Varsha Harish, Zoe K Haffner, Jenna C Bekeny, Adaah A Sayyed, David H Song, Kenneth L Fan
Purpose: As breast-conserving procedures become increasingly safe and viable options for surgical management of breast cancer, efforts have focused on assessing and optimizing patient-reported outcome measures (PROMs), such as nipple sensation. This study aims to evaluate the current understanding of nipple-areolar complex (NAC) sensation outcomes in breast cancer patients undergoing breast cancer surgeries, namely, nipple-sparing mastectomies (NSM), skin-sparing mastectomies (SSM), and lumpectomies.
Methods: Articles including terms related to "nipple," "mastectomy," "sensation," and "patient-reported outcome" were queried from three databases according to PRISMA guidelines. Study characteristics, patient demographics, and surgical details were recorded. Outcomes of interest included objective nipple sensitivity testing and PROMs.
Results: Of 888 manuscripts identified, 28 articles met the inclusion criteria. Twelve studies (n = 578 patients) used objective measures to evaluate sensitivity, such as monofilament testing. Sixteen studies (n = 1785 patients) assessed PROMs through validated or investigator-generated surveys. Three of the included studies reported NAC sensitivity in patients who received NSM with neurotization (n = 203 patients) through a variety of techniques that used various grafts to coapt a lateral intercostal nerve to the NAC nerve stumps. Results of investigator surveys showed that of 1565 patients without neurotization, nipple sensation was maintained in 29.0% (n = 453) of patients. Of 138 NSM patients without NAC neurotization, SWM testing showed an average loss of protective sensation in the nipple (average SWM score: 4.7) compared to normal or diminished sensation to light touch in nonoperated controls (average SWM score: 2.9, n = 195). Of patients who underwent NSM with neurotization, one study (n = 78) reported maintenance of NAC sensation in 100% of patients, while another study (n = 7) reported average diminished protective sensation in the nipple (average SWM score: 3.9).
Conclusion: Our study has shown that objective and patient-reported results of nipple sensitivity support nipple-sparing techniques as a viable option for preserving NAC sensation, although patients can expect a decrease in sensation overall. Neurotization of the NAC during NSM shows promising results of improved postoperative nipple sensitivity, though additional studies are warranted to confirm this finding. Variations between study methodologies highlight the lack of standardization in sensory testing techniques when evaluating NAC sensation.
{"title":"Preserving Nipple Sensitivity after Breast Cancer Surgery: A Systematic Review and Meta-Analysis.","authors":"Varsha Harish, Zoe K Haffner, Jenna C Bekeny, Adaah A Sayyed, David H Song, Kenneth L Fan","doi":"10.1155/2022/9654741","DOIUrl":"https://doi.org/10.1155/2022/9654741","url":null,"abstract":"<p><strong>Purpose: </strong>As breast-conserving procedures become increasingly safe and viable options for surgical management of breast cancer, efforts have focused on assessing and optimizing patient-reported outcome measures (PROMs), such as nipple sensation. This study aims to evaluate the current understanding of nipple-areolar complex (NAC) sensation outcomes in breast cancer patients undergoing breast cancer surgeries, namely, nipple-sparing mastectomies (NSM), skin-sparing mastectomies (SSM), and lumpectomies.</p><p><strong>Methods: </strong>Articles including terms related to \"nipple,\" \"mastectomy,\" \"sensation,\" and \"patient-reported outcome\" were queried from three databases according to PRISMA guidelines. Study characteristics, patient demographics, and surgical details were recorded. Outcomes of interest included objective nipple sensitivity testing and PROMs.</p><p><strong>Results: </strong>Of 888 manuscripts identified, 28 articles met the inclusion criteria. Twelve studies (<i>n</i> = 578 patients) used objective measures to evaluate sensitivity, such as monofilament testing. Sixteen studies (<i>n</i> = 1785 patients) assessed PROMs through validated or investigator-generated surveys. Three of the included studies reported NAC sensitivity in patients who received NSM with neurotization (<i>n</i> = 203 patients) through a variety of techniques that used various grafts to coapt a lateral intercostal nerve to the NAC nerve stumps. Results of investigator surveys showed that of 1565 patients without neurotization, nipple sensation was maintained in 29.0% (<i>n</i> = 453) of patients. Of 138 NSM patients without NAC neurotization, SWM testing showed an average loss of protective sensation in the nipple (average SWM score: 4.7) compared to normal or diminished sensation to light touch in nonoperated controls (average SWM score: 2.9, <i>n</i> = 195). Of patients who underwent NSM with neurotization, one study (<i>n</i> = 78) reported maintenance of NAC sensation in 100% of patients, while another study (<i>n</i> = 7) reported average diminished protective sensation in the nipple (average SWM score: 3.9).</p><p><strong>Conclusion: </strong>Our study has shown that objective and patient-reported results of nipple sensitivity support nipple-sparing techniques as a viable option for preserving NAC sensation, although patients can expect a decrease in sensation overall. Neurotization of the NAC during NSM shows promising results of improved postoperative nipple sensitivity, though additional studies are warranted to confirm this finding. Variations between study methodologies highlight the lack of standardization in sensory testing techniques when evaluating NAC sensation.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9701124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10343396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danielle Riley, Mary Charlton, Elizabeth A Chrischilles, Ingrid M Lizarraga, Sneha Phadke, Brian J Smith, Adam Skibbe, Charles F Lynch
Objective: Given the challenges rural cancer patients face in accessing cancer care as well as the slower diffusion and adoption of new medical technologies among rural providers, the aim of our study was to examine trends in gene expression profiling (GEP) testing and evaluate the association between hospital rurality and receipt of GEP testing.
