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Ariani R, Hwang L, Maliglig AM, Ragab O, Ye JC. Temporality and Patterns of Metastatic Recurrence in Node-Positive Breast Cancer Following Trimodality Therapy: Opportunity for Improved Oligometastases Detection and Salvage Local Therapy. Am J Clin Oncol 2022; 45:88-94. [PMID: 34991105 DOI: 10.1097/coc.0000000000000885] [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: 11/25/2022]
Abstract
OBJECTIVES There is evidence that detection and treatment of oligometastases (≤5 lesions) may improve survival in breast cancer patients. However, there are no current national guidelines for screening of early, asymptomatic metastases. This study examined the patterns and timing of recurrence with respect to survival in node-positive breast cancer (NPBC) patients at higher risk for developing metastases. METHODS A single-institution retrospective review of NPBC patients treated with trimodality therapy was performed to collect patient and disease characteristics, recurrence location, method of detection, and survival outcome. Univariate and multivariate analyses were done to identify factors associated with recurrence. RESULTS Ninety-four NPBC patients treated at a safety-net hospital between 2008 and 2019 were identified. Twenty-one developed recurrence and were divided into oligometastatic (OM) (n=10) or diffusely metastatic (DM) (n=11) subgroups. Median recurrence-free survival in OM and DM was 18 and 36 months, respectively. Median overall survival (OS) for OM was not reached. Median OS for DM was 57 months. Four patients with OM progressed to diffuse disease in a median period of 17 months; median survival thereafter was 57 months. All patients with recurrence had distant metastases on initial detection, with the most common site being bone (14). Recurrence was most frequently detected by computed tomography (CT) (13), with the majority of disease located within the thorax region. CONCLUSIONS All NPBC patients had distant metastasis at time of recurrence. Patients with OM had shorter interval to recurrence yet longer OS compared with DM. This study highlights improved surveillance imaging for timely detection of OM breast cancer that may yet be amenable to aggressive local salvage therapy to prevent progression to diffuse disease.
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Affiliation(s)
| | | | - Ana M Maliglig
- Radiology, Keck School of Medicine of University of Southern California, Los Angeles, CA
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2
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Kanbayti IH, Rae WID, McEntee MF, Gandomkar Z, Ekpo EU. Clinicopathologic breast cancer characteristics: predictions using global textural features of the ipsilateral breast mammogram. Radiol Phys Technol 2021; 14:248-261. [PMID: 34076829 DOI: 10.1007/s12194-021-00622-6] [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: 12/18/2020] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 11/25/2022]
Abstract
Radiomic features from mammograms have been shown to predict breast cancer (BC) risk; however, their contribution to BC characteristics has not yet been explored. This study included 184 women with BC between January 2012 and April 2017. A set of 33 global radiomic features were extracted from the ipsilateral breast mammogram. Associations between radiomic features and BC characteristics were investigated by univariate logistic regression analysis, and receiver-operating characteristic curve analysis was employed to evaluate the predictive performance of radiomic features. Histogram-based features (mean, 70th percentile, and 30th percentile) weakly differentiated progesterone status and tumor size (AUC range: 0.627-0.652, p ≤ 0.007). One gray level run length matrix (GLRLM)-based feature achieved an AUC of 0.68 in discriminating lymph-node status, and the fractal dimension achieved an AUC of 0.65 in predicting tumor size. After stratifying by age at BC diagnosis and baseline percent density (PD), the average predictive performance of the abovementioned features improved from 0.652 to 0.707 for baseline PD adjustment, and from 0.652 to 0.674 for age at BC diagnosis. Higher predictive performances were found for GLRLM-based features in predicting lymph-node status among younger women with high baseline PD (AUC range: 0.710-0.863), and for fractal features in predicting tumor size among patients with low PD (AUC: 0.704). Global radiomic features from the ipsilateral breast mammogram can predict lymph-node status and tumor size among certain categories of women and should be considered as a non-invasive tool for clinical decision-making in BC-affected women and for forecasting disease progression.
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Affiliation(s)
- Ibrahem H Kanbayti
- Diagnostic Radiography Technology Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia.
- Medical Image Optimization and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Campus C4 75 East Street, Sydney, NSW 2141, Australia.
| | - William I D Rae
- Medical Image Optimization and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Campus C4 75 East Street, Sydney, NSW 2141, Australia
| | - Mark F McEntee
- Medical Image Optimization and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Campus C4 75 East Street, Sydney, NSW 2141, Australia
- Department of Medicine Roinn Na Sláinte, Brookfield Health Sciences, UG 12 Áras Watson, Galway, T12 AK54, Ireland
| | - Ziba Gandomkar
- Medical Image Optimization and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Campus C4 75 East Street, Sydney, NSW 2141, Australia
| | - Ernest U Ekpo
- Medical Image Optimization and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Campus C4 75 East Street, Sydney, NSW 2141, Australia
- Orange Radiology, Laboratories and Research Centre, Calabar, Nigeria
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Rodin D, Glicksman RM, Clark K, Kakani P, Cheung MC, Singh S, Rosenthal M, Sinaiko AD. Mammographic Surveillance in Older Women With Breast Cancer in Canada and the United States: Are We Choosing Wisely? Pract Radiat Oncol 2021; 11:e384-e394. [PMID: 33753302 DOI: 10.1016/j.prro.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Guidelines on mammographic surveillance after breast cancer treatment have been disseminated internationally and incorporated into Choosing Wisely recommendations to reduce low-value care. However, adherence within different countries before their publication is unknown. METHODS AND MATERIALS Low-value mammography, defined as "short-interval" (within 6 months of radiation) or "high-frequency" (>1 within 12 months of radiation), was compared in Medicare fee-for-service in the United States and Ontario, Canada. Women ≥65 years diagnosed with breast cancer who underwent breast-conserving therapy with a minimum of 24 months of follow-up were included (n = 19,715 United States; 6479 Ontario). Secondary outcomes were patient and physician characteristics associated with discordance. RESULTS Short-interval mammography was higher in the United States than in Ontario (55.9% vs 38.0%, P < .001), as was high-frequency (39.6% vs 7.9%, P < .001). In Ontario, younger age (42% ≥85 vs 58% <74 years, P < .001) and chemotherapy (69% vs 51%, P < .001) were associated with short-interval mammography; in the United States, age, earlier diagnosis year, stage, chemotherapy, rurality, and academic center treatment were associated with greater use. Chemotherapy was associated with high-frequency mammography in both countries (13% vs 7% in Ontario, P < .001; 69% vs 51% in United States, P = .02); younger age, earlier diagnosis year, stage, and nonacademic center treatment were associated in the United States. In both countries, radiation oncologists had the highest proportion of providers ordering low-value mammograms. CONCLUSIONS Despite significant evidence guiding surveillance mammography recommendations, there are high rates of short-interval mammography in both the United States and Ontario, and high rates of high-frequency mammography in the United States. Further international efforts, such as Choosing Wisely, are needed to reduce low-value mammography.
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Affiliation(s)
- Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| | - Rachel M Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn Clark
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Pragya Kakani
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Simron Singh
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Meredith Rosenthal
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anna D Sinaiko
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Kumar G, Nandakumar K, Mutalik S, Rao CM. Biologicals to direct nanotherapeutics towards HER2-positive breast cancers. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2020; 27:102197. [PMID: 32275958 DOI: 10.1016/j.nano.2020.102197] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/17/2020] [Accepted: 03/12/2020] [Indexed: 12/24/2022]
Abstract
HER2-positive breast cancer, an aggressive cancer, is treated with combinations of conventional anticancer drugs viz., cytotoxic drugs, nibs, and mAbs. Major limitations associated with this therapy are patient non-compliance due to the adverse drug reactions and rapid development of resistance by the HER2-positive malignant cells. While the former is addressed by the nano-formulations of the anticancer-drugs to some extent, the latter is still at large. This is because the nanocarriers of the anticancer drugs, by and large, lack the target specificity and selectivity. Thus, nowadays, to overcome these problems, various safe and efficacious biological agents are being used to direct the nanotherapeutics towards the HER2-positive breast cancers. The present review describes the potentials of such biological agents.
