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MacCallum C, Elder K, Nickson C, Ruecker K, Park A, Rose A, Mann GB. Contrast Enhanced Mammography In Further Assessment Of Screen-Detected Breast Cancer. Breast 2023. [DOI: 10.1016/j.breast.2022.12.018] [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: 03/19/2023] Open
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Elder K, Matheson J, Nickson C, Box G, Ellis J, Mou A, Shadbolt C, Park A, Tay J, Rose A, Mann GB. Contrast enhanced mammography in breast cancer surveillance. Breast Cancer Res Treat 2023; 199:221-230. [PMID: 36966271 PMCID: PMC10175447 DOI: 10.1007/s10549-023-06916-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/13/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE Mammography (MG) is the standard imaging in surveillance of women with a personal history of breast cancer or DCIS (PHBC), supplemented with ultrasound. Contrast Enhanced Mammography (CEM) has higher sensitivity than MG and US. We report the performance of CEM compared with MG ± US. METHODS A retrospective study of patients undergoing their first surveillance CEM in an Australian hospital setting between June 2006 and October 2020. Cases where a patient was recalled for assessment were identified, recording radiology, pathology and treatment details. Blinded re-reading of recalled cases was performed to determine the contribution of contrast. Use of surveillance US across the board was assessed for the period. RESULTS 73/1191 (6.1%) patients were recalled. 35 (48%) were true positives (TP), with 26 invasive cancers and 9 cases of DCIS, while 38 (52%) were false positive (FP) with a positive predictive value (PPV) 47.9%. 32/73 were recalled due to MG findings, while 41/73 were only recalled due to Contrast. 14/73 had 'minimal signs' with a lesion identifiable on MG with knowledge of the contrast finding, while 27/73 were visible only with contrast. 41% (17/41) recalled due to contrast were TP. Contrast-only TPs were found with low and high mammographic density (MD). Screening breast US reduced by 55% in the year after CEM was implemented. CONCLUSION Compared to MG, CEM as a single surveillance modality for those with PHBC has higher sensitivity and comparable specificity, identifying additional malignant lesions that are clinically significant. Investigation of interval cancer and subsequent round outcomes is warranted.
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Affiliation(s)
- Kenneth Elder
- The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia.
| | - Julia Matheson
- The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia
| | - Carolyn Nickson
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Georgia Box
- The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia
| | - Jennifer Ellis
- The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia
| | - Arlene Mou
- The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, Australia
| | - Clair Shadbolt
- The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, Australia
| | - Allan Park
- The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, Australia
| | - Jia Tay
- The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia
| | - Allison Rose
- The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, Australia
| | - Gregory Bruce Mann
- The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia
- The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Parkville, Australia
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McIntosh SA, Coles CE, Dodwell D, Elder K, Foster J, Gaunt C, Kirkham A, Lyburn I, Morgan J, Pinder SE, Pirrie S, Potter S, Roberts T, Sharma N, Stobart H, Southgate E, Taylor-Phillips S, Wallis M, Rea D, Paramasivan S. Abstract P6-05-17: Recruitment challenges in a UK surgical de-escalation study: preliminary qualitative research findings from the SMALL trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-05-17] [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: 03/06/2023]
Abstract
Abstract
Background SMALL (ISRCTN 12240119) is a novel UK phase III multicentre randomised trial comparing vacuum-assisted excision (VAE) to surgery for small screen-detected breast cancers with biologically favourable characteristics. Acceptance by the clinical community and recruitment to SMALL was anticipated to be challenging as it involves randomisation, surgical de-escalation and minimally-invasive percutaneous treatment (VAE). A QuinteT Recruitment Intervention (QRI) has therefore been integrated throughout SMALL’s recruitment period, with the aim of optimising recruitment and informed consent. Methods The QRI in SMALL has involved the analysis of: a) screening log data b) written views from recruiters on the two treatments and their advantages/disadvantages c) in-depth semi-structured interviews with members of the Trial Management Group (TMG) and clinician-recruiters and d) audio-recordings of recruitment discussions with potentially eligible patients. Recruitment challenges were identified and addressed through the provision of written recruitment tips documents, and group and individual feedback sessions with recruiters. Results There was widespread support for the concept of the SMALL trial within the clinical community. Recruiters recognised the pioneering role of SMALL as the only current surgical de-escalation randomised trial in screen-detected breast cancer. Key recruitment challenges revolved around i) healthcare professionals (HCPs) who met patients early in the pathway providing information indicating that they were being referred for surgery (without mentioning SMALL or VAE), ii) concerns around the balance of de-escalation/escalation of different treatment modalities (e.g. some clinicians may prefer to de-escalate radiotherapy in preference to surgery in low-risk patients), iii) challenges in articulating equipoise in a surgical de-escalation trial, iv) patient preferences (primarily for surgery) and recruiter discomfort in exploring/addressing such preferences and v) fewer eligible patients than anticipated. QRI actions to overcome these issues included developing a tips document for HCPs meeting patients early in the pathway, highlighting the need to refrain from making treatment recommendations. A more generic tips document was also developed emphasising the importance of the early introduction of the study, provision of balanced information about both treatments, encouraging recruiters to engage with patients’ concerns and preferences, and adequate explanation of randomisation. Group and individual feedback sessions focussed on two key areas – articulating equipoise through balanced information provision, and considering optimal ways to explore patient preferences where they are expressed. Despite the many set-up and recruitment challenges that arose from opening at the start of the pandemic, SMALL has recruited 142 patients to date from 23 sites, with an approached to randomised patient ratio of ~50%. Conclusion SMALL is a novel surgical de-escalation study in breast cancer, which will provide critical evidence to support reductions in treatment of good prognosis disease. Using a range of qualitative methodology, the QRI has identified both broad support for the study within the clinical community, but has also identified barriers to recruitment at both clinician and patient level. These challenges have been addressed employing a range of methods, and the recruitment level and approach/randomised ratio shows the overall acceptability of this study to patients. Further work will involve interviews with patients, with a focus on their views on de-escalation, and further recruiter feedback sessions. Taken together, theis data will help inform the development and design of future de-escalation and treatment optimisation studies in breast cancer. SMALL is funded by the UK NIHR HTA programme, award 17/42/32
Citation Format: Stuart A. McIntosh, Charlotte E. Coles, David Dodwell, Kenneth Elder, Jessica Foster, Claire Gaunt, Amanda Kirkham, Iain Lyburn, Jenna Morgan, Sarah E. Pinder, Sarah Pirrie, Shelley Potter, Tracy Roberts, Nisha Sharma, Hilary Stobart, Elizabeth Southgate, Sian Taylor-Phillips, Matthew Wallis, Daniel Rea, Sangeetha Paramasivan. Recruitment challenges in a UK surgical de-escalation study: preliminary qualitative research findings from the SMALL trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-17.
