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Leonardis JM, Momoh AO, Lipps DB. Choosing breast-conserving therapy or mastectomy and subpectoral implant breast reconstruction: implications for pectoralis major function. Breast Cancer Res Treat 2024:10.1007/s10549-024-07381-z. [PMID: 38851662 DOI: 10.1007/s10549-024-07381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/17/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND An increasing number of women are choosing mastectomy and subpectoral implant (SI) breast reconstruction over breast-conserving therapy (BCT). It is unclear to what extent these procedures differ in their effect on the pectoralis major (PM). The purpose of this study was to assess the impact of choosing BCT or SI breast reconstruction on PM function. METHODS Ultrasound shear wave elastography images were acquired from the PM fiber regions and surface electromyography obtained activity from six shoulder muscles, while 14 BCT participants, 14 SI participants, and 14 age-matched controls remained at rest or generated submaximal shoulder torques. RESULTS BCT and SI participants were significantly weaker in shoulder adduction, while BCT participants were also weaker in internal and external rotation (all p ≤ 0.003). PM function was altered following either BCT or SI. In all treatment groups, the clavicular fiber region contributed primarily to flexion, and the sternocostal primarily contributed to adduction. However, healthy participants utilized the clavicular region more during adduction and the sternocostal region more during flexion when compared to BCT or SI participants (all p ≤ 0.049). The still intact clavicular region increased its contributions to flexion torques in SI participants compared to controls (p = 0.016). Finally, BCT and SI participants compensated for changes in PM function using synergistic shoulder musculature. CONCLUSION Both BCT and SI breast reconstruction result in significant long-term upper extremity strength deficits. Our results suggest changes to the underlying function of the PM and the adoption of unique but inadequate neuromuscular compensation strategies drive these deficits.
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Affiliation(s)
- Joshua M Leonardis
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 906 S. Goodwin Avenue, Urbana, IL, 61801, USA.
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA.
| | - Adeyiza O Momoh
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - David B Lipps
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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Levitin R, Salari K, Squires BS, Hazy AJ, Maywood MJ, Thrasher P, Delise AP, Almahariq MF, Dekhne N, Oliver L, Chen PY, Walters KJ, Dudley D, Dilworth JT. Near-Surface Dose Correlates With Moist Desquamation and Unplanned Reconstructive Surgery in Patients With Implant-Based Reconstruction Receiving Postmastectomy Radiation Therapy. Adv Radiat Oncol 2023; 8:101283. [PMID: 37492779 PMCID: PMC10363637 DOI: 10.1016/j.adro.2023.101283] [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: 04/06/2023] [Accepted: 05/12/2023] [Indexed: 07/27/2023] Open
Abstract
Purpose Postmastectomy radiation therapy (PMRT) reduces disease recurrence in appropriately selected patients but may compromise implant-based reconstruction. We investigated whether near-surface dose correlates with radiation-related toxic effects in these patients. Methods and Materials Patients receiving PMRT at a single institution from 2016 to 2019 were retrospectively reviewed. Patient demographics and treatment information were collected. Three near-surface structures were retrospectively generated, bound by the chest wall tangent beam as well as the skin surface and the skin-3 mm contour (SR3), skin surface and skin-5 mm contour (SR5), or skin-5 and skin-10 mm contours. Dosimetric analysis of these near-surface contours was performed in 2 Gy intervals. Univariate and multivariate analyses were used to identify predictors of moist desquamation, grade 2+ chest wall pain, use of opiate pain medication, unplanned reconstructive surgery, and implant failure. Logistic regression for each outcome and near-surface contour was performed for receiver-operator area under the curve (AUC) analysis and the Youden J Statistic was used to determine the optimal threshold for each dosimetric parameter. Results Of 126 patients reviewed, 109 met the study's eligibility criteria. Median follow-up was 2.3 years. Twenty-five patients (23%) underwent unplanned reconstructive surgery, and 10 (9.2%) experienced implant failure. Among clinical variables, low body mass index and history of smoking predicted unplanned surgery on univariate and multivariate analyses, and moist desquamation predicted grade 2+ chest wall pain. The top dosimetric parameters by AUC for moist desquamation, grade 2+ chest wall pain, use of opiates, unplanned reconstructive surgery, and implant failure were SR5 D10 cc (AUC = 0.701, optimal threshold 57.8 Gy, P < .001), SR3 D10 cc (AUC = 0.600, optimal threshold 56.8 Gy, P = .079), SR5 D10 cc (AUC = 0.642, optimal threshold 57.3 Gy, P = .041), SR3 V44 Gy (AUC = 0.711, optimal threshold 81%, P = .001), and SR3 V44 Gy (AUC = 0.688, optimal threshold 82%, P = .052), respectively. Conclusions Near-surface dose correlates with moist desquamation and unplanned reconstructive surgery after PMRT. Further evaluation of prospective optimization of dosimetric parameters related to SR3 and SR5 should be considered.
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Affiliation(s)
- Ronald Levitin
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Kamran Salari
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Bryan S. Squires
- Radiation oncology, Huron River Radiation Oncology Specialists, Ypsilanti, Michigan
| | - Allison J. Hazy
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Michael J. Maywood
- Department of Ophthalmology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Patrick Thrasher
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Anthony P. Delise
- Department of Family Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Muayad F. Almahariq
- Department of Radiation Oncology, Corewell Health Dearborn Hospital, Dearborn, Michigan
| | - Nayana Dekhne
- Department of Breast Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Lauren Oliver
- Department of Plastic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Peter Y. Chen
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Kailee J. Walters
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Diane Dudley
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Joshua T. Dilworth
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
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Jonczyk MM, Karamchandani M, Zaccardelli A, Bahadur A, Fisher CS, Czerniecki B, Margenthaler JA, Persing S, Homsy C, Nardello S, O'Brien J, Losken A, Chatterjee A. External Validation of the Breast Cancer Surgery Risk Calculator (BCSRc): A Predictive Model for Postoperative Complications. Ann Surg Oncol 2023; 30:6245-6253. [PMID: 37458950 DOI: 10.1245/s10434-023-13904-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/28/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The breast cancer surgical risk calculator (BCSRc) is a prognostic tool that determines a breast cancer patient's unique risk of acute complications following each possible surgical intervention. When used in the preoperative setting, it can help to stratify patients with an increased complication risk and enhance the patient-physician informed decision-making process. The objective of this study was to externally validate the four models used in the BCSRc on a large cohort of patients who underwent breast cancer surgery. METHODS The BCSRc was developed by using a retrospective cohort from the National Surgical Quality Improvement Program database from 2005 to 2018. Four models were built by using logistic regression methods to predict the following composite outcomes: overall, infectious, hematologic, and internal organ complications. This study obtained a new cohort of patients from the National Surgical Quality Improvement Program by utilizing participant user files from 2019 to 2020. The area under the curve, brier score, and Hosmer-Lemeshow goodness of fit test measured model performance, accuracy, and calibration, respectively. RESULTS A total of 192,095 patients met inclusion criteria in the development of the BCSRc, and the validation cohort included 60,144 women. The area under the curve during external validation for each model was approximately 0.70. Accuracy, or Brier scores, were all between 0.04 and 0.003. Model calibration using the Hosmer-Lemeshow statistic found all p-values > 0.05. All of these model coefficients will be updated on the web-based BCSRc platform: www.breastcalc.org . CONCLUSIONS The BCSRc continues to show excellent external-validation measures. Collectively, this prognostic tool can enhance the decision-making process, help stratify patients with an increased complication risk, and improve expectant management.
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Affiliation(s)
- Michael M Jonczyk
- Department of Surgery, Lahey Hospital & Medical Center, Burlington, MA, USA.
| | | | | | | | - Carla Suzanne Fisher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Julie A Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah Persing
- Department of General Surgery, Tufts Medical Center, Boston, MA, USA
| | - Christopher Homsy
- Department of General Surgery, Tufts Medical Center, Boston, MA, USA
| | | | - Julie O'Brien
- Department of Surgery, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Albert Losken
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Chervu N, Darbinian K, Sakowitz S, Verma A, Bakhtiyar SS, Shuch BM, Benharash P, Thompson C. Disparate Utilization of Breast Conservation Therapy in the Surgical Management of Early-Stage Breast Cancer. Clin Breast Cancer 2023:S1526-8209(23)00093-9. [PMID: 37183095 DOI: 10.1016/j.clbc.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Despite evidence suggesting oncologic equipoise of breast conservation therapy (BCT) for early-stage (stages I and II) breast cancer, mastectomy is still widely utilized. PATIENTS AND METHODS The 2004-2015 National Cancer Database was used to tabulate all adult women receiving mastectomy or BCT for early-stage breast cancer. Multivariable regression was used to evaluate factors associated with utilization of BCT, relative to mastectomy. RESULTS Of 1,079,057 women meeting study criteria, 57.4% underwent BCT. BCT patients were older and more commonly White, compared to mastectomy. They were more commonly privately insured, in the highest income quartile, and treated at metropolitan, nonacademic institutions. After adjustment, increasing age (AOR 1.01/year), Black race (AOR 1.21, Ref: White), and care at a community hospital (AOR 1.08, Ref: Academic; all P< .05) were associated with increased odds of undergoing BCT. Conversely, Asian or Pacific Islander (AAPI) race (AOR 0.74), Medicare (AOR 0.89) or Medicaid (AOR 0.95) coverage, and being in the lowest (AOR 0.95) and second lowest (AOR 0.98, all P< .05) income quartiles were associated with reduced odds of undergoing BCT. Finally, increasing tumor size (AOR 0.97, P< .05) was associated with decreased adjusted odds of undergoing BCT. CONCLUSION Our results suggest persistent socioeconomic and racial disparities in BCT utilization for early-stage breast cancer. Directed strategies should be implemented in order to reduce treatment inequality in this patient population.
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Affiliation(s)
- Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA; Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA
| | - Khajack Darbinian
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA; David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Surgery, University of Colorado, Aurora, CO
| | - Brian M Shuch
- Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA; Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA.
| | - Carlie Thompson
- Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA
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5
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Sun X, Xu S, Li Y, Lv X, Wei M, He M. Efficacy and safety of PARP inhibitors in the treatment of BRCA-mutated breast cancer: an updated systematic review and meta-analysis of randomized controlled trials. Expert Rev Clin Pharmacol 2023; 16:245-256. [PMID: 36908219 DOI: 10.1080/17512433.2023.2188193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Poly-ADP-ribose polymerase inhibitors (PARPis) have emerged as a new class of therapeutic agents for breast cancer patients with breast cancer susceptibility gene (BRCA) mutations. However, the efficacy and toxicity of PARPis have not been clearly established. METHODS This study comprehensively evaluated the efficacy and safety of PARPis in patients with BRCA-mutated breast cancer. Online databases were systematically searched, and six clinical trials were included. The primary endpoint of efficacy was progression-free survival (PFS), whereas the secondary endpoints were overall survival (OS) and objective response rate (ORR). Additionally, we assessed the safety of PARPis. RESULTS The results of the meta-analysis showed that PARPis can effectively improve the PFS and OS in patients compared with the control group. The pooled HR (PARPi vs control groups) was 0.63 (95% CI, 0.55 - 0.73) and 0.83 (95% CI, 0.73 to -0.95) for PFS and OS, respectively. In safety, PARPis demonstrated controllable adverse reactions. There were no significant differences in overall AEs or grade ≥3 AEs between the PARP inhibitor and control arms. CONCLUSIONS Our results confirm the efficacy and safety of PARPis in patients with BRCA-mutated breast cancer, and more specifically clarify the efficacy of PARPis alone or in combination with other chemotherapy drugs. [Figure: see text].
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Affiliation(s)
- Xiaoyu Sun
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China.,Liaoning Key Laboratory of Molecular Targeted anti-tumor Drug Development and Evaluation; Liaoning Cancer Immune Peptide Drug Engineering Technology Research Center; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, China Medical University, Shenyang, Liaoning, China
| | - Suying Xu
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China.,Liaoning Key Laboratory of Molecular Targeted anti-tumor Drug Development and Evaluation; Liaoning Cancer Immune Peptide Drug Engineering Technology Research Center; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, China Medical University, Shenyang, Liaoning, China
| | - Yiming Li
- NHC Key Laboratory of Antibiotic Bioengineering, Laboratory of Oncology, Institute of Medicinal Biotechnology, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xuemei Lv
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China.,Liaoning Key Laboratory of Molecular Targeted anti-tumor Drug Development and Evaluation; Liaoning Cancer Immune Peptide Drug Engineering Technology Research Center; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, China Medical University, Shenyang, Liaoning, China
| | - Minjie Wei
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China.,Liaoning Key Laboratory of Molecular Targeted anti-tumor Drug Development and Evaluation; Liaoning Cancer Immune Peptide Drug Engineering Technology Research Center; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, China Medical University, Shenyang, Liaoning, China.,Shenyang Kangwei Medical Laboratory Analysis Co. LTD, China Medical University, Liaoning, China
| | - Miao He
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China.,Liaoning Key Laboratory of Molecular Targeted anti-tumor Drug Development and Evaluation; Liaoning Cancer Immune Peptide Drug Engineering Technology Research Center; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, China Medical University, Shenyang, Liaoning, China
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6
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Maleki M, Mardani A, Ghafourifard M, Vaismoradi M. Changes and challenges in sexual life experienced by the husbands of women with breast cancer: a qualitative study. BMC Womens Health 2022; 22:326. [PMID: 35918700 PMCID: PMC9344622 DOI: 10.1186/s12905-022-01906-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/25/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Breast cancer (BC) in women can bring various problems to their marital and family life. Sexual life based on the experiences of the husbands of women diagnosed with BC has not been fully understood. Therefore, this research aimed to explore changes and challenges in sexual life experienced by the husbands of women diagnosed with BC.