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Affiliation(s)
- Gautam Kumar
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Krishnadas Nandakumar
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Srinivas Mutalik
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chamallamudi Mallikarjuna Rao
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Cocco E, Lopez S, Santin AD, Scaltriti M. Prevalence and role of HER2 mutations in cancer. Pharmacol Ther 2019; 199:188-196. [PMID: 30951733 DOI: 10.1016/j.pharmthera.2019.03.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/27/2019] [Indexed: 12/24/2022]
Abstract
HER2 activating mutations act as oncogenic drivers in various cancer types. In the clinic, they can be identified by next generation sequencing (NGS) in either tumor biopsies or circulating cell-free DNA (cfDNA). Preclinical data indicate that HER2 "hot spot" mutations are constitutively active, have transforming capacity in vitro and in vivo and show variable sensitivity to anti-HER2 based therapies. Recent clinical trials also revealed activity of HER2-targeted drugs against a variety of tumors harboring HER2 mutations. Here, we review the prevalence and type of HER2 mutations identified in different human cancers, their biochemical and biological characterization, and their sensitivity to anti HER2-based therapies in both preclinical and clinical settings.
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Affiliation(s)
- Emiliano Cocco
- Human Oncology & Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, United States of America; Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro 88100, Italy
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, United States of America.
| | - Maurizio Scaltriti
- Human Oncology & Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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6
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Abstract
BACKGROUND Deep Learning (DL) has advanced the state-of-the-art capabilities in bioinformatics applications which has resulted in trends of increasingly sophisticated and computationally demanding models trained by larger and larger data sets. This vastly increased computational demand challenges the feasibility of conducting cutting-edge research. One solution is to distribute the vast computational workload across multiple computing cluster nodes with data parallelism algorithms. In this study, we used a High-Performance Computing environment and implemented the Downpour Stochastic Gradient Descent algorithm for data parallelism to train a Convolutional Neural Network (CNN) for the natural language processing task of information extraction from a massive dataset of cancer pathology reports. We evaluated the scalability improvements using data parallelism training and the Titan supercomputer at Oak Ridge Leadership Computing Facility. To evaluate scalability, we used different numbers of worker nodes and performed a set of experiments comparing the effects of different training batch sizes and optimizer functions. RESULTS We found that Adadelta would consistently converge at a lower validation loss, though requiring over twice as many training epochs as the fastest converging optimizer, RMSProp. The Adam optimizer consistently achieved a close 2nd place minimum validation loss significantly faster; using a batch size of 16 and 32 allowed the network to converge in only 4.5 training epochs. CONCLUSIONS We demonstrated that the networked training process is scalable across multiple compute nodes communicating with message passing interface while achieving higher classification accuracy compared to a traditional machine learning algorithm.
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Abstract
Bone is the most common site of metastases from advanced breast cancer. Whole-body bone scintigraphy has been most frequently used in the process of managing cancer patients; its advantage is that it provides rapid whole-body imaging for screening of osteoblastic or sclerotic/mixed bone metastases at reasonable cost. Recent advanced techniques, such as single-photon emission computed tomography (SPECT)/CT, quantitative analysis, and bone scan index, contribute to better understanding of the disease state. More recent advances in machines and PET drugs improve the staging of the skeleton with higher sensitivity and specificity.
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Nguyen NTA, Ringash J. Head and Neck Cancer Survivorship Care: A Review of the Current Guidelines and Remaining Unmet Needs. Curr Treat Options Oncol 2018; 19:44. [DOI: 10.1007/s11864-018-0554-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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9
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Giesing M, Austrup F, Böckmann B, Driesel G, Eder C, Kusiak I, Suchy B, Uciechowski P, Grill HJ. Independent Prognostication and Therapy Monitoring of Breast Cancer Patients by Dna/Rna Typing of Minimal Residual Cancer Cells. Int J Biol Markers 2018; 15:94-9. [PMID: 10763149 DOI: 10.1177/172460080001500118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinical relevance, purification techniques and molecular characterization of minimal residual cancer cells (MRCC) is a controversial topic in the literature. An analytical concept including a novel isolation procedure and a panel of tests for DNA and RNA typing of MRCCs is described and clinically evaluated in this paper. The purification procedure exploiting the physical characteristics of MRCCs shows superior performance leading to >50% pure and viable tumor cells. Proof of the presence and purity of MRCCs in an isolated sample is given by multiparametric DNA typing (amplifications, mutations, losses of heterozygosity). On the basis of the proven presence of MRCCs tumor-relevant mRNAs can be adequately analyzed by normalized quantitative real-time RT-PCR. The molecular characterization of MRCCs isolated from blood of breast cancer patients could have a strong clinical impact on prognostication, drug targeting and therapy monitoring.
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Affiliation(s)
- M Giesing
- Institute for Molecular NanoTechnology, Recklinghausen, Germany
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Abstract
Serum determinations of tumor markers are indispensable in the diagnosis and management of cancer, and therefore play an important role in clinical practice. After a short historical survey, we systematically review a number of contemporary aspects of serum tumor markers related to various organ systems, and briefly indicate possible future developments.
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Affiliation(s)
- C.M.G. Thomas
- Department of Obstetrics and Gynecology
- Department of Chemical Endocrinology, University Medical Center Nijmegen, Nijmegen - The Netherlands
| | - C.G.J. Sweep
- Department of Chemical Endocrinology, University Medical Center Nijmegen, Nijmegen - The Netherlands
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11
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Gion M, Boracchi P, Biganzoli E, Daidone MG. A Guide for Reviewing Submitted Manuscripts: (And Indications for the Design of Translational Research Studies on Biomarkers). Int J Biol Markers 2018; 14:123-33. [PMID: 10569133 DOI: 10.1177/172460089901400301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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12
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Bjelic-Radisic V, Dorfer M, Tamussino K, Greimel E. Patients' view of routine follow-up after breast cancer treatment. Wien Klin Wochenschr 2017; 129:810-815. [PMID: 29043441 PMCID: PMC5681603 DOI: 10.1007/s00508-017-1278-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/18/2017] [Indexed: 11/29/2022]
Abstract
Background To assess emotional distress, anxiety and stress reactions in breast cancer (BC) patients before the follow-up visits. Study design Between September 2009 and December 2011 a total of 284 patients completed the BC-psychosocial assessment screening scale (PASS) and a questionnaire about their views of follow-up after treatment for BC. Results Of the patients 64% reported low level of distress on the BC-PASS. The mean scores on the physical well-being scale was 5.3, the satisfaction/sense of coherence scale 7.4, and the emotional distress scale 8.1. Women rated mammography as the most important component (71%), followed by breast ultrasound (63%) and the consultation with the physician (60%). Of the patients 94% were satisfied with the current follow-up regimen. Conclusions In this series BC patients were satisfied with their aftercare. Mammography was thought to be the most important component of aftercare. Patient-reported outcomes should be taken into account when planning follow-up.
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Affiliation(s)
- Vesna Bjelic-Radisic
- Department of Obstetrics and Gynecology, Medical University Graz, Auenbruggerplatz 14, 8036, Graz, Austria.
| | - Martha Dorfer
- Department of Obstetrics and Gynecology, Medical University Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Karl Tamussino
- Department of Obstetrics and Gynecology, Medical University Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Elfriede Greimel
- Department of Obstetrics and Gynecology, Medical University Graz, Auenbruggerplatz 14, 8036, Graz, Austria
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Nilsson M. Postgastrectomy follow-up in the West: evidence base, guidelines, and daily practice. Gastric Cancer 2017; 20:135-140. [PMID: 27718134 PMCID: PMC5316395 DOI: 10.1007/s10120-016-0654-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/28/2016] [Indexed: 02/07/2023]
Abstract
Follow-up after gastrectomy for gastric cancer has several purposes, including management of side effects of surgery, oncological recurrence surveillance, psychological support, and data collection for research. How follow-up after gastrectomy, and especially recurrence surveillance, is performed differs immensely between different Western countries, despite guidelines from Western oncological organizations quite unanimously advocating symptom-driven surveillance, without scheduled cross-sectional imaging, endoscopies, or analysis of tumor markers. Given a complete lack of randomized data, the available body of observational data does not support intensive routine surveillance for recurrent disease. Moreover, studies of other cancers have shown a negative emotional impact of routine surveillance. There is an apparent need for randomized controlled trials to address the issue of optimized strategies for postgastrectomy recurrence surveillance.
