Breast Cancer Research and Treatment最新文献

Background: People receiving treatment for breast cancer often report sleep disturbance. This systematic review explored the prevalence and impact of breast cancer treatment on sleep disturbance.

Methods: The Medline, Embase, CINAHL Plus with full text, Psych INFO, Cochrane Library/Central Register of Controlled Trials, and Scopus databases were searched up to December 2024. Eligible studies recruited people undergoing breast cancer treatment and reported the impact of treatment on their sleep. Two authors reviewed full-text publications for eligibility, data extraction, and quality appraisal. Demographics and sleep outcomes were summarised via descriptive statistics.

Results: Among the 32,119 studies identified, 80 met the eligibility criteria. Studies have used a variety of sleep assessment measures and thresholds to define sleep disturbance. The Pittsburgh Sleep Quality Index (PSQI) and actigraphy were the most frequently used, 63% and 24%, respectively. The mean prevalence of poor sleep quality (as per the PSQI) for each treatment was as follows: surgery, 63%; chemotherapy, 62%; radiation therapy, 64%; and endocrine therapy, 57%; and clinically significant insomnia (as per the Insomnia Severity Index) for surgery, 20%; chemotherapy, 24%; radiation therapy, 23%; and endocrine therapy, 35%. A significant increase in sleep disturbance related to cancer treatment was reported in 62% of the studies assessing chemotherapy, 39% assessing radiation therapy, 20% assessing endocrine therapy, and 17% assessing breast surgery.

Conclusion: Sleep disturbance is reported in approximately 60% of people receiving treatment for breast cancer, with chemotherapy being the most studied treatment. The prevalence and severity of sleep disturbance vary across studies due to the heterogeneity of assessment tools used, and thresholds to define poor sleep. This highlights the need for a consistent method of assessing sleep disturbance and the need for effective strategies to improve sleep.

Purpose: To understand how access to care influences metastatic breast cancer burden (MBC) while accounting for molecular tumor characteristics, and identify interventions to reduce metastatic disease burden.

Methods: The Carolina Breast Cancer Study is a population-based cohort with invasive breast cancer (diagnosed 2008-2013). Both de novo metastasis (stage IV at diagnosis) and distant recurrence were evaluated (12 years of follow-up. Tumor data were from medical records, pathology reports, and RNA expression data. Social variables and access to care were from participant surveys. Generalized linear models were used to estimate associations of biological and access characteristics with MBC; Cox models were used to estimate recurrence hazards.

Results: 464/2998 patients (15.5%) had MBC (n = 109 de novo; n = 355 recurrent). MBC was associated with grade 3 vs 1 (odds ratio (OR) = 4.15, 95% CI: 2.60, 6.99), LumB vs LumA (OR = 2.08, 95% CI: 1.48, 2.90), and high vs low PAM50 risk of recurrence score (OR = 4.45, 95% CI: 2.93, 6.99) vs. non-MBC. MBC was associated with Black race (Hazard ratio (HR) = 1.66, 95% CI: 1.32, 2.11), poverty (HR = 1.47; 95% CI: 1.09, 1.99), and low education (HR = 1.48, 95% CI: 1.03, 2.13). Controlling for healthcare access (screening, regular care, delayed treatment, and community healthcare) attenuated associations with metastasis for poverty and education, but had lesser effects on race associations.

Conclusions: Disparities in MBC burden persist after adjustment for individual- and community-level healthcare access. Reducing burden of MBC in Black women necessitates simultaneous targeting of biological and access to care factors.

Introduction: Black women in the United States have higher breast cancer mortality rates compared to women of other races/ethnicities. Heterogeneity in body composition between Black and non-Black women may contribute to differences in relative drug dosing and chemotherapy toxicities, leading to treatment delays and lower treatment completion rates. This study evaluated the extent to which drug dose/kilogram (kg) fat free mass (FFM) differs by race, and whether measures of FFM or adipose tissue (AT) are independently and/or jointly associated with hematologic toxicity, treatment delays, treatment discontinuation, and relative dose intensity (RDI).

Methods: Women who were treated with neo/adjuvant anthracycline- and/or taxane-containing regimens for breast cancer between 2012-2019 and had an abdominal CT scan within 12 weeks of chemotherapy initiation were included in this retrospective study. Visceral and subcutaneous AT area and FFM were measured using CT scan slices at the L3 vertebra level.

Results: A total of 230 women met the inclusion criteria. On average, Black women were older and had higher weight, FFM and AT compared to non-Black women; however, Black women had lower percent FFM. No statistically significant differences in initial or cumulative drug dose/kg FFM were observed between Black vs non-Black women for any individual drug. Similarly, neither FFM or AT were independently or jointly associated with incidence of hematologic toxicity, treatment delays or discontinuation for any individual chemotherapy drug.

Conclusion: Current BSA-based chemotherapy dosing regimens do not appear to contribute to disparities in treatment-associated toxicity or chemotherapy completion.