Methods
A qualitative research was carried out on 18 men whose wives had been diagnosed with BC at reproductive age. They were selected using purposeful sampling and were interviewed using in-depth semi-structured interviews. Collected data were analyzed using the conventional content analysis method.
Results
‘Sexual life suspension’ was the main theme of this research. Also, ‘unfulfilled sexual expectations’, ‘perceived barriers to satisfy sexual expectations’, and ‘efforts to adapt to sexual problems’ were subthemes.
Conclusions
The husbands of women with BC need support to improve their sexual and marital relationships. Education and counseling about sexual life during the treatment of BC should be incorporated into the healthcare program.
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Giaquinto AN, Sung H, Miller KD, Kramer JL, Newman LA, Minihan A, Jemal A, Siegel RL. Breast Cancer Statistics, 2022. CA Cancer J Clin 2022; 72:524-541. [PMID: 36190501 DOI: 10.3322/caac.21754] [Citation(s) in RCA: 562] [Impact Index Per Article: 281.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 12/14/2022] Open
Abstract
This article is the American Cancer Society's update on female breast cancer statistics in the United States, including population-based data on incidence, mortality, survival, and mammography screening. Breast cancer incidence rates have risen in most of the past four decades; during the most recent data years (2010-2019), the rate increased by 0.5% annually, largely driven by localized-stage and hormone receptor-positive disease. In contrast, breast cancer mortality rates have declined steadily since their peak in 1989, albeit at a slower pace in recent years (1.3% annually from 2011 to 2020) than in the previous decade (1.9% annually from 2002 to 2011). In total, the death rate dropped by 43% during 1989-2020, translating to 460,000 fewer breast cancer deaths during that time. The death rate declined similarly for women of all racial/ethnic groups except American Indians/Alaska Natives, among whom the rates were stable. However, despite a lower incidence rate in Black versus White women (127.8 vs. 133.7 per 100,000), the racial disparity in breast cancer mortality remained unwavering, with the death rate 40% higher in Black women overall (27.6 vs. 19.7 deaths per 100,000 in 2016-2020) and two-fold higher among adult women younger than 50 years (12.1 vs. 6.5 deaths per 100,000). Black women have the lowest 5-year relative survival of any racial/ethnic group for every molecular subtype and stage of disease (except stage I), with the largest Black-White gaps in absolute terms for hormone receptor-positive/human epidermal growth factor receptor 2-negative disease (88% vs. 96%), hormone receptor-negative/human epidermal growth factor receptor 2-positive disease (78% vs. 86%), and stage III disease (64% vs. 77%). Progress against breast cancer mortality could be accelerated by mitigating racial disparities through increased access to high-quality screening and treatment via nationwide Medicaid expansion and partnerships between community stakeholders, advocacy organizations, and health systems.
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Affiliation(s)
- Angela N Giaquinto
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Kimberly D Miller
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Joan L Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Lisa A Newman
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, New York, USA
| | - Adair Minihan
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Wang X, Zhao J, Xiang Z, Wang X, Zeng Y, Luo T, Yan X, Zhang Z, Wang F, Liu L. 3D-printed bolus ensures the precise postmastectomy chest wall radiation therapy for breast cancer. Front Oncol 2022; 12:964455. [PMID: 36119487 PMCID: PMC9478602 DOI: 10.3389/fonc.2022.964455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the values of a 3D-printed bolus ensuring the precise postmastectomy chest wall radiation therapy for breast cancer. Methods and materials In the preclinical study on the anthropomorphic phantom, the 3D-printed bolus was used for dosimetry and fitness evaluation. The dosimetric parameters of planning target volume (PTV) were assessed, including Dmin, Dmax, Dmean, D95%, homogeneity index (HI), conformity index (CI), and organs at risk (OARs). The absolute percentage differences (|%diff|) between the theory and fact skin dose were also estimated, and the follow-up was conducted for potential skin side effects. Results In preclinical studies, a 3D-printed bolus can better ensure the radiation coverage of PTV (HI 0.05, CI 99.91%), the dose accuracy (|%diff| 0.99%), and skin fitness (mean air gap 1.01 mm). Of the 27 eligible patients, we evaluated the radiation dose parameter (median(min–max): Dmin 4967(4789–5099) cGy, Dmax 5447(5369–5589) cGy, Dmean 5236(5171–5323) cGy, D95% 5053(4936–5156) cGy, HI 0.07 (0.06–0.17), and CI 99.94% (97.41%–100%)) and assessed the dose of OARs (ipsilateral lung: Dmean 1341(1208–1385) cGy, V5 48.06%(39.75%–48.97%), V20 24.55%(21.58%–26.93%), V30 18.40%(15.96%–19.16%); heart: Dmean 339(138–640) cGy, V30 1.10%(0%–6.14%), V40 0.38%(0%–4.39%); spinal cord PRV: Dmax 639(389–898) cGy). The skin doses in vivo were Dtheory 208.85(203.16–212.53) cGy, Dfact 209.53(204.14–214.42) cGy, and |%diff| 1.77% (0.89–2.94%). Of the 360 patients enrolled in the skin side effect follow-up study (including the above 27 patients), grade 1 was the most common toxicity (321, 89.2%), some of which progressing to grade 2 or grade 3 (32, 8.9% or 7, 1.9%); the radiotherapy interruption rate was 1.1%. Conclusion A 3D-printed bolus can guarantee the precise radiation dose on skin surface, good fitness to skin, and controllable acute skin toxicity, which possesses a great clinical application value in postmastectomy chest call radiation therapy for breast cancer.
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Affiliation(s)
- Xiran Wang
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianling Zhao
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongzheng Xiang
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuetao Wang
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanyuan Zeng
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Luo
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Yan
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuang Zhang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Feng Wang
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Lei Liu,
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9
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Orozco JIJ, Keller JK, Chang SC, Fancher CE, Grumley JG. Impact of Locoregional Treatment on Survival in Young Patients with Early-Stage Breast Cancer undergoing Upfront Surgery. Ann Surg Oncol 2022; 29:6299-6310. [PMID: 35896922 DOI: 10.1245/s10434-022-12190-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Randomized, controlled trials comparing breast-conserving therapy (BCT) with mastectomy have demonstrated equivalent overall survival (OS), but recent observational studies have shown improved OS in patients undergoing BCT. These studies provide limited data on young patients who are traditionally offered mastectomy due to perceived higher disease risk. This study examines the OS in a contemporary series of young women with breast cancer undergoing upfront BCT compared with mastectomy. METHODS Women ≤40 years old with primary invasive T1-T2, N0-N1 breast cancer were identified from the National Cancer Database between 2006 and 2016. Patient cohorts were based according to locoregional treatment: BCT, mastectomy alone (Mx), and mastectomy with radiotherapy (Mx/RT). Kaplan-Meier method followed by Cox proportional-hazards regression with inverse probability of treatment weighting (IPTW) were performed to account for treatment selection bias effects in OS. RESULTS A total of 15,611 patients met the study criteria; 9,509 patients (60.9%) had BCT, 4,020 (25.8%) had Mx/RT, and 2,082 (13.3%) had Mx alone. The median follow-up was 4.6 years (interquartile range [IQR] 3.0-6.4). After IPTW-adjustment, the 5-year OS was similar for BCT (95%), Mx (95%), and Mx/RT (94%), and there was no significant difference in OS in Mx (hazard ratio [HR] = 1.16, 95% confidence interval [CI] 0.90-1.51) and Mx/RT (HR = 1.08, 95% CI 0.88-1.34) compared with BCT. Mx/RT was associated with decreased survival in patients with pT2N0 (HR = 1.78, 95% CI 1.12-2.84). CONCLUSIONS Among young patients with early-stage breast cancer, overall survival was equivalent regardless of surgical approach. Breast-conserving therapy remains a safe option in young women despite the clinical tendency to offer upfront mastectomy in young patients.
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Affiliation(s)
- Javier I J Orozco
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Jennifer K Keller
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Shu-Ching Chang
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Saint Joseph Health, Portland, OR, USA
| | - Crystal E Fancher
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Janie G Grumley
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.
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Nelson JA, Rubenstein RN, Haglich K, Chu JJ, Yin S, Stern CS, Morrow M, Mehrara BJ, Gemignani ML, Matros E. Analysis of a Trend Reversal in US Lumpectomy Rates From 2005 Through 2017 Using 3 Nationwide Data Sets. JAMA Surg 2022; 157:702-711. [PMID: 35675047 DOI: 10.1001/jamasurg.2022.2065] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Rates of lumpectomy for breast cancer management in the United States previously declined in favor of more aggressive surgical options, such as mastectomy and contralateral prophylactic mastectomy (CPM). Objective To evaluate longitudinal trends in the rates of lumpectomy and mastectomy, including unilateral mastectomy vs CPM rates, and to determine characteristics associated with current surgical practice using 3 national data sets. Design and Setting Data from the National Surgical Quality Improvement Program (NSQIP), Surveillance, Epidemiology, and End Results (SEER) program, and National Cancer Database (NCDB) were examined to evaluate trends in lumpectomy and mastectomy rates from 2005 through 2017. Mastectomy rates were also evaluated with a focus on CPM. Longitudinal trends were analyzed using the Cochran-Armitage test for trend. Multivariate logistic regression models were performed on the NCDB data set to identify predictors of lumpectomy and CPM. Results A study sample of 3 467 645 female surgical breast cancer patients was analyzed. Lumpectomy rates reached a nadir between 2010 and 2013, with a significant increase thereafter. Conversely, in comparison with lumpectomy rates, overall mastectomy rates declined significantly starting in 2013. Cochran-Armitage trend tests demonstrated an annual decrease in lumpectomy rates of 1.31% (95% CI, 1.30%-1.32%), 0.07% (95% CI, 0.01%-0.12%), and 0.15% (95% CI, 0.15%-0.16%) for NSQIP, SEER, and NCDB, respectively, from 2005 to 2013 (P < .001, P = .01, and P < .001, respectively). From 2013 to 2017, the annual increase in lumpectomy rates was 0.96% (95% CI, 0.95%-0.98%), 1.60% (95% CI, 1.59%-1.62%), and 1.66% (95% CI, 1.65%-1.67%) for NSQIP, SEER, and NCDB, respectively (all P < .001). Comparisons of specific mastectomy types showed that unilateral mastectomy and CPM rates stabilized after 2013, with unilateral mastectomy rates remaining higher than CPM rates throughout the entire time period. Conclusions This observational longitudinal analysis indicated a trend reversal with an increase in lumpectomy rates since 2013 and an associated decline in mastectomies. The steady increase in CPM rates from 2005 to 2013 has since stabilized. The reasons for the recent reversal in trends are likely multifactorial. Further qualitative and quantitative research is required to understand the factors driving these recent practice changes and their associations with patient-reported outcomes.
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Affiliation(s)
- Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robyn N Rubenstein
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathryn Haglich
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jacqueline J Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shen Yin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carrie S Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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11
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Wang S, Tang W, Wang S, Hong S, Liu J. Racial Disparities in Survival of Breast Cancer Patients After Surgery. Front Public Health 2022; 10:831906. [PMID: 35646795 PMCID: PMC9136217 DOI: 10.3389/fpubh.2022.831906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/12/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction The racial disparities of opportunity to receive the appropriate intervention and lower insurance coverage may result in survival disparities in different races. This study aims to provide a perspective on racial disparities in the survival of breast cancer patients after surgery. Methods Through data from the Surveillance, Epidemiology, and End Results (SEER) program, this study estimated the survival of breast cancer patients of different races from 1998 to 2017. Inverse probability weighting (IPW) was utilized to adjust the imbalanced clinicopathological features of patients of different races. Results This study analyzed 214,965 breast cancer patients after surgery. Among them, 130,746 patients received BCS, and the remaining 84,219 breast cancer patients underwent mastectomy. Although Asian or Pacific Islander (API) patients after surgery showed higher survival benefit than that of white patients in the primary data, after adjusting for age at diagnosis, luminal subtype, grade, T stage, and N stage in different races, white individuals had the longest period of survival was higher than that of the minority groups in BCS group [breast cancer-specific survival (BCSS): HRWhitevs.API = 0.402, HRWhitevs.Black = 0.132; P < 0.001; overall survival (OS): HRWhitevs.API = 0.689, HRWhitevs.Black = 0.254; all P < 0.001] and mastectomy group (BCSS: HRWhitevs.API = 0.325, HRWhitevs.Black = 0.128; P < 0.001; OS: HRWhitevs.API = 0.481, HRWhitevs.Black = 0.206; all P < 0.001) Conclusions We first identified that the survival benefit of the minority group after surgery was lower than that of white individuals, regardless of tumor chrematistics and surgery types.