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Affiliation(s)
- Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Kirurggatan 53, 141 86 Stockholm, Sweden ,Center for Digestive Diseases, Karolinska University Hospital, Kirurggatan 53, 141 86 Stockholm, Sweden
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14
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Ugwumba FO, Ekwueme OEC, Okoh AD. Testicular Cancer and Testicular Self-Examination; Knowledge, Attitudes and Practice in Final Year Medical Students in Nigeria. Asian Pac J Cancer Prev 2016; 17:4999-5003. [PMID: 28032730 PMCID: PMC5454710 DOI: 10.22034/apjcp.2016.17.11.4999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The testicular cancer (TCa) incidence is increasing in many countries, with age-standardized incidence rates up to 7.8/100,000 men in the Western world, although reductions in mortality and increasingly high cure rates are being witnessed at the same time. In Africa, where rates are lower, presentation is often late and morbidity and mortality high. Given this scenario, awareness of testicular cancer and practice of testicular self-examination among future first response doctors is very important. This study was conducted to determine knowledge and attitude to testicular cancer, and practice of testicular self-examination (TSE) among final (6th) year medical students. In addition, the effect of an intervention in the form of a single PowerPoint® lecture, lasting 40 minutes with image content on testicular cancer and testicular self examination was assessed. Pre and post intervention administration of a self-administered structured pre tested questionnaire was performed on 151 medical students, 101 of whom returned answers (response rate of 66.8%). In the TC domain, there was a high level of awareness of testicular cancer, but poor knowledge of the age group most affected, with significant improvement post intervention (p<0.001). Notable also was the poor awareness of the potential curability of TC, this also being improved following the intervention (p<0.001). A poor level of awareness and practice of testicular self-examination pre-intervention was found considering the nature of the study group. Respondents had surprisingly weak/poor responses to the question “How important to men’s health is regular testicular self-examination?” Answers to the questions “Do you think it is worthwhile to examine your testis regularly?” and “Would you be interested in more information on testicular cancer and testicular self-examination?” were also suboptimal, but improved post intervention p<0.001, p<0.001 and p=0.037. Age, gender and marital status were without specific influence. In conclusion, this study showed poor levels of knowledge regarding epidemiology of TCa and its potential curability when detected early. There was also a poor awareness of, practice of, and poor attitudes to TSE. The significant improvement in these parameters post intervention indicates value in educational intervention. We recommend inclusion of TCa coverage and TSE teaching in the secondary school curriculum (targeting adolescents). Greater emphasis should also be given to testicular cancer in the curricula of medical schools and other training institutions for health care personnel.
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Affiliation(s)
- Fred O Ugwumba
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria.
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15
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Smith KL, Smith TJ. Reining in the Excessive Use of Medical Tests: What Are the Next Steps? J Clin Oncol 2016; 34:2807-9. [PMID: 27354475 DOI: 10.1200/jco.2016.68.0975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Karen L Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Thomas J Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Abstract
Earlier detection of invasive and noninvasive breast cancer and more effective treatments have led to both an improved prognosis for women with breast cancer and an increasing number of long-term survivors. However, such advances present various physical and emotional health challenges to patients facing breast cancer and its aftermath. Thus, understanding of the specific medical and psychosocial problems associated with survivorship is paramount in primary care.
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18
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Tiro JA, Sanders JM, Shay LA, Murphy CC, A Hamann H, Bartholomew LK, Savas LS, Vernon SW. Validation of self-reported post-treatment mammography surveillance among breast cancer survivors by electronic medical record extraction method. Breast Cancer Res Treat 2015; 151:427-34. [PMID: 25922083 DOI: 10.1007/s10549-015-3387-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/11/2015] [Indexed: 12/01/2022]
Abstract
Little is known about validity of self-reported mammography surveillance among breast cancer survivors. Most studies have focused on accuracy among healthy, average-risk populations and none have assessed validity by electronic medical record (EMR) extraction method. To assess validity of survivor-reported mammography post-active treatment care, we surveyed all survivors diagnosed 2004-2009 in an academic hospital cancer registry (n = 1441). We used electronic query and manual review to extract EMR data. Concordance, sensitivity, specificity, positive predictive value, and report-to-records ratio were calculated by comparing survivors' self-reports to data from each extraction method. We also assessed average difference in months between mammography dates by source and correlates of concordance. Agreement between the two EMR extraction methods was high (concordance 0.90; kappa 0.70), with electronic query identifying more mammograms. Sensitivity was excellent (0.99) regardless of extraction method; concordance and positive predictive value were good; however, specificity was poor (manual review 0.20, electronic query 0.31). Report-to-records ratios were both over 1 suggesting over-reporting. We observed slight forward telescoping for survivors reporting mammograms 7-12 months prior to survey date. Higher educational attainment and less time since mammogram receipt were associated with greater concordance. Accuracy of survivors' self-reported mammograms was generally high with slight forward telescoping among those recalling their mammograms between 7 and 12 months prior to the survey date. Results are encouraging for clinicians and practitioners relying on survivor reports for surveillance care delivery and as a screening tool for inclusion in interventions promoting adherence to surveillance guidelines.
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Affiliation(s)
- Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center and Harold C. Simmons Cancer Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9066, USA,
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The diagnostic value of 18F-FDG PET/CT in association with serum tumor marker assays in breast cancer recurrence and metastasis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:489021. [PMID: 25879025 PMCID: PMC4387967 DOI: 10.1155/2015/489021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 09/22/2014] [Indexed: 01/22/2023]
Abstract
Background. After initial treatment of breast cancer (BC), monitoring locoregional recurrence and distant metastases is a great clinical challenge. Objective. To evaluate the efficacy of PET/CT in association with serum tumor makers in BC follow-up. Methods. Twenty-six women with a history of modified radical mastectomy were evaluated by 18F-FDG PET/CT. The results of PET/CT were compared with those of conventional imaging techniques (CITs) (including mammography, chest radiography, CT, MRI, ultrasound, and bone scintigraphy). Serum tumor markers of CEA, CA 125, and CA 15-3 in the BC patients were also analyzed in association with the results of PET/CT. Results. Compared with CITs, PET/CT was more sensitive to detect the malignant foci and had better patient-based sensitivity and specificity. The mean CA 15-3 serum level was significantly higher in the confirmed positive patients of PET/CT results than in the confirmed negative ones, while there were no significant differences in the serum levels of CEA and CA 125 of both groups. Conclusion. PET/CT is a highly efficient tool for BC follow-up compared with CITs. The high serum levels of CA 15-3 in confirmed positive PET/CT patients indicated the clinical value of CA 15-3 in BC follow-up.
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Boukouris S, Mathivanan S. Exosomes in bodily fluids are a highly stable resource of disease biomarkers. Proteomics Clin Appl 2015; 9:358-67. [PMID: 25684126 DOI: 10.1002/prca.201400114] [Citation(s) in RCA: 381] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 02/01/2015] [Accepted: 02/10/2015] [Indexed: 12/25/2022]
Abstract
Biomarkers are measurable indicators of a biological state. As our understanding of diseases meliorates, it is generally accepted that early diagnosis renders the best chance to cure a disease. In the context of proteomics, the discovery phase of identifying bonafide biomarkers and the ensuing validation phase involving large cohort of patient samples are impeded by the complexity of bodily fluid samples. High abundant proteins found in blood plasma make it difficult for the detection of low abundant proteins that may be potential biomarkers. Extracellular vesicles (EVs) have reignited interest in the field of biomarker discovery. EVs contain a tissue-type signature wherein a rich cargo of proteins and RNA are selectively packaged. In addition, as EVs are membranous structures, the luminal contents are protected from degradation by extracellular proteases and are highly stable in storage conditions. Interestingly, an appealing feature of EV-based biomarker analysis is the significant reduction in the sample complexity compared to whole bodily fluids. With these prescribed attributes, which are the rate-limiting factors of traditional biomarker analysis, there is immense potential for the use of EVs for biomarker detection in clinical settings. This review will discuss the current issues with biomarker analysis and the potential use of EVs as reservoirs of disease biomarkers.
