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Springer F, Mehnert-Theuerkauf A, Gebhardt C, Stolzenburg JU, Briest S. Unmet supportive care needs among cancer patients: exploring cancer entity-specific needs and associated factors. J Cancer Res Clin Oncol 2024; 150:190. [PMID: 38607426 PMCID: PMC11009727 DOI: 10.1007/s00432-024-05715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Recognizing unmet care needs among cancer patients is crucial for improving a person-centered and tailored approach to survivorship care. This study aimed to explore the prevalence of unmet supportive care needs, pinpointing entity-specific areas of burden, and to identify factors associated with unmet needs within a diverse sample of cancer patients. METHODS In this cross-sectional sub-study of a large multicenter study, 944 adult cancer patients reported supportive care needs via the well-validated SCNS. Most frequent diagnoses included breast (n = 276), prostate (n = 237), hematological (n = 90) and gynecological cancer (n = 74), which were analyzed for entity-specific care needs. RESULTS Across most cancer entities, health system and information, and psychological needs were most commonly reported, with fear of the cancer spreading and information regarding cancer control/diminishment ranking as the most prevalent individual concerns. Notable differences in entity-specific needs emerged for gynecological cancer patients, who exhibited more psychological (p = 0.007, OR = 2.01) and physical needs (p = 0.005, OR = 2.02), and prostate cancer patients, who showed higher sexuality needs (p < 0.001, OR = 2.95) but fewer psychological (p < 0.001, OR = 0.55), physical (p < 0.001, OR = 0.31) and patient care needs (p = 0.006, OR = 0.62). Non-distressed participants had fewer supportive care needs in each domain (all p < 0.001). Patients with functional impairments and female respondents reported increased unmet needs across most domains. CONCLUSION The high prevalence of patients feeling inadequately informed about their disease and care aspects, particularly among those with functional impairments, reflects a key challenge in the healthcare system. Specific interventions and improvements in patient-doctor communication are essential to address cancer entity-specific care needs.
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Affiliation(s)
- Franziska Springer
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig, Germany.
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig, Germany
| | - Claudia Gebhardt
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig, Germany
| | - Jens-Uwe Stolzenburg
- Department of Urology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig, Germany
| | - Susanne Briest
- Department of Gynecology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig, Germany
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Hinz A, Schulte T, Mehnert-Theuerkauf A, Richter D, Sender A, Brock H, Friedrich M, Briest S. Fear of Cancer Progression: A Comparison between the Fear of Progression Questionnaire (FoP-Q-12) and the Concerns about Recurrence Questionnaire (CARQ-4). Healthcare (Basel) 2024; 12:435. [PMID: 38391810 PMCID: PMC10888487 DOI: 10.3390/healthcare12040435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
As cancer patients often suffer from fear of cancer progression (FoP), valid screening for FoP is of high relevance. The aims of this study were to test psychometric properties of two FoP questionnaires, to determine their relationship to other anxiety-related constructs, and to analyze the impact of sociodemographic and clinical factors on the FoP. Our sample consisted of n = 1733 patients with mixed cancer diagnoses. For measuring FoP, the Fear of Progression questionnaire (FoP-Q-12) and the Concerns About Cancer Recurrence Questionnaire (CARQ-4) were used. The mean scores of the FoP-Q-12 and the CARQ-4 were 30.0 ± 10.4 and 16.1 ± 10.8, respectively, indicating relatively high levels of FoP. Both questionnaires showed excellent internal consistency coefficients, α = 0.895 and α = 0.915, respectively. The correlation between the two FoP questionnaires was r = 0.72. Female patients reported more FoP than male patients (d = 0.84 and d = 0.54, respectively). There was a nonlinear age dependency of FoP, with an increase found in the age range from 18 to 50 years and a decrease in the older age range. Radiation, chemotherapy, and antibody therapy, but not surgery, lead to an increase in FoP. Both questionnaires show good psychometric properties and can be recommended for use in an oncological routine. Female patients and patients in the middle-age range deserve special attention from healthcare providers.
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Affiliation(s)
- Andreas Hinz
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Thomas Schulte
- Rehabilitation Clinic Bad Oexen, 32549 Bad Oeynhausen, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Diana Richter
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Annekathrin Sender
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Hannah Brock
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Susanne Briest
- Department of Gynecology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
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Sauer F, Grosser S, Shahryari M, Hayn A, Guo J, Braun J, Briest S, Wolf B, Aktas B, Horn L, Sack I, Käs JA. Changes in Tissue Fluidity Predict Tumor Aggressiveness In Vivo. Adv Sci (Weinh) 2023; 10:e2303523. [PMID: 37553780 PMCID: PMC10502644 DOI: 10.1002/advs.202303523] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Indexed: 08/10/2023]
Abstract
Cancer progression is caused by genetic changes and associated with various alterations in cell properties, which also affect a tumor's mechanical state. While an increased stiffness has been well known for long for solid tumors, it has limited prognostic power. It is hypothesized that cancer progression is accompanied by tissue fluidization, where portions of the tissue can change position across different length scales. Supported by tabletop magnetic resonance elastography (MRE) on stroma mimicking collagen gels and microscopic analysis of live cells inside patient derived tumor explants, an overview is provided of how cancer associated mechanisms, including cellular unjamming, proliferation, microenvironment composition, and remodeling can alter a tissue's fluidity and stiffness. In vivo, state-of-the-art multifrequency MRE can distinguish tumors from their surrounding host tissue by their rheological fingerprints. Most importantly, a meta-analysis on the currently available clinical studies is conducted and universal trends are identified. The results and conclusions are condensed into a gedankenexperiment about how a tumor can grow and eventually metastasize into its environment from a physics perspective to deduce corresponding mechanical properties. Based on stiffness, fluidity, spatial heterogeneity, and texture of the tumor front a roadmap for a prognosis of a tumor's aggressiveness and metastatic potential is presented.
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Affiliation(s)
- Frank Sauer
- Soft Matter Physics DivisionPeter‐Debye‐Institute for Soft Matter Physics04103LeipzigGermany
| | - Steffen Grosser
- Soft Matter Physics DivisionPeter‐Debye‐Institute for Soft Matter Physics04103LeipzigGermany
- Institute for Bioengineering of CataloniaThe Barcelona Institute for Science and Technology (BIST)Barcelona08028Spain
| | - Mehrgan Shahryari
- Department of RadiologyCharité‐Universitätsmedizin10117BerlinGermany
| | - Alexander Hayn
- Department of HepatologyLeipzig University Hospital04103LeipzigGermany
| | - Jing Guo
- Department of RadiologyCharité‐Universitätsmedizin10117BerlinGermany
| | - Jürgen Braun
- Institute of Medical InformaticsCharité‐Universitätsmedizin10117BerlinGermany
| | - Susanne Briest
- Department of GynecologyLeipzig University Hospital04103LeipzigGermany
| | - Benjamin Wolf
- Department of GynecologyLeipzig University Hospital04103LeipzigGermany
| | - Bahriye Aktas
- Department of GynecologyLeipzig University Hospital04103LeipzigGermany
| | - Lars‐Christian Horn
- Division of Breast, Urogenital and Perinatal PathologyLeipzig University Hospital04103LeipzigGermany
| | - Ingolf Sack
- Department of RadiologyCharité‐Universitätsmedizin10117BerlinGermany
| | - Josef A. Käs
- Soft Matter Physics DivisionPeter‐Debye‐Institute for Soft Matter Physics04103LeipzigGermany
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Dayan D, Ernst K, Aktas B, Baierl R, Briest S, Dengler M, Dieterle D, Endres A, Engelken K, Faridi A, Frenz H, Hantschmann P, Janni W, Kaiser C, Kokott T, Laufhütte S, Schober F, Ebner F. Resemblance of the Recurrence Patterns in Primary Systemic, Primary Surgery and Secondary Oncoplastic Surgery. Curr Oncol 2022; 29:8874-8885. [PMID: 36421351 PMCID: PMC9689416 DOI: 10.3390/curroncol29110698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Surgical interventions tend to have an effect on the generation of recurrences in tumor patients due to the anesthesia involved as well as tissue damage and subsequent inflammation. This can also be found in patients with breast cancer. METHODS In this multicenter study, we investigated data of 632 patients with breast cancer and the subsequent diagnosis of a recurrence. The patient data were acquired from 1 January 2006 to 31 December 2019 in eight different centers in Germany. The data sets were separated into those with primary surgery, primary systemic therapy with subsequent surgery, and reconstructive surgery. Three different starting points for observation were defined: the date of diagnosis, the date of first surgery, and the date of reconstructive surgery, if applicable. The observational period was divided into steps of six months and maxima of recurrences were compared. Furthermore, the variance was calculated using the difference of the distribution in percent. RESULTS The descriptive analysis showed no resemblance between the groups. The variance of the difference of the recurrence rates analysis using the surgical date as the starting point showed similarities in the age subgroup. CONCLUSION Our clinical analysis shows different metastatic behavior in different analysis and treatment regimes. These findings justify further investigations on a larger database. These results may possibly identify an improved follow-up setting depending on tumor stage, biology, treatment, and patient factors (i.e., age, …).
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Affiliation(s)
- Davut Dayan
- Frauenklinik, Universität Ulm, 89075 Ulm, Germany
| | | | - Bahriye Aktas
- Universitätsklinik Leipzig, Frauenklinik, 04103 Leipzig, Germany
| | - Raffaela Baierl
- Brustkrebszentrum Passau, Klinikum Passau, 94032 Passau, Germany
| | - Susanne Briest
- Universitätsklinik Leipzig, Frauenklinik, 04103 Leipzig, Germany
| | - Martin Dengler
- Brustkrebszentrum Passau, Klinikum Passau, 94032 Passau, Germany
| | - Daniela Dieterle
- Brustzentrum Kaufbeuren, Klinikum Kaufbeuren, 87600 Kaufbeuren, Germany
| | - Amelie Endres
- Medical Facility, Universität Tübingen, 72016 Tübingen, Germany
| | | | | | - Hannes Frenz
- Medical Facility, Universität Tübingen, 72016 Tübingen, Germany
| | | | | | | | | | | | - Florian Schober
- Plastische Chirurgie, Diakoneo Schwäbisch Hall, 74523 Schwäbisch Hall, Germany
| | - Florian Ebner
- Frauenarztpraxis Freising, Marienplatz, 585354 Freising, Germany
- Correspondence:
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Nitz U, Gluz O, Graeser M, Christgen M, Kuemmel S, Grischke EM, Braun M, Augustin D, Potenberg J, Krauss K, Schumacher C, Forstbauer H, Reimer T, Stefek A, Fischer HH, Pelz E, zu Eulenburg C, Kates R, Wuerstlein R, Kreipe HH, Harbeck N, von Schumann R, Kuhn W, Polata S, Bielecki W, Meyer R, Just M, Kraudelt S, Siggelkow W, Wortelmann H, Kleine-Tebbe A, Leitzen L, Kirchhof H, Krabisch P, Hackmann J, Depenbusch R, Gnauert K, Staib P, Lehnert A, Hoffmann O, Briest S, Lindner C, Heyl V, Bauer L, Uleer C, Mohrmann S, Viehstaedt N, Malter W, Link T, Buendgen N, Tio J. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG-ADAPT-HER2+/HR–): survival outcomes from a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol 2022; 23:625-635. [DOI: 10.1016/s1470-2045(22)00159-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 12/18/2022]
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Rhiem K, Auber B, Briest S, Dikow N, Ditsch N, Dragicevic N, Grill S, Hahnen E, Horvath J, Jaeger B, Kast K, Kiechle M, Leinert E, Morlot S, Püsken M, Schäfer D, Schott S, Schroeder C, Siebers-Renelt U, Solbach C, Weber-Lassalle N, Witzel I, Zeder-Göß C, Schmutzler RK. Consensus Recommendations of the German Consortium for Hereditary Breast and Ovarian Cancer. Breast Care (Basel) 2022; 17:199-207. [PMID: 35702495 PMCID: PMC9149395 DOI: 10.1159/000516376] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/17/2021] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The German Consortium for Hereditary Breast and Ovarian Cancer (GC-HBOC) has established a multigene panel (TruRisk®) for the analysis of risk genes for familial breast and ovarian cancer. SUMMARY An interdisciplinary team of experts from the GC-HBOC has evaluated the available data on risk modification in the presence of pathogenic mutations in these genes based on a structured literature search and through a formal consensus process. KEY MESSAGES The goal of this work is to better assess individual disease risk and, on this basis, to derive clinical recommendations for patient counseling and care at the centers of the GC-HBOC from the initial consultation prior to genetic testing to the use of individual risk-adapted preventive/therapeutic measures.