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Affiliation(s)
- Shuhan Wang
- Breast Cancer Center, West District of The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Weifang Tang
- Breast Cancer Center, West District of The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shengying Wang
- Breast Cancer Center, West District of The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shikai Hong
- Breast Cancer Center, West District of The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Shikai Hong
| | - Jianjun Liu
- Breast Cancer Center, West District of The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- *Correspondence: Jianjun Liu
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12
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Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality. Breast Cancer Res Treat 2022; 193:445-454. [PMID: 35286524 DOI: 10.1007/s10549-022-06564-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To examine trends in the surgical treatment of breast cancer by age, rurality, and among Black women in a populous, racially diverse, state in the Southeastern United States of America. METHODS We identified women diagnosed with localized or regional breast cancer between 2003 and 2016 in the North Carolina Central Cancer Registry (n = 86,776). Using Joinpoint regression we evaluated the average annual percentage change in proportion of women treated with mastectomy versus breast-conserving surgery overall, by age group, among Black women, and for women residing in rural areas. RESULTS Overall, the rate of mastectomy usage in the population declined 2.5% per year between 2003 and 2016 (95% CI - 3.2, - 1.7). Over this same time interval, breast-conserving surgery increased by 1.6% per year (95% CI 0.9, 2.2). These temporal trends in surgery were also observed among Black women and rural residing women. Trends in surgery type varied by age group: mastectomy declined over time among women > 50 years, but not among women aged 18-49 at diagnosis. DISCUSSION In contrast to national studies that reported increasing use of mastectomy, we found declining mastectomy rates in the early 2000s in a Southern US state with a racially and geographically diverse population. These decreasing trends were consistent among key subgroups affected by cancer inequities, including Black and White rural women.
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13
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Trends in surgery and adjuvant treatment for early-stage breast cancer: a population-based study in Queensland, Australia. Breast Cancer Res Treat 2022; 193:175-185. [PMID: 35254604 DOI: 10.1007/s10549-022-06551-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/18/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Our aim was to describe variations in the treatment of early-stage breast cancer and to examine factors associated with disease-specific survival (DSS). METHODS The study used linked data for 24,190 women with a T1 (≤ 20 mm) breast cancer who underwent surgery from 2005 to 2019. Multivariate logistic regression was used to model predictors of receiving breast-conserving surgery (BCS) compared to mastectomy and a multinomial model was used to examine factors associated with type(s) of treatment received. RESULTS Overall, 70.3% had BCS, with a reduced likelihood of BCS observed for younger women (p < 0.001), rural residence, (p < 0.001), socioeconomic disadvantage (p = 0.004), higher tumour grade (p < 0.001) and surgery in a public versus private hospital (p < 0.001). Compared to women who received BCS and radiation therapy (RT), those having mastectomy alone or mastectomy plus RT were more likely to be younger (p < 0.001), live in a rural area (p < 0.001), have higher-grade tumours (p < 0.001) and positive lymph nodes (p < 0.001). Overall 5-year survival was 95.3% and breast cancer-specific survival was 98.3%. Highest survival was observed for women having BCS and RT and lowest for those having mastectomy and RT (p < 0.001). CONCLUSION Our results indicate some variation in the management of early-stage breast cancer. Lower rates of BCS were observed for rural and disadvantaged women and for those treated in a public or low-volume hospital. Whilst survival was high for this cohort, differences in tumour biology likely explain the differences in survival according to treatment type.
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14
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O'Keefe TJ, Harismendy O, Wallace AM. Large and diffuse ductal carcinoma in situ: potentially lethal subtypes of "preinvasive" disease. Int J Clin Oncol 2022; 27:121-130. [PMID: 34618239 PMCID: PMC10874643 DOI: 10.1007/s10147-021-02036-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/17/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Trials for DCIS have not explored whether outcomes for patients with large disease burden requiring mastectomy are comparable to those of patients with lumpectomy-amenable disease. We aim to identify whether patients with DCIS larger than 5 cm and diffuse-type DCIS differ in breast cancer mortality (BCM) from patients with disease less than 5 cm. METHODS Patients diagnosed with DCIS in the SEER program were assessed to identify factors prognostic of breast-cancer-specific survival using competing risks regression. RESULTS 44,849 patients met criteria for the cumulative incidence estimate. On competing risks cumulative incidence approximation, the 10-year estimate for BCM for each group was 1.3%, 1.3%, 2.3%, and 5.1%, respectively, and the difference among groups was significant (p = 0.017). On competing risks regression of patients with known covariates, both diffuse-type disease and disease larger than 5 cm (hazard ratio [HR] = 6.2 and 1.7, p = 0.013 and p = 0.042, respectively) were associated with increased risk of BCM. After matching, DCIS > 5 cm and diffuse disease were associated with increased BCM relative to disease < 5 cm (HR = 1.69, p = 0.04). Among patients undergoing mastectomy for disease larger than 5 cm or diffuse disease, the 10-year cumulative incidence for BCM was 0.5% among patients undergoing bilateral mastectomy and 2.4% for patients undergoing unilateral mastectomy. CONCLUSION Patients with large and diffuse DCIS represent uncommon but poorly studied DCIS subgroups with worse prognoses than patients with disease smaller than 5 cm. Further studies are needed to elucidate the appropriate treatment for these patients.
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Affiliation(s)
- Thomas J O'Keefe
- Division of Breast Surgery and The Comprehensive Breast Health Center, University of California San Diego, 0819, 3855 Health Sciences Dr, La Jolla, CA, 92037, USA.
| | - Olivier Harismendy
- Division of Biomedical Informatics, Department of Medicine, Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr, La Jolla, CA, 92037, USA
| | - Anne M Wallace
- Division of Breast Surgery and The Comprehensive Breast Health Center, University of California San Diego, 0819, 3855 Health Sciences Dr, La Jolla, CA, 92037, USA
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15
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Azam M, Aslam M, Basharat J, Mughal MA, Nadeem MS, Anwar F. An empirical study on quality of life and related factors of Pakistani breast cancer survivors. Sci Rep 2021; 11:24391. [PMID: 34937873 PMCID: PMC8695584 DOI: 10.1038/s41598-021-03696-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/08/2021] [Indexed: 12/01/2022] Open
Abstract
A comprehensive understanding of the quality of life (QoL) is essential to establish long-term survivor care plans. The present study was aimed at the assessment of QoL of BC survivors with special emphasis on post-treatment physical, emotional, social, and spiritual challenges. We have assessed the QoL of 250 female BC survivors of all age groups through demographic factors. Volunteer BC survivors were registered in the present study who had got treatment from the Institute of Nuclear Medicine and Oncology (INMOL) hospital and Mayo hospital Lahore. An informed consent form was signed by each participant. The physical, psychological, and spiritual well-being was evaluated by a questionnaire filled with the help of respondents. The average age of BC survivors was 52 ± 7.8 years. Most of them (83%) complained of fatigue during daily life activities, 75.1% body pain or headache, 77.1% had problems with appetite, 63.2% reported weight loss, 77.1% had sleep problems, and 90.5% were feeling general weakness. Only 16.2% were satisfied with their physical health and 2% were not satisfied with their medication. Psychologically, 74.4% were feeling different levels of anxiety, only 10% of them were hoping to achieve a desired life. Age group 21 to 40 years reported better physical health, those with 40-50 years of age and family history of BC have shown better mental strength. The physical and psychological health of survivors from rural areas was comparatively better than those from urban areas. The BC survivor women have to face several physical, psychological and social challenges. The majorities of them complain of anxiety, body pain, fatigue, sleep problems, general weakness, and fear about the future. Our findings suggest the need for psychological support, physical activity a comprehensive post-diagnosis and post-treatment physical and mental health assistance plan for all BC survivors. Implications for Cancer Survivors. Survivors of breast cancer experience various challenges including anxiety, sleep problems, body pain, fatigue, and fear about the future. The psychological, physical and social factors make a great difference in their quality of life.
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Affiliation(s)
- Muhammad Azam
- grid.412967.f0000 0004 0609 0799Department of Statistics and Computer Science, University of Veterinary and Animal Sciences, Lahore, 54000 Pakistan
| | - Muhammad Aslam
- Department of Statistics, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.
| | - Javeria Basharat
- grid.444922.d0000 0000 9205 361XDepartment of Statistics, Kinnaird College for Women, 93-Jail Road, Lahore, 54000 Pakistan
| | - Muhammad Anwar Mughal
- grid.444905.80000 0004 0608 7004Department of Statistics, Forman Christian College (A Chartered University), Ferozepur Road, Lahore, 54600 Pakistan
| | - Muhammad Shahid Nadeem
- grid.412125.10000 0001 0619 1117Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, 21589 Saudi Arabia
| | - Firoz Anwar
- grid.412125.10000 0001 0619 1117Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, 21589 Saudi Arabia
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Machuca MPG, Wu WC, Yu BL, Cheng CT. Determinants of Breast-Conserving Therapy in Early-Stage Breast Cancer Patients: A Nationwide Study. Clin Breast Cancer 2021; 22:e473-e479. [PMID: 34974964 DOI: 10.1016/j.clbc.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/21/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Evidence from previous studies and treatment guidelines suggested that breast-conserving therapy (BCT) is the treatment of choice for early-stage breast cancer. However, in the last decades, surgeons have noticed a high percentage of mastectomies done in this population. The aim of this study is to explore the factors associated with not choosing BCT among eligible patients with early-stage breast cancer. MATERIALS AND METHODS This study uses a retrospective cohort design. Demographic and clinical characteristics derived from The Taiwan Cancer Registry Database, the National Health Insurance Database and the Death File Database from January 1, 2004 to December 31, 2014. Patients were followed until December 31, 2015. To explore the associated factors related to BCT, we used univariate and multivariate logistic regression analysis. RESULTS A total sample of 25,967 stage I breast cancer patients was included. Among them, 12,191 underwent BCT and 13,776 underwent mastectomy as their primary treatment. The logistic regression analysis reveals that age, pay-for-performance (P4P) program participation, number of affected lymph nodes, tumor size and location, were determinants of BCT. Interestingly enough, histological type did not reach the significance level. CONCLUSION This study shows that personal and clinical characteristics influence the treatment choice in stage 1 breast cancer patients.
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Affiliation(s)
| | - Wen-Ching Wu
- Department of Medical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Ben-Long Yu
- Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chih-Tao Cheng
- Department of Medical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Department of Psychology and Social Work, National Defense University, Taipei, Taiwan.
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Rayzah M, Ryu JM, Lee JH, Nam SJ, Kim SW, Lee SK, Yu J, Lee KT, Bang SI, Mun GH, Pyon JK, Jeon BJ, Lee JE. Changes in Korean National Healthcare Insurance Policy and Breast Cancer Surgery Trend in Korea. J Korean Med Sci 2021; 36:e194. [PMID: 34313035 PMCID: PMC8313396 DOI: 10.3346/jkms.2021.36.e194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/20/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM). METHODS We retrospectively analyzed breast cancer data between April 2011 and June 2016. We divided patients who underwent IBR following TM for primary breast cancer into "uninsured" and "insured" groups using their NHI statuses at the time of surgery. Univariate analyses determined the insurance influence on the decision to undergo IBR. RESULTS Of 2,897 breast cancer patients, fewer uninsured patients (n = 625) underwent IBR compared with those insured (n = 325) (30.0% vs. 39.8%, P < 0.001). Uninsured patients were younger than those insured (median age [range], 43 [38-48] vs. 45 [40-50] years; P < 0.001). Pathologic breast cancer stage did not differ between the groups (P = 0.383). More insured patients underwent neoadjuvant chemotherapy (P = 0.011), adjuvant radiotherapy (P < 0.001), and IBR with tissue expander insertion (P = 0.005) compared with those uninsured. CONCLUSION IBR rate in patients undergoing TM increased after NHI reimbursement.
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Affiliation(s)
- Musaed Rayzah
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, Riyadh, Saudi Arabia
| | - Jai Min Ryu
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Hee Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Won Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jonghan Yu
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeong Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sa Ik Bang
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Goo Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jai Kyong Pyon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Joon Jeon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Cheng D, Baynosa J, Cross C, Kirgan D, Williams SJ, St Hill C. Comparing the effect of distance to treatment facility on reconstruction and breast conservation therapy for early-stage invasive ductal carcinoma between the nation and the mountain region. Am J Surg 2021; 224:1049-1056. [PMID: 34001333 DOI: 10.1016/j.amjsurg.2021.04.024] [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: 06/11/2019] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Our objective is to evaluate the effect of distance to facility on the use of breast conservation therapy and reconstruction for early stage breast cancer. METHODS Utilizing the National Cancer Database, we identified females, age <65, with Stage I invasive ductal carcinoma from 2004 to 2015. Using logistic regression, we compared radiation, mastectomy, and reconstruction treatment patterns. A subgroup analysis was performed within the mountain region (MR). RESULTS Nationwide, there are decreasing odds of radiation, increasing odds of mastectomy, and increasing odds of reconstruction. Patients living farther were less likely to receive radiation, more likely to undergo mastectomy, with no effect on reconstruction. Within the MR, patients living farther from their facility were less likely to receive radiation, more likely to undergo mastectomy, however, they were less likely to undergo reconstruction. CONCLUSIONS Nationwide and within the MR, patients living farther from their facility are less likely to receive radiation and more likely to undergo mastectomy. There is a disparity between the MR and the nation in use of reconstruction for this population.