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Affiliation(s)
| | | | | | | | | | | | | | - Iain Lyburn
- 8Gloucestershire University Hospitals NHS Trust
| | | | - Sarah E. Pinder
- 10School of Cancer and Pharmaceutical Sciences, King’s College London Faculty of Life Sciences and Medicine, London, London, England, United Kingdom
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McIntosh SA, Coles CE, Dodwell D, Elder K, Foster J, Gaunt C, Kirkham A, Lyburn I, Morgan J, Paramasivan S, Pinder SE, Pirrie S, Potter S, Roberts T, Sharma N, Stobart H, Southgate E, Taylor-Phillips S, Wallis M, Rea D. Abstract OT3-20-02: SMALL: Open Surgery versus Minimally invasive vacuum-Assisted excision for smaLL screen-detected breast cancer – a UK phase III randomised multi-centre trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot3-20-02] [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: 03/06/2023]
Abstract
Abstract
Background: Mammographic screening programmes reduce breast cancer mortality, but detect many small tumours with favourable biological features which may not progress during a woman’s lifetime. Screen-detected cancers are treated with standard surgery and adjuvant therapies, with associated morbidities. There is a need to reduce overtreatment of good prognosis tumours and numerous studies have evaluated the omission of radiotherapy in this context. However, there is little evidence to support surgical de-escalation, although percutaneous minimally invasive treatment approaches have been described. Vacuum-assisted excision (VAE) is in widespread use for management of benign lesions and lesions of uncertain malignant potential. SMALL (ISRCTN 12240119) is designed to determine the feasibility of using this approach for treatment of small invasive tumours detected within the UK NHS Breast Screening Programme (BSP). Methods: SMALL is a phase III multicentre randomised trial comparing standard surgery with VAE for screen-detected good prognosis cancers. The main eligibility criteria are age ≥47 years, unifocal grade 1 tumours with maximum diameter 15mm, which are strongly ER/PR+ve and HER2-ve, with negative clinical/radiological axillary staging. Patients are randomised 2:1 in favour of VAE or surgery; with no axillary surgery in the VAE arm. Completeness of excision is assessed radiologically, and if excision is incomplete, patients undergo open surgery. Adjuvant radiotherapy and endocrine therapy are mandated in the VAE arm but may be omitted following surgery. Co-primary end-points are: 1. Non-inferiority comparison of the requirement for a second procedure following excision 2. Single arm analysis of local recurrence (LR) at 5 years following VAE Recruitment of 800 patients will permit demonstration of 10% non-inferiority of VAE for requirement of a second procedure. This ensures sufficient patients for single arm analysis of LR rates, where expected LR free survival is 99% at 5 years, with an undesirable survival probability after VAE of 97%. To ensure that the trial as a whole only has 5% alpha, the significance level for each co-primary outcome is set at 2.5% with 90% power. The Data Monitoring Committee will monitor LR events to ensure these do not exceed 3% per year. Secondary outcome measures include time to ipsilateral recurrence, overall survival, complications, quality of life and health economic analysis. A novel feature of SMALL is the integration of a QuinteT Recruitment Intervention (QRI), which aims to optimise recruitment to the study. Recruitment challenges are identified by analysing recruiter/patient interviews and audio-recordings of trial discussions, and by review of trial screening logs, eligibility and recruitment data and study documentation. Solutions to address these are developed collaboratively, including individual/group recruiter feedback and recruitment tips documents. Results: SMALL opened in December 2019, but recruitment halted in 2020 for 5 months due to COVID-19. At 7st July 2022, 142 patients had been randomised from 26 centres, with a randomisation rate of approximately 45%, and a per site recruitment rate of 0.4-0.5 patients/month, approaching the feasibility recruitment target of 144 patients. Drawing from preliminary QRI findings and insights from patient representatives, a recruitment tips document has been circulated (on providing balanced information about treatments, encouraging recruiters to engage with patient preferences, and explaining randomisation). Individual recruiter feedback has commenced, with wider feedback delivered across sites via recruitment training workshops. Conclusion: Despite pandemic-related challenges, SMALL has an excellent recruitment rate to date and is expected to have a global impact on treatment of breast cancer within mammographic screening programmes. SMALL is funded by the UK NIHR HTA programme, award 17/42/32
Citation Format: Stuart A. McIntosh, Charlotte E. Coles, David Dodwell, Kenneth Elder, Jessica Foster, Claire Gaunt, Amanda Kirkham, Iain Lyburn, Jenna Morgan, Sangeetha Paramasivan, Sarah E. Pinder, Sarah Pirrie, Shelley Potter, Tracy Roberts, Nisha Sharma, Hilary Stobart, Elizabeth Southgate, Sian Taylor-Phillips, Matthew Wallis, Daniel Rea. SMALL: Open Surgery versus Minimally invasive vacuum-Assisted excision for smaLL screen-detected breast cancer – a UK phase III randomised multi-centre trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-20-02.
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Affiliation(s)
| | | | | | | | | | | | | | - Iain Lyburn
- 8Gloucestershire University Hospitals NHS Trust
| | | | | | - Sarah E. Pinder
- 11School of Cancer and Pharmaceutical Sciences, King’s College London Faculty of Life Sciences and Medicine, London, London, England, United Kingdom
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Elder K, Matheson J, Nickson C, Box G, Ellis J, Mou A, Shadbolt C, Park A, Tay J, Rose A, Mann G. Contrast Enhanced Mammography in Breast Cancer Surveillance. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01364-8] [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: 11/19/2022]
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Elder K, Johnson M. Corrigenda to "The Oldham Notebooks: An analysis of the development of IVF 1969-1978. II. The treatment cycles and their outcomes" [Reprod. Biomed. Soc. Online 1/1 (2015) 9-18]. Reprod Biomed Soc Online 2022; 14:e1. [PMID: 35677865 PMCID: PMC9168771 DOI: 10.1016/j.rbms.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
[This corrects the article DOI: 10.1016/j.rbms.2015.04.003.].
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Affiliation(s)
| | - M. Johnson
- Anatomy School and Centre for Trophoblast Research, Cambridge University, Cambridge
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McIntosh SA, Coles CE, Conefrey C, Dodwell D, Elder K, Foster J, Gaunt C, Kirkham A, Lyburn I, Morgan J, Paramasivan S, Pinder S, Pirrie S, Potter S, Roberts T, Sharma N, Stobart H, Southgate E, Taylor-Phillips S, Wallis M, Rea D. Abstract OT1-06-02: SMALL - Open surgery versus minimally invasive vacuum-assisted excision for small screen detected breast cancer: A phase 3 randomised trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot1-06-02] [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: 11/16/2022]
Abstract
Abstract
Background:. Mammographic screening programmes have been shown to reduce breast cancer mortality. However, they detect many small tumours with favourable biological features which may not progress during a woman’s lifetime. These are treated with standard surgery and adjuvant therapies, which have associated morbidities. Thus, there is a need to reduce overtreatment of good prognosis tumours found by screening. Minimally invasive treatment approaches have been described but there is no prospective randomised evidence to support their routine use. Vacuum-assisted excision (VAE) is in widespread use for management of benign lesions and lesions of uncertain malignant potential. SMALL (ISRCTN 12240119) is designed to determine the feasibility of using this approach for treatment of small invasive tumours detected within the UK NHS Breast Screening Programme (BSP). Methods:. SMALL is a phase III multicentre randomised trial comparing standard surgery with VAE for screen-detected good prognosis breast cancers. The main eligibility criteria are age ≥47 years, screen-detected unifocal grade 1 tumours with maximum diameter 15mm, which are strongly ER/PR+ve and HER2-ve, with negative clinical/radiological axillary staging. Patients are randomised 2:1 in favour of VAE or surgery; with no axillary surgery in the VAE arm. Completeness of excision is assessed radiologically, and if excision is incomplete, patients undergo open surgery. Adjuvant radiotherapy and endocrine therapy are mandated in the VAE arm but may be omitted following surgery. Co-primary end-points are:1.Non-inferiority comparison of the requirement for a second procedure following excision2.Single arm analysis of local recurrence (LR) at 5 years following VAE. Recruitment of 800 patients over 4 years will permit demonstration of 10% non-inferiority of VAE for requirement of a second procedure. This ensures sufficient patients for single arm analysis of LR rates, where expected LR free survival is 99% at 5 years, with an undesirable survival probability after VAE of 97%. To ensure that the trial as a whole only has 5% alpha, the significance level for each co-primary outcome is set at 2.5% with 90% power. The Data Monitoring Committee will monitor LR events to ensure these do not exceed 3% per year. Secondary outcome measures include time to ipsilateral recurrence, overall survival, complications, quality of life and health economic analysis. A QuinteT Recruitment Intervention (QRI) is integrated throughout SMALL to optimise recruitment and informed consent. Recruitment challenges are identified by analysing recruiter/patient interviews and audio-recordings of trial discussions, and by review of screening, eligibility and recruitment data and study documentation. Solutions to address these are developed collaboratively, including individual/group recruiter feedback and recruitment tips documents. Results:. SMALL opened in December 2019, but recruitment halted in 2020 due to suspension of the NHS BSP for 5 months due to COVID-19. As of 1st July 2021, 55 patients had been approached in 10 centres, with 33 patients randomised (randomisation rate 60%). A further 23 centres are in set-up, with 8 suspended due to the pandemic. Drawing from preliminary QRI findings and insights from patient representatives, a recruitment tips document has been circulated (on introducing and discussing SMALL, providing balanced information. on treatment options and explaining randomisation). individual recruiter feedback has commenced, with wider feedback planned shortly. Conclusion:. Despite pandemic-related challenges, SMALL has an excellent recruitment rate to date and is expected to have a global impact on treatment of breast cancer within mammographic screening programmes. SMALL is funded by the UK NIHR HTA programme, award 17/42/32
Citation Format: Stuart A McIntosh, Charlotte E Coles, Carmel Conefrey, David Dodwell, Kenneth Elder, Jessica Foster, Claire Gaunt, Amanda Kirkham, Iain Lyburn, Jenna Morgan, Sangeetha Paramasivan, Sarah Pinder, Sarah Pirrie, Shelley Potter, Tracy Roberts, Nisha Sharma, Hilary Stobart, Elizabeth Southgate, Sian Taylor-Phillips, Matthew Wallis, Daniel Rea. SMALL - Open surgery versus minimally invasive vacuum-assisted excision for small screen detected breast cancer: A phase 3 randomised trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-06-02.
