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Chae EY, Jung MR, Cha JH, Shin HJ, Choi WJ, Kim HH. A predictive model using MRI and clinicopathologic features for breast cancer recurrence in young women treated with upfront surgery. Eur Radiol 2024:10.1007/s00330-024-10805-5. [PMID: 38787429 DOI: 10.1007/s00330-024-10805-5] [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: 12/12/2023] [Revised: 03/20/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To identify preoperative breast MR imaging and clinicopathological variables related to recurrence and develop a risk prediction model for recurrence in young women with breast cancer treated with upfront surgery. METHODS This retrospective study analyzed 438 consecutive women with breast cancer aged 35 years or younger between January 2007 and December 2016. Breast MR images before surgery were independently reviewed by breast radiologists blinded to patient outcomes. The clinicopathological data including patient demographics, clinical features, and tumor characteristics were reviewed. Univariate and multivariate logistic regression analyses were used to identify the independent factors associated with recurrence. The risk prediction model for recurrence was developed, and the discrimination and calibration abilities were assessed. RESULTS Of 438 patients, 95 (21.7%) developed recurrence after a median follow-up of 65 months. Tumor size at MR imaging (HR = 1.158, p = 0.006), multifocal or multicentric disease (HR = 1.676, p = 0.017), and peritumoral edema on T2WI (HR = 2.166, p = 0.001) were identified as independent predictors of recurrence, while adjuvant endocrine therapy (HR = 0.624, p = 0.035) was inversely associated with recurrence. The prediction model showed good discrimination ability in predicting 5-year recurrence (C index, 0.707 in the development cohort; 0.686 in the validation cohort) and overall recurrence (C index, 0.699 in the development cohort; 0.678 in the validation cohort). The calibration plot demonstrated an excellent correlation (concordance correlation coefficient, 0.903). CONCLUSION A prediction model based on breast MR imaging and clinicopathological features showed good discrimination to predict recurrence in young women with breast cancer treated with upfront surgery, which could contribute to individualized risk stratification. CLINICAL RELEVANCE STATEMENT Our prediction model, incorporating preoperative breast MR imaging and clinicopathological features, predicts recurrence in young women with breast cancer undergoing upfront surgery, facilitating personalized risk stratification and informing tailored management strategies. KEY POINTS Younger women with breast cancer have worse outcomes than those diagnosed at more typical ages. The described prediction model showed good discrimination performance in predicting 5-year and overall recurrence. Incorporating better risk stratification tools in this population may help improve outcomes.
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Affiliation(s)
- Eun Young Chae
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Mi Ran Jung
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joo Hee Cha
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Jung Shin
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo Jung Choi
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hak Hee Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Dunn MR, Metwally EM, Vohra S, Hyslop T, Henderson LM, Reeder-Hayes K, Thompson CA, Lafata JE, Troester MA, Butler EN. Understanding mechanisms of racial disparities in breast cancer: an assessment of screening and regular care in the Carolina Breast Cancer Study. Cancer Causes Control 2024; 35:825-837. [PMID: 38217760 PMCID: PMC11045315 DOI: 10.1007/s10552-023-01833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/16/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE Screening history influences stage at detection, but regular preventive care may also influence breast tumor diagnostic characteristics. Few studies have evaluated healthcare utilization (both screening and primary care) in racially diverse screening-eligible populations. METHODS This analysis included 2,058 women age 45-74 (49% Black) from the Carolina Breast Cancer Study, a population-based cohort of women diagnosed with invasive breast cancer between 2008 and 2013. Screening history (threshold 0.5 mammograms per year) and pre-diagnostic healthcare utilization (i.e. regular care, based on responses to "During the past ten years, who did you usually see when you were sick or needed advice about your health?") were assessed as binary exposures. The relationship between healthcare utilization and tumor characteristics were evaluated overall and race-stratified. RESULTS Among those lacking screening, Black participants had larger tumors (5 + cm) (frequency 19.6% vs 11.5%, relative frequency difference (RFD) = 8.1%, 95% CI 2.8-13.5), but race differences were attenuated among screening-adherent participants (10.2% vs 7.0%, RFD = 3.2%, 0.2-6.2). Similar trends were observed for tumor stage and mode of detection (mammogram vs lump). Among all participants, those lacking both screening and regular care had larger tumors (21% vs 8%, RR = 2.51, 1.76-3.56) and advanced (3B +) stage (19% vs 6%, RR = 3.15, 2.15-4.63) compared to the referent category (screening-adherent and regular care). Under-use of regular care and screening was more prevalent in socioeconomically disadvantaged areas of North Carolina. CONCLUSIONS Access to regular care is an important safeguard for earlier detection. Our data suggest that health equity interventions should prioritize both primary care and screening.
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Affiliation(s)
- Matthew R Dunn
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | - Eman M Metwally
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sanah Vohra
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Terry Hyslop
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Louise M Henderson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Pulmonary Disease and Critical Care Medicine, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Katherine Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Caroline A Thompson
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Elston Lafata
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa A Troester
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Eboneé N Butler
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Costa L, Kumar R, Villarreal-Garza C, Sinha S, Saini S, Semwal J, Saxsena V, Zamre V, Chintamani C, Ray M, Shimizu C, Gusic LH, Toi M, Lipton A. Diagnostic delays in breast cancer among young women: An emphasis on healthcare providers. Breast 2024; 73:103623. [PMID: 38219460 PMCID: PMC10826418 DOI: 10.1016/j.breast.2023.103623] [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: 09/18/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 01/16/2024] Open
Abstract
Despite advances in breast cancer care, breast cancer in young women (BCYW) faces unique challenges, diagnostic delays, and limited awareness in many countries. Here, we discuss the challenges and consequences associated with the delayed diagnosis of BCYW. The consequences of delayed diagnosis in young women - which generally varies among developed, developing, or underdeveloped countries - are severe due to a faster breast tumor growth rate than tumors in older women, also contributing to advanced cancer stages and poorer outcomes. Though there are many underlying reasons for diagnostic delays due to age, the article delves explicitly deep into the diagnostic delay of BCYW, focusing on healthcare providers, potential contributing factors, its consequences, and the urgent need to start minimizing such incidences. The article suggests several strategies to address these issues, including increasing awareness, developing educational programs for healthcare providers to identify signs and symptoms in young women, developing clear diagnostic guidelines, and improving screening strategies.
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Affiliation(s)
- Luis Costa
- Department of Medical Oncology, Hospital de Santa Maria- Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Instituto de Medicina Molecular-João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Breast Cancer in Young Women Foundation, Denver, CO, USA.
| | - Rakesh Kumar
- Breast Cancer in Young Women Foundation, Denver, CO, USA; Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India; Department of Human and Molecular Genetics and VCU Institute of Molecular Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA.
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico; Médicos e Investigadores en la Lucha contra el Cáncer de Mama, Mexico City, Mexico
| | | | - Sunil Saini
- Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Jayanti Semwal
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Vartika Saxsena
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Vaishali Zamre
- Breast Cancer Surgery Unit, Rajiv Gandhi Cancer Institute, Delhi, India
| | | | - Mukurdipi Ray
- Department of Surgical Oncology, All India Insititute of Medical Sciences, New Delhi, India
| | - Chikako Shimizu
- Department of Breast and Medical Oncology, Comprehensive Cancer Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Lejla Hadzikadic Gusic
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Masakazu Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Allan Lipton
- Hematology-Oncology, Department of Medicine, Penn State University School of Medicine, Hershey, PA, USA
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Tinterri C, Di Maria Grimaldi S, Sagona A, Barbieri E, Darwish S, Bottini A, Canavese G, Gentile D. Comparison of Long-Term Oncological Results in Young Women with Breast Cancer between BRCA-Mutation Carriers Versus Non-Carriers: How Tumor and Genetic Risk Factors Influence the Clinical Prognosis. Cancers (Basel) 2023; 15:4177. [PMID: 37627205 PMCID: PMC10452863 DOI: 10.3390/cancers15164177] [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: 07/31/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is very uncommon in young women (YW) and it is unclear whether a BRCA mutation has prognostic implications. Our aim was to evaluate the characteristics of YW with BC by comparing the long-term oncological results between BRCA-mutation carriers and non-carriers. METHODS We retrospectively reviewed all the consecutive YW (aged 18-40 years) diagnosed with BC. Endpoints were disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS). RESULTS 63 YW with a BRCA mutation were compared with 339 YW without BRCA mutation. BRCA-mutation carriers were younger (60.3% versus 34.8% if age ≤ 35 years, p = 0.001) and presented with more aggressive tumors (66.7% versus 40.7% if G3, p = 0.001; 57.2% versus 12.4% if biological subtype triple-negative, p = 0.001; 73.0% versus 39.2% if Ki67 ≥ 25%, p = 0.001). Non-carriers presented significantly better DFS, DDFS, and OS compared with BRCA-mutation carriers. Neoadjuvant chemotherapy was found to be an independent protective factor for OS in BRCA-mutation carriers. CONCLUSIONS BC is more likely to present at a younger age (≤ 35 years) and with more aggressive characteristics (G3, triple-negative, Ki67 ≥ 25%) in YW with BRCA mutation compared with their non-mutated counterparts. Young BRCA-mutation carriers showed a poorer prognosis in terms of recurrence and survival compared with non-carriers. The implementation of neoadjuvant chemotherapy may improve survival in YW with BC and BRCA mutation.
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Affiliation(s)
- Corrado Tinterri
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; (C.T.); (S.D.M.G.); (A.S.); (E.B.); (S.D.); (A.B.); (G.C.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Simone Di Maria Grimaldi
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; (C.T.); (S.D.M.G.); (A.S.); (E.B.); (S.D.); (A.B.); (G.C.)
| | - Andrea Sagona
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; (C.T.); (S.D.M.G.); (A.S.); (E.B.); (S.D.); (A.B.); (G.C.)
| | - Erika Barbieri
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; (C.T.); (S.D.M.G.); (A.S.); (E.B.); (S.D.); (A.B.); (G.C.)
| | - Shadya Darwish
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; (C.T.); (S.D.M.G.); (A.S.); (E.B.); (S.D.); (A.B.); (G.C.)
| | - Alberto Bottini
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; (C.T.); (S.D.M.G.); (A.S.); (E.B.); (S.D.); (A.B.); (G.C.)
| | - Giuseppe Canavese
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; (C.T.); (S.D.M.G.); (A.S.); (E.B.); (S.D.); (A.B.); (G.C.)
| | - Damiano Gentile
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; (C.T.); (S.D.M.G.); (A.S.); (E.B.); (S.D.); (A.B.); (G.C.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
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Moradpour M, Azizinik F, Zeidabadi H, Ghomi Z, Shakki Katouli F, Tavakol E, Torabi Parizi S. The imaging findings and diagnostic value of radiology modalities to assess breast malignancy among women aged younger than 30 years. Acta Radiol 2023; 64:2363-2370. [PMID: 37211759 DOI: 10.1177/02841851231176271] [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] [Indexed: 05/23/2023]
Abstract
BACKGROUND Breast cancer mainly affects women aged >50 years; however, younger women may also have advanced breast cancer, so early detection is important. PURPOSE To collect and review the imaging findings of women aged <30 years with breast cancer to find better diagnostic approaches for the early diagnosis of breast cancer in young women. MATERIAL AND METHODS In this study, 45 patients aged <30 years with a diagnosis of breast cancer were evaluated. Imaging assessments were performed based on ultrasound, mammography, and magnetic resonance imaging (MRI) findings. Finally, the findings were compared with the pathological results. RESULTS Predominant findings in ultrasound included irregular spiculated mass in 59.4%. In mammography, irregular high-density mass (46.5%) and suspicious micro calcification (42.8%) were the most common findings. In MRI, the predominant feature was a heterogeneous enhancing mass with an irregular shape and irregular margin (81%) with a 45% plateau and 36% washout kinetic pattern. In the pathology assessment, invasive ductal carcinoma was the most common finding (84.4%). All three modalities-MRI, ultrasonography, and mammography-are valuable, with sensitivities of 100%, 93.3%, and 90%, respectively. CONCLUSION Ultrasound, mammography, and MRI are highly sensitive and accurate tools for detecting breast cancer lesions in young women. Regular clinical breast examination with breast self-examination, and in suspected cases, ultrasound as the first imaging modality followed by mammography and/or MRI are the preferred diagnostic approach.