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Affiliation(s)
- Daniel Cheng
- University of Nevada, Las Vegas, School of Medicine, USA.
| | | | - Chad Cross
- University of Nevada, Las Vegas, School of Medicine, USA; University of Nevada, Las Vegas, School of Public Health, USA.
| | - Daniel Kirgan
- University of Nevada, Las Vegas, School of Medicine, USA.
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Abdulwassi HK, Amer IT, Alhibshi AH, Alnajjar AA, Bahatheq AK, Trabulsi NH, Nassif MO. Recurrence rates and long-term survival factors in young women with breast cancer. Saudi Med J 2021; 41:393-399. [PMID: 32291426 PMCID: PMC7841605 DOI: 10.15537/smj.2020.4.24987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objectives: To evaluate the factors related to breast cancer (BC) recurrence as well as survival in women ≤40 years old. Methods: This is a retrospective medical record review of women aged ≤40 years diagnosed with BC stages I to III between January 2009 and June 2017 at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Demographic data collected included patients’ initial presentation (including age and date of diagnosis), imaging studies, tumor characteristics, type of surgery, systemic therapy (if any) received, and site of first recurrence. Data was analyzed to assess recurrence rate, disease-free survival (DFS), and overall survival (OS), and determine associated factors. Descriptive statistics were used to calculate the mean, median, standard deviation, and quartiles. Chi-square test was performed to test the association between 2 variables. Kaplan-Meier analyses were performed to assess survival distribution. Results: A total of 117 patients were included for analysis. Median follow-up was 16 months (range 0 to 99). Five-year DFS 57% and OS was 89%. Adjuvant chemotherapy was associated with a better DFS (hazard ratio of 0.204; 95% confidence interval, 0.050 to 0.832; p=0.027). Higher tumor, node, metastasis stage was significantly associated with worse DFS (p=0.034). Fewer postoperative follow-up visits significantly predicted recurrence (p=0.003). Conclusion: We found a high risk of BC recurrence among patients at our institution. Higher cancer stage, nonuse adjuvant chemotherapy, and low follow-up rate were significant predictive factors for recurrence.
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Affiliation(s)
- Hassan K Abdulwassi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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20
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Li X, Yan C, Xiao J, Xu X, Li Y, Wen X, Wei H. Factors Associated With Surgical Modality Following Neoadjuvant Chemotherapy in Patients with Breast Cancer. Clin Breast Cancer 2021; 21:e611-e617. [PMID: 34001440 DOI: 10.1016/j.clbc.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The breast-conserving surgery (BCS) rate for patients with breast cancer in China is much lower than that in Europe and the United States. This study aimed to identify factors affecting the choice of surgical modality following neoadjuvant chemotherapy (NAC) in patients with breast cancer in northwest China. PATIENTS AND METHODS Patients who underwent mastectomy or BCS after NAC for invasive breast cancer from January 2013 to December 2017 were enrolled in the study. Single-factor and multivariate logistic regression analyses were applied to identify the association between the type of surgery and demographic characteristics or clinical pathological factors of patients. RESULTS This study enrolled 916 patients. Among them, 191 patients (20.9%) and 725 patients (79.1%) underwent BCS and mastectomy, respectively. Patients with high education were less likely to undergo mastectomy compared with patients with less education (P < .001; odds ratio [OR] = 0.50; 95% confidence interval [CI], 0.35-0.71). Patients with cT3 tumors were nearly six times more likely to undergo mastectomy compared with patients with cT1 tumors (P = .003; OR = 5.74; 95% CI, 2.07-15.97). Moreover, patients older than 50 years of age (P < .001; OR = 2.84; 95% CI, = 1.93-4.16) were more likely to be offered mastectomy. No association between the type of surgery and pathological complete response (P = .351) was observed. CONCLUSION Pretreatment clinical disease size remains a strong predictor of surgical management, whereas response to NAC appeared to play no role in the surgical decision, suggesting that the potential surgical benefits of NAC may be still under-recogonized in northwest China.
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Affiliation(s)
- Xin Li
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an Shaanxi, China
| | - Changjiao Yan
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an Shaanxi, China
| | - Jingjing Xiao
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an Shaanxi, China
| | - Xin Xu
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an Shaanxi, China
| | - Yike Li
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an Shaanxi, China
| | - Xinxin Wen
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an Shaanxi, China
| | - Hongliang Wei
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an Shaanxi, China.
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21
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Leonardis JM, Wolff WL, Momoh AO, Lipps DB. Neuromuscular compensation strategies adopted at the shoulder following bilateral subpectoral implant breast reconstruction. J Biomech 2021; 120:110348. [PMID: 33744721 DOI: 10.1016/j.jbiomech.2021.110348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/24/2022]
Abstract
Immediate two-stage subpectoral implant breast reconstruction after mastectomy requires the surgical disinsertion of the sternocostal fiber region of the pectoralis major (PM). The disinsertion of the PM would need increased contributions from intact shoulder musculature to generate shoulder torques. This study aimed to identify neuromuscular compensation strategies adopted by subpectoral implant breast reconstruction patients using novel muscle synergy analyses. Fourteen patients treated bilaterally with subpectoral implant breast reconstruction (>2.5 years post-reconstruction) were compared to ten healthy controls. Surface electromyography was obtained from sixteen shoulder muscles as participants generated eight three-dimensional (3D) shoulder torques in five two-dimensional arm postures bilaterally. Non-negative matrix factorization revealed the muscle synergies utilized by each experimental group on the dominant and non-dominant limbs, and the normalized similarity index assessed group differences in overall synergy structure. Bilateral subpectoral implant patients exhibited similar shoulder strength to healthy controls on the dominant and non-dominant arms. Our results suggest that 3D shoulder torque is driven by three shoulder muscle synergies in both healthy participants and subpectoral implant patients. Two out of three synergies were more similar than is expected by chance between the groups on the non-dominant arm, whereas only one synergy is more similar than is expected by chance on the dominant arm. While bilateral shoulder strength is maintained following bilateral subpectoral implant breast reconstruction, a closer analysis of the muscle synergy patterns underlying 3D shoulder torque generation reveals that subpectoral implant patients adopt compensatory neuromuscular strategies only with the dominant arm.
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Affiliation(s)
| | - Whitney L Wolff
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Adeyiza O Momoh
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - David B Lipps
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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22
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Vane MLG, Hunter-Squires J, Kim S, Smidt ML, Giuliano AE. Women Could Avoid Axillary Lymph Node Dissection by Choosing Breast-Conserving Therapy Instead of Mastectomy. Ann Surg Oncol 2021; 28:2522-2528. [PMID: 33586070 DOI: 10.1245/s10434-021-09674-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/08/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND The ACOSOG Z0011 trial showed that completion axillary lymph node dissection (cALND) can be safely omitted for some patients with T1-2 clinically node-negative breast cancer with one to two involved sentinel lymph nodes (SLNs) treated with breast-conserving therapy (BCT). There is little evidence for the safety of omitting cALND for mastectomy-treated patients. Consequently, cALND is often recommended for sentinel node-positive patients treated with mastectomy. The aim of this study is to determine the proportion of patients who could avoid cALND by choosing BCT instead of mastectomy at a tertiary cancer center. PATIENTS AND METHODS All T1-2 clinically node-negative breast cancer patients treated with BCT or mastectomy between 2012 and 2017 with metastases in the SLN(s) were selected from a prospectively maintained database. Clinical factors and outcomes were evaluated between the two groups. Differences were compared using Wilcoxon rank-sum test, chi-square test or Fisher's exact test as appropriate. Significance was set at the 0.05 level for all analyses. RESULTS A total of 306 patients were included, 199 (65.0%) of whom were treated with BCT and 107 (35.0%) with mastectomy. Patients treated with mastectomy were more often treated with cALND compared with those treated with BCT (71.0% versus 26.6%, p < 0.0001). Overall, 52 of the mastectomy patients (68.4%) could have avoided cALND if they had chosen BCT. CONCLUSIONS Patients treated with mastectomy are more likely to receive cALND than those treated with BCT. Axillary management should be addressed during discussion of primary tumor therapy, and cALND may be avoided when patients choose BCT instead of mastectomy.
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Affiliation(s)
- Marissa L G Vane
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - Sungjin Kim
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marjolein L Smidt
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Armando E Giuliano
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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23
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Galstyan A, Bunker MJ, Lobo F, Sims R, Inziello J, Stubbs J, Mukhtar R, Kelil T. Applications of 3D printing in breast cancer management. 3D Print Med 2021; 7:6. [PMID: 33559793 PMCID: PMC7871648 DOI: 10.1186/s41205-021-00095-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/31/2021] [Indexed: 12/24/2022] Open
Abstract
Three-dimensional (3D) printing is a method by which two-dimensional (2D) virtual data is converted to 3D objects by depositing various raw materials into successive layers. Even though the technology was invented almost 40 years ago, a rapid expansion in medical applications of 3D printing has only been observed in the last few years. 3D printing has been applied in almost every subspecialty of medicine for pre-surgical planning, production of patient-specific surgical devices, simulation, and training. While there are multiple review articles describing utilization of 3D printing in various disciplines, there is paucity of literature addressing applications of 3D printing in breast cancer management. Herein, we review the current applications of 3D printing in breast cancer management and discuss the potential impact on future practices.
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Affiliation(s)
- Arpine Galstyan
- University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA.,Department of Radiology, Center for Advanced 3D Technologies, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA
| | - Michael J Bunker
- University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA.,Department of Radiology, Center for Advanced 3D Technologies, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA
| | - Fluvio Lobo
- University of Florida, 3100 Technology Pkwy, Orlando, FL, 32826, USA
| | - Robert Sims
- University of Florida, 3100 Technology Pkwy, Orlando, FL, 32826, USA
| | - James Inziello
- University of Florida, 3100 Technology Pkwy, Orlando, FL, 32826, USA
| | - Jack Stubbs
- University of Florida, 3100 Technology Pkwy, Orlando, FL, 32826, USA
| | - Rita Mukhtar
- University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA.,Department of Surgery, University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA
| | - Tatiana Kelil
- University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA. .,Department of Radiology, Center for Advanced 3D Technologies, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA.
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24
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Asano M, Koh GCH, Madhukumar P, Teng GYH, Liew PLL, Nagalingam S, Tan MLM, Ng YS, Tan BKT. Study protocol: a pilot quasi-experimental trial of tele-rehabilitation and tele-drain care post-mastectomy. Pilot Feasibility Stud 2021; 7:39. [PMID: 33522962 PMCID: PMC7849141 DOI: 10.1186/s40814-021-00776-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 01/18/2021] [Indexed: 11/12/2022] Open
Abstract
Background Breast cancer is the leading cancer affecting women in Singapore. Its survivors commonly experience decline in physical function and quality of life post-mastectomy, due to their upper limb morbidity and wound issues. Rehabilitation can address the aforementioned issues. When rehabilitation is accessible and easy to adhere, it can optimize recovery. Home-based tele-rehabilitation guided by healthcare professionals and self-managed by patients can potentially optimize the patients’ adherence to rehabilitation and recovery. With that in mind, a team of breast cancer specialists (oncologists, nurses, and therapists) in Singapore has developed one of the first tele-rehabilitation systems for local women undergoing a unilateral mastectomy. To our knowledge, no such systems have been evaluated or proven effective as a treatment option among local breast cancer patients with acute disabilities. Methods This is a pilot quasi-experimental trial that aims to evaluate the feasibility of tele-rehabilitation and tele-drain care compared to usual care. Up to 40 patients (20 per group) will be recruited for this trial. They will be assigned to an intervention group that receives rehabilitation via a tele-rehabilitation system or a control group that receives rehabilitation in person at their clinic. The primary outcome of this trial is rehabilitation participation (i.e., the time spent on rehabilitation). The secondary outcomes are upper extremity functioning, perceived health, and quality of life. Discussion As part of this pilot trial, patients who opt in for the tele-rehabilitation will be asked to share their experience with and thoughts on the tele-rehabilitation system. With the evidence obtained from the tele-rehabilitation patients of this trial, we will be able to improve the current system for our future trial. Further, our additional data on rehabilitation participation, physical function, and quality of life will help us design a sufficiently powered future main trial. Trial registration The trial was approved by the National Healthcare Group’s Domain Specific Review Board (#2019/00283) and registered with www.ClinicalTrials.gov (#NCT04269967) in February 2020.
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Affiliation(s)
- Miho Asano
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #09-01, Singapore, 117549, Singapore.
