Breast Cancer Research and Treatment最新文献

Purpose: Breast cancer mortality has significantly declined in the U.S. due in part to effective clinical screening methods. However, previous studies have found many women first detect their breast cancers through means other than their providers. Given that detection method has been shown to be an important prognostic factor, we examined the association between breast cancer detection method and various demographic and health-related factors in a representative sample of female breast cancer patients aged 40 + in California.

Methods: We analyzed data from the 2009 and 2011-2012 California Health Interview Survey. Weighted percentages of breast cancer patients by detection method were calculated. A multivariable logistic regression model was used to quantify each factor's association with the likelihood of having a patient-detected versus clinically detected breast cancer using odds ratios (ORs) and 95% confidence intervals (CIs).

Results: 36% of female breast cancer patients first detected their cancer themselves. Compared to U.S.-born women, those who had spent 40% or less of their lifetime in the U.S. were more than twice as likely to report their breast cancer being patient-detected versus clinically detected (OR = 2.27, 95% CI 1.06-4.86, p = 0.035). Rural women were also more likely to report a patient-detected breast cancer than urban women (OR = 1.51, 95% CI 1.01-2.11, p = 0.044).

Conclusions: Recent immigrants and those residing in rural areas were more likely to report self-detecting their breast cancer. Given the persistent disparities with regard to breast cancer mortality, particularly among underserved communities, strategies addressing barriers to screening uptake in these populations may be warranted.

Purpose: Antidepressant treatment patterns may change after women with breast cancer (BC) initiate tamoxifen, potentially impacting health outcomes. We characterized trajectories of antidepressant use after initiating tamoxifen among young and middle-aged women with BC, identifying risk factors for trajectory group membership.

Methods: A retrospective cohort included women 18-64 years-old with BC and antidepressant treatment history who received a new tamoxifen dispensing (index date). We measured longitudinal antidepressant use post-index date as 12, monthly, proportion of days covered (PDC) measurements in a 25% random sample of IQVIA PharMetrics® Plus for Academics US claims, 2006-2022. Group-based trajectory models identified latent subgroups of antidepressant use by testing 2-6-group representations; the best model fit determined by the lowest Bayesian Information Criterion, clinical interpretability, and each subgroup comprising ≥ 5% of the cohort. Using multinomial logistic regression, baseline covariates including demographics, depression status and the CYP2D6-inhibitory strength of antidepressants were evaluated as risk factors for the trajectory of antidepressant use after tamoxifen initiation.

Results: Our sample of 851 women followed four distinct antidepressant adherence trajectories after tamoxifen initiation: 12% exhibited immediately decreasing use [mean PDC (sd) 8% (± 7)]; 7% exhibited delayed decreasing use [41% (± 14)]; 20% exhibited dynamic-moderate use [54% (± 15)]; and 60% exhibited consistently high use [91% (+ 7)]. Age, depression, and treatment with non CYP2D6-inhibiting antidepressants were associated with women's trajectory of antidepressant use after initiating tamoxifen.

Conclusion: Nearly 40% of women were nonadherent to antidepressants after tamoxifen initiation. Future research should explore cancer-related and mental health implications of this nonadherence.

Purpose: The COVID-19 pandemic significantly impacted breast cancer (BC) surgeries. Most studies showing reduced BC surgical volumes during the pandemic are from single institutions, few have described volume changes in different types of surgical procedures. This study aimed to assess the impact of the pandemic on BC surgery volumes and types at a population level.

Methods: Patients diagnosed with BC between January 1, 2018, and June 25, 2022, in Ontario, Canada, were analysed from population-based datasets. Time periods were defined as pre-pandemic (Jan 2018-Mar 2020), immediate pandemic (Mar-Jun 2020), and peri-pandemic (Jun 2020-Jun 2022). Weekly BC surgery volume and type (lumpectomy, mastectomy, or mastectomy with immediate reconstruction) were evaluated using segmented negative binomial regression models.

Results: Among 44 226 patients, 50 440 surgeries were performed. Weekly BC surgeries decreased by 16.9% during the immediate pandemic compared to pre-pandemic levels (180.5 vs. 217.1; p = 0.03). Surgical volumes recovered to pre-pandemic levels by June 2021. Mastectomies represented a higher proportion of BC surgeries during the pandemic (31.1% pre, 36.3% immediate, 32.4% peri-pandemic; p < 0.01). The proportion of mastectomies with immediate reconstruction remained stable during the immediate pandemic but increased in the peri-pandemic (20.1% vs. 17%; p < 0.01).