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Affiliation(s)
- Moein Moradpour
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Velenjak, Tehran Iran
| | - Fahimeh Azizinik
- Department of Radiology, Yas Hospital and Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tohid Square, Tehran, Iran
| | - Hamideh Zeidabadi
- Department of Gynecology and Obstetrics, Imam Khomeini Hospital Complex Tehran university of Medical Sciences, Tohid Square, Tehran, Iran
| | - Zahra Ghomi
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Velenjak, Tehran Iran
| | - Fatemeh Shakki Katouli
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Tavakol
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Velenjak, Tehran Iran
| | - Shabnam Torabi Parizi
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Velenjak, Tehran Iran
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Hindmarch S, Gorman L, Hawkes RE, Howell SJ, French DP. "I don't know what I'm feeling for": young women's beliefs about breast cancer risk and experiences of breast awareness. BMC Womens Health 2023; 23:312. [PMID: 37328760 PMCID: PMC10276361 DOI: 10.1186/s12905-023-02441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/17/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Younger women are often diagnosed with advanced breast cancer. Beliefs about risk are instrumental in motivating many health protective behaviours, but there may be confusion around which behaviour is appropriate to detect breast cancer earlier. Breast awareness, defined as an understanding of how the breasts look and feel so changes can be identified early, is widely recommended. In contrast, breast self-examination involves palpation using a specified method. We aimed to investigate young women's beliefs about their risk and experiences of breast awareness. METHODS Thirty-seven women aged 30-39 years residing in a North West region of England with no family or personal history of breast cancer participated in seven focus groups (n = 29) and eight individual interviews. Data were analysed using reflexive thematic analysis. RESULTS Three themes were generated. "Future me's problem" describes why women perceive breast cancer as an older woman's disease. Uncertainty regarding checking behaviours highlights how confusion about self-checking behaviour advice has resulted in women infrequently performing breast checks. Campaigns as a missed opportunity highlights the potential negative effects of current breast cancer fundraising campaigns and the perceived absence of educational campaigning about breast cancer for this demographic. CONCLUSIONS Young women expressed low perceived susceptibility to developing breast cancer in the near future. Women did not know what breast self-checking behaviours they should be performing and expressed a lack of confidence in how to perform a breast check appropriately due to limited knowledge about what to look and feel for. Consequently, women reported disengagement with breast awareness. Defining and clearly communicating the best strategy for breast awareness and establishing whether it is beneficial or not are essential next steps.
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Affiliation(s)
- Sarah Hindmarch
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Louise Gorman
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rhiannon E Hawkes
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sacha J Howell
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - David P French
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Factors Associated with the Breast Cancer Diagnostic Interval across Five Canadian Provinces: A CanIMPACT Retrospective Cohort Study. Cancers (Basel) 2023; 15:cancers15020404. [PMID: 36672357 PMCID: PMC9857089 DOI: 10.3390/cancers15020404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The cancer diagnostic process can be protracted, and it is a time of great anxiety for patients. The objective of this study was to examine inter- and intra-provincial variation in diagnostic intervals and explore factors related to the variation. This was a multi-province retrospective cohort study using linked administrative health databases. All females with a diagnosis of histologically confirmed invasive breast cancer in British Columbia (2007-2010), Manitoba (2007-2011), Ontario (2007-2010), Nova Scotia (2007-2012), and Alberta (2004-2010) were included. The start of the diagnostic interval was determined using algorithms specific to whether the patient's cancer was detected through screening. We used multivariable quantile regression analyses to assess the association between demographic, clinical and healthcare utilization factors with the diagnostic interval outcome. We found significant inter- and intra-provincial variation in the breast cancer diagnostic interval and by screen-detection status; patients who presented symptomatically had longer intervals than screen-detected patients. Interprovincial diagnostic interval variation was 17 and 16 days for screen- and symptom-detected patients, respectively, at the median, and 14 and 41 days, respectively, at the 90th percentile. There was an association of longer diagnostic intervals with increasing comorbid disease in all provinces in non-screen-detected patients but not screen-detected. Longer intervals were observed across most provinces in screen-detected patients living in rural areas. Having a regular primary care provider was not associated with a shorter diagnostic interval. Our results highlight important findings regarding the length of the breast cancer diagnostic interval, its variation within and across provinces, and its association with comorbid disease and rurality. We conclude that diagnostic processes can be context specific, and more attention should be paid to developing tailored processes so that equitable access to a timely diagnosis can be achieved.
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Birnbaum Z, Jones G, Diaz G, Duncan T, Romero J, Steen S. Association of socioeconomic status with the clinical management and outcomes in young patients (≤35 years) diagnosed with breast cancer: A retrospective analysis. Ann Med Surg (Lond) 2022; 82:104524. [PMID: 36268314 PMCID: PMC9577443 DOI: 10.1016/j.amsu.2022.104524] [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: 06/11/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background Methods Results Discussion Breast cancer occurring at 35 years or younger is rare and aggressive; medical management, therefore, should be equally aggressive, and early diagnosis is critical. Retrospectively analyzed databases for breast cancer from both a government-run county hospital (CH) and a neighboring private hospital (PH) for 82 months. Results of our study suggest a significant healthcare difference in very young breast cancer patients between the county and private hospital systems, which may have resulted in delays to seeking care. This difference may be a reflection of barriers in health literacy or access to medical care.
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Affiliation(s)
| | | | - Graal Diaz
- Community Memorial Hospital, Ventura, CA, USA
| | | | | | - Shawn Steen
- Ventura County Medical Center, Ventura, CA, USA
- Corresponding author. 300 Hillmont Ave, Building 340, Suite 401, Ventura, CA, 93003-309, USA.
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Momenimovahed Z, Momenimovahed S, Allahqoli L, Salehiniya H. Factors Related to the Delay in Diagnosis of Breast Cancer in the Word: A Systematic Review. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Breast Cancer Disparities Related to Young Age at Diagnosis. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tesch ME, Partridge AH. Treatment of Breast Cancer in Young Adults. Am Soc Clin Oncol Educ Book 2022; 42:1-12. [PMID: 35580291 DOI: 10.1200/edbk_360970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although breast cancer is rare and understudied in adults age 40 and younger, recent epidemiologic data show an increasing incidence of breast cancer among young women in the United States and ongoing inferior long-term outcomes. Given breast cancers arising at a young age are more likely to present at advanced stages and to have aggressive biology, multimodal treatments are often indicated. Elevated local recurrence risks and greater propensity for germline cancer predisposition mutations can impact local therapy choices. Recently, escalated systemic therapy regimens for triple-negative breast cancer incorporating immunotherapy, de-escalated anti-HER2 therapy, and emerging targeted agents, including CDK4/6 inhibitors and PARP inhibitors, for early-stage disease may be employed in younger and older patients alike, with some special considerations. Prognostic genomic signatures can spare low-risk young women with hormone receptor-positive breast cancer adjuvant chemotherapy, but management of intermediate-risk patients remains controversial. Ovarian function suppression and extended endocrine therapy are improving outcomes in hormone receptor-positive breast cancer, but treatment adherence is a particular problem for young patients. Young women may also face greater challenges in long-term survivorship, including impaired fertility, difficulties in psychosocial adjustment, and other treatment-related comorbidities. Consideration of these age-specific issues through dedicated multidisciplinary strategies is necessary for optimal care of young women with breast cancer.
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Hutajulu SH, Prabandari YS, Bintoro BS, Wiranata JA, Widiastuti M, Suryani ND, Saptari RG, Taroeno-Hariadi KW, Kurnianda J, Purwanto I, Hardianti MS, Allsop MJ. Delays in the presentation and diagnosis of women with breast cancer in Yogyakarta, Indonesia: A retrospective observational study. PLoS One 2022; 17:e0262468. [PMID: 35025941 PMCID: PMC8757982 DOI: 10.1371/journal.pone.0262468] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/23/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose
To investigate factors associated with delays in presentation and diagnosis of women with confirmed breast cancer (BC).
Methods
A cross-sectional study nested in an ongoing prospective cohort study of breast cancer patients at Dr Sardjito Hospital, Yogyakarta, Indonesia, was employed. Participants (n = 150) from the main study were recruited, with secondary information on demographic, clinical, and tumor variables collected from the study database. A questionnaire was used to gather data on other socioeconomic variables, herbal consumption, number of healthcare visits, knowledge-attitude-practice of BC, and open-ended questions relating to initial presentation. Presentation delay (time between initial symptom and first consultation) was defined as ≥3 months. Diagnosis delay was defined as ≥1 month between presentation and diagnosis confirmation. Impact on disease stage and determinants of both delays were examined. A Kruskal-Wallis test was used to assess the length and distribution of delays by disease stage. A multivariable logistic regression analysis was conducted to explore the association between delays, cancer stage and factors.
Results
Sixty-five (43.3%) patients had a ≥3-month presentation delay and 97 (64.7%) had a diagnosis confirmation by ≥1 month. Both presentation and diagnosis delays increased the risk of being diagnosed with cancer stage III-IV (odds ratio/OR 2.21, 95% CI 0.97–5.01, p = 0.059 and OR 3.03, 95% CI 1.28–7.19, p = 0.012). Visit to providers ≤3 times was significantly attributed to a reduced diagnosis delay (OR 0.15, 95% CI 0.06–0.37, p <0.001), while having a family history of cancer was significantly associated with increased diagnosis delay (OR 2.28, 95% CI 1.03–5.04, p = 0.042). The most frequent reasons for delaying presentation were lack of awareness of the cause of symptoms (41.5%), low perceived severity (27.7%) and fear of surgery intervention (26.2%).
Conclusions
Almost half of BC patients in our setting had a delay in presentation and 64.7% experienced a delay in diagnosis. These delays increased the likelihood of presentation with a more advanced stage of disease. Future research is required in Indonesia to explore the feasibility of evidence-based approaches to reducing delays at both levels, including educational interventions to increase awareness of BC symptoms and reducing existing complex and convoluted referral pathways for patients suspected of having cancer.
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Affiliation(s)
- Susanna Hilda Hutajulu
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta, Indonesia
- * E-mail:
| | - Yayi Suryo Prabandari
- Department of Health Behaviour, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center of Health Behaviour and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bagas Suryo Bintoro
- Department of Health Behaviour, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center of Health Behaviour and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Juan Adrian Wiranata
- Medical Internship Program, Academic Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mentari Widiastuti
- Center of Health Behaviour and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Norma Dewi Suryani
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Rorenz Geraldi Saptari
- Medicine Study Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Kartika Widayati Taroeno-Hariadi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Johan Kurnianda
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ibnu Purwanto
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Mardiah Suci Hardianti
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Matthew John Allsop
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
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Hassaine Y, Jacquet E, Seigneurin A, Delafosse P. Evolution of breast cancer incidence in young women in a French registry from 1990 to 2018: Towards a change in screening strategy? Breast Cancer Res 2022; 24:87. [PMID: 36471434 PMCID: PMC9724405 DOI: 10.1186/s13058-022-01581-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/28/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The worldwide incidence of invasive breast cancer in women is increasing according to several studies. This increase in incidence seems to be higher in young women (< 40 years). However, the reasons for this trend are poorly understood. This article aims to provide the most recent estimates of this trend and assess whether there is indeed an increase in the incidence of breast cancer among young women to strengthen prevention campaigns. METHODS We collected data from the Isere cancer registry in France of all invasive breast cancers from January 1990 to December 2018. The standardized incidence rate was calculated for four age groups (< 40 years, 40-49 years, 50-74 years, ≥ 75 years) for this period. The 10-year relative survival was evaluated for each age group age for two periods (1990-1999 and 2000-2008). From 2011 to 2013, we analyzed the incidence and 5-year relative survival by tumor subtype (triple negative, luminal, HER2 amplified) for each age group. RESULTS A total of 23,703 cases were selected, including 1343 young women (< 40 years). The incidence of invasive breast cancer increased annually by 0,8% (95% CI 0,7; 1) in all age groups combined from 1990 to 2018. The highest incidence increase is found among young women, by 2,1% annually (95% CI 1,3; 2,8). Regarding tumor subtypes from 2011 to 2018, the incidence of triple negatives increases higher in young women (+ 1,4% by year, 95% CI - 8,2; 11) and those over 75 years (+ 4% by year, 95% CI - 5,1; 13,2), but the results are not statistically significant. 10-year relative survival in young women increased from 74,6% (95% CI 69,6; 78,9) to 78,3%(95% CI 73,7; 82,1) between 1990-1999 and 2000-2008, respectively. Five-year relative survival is better in young women among triple negative and HER2 amplified. CONCLUSION Our study confirms the current trend of increasing the incidence of breast cancer in young women, associated with improved survival very likely attributable to earlier diagnosis due to increased awareness, and improvements in treatment. A better individualized risk-based screening strategy is needed for these patients. Additional studies will be needed to more accurately assess the risk of developing breast cancer and improve diagnostic performance.