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #09-01, Singapore, 117549, Singapore
| | - Preetha Madhukumar
- Duke-NUS Breast Centre, 20 College Rd, Singapore, 169856, Singapore.,Department of Breast Surgery, Singapore General Hospital, 10 Hospital Blvd, Singapore, 168582, Singapore.,Department of Breast Surgery, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Gladys Yu Hui Teng
- Department of Occupational Therapy, Singapore General Hospital, 10 Hospital Blvd, Singapore, 168582, Singapore
| | - Petrina Li Ling Liew
- Department of Occupational Therapy, Singapore General Hospital, 10 Hospital Blvd, Singapore, 168582, Singapore
| | - Saraswathi Nagalingam
- Nursing Division Singapore General Hospital, 10 Hospital Blvd, Singapore, 168582, Singapore
| | - May Leng Mabel Tan
- Department of Nursing, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Yee Sien Ng
- Duke-Nus Medical School, National University of Singapore, 8 College Road, Singapore, 169867, Singapore.,Department of Rehabilitation Medicine Singapore General Hospital, 10 Hospital Blvd, 168582, Singapore, Singapore
| | - Benita Kiat Tee Tan
- Duke-NUS Breast Centre, 20 College Rd, Singapore, 169856, Singapore.,Department of Breast Surgery, Singapore General Hospital, 10 Hospital Blvd, Singapore, 168582, Singapore.,Department of Breast Surgery, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
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25
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Laterality and Patient-Reported Outcomes following Autologous Breast Reconstruction with Free Abdominal Tissue: An 8-Year Examination of BREAST-Q Data. Plast Reconstr Surg 2020; 146:964-975. [PMID: 33141527 DOI: 10.1097/prs.0000000000007239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite the rise in rates of contralateral prophylactic mastectomy, few studies have used patient-reported outcomes to assess satisfaction between unilateral and bilateral breast reconstruction with autologous tissue. The purpose of this study was to investigate patient satisfaction and quality of life following autologous reconstruction to determine whether differences exist between unilateral and bilateral reconstructions to better guide clinical decision-making. METHODS The current study examined prospectively collected BREAST-Q results following abdominal free flap breast reconstruction procedures performed at a tertiary academic medical center from 2009 to 2017. The reconstruction module of the BREAST-Q was used to assess outcomes between laterality groups (unilateral versus bilateral) at 1 year, 2 years, 3 years, and more than 3 years. RESULTS Overall, 405 patients who underwent autologous breast reconstruction completed the BREAST-Q. Cross-sectional analysis at 1 year, 2 years, and 3 years revealed similar satisfaction scores between groups; however, bilateral reconstruction patients demonstrated higher satisfaction scores at more than 3 years (p = 0.04). Bilateral reconstruction patients reported lower scores of abdominal well-being at 1 year, 2 years, and more than 3 years (p = 0.01, p = 0.03, and p = 0.01, respectively). CONCLUSIONS These results suggest that satisfaction with breasts does not differ with the laterality of the autologous reconstruction up to 3 years postoperatively but may diverge thereafter. Bilateral reconstruction patients, however, have lower satisfaction with the abdominal donor site. These data can be used in preoperative counseling, informed consent, and expectations management in patients considering contralateral prophylactic mastectomy.
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26
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Savelberg W, Boersma LJ, Smidt M, van der Weijden T. Implementing a breast cancer patient decision aid: Process evaluation using medical files and the patients' perspective. Eur J Cancer Care (Engl) 2020; 30:e13387. [PMID: 33314448 PMCID: PMC8365645 DOI: 10.1111/ecc.13387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 10/29/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
Objective Although patient decision aids (PtDAs) have been shown to improve shared decision‐making, integration into clinical care pathways remains limited. This study investigated, among other outcomes, the uptake of the PtDA by professionals and the uptake as perceived by patients. Methods We performed a process evaluation among four breast cancer care teams that had been exposed to a multifaceted implementation strategy. Data were gathered by auditing patient files using a standardised data extraction sheet and conducting telephone interviews with patients using a structured interview guide. We analysed the data by using descriptive statistics. Results We found that the implementation strategies, including advice on how and when to present the PtDA to the patient, were followed for 14% of the included patients (N = 84); 92% of the patients reported to have received a login code for the web‐based PtDA, while 67% logged in and used the PtDA at home. An important factor influencing the use was the clinician promoting it when delivering the PtDA (OR 9.95 95% CI 3.03–37.72). Discussion The implementation strategies were followed in 14% of the patients, and a high delivery of the PtDA was achieved. Redesigning the care pathway and providing personal instruction on using PtDAs seem crucial.
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Affiliation(s)
- Wilma Savelberg
- Department of Quality and Safety, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Liesbeth J Boersma
- Department of Radiotherapy (MAASTRO Clinic), Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Marjolein Smidt
- GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.,Department of surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Trudy van der Weijden
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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27
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Loreti A, Siri G, De Carli M, Fanelli B, Arelli F, Spallone D, Abate O, La Pinta M, Manna E, Meli EZ, Costarelli L, Andrulli D, Broglia L, Scavina P, Fortunato L. Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture. Breast 2020; 54:127-132. [PMID: 33010626 PMCID: PMC7529839 DOI: 10.1016/j.breast.2020.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/06/2020] [Accepted: 09/22/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Capsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed aiming to reduce the incidence of CC. We evaluated the incidence and degree of CC after Direct-to-Implant (DTI) IBR with insertion of textured (TE) or polyurethane (PU) covered implants. METHODS A retrospective review of consecutive patients treated at our Institution with mastectomy and one-stage IBR and implant reconstruction between 2013 and 2018, with or without post mastectomy radiation therapy (PMRT), was conducted. Immediate breast reconstruction was performed by implanting 186 PU covered implants and 172 TE implants. RESULTS Three-hundred-twelve women underwent 358 DTI IBR with PU or TE implants, were analyzed with a median follow-up time of 2.3 years (range 1.0-3.0). The overall rate of CC Baker grade III and IV was 11.8% (95%CI: 8.4-16.3), while, after PU and TE implant placement it was 8.1% (95% CI: 4.1-15.7) and 15.8% (95% CI: 4.1-15.7) [p = 0.009]), respectively. Irradiated breasts developed CC more frequently rather than non-irradiated breasts (HR = 12.5, p < 0.001), and the relative risk was higher in the TE group compared with the PU group (HR = 0.3, p = 0.003). CONCLUSIONS After mastectomy and one-stage IBR, the use of PU covered implants is associated with a lower incidence of CC compared to TE implants. This advantage is amplified several folds for patients who necessitate PMRT. Footnote: Capsular contracture (CC); Immediate Breast Reconstruction (IBR); Directto- Implant (DTI); Textured (TE); Polyurethane (PU); Post mastectomy radiation therapy (PMRT); Nipple Sparing mastectomy (NSM).
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Affiliation(s)
- Andrea Loreti
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy.
| | - Giacomo Siri
- Department of Mathematics, University of Genoa, Genoa, Italy
| | - Matteo De Carli
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Benedetta Fanelli
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Floriana Arelli
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Diana Spallone
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Ornella Abate
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Massimo La Pinta
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Elena Manna
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Emanuele Zarba Meli
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Leopoldo Costarelli
- Pathology Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Damiana Andrulli
- Radiation Oncology Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Laura Broglia
- Breast Radiology Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Paola Scavina
- Oncology Division, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
| | - Lucio Fortunato
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, Rome, Italy
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28
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Hammond JB, Han GR, Cronin PA, Kosiorek HE, Rebecca AM, Casey WJ, Kruger EA, Teven CM, Pockaj BA. Exploring the Effect of Post-mastectomy complications on 5-year survival. Am J Surg 2020; 220:1422-1427. [PMID: 32921402 DOI: 10.1016/j.amjsurg.2020.09.007] [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: 03/20/2020] [Revised: 07/24/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ramifications of postoperative complications on long-term survival after mastectomy are uncertain. METHODS Overall complications (Clavien-Dindo Grades I-IIIB) and wound complications were analyzed using the Kaplan-Meier method for impact on 5-year overall (OS) and disease-free survival (DFS). RESULTS A total of 378 patients underwent mastectomy alone (157, 41%) or mastectomy with reconstruction (221, 59%) for Stage I-III disease with a median follow-up of 5 years. Postoperative complications occurred in 186 patients (49%), requiring non-surgical (I/II = 83, 22%) or surgical (IIIa/IIIb = 103, 27%) management. Wound complications occurred in 140 patients (37%). Reconstruction was associated with a higher rate of complication (P < 0.001). Postoperative complications after mastectomy (with or without reconstruction) did not significantly affect OS or DFS. Wound complications also showed no significant effect on OS or DFS following mastectomy alone, or mastectomy with reconstruction. CONCLUSIONS Postoperative complications after mastectomy, with or without reconstruction, bear no significant impact on 5-year survival.
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Affiliation(s)
| | - Ga-Ram Han
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Patricia A Cronin
- Division of Surgical Oncology & Endocrine Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Heide E Kosiorek
- Department of Health Sciences Research, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Alanna M Rebecca
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - William J Casey
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Erwin A Kruger
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Chad M Teven
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Barbara A Pockaj
- Division of Surgical Oncology & Endocrine Surgery, Mayo Clinic, Phoenix, AZ, USA.
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29
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Baker JL, Mailey B, Tokin CA, Blair SL, Wallace AM. Postmastectomy Reconstruction is Associated with Improved Survival in Patients with Invasive Breast Cancer: A Single-institution Study. Am Surg 2020. [DOI: 10.1177/000313481307901004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breast reconstruction after mastectomy positively affects psychosocial well-being; however, the influence of reconstruction on cancer outcomes is unknown. The objective of our study was to compare survival in reconstructed versus nonreconstructed patients after mastectomy. All consecutive female patients diagnosed with invasive breast cancer and treated with mastectomy between 2002 and 2011 were identified from our single-institution database. All cancer operations were performed by two surgeons. Survival was calculated using the Kaplan-Meier method and compared using the log-rank test. To identify the effect of reconstruction on survival, a multivariate Cox regression analysis was performed. Of 474 patients treated, 340 (71.7%) underwent breast reconstruction. At a mean follow-up 3.3 years, reconstructed patients had a longer 5-year survival (91 vs 74%, P < 0.001). After controlling for age, race, payer source, cancer stage, triple negative status, and receipt of radiation or chemotherapy, reconstructed patients maintained a survival advantage over nonreconstructed patients (hazard ratio, 0.47; 95% confidence interval, 0.25 to 0.88; P = 0.02). Patients with breast cancer who undergo reconstruction have longer survival than nonreconstructed patients. The explanation for this finding may be related to improved psychosocial qualities of life versus possible antitumorigenic effects of implants.
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Affiliation(s)
- Jennifer L. Baker
- Department of Surgery, University of California, San Diego, San Diego, California
| | - Brian Mailey
- Department of Surgery, University of California, San Diego, San Diego, California
- Plastic and Reconstructive Surgery, University of California, San Diego, San Diego, California
| | - Christopher A. Tokin
- Department of Surgery, University of California, San Diego, San Diego, California
| | - Sarah L. Blair
- Department of Surgery, University of California, San Diego, San Diego, California
- Division of Surgical Oncology, University of California, San Diego, San Diego, California
| | - Anne M. Wallace
- Department of Surgery, University of California, San Diego, San Diego, California
- Division of Surgical Oncology, University of California, San Diego, San Diego, California
- Plastic and Reconstructive Surgery, University of California, San Diego, San Diego, California
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30
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Casaubon JT, Kuehn RB, Pesek SE, Raker CA, Edmonson DA, Stuckey A, Gass JS. Breast-Specific Sensuality and Appearance Satisfaction: Comparison of Breast-Conserving Surgery and Nipple-Sparing Mastectomy. J Am Coll Surg 2020; 230:990-998. [PMID: 32272205 DOI: 10.1016/j.jamcollsurg.2020.02.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND We demonstrated previously that lumpectomy (L) patients reported higher appearance satisfaction, appreciation of a pleasurable breast caress, and persistence of the breast during intimacy than mastectomy with reconstruction, which we used to describe breast-specific sensuality. Our current objective was to compare breast-specific sensuality between L and nipple-sparing mastectomy (NSM). DESIGN An anonymous, cross-sectional survey was distributed to breast cancer survivors between 2014 and 2016. Eligible patients underwent operation between 2000 and 2014, were adults older than 18 years, English-speaking, and at least one year into the post-operative period. Demographic characteristics, treatment details, Female Sexual Function Index metrics, and investigator-generated questions about appearance satisfaction and breast-specific sensuality were collected. RESULTS Of the 600 women who participated, 585 surveys were eligible. Surgical modality was reported as L by 406 (69.4%), mastectomy alone by 50 (8.5%), and mastectomy with reconstruction by 129 (22.1%). Nipple-preservation data were available for 47 of 129 mastectomy with reconstruction patients (36.4%), with 21 NSM and 26 non-nipple-sparing mastectomy patients. Favorable postoperative appearance satisfaction was reported by 76.2% of L and 71.4% of NSM (p = 0.039). Lumpectomy patients reported feeling more comfortable being seen undressed than NSM patients (82.4% vs 71.4%; p = 0.0003). The chest remained a part of intimacy for 65.4% of L patients vs 42.9% of NSM patients (p = 0.0009). A pleasurable breast caress was reported more frequently by L patients than NSM patients (66.2% vs 20%; p ≤ 0.0001). The breast caress was unpleasant for 40% of NSM patients, nearly 4-fold higher than L patients (11.3%; p < 0.0001). CONCLUSIONS NSM patients were significantly less satisfied with appearance, less comfortable being seen undressed, had decreased persistence of breast intimacy, and experienced a less pleasurable breast caress than L patients. Counseling patients about these findings will empower informed decision making, optimize expectations, and can enhance postoperative satisfaction.