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Affiliation(s)
| | | | | | | | | | | | - Claire Gaunt
- University of Birmingham, Birmingham, United Kingdom
| | | | - Iain Lyburn
- Cheltenham General Hospital, Cheltenham, United Kingdom
| | - Jenna Morgan
- University of Sheffield, Sheffield, United Kingdom
| | | | | | - Sarah Pirrie
- University of Birmingham, Birmingham, United Kingdom
| | | | - Tracy Roberts
- University of Birmingham, Birmingham, United Kingdom
| | - Nisha Sharma
- St James's University Hospital, Leeds, United Kingdom
| | - Hilary Stobart
- Independent Cancer Patients' Voice, Cambridge, United Kingdom
| | | | | | | | - Daniel Rea
- University of Birmingham, Birmingham, United Kingdom
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Monshipouri M, Aliahmad B, Ogrin R, Elder K, Anderson J, Polus B, Kumar D. Thermal Imaging Potential and Limitations to Predict Healing of Venous Leg Ulcers. J Vasc Surg Venous Lymphat Disord 2022. [DOI: 10.1016/j.jvsv.2021.10.005] [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: 12/01/2022]
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Ganapathy V, Bailey E, Mortimer K, Lou Y, Yuan J, Mulder K, Topuria I, Cerf S, Elder K, Booth J, Bruinsma B, Globe D. 56: Real-world clinical effectiveness of elexacaftor/tezacaftor/ivacaftor and ivacaftor in people with CF: Interim results from the HELIO study. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01481-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Figueroa JD, Gray E, Pashayan N, Deandrea S, Karch A, Vale DB, Elder K, Procopio P, van Ravesteyn NT, Mutabi M, Canfell K, Nickson C. The impact of the Covid-19 pandemic on breast cancer early detection and screening. Prev Med 2021; 151:106585. [PMID: 34217412 PMCID: PMC8241687 DOI: 10.1016/j.ypmed.2021.106585] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic affects mortality and morbidity, with disruptions expected to continue for some time, with access to timely cancer-related services a concern. For breast cancer, early detection and treatment is key to improved survival and longer-term quality of life. Health services generally have been strained and in many settings with population breast mammography screening, efforts to diagnose and treat breast cancers earlier have been paused or have had reduced capacity. The resulting delays to diagnosis and treatment may lead to more intensive treatment requirements and, potentially, increased mortality. Modelled evaluations can support responses to the pandemic by estimating short- and long-term outcomes for various scenarios. Multiple calibrated and validated models exist for breast cancer screening, and some have been applied in 2020 to estimate the impact of breast screening disruptions and compare options for recovery, in a range of international settings. On behalf of the Covid and Cancer Modelling Consortium (CCGMC) Working Group 2 (Breast Cancer), we summarize and provide examples of such in a range of settings internationally, and propose priorities for future modelling exercises. International expert collaborations from the CCGMC Working Group 2 (Breast Cancer) will conduct analyses and modelling studies needed to inform key stakeholders recovery efforts in order to mitigate the impact of the pandemic on early diagnosis and treatment of breast cancer.
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Affiliation(s)
| | - Jonine D Figueroa
- Usher Institute, University of Edinburgh, UK; Institute of Genetics and Cancer, Cancer Research UK Edinburgh Centre, UK.
| | - Ewan Gray
- Institute of Genetics and Cancer, Cancer Research UK Edinburgh Centre, UK
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Silvia Deandrea
- Directorate General for Health, Lombardy Region, Milano, Italy
| | - Andre Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
| | - Diama Bhadra Vale
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | | | - Pietro Procopio
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Australia; University of Melbourne, Australia
| | | | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Australia
| | - Carolyn Nickson
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Australia; University of Melbourne, Australia
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Cheasley D, Devereux L, Hughes S, Nickson C, Procopio P, Lee G, Li N, Pridmore V, Elder K, Bruce Mann G, Kader T, Rowley SM, Fox SB, Byrne D, Saunders H, Fujihara KM, Lim B, Gorringe KL, Campbell IG. The TP53 mutation rate differs in breast cancers that arise in women with high or low mammographic density. NPJ Breast Cancer 2020; 6:34. [PMID: 32802943 PMCID: PMC7414106 DOI: 10.1038/s41523-020-00176-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 07/13/2020] [Indexed: 01/01/2023] Open
Abstract
Mammographic density (MD) influences breast cancer risk, but how this is mediated is unknown. Molecular differences between breast cancers arising in the context of the lowest and highest quintiles of mammographic density may identify the mechanism through which MD drives breast cancer development. Women diagnosed with invasive or in situ breast cancer where MD measurement was also available (n = 842) were identified from the Lifepool cohort of >54,000 women participating in population-based mammographic screening. This group included 142 carcinomas in the lowest quintile of MD and 119 carcinomas in the highest quintile. Clinico-pathological and family history information were recorded. Tumor DNA was collected where available (n = 56) and sequenced for breast cancer predisposition and driver gene mutations, including copy number alterations. Compared to carcinomas from low-MD breasts, those from high-MD breasts were significantly associated with a younger age at diagnosis and features associated with poor prognosis. Low- and high-MD carcinomas matched for grade, histological subtype, and hormone receptor status were compared for somatic genetic features. Low-MD carcinomas had a significantly increased frequency of TP53 mutations, higher homologous recombination deficiency, higher fraction of the genome altered, and more copy number gains on chromosome 1q and losses on 17p. While high-MD carcinomas showed enrichment of tumor-infiltrating lymphocytes in the stroma. The data demonstrate that when tumors were matched for confounding clinico-pathological features, a proportion in the lowest quintile of MD appear biologically distinct, reflective of microenvironment differences between the lowest and highest quintiles of MD.
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Affiliation(s)
- Dane Cheasley
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC Australia
| | - Lisa Devereux
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC Australia
- Lifepool, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Siobhan Hughes
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Carolyn Nickson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
- Cancer Research Division, Cancer Council NSW, Sydney, NSW Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW Australia
| | - Pietro Procopio
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
- Cancer Research Division, Cancer Council NSW, Sydney, NSW Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW Australia
| | - Grant Lee
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
| | - Na Li
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | | | - Kenneth Elder
- Department of Surgery, University of Melbourne, Melbourne, VIC Australia
- The Royal Melbourne and Royal Women’s Hospitals, Parkville, VIC Australia
- The Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - G. Bruce Mann
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC Australia
- The Royal Melbourne and Royal Women’s Hospitals, Parkville, VIC Australia
| | - Tanjina Kader
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC Australia
| | - Simone M. Rowley
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Stephen B. Fox
- Department of Pathology, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, VIC Australia
| | - David Byrne
- Department of Pathology, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, VIC Australia
| | - Hugo Saunders
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Kenji M. Fujihara
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Belle Lim
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Kylie L. Gorringe
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC Australia
- Cancer Genetics and Genomics Program, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Ian G. Campbell
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC Australia
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Elder K, Dixon M, Grewar J, Twelves D, Kay C, Martinez-Perez C, Meehan J, Gray M, Turnbull A. P131: Factors affecting the number of sentinel lymph nodes removed in the treatment and staging of breast cancer. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2020.03.170] [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: 11/29/2022] Open
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13
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Kader T, Elder K, Zethoven M, Semple T, Hill P, Goode DL, Thio N, Cheasley D, Rowley SM, Byrne DJ, Pang JM, Miligy IM, Green AR, Rakha EA, Fox SB, Mann GB, Campbell IG, Gorringe KL. The genetic architecture of breast papillary lesions as a predictor of progression to carcinoma. NPJ Breast Cancer 2020; 6:9. [PMID: 32195332 PMCID: PMC7067788 DOI: 10.1038/s41523-020-0150-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/13/2020] [Indexed: 12/11/2022] Open
Abstract
Intraductal papillomas (IDP) are challenging breast findings because of their variable risk of progression to malignancy. The molecular events driving IDP development and genomic features of malignant progression are poorly understood. In this study, genome-wide CNA and/or targeted mutation analysis was performed on 44 cases of IDP, of which 20 cases had coexisting ductal carcinoma in situ (DCIS), papillary DCIS or invasive ductal carcinoma (IDC). CNA were rare in pure IDP, but 69% carried an activating PIK3CA mutation. Among the synchronous IDP cases, 55% (11/20) were clonally related to the synchronous DCIS and/or IDC, only one of which had papillary histology. In contrast to pure IDP, PIK3CA mutations were absent from clonal cases. CNAs in any of chromosomes 1, 16 or 11 were significantly enriched in clonal IDP lesions compared to pure and non-clonal IDP. The observation that 55% of IDP are clonal to DCIS/IDC indicates that IDP can be a direct precursor for breast carcinoma, not limited to the papillary type. The absence of PIK3CA mutations and presence of CNAs in IDP could be used clinically to identify patients at high risk of progression to carcinoma.