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Affiliation(s)
- Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology, Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Bernd Auber
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Susanne Briest
- Department of Obstetrics and Gynaecology, University Hospital of Leipzig, Leipzig, Germany
| | - Nicola Dikow
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital of Augsburg, Augsburg, Germany
| | - Neda Dragicevic
- Institute of Human Genetics, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Sabine Grill
- Department of Gynecology and Obstetrics, University Hospital Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Eric Hahnen
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology, Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Judit Horvath
- Institute for Human Genetics, University Hospital Münster, Münster, Germany
| | - Bernadette Jaeger
- Department of Gynaecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Karin Kast
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology, Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, University Hospital Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Elena Leinert
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Susanne Morlot
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Michael Püsken
- Department of Radiology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Dieter Schäfer
- Institute for Human Genetics, University of Frankfurt, Frankfurt, Germany
| | - Sarah Schott
- Department of Obstetrics and Gynaecology, University of Heidelberg, Heidelberg, Germany
| | - Christopher Schroeder
- Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | | | - Christine Solbach
- Department of Gynecology and Obstetrics, University Hospital Frankfurt, Frankfurt, Germany
| | - Nana Weber-Lassalle
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology, Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Isabell Witzel
- Department of Obstetrics and Gynaecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Zeder-Göß
- Department of Gynecology and Obstetrics, University Hospital of Augsburg, Augsburg, Germany
| | - Rita K. Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology, Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
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Engesser D, Krauß O, Briest S, Stolzenburg JU, Singer S. [Beyond Content Alone: What Cancer Patients Consider as Important in Professional Psychosocial Support]. Psychother Psychosom Med Psychol 2022; 72:374-377. [PMID: 35158395 DOI: 10.1055/a-1685-0888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In this study we wanted to find out what cancer patients expect from professional psychosocial support. METHODS Within a multicenter prospective study, patients were asked about their expectations from professional psychosocial support two years after diagnosis. Using qualitative methods, categories were built from the answers. The answers were assigned to the categories. RESULTS 447 patients were contacted and 285 answers were obtained. Getting information as well as interaction with enough time for listening was considered as important. Support should result in enhancement of psychological strength. DISCUSSION Apart from contents, aspects of how support is given such as attention and competence are important. There should be enough time for the consideration of individual needs. CONCLUSION Both getting information and competence as well as listening and personal conversation are important.
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Affiliation(s)
- Deborah Engesser
- Epidemiologie und Versorgungsforschung, Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI) Universitätsmedizin Mainz, Deutschland.,Universitäres Centrum für Tumorerkrankungen (UCT), Mainz, Deutschland
| | - Oliver Krauß
- Psychotherapeutische Praxis, Leipzig, Deutschland
| | - Susanne Briest
- Universitätsfrauenklinik, Brustzentrum, Universitätsklinikum Leipzig, Deutschland
| | | | - Susanne Singer
- Epidemiologie und Versorgungsforschung, Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI) Universitätsmedizin Mainz, Deutschland.,Universitäres Centrum für Tumorerkrankungen (UCT), Mainz, Deutschland
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Spindler N, Ebel F, Briest S, Wallochny S, Langer S. Quality of Life After Bilateral Risk-Reducing Mastectomy and Simultaneous Reconstruction Using Pre-Pectoral Silicone Implants. Patient Prefer Adherence 2021; 15:741-750. [PMID: 33880017 PMCID: PMC8053496 DOI: 10.2147/ppa.s303208] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/13/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Bilateral risk-reducing mastectomy (BRRM) can reduce the risk of developing breast cancer by up to 95% in women with increased exposure. Although survival is increased, mastectomies can adversely affect a patient physically, psychologically, and psychosexually. High health-related quality of life (HRQoL) is often achieved after simultaneous breast reconstruction (BR) following BRRM; however, data on the pre- and postoperative results of HRQoL are lacking. Therefore, we investigated the quality of life, esthetic outcome, and patient well-being after BRRM and simultaneous implant-based BR. PATIENTS AND METHODS Of the 35 patients who underwent skin-sparing or nipple-sparing mastectomy between May 2012 and December 2017 at a university hospital, only 22 completed the evaluation. Baseline data and data on previous operations and operation techniques were retrieved from the patient's charts. BREAST-Q and short form-36 health survey (SF-36) questionnaires were used to evaluate patient satisfaction and HRQoL. RESULTS SF-36 analysis showed a significantly higher score for pain (p=0.043) in our population than in the general female population. Comparing the pre- and postoperative BREAST-Q results, a significant decrease in the physical well-being of the chest (p=0.0179) and a slight improvement in breast satisfaction were observed (p=0.3266). All patients were well-satisfied with the postoperative outcome, reconstruction, and perioperative surgeon care. CONCLUSION Bilateral mastectomy with simultaneous BR using pre-pectoral implants is associated with an HRQoL similar to that of the healthy population. Although bilateral mastectomy may have an immense effect on the psychological, physical, and social aspects, immediate BR preserves the outer appearance and improves self-esteem.
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Affiliation(s)
- Nick Spindler
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
- Correspondence: Nick Spindler Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, Leipzig, 04103, GermanyTel +49-341-9717140Fax +49-341-9717139 Email
| | - Franziska Ebel
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Briest
- Department of Gynecology, Women’s and Children’s Centre, University Hospital Leipzig, Leipzig, Germany
| | - Sandra Wallochny
- Department of Gynecology, Women’s and Children’s Centre, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Langer
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
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Untch M, Würstlein R, Lüftner D, Haidinger R, Fasching PA, Augustin D, Briest S, Ettl J, Förster F, Kurbacher CM, Lück HJ, Marschner N, Müller L, Müller V, Radke I, Ruckhäberle E, Scheffen I, Schumacher-Wulf E, Schwoerer M, Steinfeld-Birg D, Ziegler-Löhr K, Thomssen C, Harbeck N. ABC5 International Consensus Conference on Advanced Breast Cancer, Lisbon, 16 November 2019: Commentary by the German panel of experts on the ABC5 voting results. Geburtshilfe Frauenheilkd 2020; 80:588-600. [PMID: 32565549 PMCID: PMC7299684 DOI: 10.1055/a-1139-9380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022] Open
Abstract
The Advanced Breast Cancer Fifth International Consensus Conference (ABC5) which focuses on the diagnosis and treatment of advanced breast cancer was held in Lisbon on November 14 - 16, 2019. The aim of the conference is to standardize the treatment of advanced breast cancer worldwide using evidence-based data and to ensure that patients with advanced breast disease anywhere in the world are treated appropriately and have access to the latest therapies. This year, the emphasis was on new developments and study results from patients with advanced breast cancer as well as precision medicine. The collaboration with patient advocates from all over the globe is also an important goal of the ABC Conference, which is why the international ABC panel also included a number of patient advocates. We present a commentary on the voting results of the ABC5 panelists in Lisbon by a working group of German breast cancer specialists together with the implications for routine clinical care in Germany. The commentary is based on the recommendations of the Breast Commission of the German Gynecological Oncology Working Group (AGO). This commentary is useful, it includes country-specific features for the ABC consensus.
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Affiliation(s)
- Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Brustzentrum und Gynäkologisch Onkologisches Zentrum, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Rachel Würstlein
- Brustzentrum und Comprehensive Cancer Center (CCC) München, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität München (LMU), München, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | - Peter A. Fasching
- Universitätsfrauenklinik Erlangen, Comprehensive Cancer Center (CCC) Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Doris Augustin
- Mammazentrum Ostbayern, DONAUISAR Klinikum Deggendorf, Deggendorf, Germany
| | - Susanne Briest
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Johannes Ettl
- Frauenklinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum rechts der Isar, München, Germany
| | - Frank Förster
- Praxis für Gynäkologie und Geburtshilfe, Gynäkologische Onkologie und Palliativmedizin, Poliklinik gGmbH, Chemnitz, Germany
| | - Christian M. Kurbacher
- Gynäkologie I (Gynäkologische Onkologie), Gynäkologisches Zentrum, Bonn-Friedensplatz, Bonn, Germany
| | | | - Norbert Marschner
- Gemeinschaftspraxis für interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany
| | - Lothar Müller
- Onkologische Schwerpunktpraxis Leer-Emden-Papenburg, Leer, Emden, Papenburg, Germany
| | - Volkmar Müller
- Universitätsfrauenklinik Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Radke
- Brustzentrum, Universitätsklinikum Münster, Münster, Germany
| | | | - Iris Scheffen
- Brustzentrum am St. Elisabeth-Krankenhaus GmbH, Köln, Germany
| | | | - Moritz Schwoerer
- Frauenklinik, Klinikum Fürstenfeldbruck, Fürstenfeldbruck, Germany
| | | | | | - Christoph Thomssen
- Universitätsklinik und Poliklinik für Gynäkologie, Martin-Luther-Universität, Halle an der Saale; ABC panel member, ABC scientific committee member, Germany
| | - Nadia Harbeck
- Brustzentrum und Comprehensive Cancer Center (CCC) München, Universität München (LMU), München; ABC panel member, Germany
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10
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Thomssen C, Lüftner D, Untch M, Haidinger R, Würstlein R, Harbeck N, Augustin D, Briest S, Ettl J, Fasching PA, Förster F, Kurbacher CM, Lück HJ, Marschner N, Müller L, Müller V, Perlova-Griff L, Radke I, Ruckhäberle E, Scheffen I, Schumacher-Wulf E, Schwoerer M, Steinfeld-Birg D, Ziegler-Löhr K. International Consensus Conference for Advanced Breast Cancer, Lisbon 2019: ABC5 Consensus - Assessment by a German Group of Experts. Breast Care (Basel) 2020; 15:82-95. [PMID: 32231503 DOI: 10.1159/000505957] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
Abstract
The 5th International Consensus Conference for Advanced Breast Cancer (ABC5) took place on November 14-16, 2019, in Lisbon, Portugal. Its aim is to standardize the treatment of advanced breast cancer based on the available evidence and to ensure that all breast cancer patients worldwide receive adequate treatment and access to new therapies. This year, the conference focused on developments and study results in the treatment of patients with hormone receptor-positive/HER2-negative breast cancer as well as precision medicine. As in previous years, patient advocates from around the world were integrated into the ABC conference and had seats on the ABC consensus panel. In the present paper, a working group of German breast cancer experts comments on the results of the on-site ABC5 consensus votes by ABC panelists regarding their applicability for routine treatment in Germany. These comments take the recommendations of the Breast Committee of the Gynecological Oncology Working Group (Arbeitsgemeinschaft Gynäkologische Onkologie; AGO) into account. The report and assessment presented here pertain to the preliminary results of the ABC5 consensus. The final version of the statements will be published in Annals of Oncology and The Breast.