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Affiliation(s)
- Yanis Hassaine
- grid.410529.b0000 0001 0792 4829Cancer and Blood Diseases, Grenoble-Alpes University Hospital, Grenoble, France
| | - Emmanuelle Jacquet
- grid.410529.b0000 0001 0792 4829Cancer and Blood Diseases, Grenoble-Alpes University Hospital, Grenoble, France
| | - Arnaud Seigneurin
- Registre du Cancer de L’Isère, Grenoble, BP 217, 38043 Grenoble Cedex 09, France ,grid.410529.b0000 0001 0792 4829Pôle Santé Publique, Service d’évaluation Médicale, Centre Hospitalier Universitaire Grenoble Alpes, BP 217, 38043 Grenoble Cedex 09, France
| | - Patricia Delafosse
- Registre du Cancer de L’Isère, Grenoble, BP 217, 38043 Grenoble Cedex 09, France ,grid.410529.b0000 0001 0792 4829Pôle Santé Publique, Service d’évaluation Médicale, Centre Hospitalier Universitaire Grenoble Alpes, BP 217, 38043 Grenoble Cedex 09, France
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Ghelichi-Ghojogh M, Fararouei M, Seif M, Shahryari B, Pakfetrat M. Impact of social and clinical factors on the diagnostic delay of chronic kidney disease: an evaluation study. Int Urol Nephrol 2021; 54:1603-1612. [PMID: 34713367 DOI: 10.1007/s11255-021-03037-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to investigate the impact of social and clinical factors on the diagnostic delay of chronic kidney disease (CKD) among Iranian patients. MATERIALS AND METHODS Our study was conducted on 350 CKD patients who were referred to Faghihi and Motahari clinics (the two largest kidney diseases referral centers in Shiraz the capital of Fars province). Data were collected via an interviewer-administered questionnaire. A multiple linear regression model was used to measure the effect of factors affecting the delay of CKD diagnosis. RESULTS The medians and Interquartile ranges (IQR) of all delays, patient delay, and doctor delay were 6.5 (0-12.2), 5.1 (0-11.2), and 0.9 (0-3.1) months, respectively. The results showed that women were diagnosed 1.61 months earlier than men (p < 0.05). The duration of all delays in patients residing in the rural areas was 1.28 months longer than patients residing in the urban areas (p < 0.05). Also, patients with perceived good economic status were diagnosed 1.30 months earlier than patients who reported having very poor economic status (p < 0.05). CONCLUSIONS The delay is in part due to the neglect and misinterpretation of symptoms by both patients and physicians. It is necessary to improve the awareness of CKD among general public and medical professionals.
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Affiliation(s)
| | - Mohammad Fararouei
- HIV/AIDS Research Center, School of Health, Shiraz University of Medical Sciences, P.O. Box: 71645-111, Shiraz, Iran.
| | - Mozhgan Seif
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Maryam Pakfetrat
- Shiraz Nephro-Urology Research Center, Department of Internal Medicine, Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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De novo Metastatic Breast Cancer Arising in Young Women: Review of the Current Evidence. Clin Breast Cancer 2021; 22:78-87. [PMID: 34750070 DOI: 10.1016/j.clbc.2021.10.001] [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: 03/08/2021] [Revised: 09/17/2021] [Accepted: 10/03/2021] [Indexed: 01/06/2023]
Abstract
Women with metastatic breast cancer remains a heterogeneous group of patients with different prognostic outcomes and therapeutic needs. Young women with de novo metastatic breast cancer (dnMBC) represent a peculiar population with respect to tumor biology, prognosis, clinical management and survivorship issues. Overall, these patients are able to attain long-term survival with a proper management of both primary tumor and distant metastases. On the other hand, they are also at higher risk of experiencing a deterioration in their quality of life (QoL) due to primary cancer-related side effects. Young women are also likely to harbor germline pathogenic variants in cancer predisposition genes which could affect treatment decisions and have a direct impact on the lives of patients' relatives. The loco-regional management of the primary tumor represents another thorny subject, as the surgical approach has shown controversial effects on the survival and the QoL of these patients. This review aims to provide an update on these issues to better inform the clinical management of dnMBC in young women.
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16
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Lewis DR, Siembida EJ, Seibel NL, Smith AW, Mariotto AB. Survival outcomes for cancer types with the highest death rates for adolescents and young adults, 1975-2016. Cancer 2021; 127:4277-4286. [PMID: 34308557 DOI: 10.1002/cncr.33793] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Five-year relative survival for adolescent and young adult (AYA) patients with cancer diagnosed at the ages of 15 to 39 years is 85%. Survival rates vary considerably according to the cancer type. The purpose of this study was to analyze long-term survival trends for cancer types with the highest mortality among AYAs to determine where the greatest burden is and to identify areas for future research. METHODS Using data from the Surveillance, Epidemiology, and End Results cancer registry and the National Center for Health Statistics, the authors examined the incidence, mortality, and survival for the 9 cancer types with the highest mortality rates in this age group from 1975 to 2016. JPSurv, new survival trend software, was used in the analysis. RESULTS Results suggested significant improvements in 5-year relative survival for brain and other nervous system tumors, colon and rectum cancer, lung and bronchus cancer, acute myeloid leukemia, and non-Hodgkin lymphoma (all P values < .05). Limited or no improvement in survival was found for female breast cancer, cervical cancer, ovarian cancer, and bone and joint sarcomas. CONCLUSIONS Five-year relative survival for multiple cancer types in AYAs has improved, but some common cancer types in this group still show limited survival improvements (eg, ovarian cancer). Survival improvements in colorectal cancer have been overshadowed by its rising incidence, which suggests a substantial disease burden. Future research should focus on female breast, bone, ovarian, and cervical cancers, which have seen minimal or no improvements in survival. LAY SUMMARY Survival trends for adolescents and young adults with cancer are presented from a 40-year period. Although survival progress is noted for brain cancer, lung cancer, acute myeloid leukemia, and colon and rectum cancer, the incidence of colon and rectum cancer remains high. Minimal progress is evident for female breast, bone, ovarian, and cervical cancers, which are in need of renewed focus.
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Affiliation(s)
- Denise Riedel Lewis
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Elizabeth J Siembida
- Center for Health Innovation and Outcomes Research, Northwell Health, Manhasset, New York
| | - Nita L Seibel
- Division of Cancer Treatment and Detection, National Cancer Institute, Bethesda, Maryland
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Micaily I, Hackbart H, Butryn M, Abu-Khalaf MM. Obesity in early onset breast cancer in African American patients. Breast J 2021; 27:603-607. [PMID: 34117672 DOI: 10.1111/tbj.14258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Obesity is a modifiable risk factor in breast cancer patients and is predictive of disease outcomes in early-onset breast cancer survivors. The purpose of this review is to summarize the current evidence in the association between early-onset breast cancer and obesity, specifically in African-American women. Reviewing the molecular mechanisms and social determinants of disease in this population can provide a foundation for future interventions in prevention, detection, and treatment aiming at improving outcomes for young breast cancer patients.
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Affiliation(s)
- Ida Micaily
- Department of Medical Oncology, Thomas Jefferson University, Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Hannah Hackbart
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Meghan Butryn
- Department of Psychology and Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Maysa M Abu-Khalaf
- Department of Medical Oncology, Thomas Jefferson University, Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, Pennsylvania, USA
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Wassie M, Fentie B. Prevalence of late-stage presentation and associated factors of cervical cancer patients in Tikur Anbesa Specialized Hospital, Ethiopia: institutional based cross-sectional study. Infect Agent Cancer 2021; 16:30. [PMID: 33975620 PMCID: PMC8111725 DOI: 10.1186/s13027-021-00371-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background Cancer of the uterine cervix remains a main public health problem in Sub-Saharan Africa. About two-thirds of patients with cervical cancer were diagnosed at late stage with contributing factors of out-of-pocket medical bill, looking for care out of conventional health settings and multiple visits to healthcare facilities before diagnostic confirmations in Addis Ababa. Therefore, the aim of this study was to identify prevalence of late-stage presentation and associated factors among cervical cancer patients in Tikur Anbesa Specialized Hospital (TASH). Methods Institutional based cross-sectional study was conducted from March to April 2019 in TASH oncology center. Data were extracted from patient’s chart using structured checklist prepared in English and analyzed using STATA14.2. Binary logistic regression model was used to identify variables that affect the outcome variable. Results A total of 1057 cervical cancer patients were included in this five-years retrospective study. The prevalence of late-stage presentation among cervical cancer patients was 56.8%. It was affected by being anemic [AOR = 1.55,95%CI (1.17–2.10)], came from Oromia region (AOR = 0.65,95%CI (0.46–0.91) and Addis Ababa city [AOR:0.5;95%CI (0.34–0.73)], rural residency [AOR:1.88;95% (1.38–2.56)] and age ≥ 60 years [AOR:1.89;95%CI (1.12–3.20)]. Conclusion The study revealed that the prevalence of late-stage presentation among cervical cancer patients is high. Being anemic, regions where patients came from, rural residency and age group ≥ 60 years were statically significant. It is better to expand cervical cancer education for rural dwellers, expand cancer treatment centers and prioritize to patients with anemia and advanced age.
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Affiliation(s)
- Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Beletech Fentie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Assessing health disparities in breast cancer incidence burden in Tennessee: geospatial analysis. BMC WOMENS HEALTH 2021; 21:186. [PMID: 33941168 PMCID: PMC8091807 DOI: 10.1186/s12905-021-01274-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/18/2021] [Indexed: 12/22/2022]
Abstract
Background Tennessee women experience the 12th highest breast cancer mortality in the United States. We examined the geographic differences in breast cancer incidence in Tennessee between Appalachian and non-Appalachian counties from 2005 to 2015. Methods We used ArcGIS 10.7 geospatial analysis and logistic regression on the Tennessee Cancer Registry incidence data for adult women aged ≥ 18 years (N = 59,287) who were diagnosed with breast cancer from 2005 to 2015 to evaluate distribution patterns by Appalachian county designation. The Tennessee Cancer Registry is a population-based, central cancer registry serving the citizens of Tennessee and was established by Tennessee law to collect and monitor cancer incidence. The main outcome was breast cancer stage at diagnosis. Independent variables were age, race, marital status, type of health insurance, and county of residence. Results Majority of the sample were White (85.5%), married (58.6%), aged ≥ 70 (31.3%) and diagnosed with an early stage breast cancer (69.6%). More than half of the women had public health insurance (54.2%), followed by private health insurance coverage (44.4%). Over half of the women resided in non-Appalachian counties, whereas 47.6% were in the Appalachian counties. We observed a significant association among breast cancer patients with respect to marital status and type of health insurance coverage (p = < 0.0001). While the logistic regression did not show a significant result between county of residence and breast cancer incidence, the spatial analysis revealed geographic differences between Appalachian and non-Appalachian counties. The highest incidence rates of 997.49–1164.59/100,000 were reported in 6 Appalachian counties (Anderson, Blount, Knox, Rhea, Roane, and Van Buren) compared to 3 non-Appalachian counties (Fayette, Marshall, and Williamson). Conclusions There is a need to expand resources in Appalachian Tennessee to enhance breast cancer screening and early detection. Using geospatial techniques can further elucidate disparities that may be overlooked in conventional linear analyses to improve women’s cancer health and associated outcomes.
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20
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Eiriz IF, Vaz Batista M, Cruz Tomás T, Neves MT, Guerra-Pereira N, Braga S. Breast cancer in very young women-a multicenter 10-year experience. ESMO Open 2021; 6:100029. [PMID: 33399090 PMCID: PMC7807935 DOI: 10.1016/j.esmoop.2020.100029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/21/2020] [Accepted: 11/26/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer (BC) is the most prevalent cancer in adult young women in Europe. Although rare, it is one of the leading causes of death in this age group. The aim of this study is to characterize a cohort of young women regarding tumor stage, biology, treatment and survival. PATIENTS AND METHODS We present a multicenter retrospective analysis of women <35 years of age, diagnosed with BC between 2008 and 2017. A total of 207 patients from five Portuguese centers were included, from whom 172 were eligible for analysis. Data were analyzed using IBM SPPSS statistics. RESULTS Median age at diagnosis was 31 years. Fifty-one percent of tumors were hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative, 20% HR-positive/HER2-positive, 8% HR-negative/HER2-positive and 20% triple-negative BC. Twenty-two percent of patients were diagnosed in stage I, 26% stage II, 45% stage III and 6% had de novo metastatic cancer. Thirty-nine percent of patients were treated with neoadjuvant chemotherapy. Mean follow-up time was 64.9 months and overall survival at 5 years, of the entire cohort and metastatic patients, was 86.5% and 26%, respectively. CONCLUSIONS In our study we found similar population characteristics to other cohorts <35 years of age. To our knowledge, this is one of the largest cohorts in very young women. BC in young women is an important issue and further studies are needed to provide better care and survivorship to patients.