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Affiliation(s)
- Stephanie Boukouris
- Department of Biochemistry, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Victoria, Australia
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Nicolini A, Ferrari P, Fulceri F, Carpi A, Rossi G. An individual reference limit for ‘early’ diagnosis of metastatic breast cancer during postoperative follow-up. Biomark Med 2015; 9:307-17. [DOI: 10.2217/bmm.15.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: This study is a clinical pilot study with the principal aim to investigate the accuracy of a panel of serum tumor markers for the early diagnosis of relapses. We propose a systematic use of serum CEA-TPA-CA15.3 tumor marker panel and criteria in order to make it an accurate tool for a postoperative breast cancer monitoring. Materials & methods: 204 disease free breast cancer patients after mastectomy were intensively monitored with serial serum determination of CEA, CA15.3 and TPA. Results: During a mean follow-up of 3.7 years the sensitivity of the CEA-TPA-CA15.3 tumor marker panel was 93%, the specificity was 97.6% and the rate of false ‘warning signals’ per year of follow-up was 9 per 100 patients. Conclusions: Our results show that the proposed tool is promising for a postoperative monitoring of breast cancer patients.
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Affiliation(s)
| | | | | | - Angelo Carpi
- Department of Reproduction & Ageing, University of Pisa, Italy
| | - Giuseppe Rossi
- Unit of Epidemiology & Biostatistics, Institute of Clinical Physiology CNR & G Monasterio Foundation, Pisa, Italy
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Nicolini A, Ferrari P, Rossi G. Mucins and Cytokeratins as Serum Tumor Markers in Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 867:197-225. [PMID: 26530368 DOI: 10.1007/978-94-017-7215-0_13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Structural and functional characteristics of mucins and cytokeratins are shortly described. Thereafter, those commonly used in breast cancer as serum tumor markers are considered. First CA15.3, MCA, CA549, CA27.29 mucins and CYFRA21.1, TPA, TPS cytokeratins alone or in association have been examined in different stages and conditions. Then their usefulness in monitoring disease-free breast cancer patients is evaluated. The central role of the established cut-off and critical change, the "early" treatment of recurrent disease and the potential benefit in survival are other issues that have been highlighted and discussed. The successive sections and subsections deal with the monitoring of advanced disease. In them, the current recommendations and the principal findings on using the above mentioned mucins and cytokeratins have been reported. A computer program for interpreting consecutive measurements of serum tumor markers also has been illustrated. The final part of the chapter is devoted to mucins and cytokeratins as markers of circulating and disseminated tumor cells and their usefulness for prognosis.
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Affiliation(s)
- Andrea Nicolini
- Department of Oncology, Transplantations and New Technologies in Medicine, University of Pisa, Pisa, Italy.
| | - Paola Ferrari
- Department of Oncology, Transplantations and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Rossi
- Unit of Epidemiology and Biostatistics, National Council of Research, Pisa, Italy
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Health services utilisation in breast cancer survivors in Taiwan. Sci Rep 2014; 4:7466. [PMID: 25502076 PMCID: PMC4264011 DOI: 10.1038/srep07466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 11/24/2014] [Indexed: 01/22/2023] Open
Abstract
Surveillance guidelines for breast cancer survivors recommend regular history and physical and mammography, and against routine imaging for detecting distant metastasis. Stage 0, I, II breast cancer cases treated at a major cancer center were identified from the Taiwan Cancer Registry. We used multivariable negative binomial and logistic regression analyses on institutional claims data to examine factors contributing to utilisation patterns of surveillance visits and tests in disease-free survivors. The mean number of surveillance visits during months 13 to 60 after cancer treatment initiation was 18.5 (SD 8.2) among the 2,090 breast cancer survivors followed for at least five years. After adjusting for patient and disease factors, the number of visits was the highest among patients mainly followed by medical oncologists compared to surgeons and radiation oncologists. Patient cohorts treated in more recent years had lower number of visits associated with care coordination effort, the adjusted mean being 19.2 visits for the 2002 cohort, and 16.3 visits for the 2008 cohort (p < 0.0001). Although imaging tests were highly utilised, there was a significant decrease in tumor marker testing from the 2002 to the 2008 treatment cohort (adjusted rate 99.4% to 35.1% respectively, p < 0.0001) in association with an institutional guideline change.
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Natoli C, Brocco D, Sperduti I, Nuzzo A, Tinari N, De Tursi M, Grassadonia A, Mazzilli L, Iacobelli S, Gamucci T, Vici P. Breast cancer "tailored follow-up" in Italian oncology units: a web-based survey. PLoS One 2014; 9:e94063. [PMID: 24714591 PMCID: PMC3979748 DOI: 10.1371/journal.pone.0094063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/10/2014] [Indexed: 12/04/2022] Open
Abstract
Purpose Breast cancer follow-up procedures after primary treatment are still a controversial issue. Aim of this study was to investigate, through a web-based survey, surveillance methodologies selected by Italian oncologists in everyday clinical practice. Methods Referents of Italian medical oncology units were invited to participate to the study via e-mail through the SurveyMonkey website. Participants were asked how, in their institution, exams of disease staging and follow-up are planned in asymptomatic women and if surveillance continues beyond the 5th year. Results Between February and May 2013, 125 out of 233 (53.6%) invited referents of Italian medical oncology units agreed to participate in the survey. Ninety-seven (77.6%) referents state that modalities of breast cancer follow-up are planned according to the risk of disease progression at diagnosis and only 12 (9.6%) oncology units apply the minimal follow-up procedures according to international guidelines. Minimal follow-up is never applied in high risk asymptomatic women. Ninety-eight (78.4%) oncology units continue follow-up in all patients beyond 5 years. Conclusions Our survey shows that 90.4% of participating Italian oncology units declare they do not apply the minimal breast cancer follow-up procedures after primary treatment in asymptomatic women, as suggested by national and international guidelines. Interestingly, about 80.0% of interviewed referents performs the so called “tailored follow-up”, high intensity for high risk, low intensity for low risk patients. There is an urgent need of randomized clinical trials able to determine the effectiveness of risk-based follow-up modalities, their ideal frequency and persistence in time.
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Affiliation(s)
- Clara Natoli
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
- * E-mail:
| | - Davide Brocco
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Isabella Sperduti
- Unit of Biostatistics, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Nuzzo
- Oncology Department, “Floraspe Renzetti” Hospital, Lanciano, Italy
| | - Nicola Tinari
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Michele De Tursi
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Antonino Grassadonia
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Lorenzo Mazzilli
- Clinical Governance Unit, “SS. Annunziata” Hospital, Chieti, Italy
| | - Stefano Iacobelli
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Teresa Gamucci
- Department of Oncology, “S.S. Trinita′” Hospital, Sora, Italy
| | - Patrizia Vici
- Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
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Schneble EJ, Graham LJ, Shupe MP, Flynt FL, Banks KP, Kirkpatrick AD, Nissan A, Henry L, Stojadinovic A, Shumway NM, Avital I, Peoples GE, Setlik RF. Current approaches and challenges in early detection of breast cancer recurrence. J Cancer 2014; 5:281-90. [PMID: 24790656 PMCID: PMC3982041 DOI: 10.7150/jca.8016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Early detection of breast cancer recurrence is a key element of follow-up care and surveillance after completion of primary treatment. The goal is to improve survival by detecting and treating recurrent disease while potentially still curable assuming a more effective salvage surgery and treatment. In this review, we present the current guidelines for early detection of recurrent breast cancer in the adjuvant setting. Emphasis is placed on the multidisciplinary approach from surgery, medical oncology, and radiology with a discussion of the challenges faced within each setting.