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Affiliation(s)
- Tanjina Kader
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia
| | - Kenneth Elder
- The Breast Service, The Royal Women’s Hospital, Fitzroy, VIC Australia
| | | | | | - Prue Hill
- Department of Anatomical Pathology, St Vincent’s Hospital, Fitzroy, VIC Australia
| | - David L. Goode
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia
| | - Niko Thio
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Dane Cheasley
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | | | | | - Jia-Min Pang
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Islam M. Miligy
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham and Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - Andrew R. Green
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham and Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - Emad A. Rakha
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham and Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | | | - G. Bruce Mann
- The Breast Service, The Royal Women’s Hospital, Fitzroy, VIC Australia
| | - Ian G. Campbell
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia
- Department of Clinical Pathology, University of Melbourne, Parkville, VIC Australia
| | - Kylie L. Gorringe
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia
- Department of Clinical Pathology, University of Melbourne, Parkville, VIC Australia
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14
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Mueller L, Berhanu P, Bouchard J, Alas V, Elder K, Thai N, Hitchcock C, Hadzi T, Khalil I, Miller-Wilson LA. Application of Machine Learning Models to Evaluate Hypoglycemia Risk in Type 2 Diabetes. Diabetes Ther 2020; 11:681-699. [PMID: 32009223 PMCID: PMC7048891 DOI: 10.1007/s13300-020-00759-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 10/16/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION To identify predictors of hypoglycemia and five other clinical and economic outcomes among treated patients with type 2 diabetes (T2D) using machine learning and structured data from a large, geographically diverse administrative claims database. METHODS A retrospective cohort study design was applied to Optum Clinformatics claims data indexed on first antidiabetic prescription date. A hypothesis-free, Bayesian machine learning analytics platform (GNS Healthcare REFS™: Reverse Engineering and Forward Simulation) was used to build ensembles of generalized linear models to predict six outcomes defined in patients' 1-year post-index claims history, including hypoglycemia, antidiabetic class persistence, glycated hemoglobin (HbA1c) target attainment, HbA1c change, T2D-related inpatient admissions, and T2D-related medical costs. A unified set of 388 variables defined in patients' 1-year pre-index claims history constituted the set of predictors for all REFS models. RESULTS The derivation cohort comprised 453,487 patients with a T2D diagnosis between 2014 and 2017. Patients with comorbid conditions had the highest risk of hypoglycemia, including those with prior hypoglycemia (odds ratio [OR] = 25.61) and anemia (OR = 1.29). Other identified risk factors included insulin (OR = 2.84) and sulfonylurea use (OR = 1.80). Biguanide use (OR = 0.75), high blood glucose (> 125 mg/dL vs. < 100 mg/dL, OR = 0.47; 100-125 mg/dL vs. < 100 mg/dL, OR = 0.53), and missing blood glucose test (OR = 0.40) were associated with reduced risk of hypoglycemia. Area under the curve (AUC) of the hypoglycemia model in held-out testing data was 0.77. Patients in the top 15% of predicted hypoglycemia risk constituted 50% of observed hypoglycemic events, 26% of T2D-related inpatient admissions, and 24% of all T2D-related medical costs. CONCLUSIONS Machine learning models built within high-dimensional, real-world data can predict patients at risk of clinical outcomes with a high degree of accuracy, while uncovering important factors associated with outcomes that can guide clinical practice. Targeted interventions towards these patients may help reduce hypoglycemia risk and thereby favorably impact associated economic outcomes relevant to key stakeholders.
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15
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Morgan J, Potter S, Sharma N, McIntosh SA, Coles CE, Dodwell D, Elder K, Gaunt C, Lyburn ID, McIntosh SA, Morgan J, Paramasivan S, Pinder S, Pirrie S, Potter S, Rea D, Roberts T, Sharma N, Stobart H, Taylor-Phillips S, Wallis M, Wilcox M. The SMALL Trial: A Big Change for Small Breast Cancers. Clin Oncol (R Coll Radiol) 2019; 31:659-663. [PMID: 31160130 DOI: 10.1016/j.clon.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/16/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022]
Affiliation(s)
- J Morgan
- University of Sheffield, FU32, The Medical School, Sheffield, UK
| | - S Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK; Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - N Sharma
- Breast Unit, St James Hospital, Leeds, UK
| | - S A McIntosh
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK.
| | | | | | - K Elder
- Western General Hospital, Edinburgh, UK
| | - C Gaunt
- CRCTU, University of Birmingham, UK
| | | | | | | | | | | | - S Pirrie
- CRCTU, University of Birmingham, UK
| | | | - D Rea
- University of Birmingham, UK
| | | | - N Sharma
- St James's University Hospital, Leeds, UK
| | - H Stobart
- Independent Cancer Patients' Voice, UK
| | | | - M Wallis
- Addenbrooke's Hospital, Cambridge, UK
| | - M Wilcox
- Independent Cancer Patients' Voice, UK
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16
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Kader T, Hill P, Zethoven M, Goode DL, Elder K, Thio N, Doyle M, Semple T, Sufyan W, Byrne DJ, Pang JMB, Murugasu A, Miligy IM, Green AR, Rakha EA, Fox SB, Mann GB, Campbell IG, Gorringe KL. Atypical ductal hyperplasia is a multipotent precursor of breast carcinoma. J Pathol 2019; 248:326-338. [PMID: 30843206 DOI: 10.1002/path.5262] [Citation(s) in RCA: 9] [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: 10/26/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/18/2022]
Abstract
The current model for breast cancer progression proposes independent 'low grade (LG)-like' and 'high grade (HG)-like' pathways but lacks a known precursor to HG cancer. We applied low-coverage whole-genome sequencing to atypical ductal hyperplasia (ADH) with and without carcinoma to shed light on breast cancer progression. Fourteen out of twenty isolated ADH cases harboured at least one copy number alteration (CNA), but had fewer aberrations than LG or HG ductal carcinoma in situ (DCIS). ADH carried more HG-like CNA than LG DCIS (e.g. 8q gain). Correspondingly, 64% (7/11) of ADH cases with synchronous HG carcinoma were clonally related, similar to LG carcinoma (67%, 6/9). This study represents a significant shift in our understanding of breast cancer progression, with ADH as a common precursor lesion to the independent 'low grade-like' and 'high grade-like' pathways. These data suggest that ADH can be a precursor of HG breast cancer and that LG and HG carcinomas can evolve from a similar ancestor lesion. We propose that although LG DCIS may be committed to a LG molecular pathway, ADH may remain multipotent, progressing to either LG or HG carcinoma. This multipotent nature suggests that some ADH cases could be more clinically significant than LG DCIS, requiring biomarkers for personalising management. Copyright © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Tanjina Kader
- Peter MacCallum Cancer Centre, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Prue Hill
- Department of Anatomical Pathology, St Vincent's Hospital, Fitzroy, Australia
| | | | - David L Goode
- Peter MacCallum Cancer Centre, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Kenneth Elder
- The Breast Service, The Royal Women's Hospital, Melbourne, Australia
| | - Niko Thio
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Maria Doyle
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Wajiha Sufyan
- Territory Pathology, Royal Darwin Hospital, Darwin, Australia
| | | | | | - Anand Murugasu
- The Breast Service, The Royal Women's Hospital, Melbourne, Australia
| | - Islam M Miligy
- Division of Cancer and Stem Cells, Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histopathology, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - Andrew R Green
- Division of Cancer and Stem Cells, Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histopathology, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - Emad A Rakha
- Division of Cancer and Stem Cells, Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histopathology, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | | | - G Bruce Mann
- The Breast Service, The Royal Women's Hospital, Melbourne, Australia
| | - Ian G Campbell
- Peter MacCallum Cancer Centre, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia.,Department of Clinical Pathology, The University of Melbourne, Parkville, Australia
| | - Kylie L Gorringe
- Peter MacCallum Cancer Centre, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia.,Department of Clinical Pathology, The University of Melbourne, Parkville, Australia
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17
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Cheasley D, Li N, Rowley SM, Elder K, Mann GB, Loi S, Savas P, Goode DL, Kader T, Zethoven M, Semple T, Fox SB, Pang JM, Byrne D, Devereux L, Nickson C, Procopio P, Lee G, Hughes S, Saunders H, Fujihara KM, Kuykhoven K, Connaughton J, James PA, Gorringe KL, Campbell IG. Molecular comparison of interval and screen-detected breast cancers. J Pathol 2019; 248:243-252. [PMID: 30746706 DOI: 10.1002/path.5251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/27/2018] [Revised: 01/15/2019] [Accepted: 01/30/2019] [Indexed: 01/22/2023]
Abstract
Breast cancer (BC) diagnosed after a negative mammogram but prior to the next screening episode is termed an 'interval BC' (IBC). Understanding the molecular differences between IBC and screen-detected BCs (SDBC) could improve mammographic screening and management options. Therefore, we assessed both germline and somatic genomic aberrations in a prospective cohort. Utilising the Lifepool cohort of >54 000 women attending mammographic screening programs, 930 BC cases with screening status were identified (726 SDBC and 204 IBC). Clinico-pathological and family history information were recorded. Germline and tumour DNA were collected where available and sequenced for BC predisposition and driver gene mutations. Compared to SDBC, IBCs were significantly associated with a younger age at diagnosis and tumour characteristics associated with worse prognosis. Germline DNA assessment of BC cases that developed post-enrolment (276 SDBCs and 77 IBCs) for pathogenic mutations in 12 hereditary BC predisposition genes identified 8 carriers (2.27%). The germline mutation frequency was higher in IBC versus SDBC, although not statistically significant (3.90% versus 1.81%, p = 0.174). Comparing somatic genetic features of IBC and SDBC matched for grade, histological subtype and hormone receptor revealed no significant differences, with the exception of higher homologous recombination deficiency scores in IBC, and copy number changes on chromosome Xq in triple negative SDBCs. Our data demonstrates that while IBCs are clinically more aggressive than SDBC, when matched for confounding clinico-pathological features they do not represent a unique molecular class of invasive BC, but could be a consequence of timing of tumour initiation and mammographic screening. Copyright © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Dane Cheasley