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Affiliation(s)
- Christoph Thomssen
- Klinik und Poliklinik für Gynäkologie, Martin-Luther-Universität Halle-Wittenberg, Halle an der Saale, Germany
| | - Diana Lüftner
- Medical Department of Hematology, Oncology, and Tumor Immunology, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Untch
- Clinic of Gynecology and Obstetrics, Multidisciplinary Breast Cancer Center, Department of Gynecologic Oncology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Renate Haidinger
- Brustkrebs Deutschland (German Breast Cancer Association) e.V., Hohenbrunn, Germany
| | - Rachel Würstlein
- Breast Center and Comprehensive Cancer Center (CCC) Munich, Department of Obstetrics and Gynecology, University of Munich (LMU), Munich, Germany
| | - Nadia Harbeck
- Breast Center and Comprehensive Cancer Center (CCC) Munich, Department of Obstetrics and Gynecology, University of Munich (LMU), Munich, Germany
| | - Doris Augustin
- Breast Center of Eastern Bavaria, DONAUISAR Hospital of Deggendorf, Deggendorf, Germany
| | - Susanne Briest
- Department of Gynecology, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Ettl
- Department of Gynecology and Obstetrics, University Hospital Rechts der Isar, Munich, Germany
| | - Peter A Fasching
- Women's Hospital at the University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
| | - Frank Förster
- Practice for Gynecology and Obstetrics, Gynecological Oncology and Palliative Care, Poliklinik gGmbH, Chemnitz, Germany
| | - Christian M Kurbacher
- Practice - Gynecology I (Gynecologic Oncology), Gynecologic Center Bonn-Friedensplatz, Bonn, Germany
| | | | - Norbert Marschner
- Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany
| | - Lothar Müller
- Oncology Specialist Practice of Leer-Emden-Papenburg, Leer-Emden-Papenburg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Hospital, Hamburg-Eppendorf, Germany
| | - Lidia Perlova-Griff
- Gynecological Oncology of Wilmersdorf, Treatment Center II of the St. Gertrude Hospital, Berlin, Germany
| | - Isabel Radke
- Breast Center, University Hospital of Münster, Münster, Germany
| | - Eugen Ruckhäberle
- Department of Obstetrics and Gynecology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Iris Scheffen
- Breast Center at St. Elisabeth Hospital, Cologne, Germany
| | | | - Moritz Schwoerer
- Department of Gynecology, Hospital Fürstenfeldbruck, Fürstenfeldbruck, Germany
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11
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Kreklau A, Aktas B, Briest S. Die Wertigkeit von B3-Läsionen der Mamma – wie gefährlich sind Indikatorläsionen? Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- A Kreklau
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig, Leipzig
| | - B Aktas
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig, Leipzig
| | - S Briest
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig, Leipzig
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12
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Kreklau A, Stark S, Aktas B, Briest S. CUP-Syndrom nach risikoreduzierender Mastektomie mit Implantatrekonstruktion – was geschieht mit der Brust? Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- A Kreklau
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig, Leipzig
| | - S Stark
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig, Leipzig
| | - B Aktas
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig, Leipzig
| | - S Briest
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig, Leipzig
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13
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Engel C, Fischer C, Zachariae S, Bucksch K, Rhiem K, Giesecke J, Herold N, Wappenschmidt B, Hübbel V, Maringa M, Reichstein-Gnielinski S, Hahnen E, Bartram CR, Dikow N, Schott S, Speiser D, Horn D, Fallenberg EM, Kiechle M, Quante AS, Vesper AS, Fehm T, Mundhenke C, Arnold N, Leinert E, Just W, Siebers-Renelt U, Weigel S, Gehrig A, Wöckel A, Schlegelberger B, Pertschy S, Kast K, Wimberger P, Briest S, Loeffler M, Bick U, Schmutzler RK. Breast cancer risk in BRCA1/2 mutation carriers and noncarriers under prospective intensified surveillance. Int J Cancer 2019; 146:999-1009. [PMID: 31081934 DOI: 10.1002/ijc.32396] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/17/2019] [Accepted: 04/25/2019] [Indexed: 01/15/2023]
Abstract
Comparably little is known about breast cancer (BC) risks in women from families tested negative for BRCA1/2 mutations despite an indicative family history, as opposed to BRCA1/2 mutation carriers. We determined the age-dependent risks of first and contralateral breast cancer (FBC, CBC) both in noncarriers and carriers of BRCA1/2 mutations, who participated in an intensified breast imaging surveillance program. The study was conducted between January 1, 2005, and September 30, 2017, at 12 university centers of the German Consortium for Hereditary Breast and Ovarian Cancer. Two cohorts were prospectively followed up for incident FBC (n = 4,380; 16,398 person-years [PY], median baseline age: 39 years) and CBC (n = 2,993; 10,090 PY, median baseline age: 42 years). Cumulative FBC risk at age 60 was 61.8% (95% CI 52.8-70.9%) for BRCA1 mutation carriers, 43.2% (95% CI 32.1-56.3%) for BRCA2 mutation carriers and 15.7% (95% CI 11.9-20.4%) for noncarriers. FBC risks were significantly higher than in the general population, with incidence rate ratios of 23.9 (95% CI 18.9-29.8) for BRCA1 mutation carriers, 13.5 (95% CI 9.2-19.1) for BRCA2 mutation carriers and 4.9 (95% CI 3.8-6.3) for BRCA1/2 noncarriers. Cumulative CBC risk 10 years after FBC was 25.1% (95% CI 19.6-31.9%) for BRCA1 mutation carriers, 6.6% (95% CI 3.4-12.5%) for BRCA2 mutation carriers and 3.6% (95% CI 2.2-5.7%) for noncarriers. CBC risk in noncarriers was similar to women with unilateral BC from the general population. Further studies are needed to confirm whether less intensified surveillance is justified in women from BRCA1/2 negative families with elevated risk.
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Affiliation(s)
- Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Christine Fischer
- Institute of Human Genetics, Ruprecht-Karls University, Heidelberg, Germany
| | - Silke Zachariae
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Karolin Bucksch
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Jutta Giesecke
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Natalie Herold
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Barbara Wappenschmidt
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Verena Hübbel
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Monika Maringa
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Simone Reichstein-Gnielinski
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Eric Hahnen
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Claus R Bartram
- Institute of Human Genetics, Ruprecht-Karls University, Heidelberg, Germany
| | - Nicola Dikow
- Institute of Human Genetics, Ruprecht-Karls University, Heidelberg, Germany
| | - Sarah Schott
- Department of Gynaecology, Ruprecht-Karls University, Heidelberg, Germany
| | - Dorothee Speiser
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Denise Horn
- Institute of Medical Genetics and Human Genetics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva M Fallenberg
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany
| | - Anne S Quante
- Department of Gynecology and Obstetrics, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany
| | - Anne-Sophie Vesper
- Department of Obstetrics and Gynecology, University Hospital and Medical Faculty of the Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Tanja Fehm
- Department of Obstetrics and Gynecology, University Hospital and Medical Faculty of the Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Christoph Mundhenke
- Department of Gynecology and Obstetrics, University Hospital of Schleswig-Holstein, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Norbert Arnold
- Department of Gynecology and Obstetrics, Institute of Clinical Molecular Biology, University Hospital of Schleswig-Holstein, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Elena Leinert
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Walter Just
- Institute of Human Genetics, University of Ulm, Ulm, Germany
| | | | - Stefanie Weigel
- Institute of Clinical Radiology, Medical Faculty, University of Muenster, University Hospital Muenster, Muenster, Germany
| | - Andrea Gehrig
- Institute of Human Genetics, Würzburg University, Würzburg, Germany
| | - Achim Wöckel
- Department of Obstetrics and Gynecology, Würzburg University Hospital, Würzburg, Germany
| | | | - Stefanie Pertschy
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Karin Kast
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Susanne Briest
- Department of Obstetrics and Gynecology, University Hospital Leipzig, Leipzig, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Ulrich Bick
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Rita K Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
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14
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Meyer HJ, Briest S, Schierle K, Surov A. Diffuse Muskelmetastasierung als einziger Metastasierungsort eines Mammakarzinom-Rezidivs. ROFO-FORTSCHR RONTG 2019; 191:653-654. [PMID: 30665252 DOI: 10.1055/a-0820-5711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hans Jonas Meyer
- Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Briest
- Department of Gynecology, University Hospital Leipzig, Leipzig, Germany
| | - Katrin Schierle
- Department of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Alexey Surov
- Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
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15
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Untch M, Würstlein R, Marschner N, Lüftner D, Augustin D, Briest S, Ettl J, Haidinger R, Müller L, Müller V, Ruckhäberle E, Harbeck N, Thomssen C. 4th International Consensus Conference on Advanced Breast Cancer (ABC4), Lisbon, November 4, 2017 : ABC4 Consensus: Assessment by a Panel of German Experts. Geburtshilfe Frauenheilkd 2018; 78:469-480. [PMID: 29880982 PMCID: PMC5986575 DOI: 10.1055/a-0594-2243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/15/2018] [Accepted: 03/18/2018] [Indexed: 01/18/2023] Open
Abstract
The fourth international advanced breast cancer consensus conference (ABC4) on the diagnosis and treatment of advanced breast cancer (ABC) headed by Professor Fatima Cardoso was once again held in Lisbon on November 2 - 4, 2017. To simplify matters, the abbreviation ABC will be used hereinafter in the text. In clinical practice, the abbreviation corresponds to metastatic breast cancer or locally far-advanced disease. This year the focus was on new developments in the treatment of ABC. Topics discussed included the importance of CDK4/6 inhibition in hormone receptor (HR)-positive ABC, the use of dual antibody blockade to treat HER2-positive ABC, PARP inhibition in triple-negative ABC and the potential therapeutic outcomes. Another major area discussed at the conference was BRCA-associated breast cancer, the treatment of cerebral metastasis, and individualized treatment decisions based on molecular testing (so-called precision medicine). As in previous years, close cooperation with representatives from patient organizations from around the world is an important aspect of the ABC conference. This cooperation was reinforced and expanded at the ABC4 conference. A global alliance was founded at the conclusion of the consensus conference, which aims to promote and coordinate the measures considered necessary by patient advocates worldwide. Because the panel of experts was composed of specialists from all over the world, it was inevitable that the ABC consensus also reflected country-specific features. As in previous years, a team of German breast cancer specialists who closely followed the consensus voting of the ABC panelists in Lisbon and intensively discussed the votes has therefore commented on the consensus in the context of the current German guidelines on the diagnosis and treatment of breast cancer 1 , 2 used in clinical practice in Germany. The ABC consensus is based on the votes of the ABC panelists in Lisbon.