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Affiliation(s)
- I F Eiriz
- Oncology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Lisbon, Portugal.
| | - M Vaz Batista
- Oncology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Lisbon, Portugal
| | - T Cruz Tomás
- Oncology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Lisbon, Portugal
| | - M T Neves
- Oncology Department, Centro Hospitalar Lisboa Ocidental, Hospital S. Francisco Xavier, Lisboa, Portugal
| | - N Guerra-Pereira
- Oncology Department, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - S Braga
- Oncology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Lisbon, Portugal; Oncology Department, Hospital Vila Franca de Xira, Lisbon, Portugal; Oncology Department, Cuf Hospitals, Lisbon, Portugal
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21
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Expert consensus on diagnosis, treatment and fertility management of young breast cancer patients. JOURNAL OF THE NATIONAL CANCER CENTER 2021. [DOI: 10.1016/j.jncc.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Foerster M, McKenzie F, Zietsman A, Galukande M, Anele A, Adisa C, Parham G, Pinder L, Schüz J, McCormack V, dos‐Santos‐Silva I. Dissecting the journey to breast cancer diagnosis in sub-Saharan Africa: Findings from the multicountry ABC-DO cohort study. Int J Cancer 2021; 148:340-351. [PMID: 32663320 PMCID: PMC7754476 DOI: 10.1002/ijc.33209] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/29/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022]
Abstract
Most breast cancer patients in sub-Saharan Africa are diagnosed at advanced stages after prolonged symptomatic periods. In the multicountry African Breast Cancer-Disparities in Outcomes cohort, we dissected the diagnostic journey to inform downstaging interventions. At hospital presentation for breast cancer, women recalled their diagnostic journey, including dates of first noticing symptoms and health-care provider (HCP) visits. Negative binomial regression models were used to identify correlates of the length of the diagnostic journey. Among 1429 women, the median (inter-quartile range) length (months) of the diagnostic journey ranged from 11.3 (5.7-21.2) in Ugandan, 8.2 (3.4-16.4) in Zambian, 6.5 (2.4-15.7) in Namibian-black to 5.6 (2.3-13.1) in Nigerian and 2.4 (0.6-5.5) in Namibian-non-black women. Time from first HCP contact to diagnosis represented, on average, 58% to 79% of the diagnostic journey in each setting except Nigeria where most women presented directly to the diagnostic hospital with advanced disease. The median number of HCPs visited was 1 to 4 per woman, but time intervals between visits were long. Women who attributed their initial symptoms to cancer had a 4.1 months (absolute) reduced diagnostic journey than those who did not, while less-educated (none/primary) women had a 3.6 months longer journey than more educated women. In most settings the long journey to breast cancer diagnosis was not primarily due to late first presentation but to prolonged delays after first presentation to diagnosis. Promotion of breast cancer awareness and implementation of accelerated referral pathways for women with suspicious symptoms are vital to downstaging the disease in the region.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Joachim Schüz
- International Agency for Research on CancerLyonFrance
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23
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Huang Y, Ip EC, Ng AKT, Cohen-Hallaleh R. Variations in intrinsic breast cancer characteristics in screen-detected breast cancer patients aged between 45 and 69 and above the age of 70. ANZ J Surg 2020; 91:691-694. [PMID: 33215850 DOI: 10.1111/ans.16430] [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: 08/14/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increasing age is a well-recognized risk factor for breast cancer. With an increase in life expectancy of women, more older patients are diagnosed with breast cancer. This study aimed to identify the variations in breast cancer attributes and mortality in different age groups in New Zealand. METHODS This was a retrospective study of data from the Auckland Breast Cancer Register between 1 June 2000 and 28 February 2017. Patients who were diagnosed through Breast Screen were included. Group A included those aged between 45 and 69 years. Group B included individuals with an age of 70 years or above. RESULTS From June 2000 to February 2017, a total of 6304 new cases of new breast cancer were diagnosed through Auckland Breast Screen, with 5788 patients in group A and 516 patients in group B. Group B was more likely to have the lower grade invasive cancers, with fewer grade 3 cancers. Oestrogen receptor positivity was more pronounced in group B, along with progesterone receptor positivity. Conversely, HER-2 receptor was less likely to be positive in group B. There was a significantly higher breast cancer-related mortality in group B (6.0% versus 2.7%). Mortality related to other causes was also much higher in group B as compared to that in group A (12.8% versus 2.5%). CONCLUSION Women aged 70 years or above generally tend to have a more favourable type of breast cancer, with a lower tumour grade, oestrogen and progesterone receptor positivity, and lower rate of HER-2 overexpression.
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Affiliation(s)
- Yeqian Huang
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,South Western Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Eugenia C Ip
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Alexander K T Ng
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Ruben Cohen-Hallaleh
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,South Western Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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Tesfaw A, Demis S, Munye T, Ashuro Z. Patient Delay and Contributing Factors Among Breast Cancer Patients at Two Cancer Referral Centres in Ethiopia: A Cross-Sectional Study. J Multidiscip Healthc 2020; 13:1391-1401. [PMID: 33173301 PMCID: PMC7646382 DOI: 10.2147/jmdh.s275157] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022] Open
Abstract
Background Unlike developed countries, there is high mortality of breast cancer in low- and middle-income countries associated with prolonged patient delays and advanced stage presentations. However, evidence-based information about patient delay in presentation and contributing factors to diagnosis of breast cancer in Ethiopia is scarce. Methods Institution-based cross-sectional study was conducted at oncology units of the University of Gondar and Felege Hiwot specialized hospitals. A total of 371 female breast cancer patients who were newly diagnosed from September 2019 to April 30, 2020 were included. Data were entered using EPI info version 7.2 and analyzed in SPSS version 23. Descriptive statistics was used to summarize socio-demographic and clinical characteristic of the patients. Multivariable logistic regression at a P-value<0.05 significance level was used to identify predictors of patient delay. Results A total of 281 (75.7%) patients had long patient delay of ≥90 days (3 months) with the average patient delay time of 8 months, and advanced stage diagnosis was found on 264 (71.2%) of patients. The median age of patients was 40 years. Rural residence (AOR=3.72; 95% CI=1.82–7.61), illiterate (AOR=3.8; 95% CI=1.71–8.64), having a painless wound (AOR=3.32; 95% CI=1.93, 5.72), travel distance ≥5 km (AOR=1.66; 95% CI=1.09–3.00), having no lump/swelling in the armpit (AOR=6.16; 95% CI=2.80–13.54), and no history of any breast problem before (AOR=2.46; 95% CI=(1.43–4.22) were predictors for long patient delay. Conclusion Long patient delay and advanced stage diagnosis of breast cancer are higher in our study. Travel distance ≥5 km, rural residence, no history of any breast problem before, having no lump/swelling in the arm pit, a painless lump in the breast, and being illiterate were important predictors for patient delay. Therefore, public awareness programs about breast cancer should be designed to prevent patient delay in presentation and to promote early detection of cases before advancement.
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Affiliation(s)
- Aragaw Tesfaw
- Department of Public Health, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Pediatrics and neonatal Nursing, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Tigabu Munye
- Department of Comprehensive Nursing, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Zemachu Ashuro
- Dilla University, College of Health Sciences, Dilla, Southern Ethiopia
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Halbony H, Salman K, Alqassieh A, Albrezat M, Hamdan A, Abualhaija'a A, Alsaeidi O, Masad Melhem J, Sagiroglu J, Alimoglu O. Breast cancer epidemiology among surgically treated patients in Jordan: A retrospective study. Med J Islam Repub Iran 2020; 34:73. [PMID: 33306068 PMCID: PMC7711030 DOI: 10.34171/mjiri.34.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Indexed: 11/09/2022] Open
Abstract
Background: Multiple risk factors contribute to the development of breast cancer, including age, positive family history, early menarche, late menopause and the strongest factor being female gender. In this study, we aimed to investigate the proportion of breast cancer patients with certain risk factors, the prevalence of each cancer type, in addition to the surgical procedures performed.
Methods: The medical records of patients diagnosed with breast cancer from January 2010 to November 2015 were evaluated retrospectively regarding demographics, breast cancer risk factors, comorbidities, diagnostic methods, tumor location, cancer type and stage, pathological findings, tumor markers, harvested lymph nodes and the types of surgical procedures. The collected data were statistically analyzed as number, mean, and frequency as percentages. Cases with deficient medical records were excluded from the analysis of certain parameters.
Results: The sample consisted of 120 patients, 118 (98.3%) of whom were women. The mean age was 56.5±12.0 years. The most common diagnostic method at presentation was self-exam in 93.3% of patients. Invasive ductal carcinoma was the most common type of tumor (80.0%). The pathological stages could be determined for only 106 patients, and 26 patients (24.5%) were at stage 1 disease, 45 patients (42.5%) were at stage 2 whereas 34 patients (32.1%) were at stage 3. According to the results of pathological examinations, 72.6% (85 patients) of the cases were estrogen receptor positive, 61.2% (71 patients) were progesterone receptor positive while 24.8% (27 patients) were HER positive. Modified radical mastectomy (MRM) was performed in 52 (43.3%) patients and wide local excision (WLE) was preferred in 46 (38.3%) cases.
Conclusion: Advanced age, positive family history, and prolonged estrogen exposure were remarkable in the majority of patients. Moreover, the most common type of breast cancer was invasive ductal carcinoma, and around half of the patients presented at stage 2 disease. Modified radical mastectomy and WLE were the most commonly performed surgical procedures.
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Affiliation(s)
- Hala Halbony
- University of Jordan, Faculty of Medicine, Amman, Jordan
| | - Khadija Salman
- University of Jordan, General Surgery Department, Amman, Jordan
| | - Ahmad Alqassieh
- University of Jordan, General Surgery Department, Amman, Jordan
| | - Mutaz Albrezat
- University of Jordan, General Surgery Department, Amman, Jordan
| | - Ahmad Hamdan
- Istanbul Medeniyet University, Goztepe Research and Training Hospital, General Surgery Department, Istanbul, Turkey
| | - Ali Abualhaija'a
- Istanbul Medeniyet University, Goztepe Research and Training Hospital, General Surgery Department, Istanbul, Turkey
| | - Omar Alsaeidi
- Istanbul Medeniyet University, Goztepe Research and Training Hospital, General Surgery Department, Istanbul, Turkey
| | | | - Julide Sagiroglu
- Istanbul Medeniyet University, Goztepe Research and Training Hospital, General Surgery Department, Istanbul, Turkey
| | - Orhan Alimoglu
- University of Jordan, General Surgery Department, Amman, Jordan
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26
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Unger-Saldaña K, Fitch-Picos K, Villarreal-Garza C. Breast Cancer Diagnostic Delays Among Young Mexican Women Are Associated With a Lack of Suspicion by Health Care Providers at First Presentation. J Glob Oncol 2020; 5:1-12. [PMID: 31335236 PMCID: PMC6690634 DOI: 10.1200/jgo.19.00093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE There is insufficient evidence in the literature regarding the association between young age and diagnostic delay of breast cancer (BC). This study aimed to determine whether young age increases the risk of diagnostic delays among patients with BC and also to identify the mechanisms through which young age affects diagnostic delay. PATIENTS AND METHODS This was a cross-sectional study of 592 patients with symptomatic BC treated at two of the largest public cancer hospitals in Mexico City available for the uninsured and those covered by Seguro Popular. A validated questionnaire was administered via face-to-face interviews with the patients, and their medical files were reviewed. Path analyses, using multivariable logistic regression models, were conducted to assess the relationship between age and diagnostic delay, as well as the role of potential confounders. RESULTS Younger participants (40 years of age or younger) had significantly longer diagnostic intervals and presented with more advanced cancer stage than did their older counterparts. Younger participants more often sought initial health care in private services led by gynecologists, more frequently experienced a lack of cancer suspicion by the first physician they consulted, used a higher number of different health services, and had more medical consultations before arrival to a cancer care center. Younger age was significantly associated with longer diagnostic delays after controlling for education, occupation, lack of health insurance, history of benign breast conditions, type of first health service used, specialty of the first physician consulted, first symptom presented, and benign interpretation of the first breast image study. CONCLUSION Young age increased the risk of diagnostic delays, which seems to be a result of an increased risk of lack of cancer suspicion at the first health care service consulted.