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Na Li
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Simone M Rowley
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kenneth Elder
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,The Royal Melbourne and Royal Women's Hospitals, Parkville, Victoria, Australia.,The Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - G Bruce Mann
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,The Royal Melbourne and Royal Women's Hospitals, Parkville, Victoria, Australia
| | - Sherene Loi
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Savas
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David L Goode
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Tanjina Kader
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Magnus Zethoven
- Bioinformatics Consulting Core, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tim Semple
- Genomics Core, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Stephen B Fox
- Department of Pathology, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia
| | - Jia-Min Pang
- Department of Pathology, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia
| | - David Byrne
- Department of Pathology, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Devereux
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Lifepool, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carolyn Nickson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Pietro Procopio
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grant Lee
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Siobhan Hughes
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Hugo Saunders
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kenji M Fujihara
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Keilly Kuykhoven
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jacquie Connaughton
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Paul A James
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kylie L Gorringe
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Cancer Genetics and Genomics Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ian G Campbell
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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18
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Mann GB, Nickson C, Elder K. Treatment Intensity Differences According to Participation in a Population Screening Program. Ann Surg Oncol 2018; 26:698-699. [DOI: 10.1245/s10434-018-07113-w] [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] [Received: 09/05/2018] [Indexed: 11/18/2022]
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Elder K, Nickson C, Mann GB. ASO Author Reflections: Impact of Breast Cancer Screening Beyond Mortality Reductions. Ann Surg Oncol 2018; 25:687-688. [PMID: 30414033 DOI: 10.1245/s10434-018-7001-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Kenneth Elder
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Carolyn Nickson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.,Cancer Council New South Wales, Woolloomooloo, NSW, Australia
| | - G Bruce Mann
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia. .,Department of Surgery, The University of Melbourne, Parkville, VIC, Australia.
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20
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Affiliation(s)
- J Michael Dixon
- Edinburgh Breast Unit, Western General Hospital, Crewe Road South, Edinburgh, EH2 4XU, UK
| | - Kenneth Elder
- ST6 General Surgery Trainee Edinburgh Breast Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Sarah McLaughlin
- Associate Professor of Surgery Mayo Clinic, 4500 San Pablo Rd Jacksonville, FL 32225, USA
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21
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Philpott A, Wong J, Elder K, Gorelik A, Mann GB, Skandarajah A. Factors influencing reoperation following breast-conserving surgery. ANZ J Surg 2018; 88:922-927. [PMID: 29763991 DOI: 10.1111/ans.14467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 10/11/2017] [Revised: 02/08/2018] [Accepted: 02/10/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Reoperation rates after breast-conserving surgery are highly variable and the best techniques for optimizing margin clearance are being evaluated. The aim was to identify the reoperation rate at our centre and identify influential factors, including a change in guidelines on margin recommendations and the introduction of in-theatre specimen X-ray. METHODS A retrospective review of medical records was undertaken to identify 562 patients who underwent breast conservation at The Royal Melbourne Hospital and Royal Women's Hospital between 2013 and 2015. All cases that underwent subsequent re-excision or total mastectomy were captured and factors influencing margin excision recorded. RESULTS Reoperation was undertaken in 19.5% of patients (110; 86 re-excisions and 24 total mastectomies). There was a reduction in reoperation rate from 25% to 17% (P = 0.01) with adoption of the margin guidelines in 2014, but no significant reduction with the introduction of in-theatre specimen X-ray in 2015 (21% versus 16%, P = 0.14). On multivariate analysis, factors that significantly influenced reoperation rates were the presence of multifocality on mammogram (odds ratio (OR): 5.3, 95% confidence interval (CI): 1.6-16.7, P < 0.01); lesion size on mammogram (OR: 2.2 per 10 mm, 95% CI: 1.4-3.6, P < 0.01); smaller excision specimen weight (OR: 0.5 per 25 g of resection, 95% CI: 0.3-0.8, P < 0.01); and pure ductal carcinoma in situ on final pathology (OR: 5.9, 95% CI: 1.9-16.7, P < 0.01). CONCLUSION Optimizing reoperation rates following breast-conserving surgery remains a surgical challenge, particularly in patients with in situ or multifocal disease. Adoption of international margin guidelines reduced reoperation rates at our centre; however, introduction of intraoperative specimen X-ray had no influence.
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Affiliation(s)
- Andrew Philpott
- The Breast Service, The Royal Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Joshua Wong
- The Breast Service, The Royal Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Kenneth Elder
- The Breast Service, The Royal Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Alexandra Gorelik
- Melbourne EpiCentre, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - G Bruce Mann
- The Breast Service, The Royal Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- The Breast Service, The Royal Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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22
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Elder K, Nickson C, Pattanasri M, Cooke S, Machalek D, Rose A, Mou A, Collins JP, Park A, De Boer R, Phillips C, Pridmore V, Farrugia H, Bruce Mann G. Treatment Intensity Differences After Early-Stage Breast Cancer (ESBC) Diagnosis Depending on Participation in a Screening Program. Ann Surg Oncol 2018; 25:2563-2572. [PMID: 29717421 DOI: 10.1245/s10434-018-6469-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND While population mammographic screening identifies early-stage breast cancers (ESBCs; ductal carcinoma in situ [DCIS] and invasive disease stages 1-3A), commentaries suggest that harms from overdiagnosis and overtreatment may outweigh the benefits. Apparent benefits to patients with screen-detected cancers may be due to selection bias from exclusion of interval cancers (ICs). Treatment intensity is rarely discussed, with an assumption that all ESBCs are treated similarly. We hypothesized that women diagnosed while in a screening program would receive less-intense treatment than those never or not recently screened (NRS). METHODS This was a retrospective analysis of all women aged 50-69 years managed for ESBC (invasive or DCIS) during the period 2007-2013 within a single service, comparing treatment according to screening status. Data on demographics, detection, pathology, and treatment were derived from hospital, cancer registry, and screening service records. RESULTS Overall, 622 patients were active screeners (AS) at diagnosis (569 screen-detected and 53 ICs) and 169 patients were NRS. AS cancers were smaller (17 mm vs. 26 mm, p < 0.0001), less likely to involve nodes (26% vs. 48%, p < 0.0001), and lower grade. For invasive cancer, NRS patients were more likely to be recommended for mastectomies [35% vs. 16%; risk ratio(RR) 2.2, p < 0.0001], axillary dissection (43% vs. 19%; RR 2.3, p < 0.0001), adjuvant chemotherapy (65% vs. 37%; RR 1.7, p < 0.0001), and postmastectomy radiotherapy (58% vs. 39%; RR 1.5, p = 0.04). CONCLUSION Participants in population screening diagnosed with ESBC receive substantially less-intense treatment than non-participants. Differences persist when potential overdiagnosis is taken into account; these differences should be factored into debates around mammographic screening.
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Affiliation(s)
- Kenneth Elder
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Carolyn Nickson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.,Cancer Council New South Wales, Woolloomooloo, NSW, Australia
| | - Melinda Pattanasri
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Samuel Cooke
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Dorothy Machalek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Allison Rose
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Arlene Mou
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - John Paxton Collins
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia.,Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Allan Park
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Richard De Boer
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Claire Phillips
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | | | | | - G Bruce Mann
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia. .,Department of Surgery, The University of Melbourne, Parkville, VIC, Australia.