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Affiliation(s)
- Michael Untch
- Klinik für Gynäkologie, HELIOS Klinikum Berlin-Buch, Berlin, Germany; Writing Committee
| | - Rachel Würstlein
- Brustzentrum und CCC München, Klinikum der Universität München, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, München, Germany; Writing Committee
| | - Norbert Marschner
- Gemeinschaftspraxis für interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany; Writing Committee
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany; Writing Committee
| | - Doris Augustin
- Mammazentrum Ostbayern, DONAUISAR Klinikum Deggendorf, Deggendorf, Germany
| | | | - Johannes Ettl
- Frauenklinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum rechts der Isar, München, Germany
| | - Renate Haidinger
- Patientenvertreterin, Brustkrebs Deutschland e. V.; Patient Advocacy Committee ABC4, Faculty
| | - Lothar Müller
- Onkologische Schwerpunktpraxis Leer-Emden-Papenburg, Leer, Germany
| | - Volkmar Müller
- Universitätsfrauenklinik Hamburg-Eppendorf, Hamburg, Germany
| | | | - Nadia Harbeck
- Brustzentrum und CCC München, Klinikum der Universität München, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, München, Germany; Writing Committee, ABC Panel Member, ABC Scientific Committee Member
| | - Christoph Thomssen
- Universitätsklinik und Poliklinik für Gynäkologie, Martin-Luther-Universität, Halle an der Saale, Germany; Writing Committee, ABC Panel Member
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16
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Singer S, Claus S, Briest S, Stolzenburg JU, Papsdorf K, Gockel I, Köhler U, Oestreicher G, Heß G, Schmidt M, Almstedt K. Positive und negative Veränderungen im Leben nach der Krebsdiagnose. Onkologe 2018. [DOI: 10.1007/s00761-018-0369-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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17
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Engel C, Rhiem K, Hahnen E, Loibl S, Weber KE, Seiler S, Zachariae S, Hauke J, Wappenschmidt B, Waha A, Blümcke B, Kiechle M, Meindl A, Niederacher D, Bartram CR, Speiser D, Schlegelberger B, Arnold N, Wieacker P, Leinert E, Gehrig A, Briest S, Kast K, Riess O, Emons G, Weber BHF, Engel J, Schmutzler RK. Prevalence of pathogenic BRCA1/2 germline mutations among 802 women with unilateral triple-negative breast cancer without family cancer history. BMC Cancer 2018. [PMID: 29514593 PMCID: PMC5842578 DOI: 10.1186/s12885-018-4029-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background There is no international consensus up to which age women with a diagnosis of triple-negative breast cancer (TNBC) and no family history of breast or ovarian cancer should be offered genetic testing for germline BRCA1 and BRCA2 (gBRCA) mutations. Here, we explored the association of age at TNBC diagnosis with the prevalence of pathogenic gBRCA mutations in this patient group. Methods The study comprised 802 women (median age 40 years, range 19–76) with oestrogen receptor, progesterone receptor, and human epidermal growth factor receptor type 2 negative breast cancers, who had no relatives with breast or ovarian cancer. All women were tested for pathogenic gBRCA mutations. Logistic regression analysis was used to explore the association between age at TNBC diagnosis and the presence of a pathogenic gBRCA mutation. Results A total of 127 women with TNBC (15.8%) were gBRCA mutation carriers (BRCA1: n = 118, 14.7%; BRCA2: n = 9, 1.1%). The mutation prevalence was 32.9% in the age group 20–29 years compared to 6.9% in the age group 60–69 years. Logistic regression analysis revealed a significant increase of mutation frequency with decreasing age at diagnosis (odds ratio 1.87 per 10 year decrease, 95%CI 1.50–2.32, p < 0.001). gBRCA mutation risk was predicted to be > 10% for women diagnosed below approximately 50 years. Conclusions Based on the general understanding that a heterozygous mutation probability of 10% or greater justifies gBRCA mutation screening, women with TNBC diagnosed before the age of 50 years and no familial history of breast and ovarian cancer should be tested for gBRCA mutations. In Germany, this would concern approximately 880 women with newly diagnosed TNBC per year, of whom approximately 150 are expected to be identified as carriers of a pathogenic gBRCA mutation.
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Affiliation(s)
- Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany
| | - Eric Hahnen
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany.,Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
| | | | | | - Silke Zachariae
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Jan Hauke
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany
| | - Barbara Wappenschmidt
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany
| | - Anke Waha
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany
| | - Britta Blümcke
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany
| | - Marion Kiechle
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Alfons Meindl
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Dieter Niederacher
- Department of Gynecology and Obstetrics, University Hospital of the Heinrich-Heine University, Düsseldorf, Germany
| | - Claus R Bartram
- Institute of Human Genetics, University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Dorothee Speiser
- Zentrum für Familiären Brust- und Eierstockkrebs, Klinik für Gynäkologie mit Brustzentrum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Norbert Arnold
- Institute of Clinical Molecular Biology/Department of Gynecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
| | - Peter Wieacker
- Institute of Human Genetics, University Hospital Münster, Münster, Germany
| | - Elena Leinert
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Andrea Gehrig
- Institute of Human Genetics, University Würzburg, Würzburg, Germany
| | - Susanne Briest
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Leipzig, Leipzig, Germany
| | - Karin Kast
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Günter Emons
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin, Göttingen, Germany
| | - Bernhard H F Weber
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Rita K Schmutzler
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany.
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18
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Harbeck N, Lüftner D, Marschner N, Untch M, Augustin D, Briest S, Ettl J, Haidinger R, Müller L, Müller V, Ruckhäberle E, Wuerstlein R, Thomssen C. ABC4 Consensus: Assessment by a German Group of Experts. Breast Care (Basel) 2018; 13:48-58. [PMID: 29950968 PMCID: PMC6016060 DOI: 10.1159/000486722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The Advanced Breast Cancer Fourth Consensus (ABC4) on diagnosis and treatment of advanced breast cancer (ABC) again took place in Lisbon, on November 2-4, 2017, and was chaired by Fatima Cardoso, MD, PhD. This year's contents focused very much on new developments in the treatment of ABC. For example, the significance of inhibition of cyclin-dependent kinases 4 and 6 (CDK4/6) in hormone receptor (HR)-positive ABC, of dual antibody blockade in human epidermal growth factor receptor 2 (HER2)-positive ABC, and of poly(ADP-ribose) polymerase (PARP) inhibition in triple-negative ABC, as well as the potential therapeutic consequences, were discussed. Other key issues were BRCA-associated breast cancer, treatment of brain metastases, and personalized therapy decision-making using molecular testing (so-called 'precision medicine'). As in past years, an important objective of the ABC conference was cooperation with representatives of patient organizations from around the world. This cooperation was further intensified during the ABC4. Following the main conference, the 'Global Alliance' was founded, with the goal of publicizing and coordinating measures necessary worldwide from the patient advocates' standpoint. - The ABC consensus inevitably cannot accommodate country-specific needs, due to the truly global expert panel. Therefore, a working group of German breast cancer experts commented - as in the past years - on the on-site voting results by the ABC panelists upon which the final ABC4 consensus will be based, with particular consideration of the German guidelines on diagnosis and treatment of breast cancer for everyday treatment in Germany.
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Affiliation(s)
- Nadia Harbeck
- Breast Center and CCC Munich, University of Munich (LMU), Department of Obstetrics and Gynecology, Munich, Germany
| | - Diana Lüftner
- Medical Department of Hematology, Oncology and Tumor Immunology, Humboldt University Berlin, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Norbert Marschner
- Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg i.Br., Germany
| | - Michael Untch
- Gynecology Clinic, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Doris Augustin
- Breast Center of Eastern Bavaria, DONAUISAR Hospital Deggendorf, Deggendorf, Germany
| | | | - Johannes Ettl
- Women's Hospital and Polyclinic for Gynecology and Obstetrics, Klinikum Rechts der Isar Hospital, Munich, Germany
| | | | - Lothar Müller
- Practice Focusing on Oncology Leer-Emden-Papenburg, Leer, Germany
| | - Volkmar Müller
- University Women's Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Eugen Ruckhäberle
- Women's Hospital, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Rachel Wuerstlein
- Breast Center and CCC Munich, University of Munich (LMU), Department of Obstetrics and Gynecology, Munich, Germany
| | - Christoph Thomssen
- University Hospital and Polyclinic of Gynecology, Martin Luther University, Halle (Saale), Germany
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Singer S, Danker H, Roick J, Einenkel J, Briest S, Spieker H, Dietz A, Hoffmann I, Papsdorf K, Meixensberger J, Mössner J, Schiefke F, Dietel A, Wirtz H, Niederwieser D, Berg T, Kersting A. Effects of stepped psychooncological care on referral to psychosocial services and emotional well-being in cancer patients: A cluster-randomized phase III trial. Psychooncology 2017; 26:1675-1683. [DOI: 10.1002/pon.4492] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/11/2017] [Accepted: 06/27/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Susanne Singer
- Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI); University Medical Centre Mainz; Mainz Germany
- University Cancer Centre; University Medical Centre Mainz; Mainz Germany
| | - Helge Danker
- Department of Medical Psychology and Medical Sociology; University Medical Centre Leipzig; Leipzig Germany
- Department of Psychosomatic Medicine and Psychotherapy; University Medical Centre Leipzig; Leipzig Germany
| | - Julia Roick
- Department of Medical Sociology; University of Halle; Halle Germany
| | - Jens Einenkel
- Department of Obstetrics and Gynaecology; University Medical Centre Leipzig; Leipzig Germany
| | - Susanne Briest
- Department of Obstetrics and Gynaecology; University Medical Centre Leipzig; Leipzig Germany
| | - Henning Spieker
- Department of Surgery; University Medical Centre Leipzig; Leipzig Germany
| | - Andreas Dietz
- Department of Otolaryngology; University Medical Centre Leipzig; Leipzig Germany
| | - Isabell Hoffmann
- Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI); University Medical Centre Mainz; Mainz Germany
| | - Kirsten Papsdorf
- Department of Radiation-Oncology; University Medical Centre Leipzig; Leipzig Germany
| | | | - Joachim Mössner
- Department of Gastroenterology; University Medical Centre Leipzig; Leipzig Germany
| | - Franziska Schiefke
- Department of Maxillofacial Surgery; University Medical Centre Leipzig; Leipzig Germany
| | - Anja Dietel
- Department of Urology; University Medical Centre Leipzig; Leipzig Germany
| | - Hubert Wirtz
- Department of Pneumology; University Medical Centre Leipzig; Leipzig Germany
| | - Dietger Niederwieser
- Department of Medical Oncology; University Medical Centre Leipzig; Leipzig Germany
| | - Thomas Berg
- Division of Hepatology; University Medical Centre Leipzig; Leipzig Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy; University Medical Centre Leipzig; Leipzig Germany
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20
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Roick J, Danker H, Kersting A, Briest S, Dietrich A, Dietz A, Einenkel J, Papsdorf K, Lordick F, Meixensberger J, Mössner J, Niederwieser D, Prietzel T, Schiefke F, Stolzenburg JU, Wirtz H, Singer S. Factors associated with non-participation and dropout among cancer patients in a cluster-randomised controlled trial. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28134477 DOI: 10.1111/ecc.12645] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 12/01/2022]
Abstract
We investigated the impact of demographic and disease related factors on non-participation and dropout in a cluster-randomised behavioural trial in cancer patients with measurements taken between hospitalisation and 6 months thereafter. The percentages of non-participation and dropout were documented at each time point. Factors considered to be potentially related with non-participation and dropout were as follows: age, sex, marital status, education, income, employment status, tumour site and stage of disease. Of 1,338 eligible patients, 24% declined participation at baseline. Non-participation was higher in older patients (Odds Ratio [OR] 2.1, CI: 0.6-0.9) and those with advanced disease (OR 2.0, CI: 0.1-1.3). Dropout by 6 months was 25%. Dropout was more frequent with increased age (OR 2.8, CI: 0.8-1.2), advanced disease (OR 3.0, CI: 1.0-1.2), being married (OR 2.4, CI 0.7-1.1) and less frequent with university education (OR 0.4, CI -1.3 to -0.8) and middle income (OR 0.4, CI -0.9 to -0.7). When planning clinical trials, it is important to be aware of patient groups at high risk of non-participation or dropout, for example older patients or those with advanced disease. Trial designs should consider their special needs to increase their rate of participation.