Methods: Data from the Iowa Cancer Registry (ICR) were used to identify women with newly diagnosed, histologically confirmed breast cancer from 2010 through 2018 who met eligibility criteria for GEP testing. Patients were allocated to the hospitals where their most definitive surgical treatment was received, and Rural-Urban Commuting Area codes were used to categorize hospitals into urban (N = 43), large rural (N = 16), and small rural (N = 48). Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression to evaluate the association between hospital rurality and GEP test use, adjusting for demographic and clinical characteristics. The association between test result and treatment received was assessed among patients who received Oncotype DX (ODX) testing.
Results: Of 6,726 patients eligible for GEP test use, 46% (N = 3,069) underwent testing with 95% receiving ODX. While overall GEP testing rates increased over time from 42% between 2010 and 2012 to 51% between 2016 and 2018 (Ptrend < 0.0001), use continued to be the lowest among patients treated at hospitals in small rural areas. The odds of GEP testing remained significantly lower among patients treated at hospitals located in small rural areas (aOR 0.55; 95% CI 0.43-0.71), after adjusting for demographic and clinical characteristics. ODX recurrence scores were highly correlated with chemotherapy use across all strata of hospital rurality.
Conclusions: GEP testing continues to be underutilized, especially among those treated at small rural hospitals. Targeted interventions aimed at increasing rates of GEP testing to ensure the appropriate use of adjuvant chemotherapy may improve health outcomes and lower treatment-related costs.
{"title":"Hospital Rurality and Gene Expression Profiling for Early-Stage Breast Cancer among Iowa Residents (2010-2018).","authors":"Danielle Riley, Mary Charlton, Elizabeth A Chrischilles, Ingrid M Lizarraga, Sneha Phadke, Brian J Smith, Adam Skibbe, Charles F Lynch","doi":"10.1155/2022/8582894","DOIUrl":"https://doi.org/10.1155/2022/8582894","url":null,"abstract":"<p><strong>Objective: </strong>Given the challenges rural cancer patients face in accessing cancer care as well as the slower diffusion and adoption of new medical technologies among rural providers, the aim of our study was to examine trends in gene expression profiling (GEP) testing and evaluate the association between hospital rurality and receipt of GEP testing.</p><p><strong>Methods: </strong>Data from the Iowa Cancer Registry (ICR) were used to identify women with newly diagnosed, histologically confirmed breast cancer from 2010 through 2018 who met eligibility criteria for GEP testing. Patients were allocated to the hospitals where their most definitive surgical treatment was received, and Rural-Urban Commuting Area codes were used to categorize hospitals into urban (<i>N</i> = 43), large rural (<i>N</i> = 16), and small rural (<i>N</i> = 48). Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression to evaluate the association between hospital rurality and GEP test use, adjusting for demographic and clinical characteristics. The association between test result and treatment received was assessed among patients who received Oncotype DX (ODX) testing.</p><p><strong>Results: </strong>Of 6,726 patients eligible for GEP test use, 46% (<i>N</i> = 3,069) underwent testing with 95% receiving ODX. While overall GEP testing rates increased over time from 42% between 2010 and 2012 to 51% between 2016 and 2018 (<i>P</i> <sub>trend</sub> < 0.0001), use continued to be the lowest among patients treated at hospitals in small rural areas. The odds of GEP testing remained significantly lower among patients treated at hospitals located in small rural areas (aOR 0.55; 95% CI 0.43-0.71), after adjusting for demographic and clinical characteristics. ODX recurrence scores were highly correlated with chemotherapy use across all strata of hospital rurality.</p><p><strong>Conclusions: </strong>GEP testing continues to be underutilized, especially among those treated at small rural hospitals. Targeted interventions aimed at increasing rates of GEP testing to ensure the appropriate use of adjuvant chemotherapy may improve health outcomes and lower treatment-related costs.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9448596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10620154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renata Faermann, Eitan Friedman, Orit Kaidar-Person, Jonathan Weidenfeld, Malka Brodsky, Anat Shalmon, Osnat Halshtok Neiman, Michael Gotlieb, Yael Yagil, David Samoocha, Dana Madorsky Feldman, Miri Sklair-Levy
Background: While BRCA1/BRCA2 pathogenic sequence variants (PSVs) clearly confer an increased risk for invasive breast cancer, the extent to which these mutant alleles increase DCIS risk is less clear.