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Affiliation(s)
- Erika J Schneble
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Lindsey J Graham
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Matthew P Shupe
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Frederick L Flynt
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Kevin P Banks
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Aaron D Kirkpatrick
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Aviram Nissan
- 2. Hadassah Medical Center, Kiryat Hadassah, POB 12000, Jerusalem, 91120, Israel
| | - Leonard Henry
- 3. IU Health Goshen, 200 High Park Ave., Goshen, IN 46526, USA
| | | | - Nathan M Shumway
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Itzhak Avital
- 4. Bon Secours Cancer Institute, 5855 Bremo Road, Richmond, VA 23226, USA
| | - George E Peoples
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
| | - Robert F Setlik
- 1. San Antonio Military Medical Center (SAMMC), 3551 Roger Brooke Dr., Ft. Sam Houston, TX 78234, USA
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Advani PS, Ying J, Theriault R, Melhem-Bertrand A, Moulder S, Bedrosian I, Tereffe W, Black S, Pini TM, Brewster AM. Ethnic disparities in adherence to breast cancer survivorship surveillance care. Cancer 2014; 120:894-900. [PMID: 24258799 PMCID: PMC4128181 DOI: 10.1002/cncr.28490] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 10/17/2013] [Accepted: 10/24/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adherence to guidelines for surveillance mammography and clinic visits is an important component of breast cancer survivorship care. Identifying ethnic disparities in adherence may lead to improved care delivery and outcomes. METHODS Records were evaluated for 4535 patients who were treated for stage I, II, or III breast cancer at the University of Texas MD Anderson Cancer Center, Houston, Texas, cancer center between January 1997 and December 2006. Generalized estimating equations and Cox proportional hazards analyses were used to evaluate ethnic differences in missed mammograms and clinic visits up to 4 years of follow-up and the impact of those differences on overall survival. RESULTS Nonadherence to guidelines for mammography (P = .0002) and clinic visits (P < .0001) increased over time. Hispanic and black patients were more likely to be nonadherent to guidelines for mammography (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.10-1.65; OR = 1.36, 95% CI = 1.11-1.66, respectively) and clinic visits (OR = 1.62, 95% CI = 1.27-2.06; OR = 1.45, 95% CI = 1.13-1.86, respectively) than white patients. There was an interaction between Hispanic ethnicity and endocrine therapy on nonadherence to mammography guidelines (P = .001). Nonadherence to mammography and clinic visit guidelines was not associated with overall survival. CONCLUSIONS Withdrawal from breast cancer survivorship care increases over time, and black and Hispanic patients are more likely to be nonadherent. An understanding of the reasons for ethnic disparities in adherence to guidelines for mammography and clinic visits is needed to improve retention in survivorship care.
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Affiliation(s)
- Pragati S. Advani
- Department of Health Promotion and Behavioral Sciences, University of Texas (UT) School of Public Health, Houston, Texas
| | - Jun Ying
- Department of Biostatistics, the UT, MD Anderson Cancer Center, Houston, Texas
| | - Richard Theriault
- Department of Breast Medical Oncology, the UT, MD Anderson Cancer Center, Houston, Texas
| | - Amal Melhem-Bertrand
- Department of Breast Medical Oncology, the UT, MD Anderson Cancer Center, Houston, Texas
| | - Stacy Moulder
- Department of Breast Medical Oncology, the UT, MD Anderson Cancer Center, Houston, Texas
| | - Isabelle Bedrosian
- Department of Surgical Oncology, the UT, MD Anderson Cancer Center, Houston, Texas
| | - Welela Tereffe
- Department of Radiation Oncology, the UT, MD Anderson Cancer Center, Houston, Texas
| | - Shon Black
- Department of Surgical Oncology, the UT, MD Anderson Cancer Center, Houston, Texas
| | - Tunghi May Pini
- Department of Clinical Cancer Prevention, the UT, MD Anderson Cancer Center, Houston, Texas
| | - Abenaa M. Brewster
- Department of Clinical Cancer Prevention, the UT, MD Anderson Cancer Center, Houston, Texas
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Fuqua SAW, Gu G, Rechoum Y. Estrogen receptor (ER) α mutations in breast cancer: hidden in plain sight. Breast Cancer Res Treat 2014; 144:11-9. [PMID: 24487689 DOI: 10.1007/s10549-014-2847-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 01/18/2014] [Indexed: 11/25/2022]
Abstract
The idea that somatic ERα mutations could play an important role in the evolution of hormone-dependent breast cancers was proposed some years ago (Fuqua J Mammary Gland Biol Neoplasia 6(4):407-417, 2001; Dasgupta et al. Annu Rev Med 65:279-292, 2013), but has remained controversial until recently. A significant amount of new data has confirmed these initial observations and shown their significance, along with much additional work relevant to the treatment of breast cancer. Thus, it is the purpose of this review to summarize the research to date on the existence and clinical consequences of ERα mutations in primary and metastatic breast cancer.
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Affiliation(s)
- Suzanne A W Fuqua
- Lester and Sue Smith Breast Center, Dan L Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA,
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Breast cancer follow-up strategies in randomized phase III adjuvant clinical trials: a systematic review. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2013; 32:89. [PMID: 24438135 PMCID: PMC3828573 DOI: 10.1186/1756-9966-32-89] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/07/2013] [Indexed: 01/02/2023]
Abstract
The effectiveness of different breast cancer follow-up procedures to decrease breast cancer mortality are still an object of debate, even if intensive follow-up by imaging modalities is not recommended by international guidelines since 1997. We conducted a systematic review of surveillance procedures utilized, in the last ten years, in phase III randomized trials (RCTs) of adjuvant treatments in early stage breast cancer with disease free survival as primary endpoint of the study, in order to verify if a similar variance exists in the scientific world. Follow-up modalities were reported in 66 RCTs, and among them, minimal and intensive approaches were equally represented, each being followed by 33 (50%) trials. The minimal surveillance regimen is preferred by international and North American RCTs (P = 0.001) and by trials involving more than one country (P = 0.004), with no relationship with the number of participating centers (P = 0.173), with pharmaceutical industry sponsorship (P = 0.80) and with trials enrolling > 1000 patients (P = 0.14). At multivariate regression analysis, only geographic location of the trial was predictive for a distinct follow-up methodology (P = 0.008): Western European (P = 0.004) and East Asian studies (P = 0.010) use intensive follow-up procedures with a significantly higher frequency than international RCTs, while no differences have been detected between North American and international RCTs. Stratifying the studies according to the date of beginning of patients enrollment, before or after 1998, in more recent RCTs the minimal approach is more frequently followed by international and North American RCTs (P = 0.01), by trials involving more than one country (P = 0.01) and with more than 50 participating centers (P = 0.02). It would be highly desirable that in the near future breast cancer follow-up procedures will be homogeneous in RCTs and everyday clinical settings.
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Hahn EE, Hays RD, Kahn KL, Litwin MS, Ganz PA. Use of imaging and biomarker tests for posttreatment care of early-stage breast cancer survivors. Cancer 2013; 119:4316-24. [PMID: 24105101 DOI: 10.1002/cncr.28363] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/10/2013] [Accepted: 08/06/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND The American Society of Clinical Oncology (ASCO) recently released a "Top Five" list of opportunities to improve the quality of cancer care. Item 4 on the list advises against using advanced imaging and biomarkers for surveillance in patients with breast cancer who are treated with curative intent. This study examined concordance with ASCO follow-up care guidelines for breast cancer survivors treated at an academic medical center. METHODS Claims data and medical records were reviewed and abstracted for early stage breast cancer survivors starting 1 year post diagnosis. A trained abstractor classified imaging tests as diagnostic or surveillance. Proportions and frequencies were generated for receipt of services. Multilevel logistic regression was used to estimate factors associated with receiving recommended and nonrecommended services and biomarker tests. RESULTS Records were available for 258 patients. Mean age at diagnosis was 58 years (standard deviation of 13 years), mean time since diagnosis was 6 years (standard deviation of 2 years), and 71% were stage 0/1. Only 47% of the sample received a mammogram within 1 year of diagnosis, and 55% of the sample received at least 1 nonrecommended imaging service for surveillance purposes. Seventy-seven percent of the sample received at least 1 nonrecommended biomarker test. Regression results indicate that main treating physician, advanced disease stage, younger age at diagnosis, and greater number of years since diagnosis were associated with receiving nonrecommended services for surveillance. CONCLUSIONS Use of nonrecommended services for surveillance occurs frequently among early-stage breast cancer survivors. There are opportunities to increase use of guideline concordant posttreatment care for breast cancer survivors.