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Affiliation(s)
| | | | - Cynthia Villarreal-Garza
- Instituto Nacional de Cancerología, Mexico City, Mexico.,Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Monterrey, Mexico
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Paluch-Shimon S, Cardoso F, Partridge AH, Abulkhair O, Azim HA, Bianchi-Micheli G, Cardoso MJ, Curigliano G, Gelmon KA, Harbeck N, Merschdorf J, Poortmans P, Pruneri G, Senkus E, Spanic T, Stearns V, Wengström Y, Peccatori F, Pagani O. ESO-ESMO 4th International Consensus Guidelines for Breast Cancer in Young Women (BCY4). Ann Oncol 2020; 31:674-696. [PMID: 32199930 DOI: 10.1016/j.annonc.2020.03.284] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/07/2020] [Indexed: 12/16/2022] Open
Abstract
The 4th International Consensus Conference for Breast Cancer in Young Women (BCY4) took place in October 2018, in Lugano, Switzerland, organized by the European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY3 with incorporation of new evidence to inform the guidelines. Areas of research priorities were also identified. This article summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).
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Affiliation(s)
| | - F Cardoso
- Breast Unit Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - A H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - O Abulkhair
- King Abdulaziz Medical City for National Guard, Riyadh, Saudi Arabia
| | - H A Azim
- School of Medicine, Monterrey Institute of Technology, Monterrey, MX
| | | | - M-J Cardoso
- Breast Unit Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Nova Medical School Lisbon, Portugal
| | - G Curigliano
- European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - K A Gelmon
- British Columbia Cancer, Vancouver, Canada
| | - N Harbeck
- Breast Center, Dept. OB&GYN, University of Munich (LMU), Munich, Germany
| | | | - P Poortmans
- Institut Curie, Department of Radiation Oncology & Paris Sciences & Lettres - PSL University, Paris, France
| | - G Pruneri
- National Cancer Institute, IRCCS Foundation, Milan, Italy
| | - E Senkus
- Medical University of Gdansk, Gdansk, Poland
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - V Stearns
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA
| | - Y Wengström
- Department of Neurobiology Cancer Science and Society, Karolinska Institute and Theme Cancer Karolinska University Hospital, Sweden
| | - F Peccatori
- European Institute of Oncology IRCCS & European School of Oncology, Milan, Italy
| | - O Pagani
- Oncology Institute of Southern Switzerland and Breast Unit of Southern Switzerland, Geneva University Hospitals, Swiss Group for Clinical Cancer Research (SAKK), Bellinzona, Switzerland
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28
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Youlden DR, Baade PD, Walker R, Pyke CM, Roder DM, Aitken JF. Breast Cancer Incidence and Survival Among Young Females in Queensland, Australia. J Adolesc Young Adult Oncol 2020; 9:402-409. [DOI: 10.1089/jayao.2019.0119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Danny R. Youlden
- Cancer Council Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Peter D. Baade
- Cancer Council Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Rick Walker
- Oncology Service, Queensland Children's Hospital, Brisbane, Australia
- Oncology Service, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher M. Pyke
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Surgery, Mater Hospital, Brisbane, Australia
| | - David M. Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Joanne F. Aitken
- Cancer Council Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia
- School of Public Health, University of Queensland, Brisbane, Australia
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29
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Newman-Toker DE, Wang Z, Zhu Y, Nassery N, Saber Tehrani AS, Schaffer AC, Yu-Moe CW, Clemens GD, Fanai M, Siegal D. Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”. Diagnosis (Berl) 2020; 8:67-84. [DOI: 10.1515/dx-2019-0104] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 02/12/2020] [Indexed: 02/06/2023]
Abstract
Abstract
Background
Missed vascular events, infections, and cancers account for ~75% of serious harms from diagnostic errors. Just 15 diseases from these “Big Three” categories account for nearly half of all serious misdiagnosis-related harms in malpractice claims. As part of a larger project estimating total US burden of serious misdiagnosis-related harms, we performed a focused literature review to measure diagnostic error and harm rates for these 15 conditions.
Methods
We searched PubMed, Google, and cited references. For errors, we selected high-quality, modern, US-based studies, if available, and best available evidence otherwise. For harms, we used literature-based estimates of the generic (disease-agnostic) rate of serious harms (morbidity/mortality) per diagnostic error and applied claims-based severity weights to construct disease-specific rates. Results were validated via expert review and comparison to prior literature that used different methods. We used Monte Carlo analysis to construct probabilistic plausible ranges (PPRs) around estimates.
Results
Rates for the 15 diseases were drawn from 28 published studies representing 91,755 patients. Diagnostic error (false negative) rates ranged from 2.2% (myocardial infarction) to 62.1% (spinal abscess), with a median of 13.6% [interquartile range (IQR) 9.2–24.7] and an aggregate mean of 9.7% (PPR 8.2–12.3). Serious misdiagnosis-related harm rates per incident disease case ranged from 1.2% (myocardial infarction) to 35.6% (spinal abscess), with a median of 5.5% (IQR 4.6–13.6) and an aggregate mean of 5.2% (PPR 4.5–6.7). Rates were considered face valid by domain experts and consistent with prior literature reports.
Conclusions
Diagnostic improvement initiatives should focus on dangerous conditions with higher diagnostic error and misdiagnosis-related harm rates.
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Affiliation(s)
- David E. Newman-Toker
- Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore, MD , USA
- Director, Armstrong Institute Center for Diagnostic Excellence , The Johns Hopkins University School of Medicine , Baltimore, MD , USA
- Professor, Department of Epidemiology , The Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
| | - Zheyu Wang
- Department of Oncology , The Johns Hopkins University School of Medicine , Baltimore, MD , USA
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
| | - Yuxin Zhu
- Department of Oncology , The Johns Hopkins University School of Medicine , Baltimore, MD , USA
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
| | - Najlla Nassery
- Department of Medicine , The Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Ali S. Saber Tehrani
- Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Adam C. Schaffer
- Department of Patient Safety, CRICO , Boston, MA , USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School , Boston, MA , USA
| | | | - Gwendolyn D. Clemens
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
| | - Mehdi Fanai
- Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Dana Siegal
- Director of Patient Safety, CRICO Strategies , Boston, MA , USA
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Soussoko M, Salleron J, Desandes E, Lesur A. [Breast cancer management before 40 years: what change in one decade? A retrospective study at the "Institut de cancérologie de Lorraine": 2002-2012]. Bull Cancer 2020; 106:S60-S74. [PMID: 32008740 DOI: 10.1016/s0007-4551(20)30049-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Breast cancer of young women has medico-psychological issues, particularly in the perspective of "after cancer" period. The objective of the study was to analyze the changes in management, in a decade including the publication of Cancer Plans I and II. METHODS This retrospective unicentric study involved two populations of women aged 40 and treated at the "Institut de cancérologie de Lorraine" in 2002-2004 (P1) and 2012-2014 (P2). Epidemiological-demographic, histological, diagnostic and therapeutic sequences were analyzed. RESULTS 216 patients were included. The mean age was 35.7 years (range 22-40), with no significant epidemiological difference, except for an increased rate of obesity in P2. Preoperative biopsies became almost systematic and the pre-therapeutic care plan rate increased over the decade from 3.8% to 8% (p < 0.001). The rate of breast-conserving treatment remained stable. The sentinel lymph node rate increased from 4.4% in P1 to 31.9% in P2 (p < 0.001), while the rate of lymph node dissection decreased (p < 0.001) between the two periods. Resort to breast nurses, psycho-oncologists, fertility experts and oncogenetic consultations has also increased. CONCLUSION There is an improvement in the care and management of young women under 40 because of the first Cancer Plans. A study about the impact on the prognosis and a reflection to improve the experience of illness for these women are to lead.
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Affiliation(s)
- Mariam Soussoko
- Institut de cancérologie de Lorraine Alexis-Vautrin, Parcours sein, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France.
| | - Julia Salleron
- Cellule data biostatistique, Institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Emmanuel Desandes
- Service en charge des données de santé, Institut de cancérologie de Lorraine Alexis-Vautrin, Parcours sein, 6, avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy cedex, France
| | - Anne Lesur
- Institut de cancérologie de Lorraine Alexis-Vautrin, Parcours sein, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France
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Somanna SN, Nandagudi Srinivasa M, Chaluvarayaswamy R, Malila N. Time Interval between Self-Detection of Symptoms to Treatment of Breast Cancer. Asian Pac J Cancer Prev 2020; 21:169-174. [PMID: 31983180 PMCID: PMC7294006 DOI: 10.31557/apjcp.2020.21.1.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Indexed: 12/24/2022] Open
Abstract
Background: In India breast cancer is the number one cancer among females with an incidence rate of 25.8 per 100,000 women and mortality of 12.7 per 100,000 women. India continues to have a low 5-year survival rate of breast cancer with only 66.1% as compared to 90% in developed countries. The major reason for low survival is that patients are diagnosed with cancer at high stage. The present study attempts to delineate the time interval between self-detection of breast cancer symptoms and seeking care and to find the main reasons for delay in seeking care. Methods: A cross sectional study was undertaken from October 2016 to March 2017 in a population based cancer registry (PBCR) and hospital based cancer registry (HBCR) located in south of India. Histologically confirmed breast cancer patients (N=181) were interviewed at hospital using a pre-tested semi structured questionnaire. Results: The median time interval between the self-detection of breast cancer symptoms and first contact with general physician was 60 [IQR 30-180] days. The median time to diagnosis from the first contact was 30 [IQR 10 - 60] days and the overall median time span from self-detection of symptoms to treatment was 150 [IQR 95-265] days. The major reason given for not seeking medical care in time was lack of awareness in identifying the cancer symptoms both among patients and primary care providers. Conclusion: There was considerable delay from self-detection of symptoms to cancer specific primary treatment of breast cancer. We found lack of awareness among patients as well as in primary care providers to be the major concern for delay. Awareness among the target population and health care professionals would have to be improved for early diagnostics and access to care.
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Affiliation(s)
| | | | - Ramesh Chaluvarayaswamy
- Department of Epidemiology and Biostatistics, Kidwai Memorial Institute of Oncology, Bangalore, India
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32
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Breast Cancer in Young Women: Status Quo and Advanced Disease Management by a Predictive, Preventive, and Personalized Approach. Cancers (Basel) 2019; 11:cancers11111791. [PMID: 31739537 PMCID: PMC6896106 DOI: 10.3390/cancers11111791] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 12/24/2022] Open
Abstract
Why does healthcare of breast cancer (BC) patients, especially in a young population, matter and why are innovative strategies by predictive, preventive, and personalized medicine (PPPM) strongly recommended to replace current reactive medical approach in BC management? Permanent increase in annual numbers of new BC cases with particularly quick growth of premenopausal BC patients, an absence of clearly described risk factors for those patients, as well as established screening tools and programs represent important reasons to focus on BC in young women. Moreover, "young" BC cases are frequently "asymptomatic", difficult to diagnose, and to treat effectively on time. The objective of this article is to update the knowledge on BC in young females, its unique molecular signature, newest concepts in diagnostics and therapy, and to highlight the concepts of predictive, preventive, and personalized medicine with a well-acknowledged potential to advance the overall disease management.
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33
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Menes TS, Sella T, Chodick G. Time to Cancer Diagnosis in Young Women Presenting to Surgeons with Breast-Related Symptoms: A Population-Based Cohort Study. J Womens Health (Larchmt) 2019; 29:493-502. [PMID: 31697607 DOI: 10.1089/jwh.2019.7967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Delay in diagnosis may be a contributing factor to the observed correlation between young age and advanced disease. We examined time to cancer diagnosis in young women presenting to surgeons with breast-related complaints. Materials and Methods: This population-based cohort study included all women aged 18-44 presenting to a surgeon with breast-related complaints between 2005 and 2015 in a large health care plan (n = 157,264). Data included demographics, diagnosis codes, and workup. Cancer diagnosis was ascertained from the national cancer registry. Time to breast imaging and biopsy was compared between the different age groups. Logistic regression analysis was used to determine the association between age and delay to biopsy while adjusting for possible confounders. Results: During the 1st year after the visit, 45,434 (29%) women had breast imaging; 5,766 (3.7%) women had a breast biopsy; and 676 (0.43%) were diagnosed with breast cancer. Overall, time to first breast imaging and biopsy did not differ significantly between the age groups. But nonspecific visit codes (other than breast mass) were associated with delays to imaging and biopsy. Among, women diagnosed with breast cancer, age under 40 years (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.4-3.9), being postpartum (OR: 2.6, 95% CI: 1.1-5.9), and a nonspecific visit code (OR: 8.3, 95% CI: 4.9-14.2) were associated with delay. Conclusions: Symptomatic women with lower a-priori likelihood of malignancy (younger age, postpartum, or nonspecific visit code) are at significantly greater risk of delayed diagnosis of cancer. Physicians should be aware of the diagnostic challenge in young women presenting with nonspecific symptoms.