Purpose: This study assessed the accuracy of self-reported inflammatory breast cancer (IBC) diagnoses within the Count Me In (CMI) Metastatic Breast Cancer Project. Given IBC's aggressive nature and diagnostic complexity, we aimed to evaluate the reliability of patient-reported data by quantifying concordance rates between self-reported and clinically confirmed diagnoses.

Methods: Medical records from 79 patients who self-identified as having IBC were reviewed to confirm the diagnosis through provider documentation. When explicit confirmation was absent, a recently validated quantitative IBC scoring system was applied. Each patient's diagnosis was adjudicated by an expert physician, with cases classified as concordant or discordant based on predefined criteria. A concordance threshold of 90% was established to consider patient-reported diagnoses as sufficiently reliable.

Results: Among the 79 patients, 57/79 (72.2%) had concordant diagnoses based on either explicit documentation or scoring system verification. Specifically, 51/79 (64.6%) had explicit documentation, while an additional 6/79 (7.6%) met scoring system criteria. However, 22/79 (27.8%) were discordant, either lacking evidence or unable to be confirmed due to incomplete medical records, falling below the 90% concordance threshold required for reliability.

Conclusion: Although patient self-reporting via the CMI initiative allows rapid data collection, reliance solely on self-identification for diagnosing IBC may lead to misclassification. Future strategies should incorporate refined symptom-specific screening and prioritize enrolling patients with stage III IBC. Advanced technologies such as AI-assisted medical record analysis could further enhance diagnostic accuracy and facilitate high-quality data collection for improved diagnosis and outcomes.

Purpose: Systemic therapy is standard for metastatic inflammatory breast cancer (MIBC), but the role of locoregional therapy in survival remains unclear. The objective of this study was to compare overall survival (OS) between patients with MIBC who received trimodal therapy vs chemotherapy alone.

Methods: Patients diagnosed with MIBC between 2004 and 2021 were identified in the NCDB. The cohort was divided into those who received trimodal therapy vs chemotherapy only. Trimodal therapy included receipt of chemotherapy, surgery (modified radical or radical mastectomy), and radiation therapy. Overlap Propensity Score Weighted Cox proportional hazard models examined the association between treatment (chemotherapy versus trimodal therapy) and OS.

Results: A total of 2872 patients with MIBC were included, of whom 403 (14.0%) underwent trimodal therapy and 2469 (86.0%) received chemotherapy alone. Median OS was longer with trimodality therapy than with chemotherapy alone (47.0 months vs 34.4 months, p < 0.001). Receiving trimodal therapy was associated with a 28% lower hazard of mortality compared to chemotherapy only (aHR: 0.72, 95% CI 0.62-0.84).

Conclusions: In this NCDB cohort of patients with MIBC, receipt of trimodal therapy improved OS compared with chemotherapy only.

Background: Despite the increasing popularity of microsurgical techniques for the treatment of lymphedema, there is a lack of high-level, prospective, long-term data and standardized outcome metrics. The purpose of this study was to analyze the long-term outcomes of Lymphovenous Bypass (LVB) surgery throughout the past two decades.

Methods: We conducted a systematic review of PubMed, Embase, and Web of Science databases to identify prospective clinical trials investigating LVB for lymphedema treatment. Reported outcome data included limb volume measurements, number of cellulitis episodes, compression garment use, and the assessment of complications. For studies involving multiple procedures, only outcomes from the respective LVB cohorts were analyzed. Retrospective data analyses were excluded.

Results: Eight prospective studies (2009-2023) were included in the meta-analysis, comprising a total of 431 patients undergoing LVB with a mean follow-up of 21.8 ± 7.7 months. An average of 3.4 ± 1.0 anastomoses were performed per patient. LVB was associated with a 14.26% mean reduction in limb volume (95% CI 6.63-21.88; p < 0.0001) at one-year, and 46.3% (95% CI 24.9%-69.1%; p < 0.01) reduction/discontinuation of compression therapy following surgery. Patients also reported subjective symptom relief and reduced cellulitis episodes.

Conclusions: This systematic review provides the most comprehensive synthesis to date of long-term outcomes following LVB surgery for lymphedema. The findings support LVB as a safe and effective microsurgical intervention, with consistent reductions in limb volume, cellulitis episodes, and reliance on compression therapy.

Background: Compression sleeves are widely used for breast cancer-related lymphedema, but evidence on their effectiveness of prevention and treatment in volume reduction is limited.

Objective: To compare the effects of compression sleeves and conventional care on breast cancer-related lymphedema, providing evidence-based support for clinical application.

Methods: A systematic search of 9 databases was conducted up to June 9, 2025. Meta-analysis was performed using RevMan 5.4, and evidence quality was assessed with GRADE profiler 3.6.

Results: 1532 patients were included. Compression sleeves significantly reduced lymphedema incidence post-surgery (P =0 .02) and edema volume/circumference (P <0 .001), and improved shoulder flexion (P =0.02). No significant effects were seen on shoulder abduction (P =0 .18), subjective symptoms (P =0.62), or quality of life (P = 0.32). Evidence quality was moderate for incidence and volume/circumference reduction, and low for other outcomes.