Objective: To assess the rate of detection over a 5-year period, and MRI imaging features of pure noncalcified DCIS in a cohort of Israeli BRCA1/BRCA2 PSV carriers attending a high-risk clinic from 2015 to 2020.
Materials and methods: All female BRCA1/BRCA2 PSV-carriers followed at the Meirav High-risk clinic from 2015 to 2020 were eligible if they underwent semiannual breast imaging (MRI/mammography) and MRI-guided biopsy-proven pure DCIS. Clinical data, pathology information, and imaging characteristics were retrieved from the computerized archiving system.
Results: 18/121 (15.2%) participating BRCA1 PSV carriers and 8/81 (10.1%) BRCA2 PSV-carriers who underwent MRI-guided biopsy were diagnosed with DCIS. The median age of BRCA1 carriers and BRCA2 carriers was 49.8 years and 60.6 years, respectively (p = 0.55). Negative estrogen-receptor tumors were diagnosed in 13/18 (72%) BRCA1 and 2/8 (25%) BRCA2 PSV carriers (p < 0.05). Thirteen (13/18-72%) BRCA1 carriers had intermediate to high-grade or high-grade DCIS compared with 4/8 (50%) of BRCA2 carriers (p = 0.03). Over the 5-year study period, 29/1100 (2.6%) BRCA1/BRCA2 PSV carriers were diagnosed with DCIS seen on MRI only.
Conclusion: MRI-detected noncalcified DCIS is more frequent in BRCA1 PSV carriers compared with BRCA2 carriers, unlike the BRCA2 predominance in mammography-detected calcified DCIS. BRCA1-related DCIS is diagnosed earlier, more likely to be estrogen receptor-negative and of higher grade compared with BRCA2-related DCIS. Future prospective studies should validate these results and assess the actual impact they might have on clinical management of BRCA PSV carriers.
{"title":"Ductal Carcinoma In Situ (DCIS) Diagnosed by MRI-Guided Biopsy among <i>BRCA1/BRCA2</i> Mutation Carriers.","authors":"Renata Faermann, Eitan Friedman, Orit Kaidar-Person, Jonathan Weidenfeld, Malka Brodsky, Anat Shalmon, Osnat Halshtok Neiman, Michael Gotlieb, Yael Yagil, David Samoocha, Dana Madorsky Feldman, Miri Sklair-Levy","doi":"10.1155/2022/4317693","DOIUrl":"https://doi.org/10.1155/2022/4317693","url":null,"abstract":"<p><strong>Background: </strong>While <i>BRCA1/BRCA2</i> pathogenic sequence variants (PSVs) clearly confer an increased risk for invasive breast cancer, the extent to which these mutant alleles increase DCIS risk is less clear.</p><p><strong>Objective: </strong>To assess the rate of detection over a 5-year period, and MRI imaging features of pure noncalcified DCIS in a cohort of Israeli <i>BRCA1/BRCA2</i> PSV carriers attending a high-risk clinic from 2015 to 2020.</p><p><strong>Materials and methods: </strong>All female <i>BRCA1/BRCA2</i> PSV-carriers followed at the Meirav High-risk clinic from 2015 to 2020 were eligible if they underwent semiannual breast imaging (MRI/mammography) and MRI-guided biopsy-proven pure DCIS. Clinical data, pathology information, and imaging characteristics were retrieved from the computerized archiving system.</p><p><strong>Results: </strong>18/121 (15.2%) participating <i>BRCA1</i> PSV carriers and 8/81 (10.1%) <i>BRCA2</i> PSV-carriers who underwent MRI-guided biopsy were diagnosed with DCIS. The median age of <i>BRCA1</i> carriers and <i>BRCA2</i> carriers was 49.8 years and 60.6 years, respectively (<i>p</i> = 0.55). Negative estrogen-receptor tumors were diagnosed in 13/18 (72%) <i>BRCA1</i> and 2/8 (25%) <i>BRCA2</i> PSV carriers (<i>p</i> < 0.05). Thirteen (13/18-72%) <i>BRCA1</i> carriers had intermediate to high-grade or high-grade DCIS compared with 4/8 (50%) of <i>BRCA2</i> carriers (<i>p</i> = 0.03). Over the 5-year study period, 29/1100 (2.6%) <i>BRCA1/BRCA2</i> PSV carriers were diagnosed with DCIS seen on MRI only.</p><p><strong>Conclusion: </strong>MRI-detected noncalcified DCIS is more frequent in <i>BRCA1</i> PSV carriers compared with <i>BRCA2</i> carriers, unlike the <i>BRCA2</i> predominance in mammography-detected calcified DCIS. <i>BRCA1</i>-related DCIS is diagnosed earlier, more likely to be estrogen receptor-negative and of higher grade compared with <i>BRCA2</i>-related DCIS. Future prospective studies should validate these results and assess the actual impact they might have on clinical management of <i>BRCA</i> PSV carriers.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10404786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jong Ho Lee, Jeong Yeop Ryu, Kang Young Choi, Jung Dug Yang, Ho Yun Chung, Byung Chae Cho, Byeongju Kang, Jeeyeon Lee, Ho Yong Park, Joon Seok Lee