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Affiliation(s)
- Jesse T Casaubon
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI.
| | - Reed B Kuehn
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Sarah E Pesek
- Breast Surgery, St Peter's Health Partners, Albany, NY
| | - Christina A Raker
- Division of Research, Women & Infants Hospital of Rhode Island, Providence, RI
| | - David A Edmonson
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Ashley Stuckey
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Jennifer S Gass
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
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Zehra S, Doyle F, Barry M, Walsh S, Kell MR. Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis. Breast Cancer 2020; 27:534-566. [PMID: 32162181 DOI: 10.1007/s12282-020-01076-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 02/27/2020] [Indexed: 12/21/2022]
Abstract
The present review evaluated health-related quality of life (HR-QoL) outcomes in surgical breast cancer survivors who received breast reconstruction (BR), breast-conservation surgery (BCS) or mastectomy (M), and whether HR-QoL domains across generic and disease/surgery-specific questionnaires are compatible. Six electronic databases were searched for appropriate observational studies. Standardized scores for different HR-QoL domains in the BR, BCS, and M treatment groups were extracted from each study for the purpose of a meta-analysis. Using Stata version 14.0, a random-effects meta-analysis model was adopted for each outcome variable to estimate the effect size, 95% CI-confidence intervals, and statistical significance. Sixteen of the 18 eligible studies with BR (n = 1474) and BCS (n = 2612) or M (n = 1458) groups were included in the meta-analysis. The BR group exhibited a better physical health (k = 12; 0.1, 95% CI 0.04, 0.24) and body image (k = 12; 0.50, 95% CI 0.10, 0.89) than the M group. However, the two groups exhibited comparable social health (k = 13; 0.1, 95% CI -0.07, 0.37), emotional health (k = 13; -0.08, 95% CI - 0.41, 0.25), global health (k = 7; 0.1, 95% CI - 0.01, 0.27), and sexual health (k =11; 0.2, 95% CI - 0.02,0.57). There was no clear evidence of the superiority of BR to BCS for all the six domains. These results suggest that HR-QoL outcomes in BR and BCS groups are better than the M group. Therefore, women opting for BR or BCS are likely to report fairly better HR-QoL outcomes than M. However, due to the significant heterogeneity observed in most BR versus BCS outcomes, developing a unified questionnaire incorporating both breast/surgery-specific and generic HR-QoL domains is warranted.
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Affiliation(s)
- Sadaf Zehra
- Department of General Surgery, St George's University Hospital, London, UK.
| | - F Doyle
- Royal College of Surgeon Ireland, Dublin, Ireland
| | - M Barry
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Walsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M R Kell
- Mater Misericordiae University Hospital, Dublin, Ireland
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Lin HY, Han HW, Wang YS, He DL, Sun WX, Feng L, Wen ZL, Yang MK, Lu GH, Wang XM, Qi JL, Yang YH. Shikonin and 4-hydroxytamoxifen synergistically inhibit the proliferation of breast cancer cells through activating apoptosis signaling pathway in vitro and in vivo. Chin Med 2020; 15:23. [PMID: 32175001 PMCID: PMC7063777 DOI: 10.1186/s13020-020-00305-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/28/2020] [Indexed: 01/13/2023] Open
Abstract
Background Tamoxifen (TAM) is a cell type-specific anti-estrogen and is applied to improve the survival of patients with estrogen receptor positive (ER +) breast cancer. However, long-term TAM use can induce serious drug resistance, leading to breast cancer recurrence and death in patients. Further, it is almost useless among patients with estrogen receptor negative (ER −) breast cancer. Shikonin (SK) is a natural product broadly explored in cancer therapy. Some studies have demonstrated the combined treatment of SK and clinical anticancer drugs including TAM on various tumors. However, the combined effect of SK and 4-hydroxytamoxifen (4-OHT) on ER- breast cancer is not known. The current study aimed to assess the combination effects of SK and 4-OHT on human breast cancer cells, MCF-7 (ER +) and MDA-MB-435S (ER −), in vitro and in vivo and to investigate the underlying mechanisms. Methods CCK-8 assays and flow cytometry were conducted to determine the cell viability and apoptotic profiles of human breast cancer cell lines (MCF-7 and MDA-MB-435S) treated with SK, 4-OHT, and the combination. ROS and JC-1 assays were used to determine ROS level and mitochondrial membrane potential. Western blot analysis was performed to investigate proteins that are associated with apoptosis. Haematoxylin & Eosin (HE) staining was used to detect the tumor and kidney morphology of mice. TUNEL and immunohistochemical staining were performed to detect Ki67 expression level and cell apoptotic profile in tumor tissues. Results SK and 4-OHT synergistically inhibited MCF-7 and MDA-MB-435S cell proliferation and promoted apoptosis by reducing mitochondrial membrane potential and increasing the intracellular ROS level. The combination of SK and 4-OHT activated the mitochondrial-dependent apoptosis and the death receptor pathways, significantly regulating the PI3K/AKT/Caspase 9 signaling pathway. Compared with SK and 4-OHT alone, the combination of SK and 4-OHT could better inhibit tumor growth in mice. Conclusion The combination of SK and 4-OHT shows highly efficient anticancer effects on breast cancer therapy. SK may be a promising candidate as an adjuvant to 4-OHT for breast cancer treatments, especially for ER- breast cancer.
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Affiliation(s)
- Hong-Yan Lin
- 1State Key Laboratory of Pharmaceutical Biotechnology, Institute of Plant Molecular Biology, School of Life Sciences, Nanjing University, Nanjing, 210023 People's Republic of China.,2Co-Innovation Center for Sustainable Forestry in Southern China, Nanjing Forestry University, Nanjing, 210037 People's Republic of China
| | - Hong-Wei Han
- 1State Key Laboratory of Pharmaceutical Biotechnology, Institute of Plant Molecular Biology, School of Life Sciences, Nanjing University, Nanjing, 210023 People's Republic of China.,2Co-Innovation Center for Sustainable Forestry in Southern China, Nanjing Forestry University, Nanjing, 210037 People's Republic of China
| | - Yin-Song Wang
- 1State Key Laboratory of Pharmaceutical Biotechnology, Institute of Plant Molecular Biology, School of Life Sciences, Nanjing University, Nanjing, 210023 People's Republic of China
| | - De-Liu He
- 1State Key Laboratory of Pharmaceutical Biotechnology, Institute of Plant Molecular Biology, School of Life Sciences, Nanjing University, Nanjing, 210023 People's Republic of China
| | - Wen-Xue Sun
- 1State Key Laboratory of Pharmaceutical Biotechnology, Institute of Plant Molecular Biology, School of Life Sciences, Nanjing University, Nanjing, 210023 People's Republic of China
| | - Lu Feng
- 1State Key Laboratory of Pharmaceutical Biotechnology, Institute of Plant Molecular Biology, School of Life Sciences, Nanjing University, Nanjing, 210023 People's Republic of China
| | - Zhong-Ling Wen
- 1State Key Laboratory of Pharmaceutical Biotechnology, Institute of Plant Molecular Biology, School of Life Sciences, Nanjing University, Nanjing, 210023 People's Republic of China
| | - Min-Kai Yang
- 1State Key Laboratory of Pharmaceutical Biotechnology, Institute of Plant Molecular Biology, School of Life Sciences, Nanjing University, Nanjing, 210023 People's Republic of China
| | - Gui-Hua Lu
- 1State Key Laboratory of Pharmaceutical Biotechnology, Institute of Plant Molecular Biology, School of Life Sciences, Nanjing University, Nanjing, 210023 People's Republic of China.,3School of Life Sciences, Huaiyin Normal University, Huaian, 223300 China
| | - Xiao-Ming Wang
- 1State Key Laboratory of Pharmaceutical Biotechnology, Institute of Plant Molecular Biology, School of Life Sciences, Nanjing University, Nanjing, 210023 People's Republic of China.,2Co-Innovation Center for Sustainable Forestry in Southern China, Nanjing Forestry University, Nanjing, 210037 People's Republic of China
| | - Jin-Liang Qi
- 1State Key Laboratory of Pharmaceutical Biotechnology, Institute of Plant Molecular Biology, School of Life Sciences, Nanjing University, Nanjing, 210023 People's Republic of China.,2Co-Innovation Center for Sustainable Forestry in Southern China, Nanjing Forestry University, Nanjing, 210037 People's Republic of China
| | - Yong-Hua Yang
- 1State Key Laboratory of Pharmaceutical Biotechnology, Institute of Plant Molecular Biology, School of Life Sciences, Nanjing University, Nanjing, 210023 People's Republic of China.,2Co-Innovation Center for Sustainable Forestry in Southern China, Nanjing Forestry University, Nanjing, 210037 People's Republic of China
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Montagna G, Morrow M. Contralateral prophylactic mastectomy in breast cancer: what to discuss with patients. Expert Rev Anticancer Ther 2020; 20:159-166. [PMID: 32077338 DOI: 10.1080/14737140.2020.1732213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: The contralateral prophylactic mastectomy (CPM) rate in the U.S. has been steadily increasing. This is of particular concern because many women who undergo this procedure are candidates for breast-conserving surgery.Areas covered: CPM's medical benefit is related to the risk of contralateral cancer development and whether CPM provides a survival benefit. Contralateral cancer rates have decreased, and CPM does not provide a survival benefit. Other potential benefits of the procedure may be improved quality of life; these data are reviewed. Research efforts have been undertaken to better understand the decision-making process of patients who consider, and ultimately undergo, this procedure.Expert opinion: Decisional traits, personal values, the desire for peace of mind, and the desire to obtain breast symmetry are important factors that drive a woman's decision to undergo CPM. Additionally, many patients lack the knowledge on how different types of breast surgery impact outcomes. To improve the shared decision-making process, a stepwise approach to address possible misconceptions, and clarify the real risks/benefits of this procedure should be utilized. A clear recommendation (for/against) should be made for every patient with newly diagnosed breast cancer who considers CPM. Communication tools to assist patients and surgeons in this process are sorely needed.
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Affiliation(s)
- Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Siotos C, Lagiou P, Cheah MA, Bello RJ, Orfanos P, Payne RM, Broderick KP, Aliu O, Habibi M, Cooney CM, Naska A, Rosson GD. Determinants of receiving immediate breast reconstruction: An analysis of patient characteristics at a tertiary care center in the US. Surg Oncol 2020; 34:1-6. [PMID: 32103789 DOI: 10.1016/j.suronc.2020.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/14/2020] [Accepted: 02/14/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast reconstruction is an option for women undergoing mastectomy for breast cancer. Previous studies have reported underutilization of reconstructive surgery. This study aims to examine the role demographic, clinical and socio-economic factors may have on patients' decisions to undergo breast reconstruction. METHODS We analyzed data from our institutional database. Using multivariable and multinomial logistic regression, we compared breast cancer patients who had undergone mastectomy-only to those who had immediate breast reconstruction (overall and by type of reconstruction). RESULTS We analyzed data on 1459 women who underwent mastectomy during the period 2003-2015. Of these, 475 (32.6%) underwent mastectomy-only and 984 (67.4%) also underwent immediate breast reconstruction. After adjusting for potential confounders, older age (OR = 0.18, 95%CI:0.08-0.40), Asian race (OR = 0.29, 95%CI:0.19-0.45), bilateral mastectomy (OR = 0.71, 95%CI:0.56-0.90), and higher stage of disease (OR = 0.44, 95%CI:0.26-0.74) were independent risk factors for not receiving immediate breast reconstruction. Furthermore, patients with Medicare or Medicaid insurance were less likely than patients with private insurance to receive an autologous reconstruction. There was no evidence for changes over time in the way socio-demographic and clinical factors were related to receiving immediate breast reconstruction after mastectomy. CONCLUSIONS Clinical characteristics, sociodemographic factors like age, race and insurance coverage affect the decision for reconstructive surgery following mastectomy.
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Affiliation(s)
- Charalampos Siotos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287.
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece
| | - Michael A Cheah
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Ricardo J Bello
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287; Department of Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Phillipos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece
| | - Rachael M Payne
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Kristen P Broderick
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Oluseyi Aliu
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Mehran Habibi
- Department of Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Androniki Naska
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece
| | - Gedge D Rosson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
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The Effect of the Breast Cancer Provider Discussion Law on Breast Reconstruction Rates in New York State. Plast Reconstr Surg 2020; 144:560-568. [PMID: 31461002 DOI: 10.1097/prs.0000000000005904] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND New York State passed the Breast Cancer Provider Discussion Law in 2010, mandating discussion of insurance coverage for reconstruction and expedient plastic surgical referral, two significant factors found to affect reconstruction rates. This study examines the impact of this law. METHODS A retrospective cohort study of the New York State Planning and Research Cooperative System database to examine breast reconstruction rates 3 years before and 3 years after law enactment was performed. Difference-interrupted time series models were used to compare trends in the reconstruction rates by sociodemographic factors and provider types. RESULTS The study included 32,452 patients. The number of mastectomies decreased from 6479 in 2008 to 5235 in 2013; the rate of reconstruction increased from 49 percent in 2008 to 62 percent in 2013. This rise was seen across all median income brackets, races, and age groups. When comparing before to after law enactment, the increase in risk-adjusted reconstruction rates was significantly higher for African Americans and elderly patients, but the disparity in reconstruction rates did not change for other races, different income levels, or insurance types. Reconstruction rates were also not significantly different between those treated in various hospital settings. CONCLUSIONS The aim of the Breast Cancer Provider Discussion Law is to improve reconstruction rates through provider-driven patient education. The authors' data show significant change following law passage in African American and elderly populations, suggesting effectiveness of the law. The New York State Provider Discussion Law may provide a template for other states to model legislation geared toward patient-centered improvement of health outcomes.