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Affiliation(s)
- Tehillah S Menes
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Sella
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gabriel Chodick
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
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Refaat R, Abd Alkhalik Basha M, Sobhi Hassan M, Hussein RS, Al-Molla RM, Awad NM, Elkholy E. Is FDG maximum standardized uptake value of primary breast cancer a prognostic factor for locoregional axillary lymph node metastasis? Acta Radiol 2019; 60:1241-1250. [PMID: 30717605 DOI: 10.1177/0284185118824770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Rania Refaat
- Department of Radiodiagnosis, Ain Shams University, Cairo, Egypt
| | | | | | - Rasha S Hussein
- Department of Radiodiagnosis, Ain Shams University, Cairo, Egypt
| | - Rania M Al-Molla
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
| | - Nahla M Awad
- Early Cancer Detection Unit, Ain Shams University hospitals, Cairo, Egypt
| | - Engi Elkholy
- Department of Clinical Oncology, Ain Shams University, Cairo, Egypt
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35
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Rath M, Li Q, Li H, Lindström S, Miron A, Miron P, Dowton AE, Meyer ME, Larson BG, Pomerantz M, Seo JH, Collins LC, Vardeh H, Brachtel E, Come SE, Borges V, Schapira L, Tamimi RM, Partridge AH, Freedman M, Ruddy KJ. Evaluation of significant genome-wide association studies risk - SNPs in young breast cancer patients. PLoS One 2019; 14:e0216997. [PMID: 31125336 PMCID: PMC6534300 DOI: 10.1371/journal.pone.0216997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 05/02/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose Genome-wide-association studies (GWAS) have identified numerous single nucleotide polymorphisms (SNPs) that are associated with an increased risk of breast cancer. Most of these studies were conducted primarily in postmenopausal breast cancer patients. Therefore, we set out to assess whether or not these breast cancer variants are also associated with an elevated risk of breast cancer in young premenopausal patients. Methods In 451 women of European ancestry who had prospectively enrolled in a longitudinal cohort study for women diagnosed with breast cancer at or under age 40, we genotyped 44 SNPs that were previously associated with breast cancer risk. A control group was comprised of 1142 postmenopausal healthy women from the Nurses’ Health Study (NHS). We assessed if the frequencies of the adequately genotyped SNPs differed significantly (p≤0.05) between the cohort of young breast cancer patients and postmenopausal controls, and then we corrected for multiple testing. Results Genotyping of the controls or cases was inadequate for comparisons between the groups for seven of the 44 SNPs. 9 of the remaining 37 were associated with breast cancer risk in young women with a p-value <0.05: rs10510102, rs1219648, rs13387042, rs1876206, rs2936870, rs2981579, rs3734805, rs3803662 and rs4973768. The directions of these associations were consistent with those in postmenopausal women. However, after correction for multiple testing (Benjamini Hochberg) none of the results remained statistically significant. Conclusion After correction for multiple testing, none of the alleles for postmenopausal breast cancer were clearly associated with risk of premenopausal breast cancer in this relatively small study.
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Affiliation(s)
- Michelle Rath
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Qiyuan Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
- National Engineering Research Center for Biochip, Shanghai Biochip Limited Corporation, Shanghai, China
| | - Huili Li
- National Engineering Research Center for Biochip, Shanghai Biochip Limited Corporation, Shanghai, China
| | - Sara Lindström
- Department of Epidemiology, University of Washington, Seattle, United States of America
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, United States of America
| | - Alexander Miron
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, United States of America
| | - Penelope Miron
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, United States of America
| | - Anne E. Dowton
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Meghan E. Meyer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Bryce G. Larson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Mark Pomerantz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Ji-Heui Seo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Laura C. Collins
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States of America
| | - Hilde Vardeh
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States of America
| | - Elena Brachtel
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, United States of America
| | - Steven E. Come
- Beth Israel Deaconess Medical Center, Boston, United States of America
| | - Virginia Borges
- University of Colorado Denver, Aurora, United States of America
| | - Lidia Schapira
- Stanford University Medical Center, Palo Alto, United States of America
| | - Rulla M. Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United States of America
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Matthew Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Kathryn J. Ruddy
- Department of Oncology, Mayo Clinic, Rochester, United States of America
- * E-mail:
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Relationship between Clinicopathologic Variables in Breast Cancer Overall Survival Using Biogeography-Based Optimization Algorithm. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2304128. [PMID: 31058185 PMCID: PMC6463600 DOI: 10.1155/2019/2304128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 12/02/2022]
Abstract
Breast cancer is the most common cancer among women and is considered a major public health concern worldwide. Biogeography-based optimization (BBO) is a novel metaheuristic algorithm. This study analyzed the relationship between the clinicopathologic variables of breast cancer using Cox proportional hazard (PH) regression on the basis of the BBO algorithm. The dataset is prospectively maintained by the Division of Breast Surgery at Kaohsiung Medical University Hospital. A total of 1896 patients with breast cancer were included and tracked from 2005 to 2017. Fifteen general breast cancer clinicopathologic variables were collected. We used the BBO algorithm to select the clinicopathologic variables that could potentially contribute to predicting breast cancer prognosis. Subsequently, Cox PH regression analysis was used to demonstrate the association between overall survival and the selected clinicopathologic variables. C-statistics were used to test predictive accuracy and the concordance of various survival models. The BBO-selected clinicopathologic variables model obtained the highest C-statistic value (80%) for predicting the overall survival of patients with breast cancer. The selected clinicopathologic variables included tumor size (hazard ratio [HR] 2.372, p = 0.006), lymph node metastasis (HR 1.301, p = 0.038), lymphovascular invasion (HR 1.606, p = 0.096), perineural invasion (HR 1.546, p = 0.168), dermal invasion (HR 1.548, p = 0.028), total mastectomy (HR 1.633, p = 0.092), without hormone therapy (HR 2.178, p = 0.003), and without chemotherapy (HR 1.234, p = 0.491). This number was the minimum number of discriminators required for optimal discrimination in the breast cancer overall survival model with acceptable prediction ability. Therefore, on the basis of the clinicopathologic variables, the survival prediction model in this study could contribute to breast cancer follow-up and management.
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Hameed Khaliq I, Mahmood HZ, Sarfraz MD, Masood Gondal K, Zaman S. Pathways to care for patients in Pakistan experiencing signs or symptoms of breast cancer. Breast 2019; 46:40-47. [PMID: 31075671 DOI: 10.1016/j.breast.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022] Open
Abstract
Multiple social and financial barriers exist to breast cancer detection in Pakistan, which may cause a delay in seeking care and the final diagnosis. This analytical study documents the pathways and time courses associated with referral to diagnostic centres to evaluate the clinical signs and symptoms of breast cancer. This report also verifies the association between socio-demographic and clinical indicators concerning the length of time spent before reaching diagnostic facilities. A purposive sample of 200 patients was selected from two tertiary care hospitals in Lahore, Pakistan, for the interviews. Descriptive statistics (that is, percentages, frequencies, and measures of central tendencies) and a multiple linear regression model were used to achieve the study objectives. The descriptive model showed 31-128 days interval between a patient's awareness of a clinical sign or symptom and receiving care. The healthcare system, including traditional healers, took from 7 to 194 days, and the time to diagnosis ranged from 15 to 30 days. Pain severity, larger tumour size, lack of clinical improvement, and the desire to obtain better treatment were reasons given for seeking care, but lack of awareness and fear of financial burden related to accessing healthcare facilities were identified as barriers. Moreover, socio-demographic and other predictive clinical factors were potentially associated with and substantially influenced the likelihood of the increased length of breast cancer patients' time to reach diagnostic centres. In conclusion, referrals by multiple healthcare providers, especially traditional healers and general practitioners, was a significant predictor for delay in diagnosis. Therefore, increased awareness and a responsive healthcare system may reduce the time from the recognition of symptoms to the early detection of breast cancer among women, thus improving outcomes in a developing country.
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Affiliation(s)
- Imran Hameed Khaliq
- Department of Public Health, University of Health Sciences Lahore, Pakistan.
| | - Hafiz Zahid Mahmood
- Department of Economics, COMSATS University Islamabad, Lahore Campus, Pakistan
| | | | - Khalid Masood Gondal
- Vice Chancellor, King Edward Medical University/ Mayo Hospital, Lahore, Pakistan
| | - Shakila Zaman
- Department of Public Health, University of Health Sciences Lahore, Pakistan
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38
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Mutonga M, Speedy S, Rademaker A, Liu D, Uthe R, Jain S, Gradishar WJ, Flaum L, Santa-Maria CA. Relationship of pathological features and a 21 gene expression assay in younger versus older women with node-negative endocrine receptor-positive breast cancer. Breast Cancer Res Treat 2019; 176:95-100. [DOI: 10.1007/s10549-018-05088-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/06/2018] [Indexed: 01/07/2023]
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39
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Martínez MT, Oltra SS, Peña-Chilet M, Alonso E, Hernando C, Burgues O, Chirivella I, Bermejo B, Lluch A, Ribas G. Breast Cancer in Very Young Patients in a Spanish Cohort: Age as an Independent Bad Prognostic Indicator. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2019; 13:1178223419828766. [PMID: 30814839 PMCID: PMC6383086 DOI: 10.1177/1178223419828766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/28/2018] [Indexed: 12/24/2022]
Abstract
Purpose: Breast cancer (BC) in very young women (BCVY) is more aggressive than in
older women. The purpose of this study was to evaluate the relevance of a
range of clinico-pathological factors in the prognosis of BCVY patients. Methods: We retrospectively analyzed 258 patients diagnosed with BCVY at our hospital
from 1998 to 2014; the control group comprised 101 older patients with BC.
We correlated clinicopathological factors, treatments, relapse and exitus
with age and with previously published miRNA expression data. Results: We identified some significant differences in risk factors between BCVY and
older patients. The age at menarche, number of pregnancies, and age at first
pregnancy were lower in the BCVY group and had a greater probability of
recurrence and death in all cases. Lymph node-positive patients in the BCVY
group are associated with a worse prognosis
(P = .02), an immunohistochemical
HER2+ subtype, and disease relapse
(P = .03). Moreover, there was a
shorter time between diagnosis and first relapse in BCVY patients compared
with controls, and they were more likely to die from the disease
(P = .002). Finally, from our panel of
miRNAs deregulated in BC, reduced miR-30c expression was associated with
more aggressive BC in very young patients, lower overall survival, and with
axillary lymph node metastases. Conclusions: Patient age and axillary lymph node status post-surgery are independent and
significant predictors of distant disease-free survival, local
recurrence-free survival, and overall survival. The HER2+ subtype
and lower miR-30c expression are related to poor prognosis in lymph
node-positive young BC patients.
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Affiliation(s)
- María Teresa Martínez
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, Valencia, Spain.,Centre of Networked Biomedical Cancer Research (CIBERONC), Valencia, Spain
| | - Sara S Oltra
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, Valencia, Spain.,Centre of Networked Biomedical Cancer Research (CIBERONC), Valencia, Spain
| | - María Peña-Chilet
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, Valencia, Spain.,Centre of Networked Biomedical Cancer Research (CIBERONC), Valencia, Spain
| | - Elisa Alonso
- Department of Pathology, Health Research Institute INCLIVA, Valencia, Spain
| | - Cristina Hernando
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, Valencia, Spain.,Centre of Networked Biomedical Cancer Research (CIBERONC), Valencia, Spain
| | - Octavio Burgues
- Department of Pathology, Health Research Institute INCLIVA, Valencia, Spain
| | - Isabel Chirivella
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, Valencia, Spain.,Centre of Networked Biomedical Cancer Research (CIBERONC), Valencia, Spain
| | - Begoña Bermejo
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, Valencia, Spain.,Centre of Networked Biomedical Cancer Research (CIBERONC), Valencia, Spain
| | - Ana Lluch
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, Valencia, Spain.,Centre of Networked Biomedical Cancer Research (CIBERONC), Valencia, Spain
| | - Gloria Ribas
- Medical Oncology and Hematology Unit, Health Research Institute INCLIVA, Valencia, Spain.,Centre of Networked Biomedical Cancer Research (CIBERONC), Valencia, Spain
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Villarreal-Garza C, Lopez-Martinez EA, Muñoz-Lozano JF, Unger-Saldaña K. Locally advanced breast cancer in young women in Latin America. Ecancermedicalscience 2019; 13:894. [PMID: 30792811 PMCID: PMC6372300 DOI: 10.3332/ecancer.2019.894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Indexed: 01/07/2023] Open
Abstract
The purpose of this review is to organise, summarise and critically assess existing knowledge on locally advanced breast cancer (LABC) among young women in Latin America. We discuss the most relevant findings in six sections: 1) epidemiology of breast cancer in young women in Latin America; 2) being young as a factor for worse prognosis; 3) LABC in young women in the region; 4) aggressive tumour behaviour among young women; 5) delays in diagnosis and treatment and 6) burden of advanced disease. We point out the need to dedicate resources to enhance earlier diagnosis and prompt referrals of young women with breast cancer; promote research regarding prevalence, biologic characteristics, outcomes and reasons for diagnosis and treatment delays for this age group; and finally, implement supportive care programmes as a means of improving patients and their families’ well-being. The recognition of the current standpoint of breast cancer in young patients across the continent should shed some light on the importance of this pressing matter.