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Affiliation(s)
- J Roick
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - H Danker
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - A Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - S Briest
- Department of Obstetrics and Gynecology, University Medical Center Leipzig, Leipzig, Germany
| | - A Dietrich
- Department of Visceral-, Transplantation-, Thoracic-, and Vascular Surgery, University Medical Center Leipzig, Leipzig, Germany
| | - A Dietz
- Department of Otolaryngology, University Medical Center Leipzig, Leipzig, Germany
| | - J Einenkel
- Department of Obstetrics and Gynecology, University Medical Center Leipzig, Leipzig, Germany
| | - K Papsdorf
- Department of Radiation-Oncology, University Medical Center Leipzig, Leipzig, Germany
| | - F Lordick
- University Cancer Center, University Medical Center Leipzig, Leipzig, Germany
| | - J Meixensberger
- Department of Neurosurgery, University Medical Center Leipzig, Leipzig, Germany
| | - J Mössner
- Department of Gastroenterology, University Medical Center Leipzig, Leipzig, Germany
| | - D Niederwieser
- Department of Hematology and Oncology, University Medical Center Leipzig, Leipzig, Germany
| | - T Prietzel
- Department of Orthopedics and Accident Surgery, Helios Clinic Blankenhain, Blankenhain, Germany
| | - F Schiefke
- Department of Maxillofacial Surgery, University Medical Center Leipzig, Leipzig, Germany
| | - J-U Stolzenburg
- Department of Urology, University Medical Center Leipzig, Leipzig, Germany
| | - H Wirtz
- Department of Pneumology, University Medical Center Leipzig, Leipzig, Germany
| | - S Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of Johannes Gutenberg University Mainz, Mainz, Germany
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21
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Singer S, Bartels M, Briest S, Einenkel J, Niederwieser D, Papsdorf K, Stolzenburg JU, Künstler S, Taubenheim S, Krauß O. Socio-economic disparities in long-term cancer survival-10 year follow-up with individual patient data. Support Care Cancer 2016; 25:1391-1399. [PMID: 27942934 DOI: 10.1007/s00520-016-3528-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/05/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Reasons for the social gradient in cancer survival are not fully understood yet. Previous studies were often only able to determine the socio-economic status of the patients from the area they live in, not from their individual socio-economic characteristics. METHODS In a multi-centre cohort study with 1633 cancer patients and 10-year follow-up, individual socio-economic position was measured using the indicators: education, job grade, job type, and equivalence income. The effect on survival was measured for each indicator individually, adjusting for age, gender, and medical characteristics. The mediating effect of health behaviour (alcohol and tobacco consumption) was analysed in separate models. RESULTS Patients without vocational training were at increased risk of dying (rate ratio (RR) 1.5, 95% confidence interval (CI) 1.1-2.2) compared to patients with the highest vocational training; patients with blue collar jobs were at increased risk (RR 1.2; 95% CI 1.0-1.5) compared to patients with white collar jobs; income had a gradual effect (RR for the lowest income compared to highest was 2.7, 95% CI 1.9-3.8). Adding health behaviour to the models did not change the effect estimates considerably. There was no evidence for an effect of school education and job grade on cancer survival. CONCLUSIONS Patients with higher income, better vocational training, and white collar jobs survived longer, regardless of disease stage at baseline and of tobacco and alcohol consumption.
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Affiliation(s)
- Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Epidemiology and Health Services Research, University Medical Centre Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany.
- University Cancer Centre Mainz, Mainz, Germany.
| | - Michael Bartels
- Department of General and Visceral Surgery, Helios Park Clinic, Leipzig, Germany
| | - Susanne Briest
- Department of Gynaecology, University Medical Centre Leipzig, Leipzig, Germany
| | - Jens Einenkel
- Department of Gynaecology, University Medical Centre Leipzig, Leipzig, Germany
| | - Dietger Niederwieser
- Department of Medical Oncology, University Medical Centre Leipzig, Leipzig, Germany
| | - Kirsten Papsdorf
- Department of Radiation Oncology, University Medical Centre Leipzig, Leipzig, Germany
| | | | - Sophie Künstler
- Department of Social Pedagogy and Adult Education, Faculty of Educational Sciences, Goethe University, Frankfurt, Germany
| | - Sabine Taubenheim
- Regional Clinical Cancer Registry Leipzig, University Medical Centre Leipzig, Leipzig, Germany
| | - Oliver Krauß
- Department of Psychotherapy, Helios Park Clinic, Leipzig, Germany
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22
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Abstract
Several advances in the adjuvant systemic therapy of primary breast cancer have occurred in the last decade and contributed to a decline in disease-related mortality. These include the introduction of aromatase inhibitors, new chemotherapy agents, and the novel antibody trastuzumab. New supportive treatments, such as growth factors, have contributed to the optimization of chemotherapy dose and schedule, and have improved the efficacy and safety of the treatment. In this review we will outline some of the recent advances in the adjuvant and neoadjuvant treatment of breast cancer. We will also discuss ongoing and proposed clinical trials.
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Affiliation(s)
- Susanne Briest
- University of Leipzig, Department of Gynecology and Obstetrics, Leipzig Germany
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, 1650 Orleans Street, CRB I, Room 186, Baltimore, MD 21231-1000, USA, Tel.: +1 410 502 3472; Fax: +1 410 614 9421
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, 1650 Orleans Street, CRB I, Room 1M-53 Baltimore, MD 21231-1000, USA, Tel.: +1 443 287 6489; Fax: +1 410 955 0125
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23
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Singer S, Roick J, Briest S, Stark S, Gockel I, Boehm A, Papsdorf K, Meixensberger J, Müller T, Prietzel T, Schiefke F, Dietel A, Bräunlich J, Danker H. Impact of socio-economic position on cancer stage at presentation: Findings from a large hospital-based study in Germany. Int J Cancer 2016; 139:1696-702. [PMID: 27244597 DOI: 10.1002/ijc.30212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/23/2016] [Accepted: 04/19/2016] [Indexed: 12/20/2022]
Abstract
We explored the relationship between socio-economic characteristics and cancer stage at presentation. Patients admitted to a university hospital for diagnosis and treatment of cancer provided data on their education, vocational training, income, employment, job, health insurance and postcode. Tumor stage was classified according to the Union International Contre le Cancer (UICC). To analyze disparities in the likelihood of late-stage (UICC III/IV vs. I/II) diagnoses, logistic regression models adjusting for age and gender were used. Out of 1,012 patients, 572 (59%) had late-stage cancer. Separately tested, increased odds of advanced disease were associated with post-compulsory education compared to college degrees, with apprenticeship and no vocational training, with unemployment, disability pension, jobs with a low hierarchy level, blue collar jobs and with low income. Health insurance and community size were not related with late-stage cancer. Jointly modelled, there was evidence for an independent effect of unemployment (odds ratio (OR) 1.7, CI 1.0-2.8), disability pension (OR 1.8, CI 1.0-3.2) and very low income (OR 2.6, CI 1.1-6.1) on the likelihood of advanced disease stage. It is of great concern that these socio-economic gradients occur even in systems with equal access to health care.
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Affiliation(s)
- Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Mainz, Germany.,University Cancer Centre, Mainz, Germany.,Mainz-Frankfurt, German Consortium of Translational Cancer Research, Germany
| | - Julia Roick
- Department of Medical Psychology and Medical Sociology, University Medical Centre, Leipzig, Germany
| | - Susanne Briest
- Department of Obstetrics and Gynaecology, University Medical Centre, Leipzig, Germany
| | - Sylvia Stark
- Department of Obstetrics and Gynaecology, University Medical Centre, Leipzig, Germany
| | - Ines Gockel
- Department of General Surgery, University Medical Centre, Leipzig, Germany
| | - Andreas Boehm
- Department of Otolaryngology, University Medical Centre, Leipzig, Germany
| | - Kirsten Papsdorf
- Department of Radiation-Oncology, University Medical Centre, Leipzig, Germany
| | | | - Tobias Müller
- Department of Hepatology and Gastroenterology, University Medical Centre Charité, Campus Virchow Clinic, Berlin, Germany
| | - Torsten Prietzel
- Department of Orthopaedics, University Medical Centre, Leipzig, Germany
| | - Franziska Schiefke
- Department of Maxillofacial Surgery, University Medical Centre, Leipzig, Germany
| | - Anja Dietel
- Department of Urology, University Medical Centre, Leipzig, Germany
| | - Jens Bräunlich
- Department of Pneumology, University Medical Centre, Leipzig, Germany
| | - Helge Danker
- Department of Medical Psychology and Medical Sociology, University Medical Centre, Leipzig, Germany
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24
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Horn LC, Taubenheim S, Sändig I, Ossada V, Kant J, Briest S. Metastasen extramammärer Karzinome in der Brust – eine Fallserie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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25
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Kant J, Briest S, Hagert-Winkler A, Monecke A, Horn LC. Postradiogenes Angiosarkom nach brusterhaltender Therapie – ein Fallbericht. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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26
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Singer S, Danker H, Briest S, Dietrich A, Dietz A, Einenkel J, Papsdorf K, Lordick F, Meixensberger J, Mössner J, Niederwieser D, Prietzel T, Schiefke F, Stolzenburg JU, Wirtz H, Kersting A. Effect of a structured psycho-oncological screening and treatment model on mental health in cancer patients (STEPPED CARE): study protocol for a cluster randomized controlled trial. Trials 2014; 15:482. [PMID: 25491069 PMCID: PMC4295289 DOI: 10.1186/1745-6215-15-482] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/20/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND High levels of emotional distress in cancer patients often goes unnoticed in daily clinical routine, resulting in severe undertreatment of mental health problems in this patient group. Screening tools can be used to increase case identification, however, screening alone does not necessarily translate into better mental health for the patient. Doctors play a key role in providing basic emotional support and transferring the patients in need of such specific support to mental health professionals. This study investigates whether a stepped care model, combining screening, doctor consultation and professional psycho-oncological service in a structured way, improves the emotional wellbeing of cancer patients. METHODS/DESIGN This study is a cluster randomized trial with two parallel groups (intervention vs. care as usual), set in an academic hospital. Participants are cancer patients, a total of 1,000 at baseline. The intervention consists of stepped psychosocial care. Step one: screening for distress, step two: feedback of screening results to the doctor in charge of the patient and consultation with the patient, and step three: based on a shared patient-doctor decision, either transferal to the consultation liaison (CL) service or not. The outcome will be emotional well-being half a year after baseline, ascertained with the Hospital Anxiety and Depression Scale. Randomization will be done by the cluster randomization of wards. DISCUSSION Mental health problems not only cause emotional suffering but also direct and indirect costs. This calls for timely and adequate psychosocial support, especially as we know that such support is effective. However, not every cancer patient can and must be treated by a mental health professional. Allocating limited resources most sensibly and economically is of crucial importance for our healthcare system to ensure the best quality of care to as many patients as possible. It is the hope of the STEPPED CARE trial that this model is both effective and efficient, and that it can be implemented in other hospitals as well, if proven to be effective. TRIAL REGISTRATION Clinical Trials Register (Clinicaltrials.gov) identifier: NCT01859429 registration date 17 May 2013.