Background: A combination of the reduction mammoplasty technique and breast reconstruction allows surgeons to lift ptotic breasts through local flaps and skin reduction during surgery for breast cancer. This study presents a reliable course for the combination of partial and skin or nipple-sparing mastectomy with reduction-reconstruction surgery.
Methods: Fifty-seven patients underwent a partial mastectomy before reduction mammoplasty of both breasts during the same time period between 2014 and 2021 at our institution and thirteen patients underwent skin or nipple-sparing mastectomy, breast reconstruction with an extended latissimus dorsi flap or silicone implant, and aesthetic reduction mammoplasty of the contralateral breast during the same time period. Additional photos were obtained preoperatively, immediately after the operation, and at one, three, six, and twelve months postoperatively. Patient satisfaction was evaluated preoperatively and postoperatively and postoperative complications were noted.
Results: Among the patients who underwent a partial mastectomy, the mean age was 45.18 ± 11.05 years, the mean body mass index (BMI) was 26.74 ± 3.53 kg/m2, and the mean preoperative right and left breast volumes were 663.85 (±28.12) cc and 664.34 (±37.13) cc, respectively, and the mean excised mass weight was 177.74 (±213.93) g. Among the patients who underwent a skin-sparing mastectomy, the mean age was 51.62 ± 8.96 years, the mean BMI was 26.91 ± 4.34 kg/m2, and the mean preoperative right and left breast volumes were 624.17 (±98.52) cc and 562.31 (±80.81) cc, respectively, and the mean excised mass weight was 618.05 (±338.17) g. Four patients (5.3%) in the partial mastectomy group had fat necrosis. The mean patient satisfaction score was higher postoperatively in both groups.
Conclusion: Patients with breast cancer and large and/or ptotic breasts can successfully undergo reduction mammoplasty for both breasts immediately following partial mastectomy and nipple or skin-sparing mastectomy.
{"title":"Useful Reduction Mammoplasty Technique in Oncoplastic Breast Surgery and Reconstruction.","authors":"Jong Ho Lee, Jeong Yeop Ryu, Kang Young Choi, Jung Dug Yang, Ho Yun Chung, Byung Chae Cho, Byeongju Kang, Jeeyeon Lee, Ho Yong Park, Joon Seok Lee","doi":"10.1155/2022/2952322","DOIUrl":"https://doi.org/10.1155/2022/2952322","url":null,"abstract":"<p><strong>Background: </strong>A combination of the reduction mammoplasty technique and breast reconstruction allows surgeons to lift ptotic breasts through local flaps and skin reduction during surgery for breast cancer. This study presents a reliable course for the combination of partial and skin or nipple-sparing mastectomy with reduction-reconstruction surgery.</p><p><strong>Methods: </strong>Fifty-seven patients underwent a partial mastectomy before reduction mammoplasty of both breasts during the same time period between 2014 and 2021 at our institution and thirteen patients underwent skin or nipple-sparing mastectomy, breast reconstruction with an extended latissimus dorsi flap or silicone implant, and aesthetic reduction mammoplasty of the contralateral breast during the same time period. Additional photos were obtained preoperatively, immediately after the operation, and at one, three, six, and twelve months postoperatively. Patient satisfaction was evaluated preoperatively and postoperatively and postoperative complications were noted.</p><p><strong>Results: </strong>Among the patients who underwent a partial mastectomy, the mean age was 45.18 ± 11.05 years, the mean body mass index (BMI) was 26.74 ± 3.53 kg/m<sup>2</sup>, and the mean preoperative right and left breast volumes were 663.85 (±28.12) cc and 664.34 (±37.13) cc, respectively, and the mean excised mass weight was 177.74 (±213.93) g. Among the patients who underwent a skin-sparing mastectomy, the mean age was 51.62 ± 8.96 years, the mean BMI was 26.91 ± 4.34 kg/m<sup>2</sup>, and the mean preoperative right and left breast volumes were 624.17 (±98.52) cc and 562.31 (±80.81) cc, respectively, and the mean excised mass weight was 618.05 (±338.17) g. Four patients (5.3%) in the partial mastectomy group had fat necrosis. The mean patient satisfaction score was higher postoperatively in both groups.</p><p><strong>Conclusion: </strong>Patients with breast cancer and large and/or ptotic breasts can successfully undergo reduction mammoplasty for both breasts immediately following partial mastectomy and nipple or skin-sparing mastectomy.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10417446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leena Vehmanen, Johanna Mattson, Evangelos Karademas, Albino J Oliveira-Maia, Berta Sousa, Ruth Pat-Horenczyk, Ketti Mazzocco, Panagiotis Simos, Fátima Cardoso, Greta Pettini, Chiara Marzorati, Eleni Kolokotroni, Georgios Stamatakos, Diana Frasquilho, Paula Poikonen-Saksela