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Affiliation(s)
- Cynthia Villarreal-Garza
- Breast Cancer Center, TecSalud, Tecnologico de Monterrey, Monterrey 66278, Mexico.,Research and Breast Cancer Department, Mexican National Cancer Institute, Mexico City 14080, Mexico.,Joven and Fuerte Program for Young Women with Breast Cancer, Mexico City 03720, Mexico
| | - Edna A Lopez-Martinez
- Breast Cancer Center, TecSalud, Tecnologico de Monterrey, Monterrey 66278, Mexico.,Joven and Fuerte Program for Young Women with Breast Cancer, Mexico City 03720, Mexico
| | - Jose Felipe Muñoz-Lozano
- Breast Cancer Center, TecSalud, Tecnologico de Monterrey, Monterrey 66278, Mexico.,Joven and Fuerte Program for Young Women with Breast Cancer, Mexico City 03720, Mexico
| | - Karla Unger-Saldaña
- CONACYT fellow-Epidemiology Unit, Mexican National Cancer Institute, Mexico City 14080, Mexico
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41
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Suter MB, Pagani O. Should age impact breast cancer management in young women? Fine tuning of treatment guidelines. Ther Adv Med Oncol 2018; 10:1758835918776923. [PMID: 29977348 PMCID: PMC6024273 DOI: 10.1177/1758835918776923] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/12/2018] [Indexed: 01/12/2023] Open
Abstract
Despite breast cancer being uncommon in young women, it is still the most frequent cancer diagnosed in women aged 15–39 years, and the leading cause of death in this age group in high-income countries, after accidents and self-injury. The present review summarizes the most recent guidelines and offers an expert perspective on the many challenges associated with treatment of young women with breast cancer. We will especially focus on early breast cancer, exploring the specificities of the diagnostic process, imaging techniques, locoregional and systemic treatments, and the added value of dedicated multidisciplinary teams. Specific differences in adjuvant treatment between premenopausal and postmenopausal women, especially regarding endocrine therapy, will be addressed in detail. Research questions and current gaps in important fields, such as the paucity of age-specific data regarding antihuman epidermal growth factor receptor 2 (anti-HER2) therapy and gene panels such as OncotypeDX or MAMMAPRINT will be highlighted. A consistent part of this review is dedicated to the issues defining ‘young women’, such as fertility preservation, managing long-term side effects of oncological treatments and genetic counselling, by detailing current strategies and future perspectives.
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Affiliation(s)
| | - Olivia Pagani
- Institute of Oncology and Breast Unit of Southern Switzerland, Bellinzona, Switzerland
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42
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Bardia A, Hurvitz S. Targeted Therapy for Premenopausal Women with HR +, HER2 - Advanced Breast Cancer: Focus on Special Considerations and Latest Advances. Clin Cancer Res 2018; 24:5206-5218. [PMID: 29884743 DOI: 10.1158/1078-0432.ccr-18-0162] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/12/2018] [Accepted: 06/06/2018] [Indexed: 11/16/2022]
Abstract
The incidence of advanced breast cancer in premenopausal women is increasing, and breast cancer in younger women is often more aggressive and has a worse prognosis compared with breast cancer in older women. Premenopausal women with hormone receptor-positive (HR+) breast cancer are frequently under-represented in clinical trials, and treatment strategies in the premenopausal setting are usually extrapolated from data from postmenopausal patients, with the addition of ovarian function suppression to endocrine therapy in HR+ disease. However, the underlying biology of breast cancer in premenopausal women can be different from postmenopausal women, and treatment strategies should ideally be specifically tested in premenopausal patients. Recent phase III trials have now investigated cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in premenopausal patients with HR+, HER2- advanced breast cancer: Palbociclib and abemaciclib have been tested in a subset of premenopausal patients in the PALOMA-3 and MONARCH-2 studies, and ribociclib has been tested in the phase III MONALEESA-7 trial, which was entirely dedicated to premenopausal women. This comprehensive review summarizes the differences in the biology of HR+, HER2- breast cancer in the premenopausal population compared with the postmenopausal population; discusses special considerations for treatment of premenopausal women; and reviews the evidence from clinical trials investigating endocrine therapy, other targeted treatments, and ovarian function suppression in the HR+, HER2- advanced breast cancer setting. Clin Cancer Res; 24(21); 5206-18. ©2018 AACR.
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Affiliation(s)
- Aditya Bardia
- Massachusetts General Hospital Cancer Center/Harvard Medical School, Boston, Massachusetts.
| | - Sara Hurvitz
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California
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43
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Paluch-Shimon S, Pagani O, Partridge AH, Abulkhair O, Cardoso MJ, Dent RA, Gelmon K, Gentilini O, Harbeck N, Margulies A, Meirow D, Pruneri G, Senkus E, Spanic T, Sutliff M, Travado L, Peccatori F, Cardoso F. ESO-ESMO 3rd international consensus guidelines for breast cancer in young women (BCY3). Breast 2017; 35:203-217. [DOI: 10.1016/j.breast.2017.07.017] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022] Open
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44
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Stamatovic L, Vasovic S, Trifunovic J, Boskov N, Gajic Z, Parezanovic A, Icevic M, Cirkovic A, Milic N. Factors influencing time to seeking medical advice and onset of treatment in women who are diagnosed with breast cancer in Serbia. Psychooncology 2017; 27:576-582. [PMID: 28857314 DOI: 10.1002/pon.4551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Streamlining the diagnosis is a key factor in improving the treatment outcomes for breast cancer. The aim of this study was to determine factors influencing time to seeking medical advice and treatment onset in women who are diagnosed with breast cancer in Serbia. METHODS The study was a multicenter, cross-sectional national survey, performed at 10 oncology centers in Serbia. Time intervals spent throughout the complex diagnostic pathway were evaluated using a validated questionnaire administered to women with breast cancer (n = 800). Total interval (TI) was determined using predefined time scales, including one referring to patient interval (PI), and several related to health care system interval (SI). RESULTS Mean PI, SI, and TI were 4.5, 9.2, and 12.9 weeks, respectively; 20% of patients had a PI>12 weeks. Based on the multivariate regression model, longer PI was associated with perceived lack of time and personal disregard or trivialization of detected symptoms and signs. Women who were supported by family members or friends and had at least a secondary level education tended to have a shorter PI. Longer PI was correlated with a longer SI, while regular self-examination, having been diagnosed by an oncologist, and living in a major city were associated with shorter SI. CONCLUSIONS Several factors, related to psychological, demographic, behavioral, and health system characteristics, determined both the time to seeking medical advice and treatment onset for breast cancer. These findings support review and refining of national strategies and policies to promote early detection, diagnosis, and treatment of breast cancer.
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Affiliation(s)
- L Stamatovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - S Vasovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - J Trifunovic
- Oncology Institute of Vojvodina, Novi Sad, Serbia
| | - N Boskov
- General Hospital Zrenjanin, Zrenjanin, Serbia
| | - Z Gajic
- General Hospital Kruševac, Kruševac, Serbia
| | | | | | - A Cirkovic
- Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia
| | - N Milic
- Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia.,Department for Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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45
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Dianatinasab M, Mohammadianpanah M, Daneshi N, Zare-Bandamiri M, Rezaeianzadeh A, Fararouei M. Socioeconomic Factors, Health Behavior, and Late-Stage Diagnosis of Breast Cancer: Considering the Impact of Delay in Diagnosis. Clin Breast Cancer 2017; 18:239-245. [PMID: 29033239 DOI: 10.1016/j.clbc.2017.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/26/2017] [Accepted: 09/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Stage of cancer at diagnosis is one of the most important factors in patient prognosis. By controlling for diagnostic delay, this study aimed to identify factors associated with late-stage breast cancer (BC). PATIENTS AND METHODS From November 2014 to January 2017, required information on 497 patients who were newly diagnosed with BC was obtained from patients' medical records. Logistic regression was used to measure the association between cancer stage and study variables. RESULTS Only 18.3% of patients were diagnosed at stage I. The rest were diagnosed at stage II (45.5%) or higher (36.2%). Among those with ≤ 3 months' diagnostic delay, age (odds ratio [OR] = 0.96; 95% confidence interval [CI], 0.93-0.99), place of residence (OR urban/rural = 1.72; 95% CI, 1.42-1.93), income (OR high/low = 0.27; 95% CI, 0.10-0.72), performing breast self-examination (OR yes/no = 0.51; 95% CI, 0.0.26 -0.98), smoking (OR yes/no = 2.23; 95% CI, 1.37-3.62), history of chest X-ray (OR yes/no = 1.40; 95% CI, 1.16-1.98), presence of chronic diseases (OR yes/no = 1.73; 95% CI, 1.36-5.48), and, for those with a delay of > 3 months, marriage age (OR = 0.83; 95% CI, 0.73-0.94), income (OR high/low = 0.07; 95% CI, 0.008-0.63), family history of BC (OR = 3.82; 95% CI, 1.05-5.05), daily exercise (OR < 10/10-20 = 0.10; 95% CI, 0.01-0.67), and presence of chronic diseases (OR yes/no = 1.77; 95% CI, 1.73-5.07), were associated with late-stage of cancer. CONCLUSION Shortening the diagnostic delay can help patients receive medical treatment at an earlier disease stage, resulting in better prognosis. Smokers, younger women, and those with chronic conditions or a family history of BC should take extra caution, as they may have worse prognosis if diagnosed with cancer.
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Affiliation(s)
- Mostafa Dianatinasab
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran; Department of Epidemiology, Faculty of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Nima Daneshi
- Department of Epidemiology, Faculty of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Zare-Bandamiri
- Department of Epidemiology, Faculty of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaeianzadeh
- Department of Epidemiology, Faculty of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran; Colorectal Research Center, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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46
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Montagna G, Schneeberger AR, Rossi L, Bianchi Micheli G, Meani F, Imperiali M, Spitale A, Pagani O. Can we make a portrait of women with inoperable locally advanced breast cancer? Breast 2017; 33:83-90. [PMID: 28288387 DOI: 10.1016/j.breast.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Delay between clinical presentation and treatment of breast cancer (BC) can significantly impact mortality. We aimed at drawing a picture of women with locally advanced breast cancer (LABC) treated at our Breast Unit and at investigating factors associated with treatment delay. MATERIAL AND METHODS A retrospective descriptive analysis, using a specific 28-item semi-structured questionnaire, was conducted in 67 patients diagnosed with T4 BC. RESULTS Nearly a third of our patients had at least one known predisposing factor for LABC. 42% of patients did not perform routine medical breast checks, 49% reported indifference as the first feeling and 47% waited at least 3 months before seeking medical attention. The reasons for diagnostic delay were different in the various age groups. Doctor's delay in making the right diagnosis occurred in 60% of younger patients (≤40 years, n = 5), whereas among women aged 41-69years (n = 34) 50% suffered from psychiatric comorbidities. In patients ≥70 years (n = 28) social factors such as isolation, being widowed and living in a retirement home were present in most of the cases. Delay in seeking medical care was also associated with increasing age. Across all age groups, coping factors such as denial and indifference were also associated with an increase in the odds of delayed presentation, as opposed to fear. CONCLUSIONS Factors possibly explaining late medical consultation seem to differ according to age. Psychological factors are crucial in patients' delay whereas age and social factors are relevant in doctors' and system's delay.
