Clinical breast cancer最新文献

Background: Risk-stratified breast cancer screening has been proposed as an alternative to the age-based approach currently used by most screening programs. This study, part of the Canadian PERSPECTIVE I&I project, examined perceived advantages and disadvantages of learning your breast cancer risk category and associated screening plans.

Method: Women aged 40 to 69 from Ontario and Quebec (N = 3319) had multifactorial risk assessments using the CanRisk tool. Risk categories (average [78.9%], higher than average [16.4%], high [4.6%]) were communicated along with screening plans. Participants completed questionnaires on attitudes toward learning their risk before, at the time of, and 1 year later risk communication. Participant characteristics associated with these attitudes were assessed using multinomial logistic regression.

Results: At the time of risk communication, most participants (72.9%) perceived ``Easing worry'' as an advantage of learning their risk. However, participants at higher risk were more likely to report that it did not ease their worry. Visible minority participants (OR = 1.86, 95% CI, 1.16, 2.98) and those with lower education attainment were more likely to view "complicated information" as a disadvantage (College/Apprenticeship/Trades: OR = 1.54, 95% CI, 1.24, 1.92; High School or below: OR = 1.77, 95% CI, 1.29, 2.42). Ontario participants were more likely to view risk communication as "information I do not want to know" (OR = 0.44, 95% CI, 0.32, 0.59) compared to Quebec participants.

Conclusion: Most women responded positively to learning their breast cancer risk category and screening plan. Successful implementation of risk-stratified screening will require clear communication, healthcare provider support, and adaptation to regional resources.

Ductal carcinoma in situ (DCIS) of the breast is a distinct biologic entity from invasive cancer with an excellent prognosis which represents about 20% of all mammographically detected breast neoplasms. The primary goal of treatment is to minimize the risk of invasive in-breast recurrence. The American Radium Society (ARS) Appropriate Use Criteria (AUC) expert panel examined the evidence for key questions in contemporary treatment of DCIS related to the benefit of radiation after lumpectomy, the established dose and fractionation radiation regimens and the use of predictive and prognostic assays in treatment management of DCIS. For patients undergoing breast conserving surgery, postoperative radiation to the breast reduces the risk of local recurrence by at least 50%. The absolute benefit depends upon the baseline risk of in breast recurrence based on clinicopathologic features identified in randomized or prospective clinical trials and meta-analyses. These features include age and menopausal status, grade, margin width, tumor size, receptor expression, and presence of comedonecrosis. Randomized and prospective studies have not identified a definitive cohort of patients who do not benefit from adjuvant radiation to reduce in breast recurrence. Margin width appears to be the most significant factor in local recurrence risk. Patients with close or positive margins demonstrate a higher local recurrence risk and benefit from dose escalation by use of a tumor bed boost. Recently developed biosignatures of DCIS in-breast recurrence risk have been validated and found to confer potential clinical utility in the decision-making process regarding recommendations to undergo treatment with adjuvant breast radiation.