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Zhu S, Li S, Huang J, Fei X, Shen K, Chen X. Time interval between breast cancer diagnosis and surgery is associated with disease outcome. Sci Rep 2023; 13:12091. [PMID: 37495705 PMCID: PMC10372101 DOI: 10.1038/s41598-023-39259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023] Open
Abstract
Time interval between breast cancer (BC) diagnosis and surgery is of concern to patients and clinicians, but its impact on survival remains unclear. We identified 5130 BC patients receiving surgery between 2009 and 2017 from the Shanghai Jiaotong University Breast Cancer Database (SJTU-BCDB), and divided as Ruijin cohort and SJTU cohort. All participants were divided into three groups according to the interval between diagnosis and surgery: ≤ 1 week, 1-2 weeks, and > 2 weeks. Among 3144 patients of Ruijin cohort, the estimated 5-year breast cancer-free interval (BCFI) rates for the ≤ 1 week, 1-2 weeks and > 2 weeks groups were 91.8%, 87.5%, and 84.0% (P = 0.088), and the estimated 5-year overall survival (OS) rates were 95.6%, 89.6%, and 91.5% (P = 0.002). Multivariate analysis showed that patients with a TTS > 2 weeks had significantly lower BCFI (HR = 1.80, 95%CI 1.05-3.11, P = 0.034) and OS (HR = 2.07, 95% CI 1.04-4.13, P = 0.038) rates than patients with a TTS ≤ 1 week. Among 5130 patients when combining Ruijin cohort with SJTU cohort, the estimated 5-year BCFI rates for the ≤ 1 week, 1-2 weeks, and > 2 weeks groups were 91.0%, 87.9%, and 78.9%, and the estimated 5-year OS rates for the ≤ 1 week, 1-2 weeks, and > 2 weeks groups were 95.8%, 90.6%, and 91.5%, both with a significantly p value < 0.001. Our findings demonstrated the prolonged time to surgery (more than 2 weeks) after BC diagnosis was associated with poor disease outcomes, suggesting that efforts to early initiate treatment after diagnosis need to be pursued where possible to improve survival.
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Affiliation(s)
- Siji Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Shuai Li
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Jiahui Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Xiaochun Fei
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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Passing as normal: Negotiating boundaries and coping with male breast cancer. Soc Sci Med 2021; 284:114239. [PMID: 34303290 DOI: 10.1016/j.socscimed.2021.114239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Male breast cancer is a rare and understudied disease. In addition to coping with cancer, suffering from what is perceived as a "woman's disease" significantly burdens men's illness experience and can lead to stigmatization. The way men cope with these challenges has not been studied to date. Drawing on stigma, coping, and destigmatization theories, this study aims to explore how men experience and respond to the diagnosis of an illness typically associated with women. METHODS In-depth interviews were conducted with 16 Israeli men who were diagnosed with breast cancer within the past 10 years. Thematic analysis was performed, focusing on participants' references to experiencing and managing the psychosocial implications of being a male breast cancer patient. RESULTS Results demonstrated that participants faced stigmatizing situations both inside and outside healthcare settings. In addition, findings revealed four main responses to stigmatization: (1) selective disclosure, (2) concealment practices, (3) universalizing, and (4) making comparisons. Whereas the first two are strategic reactions to specific situations, the latter two are general conceptual destigmatizing responses. CONCLUSIONS Men's coping styles reveal their efforts to disengage from the discrediting attributes of male breast cancer, to distance themselves from female breast cancer, and to avoid emasculation. They manage stigmatizing situations using disengagement situational responses, such as concealment and selective disclosure, and negotiate group boundaries with the goal of destigmatizing male breast cancer. Beyond broadening the understanding of coping with male breast cancer, this study also illustrates the significant place of boundary work as a destigmatization practice about illness-related stigma.
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Nathanson SD, Detmar M, Padera TP, Yates LR, Welch DR, Beadnell TC, Scheid AD, Wrenn ED, Cheung K. Mechanisms of breast cancer metastasis. Clin Exp Metastasis 2021; 39:117-137. [PMID: 33950409 PMCID: PMC8568733 DOI: 10.1007/s10585-021-10090-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/20/2021] [Indexed: 02/06/2023]
Abstract
Invasive breast cancer tends to metastasize to lymph nodes and systemic sites. The management of metastasis has evolved by focusing on controlling the growth of the disease in the breast/chest wall, and at metastatic sites, initially by surgery alone, then by a combination of surgery with radiation, and later by adding systemic treatments in the form of chemotherapy, hormone manipulation, targeted therapy, immunotherapy and other treatments aimed at inhibiting the proliferation of cancer cells. It would be valuable for us to know how breast cancer metastasizes; such knowledge would likely encourage the development of therapies that focus on mechanisms of metastasis and might even allow us to avoid toxic therapies that are currently used for this disease. For example, if we had a drug that targeted a gene that is critical for metastasis, we might even be able to cure a vast majority of patients with breast cancer. By bringing together scientists with expertise in molecular aspects of breast cancer metastasis, and those with expertise in the mechanical aspects of metastasis, this paper probes interesting aspects of the metastasis cascade, further enlightening us in our efforts to improve the outcome from breast cancer treatments.