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Affiliation(s)
- Susanne Singer
- />Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), Division of Epidemiology and Health Services Research, University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany
- />Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Helge Danker
- />Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Susanne Briest
- />Breast Cancer Center, University Medical Center, Liebigstraße 18, 04107 Leipzig, Germany
| | - Arne Dietrich
- />Department of General Surgery, University Medical Center, Liebigstraße 18, 04107 Leipzig, Germany
| | - Andreas Dietz
- />Department of Otolaryngology, University Medical Center, Liebigstraße 18, 04107 Leipzig, Germany
| | - Jens Einenkel
- />Department of Obstetrics and Gynecology, University Medical Center, Liebigstraße 18, 04107 Leipzig, Germany
| | - Kirsten Papsdorf
- />Department of Radiation-Oncology, University Medical Center, Liebigstraße 18, 04107 Leipzig, Germany
| | - Florian Lordick
- />University Cancer Center, University Hospital Leipzig, Liebigstraße 20, 04107 Leipzig, Germany
| | - Jürgen Meixensberger
- />Department of Neurosurgery, University Medical Center, Liebigstraße 18, 04107 Leipzig, Germany
| | - Joachim Mössner
- />Department of Gastroenterology, University Medical Center, Liebigstraße 18, 04107 Leipzig, Germany
| | - Dietger Niederwieser
- />Department of Hematology and Oncology, University Medical Center, Liebigstraße 18, 04107 Leipzig, Germany
| | - Torsten Prietzel
- />Department of Orthopedics, University Medical Center, Liebigstraße 18, 04107 Leipzig, Germany
| | - Franziska Schiefke
- />Department of Maxillofacial Surgery, University Medical Center, Liebigstraße 18, 04107 Leipzig, Germany
| | - Jens-Uwe Stolzenburg
- />Department of Urology, University Medical Center, Liebigstraße 18, 04107 Leipzig, Germany
| | - Hubert Wirtz
- />Department of Pneumology, University Medical Center, Liebigstraße 18, 04107 Leipzig, Germany
| | - Anette Kersting
- />Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Semmelweisstraße 10, 04103 Leipzig, Germany
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27
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Kast K, Schmutzler RK, Rhiem K, Kiechle M, Fischer C, Niederacher D, Arnold N, Grimm T, Speiser D, Schlegelberger B, Varga D, Horvath J, Beer M, Briest S, Meindl A, Engel C. Validation of the Manchester scoring system for predictingBRCA1/2mutations in 9,390 families suspected of having hereditary breast and ovarian cancer. Int J Cancer 2014; 135:2352-61. [DOI: 10.1002/ijc.28875] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 02/27/2014] [Accepted: 03/06/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Karin Kast
- Department of Gynecology and Obstetrics; University Hospital Carl Gustav Carus; Technische Universität Dresden; Germany
| | - Rita K. Schmutzler
- Center of Familial Breast and Ovarian Cancer; Department of Gynecology and Obstetrics; University Hospital Cologne; Germany
| | - Kerstin Rhiem
- Center of Familial Breast and Ovarian Cancer; Department of Gynecology and Obstetrics; University Hospital Cologne; Germany
| | - Marion Kiechle
- Department for Gynecology and Obstetrics; Technical University of Munich; Germany
| | - Christine Fischer
- Institute of Human Genetics; Ruprecht-Karls University; Heidelberg Germany
| | - Dieter Niederacher
- Department of Obstetrics and Gynecology; University Medical Center Düsseldorf; Heinrich-Heine-University; Düsseldorf Germany
| | - Norbert Arnold
- Department of Obstetrics and Gynecology; University Hospital of Schleswig-Holstein; University Kiel; Kiel Germany
| | - Tiemo Grimm
- Department of Human Genetics; University Würzburg; Biozentrum Würzburg Germany
| | - Dorothee Speiser
- Department of Gynecology and Obstetrics; Charité University Medicine Berlin; Germany
| | | | - Dominic Varga
- Department of Gynecology and Obstetrics; University Hospital; Universität Ulm; Germany
| | - Judit Horvath
- Institute for Human Genetics; University of Münster; Münster Germany
| | - Marit Beer
- Institute for Clinical Genetics; Technische Universität Dresden; Dresden Germany
| | - Susanne Briest
- Department of Gynecology and Obstetrics; University of Leipzig; Leipzig Germany
| | - Alfons Meindl
- Department for Gynecology and Obstetrics; Technical University of Munich; Germany
| | - Christoph Engel
- Institute for Medical Informatics; Statistics and Epidemiology; University of Leipzig; Leipzig Germany
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28
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Singer S, Meyer A, Wienholz S, Briest S, Brown A, Dietz A, Binder H, Jonas S, Papsdorf K, Stolzenburg JU, Köhler U, Raßler J, Zwerenz R, Schröter K, Mehnert A, Löbner M, König HH, Riedel-Heller SG. Early retirement in cancer patients with or without comorbid mental health conditions: a prospective cohort study. Cancer 2014; 120:2199-206. [PMID: 24752999 DOI: 10.1002/cncr.28716] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 10/25/2013] [Accepted: 12/16/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND The authors investigated whether cancer patients who have comorbid mental health disorders (MD) are at greater risk of early retirement compared with those who do not have MD. METHODS Individuals ages 18 to 55 years from a consecutive sample of patients who were admitted for inpatient oncologic treatment were interviewed using structured clinical interviews to ascertain MD. The patients were followed for 15 months, and the date of early retirement was documented. Rates of early retirement per 100 person-years (py) in patients with and without MD were compared using multivariate Poisson regression models. RESULTS At baseline, 491 patients were interviewed, and 150 of those patients (30.6%) were diagnosed with MD. Forty-one patients began full early retirement during follow-up. In patients with MD, the incidence of early retirement was 9.3 per 100 py compared with 6.1 per 100 py in mentally healthy patients. The crude rate ratio (RR) was 1.5 (95% confidence interval [CI], 0.8-2.8). The effect of MD on early retirement was modified in part by income: in patients with low income, the adjusted RR was 11.7, whereas no effect was observed in higher income groups. Patients with depression were at greater risk of retirement when they had higher income (RR, 3.4; P = .05). The effects of anxiety (RR, 2.4; P = .05), adjustment disorders (RR, 1.7; P = .21), and alcohol dependence (RR, 1.8; P = .40) on early retirement were equal across income groups. CONCLUSIONS Mental health conditions are risk factors for early retirement in cancer patients, although this effect differs according to the type of disorder and the patient's income level.
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Affiliation(s)
- Susanne Singer
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center, Mainz, Germany; Division of Psychosocial Oncology, University of Leipzig, Leipzig, Germany
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29
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Abstract
In 2005, cancer accounted for 13% of all deaths worldwide. Breast cancer is the number-one cause of cancer-related death among women in the USA, affecting 178,480 of them in 2007. As 75% of tumors in postmenopausal women and half in premenopausal women express estrogen receptor, endocrine therapy plays a significant role as a systemic treatment. Robust datasets have demonstrated the impact of tamoxifen in reducing breast cancer recurrence and mortality, regardless of the age of the patient. Other estrogen-deprivation strategies, such as aromatase inhibitors in postmenopausal women and luteinizing hormone-releasing hormone agonists in premenopausal women, are being increasingly used for estrogen receptor-positive breast cancer. This review discusses basic principles regarding endocrine therapy, the need for accurate estrogen receptor testing and the role of menopause in therapy selection.
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Affiliation(s)
- Susanne Briest
- University of Leipzig, Department of Gynecology & Obstetrics, Leipzig, Germany.
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Singer S, Szalai C, Briest S, Brown A, Dietz A, Einenkel J, Jonas S, Konnopka A, Papsdorf K, Langanke D, Löbner M, Schiefke F, Stolzenburg JU, Weimann A, Wirtz H, König HH, Riedel-Heller S. Co-morbid mental health conditions in cancer patients at working age--prevalence, risk profiles, and care uptake. Psychooncology 2013; 22:2291-7. [PMID: 23494948 DOI: 10.1002/pon.3282] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/16/2013] [Accepted: 02/18/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study examined the prevalence of mental health conditions in cancer patients, the role of socioeconomic position in relation to that, and the use of professional mental health care. METHODS Prospective cohort with measurements at the beginning of inpatient treatment (baseline) and 3, 9, and 15 months after baseline using structured clinical interviews based on DSM-IV, questionnaires, and medical records. RESULTS At baseline, 149 out of 502 cancer patients (30%) were diagnosed with a mental health condition. Prevalence was associated with unemployment (odds ratio [OR] 2.0), fatigue (OR 1.9), and pain (OR 1.7). Of those with mental health conditions, 9% saw a psychotherapist within 3 months of the diagnosis, 19% after 9 months, and 11% after 15 months. Mental health care use was higher in patients with children ≤18 years (OR 3.3) and somatic co-morbidity (OR 2.6). There was no evidence for an effect of sex on the use of mental health care. CONCLUSION Few cancer patients with psychiatric disorders receive professional mental health care early enough. If patients are unemployed or if they suffer from fatigue or pain, special attention should be paid because the risk of having a mental health condition is increased in these patients.