Background: Identifying and understanding modifiable factors for the well-being of cancer patients is critical in survivorship research. We studied variables associated with the exercise habits of breast cancer patients and investigated if the achievement of exercise recommendations was associated with enhanced quality of life and/or psychological well-being. Material and Methods. 311 women from Finland, Portugal, Israel, and Italy receiving adjuvant therapy for stage I-III breast cancer answered questions about sociodemographic factors and physical exercise. Quality of life was assessed by the EORTC C30 and BR23 questionnaires. Anxiety and depression were evaluated using the HADS scale.
Results: At the beginning of adjuvant therapy and after twelve months, 32% and 26% of participants were physically inactive, 27% and 30% exercised between 30 and 150 minutes per week, while 41% and 45% exercised the recommended 150 minutes or more per week. Relative to other countries, Finnish participants were more likely to be active at baseline and at twelve months (89% vs. 50%, p < 0.001 and 87% vs. 64%, p < 0.001). Participants with stage I cancer were more likely to be active at twelve months than those with a higher stage (80% vs. 70%,p < 0.05). The inactive participants reported more anxiety (p < 0.05) and depression (p < 0.001), lower global quality of life (p < 0.001), and more side effects (p < 0.05) than the others at twelve months. Accordingly, those who remained inactive or decreased their level of exercise from baseline to twelve months reported more anxiety (p < 0.01) and depression (p < 0.001), lower global quality of life (p < 0.001), and more side effects (p < 0.05) than those with the same or increased level of exercise.
Conclusion: For women with early breast cancer, exercise was associated with a better quality of life, less depression and anxiety, and fewer adverse events of adjuvant therapy. Trial registration number: NCT05095675. Paula Poikonen-Saksela on behalf of Bounce consortium (https://www.bounce-project.eu/).
{"title":"Associations between Physical Exercise, Quality of Life, Psychological Symptoms and Treatment Side Effects in Early Breast Cancer.","authors":"Leena Vehmanen, Johanna Mattson, Evangelos Karademas, Albino J Oliveira-Maia, Berta Sousa, Ruth Pat-Horenczyk, Ketti Mazzocco, Panagiotis Simos, Fátima Cardoso, Greta Pettini, Chiara Marzorati, Eleni Kolokotroni, Georgios Stamatakos, Diana Frasquilho, Paula Poikonen-Saksela","doi":"10.1155/2022/9921575","DOIUrl":"https://doi.org/10.1155/2022/9921575","url":null,"abstract":"<p><strong>Background: </strong>Identifying and understanding modifiable factors for the well-being of cancer patients is critical in survivorship research. We studied variables associated with the exercise habits of breast cancer patients and investigated if the achievement of exercise recommendations was associated with enhanced quality of life and/or psychological well-being. <i>Material and Methods</i>. 311 women from Finland, Portugal, Israel, and Italy receiving adjuvant therapy for stage I-III breast cancer answered questions about sociodemographic factors and physical exercise. Quality of life was assessed by the EORTC C30 and BR23 questionnaires. Anxiety and depression were evaluated using the HADS scale.</p><p><strong>Results: </strong>At the beginning of adjuvant therapy and after twelve months, 32% and 26% of participants were physically inactive, 27% and 30% exercised between 30 and 150 minutes per week, while 41% and 45% exercised the recommended 150 minutes or more per week. Relative to other countries, Finnish participants were more likely to be active at baseline and at twelve months (89% vs. 50%, <i>p</i> < 0.001 and 87% vs. 64%, <i>p</i> < 0.001). Participants with stage I cancer were more likely to be active at twelve months than those with a higher stage (80% vs. 70%,<i>p</i> < 0.05). The inactive participants reported more anxiety (<i>p</i> < 0.05) and depression (<i>p</i> < 0.001), lower global quality of life (<i>p</i> < 0.001), and more side effects (<i>p</i> < 0.05) than the others at twelve months. Accordingly, those who remained inactive or decreased their level of exercise from baseline to twelve months reported more anxiety (<i>p</i> < 0.01) and depression (<i>p</i> < 0.001), lower global quality of life (<i>p</i> < 0.001), and more side effects (<i>p</i> < 0.05) than those with the same or increased level of exercise.