammography practice but not BSE and BCE; however, after adjusting the subscales of HBM and socio-demographic characteristics, its effect remained significant (adjusted OR=1.97(95% CI: 1.02–3.08)). The perceived risk from HBM in particular self-efficacy (p=0.001) remained positively significant on all forms of screening practice. Conclusion While the perceived risk from HBM scale was meaningful in screening performance, the calculated risk from the Gail model had a clinical impact on mammography behaviors independent of HBM scales.
Collapse
Affiliation(s)
- Maryam Nikpour
- Student Research Committee, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Karimollah Hajian-Tilaki
- Department of Biostatistics and Epidemiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Afsaneh Bakhtiari
- Department of Midwifery, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
18
|
Kriaucioniene V, Petkeviciene J. Predictors and Trend in Attendance for Breast Cancer Screening in Lithuania, 2006-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224535. [PMID: 31744058 PMCID: PMC6887946 DOI: 10.3390/ijerph16224535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/24/2022]
Abstract
In Lithuania, a Nationwide Breast Cancer (BC) Screening Program was launched in 2005, offering mammography for women aged 50 to 69 years, every other year. This study aimed to determine the trend in the attendance for mammography screening during 2006–2014 and to identify the factors that are predictive for participation in it. The study sample consisted of 1941 women aged 50–64 years, who participated in five cross-sectional biennial postal surveys of Lithuanian Health Behavior Monitoring, carried out in independent national random samples. The attendance for screening was identified if women reported having had a mammogram within the last two years. The proportion of women attending the screening was continuously increasing from 20.0% in 2006 up to 65.8% in 2014. The attendance for BC screening was associated with the participation in cervical cancer screening. A higher level of education, living in a city, frequent contact with a doctor, and healthy behaviors (fresh-vegetable consumption, physical activity, and absence of alcohol abuse) were associated with higher participation rates in BC screening. To increase BC screening uptake and to reduce inequalities in attendance, new strategies of organized BC screening program using systematic personal invitations are required in Lithuania.
Collapse
|
19
|
Pusceddu C, Paliogiannis P, Nigri G, Fancellu A. Cryoablation In The Management Of Breast Cancer: Evidence To Date. BREAST CANCER-TARGETS AND THERAPY 2019; 11:283-292. [PMID: 31632134 PMCID: PMC6791835 DOI: 10.2147/bctt.s197406] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/27/2019] [Indexed: 02/05/2023]
Abstract
Cryoablation has been successfully used to treat various type of solid tumors, including breast carcinomas. This ablation method has the advantage of being a minimally invasive procedure useful in various clinical situations, including early breast cancer and metastatic breast cancer, when co-morbidities preclude the use of surgical treatment. However, due to the small sample size of the available studies, reliable and definitive conclusions on the usefulness of cryoablation in patients with breast cancer could not be drawn. In fact, many aspects necessitate to be elucidated, regarding technical issues, indications, efficacy, imaging follow-up, and possible advantages over other percutaneous ablative methods. This review article has the aim to clarify the current evidence supporting cryoablation of breast cancer, and discuss the future perspectives, including those arising from the new studies on immunological effects related to cryoablation.
Collapse
Affiliation(s)
- Claudio Pusceddu
- Division of Interventional Radiology, Department of Oncologic Radiology, Businco Hospital, Cagliari, Italy
| | - Panagiotis Paliogiannis
- Unit of Experimental Pathology and Oncology, Department of Medical Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, St. Andrea University Hospital, Rome, Italy
| | - Alessandro Fancellu
- Unit of General Surgery 2 - Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| |
Collapse
|