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Affiliation(s)
- Erin E Hahn
- University of California Los Angeles (UCLA) Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, California; Division of Cancer Prevention and Control Research Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
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Nurgalieva ZZ, Franzini L, Morgan R, Vernon SW, Liu CC, Du XL. Surveillance mammography use after treatment of primary breast cancer and racial disparities in survival. Med Oncol 2013; 30:691. [DOI: 10.1007/s12032-013-0691-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
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Khatcheressian JL, Hurley P, Bantug E, Esserman LJ, Grunfeld E, Halberg F, Hantel A, Henry NL, Muss HB, Smith TJ, Vogel VG, Wolff AC, Somerfield MR, Davidson NE. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2012; 31:961-5. [PMID: 23129741 DOI: 10.1200/jco.2012.45.9859] [Citation(s) in RCA: 390] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To provide recommendations on the follow-up and management of patients with breast cancer who have completed primary therapy with curative intent. METHODS To update the 2006 guideline of the American Society of Clinical Oncology (ASCO), a systematic review of the literature published from March 2006 through March 2012 was completed using MEDLINE and the Cochrane Collaboration Library. An Update Committee reviewed the evidence to determine whether the recommendations were in need of updating. RESULTS There were 14 new publications that met inclusion criteria: nine systematic reviews (three included meta-analyses) and five randomized controlled trials. After its review and analysis of the evidence, the Update Committee concluded that no revisions to the existing ASCO recommendations were warranted. RECOMMENDATIONS Regular history, physical examination, and mammography are recommended for breast cancer follow-up. Physical examinations should be performed every 3 to 6 months for the first 3 years, every 6 to 12 months for years 4 and 5, and annually thereafter. For women who have undergone breast-conserving surgery, a post-treatment mammogram should be obtained 1 year after the initial mammogram and at least 6 months after completion of radiation therapy. Thereafter, unless otherwise indicated, a yearly mammographic evaluation should be performed. The use of complete blood counts, chemistry panels, bone scans, chest radiographs, liver ultrasounds, pelvic ultrasounds, computed tomography scans, [(18)F]fluorodeoxyglucose-positron emission tomography scans, magnetic resonance imaging, and/or tumor markers (carcinoembryonic antigen, CA 15-3, and CA 27.29) is not recommended for routine follow-up in an otherwise asymptomatic patient with no specific findings on clinical examination.
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Tan ASL, Moldovan-Johnson M, Gray SW, Hornik RC, Armstrong K. An analysis of the association between cancer-related information seeking and adherence to breast cancer surveillance procedures. Cancer Epidemiol Biomarkers Prev 2012; 22:167-74. [PMID: 23118144 DOI: 10.1158/1055-9965.epi-12-0781] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Breast cancer surveillance is important for women with a known history of breast cancer. However, relatively little is known about the prevalence and determinants of adherence to surveillance procedures, including associations with seeking of cancer-related information from medical and nonmedical sources. METHODS We conducted a longitudinal cohort study of breast cancer patients diagnosed in Pennsylvania in 2005. Our main analyses included 352 women who were eligible for surveillance and participated in both baseline (~1 year after cancer diagnosis) and follow-up surveys. Outcomes were self-reported doctor visits and physical examination, mammography, and breast self-examination (BSE) at 1-year follow-up. RESULTS Most women underwent two or more physical examinations according to recommended guidelines (85%). For mammography, 56% of women were adherent (one mammogram in a year) while 39% reported possible overuse (two or more mammograms). Approximately 60% of respondents reported regular BSE (≥ 5 times in a year). Controlling for potential confounders, higher levels of cancer-related information seeking from nonmedical sources at baseline was associated with regular BSE (OR, 1.52; 95% CI, 1.01-2.29; P, 0.046). There was no significant association between information-seeking behaviors from medical or nonmedical sources and surveillance with physical examination or mammography. CONCLUSIONS Seeking cancer-related information from nonmedical sources is associated with regular BSE, a surveillance behavior that is not consistently recommended by professional organizations. IMPACT Findings from this study will inform clinicians on the contribution of active information seeking toward breast cancer survivors' adherence to different surveillance behaviors.
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Affiliation(s)
- Andy S L Tan
- University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA 19104, USA.
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Patterson SG, Teller P, Iyengar R, Carlson GW, Gabram-Mendola SGA, Losken A, Styblo T, Torres M, Wood WC, Perez SD, Mosunjac M, Rizzo M. Locoregional recurrence after mastectomy with immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. Ann Surg Oncol 2012; 19:2679-84. [PMID: 22476750 DOI: 10.1245/s10434-012-2329-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Indexed: 01/29/2023]
Abstract
BACKGROUND The locoregional recurrence (LRR) rate after mastectomy is reported to be similar with immediate reconstruction. We aimed to identify characteristics of LRR after transverse rectus abdominis myocutaneous (TRAM) reconstruction. METHODS We retrospectively reviewed patients undergoing immediate TRAM reconstruction for breast cancer who were diagnosed with LRR. RESULTS We identified 18 LRR (4.6 %) in 18 of 390 patients who underwent immediate TRAM reconstructions for breast cancer from 1998 to 2008. The median follow-up was 69.2 months. The mean age at time of mastectomy was 49.5 years. All LRR were detected by physical examination. The LRR occurred in the TRAM subcutaneous tissue (n = 9), five in the ipsilateral axillary lymph node and four in the supraclavicular lymph node. Of the 18 patients who developed LRR, 14 (77.7 %) presented with stage 0-1-2 and 4 (22.2 %) with stage 3 disease at the time of the original mastectomy. The average time for a LRR to present was 35.8 months after initial mastectomy and reconstruction. For patients who initially presented with stage 3 disease, the average time to LRR was shorter (22.9 months). Nine patients (50.0 %) were found to have metastatic disease at the time of the LRR, and 6 (33.3 %) died of disease. CONCLUSIONS All TRAM LRR were detected by routine physical examination by the patient or the surgeon. Our findings suggest that routine history and clinical breast examination of the breast reconstructed with a TRAM flap along with patient self-awareness are reliable in the diagnosis of LRR.
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Salloum RG, Hornbrook MC, Fishman PA, Ritzwoller DP, O'Keeffe Rossetti MC, Elston Lafata J. Adherence to surveillance care guidelines after breast and colorectal cancer treatment with curative intent. Cancer 2012; 118:5644-51. [PMID: 22434568 DOI: 10.1002/cncr.27544] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 01/17/2012] [Accepted: 02/22/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND Evidence-based guidelines recommend routine surveillance, including office visits and testing, to detect new and recurrent disease among survivors of breast and colorectal cancer. The extent to which surveillance practice is consistent with guideline recommendations or may vary by age is not known. METHODS Cohorts of adult patients diagnosed with breast (n = 6205) and colorectal (n = 2297) cancer between 2000 and 2008 and treated with curative intent in 4 geographically diverse managed care environments were identified via tumor registries. Kaplan-Meier estimates were used to describe time to initial and subsequent receipt of surveillance services. Cox proportional hazards models evaluated the relation between patient characteristics and receipt of metastatic screening. RESULTS Within 18 months of treatment, 87.2% of breast cancer survivors received recommended mammograms, with significantly higher rates noted for patients aged 50 years to 65 years. Among survivors of colorectal cancer, only 55.0% received recommended colon examinations, with significantly lower rates for those aged ≥ 75 years. The majority of breast (64.7%) and colorectal (73.3%) cancer survivors received nonrecommended metastatic disease testing. In patients with breast cancer, factors associated with metastatic disease testing include white race (hazards ratio [HR], 1.13), comorbidities (HR, 1.17), and younger age (HR, 1.13; 1.15; 1.13 for age groups: <50, 50-64, and 65-74 respectively). In those with colorectal cancer, these factors included younger age (HR, 1.31; 1.25 for age groups: <50 and 50-64 respectively) and comorbidities (HR, 1.10). CONCLUSIONS Among an insured population, wide variation regarding the use of surveillance care was found by age and relative to guideline recommendations. Breast cancer survivors were found to have high rates of both guideline-recommended recurrence testing and non-guideline-recommended metastatic testing. Only approximately 50% of colorectal cancer survivors received recommended tests but greater than 67% received metastatic testing.