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23
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Pattanasri M, Elder K, Nickson C, Cooke S, Machalek D, Rose A, Mou A, Collins JP, Park A, De Boer R, Phillips C, Pridmore V, Farrugia H, Mann GB. Uptake of adjuvant breast cancer treatments recommended by multi-disciplinary meetings. ANZ J Surg 2018; 88:745-750. [PMID: 29363225 DOI: 10.1111/ans.14368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 09/13/2017] [Revised: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adjuvant therapy for breast cancer is routinely discussed and recommended in multi-disciplinary meetings (MDMs). Current literature explores how treatments received by patients differ from national guidelines; however, it does not explore whether treatment is concordant with MDMs. This study provides an Australian perspective on the uptake of MDM recommendations and reasons for non-concordance. METHODS A retrospective cohort study of patients with breast cancer presented at The Royal Melbourne Hospital MDM in 2010 and 2014 to investigate the concordance between MDM recommendations and treatment received. RESULTS The study group comprised 441 patients (161 from 2010 and 280 from 2014). A total of 375 patients were included in the analyses. Overall, 82% of patients had perfect concordance between recommended and received treatment for all modes of adjuvant therapy. Concordance to endocrine therapy was higher for invasive cancers than ductal carcinoma in situ (97% versus 81%, P < 0.0001). Concordance to radiotherapy was high and did not differ according to type of cancer or surgery (ranging from 88 to 91%). Concordance to chemotherapy recommendations was high overall (92%) and did not vary with nodal status. Women aged over 65 years were least likely to be recommended for adjuvant therapy but most likely to concordant with the recommendation. CONCLUSIONS Uptake of MDM-recommended treatments is high. There is a minority of patients in whom MDM recommendations are not followed, highlighting that there are extra steps between recommendations at an MDM and decisions with patients. More attention to this issue is appropriate, and the reasons for non-concordance warrant further study.
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Affiliation(s)
- Melinda Pattanasri
- Breast Service, The Royal Melbourne and Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Kenneth Elder
- Breast Service, The Royal Melbourne and Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Carolyn Nickson
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Cancer Council NSW, Sydney, New South Wales, Australia
| | - Samuel Cooke
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Dorothy Machalek
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Allison Rose
- Department of Radiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- BreastScreen Victoria, Melbourne, Victoria, Australia
| | - Arlene Mou
- Department of Radiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- BreastScreen Victoria, Melbourne, Victoria, Australia
| | - John P Collins
- Breast Service, The Royal Melbourne and Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Allan Park
- Breast Service, The Royal Melbourne and Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Richard De Boer
- Breast Service, The Royal Melbourne and Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Claire Phillips
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | - G Bruce Mann
- Breast Service, The Royal Melbourne and Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Fang Y, Elder K, Hao S, Qian Z, Zhou Z. HEALTH INEQUALITY AND ITS DECOMPOSITION AMONG THE OLDER ADULTS IN XIAMEN, CHINA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1481] [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: 11/13/2022] Open
Affiliation(s)
- Y. Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen, China,
- Key Laboratory of Health Technology Assessment of Fujian Province University, Xiamen, China,
| | - K. Elder
- Department of Health Management & Policy, Saint Louis University College for Public Health & Social Justice, Saint Louis, Missouri,
| | - S. Hao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen, China,
- Key Laboratory of Health Technology Assessment of Fujian Province University, Xiamen, China,
| | - Z. Qian
- Department of Epidemiology, Saint Louis University College for Public Health & Social Justice, Saint Louis, Missouri
| | - Z. Zhou
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen, China,
- Key Laboratory of Health Technology Assessment of Fujian Province University, Xiamen, China,
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25
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Elder K, Nickson C, Farrugia H, Mann B. Are community detected cancers more biologically similar to screen detected or interval breast cancers and how is this reflected in survival? Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30157-0] [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: 10/20/2022]
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26
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Engman M, Bystrom B, Varghese S, Lalitkumar PGL, Gemzell-Danielsson K, Romeu C, Urries A, Lierta M, Sanchez Rubio J, Sanz B, Perez I, Casis L, Salerno A, Nazzaro A, Di Iorio L, Bonassisa P, Van Os L, Vink-Ranti CQJ, de Haan-Cramer JH, Rijnders PM, Jansen CAM, Nazzaro A, Salerno A, Marino S, Granato C, Pastore E, Brandes M, Hamilton CJCM, de Bruin JP, Bots RSGM, Nelen WLDM, Kremer JAM, Szkodziak P, Wozniak S, Czuczwar P, Paszkowski T, Wozniak S, Szkodziak P, Czuczwar P, Paszkowski T, Agirregoitia N, Peralta L, Mendoza R, Exposito A, Matorras R, Agirregoitia E, Chuderland D, Ben-Ami I, Kaplan-Kraicer R, Grossman H, Satchi- Fainaro R, Eldar-Boock A, Ron-El R, Shalgi R, Custers IM, Scholten I, Moolenaar LM, Flierman PA, Dessel TJHM, Gerards MH, Cox T, Janssen CAH, van der Veen F, Mol BWJ, Wathlet S, Adriaenssens T, Verheyen G, Coucke W, Smitz J, Feliciani E, Ferraretti AP, Paesano C, Pellizzaro E, Magli MC, Gianaroli L, Hernandez J, Rodriguez-Fuentes A, Garcia-Guzman R, Palumbo A, Radunovic N, Tosic T, Djukic S, Lockwood JC, Adriaenssens T, Wathlet S, Van Landuyt L, Verheyen G, Coucke W, Smitz J, Karayalcin R, Ozcan SARP, Ozyer S, Gurlek B, Kale I, Moraloglu O, Batioglu S, Chaudhury K, Narendra Babu K, Mamata Joshi V, Srivastava S, Chakravarty BN, Viardot-Foucault V, Prasath EB, Tai BC, Chan JKY, Loh SF, Cordeiro I, Leal F, Soares AP, Nunes J, Sousa S, Aguiar A, Carvalho M, Calhaz-Jorge C, Karkanaki A, Piouk A, Katsikis I, Mousatat T, Koiou E, Daskalopoulos GN, Panidis D, Tolikas A, Tsakos E, Gerou S, Prapas Y, Loufopoulos A, Abanto E, Barrenetxea G, Agirregoikoa J, Anarte C, De Pablo JL, Burgos J, Komarovsky D, Friedler S, Gidoni Y, Ben-ami I, Strassburger D, Bern O, Kasterstein E E, Komsky A, Maslansky B, Ron-El R, Raziel A, Fuentes A, Argandona F, Gabler F, Galleguillos A, Torres A, Palomino WA, Gonzalez-Fernandez R, Pena O, Hernandez J, Palumbo A, Avila J, Talebi Chahvar S, Biondini V, Battistoni S, Giannubilo S, Tranquilli AL, Stensen MH, Tanbo T, Storeng R, Abyholm T, Fedorcsak P, Johnson SR, Foster L, Ellis J, Choi JR, Joo JK, Son JB, Lee KS, Helmgaard L, Klein BM, Arce JC, Sanhueza P, Donoso P, Salinas R, Enriquez R, Saez V, Carrasco I, Rios M, Gonzalez P, Macklon N, Guo M, Richardson M, Wilson P, Chian RC, Eapen A, Hrehorcak M, Campbell S, Nargund G, Oron G, Fisch B, Ao A, Freidman O, Zhang XY, Ben-Haroush A, Abir R, Hantisteanu S, Ellenbogen A, Hallak M, Michaeli M, Fainaru O, Maman E, Yong G, Kedem A, Yeruahlmi G, Konopnicki S, Cohen B, Dor J, Hourvitz A, Moshin V, Croitor M, Hotineanu A, Ciorap Z, Rasohin E, Aleyasin A, Agha Hosseini M, Mahdavi A, Safdarian L, Fallahi P, Mohajeri MR, Abbasi M, Esfahani F, Elnashar A, Badawy A, Totongy M, Mohamed H, Mustafa F, Seidman DS, Tadir Y, Goldchmit C, Gilboa Y, Siton A, Mashiach R, Rabinovici J, Yerushalmi GM, Inoue O, Kuji N, Fukunaga T, Ogawa S, Sugawara K, Yamada M, Hamatani T, Hanabusa H, Yoshimura Y, Kato S, Casarini L, La Marca A, Lispi M, Longobardi S, Pignatti E, Simoni M, Halpern G, Braga DPAF, Figueira RCS, Setti AS, Iaconelli Jr. A, Borges Jr. E, Vingris L, Setti AS, Braga DPAF, Figueira RCS, Iaconelli Jr. A, Pasqualotto FF, Borges Jr. E, Collado-Fernandez E, Harris SE, Cotterill M, Elder K, Picton HM, Serra V, Garrido N, Casanova C, Lara C, Remohi J, Bellver J, Steiner HP, Kim CH, You RM, Nah HY, Kang HJ, Kim S, Chae HD, Kang BM, Reig Viader R, Brieno Enriquez MA, Toran N, Cabero L, Giulotto E, Garcia Caldes M, Ruiz-Herrera A, Brieno-Enriquez M, Reig-Viader R, Toran N, Cabero L, Martinez F, Garcia-Caldes M, Velthut A, Zilmer M, Zilmer K, Haller T. Kaart E, Karro H, Salumets A, Bromfield JJ, Sheldon IM, Rezacova J, Madar J, Cuchalova L, Fiserova A, Shao R, Billig H. POSTER VIEWING SESSION - FEMALE (IN) FERTILITY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
The technique of intracytoplasmic sperm injection (ICSI) requires mechanical immobilization of the sperm that are to be injected; damage thus caused to the sperm membrane is considered to be necessary to activate the sperm for fertilization. Mechanical immobilization and the injection procedure are facilitated by introducing the sperm into a viscous medium that will hinder motility: a solution of polyvinylpyrrolidone (PVP) has been used successfully for this purpose. PVP is an artificial polymer, which has been regarded as chemically inert, although adverse effects have been reported as a result of its use both in vivo and in vitro. Therefore, the use of hyaluronate, the natural component of the extracellular matrix of the cumulus-oocyte complex, was investigated as a replacement for PVP during ICSI. A solution of hyaluronate was found to be as effective as PVP in facilitating the injection procedure, its effect on sperm motility was readily reversible, and its use did not affect the outcome of the treatment cycles in terms of fertilization, pregnancy and live birth rates. Every attempt should be made to eliminate artificial factors in assisted reproductive procedures. Hyaluronate, a natural and readily degradable glycosaminoglycan can be used as a substitute for the artificial PVP polymer without jeopardising the outcome of the treatment cycle.