Conclusion: This meta-analysis shows that compression sleeves reduce lymphedema incidence and volume/circumference, and improve shoulder flexion. They should be considered in lymphedema management, though further research is needed for other outcomes.

Purpose: Neoadjuvant chemotherapy (NACT) is often the preferred systemic treatment modality for advanced breast tumors. Delays in NACT initiation are associated with worse outcomes although it is unclear which patients are at the highest risk for delays and whether these delays impact pathologic complete response (pCR). We sought to determine the incidence, predictors, and cancer-related outcomes associated with delays in NACT initiation among patients with HER2-positive (HER2 +) breast cancer in the modern era.

Methods: We retrospectively analyzed a cohort of patients with stage II-III HER2 + breast cancer who were treated with NACT and surgery using the National Cancer Database. Multivariable logistic regression, adjusted for demographic, socioeconomic and tumor characteristics, was used to identify characteristics associated with and the likelihood of achieving a pCR with delays in NACT initiation.

Results: 56,868 patients were included in the analysis. Delays in NACT initiation of > 60 days from diagnosis was observed in 9% of patients. In a multivariable analysis, patients who were Black (OR 1.88 95%CI 1.74-2.04), Hispanic (OR 2.19, 95%CI 2.00-2.39), had Medicaid (2.14, 95%CI 1.97-2.32), or no insurance (2.39, 95%CI 2.09-2.72) were more likely to be delayed. Delay was associated with a lower likelihood of achieving pCR (OR 0.86 95% CI 0.81-0.92) and an increased risk of death (HR 1.15 95%CI 1.03-1.29).

Conclusion: There are racial, ethnic, and socioeconomic disparities in NACT initiation delays and an association with worse cancer-related outcomes. Future studies and interventions are needed to mitigate these delays.

Purpose: Structural racism may be associated with disparities in breast cancer access to care and outcomes. We examined the association between contemporary mortgage lending bias (redlining) and the receipt of guideline-concordant systemic treatment.

Methods: Women with stage I-III invasive breast cancer in 2010-2017 were identified from the Surveillance, Epidemiology, and End Results-Medicare linked database. Contemporary redlining was estimated using 2010-2017 Home Mortgage Disclosure Act data. Simple and multiple logistic regression models estimated the unadjusted and adjusted odds of receiving guideline-concordant systemic treatment: appropriate receipt of chemotherapy, HER2/neu (HER2)-targeted therapy, hormonal therapy, and a composite systemic treatment measure.

Results: Overall compliance rates were 85%, 96%, and 87% for chemotherapy, HER2-targeted therapy, and hormonal therapy, respectively. For the composite outcome, 95% received some or fully concordant care. In unadjusted and adjusted models, women living in higher redlined neighborhoods were less likely to receive guideline-concordant care for all modalities, except hormonal therapy (p = 0.846). For HER2-targeted therapy and composite score, the redlining effect differed by dual Medicare-Medicaid enrollment eligibility status. Dual eligibility eliminated the negative effect of redlining. Among those not dual eligible, the negative effect of redlining persisted.

Conclusions: Older breast cancer survivors living in higher redlined areas were less likely to receive guideline-concordant chemotherapy, HER2-targeted therapy, and overall systemic treatment. While more work is needed to better understand structural racism and neighborhood socioeconomic disinvestment to address equitable access to cancer care, the housing sector may be one actionable policy target. Care teams should consider patient context to ensure high quality care.

Objective: Surgical operation serves as a primary approach for addressing cancer of the breast, but it also has potential complications, including hemorrhaging following surgery. Identifying the risk variables associated with this problem may assist individuals in stratifying and optimizing their risks. A meta-analysis and comprehensive review was conducted to pinpoint the risk variables associated with postoperative hemorrhaging in breast carcinoma.

Methods: We performed a systematic review and searched through Cochrane Library, PubMed, WoS, Embase, China National Knowledge Infrastructure, and Wanfang. The investigation spanned from the creation of the records until May 2025. A meta-analysis was performed to investigate the risk variables associated with postoperative hemorrhaging in breast carcinoma patients.

Results: 8 studies were included, comprising 82,012 patients. A total of 10 risk factors were analyzed. They are mastectomy and axillary lymph node dissection, antithrombotic medication, age ≥ 60 years old, hypertension, and diabetes, chronic pulmonary illness, congestive heart failure, reconstruction and neoadjuvant chemotherapy. These results indicated that among the multiple risk factors included in the analysis, 3 had statistically significant effects on postoperative bleeding following breast cancer surgery: specifically, mastectomy (OR = 1.93,95%CI:1.20-3.09), hypertension(OR = 1.23,95%CI:1.05-1.44), CHF(OR = 2.18,95%CI:1.54-3.08).

Conclusion: Breast cancer risk factors for postoperative hemorrhage include mastectomy, hypertension and CHF. Understanding the risk factors closely related to postoperative bleeding in breast cancer is helpful for identifying high-risk patients with postoperative bleeding, who can benefit from enhanced prevention and treatment. In the future, more and larger sample size studies are needed to continue to investigate additional indicators of risk for hemorrhaging following surgery in breast carcinoma.