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Affiliation(s)
- Ramzi G Salloum
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Health Insurance and Other Factors Associated With Mammography Surveillance Among Breast Cancer Survivors. Med Care 2012; 50:270-6. [DOI: 10.1097/mlr.0b013e318244d294] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shelby RA, Scipio CD, Somers TJ, Soo MS, Weinfurt KP, Keefe FJ. Prospective study of factors predicting adherence to surveillance mammography in women treated for breast cancer. J Clin Oncol 2012; 30:813-9. [PMID: 22331949 DOI: 10.1200/jco.2010.34.4333] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This prospective study examined the factors that predicted sustained adherence to surveillance mammography in women treated for breast cancer. METHODS Breast cancer survivors (N = 204) who were undergoing surveillance mammography completed questionnaires assessing mammography-related anticipatory anxiety, persistent breast pain, mammography pain, and catastrophic thoughts about mammography pain. Adherence to mammography in the following year was assessed. RESULTS In the year after study entry, 84.8% of women (n = 173) returned for a subsequent mammogram. Unadjusted associations showed that younger age, shorter period of time since surgery, and having upper extremity lymphedema were associated with lower mammography adherence. Forty percent of women reported moderate to high levels of mammography pain (score of ≥ 5 on a 0 to 10 scale). Although mammography pain was not associated with adherence, higher levels of mammography-related anxiety and pain catastrophizing were associated with not returning for a mammogram (P < .05). The impact of anxiety on mammography use was mediated by pain catastrophizing (indirect effect, P < .05). CONCLUSION Findings suggest that women who are younger, closer to the time of surgery, or have upper extremity lymphedema may be less likely to undergo repeated mammograms. It may be important for health professionals to remind selected patients directly that some women avoid repeat mammography and to re-emphasize the value of mammography for women with a history of breast cancer. Teaching women behavioral techniques (eg, redirecting attention) or providing medication for reducing anxiety could be considered for women with high levels of anxiety or catastrophic thoughts related to mammography.
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Grunfeld E, Hodgson DC, Del Giudice ME, Moineddin R. Population-based longitudinal study of follow-up care for breast cancer survivors. J Oncol Pract 2011; 6:174-81. [PMID: 21037867 DOI: 10.1200/jop.200009] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To describe the patterns of follow-up care provided to a population-based cohort of breast cancer survivors, and to assess factors associated with adherence to guidelines on follow-up care. PATIENTS AND METHODS We conducted a retrospective longitudinal study of all women with surgically treated breast cancer who were without evidence of recurrence, advanced breast cancer, or new primary cancer and were diagnosed in Ontario, Canada, within a 2-year period (n = 11,219). They were followed for 5 years. The cohort was identified through the Ontario Cancer Registry, and individuals were linked across population-based administrative health databases. Frequency of and adherence to guideline recommendations for oncologist and primary care physician (PCP) visits; surveillance imaging for metastatic disease; and surveillance mammograms by year from diagnosis, age group, and income quintile were analyzed. Factors associated with adherence to guideline recommendations were analyzed. RESULTS Most women saw both oncologists and PCPs in each follow-up year. Approximately two thirds had surveillance mammograms in each follow-up year. Overall, two thirds had either fewer or greater than recommended oncology visits, one quarter had fewer than recommended surveillance mammograms, and half had greater than recommended surveillance imaging for metastatic disease. CONCLUSION This population-based study shows substantial variation in adherence to guideline recommendations, with both overuse and underuse of surveillance visits and tests. Most importantly, a substantial proportion are receiving more than recommended imaging for metastatic disease but fewer than recommended mammograms for detection of local recurrence or new primary cancer, for which effective intervention is possible.
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Affiliation(s)
- Eva Grunfeld
- Ontario Institute for Cancer Research; Cancer Care Ontario Health Services Research Program; Department of Family and Community Medicine, University of Toronto; Institute of Clinical Evaluative Sciences, Sunnybrook Health Science Centre; Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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Yu KD, Li S, Shao ZM. Different annual recurrence pattern between lumpectomy and mastectomy: implication for breast cancer surveillance after breast-conserving surgery. Oncologist 2011; 16:1101-10. [PMID: 21680575 DOI: 10.1634/theoncologist.2010-0366] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To investigate the recurrence pattern and annual recurrence risk after breast-conserving surgery and compare them with those after mastectomy. METHODS This retrospective analysis included 6,135 consecutive unilateral breast cancer patients undergoing surgery in 1998-2008, with 847 lumpectomy patients and 5,288 mastectomy patients. Recurrence patterns were scrutinized and annual recurrence rates were calculated. Furthermore, a literature-based review including seven relevant studies was subsequently performed to confirm our single-institution data-based observations. RESULTS After lumpectomy, 50.9% of recurrences occurred within 3 years and 30.2% of recurrences were detected at 3-5 years; after mastectomy, 64.9% of recurrences occurred within 3 years and 20.4% occurred at 3-5 years. The major locoregional recurrence pattern after lumpectomy was ipsilateral breast tumor recurrence, which mainly (81.3%) occurred ≤5 years postsurgery but with a low incidence of 37.5% ≤3 years postsurgery. Annual recurrence curves indicated that the relapse peak after mastectomy emerged in the first 2 years; however, recurrence after lumpectomy increased annually with the highest peak near 5 years. By reviewing relevant studies, we confirmed our finding of different annual recurrence patterns for lumpectomy and mastectomy patients. The hazard ratio of dying for those recurring ≤5 years postlumpectomy relative to patients relapsing >5 years postlumpectomy was 4.62 (95% confidence interval, 1.05-20.28; p = .042). CONCLUSIONS Different recurrence patterns between mastectomy and lumpectomy patients imply that scheduling of surveillance visits should be more frequent during the 4-6 years after lumpectomy. Further prospective trials addressing the necessity of frequent and longer surveillance after lumpectomy are warranted.
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Affiliation(s)
- Ke-Da Yu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, PR China
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Onega T, Cook A, Kirlin B, Shi X, Alford-Teaster J, Tuzzio L, Buist DSM. The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography. Breast Cancer Res Treat 2011; 129:269-75. [PMID: 21553117 DOI: 10.1007/s10549-011-1549-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/25/2011] [Indexed: 10/18/2022]
Abstract
Travel time has been shown to influence some aspects of cancer characteristics at diagnosis and care for women with breast cancer, but important gaps remain in our understanding of its impact. We examined the influence of travel time to the nearest radiology facility on breast cancer characteristics, treatment, and surveillance for women with early-stage invasive breast cancer. We included 1,012 women with invasive breast cancer (stages I and II) who had access to care within an integrated health care delivery system in western Washington State. The travel times to the nearest radiology facility were calculated for all the U.S. Census blocks within the study area and assigned to women based on residence at diagnosis. We collected cancer characteristics, primary and adjuvant therapies, and surveillance mammography for at least 2.5 years post diagnosis and used multivariable analyses to test the associations of travel time. The majority of women (68.6%) lived within 20 min of the nearest radiology facility, had stage I disease (72.7%), received breast conserving therapy (68.7%), and had annual surveillance mammography the first 2 years after treatment (73.7%). The travel time was not significantly associated with the stage or surveillance mammography after adjusting for covariates. Primary therapy was significantly related to travel time, with greater travel time (>30 min vs. ≤ 10 min) associated with a higher likelihood of mastectomy compared to breast conserving surgery (RR = 1.53; 95% CI, 1.16-2.01). The travel time was not associated with the stage at diagnosis or surveillance mammography receipt. The travel time does seem to influence the type of primary therapy among women with breast cancer, suggesting that women may prefer low frequency services, such as mastectomy, if geographic access to a radiology facility is limited.
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Affiliation(s)
- Tracy Onega
- Department of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03756, USA.
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Winchester DP. Post-treatment surveillance of breast cancer patients in an organized, multidisciplinary setting. J Surg Oncol 2011; 103:358-61. [PMID: 21337571 DOI: 10.1002/jso.21713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Post-treatment surveillance protocols should include early detection of local, regional, and systemic recurrence, new primary tumors and should address treatment complications and psychosocial needs. In addition to annual mammography, history and physical examination in the treated, asymptomatic breast cancer patient surveillance visits should occur every 3-4 months for 3 years, every 6 months for the next 2 years, and annually thereafter. Scans and other tests should be reserved for high risk or symptomatic patients.
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Arora NK, Reeve BB, Hays RD, Clauser SB, Oakley-Girvan I. Assessment of quality of cancer-related follow-up care from the cancer survivor's perspective. J Clin Oncol 2011; 29:1280-9. [PMID: 21357781 DOI: 10.1200/jco.2010.32.1554] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We assessed cancer survivors' perceptions of the quality of their follow-up care. METHODS We surveyed a population-based cohort of leukemia, bladder, and colorectal cancer survivors diagnosed 2 to 5 years previously in northern California (N = 623; participation rate, 69.2%; overall response rate, 49.2%). Data were collected between April 2003 and November 2004. Ten scales assessed survivors' perceptions of different aspects of care in the last 12 months, and an eleventh scale measured their overall ratings of care. RESULTS On nine of the 11 scales, mean scores ranged from 88 to 97 on a 0 to 100 response format, indicating very positive experiences. The two areas where quality perceptions were lower were discussions about health promotion and the physician's knowledge of the whole patient. In adjusted analyses, those without private health insurance (P = .02) and Hispanic and Asian survivors compared with whites (P < .001) reported worse timeliness of care. Survivors who had multiple comorbidities reported better scores on timeliness of care (P < .01) and physicians' knowledge (P = .05) than survivors without any comorbidity. Length of the patient-physician relationship was the variable most consistently found to be significantly associated with survivors' quality assessments. Physicians' information exchange had the strongest relationship with overall ratings of care, followed by physicians' affective behavior, their knowledge of the survivor, and survivors' perceptions of coordination of care (P < .001 for all). CONCLUSION Delivery of quality follow-up care to cancer survivors may require efforts to improve patient-centered communication and coordination. Special emphasis may need to be placed on health promotion discussions and adoption of a whole-person orientation.