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Affiliation(s)
- Y Barak
- In Vitro Fertilization Unit, Herzliya Medical Center, 7 Ramot-Yam Street, Herzliya-on-Sea 46851, Israel
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28
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Petersen CG, Mauri AL, Baruffi RL, Oliveira JBA, Massaro FC, Elder K, Franco JG. Implantation failures: success of assisted hatching with quarter-laser zona thinning. Reprod Biomed Online 2005; 10:224-9. [PMID: 15823228 DOI: 10.1016/s1472-6483(10)60944-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Implantation failure after IVF is one of the factors associated with a reduced chance of pregnancy for some patients. Assisted hatching methodologies are designed to facilitate the embryo's escape from the zona pellucida, and this strategy has been suggested as a means of improving pregnancy rates in patients with previous implantation failure. The aim of this prospective and randomized study was to evaluate the efficacy of quarter-laser zona thinning assisted hatching (qLZT-AH) in improving the implantation of embryos in patients with previous implantation failure. A total of 150 patients with a history of previous implantation failure were treated with intracytoplasmic sperm injection, and allocated into two groups: group 1, only one previous implantation failure, and group 2, repeated implantation failures. The patients in each group were randomized at the time of embryo transfer into a control group (no qLZT-AH) or experimental group where qLZT-AH was performed. For patients with repeated implantation failures, the implantation rate in those who received laser-thinned embryos was significantly higher (P = 0.02) than in those whose embryos were not laser-thinned (10.9 and 2.6% respectively). However, this difference was not observed in patients who presented with only one previous implantation failure. The data demonstrate that qLZT-AH is an effective strategy for improving the implantation of embryos in patients with repeated implantation failures.
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Affiliation(s)
- C G Petersen
- Centre for Human Reproduction Sinhá Junqueira-Ribeirão Preto, Rua D. Alberto Gonçalves, 1500-CEP 14085-100, Ribeirão Preto, SP-Brazil
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29
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Abstract
A novel 2D image analysis technique is demonstrated. Using the digitized images of articular cartilage from transmission electron microscopy (TEM), this technique performs a localized 'vector' analysis at each region that is large enough to include several or tens of collagen fibrils but small enough to provide a fine resolution for the whole tissue. For each small and localized region, the morphology of the collagen fibrils can be characterized by three quantities essential to the nature of the tissue: the concentration of the fibrils, the overall orientation of the fibrils, and the anisotropy of the fibrils. This technique is capable of providing new insight to the existing technology by assigning quantitative attributes to the qualitative graphics. The assigned quantities are sensitive to the fine structure of the collagen matrix and meaningful in the architectural nature of the collagen matrix. These quantities could provide a critical linkage between the ultrastructure of the tissue and the macroscopic behaviours of the material. In addition, coarse-graining the microscopic resolution of EM without compromising the essential features of the tissue's structure provides a direct view of the tissue's morphology and permits direct correlations and comparisons among interdisciplinary techniques.
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Affiliation(s)
- Y Xia
- Department of Physics, Center for Biomedical Research, Oakland University, Rochester, MI 48309, USA.
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30
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Barak Y, Menezo Y, Veiga A, Elder K. A physiological replacement for polyvinylpyrrolidone (PVP) in assisted reproductive technology. Fertil Steril 2001. [DOI: 10.1016/s0015-0282(01)02060-x] [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: 10/18/2022]
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31
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Abstract
Kinematics of the scaphotrapezio-trapezoidal joint during wrist flexion/extension motion (FEM) and radial/ulnar deviation (RUD) was investigated using a 3-dimensional dynamic motion analysis system. The scaphoid/trapezoid motion was found to be a rotational motion obliquely oriented relative to the sagittal plane of the wrist and described in an ulnoflexion/radial extension motion plane in both FEM and RUD of the wrist. The axis of rotation of the scaphoid/trapezoid motion during both FEM and RUD wrist motions was essentially the same and runs through the radiopalmar aspect of the distal scaphoid and the waist of the capitate. Motion analysis also revealed that the trapezium-trapezoid and trapezoid-capitate joints are essentially immobile. Hence, the scaphotrapezio-trapezoidal motion is considered to be a single degree of freedom that is essentially the same in both FEM and RUD of the wrist.
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Affiliation(s)
- H Moritomo
- Division of Hand Surgery, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Center, Galveston, TX 77555-1350, USA
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32
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Gardner K, Hockett P, Preiser D, Elder K. Nurse case managers bring the element of caring to cost-contained care. ONS News 1998; 13:1, 4-5. [PMID: 9582806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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33
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Christensen JJ, Elder K, Fogedby HC. Phase segregation dynamics of a chemically reactive binary mixture. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 1996; 54:R2212-R2215. [PMID: 9965444 DOI: 10.1103/physreve.54.r2212] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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34
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Patterson RM, Viegas SF, Elder K, Buford WL. Quantification of anatomic, geometric, and load transfer characteristics of the wrist joint. Semin Arthroplasty 1995; 6:13-9. [PMID: 10155681] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The work reported here is an assimilation of 8 years of research, the purpose of which was to gain a better understanding of the normal and abnormal workings of the wrist joint. The results are summarized in three major areas of concentration: descriptive anatomic studies, which include direct measurements of cadaver specimens, biomechanical loading studies to define load distribution through normal and abnormal wrists, and three-dimensional (3D) anatomy studies using solid models derived from computed tomographic (CT) images of in vivo and cadaver wrists. The descriptive anatomic studies used 393 cadaver wrists to evaluate the incidence and distribution of anatomic features, arthroses, chondromalacia, and soft-tissue lesions. The data were analyzed for any statistically significant associations among different variables. The biomechanical studies characterized the biomechanics of the human wrist in a variety of normal, simulated traumatic, and surgically treated conditions. The results of the load studies have provided clinically relevant information on the normal anatomy and functional mechanics of the wrist as well as guidelines for the treatment of a number of different fractures and ligament injuries. The 3D anatomic studies use quantitative analysis of 3D reconstructions of CT scan data to build a normative database of carpal bone morphology. Thirty-five wrists were imaged in a CT scanner. Quantitative measurements of volume, surface area, maximum length, and intercarpal distances were than assessed. A reliable 3D carpal height ratio (3DCHR) was calculated by dividing the capitate maximum length by the carpal height, which is the minimum distance between the fourth metacarpal and the radius.
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Affiliation(s)
- R M Patterson
- Department of Orthopaedic Surgery, University of Texas Medical Branch, Galveston 77555-0353, USA
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35
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Abstract
The aim of this project was noninvasively to analyze and quantitate the geometry, load transfer characteristics, and spatial relationships of the carpal bones by using a new three-dimensional CT scan reconstruction technique. The determination of mechanical parameters such as distances between centroids and between bone surfaces, carpal alignment, volumes, surface areas, and contact areas can provide the basis for comparison between normal wrists and wrists with a variety of progressive instability patterns, types of fracture, pathologic and posttraumatic states, and different simulated surgical procedures. This new technology has demonstrated a volumetric accuracy of 94% and a linear accuracy of 97%. Simultaneous analysis of all articulating surfaces of multiple joints can be performed in cadavers and in patients because of the noninvasive nature of the imaging reconstruction technique. This new research offers much more information than has previously been available. It also promises direct application to the clinical setting and eliminates several limitations and questions that were inescapable with previous technology.