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Affiliation(s)
- S David Nathanson
- Department of Surgery, Henry Ford Cancer Institute, 2799 W Grand Boulevard, Detroit, MI, USA.
| | - Michael Detmar
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Timothy P Padera
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Danny R Welch
- Department of Cancer Biology, University of Kansas Medical Center and University of Kansas Cancer Center, Kansas City, KS, USA
| | - Thomas C Beadnell
- Department of Cancer Biology, University of Kansas Medical Center and University of Kansas Cancer Center, Kansas City, KS, USA
| | - Adam D Scheid
- Department of Cancer Biology, University of Kansas Medical Center and University of Kansas Cancer Center, Kansas City, KS, USA
| | - Emma D Wrenn
- Translational Research Program, Public Health Sciences and Human Biology Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Molecular and Cellular Biology Graduate Program, University of Washington, Seattle, WA, USA
| | - Kevin Cheung
- Translational Research Program, Public Health Sciences and Human Biology Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Eaglehouse YL, Georg MW, Jatoi I, Shriver CD, Zhu K. Factors related to re-excision procedures following primary breast-conserving surgery for women with breast cancer in the U.S. Military Health System. J Surg Oncol 2020; 121:200-209. [PMID: 31784990 DOI: 10.1002/jso.25788] [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: 09/03/2019] [Accepted: 11/17/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Re-excision surgery is undertaken to obtain clear margins after breast-conserving surgery (BCS) for localized breast cancer. This study examines patient and tumor characteristics related to re-excision surgery in the universal-access Military Health System (MHS). METHODS Retrospective analysis of patients with pathologically confirmed stage I-III breast cancer between 1998 and 2014 in the Department of Defense Central Cancer Registry and MHS Data Repository-linked databases who received primary BCS. Multivariable stepwise logistic regression methods identified characteristics associated with re-excision surgery (lumpectomy and mastectomy) and conversion to mastectomy, given as adjusted odds ratios (AOR) and 95% confidence intervals (CIs). RESULTS Of 7637 women receiving BCS, 26.3% had a re-excision and 9.9% converted to mastectomy. Tumor location, larger tumor size (≥4 cm), and regional lymph node involvement were associated with a greater likelihood of re-excision and mastectomy conversion. Pathology before BCS (AOR, 0.39; 95% CI, 0.35, 0.44 for re-excision) and neoadjuvant treatment (AOR, 0.50; 95% CI, 0.36, 0.69 for re-excision) were associated with a decreased likelihood of these outcomes. Additionally, age, tumor histology, and military-specific variables were associated with mastectomy conversion. CONCLUSION Comprehensive preoperative workup, including tumor pathology, may better inform surgical decision-making and reduce re-excision rates.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Matthew W Georg
- Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Ismail Jatoi
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Time-to-surgery and overall survival after breast cancer diagnosis in a universal health system. Breast Cancer Res Treat 2019; 178:441-450. [DOI: 10.1007/s10549-019-05404-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022]
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Staruch RM, Rouhani MJ, Ellabban M. The surgical management of male breast cancer: Time for an easy access national reporting database? Ann Med Surg (Lond) 2016; 9:41-9. [PMID: 27408713 PMCID: PMC4927636 DOI: 10.1016/j.amsu.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Male breast cancer is extremely rare with an incidence of less than 1% of all breast cancers. Literature reports a peak of incidence at roughly 71 years of age. Management currently follows the same clinical pathways as female breast cancer as a general rule. METHODS A retrospective search for all patients who were referred and diagnosed with male breast cancer at our centre was undertaken. Patients notes were then explored for demographics, histological staging, multidisciplinary team meeting outcome and treatment. A literature search including the search terms 'Male Breast Cancer AND Surgery' or 'Male Breast Cancer AND Experience' were used. Non English language articles, or those without abstracts were excluded. RESULTS Seven patients were reviewed over 3 years (2006-2009). Mean agea was 69 years and mean lesion size was 15 mm. Histology was invasive ductal carcinoma for all patients. All patients were ER receptor positive. Two patients were HER2 positive. Five patients were offered mastectomy. One patient refused treatment. In follow up at 36 months there were 3 recurrences. 1 patient was lost to follow up. There were 3 mortalities. The literature search identified 72 articles. Articles were subdivided into those that discussed the surgical management of male breast cancer (n = 8), articles that discussed male breast cancer as podium presentations or posters with no full text article publication (n = 13) and finally full text publications of case experience of male breast cancer (n = 21). DISCUSSION We report a series of seven cases of male breast cancer encountered over three years, evaluating patient demographics as well as treatment and outcomes. In our series patients were managed with mastectomy. New evidence is questioning the role of mastectomy against breast conserving surgery in male patients. Furthermore there is a lack of reporting infrastructure for national data capture of the benefits of surgical modalities. Literature review highlights the varied clinical experience between units that remains reported as podium presentation but not published. The establishment of an online international reporting registry would allow for efficient analysis of surgical outcomes to improve patient care from smaller single centres. This would facilitate large scale meta analysis by larger academic surgical centres.
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Affiliation(s)
| | - Maral J. Rouhani
- North Central Thames Deanery Basildon University Hospital, Nethermayne, Basildon, SS16 5NL, United Kingdom
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