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Affiliation(s)
- Neeraj K Arora
- Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, MSC 7344, EPN 4092, Bethesda, MD 20892-7344, USA.
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Local Recurrence of Breast Cancer 52 Years after Halsted Mastectomy: Is There a Role for More Aggressive Ipsilateral Surveillance? Case Rep Oncol Med 2011; 2011:107370. [PMID: 22606439 PMCID: PMC3350219 DOI: 10.1155/2011/107370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 08/29/2011] [Indexed: 11/18/2022] Open
Abstract
We present the longest reported case of breast cancer recurrence, 52 years after initial diagnosis, in a patient initially treated with Halsted mastectomy. Observation and palpation of the chest wall resulted in late presentation, and this patient went on to demonstrate metastatic disease. Current surveillance guidelines lack specific recommendations regarding monitoring of the ipsilateral chest wall. In addition, the growing utilization of breast reconstruction poses an additional challenge to surveillance strategies of the ipsilateral breast. However, the emergence of MRI may present a new opportunity to identify ipsilateral recurrence. The changing landscape of breast cancer therapy warrants guidance from groups of national import such as ASCO, in the surveillance of breast cancer patients.
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Liedtke C, Kiesel L. Behandlung von klimakterischen Beschwerden bei Patientinnen mit Mammakarzinom. GYNAKOLOGISCHE ENDOKRINOLOGIE 2010. [DOI: 10.1007/s10304-010-0378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Punglia RS, Hassett MJ. Using lifetime risk estimates to recommend magnetic resonance imaging screening for breast cancer survivors. J Clin Oncol 2010; 28:4108-10. [PMID: 20697089 DOI: 10.1200/jco.2010.30.0350] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rinaa S Punglia
- Dana-Farber Cancer Institute, Brigham & Women's Hospital, and Harvard Medical School, Boston, MA, USA
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Kim JH, Jang YJ, Park SS, Park SH, Mok YJ. Benefit of post-operative surveillance for recurrence after curative resection for gastric cancer. J Gastrointest Surg 2010; 14:969-76. [PMID: 20411347 DOI: 10.1007/s11605-010-1200-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 03/31/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although most clinicians perform surveillance after gastrectomy, there is no consensus on the optimal follow-up schedule. This study aimed to evaluate the benefit of postoperative surveillance for recurrence after curative resection for gastric cancer. METHOD We retrospectively studied 110 patients who had recurrences after undergoing curative gastrectomies between 2000 and 2004 at Korea University Hospital. We analyzed the clinico-pathologic factors and oncologic results according to the presence of recurrence symptoms. RESULTS Fifty-five (50%) patients had symptomatic recurrences. There were significant differences in recurrence patterns; locoregional (29.1%) and peritoneal recurrences (27.3%) were dominant in asymptomatic group; peritoneal (47.3%) and hematogenous recurrences (25.5%) were dominant in symptomatic group. The median recurrence-free survival was not different for both groups (p = 0.054). However, median overall and post-recurrence survival was poor in the symptomatic group (p = 0.004, p < 0.001). The presence of symptoms and short disease-free survival were independent poor prognostic factors for post-recurrence survival. CONCLUSION Patients with asymptomatic recurrences could have increased survival compared to symptomatic patients. Although our post-operative surveillance could not be any benefit to improve outcomes for recurrent gastric cancer, it is important to discriminate the nature of recurrent gastric cancer by the presence of symptoms for planning further treatment.
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Affiliation(s)
- Jong-Han Kim
- Department of Surgery, Korea University College of Medicine, 5-ga, Anam-dong, Sungbuk-gu, Seoul 136-701, South Korea
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Kennecke H, Yerushalmi R, Woods R, Cheang MCU, Voduc D, Speers CH, Nielsen TO, Gelmon K. Metastatic behavior of breast cancer subtypes. J Clin Oncol 2010; 28:3271-7. [PMID: 20498394 DOI: 10.1200/jco.2009.25.9820] [Citation(s) in RCA: 1453] [Impact Index Per Article: 103.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Prognostic and predictive factors are well established in early-stage breast cancer, but less is known about which metastatic sites will be affected. METHODS Patients with early-stage breast cancer diagnosed between 1986 and 1992 with archival tissue were included. Subtypes were defined as luminal A, luminal B, luminal/human epidermal growth factor receptor 2 (HER2), HER2 enriched, basal-like, and triple negative (TN) nonbasal. Distant sites were classified as brain, liver, lung, bone, distant nodal, pleural/peritoneal, and other. Cumulative incidence curves were estimated for each site according to competing risks methods. Association between the site of relapse and subtype was assessed in multivariate models using logistic regression. RESULTS Median follow-up time among 3,726 eligible patients was 14.8 years. Median durations of survival with distant metastasis were 2.2 (luminal A), 1.6 (luminal B), 1.3 (luminal/HER2), 0.7 (HER2 enriched), and 0.5 years (basal-like; P < .001). Bone was the most common metastatic site in all subtypes except basal-like tumors. In multivariate analysis, compared with luminal A tumors, luminal/HER2 and HER2-enriched tumors were associated with a significantly higher rate of brain, liver, and lung metastases. Basal-like tumors had a higher rate of brain, lung, and distant nodal metastases but a significantly lower rate of liver and bone metastases. TN nonbasal tumors demonstrated a similar pattern but were not associated with fewer liver metastases. CONCLUSION Breast cancer subtypes are associated with distinct patterns of metastatic spread with notable differences in survival after relapse.
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Affiliation(s)
- Hagen Kennecke
- Vancouver Clinic, Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
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Cancer screening practices among racially and ethnically diverse breast cancer survivors: results from the 2001 and 2003 California Health Interview Survey. J Cancer Surviv 2009; 4:1-14. [DOI: 10.1007/s11764-009-0102-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 10/21/2009] [Indexed: 11/26/2022]
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Hur H, Song KY, Park CH, Jeon HM. Follow-up strategy after curative resection of gastric cancer: a nationwide survey in Korea. Ann Surg Oncol 2009; 17:54-64. [PMID: 19777193 DOI: 10.1245/s10434-009-0676-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 05/12/2009] [Accepted: 05/19/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND To date, guidelines for follow-up after curative resection in patients with gastric cancer have not been reported. Thus, most centers have managed the process according to institution-specific protocols. We investigated current follow-up practices after curative resection of gastric cancer using a nationwide survey in Korea, where gastric cancer is epidemic. METHODS From July to September 2007, questionnaires were sent out to 205 members of the Korean Gastric Cancer Association (KGCA). The questionnaire packet contained a covering letter, general information, and a questionnaire about follow-up schedules and methodologies. RESULTS Forty-six percent (96/205) of the members of the KGCA returned the survey. The majority of responders indicated that patients with early gastric cancer were followed up every 6 months (64.4%) for the first year, every 12 months (47.9%) for the next 4 years, and every 12 months (68.8%) from the fifth year after surgery on. For patients with advanced gastric cancer, follow-up studies were carried out every 3 months (43.8%) for the first year, every 6 months for the next 4 years, and every 12 months (75.0%) from the fifth year onward. After surgery, most responders used computed tomography for imaging, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9 as tumor markers, and serum iron among follow-up measures. CONCLUSIONS Clinicians have a variety of approaches regarding the extent of follow-up and methodologies used after curative resection for gastric cancer. Therefore, a multicenter randomized trial will be needed to compare routine follow-up with intensive schedules. Our results could facilitate the design of such studies.
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Affiliation(s)
- Hoon Hur
- Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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