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Affiliation(s)
- S F Viegas
- Department of Pharmacology, University of Texas Medical Branch, Galveston 77551
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36
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Abstract
A preliminary study on intercellular communicative devices in the early human embryo has been made using dye-coupling techniques and electron microscopy (EM). Lucifer yellow injected into single blastomeres of embryos at the 4-cell stage up to the late morula stage did not spread to neighbouring cells, indicating that gap junctions and cytoplasmic bridges are not significant pathways for information transfer. Dye spread was first observed in the blastocyst stage, where trophectoderm cells and inner mass cells were shown to be in communication through gap junctions. Studies at the EM level confirmed this finding. Tight junctions and desmosome-like structures, apparent from the 6-cell stage onward, were located both peripherally and centrally and were initially nonzonular. The role of intercellular devices in the primary differentiation of the human embryo is discussed.
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Affiliation(s)
- B Dale
- Stazione Zoologica, University of Naples, Italy
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Hartshorne GM, Elder K, Crow J, Dyson H, Edwards RG. The influence of in-vitro development upon post-thaw survival and implantation of cryopreserved human blastocysts. Hum Reprod 1991; 6:136-41. [PMID: 1874946 DOI: 10.1093/oxfordjournals.humrep.a137247] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Blastocysts from 198 patients were frozen using glycerol as cryoprotectant. No difference in the post-thaw survival of blastocysts or implantation rates was found between 177 patients (122 transfers) with all surplus embryos cultured to blastocysts before freezing and 20 patients (12 transfers) whose embryos were considered unsuitable for freezing during cleavage and were then frozen as blastocysts. Nineteen pregnancies were achieved, of which six aborted. Pre-freezing morphology was similar in blastocysts of patients in groups 1 and 2 and did not relate to their survival after cryopreservation. A significantly lower proportion with suspected damage after thawing was present among patients becoming pregnant after transfers of single blastocysts (P less than 0.01) and implanting embryos were in general more expanded at the time of transfer. No differences were detected between blastocysts resulting in normal development and those leading to abortion. The developmental consequences of damage to human blastocysts are discussed.
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Hartshorne GM, Blayney M, Dyson H, Elder K. In vitro fertilization and development of one of two human oocytes with fused zonae pellucidae: case report. Fertil Steril 1990; 54:947-9. [PMID: 2226933 DOI: 10.1016/s0015-0282(16)53965-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This report describes a pair of human oocytes of differing maturities but fused at the zona pellucida, believed to have originated from a binovular follicle. After insemination in vitro, one oocyte fertilized and developed into an expanded blastocyst, whereas the other, which contained a germinal vesicle, degenerated. A biopsy was aspirated from the blastocyst, which subsequently re-expanded but did not hatch.
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Rizk B, Morcos S, Avery S, Elder K, Brinsden P, Mason B, Edwards R. Rare ectopic pregnancies after in-vitro fertilization: one unilateral twin and four bilateral tubal pregnancies. Hum Reprod 1990; 5:1025-8. [PMID: 2081799 DOI: 10.1093/oxfordjournals.humrep.a137211] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Between 1985 and 1989, one unilateral twin and four bilateral tubal pregnancies were encountered among 124 extrauterine pregnancies and 1648 intrauterine pregnancies following in-vitro fertilization and embryo transfer. The two factors associated with this high incidence of single and multiple extrauterine pregnancies were tubal damage and multiple embryo transfer. Embryos at different stages of development appear to have the capacity to implant ectopically. Despite advances in diagnostic capabilities, ectopic pregnancy remains a major cause of maternal mortality. Early diagnosis prior to rupture must be made if mortality and morbidity are to be abolished. The use of transvaginal sonography has improved the diagnosis of ectopic pregnancy and should be routinely used in all pregnancies following assisted conception. The identification of an intrauterine pregnancy should not be sufficient to rule out the possibility of an extrauterine pregnancy or even bilateral tubal pregnancies.
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Affiliation(s)
- B Rizk
- Bourn-Hallam Medical Centre, London, UK
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40
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Hartshorne GM, Wick K, Elder K, Dyson H. Effect of cell number at freezing upon survival and viability of cleaving embryos generated from stimulated IVF cycles. Hum Reprod 1990; 5:857-61. [PMID: 2125058 DOI: 10.1093/oxfordjournals.humrep.a137198] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The survival of cleaving embryos after freezing and thawing has been assessed. First, comparisons were made of the proportions of embryos in which all blastomeres were viable cells after thawing, following various forms of ovarian stimulation. A flare-up protocol using a GnRH-agonist (buserelin) produced significantly higher numbers of these embryos than a pituitary down-regulation protocol (P less than 0.05), though neither was significantly different from clomiphene citrate/HMG stimulation. Secondly, other parameters of embryo survival e.g. proportions with one or more surviving cells and pregnancy rates were assessed and were similar among stimulation protocols and treatments in the embryo replacement cycle. Survival of blastomeres in 2- to 8-cell embryos was inversely related to the theoretical total surface area of all blastomeres in the embryo. Thawed embryos with one or more blastomeres damaged during freezing had the same capacity to produce pregnancies as did those with all blastomeres intact. The survival of individual cells was clearly related to the stage at which the cleaving embryo is frozen, but moderate loss of cells does not significantly influence implantation.
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41
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Strong LC, Herson J, Haas C, Elder K, Chakraborty R, Weiss KM, Majumder P. Cancer mortality in relatives of retinoblastoma patients. J Natl Cancer Inst 1984; 73:303-11. [PMID: 6589425 DOI: 10.1093/jnci/73.2.303] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The risk of other cancers in relatives of retinoblastoma (RTB) patients was determined by a survey of the mortality experience of siblings, parents, parental siblings, and grandparents of all U.S. or Canadian RTB patients referred to The University of Texas M.D. Anderson Hospital and Tumor Institute between 1944 and 1980. Expected mortality was ascertained by the application of age-, sex-, race-, and calendar year-specific U.S. mortality rates to the observed person-years. Among 607 relatives of 33 unilateral-sporadic RTB probands, no excess in cancer deaths was observed (observed/expected = 18/22). Among 733 relatives of 47 bilateral-familial RTB probands, a slight excess in cancer deaths was observed (41/31). A significant excess in cancer deaths was occurred in relatives under age 55 years (18/9) and in fathers (7/1) of the bilateral RTB probands. To determine whether the cancer excess was related to some unique allele associated with second tumors in RTB survivors, the cancer mortality of 203 relatives of the 14 RTB patients with second tumors was examined, and no excess was observed (11/11). To determine whether the excess might be attributable to an unexpressed RTB gene or precursor, the mortality experience was examined in 6 kindreds in which parents, unaffected by RTB, had more than 1 child with RTB. Among these 72 relatives a significant excess in cancer deaths was observed (8/2). The findings demonstrate a modest overall cancer excess in relatives of hereditary RTB patients and suggest it may be attributable to an unexpressed RTB gene or precursor in a small number of kindreds. Mechanisms for an apparent "precursor" might involve a delayed mutation, genetic mosaicism, or a submicroscopic balanced chromosomal translocation.
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Abstract
The biosynthesis of the haemagglutinin glycoproteins of infectious influenza virus particles involves proteolytic cleavage of the primary translation products and the amino acid sequences at the two sites of processing are presented. In addition, details of the primary structure of the haemagglutinin of A/Japan/305/57 (H2N1) are reported and compared with information available for haemagglutinins of other subtypes.
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Herson J, Sutow WW, Elder K, Vietti TJ, Falletta JM, Crist WM, Vats TS, Miale T. Adjuvant chemotherapy in nonmetastatic osteosarcoma: a Southwest Oncology Group Study. Med Pediatr Oncol 1980; 8:343-52. [PMID: 7005643 DOI: 10.1002/mpo.2950080405] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This report updates experience with the CONPADRI-I, COMPADRI-II, and COMPADRI-III adjuvant chemotherapy programs for the treatment of nonmetastatic osteosarcoma. A total of 200 patients received one of the three regimens. The analysis of response to treatment is based on disease-free survival time (DFS time). The effect of treatment, age, sex, site of disease involvement, and race on DFS time were investigated. Cox's life-table regression analysis found only sex to have a significant effect on DFS time with males having 1.8 times the risk of recurrence or death per unit time as female patients (P = 0.004). An analysis of the 81 patients still alive and disease-free 18 months after the start of treatment shows significantly longer DFS time for CONPADRI-I than COMPADRI-II patients (P = 0.01). This trend is true for both male (P = 0.12) and female (P = 0.08) patients.
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