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Affiliation(s)
- Giacomo Montagna
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale, Lugano, Switzerland; Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland.
| | - Andres R Schneeberger
- Psychiatric University Hospital (UPK), University Basel, Basel, Switzerland; Psychiatric Services Grisons (PDGR), Chur, Switzerland; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences (AECOM), New York, NY, USA
| | - Lorenzo Rossi
- Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland; Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | | | - Francesco Meani
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale, Lugano, Switzerland; Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland
| | - Mauro Imperiali
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Olivia Pagani
- Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland; Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
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47
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O'Mahony M, Comber H, Fitzgerald T, Corrigan MA, Fitzgerald E, Grunfeld EA, Flynn MG, Hegarty J. Interventions for raising breast cancer awareness in women. Cochrane Database Syst Rev 2017; 2:CD011396. [PMID: 28185268 PMCID: PMC6464597 DOI: 10.1002/14651858.cd011396.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Breast cancer continues to be the most commonly diagnosed cancer in women globally. Early detection, diagnosis and treatment of breast cancer are key to better outcomes. Since many women will discover a breast cancer symptom themselves, it is important that they are breast cancer aware i.e. have the knowledge, skills and confidence to detect breast changes and present promptly to a healthcare professional. OBJECTIVES To assess the effectiveness of interventions for raising breast cancer awareness in women. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialised Register (searched 25 January 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 12) in the Cochrane Library (searched 27 January 2016), MEDLINE OvidSP (2008 to 27 January 2016), Embase (Embase.com, 2008 to 27 January 2016), the World Health Organization's International Clinical Trials Registry Platform (ICTRP) search portal and ClinicalTrials.gov (searched 27 Feburary 2016). We also searched the reference lists of identified articles and reviews and the grey literature for conference proceedings and published abstracts. No language restriction was applied. SELECTION CRITERIA Randomised controlled trials (RCTs) focusing on interventions for raising women's breast cancer awareness i.e. knowledge of potential breast cancer symptoms/changes and the confidence to look at and feel their breasts, using any means of delivery, i.e. one-to-one/group/mass media campaign(s). DATA COLLECTION AND ANALYSIS Two authors selected studies, independently extracted data and assessed risk of bias. We reported the odds ratio (OR) and 95% confidence intervals (CIs) for dichotomous outcomes and mean difference (MD) and standard deviation (SD) for continuous outcomes. Since it was not possible to combine data from included studies due to their heterogeneity, we present a narrative synthesis. We assessed the quality of evidence using GRADE methods. MAIN RESULTS We included two RCTs involving 997 women: one RCT (867 women) randomised women to receive either a written booklet and usual care (intervention group 1), a written booklet and usual care plus a verbal interaction with a radiographer or research psychologist (intervention group 2) or usual care (control group); and the second RCT (130 women) randomised women to either an educational programme (three sessions of 60 to 90 minutes) or no intervention (control group). Knowledge of breast cancer symptomsIn the first study, knowledge of non-lump symptoms increased in intervention group 1 compared to the control group at two years postintervention, but not significantly (OR 1.1, 95% CI 0.7 to 1.6; P = 0.66; 449 women; moderate-quality evidence). Similarly, at two years postintervention, knowledge of symptoms increased in the intervention group 2 compared to the control group but not significantly (OR 1.4, 95% CI 0.9 to 2.1; P = 0.11; 434 women; moderate-quality evidence). In the second study, women's awareness of breast cancer symptoms had increased one month post intervention in the educational group (MD 3.45, SD 5.11; 65 women; low-quality evidence) compared to the control group (MD -0.68, SD 5.93; 65 women; P < 0.001), where there was a decrease in awareness. Knowledge of age-related riskIn the first study, women's knowledge of age-related risk of breast cancer increased, but not significantly, in intervention group 1 compared to control at two years postintervention (OR 1.8; 95% CI 0.9 to 3.5; P < 0.08; 447 women; moderate-quality evidence). Women's knowledge of risk increased significantly in intervention group 2 compared to control at two years postintervention (OR 4.8, 95% CI 2.6 to 9.0; P < 0.001; 431 women; moderate-quality evidence). In the second study, women's perceived susceptibility (how at risk they considered themselves) to breast cancer had increased significantly one month post intervention in the educational group (MD 1.31, SD 3.57; 65 women; low-quality evidence) compared to the control group (MD -0.55, SD 3.31; 65 women; P = 0.005), where a decrease in perceived susceptibility was noted. Frequency of Breast CheckingIn the first study, no significant change was noted for intervention group 1 compared to control at two years postintervention (OR 1.1, 95% CI 0.8 to 1.6; P = 0.54; 457 women; moderate-quality evidence). Monthly breast checking increased, but not significantly, in intervention group 2 compared to control at two years postintervention (OR 1.3, 95% CI 0.9 to 1.9; P = 0.14; 445 women; moderate-quality evidence). In the second study, women's breast cancer preventive behaviours increased significantly one month post intervention in the educational group (MD 1.21, SD 2.54; 65 women; low-quality evidence) compared to the control group (MD 0.15, SD 2.94; 65 women; P < 0.045). Breast Cancer AwarenessWomen's overall breast cancer awareness did not change in intervention group 1 compared to control at two years postintervention (OR 1.8, 95% CI 0.6 to 5.30; P = 0.32; 435 women; moderate-quality evidence) while overall awareness increased in the intervention group 2 compared to control at two years postintervention (OR 8.1, 95% CI 2.7 to 25.0; P < 0.001; 420 women; moderate-quality evidence). In the second study, there was a significant increase in scores on the Health Belief Model (that included the constructs of awareness and perceived susceptibility) at one month postintervention in the educational group (mean 1.21, SD 2.54; 65 women) compared to the control group (mean 0.15, SD 2.94; 65 women; P = 0.045).Neither study reported outcomes relating to motivation to check their breasts, confidence to seek help, time from breast symptom discovery to presentation to a healthcare professional, intentions to seek help, quality of life, adverse effects of the interventions, stages of breast cancer, survival estimates or breast cancer mortality rates. AUTHORS' CONCLUSIONS Based on the results of two RCTs, a brief intervention has the potential to increase women's breast cancer awareness. However, findings of this review should be interpreted with caution, as GRADE assessment identified moderate-quality evidence in only one of the two studies reviewed. In addition, the included trials were heterogeneous in terms of the interventions, population studied and outcomes measured. Therefore, current evidence cannot be generalised to the wider context. Further studies including larger samples, validated outcome measures and longitudinal approaches are warranted.
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Affiliation(s)
- Máirín O'Mahony
- University College CorkSchool of Nursing & Midwifery, Brookfield Health Sciences ComplexCollege RoadCorkIreland
| | - Harry Comber
- University College CorkCork Specialist Training Programme for General Practice3 BloomfieldCorkIreland
| | - Tony Fitzgerald
- University College CorkDepartment of Epidemiology and Public HealthBrookfield Health Sciences ComplexCorkIreland
| | - Mark A Corrigan
- Cork University HospitalDepartment of SurgeryWilton RoadCorkIreland
| | | | - Elizabeth A Grunfeld
- Coventry UniversityCentre for Technology Enabled Health Research (CTEHR)CoventryUKCV1 5FB
| | - Maura G Flynn
- University College CorkNursing and Midwifery, Boston Scientific Health Sciences Library, Brookfield Health Sciences ComplexCollege RoadCorkIreland
| | - Josephine Hegarty
- University College CorkSchool of Nursing & Midwifery, Brookfield Health Sciences ComplexCollege RoadCorkIreland
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Value Analysis of Digital Breast Tomosynthesis for Breast Cancer Screening in a US Medicaid Population. J Am Coll Radiol 2017; 14:467-474.e5. [PMID: 28139412 DOI: 10.1016/j.jacr.2016.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Better understanding regarding the clinical-economic value of digital breast tomosynthesis (DBT) for breast cancer screening for Medicaid enrollees is needed to help inform sound, value-based decision making. The objective of this study was to conduct a clinical-economic value analysis of DBT for breast cancer screening among women enrolled in Medicaid to assess the potential clinical benefits, associated expenditures, and net budget impact of DBT. METHODS Two annual screening mammography scenarios were evaluated with an economic model: (1) full-field digital mammography and (2) combined full-field digital mammography and DBT. The model focused on two main drivers of DBT value: (1) capacity for DBT to reduce the number of women recalled for additional follow-up imaging and diagnostic services and (2) capacity of DBT to facilitate earlier diagnosis of cancer at earlier stages, when treatment costs are lower. RESULTS Model analysis results showed that the use of DBT as a mammographic screening modality by Medicaid enrollees potentially reduces the need for follow-up diagnostic services and improves the detection of invasive cancers, allowing earlier, less costly treatment. With the modest incremental reimbursement of $37 for DBT expected for a typical Medicaid claim, annual cost savings from DBT predicted by the model amounts to $8.14 per patient, potentially translating into more than $12,000 savings per year for an average-sized Medicaid plan and as much as $207,000 savings per year for a typical state Medicaid program. CONCLUSIONS Wider adoption of DBT presents an opportunity to deliver value-based care to Medicaid programs and to help address disparities and barriers to accessing preventive care by some of the nation's most vulnerable citizens.
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Rana P, Ratcliffe J, Sussman J, Forbes M, Levine M, Hodgson N. Young women with breast cancer: Needs and experiences. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1278836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Punam Rana
- Department of Oncology, Juravinski Cancer Centre, McMaster University/Hamilton Health Sciences, 699 Concession Street, Suite 4–214, Hamilton, Ontario, Canada L8V 5C2
| | - Jenna Ratcliffe
- Department of Oncology, Juravinski Cancer Centre, McMaster University/Hamilton Health Sciences, 699 Concession Street, Suite 4–214, Hamilton, Ontario, Canada L8V 5C2
| | - Jonathan Sussman
- Department of Oncology, Juravinski Cancer Centre, McMaster University/Hamilton Health Sciences, 699 Concession Street, Suite 4–214, Hamilton, Ontario, Canada L8V 5C2
| | - Margaret Forbes
- Department of Oncology, Juravinski Cancer Centre, McMaster University/Hamilton Health Sciences, 699 Concession Street, Suite 4–214, Hamilton, Ontario, Canada L8V 5C2
| | - Mark Levine
- Department of Oncology, Juravinski Cancer Centre, McMaster University/Hamilton Health Sciences, 699 Concession Street, Suite 4–214, Hamilton, Ontario, Canada L8V 5C2
| | - Nicole Hodgson
- Department of Oncology, Juravinski Cancer Centre, McMaster University/Hamilton Health Sciences, 699 Concession Street, Suite 4–214, Hamilton, Ontario, Canada L8V 5C2
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Youl PH, Aitken JF, Turrell G, Chambers SK, Dunn J, Pyke C, Baade PD. The Impact of Rurality and Disadvantage on the Diagnostic Interval for Breast Cancer in a Large Population-Based Study of 3202 Women in Queensland, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1156. [PMID: 27869758 PMCID: PMC5129366 DOI: 10.3390/ijerph13111156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/11/2016] [Accepted: 11/15/2016] [Indexed: 01/07/2023]
Abstract
Delays in diagnosing breast cancer (BC) can lead to poorer outcomes. We investigated factors related to the diagnostic interval in a population-based cohort of 3202 women diagnosed with BC in Queensland, Australia. Interviews ascertained method of detection and dates of medical/procedural appointments, and clinical information was obtained from medical records. Time intervals were calculated from self-recognition of symptoms (symptom-detected) or mammogram (screen-detected) to diagnosis (diagnostic interval (DI)). The cohort included 1560 women with symptom-detected and 1642 with screen-detected BC. Symptom-detected women had higher odds of DI of >60 days if they were Indigenous (OR = 3.12, 95% CI = 1.40, 6.98); lived in outer regional (OR = 1.50, 95% CI = 1.09, 2.06) or remote locations (OR = 2.46, 95% CI = 1.39, 4.38); or presented with a "non-lump" symptom (OR = 1.84, 95% CI = 1.43, 2.36). For screen-detected BC, women who were Indigenous (OR = 2.36, 95% CI = 1.03, 5.80); lived in remote locations (OR = 2.35, 95% CI = 1.24, 4.44); or disadvantaged areas (OR = 1.69, 95% CI = 1.17, 2.43) and attended a public screening facility (OR = 2.10, 95% CI = 1.40, 3.17) had higher odds of DI > 30 days. Our study indicates a disadvantage in terms of DI for rural, disadvantaged and Indigenous women. Difficulties in accessing primary care and diagnostic services are evident. There is a need to identify and implement an efficient and effective model of care to minimize avoidable longer diagnostic intervals.
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Affiliation(s)
- Philippa H Youl
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia.
| | - Joanne F Aitken
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia.
- School of Population Health, University of Queensland, Brisbane, QLD 4072, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
| | - Gavin Turrell
- Institute of Health and Ageing, Australian Catholic University, Fitzroy, VIC 3115, Australia.
| | - Suzanne K Chambers
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
| | - Jeffrey Dunn
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
- School of Social Science, University of Queensland, Brisbane, QLD4072, Australia.
| | - Christopher Pyke
- Mater Medical Centre, 293 Vulture Street, South Brisbane, QLD 4101, Australia.
| | - Peter D Baade
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD 4000, Australia.
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