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Affiliation(s)
- S Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Johannes Gutenberg University, Mainz, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
- Division of Psychosocial Oncology, University of Leipzig, Leipzig, Germany
| | - C Szalai
- Division of Psychosocial Oncology, University of Leipzig, Leipzig, Germany
| | - S Briest
- Breast Cancer Centre, University of Leipzig, Leipzig, Germany
| | - A Brown
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - A Dietz
- Department of Otolaryngology, University of Leipzig, Leipzig, Germany
| | - J Einenkel
- Department of Obstetrics and Gynecology, University of Leipzig, Leipzig, Germany
| | - S Jonas
- Department of Surgery, University of Leipzig, Leipzig, Germany
| | - A Konnopka
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Papsdorf
- Department of Radiation-Oncology, University of Leipzig, Leipzig, Germany
| | - D Langanke
- Breast Cancer Centre, Hospital St. Elisabeth, Leipzig, Germany
| | - M Löbner
- Department of Social Medicine, Occupational Health, and Public Health, University of Leipzig, Leipzig, Germany
| | - F Schiefke
- Department of Maxillofacial Surgery, University of Leipzig, Leipzig, Germany
| | - J-U Stolzenburg
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - A Weimann
- Cancer Centre, Hospital St. Georg, Leipzig, Germany
| | - H Wirtz
- Department of Pulmonology, University of Leipzig, Leipzig, Germany
| | - H H König
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Riedel-Heller
- Department of Social Medicine, Occupational Health, and Public Health, University of Leipzig, Leipzig, Germany
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Roick J, Danker H, Briest S, Schiefke F, Meixensberger J, Wirtz H, Stolzenburg JU, Kersting A, Singer S. STEPPED CARE - Optimierung psychoonkologischer Versorgung durch gestufte Vermittlung. Studiendesign und erste Ergebnisse. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stearns V, Jacobs LK, Fackler M, Tsangaris TN, Rudek MA, Higgins M, Lange J, Cheng Z, Slater SA, Jeter SC, Powers P, Briest S, Chao C, Yoshizawa C, Sugar E, Espinoza-Delgado I, Sukumar S, Gabrielson E, Davidson NE. Biomarker modulation following short-term vorinostat in women with newly diagnosed primary breast cancer. Clin Cancer Res 2013; 19:4008-16. [PMID: 23719261 DOI: 10.1158/1078-0432.ccr-13-0033] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE Agents that target the epigenome show activity in breast cancer models. In preclinical studies, the histone deacetylase inhibitor vorinostat induces cell-cycle arrest, apoptosis, and differentiation. We evaluated biomarker modulation in breast cancer tissues obtained from women with newly diagnosed invasive disease who received vorinostat and those who did not. EXPERIMENTAL DESIGN Tumor specimens were collected from 25 women who received up to 6 doses of oral vorinostat 300 mg twice daily and from 25 untreated controls in a nonrandomized study. Candidate gene expression was analyzed by reverse transcription PCR (RT-PCR) using the Oncotype DX 21-gene assay, and by immunohistochemistry for Ki-67 and cleaved caspase-3. Matched samples from treated women were analyzed for gene methylation by quantitative multiplex methylation-specific PCR (QM-MSP). Wilcoxon nonparametric tests were used to compare changes in quantitative gene expression levels pre- and post-vorinostat with changes in expression in untreated controls, and changes in gene methylation between pre- and post-vorinostat samples. RESULTS Vorinostat was well tolerated and there were no study-related delays in treatment. Compared with untreated controls, there were statistically significant decreases in the expression of proliferation-associated genes Ki-67 (P = 0.003), STK15 (P = 0.005), and Cyclin B1 (P = 0.03) following vorinostat, but not in other genes by the Oncotype DX assay, or in expression of Ki-67 or cleaved caspase-3 by immunohistochemistry. Changes in methylation were not observed. CONCLUSIONS Short-term vorinostat administration is associated with a significant decrease in expression of proliferation-associated genes in untreated breast cancers. This demonstration of biologic activity supports investigation of vorinostat in combination with other agents for the management of breast cancer.
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Affiliation(s)
- Vered Stearns
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Rhiem K, Engel C, Graeser M, Zachariae S, Kast K, Kiechle M, Ditsch N, Janni W, Mundhenke C, Golatta M, Varga D, Preisler-Adams S, Heinrich T, Bick U, Gadzicki D, Briest S, Meindl A, Schmutzler RK. The risk of contralateral breast cancer in patients from BRCA1/2 negative high risk families as compared to patients from BRCA1 or BRCA2 positive families: a retrospective cohort study. Breast Cancer Res 2012; 14:R156. [PMID: 23216834 PMCID: PMC4053142 DOI: 10.1186/bcr3369] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 10/23/2012] [Indexed: 01/23/2023] Open
Abstract
Introduction While it has been reported that the risk of contralateral breast cancer in patients from BRCA1 or BRCA2 positive families is elevated, little is known about contralateral breast cancer risk in patients from high risk families that tested negative for BRCA1/2 mutations. Methods A retrospective, multicenter cohort study was performed from 1996 to 2011 and comprised 6,235 women with unilateral breast cancer from 6,230 high risk families that had tested positive for BRCA1 (n = 1,154) or BRCA2 (n = 575) mutations or tested negative (n = 4,501). Cumulative contralateral breast cancer risks were calculated using the Kaplan-Meier product-limit method and were compared between groups using the log-rank test. Cox regression analysis was applied to assess the impact of the age at first breast cancer and the familial history stratified by mutation status. Results The cumulative risk of contralateral breast cancer 25 years after first breast cancer was 44.1% (95%CI, 37.6% to 50.6%) for patients from BRCA1 positive families, 33.5% (95%CI, 22.4% to 44.7%) for patients from BRCA2 positive families and 17.2% (95%CI, 14.5% to 19.9%) for patients from families that tested negative for BRCA1/2 mutations. Younger age at first breast cancer was associated with a higher risk of contralateral breast cancer. For women who had their first breast cancer before the age of 40 years, the cumulative risk of contralateral breast cancer after 25 years was 55.1% for BRCA1, 38.4% for BRCA2, and 28.4% for patients from BRCA1/2 negative families. If the first breast cancer was diagnosed at the age of 50 or later, 25-year cumulative risks were 21.6% for BRCA1, 15.5% for BRCA2, and 12.9% for BRCA1/2 negative families. Conclusions Contralateral breast cancer risk in patients from high risk families that tested negative for BRCA1/2 mutations is similar to the risk in patients with sporadic breast cancer. Thus, the mutation status should guide decision making for contralateral mastectomy.
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Rhiem K, Engel C, Graeser M, Kiechle M, Ditsch N, Mundhenke C, Kreienberg R, Tio J, Golatta M, Hönig A, Gadzicki D, Speiser D, Kast K, Briest S, Meindl A, Schmutzler R. Kontralaterales Mammakarzinom-Risiko bei BRCA1/2-negativen Patientinnen mit familiärer Hochrisikosituation. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Singer S, Kuhnt S, Zwerenz R, Eckert K, Hofmeister D, Dietz A, Giesinger J, Hauss J, Papsdorf K, Briest S, Brown A. Age- and sex-standardised prevalence rates of fatigue in a large hospital-based sample of cancer patients. Br J Cancer 2011. [PMID: 21750551 DOI: 10.1038/bjc.2011.251; 10.1038/bjc.2011.251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this longitudinal study was to determine age- and sex-standardised prevalence rates of cancer-related fatigue in different groups of patients. METHODS This was a prospective study in a cohort of N=1494 cancer patients investigating fatigue at three time points t1-t3 (t1: admission to hospital, t2: discharge, t3: half a year after t1). Fatigue was measured with the Multidimensional Fatigue Inventory. Age- and sex-adjusted norms were derived from a representative community sample of N=2037, using a cutoff at the 75th percentile. RESULTS At admission to the hospital, 32% of the patients were classified as fatigued. At discharge, the overall prevalence rate was 40%, and at half a year after t1, prevalence was 34%. Fatigue prevalence rates differed according to tumour stage, site, age, and sex of the patients. CONCLUSION The prevalence rates provided by this study can be used for the planning of research and clinical routine.
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Affiliation(s)
- S Singer
- Department of Health Psychology and Applied Diagnostics, University of Wuppertal, Wuppertal, Germany.
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Rhiem K, Engel C, Graeser M, Janni W, Kiechle M, Ditsch N, Mundhenke C, Kreienberg R, Tio J, Golatta M, Honig A, Gadzicki D, Speiser D, Kast K, Briest S, Meindl A, Schmutzler R. Contralateral breast cancer risk in patients with familial breast cancer who tested negative for BRCA1 and BRCA2. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Singer S, Krauß O, Keszte J, Siegl G, Papsdorf K, Severi E, Hauss J, Briest S, Dietz A, Brähler E, Kortmann RD. Predictors of emotional distress in patients with head and neck cancer. Head Neck 2011; 34:180-7. [DOI: 10.1002/hed.21702] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 09/15/2010] [Accepted: 10/26/2010] [Indexed: 11/12/2022] Open
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Rüger RD, Horn LC, Helbig D, Simon JC, Wetzig T, Briest S. [Perimamillar located ulcerous skin lesion in a 75-year old patient]. J Dtsch Dermatol Ges 2011; 9:162-6. [PMID: 21276197 DOI: 10.1111/j.1610-0387.2010.07544.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robin D Rüger
- Klinik für Dermatologie, Venerologie und Allergologie am Universitätsklinikum Leipzig AÖR, Leipzig.
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Olkhanud PB, Baatar D, Bodogai M, Hakim F, Gress R, Anderson RL, Deng J, Xu M, Briest S, Biragyn A. Breast cancer lung metastasis requires expression of chemokine receptor CCR4 and regulatory T cells. Cancer Res 2009; 69:5996-6004. [PMID: 19567680 DOI: 10.1158/0008-5472.can-08-4619] [Citation(s) in RCA: 220] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cancer metastasis is a leading cause of cancer morbidity and mortality. More needs to be learned about mechanisms that control this process. In particular, the role of chemokine receptors in metastasis remains controversial. Here, using a highly metastatic breast cancer (4T1) model, we show that lung metastasis is a feature of only a proportion of the tumor cells that express CCR4. Moreover, the primary tumor growing in mammary pads activates remotely the expression of TARC/CCL17 and MDC/CCL22 in the lungs. These chemokines acting through CCR4 attract both tumor and immune cells. However, CCR4-mediated chemotaxis was not sufficient to produce metastasis, as tumor cells in the lung were efficiently eliminated by natural killer (NK) cells. Lung metastasis required CCR4(+) regulatory T cells (Treg), which directly killed NK cells using beta-galactoside-binding protein. Thus, strategies that abrogate any part of this process should improve the outcome through activation of effector cells and prevention of tumor cell migration. We confirm this prediction by killing CCR4(+) cells through delivery of TARC-fused toxins or depleting Tregs and preventing lung metastasis.