</p><p><strong>Conclusion: </strong>For women with early breast cancer, exercise was associated with a better quality of life, less depression and anxiety, and fewer adverse events of adjuvant therapy. Trial registration number: NCT05095675. Paula Poikonen-Saksela on behalf of Bounce consortium (https://www.bounce-project.eu/).</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9701120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10336653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yik Shuen Chan, Wai Ka Hung, Lok Wa Yuen, Ho Yan Yolanda Chan, Chiu Wing Winnie Chu, Polly Suk Yee Cheung
Background: We compared the clinico-radio-pathological characteristics of breast cancer detected through mammogram (MMG) and ultrasound (USG) and discuss the implication of the choice of imaging as the future direction of our recently launched local screening program.
Methods: Retrospective study of 14613 Hong Kong Chinese female patients with histologically confirmed breast cancer registered in the Hong Kong Breast Cancer Registry between January 2006 and February 2020. Patients were classified into four groups based on the mode of breast cancer detection (detectable by both mammogram and ultrasound (MMG+/USG+), mammogram only (MMG+/USG-), ultrasound only (MMG-/USG+), or not detectable by either (MMG-/USG-). Characteristics of breast cancer detected were compared, including patient demographics, breast density on MMG, mode of presentation, tumour size, histological type, and staging. Types of mammographic abnormalities were also evaluated for MMG+ subgroups.
Results: 85% of the cancers were detectable by MMG, while USG detected an additional 9%. MMG+/USG+ cancers were larger, more advanced in stage, often of symptomatic presentation, and commonly manifested as mammographic mass. MMG+/USG- cancers were more likely of asymptomatic presentation, manifested as microcalcifications, and of earlier stage and to be ductal carcinoma in situ. MMG-/USG+ cancers were more likely seen in young patients and those with denser breasts and more likely of symptomatic presentation. MMG-/USG- cancers were often smaller and found in denser breasts.
Conclusion: Mammogram has a good detection rate of cancers in our local population. It has superiority in detecting early cancers by detecting microcalcifications. Our current study agrees that ultrasound is one of the key adjunct tools of breast cancer detection.
{"title":"Comparison of Characteristics of Breast Cancer Detected through Different Imaging Modalities in a Large Cohort of Hong Kong Chinese Women: Implication of Imaging Choice on Upcoming Local Screening Program.","authors":"Yik Shuen Chan, Wai Ka Hung, Lok Wa Yuen, Ho Yan Yolanda Chan, Chiu Wing Winnie Chu, Polly Suk Yee Cheung","doi":"10.1155/2022/3882936","DOIUrl":"https://doi.org/10.1155/2022/3882936","url":null,"abstract":"<p><strong>Background: </strong>We compared the clinico-radio-pathological characteristics of breast cancer detected through mammogram (MMG) and ultrasound (USG) and discuss the implication of the choice of imaging as the future direction of our recently launched local screening program.</p><p><strong>Methods: </strong>Retrospective study of 14613 Hong Kong Chinese female patients with histologically confirmed breast cancer registered in the Hong Kong Breast Cancer Registry between January 2006 and February 2020. Patients were classified into four groups based on the mode of breast cancer detection (detectable by both mammogram and ultrasound (MMG+/USG+), mammogram only (MMG+/USG-), ultrasound only (MMG-/USG+), or not detectable by either (MMG-/USG-). Characteristics of breast cancer detected were compared, including patient demographics, breast density on MMG, mode of presentation, tumour size, histological type, and staging. Types of mammographic abnormalities were also evaluated for MMG+ subgroups.</p><p><strong>Results: </strong>85% of the cancers were detectable by MMG, while USG detected an additional 9%. MMG+/USG+ cancers were larger, more advanced in stage, often of symptomatic presentation, and commonly manifested as mammographic mass. MMG+/USG- cancers were more likely of asymptomatic presentation, manifested as microcalcifications, and of earlier stage and to be ductal carcinoma in situ. MMG-/USG+ cancers were more likely seen in young patients and those with denser breasts and more likely of symptomatic presentation. MMG-/USG- cancers were often smaller and found in denser breasts.