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Rahmati M, Johari B, Kadivar M, Rismani E, Mortazavi Y. Suppressing the metastatic properties of the breast cancer cells using STAT3 decoy oligodeoxynucleotides: A promising approach for eradication of cancer cells by differentiation therapy. J Cell Physiol 2020; 235:5429-5444. [PMID: 31912904 DOI: 10.1002/jcp.29431] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022]
Abstract
Due to the presence of cancer stem cells (CSCs), breast cancer often relapsed after conventional therapies. Strategies that induce differentiation of CSCs will be helpful in eradication of tumor cells, so we designed an oligodeoxynucleotide (ODNs) for targeting of signal transducer and activator of transcription 3 (STAT3) transcription factor which is involved in stemness, and constitutively activated in triple-negative breast cancer. Molecular docking and electrophoretic mobility shift assay analysis showed that decoy ODN bound specifically to the DNA binding site of STAT3 protein. The prevalent uptake of Cy3-labeled ODNs is in the cytoplasm and the nucleus of MDA-MB-231 treated cells. STAT3 decoy ODNs treatment showed cell growth inhibition by decreasing cell viability (17%), increasing the percentage of arrested cells in G0/G1 phases (18%), and triggering apoptosis (29%). Migration and invasion potential decreased from 10.77 to 6.76 µm/hr, by wound closure rate, and migrated/invaded percentage by 26.4% and 15.4% in the transwell assays, respectively. CD44 protein expression level on the cell surface also decreased, while CD24 increased. Mammosphere formation efficiency reduced in terms of tumorsphere size by 47%, while the required time increased. Cells morphology was changed, and lipid droplets were accumulated in the cytoplasm compared to the control and scrambled groups, in all assays (repeated triplicate). Furthermore, the gene expression of all downstream targets significantly decreased owing to suppressing the STAT3 transcription factor. Overall, the results confirmed the antitumor effects of STAT3 decoy in MDA-MB-231 cells. Thus, it seems that STAT3 decoy ODNs might be considered as an auxiliary tool for breast cancer eradicating by the differentiation therapy approach.
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Affiliation(s)
- Mohammad Rahmati
- Department of Medical Biotechnology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Behrooz Johari
- Department of Medical Biotechnology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.,Cancer Gene Therapy Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehdi Kadivar
- Department of Biochemistry, Pasteur Institute of Iran, Tehran, Iran
| | - Elham Rismani
- Molecular Medicine Department, Pasteur Institute of Iran, Tehran, Iran
| | - Yousef Mortazavi
- Department of Medical Biotechnology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.,Cancer Gene Therapy Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
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Yadav S, Karam D, Riaz IB, Xie H, Durani U, Duma N, Giridhar KV, Hieken TJ, Boughey JC, Mutter RW, Hawse JR, Jimenez RE, Couch FJ, Ferre RAL, Ruddy KJ. Male breast cancer in the United States: Treatment patterns and prognostic factors in the 21st century. Cancer 2020; 126:26-36. [PMID: 31588557 PMCID: PMC7668385 DOI: 10.1002/cncr.32472] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/02/2019] [Accepted: 07/29/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Male breast cancer (MBC) is a rare disease for which there is limited understanding of treatment patterns and prognostic factors. METHODS Men with TNM stage I to stage III breast cancer diagnosed between 2004 and 2014 in the National Cancer Data Base were included. Trends in treatment modalities were described using the average annual percentage change (AAPC) and estimated using Joinpoint software for the analysis of trends. Kaplan-Meier curves and the multivariate Cox proportional hazards regression model were used to compare survival between subgroups and to identify prognostic factors. RESULTS A total of 10,873 MBC cases were included, with a median age at diagnosis of 64 years. Breast-conserving surgery was performed in 24% of patients, and 70% of patients undergoing breast conservation received radiotherapy. Approximately 44% of patients received chemotherapy, and 62% of patients with estrogen receptor-positive disease received endocrine therapy. Oncotype DX was ordered in 35% of patients with lymph node-negative, estrogen receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative tumors. During the study period, there was a significant increase in the rates of total mastectomy, contralateral prophylactic mastectomy, radiotherapy after breast conservation, ordering of Oncotype DX, and the use of endocrine therapy (P < .05). On multivariate analysis, factors found to be associated with worse overall survival were older age, black race, higher Charlson Comorbidity Index, high tumor grade and stage of disease, and undergoing total mastectomy. Residing in a higher income area; having progesterone receptor-positive tumors; and receipt of chemotherapy, radiotherapy, and endocrine therapy were associated with better overall survival. CONCLUSIONS Despite the lack of prospective randomized trials in patients with MBC, the results of the current study demonstrated that the treatment of this disease has evolved over the years. These findings further the understanding of the modern treatment and prognosis of MBC, and identify several areas for further research.
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Affiliation(s)
- Siddhartha Yadav
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Dhauna Karam
- Department of Community Internal Medicine, Mayo Clinic Health System at Austin and Albert Lea, Albert Lea, MN 56007, USA
| | - Irbaz Bin Riaz
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Hao Xie
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Urshila Durani
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Narjust Duma
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Karthik V. Giridhar
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Tina J. Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Judy C. Boughey
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert W. Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - John R. Hawse
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rafael E. Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Roberto A. Leon Ferre
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kathryn J. Ruddy
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
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DeBiase SR, Sun W, Boulware D, Laronga C, Lee MC. Busting the Contralateral Prophylactic Mastectomy Myth: Incidence of Follow-up Imaging and Biopsy After Risk-Reductive Breast Surgery. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-00338-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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39
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Brown CL, McEvoy MP, Smith BL, Lanahan CR, Kelly BN, Coopey SB, Hughes KS, Oseni TS, McGugin C, Wong SM, Gadd MA, Specht MC. Long-Term Outcomes of Multiple-Wire Localizations for More Extensive Breast Cancer: Multiple-Wire Excision Does Not Increase Recurrence, Unplanned Imaging, or Biopsies. Clin Breast Cancer 2019; 20:215-219. [PMID: 31859233 DOI: 10.1016/j.clbc.2019.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/11/2019] [Accepted: 11/16/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND We previously reported that breast conservation was feasible for women with large or irregularly shaped breast cancers when tumor resection was guided by multiple localizing wires. We now report long-term outcomes of multiple-wire versus single-wire localized lumpectomies for breast cancer. PATIENTS AND METHODS We retrospectively reviewed wire-localized lumpectomies at our institution from May 2000 to November 2006. Rates of ipsilateral in-breast tumor recurrence, metastasis, and subsequent unplanned diagnostic imaging and biopsy were compared between multiple-wire and single-wire cohorts. RESULTS We identified 112 multiple-wire and 160 single-wire breast cancer lumpectomies that achieved clear margins. Median age was 64 years in the multiple-wire cohort and 57 years in the single-wire cohort. Mean lumpectomy volume was 75 mL in multiple-wire patients and 49 mL in single-wire patients (P = .003). Invasive tumor size, axillary node status, and use of radiation and systemic therapy were similar, but the multiple-wire group had more patients with ductal carcinoma-in-situ only (38% vs. 28%). At 108 months' median follow-up, there was no significant difference in local or distant recurrence rates between multiple-wire and single-wire cohorts. Six (5%) multiple-wire patients and 6 (4%) single-wire patients had local recurrences and 3 (3%) multiple-wire and 5 (3%) single-wire patients developed metastatic disease. Unplanned diagnostic imaging was required for 53 (47%) multiple-wire and 65 (41%) single-wire patients. Subsequent ipsilateral biopsy occurred in 15 (13%) multiple-wire and 19 (12%) single-wire patients. CONCLUSION Breast-conserving surgery with multiple localizing wires is a safe alternative to mastectomy for breast cancer patients with large mammographic lesions.
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Affiliation(s)
- Carson L Brown
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Maureen P McEvoy
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Barbara L Smith
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA.
| | - Conor R Lanahan
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Bridget N Kelly
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Suzanne B Coopey
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - T Salewa Oseni
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Caroline McGugin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Stephanie M Wong
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Michele A Gadd
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Michelle C Specht
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
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DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Breast cancer statistics, 2019. CA Cancer J Clin 2019; 69:438-451. [PMID: 31577379 DOI: 10.3322/caac.21583] [Citation(s) in RCA: 1755] [Impact Index Per Article: 351.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022] Open
Abstract
This article is the American Cancer Society's biennial update on female breast cancer statistics in the United States, including data on incidence, mortality, survival, and screening. Over the most recent 5-year period (2012-2016), the breast cancer incidence rate increased slightly by 0.3% per year, largely because of rising rates of local stage and hormone receptor-positive disease. In contrast, the breast cancer death rate continues to decline, dropping 40% from 1989 to 2017 and translating to 375,900 breast cancer deaths averted. Notably, the pace of the decline has slowed from an annual decrease of 1.9% during 1998 through 2011 to 1.3% during 2011 through 2017, largely driven by the trend in white women. Consequently, the black-white disparity in breast cancer mortality has remained stable since 2011 after widening over the past 3 decades. Nevertheless, the death rate remains 40% higher in blacks (28.4 vs 20.3 deaths per 100,000) despite a lower incidence rate (126.7 vs 130.8); this disparity is magnified among black women aged <50 years, who have a death rate double that of whites. In the most recent 5-year period (2013-2017), the death rate declined in Hispanics (2.1% per year), blacks (1.5%), whites (1.0%), and Asians/Pacific Islanders (0.8%) but was stable in American Indians/Alaska Natives. However, by state, breast cancer mortality rates are no longer declining in Nebraska overall; in Colorado and Wisconsin in black women; and in Nebraska, Texas, and Virginia in white women. Breast cancer was the leading cause of cancer death in women (surpassing lung cancer) in four Southern and two Midwestern states among blacks and in Utah among whites during 2016-2017. Declines in breast cancer mortality could be accelerated by expanding access to high-quality prevention, early detection, and treatment services to all women.
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Affiliation(s)
- Carol E DeSantis
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Jiemin Ma
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Mia M Gaudet
- Behavioral and Epidemiology Research, American Cancer Society, Atlanta, Georgia
| | - Lisa A Newman
- Department of Surgery, Weill Cornell Medical Center, New York, New York
| | - Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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Nealon KP, Sobti N, Gadd M, Specht M, Liao EC. Assessing the additional surgical risk of contralateral prophylactic mastectomy and immediate breast implant reconstruction. Breast Cancer Res Treat 2019; 179:255-265. [PMID: 31605310 DOI: 10.1007/s10549-019-05460-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/25/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION There has been a sharp rise in the rate of contralateral prophylactic mastectomy over the last decade, despite the low incidence of new primary cancers predicted for the contralateral breast. This study compares the postoperative complication rates between the diseased breast treated with mastectomy and the contralateral breast that underwent prophylactic mastectomy, followed by immediate bilateral breast implant reconstruction. We hypothesized that there will be no difference in postoperative outcomes between prophylactic and diseased groups, as the surgical approach would be comparable. METHODS After IRB approval, a retrospective chart review identified consecutive unilateral breast cancer patients who underwent bilateral mastectomy and immediate breast reconstruction between May 2008 and May 2018 at a tertiary academic medical center. A paired sample t-test and a penalized logic regression model were constructed to identify relationships between breast laterality and outcomes. RESULTS A total of 1117 patients with unilateral breast cancer who underwent bilateral mastectomy and immediate breast implant reconstruction were identified. Rates of capsular contracture and infection were significantly greater in the diseased breast, while rates of revision were significantly greater in the contralateral prophylactic breast. There were no statistically significant differences between breasts in rates of explant, skin flap necrosis or hematoma. When adjusted for confounding variables, a higher infection rate was observed in the diseased breast. CONCLUSION This study detected significant differences in postoperative complication rates between the diseased and prophylactic breasts following bilateral mastectomy and immediate breast implant reconstruction. Postoperative complications occurred more frequently in the diseased breast compared with low rates of complications in the contralateral prophylactic breast. This information is helpful for preoperative decision making, as surgeons and patients carefully weigh the additional risks of contralateral prophylactic procedure.
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Affiliation(s)
- Kassandra P Nealon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WACC 435, Boston, MA, 02114, USA
| | - Nikhil Sobti
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WACC 435, Boston, MA, 02114, USA
| | - Michele Gadd
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle Specht
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Eric C Liao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WACC 435, Boston, MA, 02114, USA.
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Silva E, Tan M. The Impact of Margin Status on Breast Conservation Rates. Ann Surg Oncol 2019; 26:3931-3938. [PMID: 31482391 DOI: 10.1245/s10434-019-07641-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Contemporary data indicate that breast conservation treatment (BCT) results in superior survival outcomes compared with mastectomy. However, positive margins after lumpectomy have implications for local control, and re-excisions are recommended to achieve negative margins. The need for reoperations after an initial attempt at BCT is associated with higher chance of conversion to mastectomy. Achieving negative margins at the first therapeutic surgical procedure is therefore critical to optimise BCT rates and survival outcomes. METHODS A compilation of scientific reports on BCT, margin status, rates of reoperation, and the impact on BCT rates was reviewed. Re-excision rates after initial lumpectomy is variable to a staggering degree and reported to be between 0 and 100%. High reoperation rates (ROR) are associated with higher likelihood of conversion to mastectomy, which may not confer favourable treatment outcomes. Although widely agreed that decreasing ROR is a desirable objective, there is controversy regarding the need for its urgent implementation as a quality metric. Critics of this cite challenges related to how this can be achieved and its attendant ramifications. On the other hand, without the appropriate incentive for quality improvement of surgical treatment of breast cancer, patients may be subject to poorer overall outcomes. DISCUSSION Techniques and approaches are discussed in this article to enable a reduction in positive margin status, and therefore ROR. The rationale for achieving ROR of 10-20% are explicated, as well as the impact this would have on BCT rates, which translates to better survival outcomes for women with breast cancer.