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Affiliation(s)
- Purevdorj B Olkhanud
- Laboratory of Immunology, National Institute on Aging, Baltimore, Maryland 21224, USA
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Stearns V, Jacobs LK, Tsangaris TN, Briest S, Lange JR, Slater S, Fackler M, Sugar E, Gabrielson E, Davidson NE. A pilot study evaluating surrogates of response to short-term vorinostat in women with newly diagnosed breast cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e14508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14508 Background: Epigenetic modifications contribute to breast cancer initiation and progression and may be reversible, thus representing an attractive area for new drug investigation. In preclinical breast cancer models, the histone deacetylase (HDAC) inhibitor suberoylanilide hydroxamic acid (SAHA, vorinostat) induces cell cycle arrest, apoptosis and differentiation. Methods: We evaluated the safety and tolerability of short term vorinostat in women with a primary clinical stage I-III histologically confirmed carcinoma of the breast on a core needle biopsy. Participants received vorinostat 300 mg PO bid for a total of 6 doses, the last dose 2 hours prior to surgery or biopsy. Peripheral blood mononuclear cells were collected at baseline and following the last vorinostat dose to determine histone acetylation. Baseline and post-treatment tumor specimens were collected for analysis of histone acetylation, candidate gene methylation and expression. Tissues were also collected from untreated controls. Paired t-tests and Fisher's exact tests were used to evaluate changes from baseline for continuous and categorical data, respectively. Results: From March 2006 to October 2008, 25 women signed an informed consent and initiated study drug. Median age was 55 and 80% had hormone receptor positive tumors. Twenty-two women took all 6 prescribed doses. One participant took 4 and one 5 doses due to insurance clearance delay; one received a single dose due to fatigue and abdominal pain. Study-related surgical delays did not occur. Grade 1 toxicities included diarrhea (28%), low white blood cell count (24%), and fatigue, taste alterations and nausea (16% each). Tissue and blood samples were successfully collected. Tissue was also collected from 25 untreated controls. No significant change was observed in the proliferation marker Ki67 following 3 days of agent administration. Modulation of apoptosis, histone acetylation and gene methylation will be presented. Conclusions: Short-term administration of vorinostat is feasible, safe, and allows for studies of biomarker modulation. The results will be used to design future studies in which vorinostat will be administered in combination with other targeted therapies or with other epigenetic modifiers. [Table: see text]
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Affiliation(s)
- V. Stearns
- Johns Hopkins School of Medicine, Baltimore, MD
| | | | | | - S. Briest
- Johns Hopkins School of Medicine, Baltimore, MD
| | - J. R. Lange
- Johns Hopkins School of Medicine, Baltimore, MD
| | - S. Slater
- Johns Hopkins School of Medicine, Baltimore, MD
| | - M. Fackler
- Johns Hopkins School of Medicine, Baltimore, MD
| | - E. Sugar
- Johns Hopkins School of Medicine, Baltimore, MD
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Briest S, Stearns V. Tamoxifen metabolism and its effect on endocrine treatment of breast cancer. Clin Adv Hematol Oncol 2009; 7:185-192. [PMID: 19398943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Tamoxifen is the most common endocrine therapy administered worldwide to women with hormone receptor-positive metastatic breast cancer or as adjuvant therapy for early stages of the disease. Tamoxifen may also be prescribed to women with ductal carcinoma in situ or to decrease the risk of breast cancer in women at high risk of developing the disease. While the use of aromatase inhibitors is increasing in the postmenopausal treatment setting, tamoxifen remains the drug of choice for premenopausal women. Several factors may contribute to reduced benefit from tamoxifen. It has been increasingly recognized in recent years that pharmacogenetics may play a role in tamoxifen's metabolism, efficacy, and safety. Cytochrome P450 (CYP) 2D6 encodes for a liver enzyme that is responsible for the conversion of tamoxifen into its active metabolite, endoxifen. Variant alleles in CYP2D6 or the use of medications that inhibit the enzyme clearly influence tamoxifen's metabolism into endoxifen. In addition, several retrospective studies suggest that variants in CYP2D6 may influence long term outcomes. In this review, we will summarize recent data that examined associations between CYP2D6 activity and effects on tamoxifen's metabolism and efficacy.
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Affiliation(s)
- Susanne Briest
- Breast Cancer Center, University of Leipzig, 04109 Leipzig, Germany
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Briest S, Vang R, Terrell K, Emens L, R Lange J. Invasive Lobular Carcinoma of the Male Breast: A Rare Histology in an Uncommon Disease. Breast Care (Basel) 2009; 4:36-38. [PMID: 20877682 DOI: 10.1159/000190078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
SUMMARY: BACKGROUND: Breast cancer in men is an uncommon disease. Nearly all cases of male breast cancer originate in the terminal ductulolobular unit, with exceedingly rare reports of lobular carcinoma in men. Invasive lobular cancer is found in no more than 1-2% of male breast cancer cases. Most of what is known about this disease is in the form of approximately 30 case reports in the literature. CASE REPORT: We report the case of a 52-year-old man who presented at our institution with a lump in his left breast. Ultrasound-guided biopsy revealed an invasive lobular cancer. The rare histological type was confirmed by the result of the histological examination of the mastectomy specimen. The treatment was completed by dose dense chemotherapy, radiation, and endocrine therapy. CONCLUSION: Even though lobular structures are quite infrequent in the normal male, sporadic cases of invasive lobular breast cancer have been described. A short overview will be given in this case report.
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Affiliation(s)
- Susanne Briest
- Department of Gynecology and Obstetrics, University of Leipzig, Germany
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Abstract
The present study examines changes in a variety of oculomotoric variables as a function of increasing sleepiness in 129 participants, who have been passed through a broad range of subjective alertness. Up to now, spontaneous eye blinks are the most promising biosignal for in-car sleepiness warnings. Reviewing the current literature on eye movements and fatigue, experimental data are provided including additional indicative oculomotoric parameters; inter-individual differences in the experiments were also assessed. Here, self-rated alertness decreased over six steps on average and proved itself a reliable measurement. Regarding oculomotoric parameters, blink duration, delay of lid reopening, blink interval and standardised lid closure speed were identified as the best indicators of subjective as well as objective sleepiness. Saccadic parameters and fixation durations also showed specific changes with increasing sleepiness. Substantial inter-individual differences in all of these variables were illustrated. Oculomotoric parameters were linked to three different components of sleepiness while driving: a) deactivation; b) decreasing attention, resulting in disinhibition of spontaneous blinks and reflexive saccades; c) increasing attempts of self-activation. Finally, implications for the development of drowsiness detection devices were discussed.
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Affiliation(s)
- R Schleicher
- Deutsche Telekom Laboratories, Berlin University of Technology, Ernst-Reuter-Platz 7, Berlin, Germany.
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45
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Briest S, Stearns V. Chemotherapeutic Strategies for advanced breast cancer. Oncology (Williston Park) 2007; 21:1325-1340. [PMID: 18080617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Disease-free and overall survival have improved significantly for women diagnosed with early-stage breast cancer. At the same time, systemic therapy has only slightly enhanced long-term outcomes in advanced breast cancer, a disease that remains largely incurable. Several single-agent and combination chemotherapy approaches are available to women with hormone-insensitive advanced disease that may improve overall survival and progression-free survival, minimize symptoms and complications related to the disease, and improve overall quality of life. In addition, new cytotoxic and targeted agents have been recently introduced into practice and have improved both survival outcomes and quality of life. In this review, we will provide an update on commonly used chemotherapy-based regimens for the treatment of metastatic breast cancer, with a focus on tailoring therapy to different subtypes of the disease.
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Affiliation(s)
- Susanne Briest
- University of Leipzig Department of Gynecology and Obstetrics Leipzig, Germany
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Abstract
Endocrine therapy is a mainstay for the many women who develop in situ or invasive steroid receptor-positive breast cancer. The use of tamoxifen has reduced mortality in such women. Recently estrogen deprivation strategies have come under scrutiny. Here the use of aromatase inhibitors for treatment of postmenopausal endocrine-responsive breast cancer in the metastatic, adjuvant, and preoperative settings is reviewed.
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Affiliation(s)
- Susanne Briest
- Department of Gynecology and Obstetrics, University of Leipzig, Leipzig, Germany.
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Leo C, Briest S, Pilch H, Schütz A, Horn LC, Leinung S. Granular cell tumor of the breast mimicking breast cancer. Eur J Obstet Gynecol Reprod Biol 2006; 127:268-70. [PMID: 16849031 DOI: 10.1016/j.ejogrb.2006.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2005] [Revised: 12/28/2005] [Accepted: 01/13/2006] [Indexed: 11/19/2022]
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Vaupel P, Mayer A, Briest S, Höckel M. Hypoxia in breast cancer: role of blood flow, oxygen diffusion distances, and anemia in the development of oxygen depletion. Adv Exp Med Biol 2006; 566:333-42. [PMID: 16594170 DOI: 10.1007/0-387-26206-7_44] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Heterogeneously distributed hypoxic areas are a characteristic property of locally advanced breast cancers. Hypoxia results from an imbalance between the supply and consumption of oxygen (O2). Major pathogenetic mechanisms for the emergence of hypoxia are (i) structural and functional abnormalities in the tumor microvasculature, (ii) an adverse diffusion geometry, and (iii) tumor-related and therapy-induced anemia leading to a reduced O2 transport capacity of the blood. There is pronounced intertumor variability in the extent of hypoxia, which is independent of clinical size, stage, histology and grade. Hypoxia is intensified in anemic patients, especially in tumor (areas) with low perfusion rates. Tumor hypoxia is a therapeutic problem since it makes solid tumors resistant to sparsely ionizing radiation, some forms of chemotherapy, and photodynamic therapy. However, besides more direct mechanisms involved in the development of therapeutic resistance, there are, in addition, indirect machineries that can cause barriers to therapies. These include hypoxia-mediated alterations in gene expression, proteomic and genomic changes, and clonal selection. These in turn can drive subsequent events that are known to further increase resistance to therapy in addition to critically affecting long-term prognosis.
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Abstract
Neuroimaging is usually unremarkable in paraneoplastic cerebellar degeneration (PCD), at least in the early stages of the disease. A patient with proven PCD is reported in whom it could be shown that cerebellar atrophy evolved very rapidly and was present in early imaging studies. Even with the use of the whole spectrum of modern diagnostic tools, the underlying malignancy can be difficult to diagnose. In addition to mammography, MRI is recommended in these cases and repeat FDG-PET may be necessary.
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Affiliation(s)
- R Scheid
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
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50
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Chance B, Nioka S, Zhang J, Conant EF, Hwang E, Briest S, Orel SG, Schnall MD, Czerniecki BJ. Breast cancer detection based on incremental biochemical and physiological properties of breast cancers: a six-year, two-site study. Acad Radiol 2005; 12:925-33. [PMID: 16023383 DOI: 10.1016/j.acra.2005.04.016] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Revised: 04/28/2005] [Accepted: 04/29/2005] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES To demonstrate that near-infrared spectroscopy would achieve sufficient sensitivity and specificity in human breast cancer to reach ROC/AUC values in the 90s and yet to warn of the potential liabilities of introduction of a novel technology in this field. MATERIALS AND METHODS 116 subjects from two nations (44 were cancer-verified by biopsy and histopathology) were reviewed. NIR spectroscopy of total hemoglobin and its relative oxygenation were monitored in breast cancers and compared to their contralateral breast in a 2D nomogram for diagnostic evaluation. A novel handheld NIR breast cancer detector pad with a 3-wavelength LED and 8 detectors with 4 cm separation between source and detectors was placed on the subject's breast. The method is convenient, rapid, and safe and has achieved high patient compliance with minimal patient apprehension of compression, confinement, or radioactivity. RESULTS The absorbance increments of the cancerous region are referred to the mirror image location on the contralateral breast. The two metrics are increased hemoglobin concentration due to angiogenesis and decreased hemoglobin saturation due to hypermetabolism of the cancer. The 2D nomogram display of these two metrics shows Zone 1 contains verified cancers and Zone 2 contains noncancers. ROC evaluation of the nomogram gives 95% AUC for the two sites, Philadelphia and Leipzig. CONCLUSION A simple, economical breast cancer detector has achieved high patient compliance and a high ROC/AUC score for a population which involved a range of tumors down to and including those of 0.8-1 cm in diameter.
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Affiliation(s)
- Britton Chance
- University of Pennsylvania, Department of Biochemistry, Philadelphia, 19104-6059, USA.
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