</p><p><strong>Conclusion: </strong>Mammogram has a good detection rate of cancers in our local population. It has superiority in detecting early cancers by detecting microcalcifications. Our current study agrees that ultrasound is one of the key adjunct tools of breast cancer detection.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10205402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9569198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Farewell to The Breast Journal: A novel scientific publication led by a pathologist who moved beyond the microscope and faced the patients","authors":"Shahla Masood MD","doi":"10.1111/tbj.14304","DOIUrl":"10.1111/tbj.14304","url":null,"abstract":"","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2021-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39719011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Axillary lymph node dissection (ALND) specimens should have at least ten-lymph nodes for examination according to established guidelines. Nonetheless, recent evidence suggests that neoadjuvant chemotherapy (NAC) results in fewer nodes in the specimen. We sought to examine if NAC patients have lower lymph node yield from ALND specimens and whether the number of lymph nodes in the specimen is correlated with pathologic complete response (pCR). Using the National Cancer Database (NCDB), a study cohort of female patients with node-positive, non-metastatic invasive breast cancer diagnosed from 2012 to 2015 was identified. The axillary lymph node retrieval count was compared in NAC and non-NAC patients and then correlated with pCR. A multivariable analysis was performed to identify factors that were associated with less than ten-lymph nodes in the ALND pathologic specimen. Of 56,976 patients identified, 27,197 (48%) received neoadjuvant chemotherapy; 29,779 (52%) did not. NAC patients failed to meet the ten-lymph node minimum in the ALND specimen more often than non-NAC patients (35% vs. 27%, p < 0.001). NAC patients with fewer than ten-lymph nodes were more likely to have a pCR than those with ten or more (22% vs. 16%, p < 0.001). On multivariable analysis, pCR of the primary tumor and receptor status were found to be independent predictors of having fewer than ten-lymph nodes in the ALND specimen. Node-positive breast cancer patients that underwent NAC were more likely to not meet the ten-lymph node standard. However, NAC patients who did not meet the minimum were also more likely to have a pCR compared to NAC patients who did. This suggests lower lymph node yield may not truly be a marker of lower quality surgery but rather a potential marker of NAC treatment effect.
腋窝淋巴结清扫(ALND)标本应至少有十个淋巴结检查根据既定的指导方针。尽管如此,最近的证据表明,新辅助化疗(NAC)可减少标本中的淋巴结。我们试图研究NAC患者在ALND标本中是否有较低的淋巴结产量,以及标本中淋巴结的数量是否与病理完全缓解(pCR)相关。使用国家癌症数据库(NCDB),确定了2012年至2015年诊断为淋巴结阳性,非转移性浸润性乳腺癌的女性患者的研究队列。比较NAC和非NAC患者腋窝淋巴结恢复计数,并与pCR进行相关分析。进行多变量分析以确定与ALND病理标本中少于10个淋巴结相关的因素。在确定的56,976例患者中,27,197例(48%)接受了新辅助化疗;29779例(52%)没有。NAC患者在ALND标本中未能达到10个淋巴结最小值的比例高于非NAC患者(35% vs. 27%, p <0.001)。小于10个淋巴结的NAC患者比大于或等于10个淋巴结的NAC患者更容易出现pCR (22% vs. 16%, p <0.001)。在多变量分析中,发现原发肿瘤的pCR和受体状态是ALND标本中淋巴结少于10个的独立预测因子。接受NAC的淋巴结阳性乳腺癌患者更有可能不符合10个淋巴结的标准。然而,与达到最低要求的NAC患者相比,未达到最低要求的NAC患者也更有可能出现pCR。这表明较低的淋巴结产量可能不是手术质量较差的标志,而是NAC治疗效果的潜在标志。
{"title":"Lower lymph node yield in axillary lymph node dissection specimens in breast cancer patients receiving neoadjuvant chemotherapy: Quality concern or treatment effect?","authors":"Junko Ozao-Choy MD, FACS, Ashkan Moazzez MD, MPH, FACS, Christine Dauphine MD, FACS","doi":"10.1111/tbj.14303","DOIUrl":"10.1111/tbj.14303","url":null,"abstract":"<p>Axillary lymph node dissection (ALND) specimens should have at least ten-lymph nodes for examination according to established guidelines. Nonetheless, recent evidence suggests that neoadjuvant chemotherapy (NAC) results in fewer nodes in the specimen. We sought to examine if NAC patients have lower lymph node yield from ALND specimens and whether the number of lymph nodes in the specimen is correlated with pathologic complete response (pCR). Using the National Cancer Database (NCDB), a study cohort of female patients with node-positive, non-metastatic invasive breast cancer diagnosed from 2012 to 2015 was identified. The axillary lymph node retrieval count was compared in NAC and non-NAC patients and then correlated with pCR. A multivariable analysis was performed to identify factors that were associated with less than ten-lymph nodes in the ALND