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Affiliation(s)
- Edibaldo Silva
- Surgical Oncology, University of Nebraska Medical Center, Omaha, USA.
| | - Mona Tan
- MammoCare, Breast Surgery, Singapore, Singapore
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Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, Jemal A, Kramer JL, Siegel RL. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin 2019; 69:363-385. [PMID: 31184787 DOI: 10.3322/caac.21565] [Citation(s) in RCA: 2780] [Impact Index Per Article: 556.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.
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Affiliation(s)
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | | | - Ahmedin Jemal
- Surveillance Research, American Cancer Society, Atlanta, Georgia
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Joan L Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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Patterns of Recurrence Among Higher-Risk Patients Receiving Daily External Beam Accelerated Partial-Breast Irradiation to 40 Gy in 10 Fractions. Adv Radiat Oncol 2019; 5:27-33. [PMID: 32051887 PMCID: PMC7004933 DOI: 10.1016/j.adro.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose The 2016 American Society for Radiation Oncology consensus guidelines for the use of accelerated partial-breast irradiation (APBI) define “suitable,” “cautionary,” and “unsuitable” populations for this adjuvant breast radiation therapy technique. We sought to determine whether patients in the cautionary group exhibited adverse outcomes after APBI compared with their suitable counterparts. Methods and Materials We identified 252 consecutively treated patients from a single institution with in situ or early-stage invasive breast cancer who underwent APBI between 2008 and 2017. Treatment technique was uniform throughout the population, consisting of 3-dimensional conformal radiation therapy to 40 Gy administered in 10 daily fractions. Results One hundred seventy-eight patients (70%) were classified as suitable, 69 (27%) as cautionary, and 5 (2.0%) as unsuitable. Because unsuitable patients were few and had no recurrences, they were excluded from analysis. At a median follow-up time of 3.9 years, 97.2% of patients were free of recurrence. Four patients (1.5% overall; 3 suitable and 1 cautionary) experienced ipsilateral in-breast recurrences, and 1 cautionary patient developed an ipsilateral regional recurrence in an axillary lymph node. There was no significant difference in the rate of ipsilateral breast recurrence (2.4% vs 1.0%) between cautionary and suitable groups. Conclusions Local recurrences are rare among guideline-defined cautionary patients with in situ or invasive breast cancer treated with APBI delivered via daily 3-dimensional conformal radiation therapy to 40 Gy. At a median follow-up of 3.9 years, no significant differences in local control were noted between cautionary and suitable patient groups. Further study is needed to characterize long-term disease outcomes among various risk groups.
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Squires JE, Simard SN, Asad S, Stacey D, Graham ID, Coughlin M, Clemons M, Grimshaw JM, Zhang J, Caudrelier JM, Arnaout A. Exploring reasons for overuse of contralateral prophylactic mastectomy in Canada. ACTA ACUST UNITED AC 2019; 26:e439-e457. [PMID: 31548812 DOI: 10.3747/co.26.4951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Contralateral prophylactic mastectomy (cpm) in women with known unilateral breast cancer (bca) has been increasing despite the lack of supportive evidence. The purpose of the present study was to identify the determinants of cpm in women with unilateral bca. Methods This qualitative descriptive study used semi-structured interviews informed by the Theoretical Domains Framework. We interviewed 74 key informants (surgical oncologists, plastic surgeons, medical oncologists, radiation oncologists, nurses, women with bca) across Canada. Interviews were analyzed using thematic analysis and an analysis for shared and discipline-specific beliefs. Results In total, 58 factors influencing the use of cpm were identified: 26 factors shared by various health care professional groups, 15 discipline-specific factors (identified by a single health care professional group), and 17 factors shared by women with unilateral bca. Health care professionals identified more factors discouraging the use of cpm (n = 26) than encouraging its use (n = 15); women with bca identified more factors encouraging use of cpm (n = 12) than discouraging its use (n = 5). The factor most commonly identified by health care professionals that encouraged cpm was lack of awareness of existing evidence or guidelines for the appropriate use of cpm (n = 44, 75%). For women with bca, the factor most likely influencing their decision for cpm was wanting a better esthetic outcome (n = 14, 93%). Conclusions Multiple factors discouraging and encouraging the use of cpm in unilateral bca were identified. Those factors identify potential individual, team, organization, and system targets for behaviour change interventions to reduce cpm.
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Affiliation(s)
- J E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - S N Simard
- Bloomberg School of Nursing, University of Toronto, Toronto, ON
| | - S Asad
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - D Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - I D Graham
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - M Coughlin
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - M Clemons
- Department of Medicine, University of Ottawa, Ottawa, ON.,Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON.,Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - J M Grimshaw
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON.,Department of Medicine, University of Ottawa, Ottawa, ON
| | - J Zhang
- Department of Plastic Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON
| | - J M Caudrelier
- Department of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON
| | - A Arnaout
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON.,Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON
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Cleversey C, Robinson M, Willerth SM. 3D Printing Breast Tissue Models: A Review of Past Work and Directions for Future Work. MICROMACHINES 2019; 10:E501. [PMID: 31357657 PMCID: PMC6723606 DOI: 10.3390/mi10080501] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 12/24/2022]
Abstract
Breast cancer often results in the removal of the breast, creating a need for replacement tissue. Tissue engineering offers the promise of generating such replacements by combining cells with biomaterial scaffolds and serves as an attractive potential alternative to current surgical repair methods. Such engineered tissues can also serve as important tools for drug screening and provide in vitro models for analysis. 3D bioprinting serves as an exciting technology with significant implications and applications in the field of tissue engineering. Here we review the work that has been undertaken in hopes of generating the recognized in-demand replacement breast tissue using different types of bioprinting. We then offer suggestions for future work needed to advance this field for both in vitro and in vivo applications.
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Affiliation(s)
- Chantell Cleversey
- Doctor of Medicine (MD), Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Meghan Robinson
- Department of Urological Sciences, Vancouver Prostate Centre, Vancouver, BC V6H 3Z6, Canada
- Department of Mechanical Engineering and Division of Medical Science, University of Victoria, Victoria, BC V8W 2Y2, Canada
| | - Stephanie M Willerth
- Department of Urological Sciences, Vancouver Prostate Centre, Vancouver, BC V6H 3Z6, Canada.
- Department of Mechanical Engineering and Division of Medical Science, University of Victoria, Victoria, BC V8W 2Y2, Canada.
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Lan XW, Wen G, He Z, Huang JH, Zou XB, Lin X, Tan YT, Huang XB. Comparison of long-term results between radiotherapy after breast-conserving surgery and postmastectomy radiotherapy in stage T1-2N1M0 breast cancer. Cancer Manag Res 2019; 11:6477-6487. [PMID: 31372049 PMCID: PMC6636609 DOI: 10.2147/cmar.s209634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/06/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose Postoperative radiotherapy (RT) can improve survival for T1-2N1 breast cancer. However, there exists a concern whether BCS plus RT has the same or a superior therapeutic effect as that of mastectomy. In this study, we aimed to compare the long-term results between RT after BCS and postmastectomy RT in stage T1-2N1M0 breast cancer. Patients and Methods Totally 1816 pathological stage T1-2N1M0 breast cancer patients were analyzed. The propensity score matching (PSM) method was used to select 196 pairs of patients between BCS and mastectomy receiving postoperative RT. Five-year locoregional relapse (LRR), locoregional relapse-free survival (LRFS), distant metastasis (DM), distant metastasis-free survival (DMFS), disease-free survival (DFS), breast cancer-specific survival (BCSS) were analyzed as endpoints. Results In the whole group, significant differences were observed in all endpoints (P<0.05) between the no-RT and RT groups. For patients receiving mastectomy, DM, DMFS, DFS and BCSS rates had no differences between the two groups. For patients without RT in the multivariable analysis, the molecular subtype was associated with each endpoint (P<0.05). Age, primary tumor site, tumor size, and LVI status were significantly associated with DM. The analysis of 196 pairs of patients selected by PSM showed that BCS plus RT resulted in a significantly lower 5-year DM rate (P=0.015) and superior survival in terms of the 5-year DMFS (P=0.046), DFS (P=0.049) and BCSS (P=0.024) compared with mastectomy. Conclusions Postoperative radiotherapy remarkably improved survival in T1-2N1M0 breast cancer but not in the mastectomy subgroup, except for LRR and LRFS. Patients with BCS plus RT had better survival compared with those with postmastectomy radiation in terms of DM, DMFS, DFS and BCSS.
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Affiliation(s)
- Xiao-Wen Lan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China.,Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China
| | - Ge Wen
- Department of Radiation Oncology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, People's Republic of China
| | - Zhen He
- Department of Oncology, The First Affiliation Hospital of Guangdong Pharmaceutical University, Guangzhou 510062, People's Republic of China
| | - Jiang-Hua Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China.,Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China
| | - Xue-Bin Zou
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong 510060, People's Republic of China
| | - Xiao Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China.,Department of Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China
| | - Yu-Ting Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China.,Department of Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China
| | - Xiao-Bo Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China.,Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China.,Department of Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China
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Dames LS, Ghekiere E, Zalaquett CP, Kromrey JD, Ellerbrock CR, Exum H, Paxton RJ. Correlates of dysfunctional career thoughts in breast cancer survivors from the Bahamas. J Psychosoc Oncol 2019; 37:665-675. [PMID: 31107194 DOI: 10.1080/07347332.2019.1580330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: The purpose of this research was to examine the correlates of dysfunctional career thoughts (DCTs) in a sample of breast cancers survivors. Sample and design: A total of 195 breast cancer survivors from the Bahamas completed a cross-sectional survey. Methods: The Career Thoughts Inventory (CTI) and standard medical and demographic items were administered. Analysis of Variance and logistic regression models were used to examine associations. Findings: Total CTI scores differed by age group, marital status, surgical remedy, and employment prior to diagnosis. The odds of DCT were higher among younger (Odds Ratio [OR] = 4.4), married (OR = 2.4), who were unemployed prior to diagnosis (OR = 3.5). Conclusion: Dysfunctional career thoughts appear to be common in certain breast cancer survivors. Further research is needed to determine whether similar associations are observed in other samples. Implications for Providers: Providers should discuss DCTs after treatment.
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Affiliation(s)
- Levette S Dames
- Counseling Education Program, North Carolina Central University , Durham , NC , USA
| | - Elizabeth Ghekiere
- Counseling Education Program, North Carolina Central University , Durham , NC , USA
| | - Carlos P Zalaquett
- Department of Educational Psychology, The Pennsylvania State University , University Park , PA , USA
| | - Jeffrey D Kromrey
- College of Education, University of South Florida , Tampa , FL , USA
| | | | - Herbert Exum
- College of Education, University of South Florida , Tampa , FL , USA
| | - Raheem J Paxton
- Department of Community Medicine and Population Health, University of Alabama , Tuscaloosa , AL , USA
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Surgical Therapy for Women with Multiple Synchronous Ipsilateral Breast Cancer (MIBC): Current Evidence to Guide Clinical Practice. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-0309-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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50
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Trends of mastectomy and breast-conserving surgery and related factors in female breast cancer patients treated at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, 2009-2017: A retrospective cohort study. Ann Med Surg (Lond) 2019; 41:47-52. [PMID: 31245000 PMCID: PMC6582239 DOI: 10.1016/j.amsu.2019.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/28/2019] [Accepted: 03/31/2019] [Indexed: 12/23/2022] Open
Abstract
Background Breast cancer is the most common cancer in women and accounts for 14.7% of cancer-related deaths among females worldwide. Its core management includes surgical removal of the tumor either by breast-conserving surgery (BCS) or mastectomy. Choosing between these two procedures may be influenced by factors that are not studied in our region. We aimed to determine the prevalence of BCS and mastectomy and the factors that may influence the choice of procedure. Methods This retrospective study was carried out by reviewing the records of female breast cancer patients who underwent BCS or mastectomy at between 2009 to June 2017, excluding those with metastasis or recurrence. Frequencies and multivariate tests were used for detecting correlations between procedures and demographic, clinicopathological, and radiological factors. Results Of 335 patients (mean age 52.75 ± 12.2 years), 62.4% had mastectomy and 37.6% had BCS. Modified radical mastectomy accounted for 70.8% of mastectomies. Multivariate analysis showed non-Saudi nationality (P = 0.002), multifocal (P = 0.0001) and multicentric tumors (P = 0.0001), large tumor size (P = 0.0001), tumor stages IIIA (P = 0.005) and IIIB (P = 0.014), positive HER2 (0.009), and triple-negative receptor status (P = 0.010) significantly correlated with mastectomy. Conclusion Mastectomy has a much higher prevalence than BCS in our study mainly due to advanced tumor stage at the time of diagnosis. This emphasizes the urgent need for early detection of breast cancer to move towards BCS, with education and increasing awareness of breast cancer and the surgical options, especially that it is more common in a significantly younger population in our area.
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