pathologic specimen. Of 56,976 patients identified, 27,197 (48%) received neoadjuvant chemotherapy; 29,779 (52%) did not. NAC patients failed to meet the ten-lymph node minimum in the ALND specimen more often than non-NAC patients (35% vs. 27%, <i>p </i>< 0.001). NAC patients with fewer than ten-lymph nodes were more likely to have a pCR than those with ten or more (22% vs. 16%, <i>p </i>< 0.001). On multivariable analysis, pCR of the primary tumor and receptor status were found to be independent predictors of having fewer than ten-lymph nodes in the ALND specimen. Node-positive breast cancer patients that underwent NAC were more likely to not meet the ten-lymph node standard. However, NAC patients who did not meet the minimum were also more likely to have a pCR compared to NAC patients who did. This suggests lower lymph node yield may not truly be a marker of lower quality surgery but rather a potential marker of NAC treatment effect.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39814706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julian K K Chan MBChB MRCP, Natalia Garibotto BMedSci(Hons) MBBS MRCS(Edin) FRACS, Deepthi Dissanayake MBBS FRANZCR, Benjamin F Dessauvagie BMedSci MBBS FRCPA, Anmol Rijhumal MBBCh FRCPA, Elizabeth J Wylie MBBS FRANZCR
Carney complex (CNC) is an extremely rare, autosomal dominant genetic syndrome consisting of pigmented skin and mucosal changes with multiple endocrine and nonendocrine tumors, including the breast. Breast tumors are typically multiple and benign and are most commonly reported as myxoid fibroadenomas and/or intraductal papillomas. We present a young female patient with known CNC who presented with copious bloody nipple discharge with multiple breast lumps and discuss the breast imaging features regarding this complex and often underrecognized genetic condition.
{"title":"Bloody nipple discharge in Carney complex: A case report","authors":"Julian K K Chan MBChB MRCP, Natalia Garibotto BMedSci(Hons) MBBS MRCS(Edin) FRACS, Deepthi Dissanayake MBBS FRANZCR, Benjamin F Dessauvagie BMedSci MBBS FRCPA, Anmol Rijhumal MBBCh FRCPA, Elizabeth J Wylie MBBS FRANZCR","doi":"10.1111/tbj.14302","DOIUrl":"10.1111/tbj.14302","url":null,"abstract":"<p>Carney complex (CNC) is an extremely rare, autosomal dominant genetic syndrome consisting of pigmented skin and mucosal changes with multiple endocrine and nonendocrine tumors, including the breast. Breast tumors are typically multiple and benign and are most commonly reported as myxoid fibroadenomas and/or intraductal papillomas. We present a young female patient with known CNC who presented with copious bloody nipple discharge with multiple breast lumps and discuss the breast imaging features regarding this complex and often underrecognized genetic condition.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2021-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39788115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iram Dubin MD, Shabnam Mortazavi MD, Tiffany Yu MD, Irene R. Riahi MD, Jennifer L. Baker MD
Superficial angiomyxoma (SA) is a rare benign soft-tissue tumor, arising sporadically or as the earliest manifestation of Carney's complex. When it arises sporadically, the breast is infrequently involved with only few cases reported in the literature. Key imaging findings include T2 signal hyperintensity on MRI and hypervascularity. In this study, we report the clinical, radiological, surgical, and histopathologic findings of a case of sporadic SA of the breast in a 16-year-old girl.
{"title":"Superficial angiomyxoma of the breast in a 16-year-old girl without carney’s complex: A case report","authors":"Iram Dubin MD, Shabnam Mortazavi MD, Tiffany Yu MD, Irene R. Riahi MD, Jennifer L. Baker MD","doi":"10.1111/tbj.14301","DOIUrl":"10.1111/tbj.14301","url":null,"abstract":"<p>Superficial angiomyxoma (SA) is a rare benign soft-tissue tumor, arising sporadically or as the earliest manifestation of Carney's complex. When it arises sporadically, the breast is infrequently involved with only few cases reported in the literature. Key imaging findings include T2 signal hyperintensity on MRI and hypervascularity. In this study, we report the clinical, radiological, surgical, and histopathologic findings of a case of sporadic SA of the breast in a 16-year-old girl.</p>","PeriodicalId":56326,"journal":{"name":"Breast Journal","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2021-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39690099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}