Conclusion: There was a significant reduction in all BC surgeries during the pandemic. Mastectomies accounted for a higher proportion of BC surgeries in the pandemic period however access to reconstruction was maintained. Surgical volumes recovered within a year despite ongoing pandemic hospitalizations. Future studies are needed to explore the pandemic's long-term impact on BC care.

Purpose: To analyze the relationship between mammographic breast density and tumor response and outcome at follow-up, in terms of overall survival (OS) and disease-free survival (DFS), in patients with unilateral invasive breast cancer receiving neoadjuvant chemotherapy (NACT).

Methods: A total of 228 women (mean age, 47.6 years ± 10 [SD]; range: 24-74 years) with invasive breast cancer who underwent NACT were included in this observational retrospective study. Clinical, radiological and histopatological data were retrieved. Categorization of breast density was performed by two radiologists in consensus on mammography acquired at the time of diagnosis according to BI-RADS categories. Association between density categories and tumor response was analyzed in the overall population and in subgroups defined by menopausal status, tumor phenotype and stage at diagnosis. Kaplan-Meier (KM) curves were used to estimate the OS and DFS probabilities. Subgroup analyses based on menopausal status and tumor phenotype were performed.

Results: A total of 30 patients (13.2%) achieved pathological complete response (pCR). No association between density categories and pCR was found (P = 0.973), even at subgroups analysis. The median follow-up time was 92 months. Patients with dense breast showed the longest DFS (P = 0.0094), results confirmed in premenopausal patients (P = 0.0024) and in triple negative breast cancers (P = 0.0292). Density category did not show a statistically significant association with OS.

Conclusion: Breast cancer patients receiving NACT with extremely dense breasts showed better DFS. No evidence of breast density as a predictive marker for complete pathological response or as a prognostic factor in terms of OS was found.

Despite progress, breast cancer remains the most feared disease among women. In the USA alone, the incidence is now almost 300,000 new cancers per year, a rate that has nearly doubled in the last 30 years. Most women survive, but over 40,000 women a year still die of their disease National Cancer Institute [Internet]. [cited 2024 Nov 4]. Cancer of the Breast (Female) - Cancer Stat Facts. Available from: https://seer.cancer.gov/statfacts/html/breast.html. It is the most diagnosed cancer among women and the second leading cause of cancer death. Important disparities exist in breast cancer outcomes among African American women, where women die of breast cancer at higher rates, are diagnosed younger, and at a more advanced stage. We are proposing a radical shift in our thinking about breast cancer prevention with an aspiration to dramatically lower breast cancer incidence. Most breast cancers are driven by steroid hormones. Throughout the life course, women are offered an array of hormonal treatments for menstrual cycle control, family planning, in vitro fertilization, postpartum weaning, and menopausal symptom management. There are mixed data on the extent to which each of these may contribute to increased or decreased risk for breast cancer. These endocrine manipulations could represent a great opportunity to potentially reduce breast cancer incidence and improve quality of life for survivors. To date, they have not been designed to explicitly reduce breast cancer risk. A new holistic approach will require scientists, drug developers, breast oncologists, obstetricians, gynecologists, endocrinologists, radiologists, and family medicine/internists to work together toward the common goal of reducing breast cancer risk while addressing other critical issues in women's health.

Background: Weight management is included in the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guidelines for its clinical impact on breast cancer (BC) survivorship. Few studies have examined the impact of neighborhood-level factors associated with postdiagnosis weight change among Black BC survivors.

Methods: We recruited 100 Black female BC survivors to complete an online survey, including demographic, clinical characteristics, and lifestyle factors, between January 5, 2022 and August 18, 2022. We utilized the 2023 County Health Rankings Food Environment Index (FEI), which ranges from 0 (worst) to 10 (best), to capture the food environment as the primary exposure for postdiagnosis weight gain. We calculated postdiagnosis weight gain as percent weight change from time at diagnosis to time of survey. Participants were grouped into categories of stable weight (within ± 3%) or weight loss (≤ -3%) compared to weight gain (≥ 3%). We calculated adjusted odds ratios (aORs) for the associations between county-FEI, clinical factors, and postdiagnosis weight gain.

Results: Among the 95 women who reported weight measurements, we observed that women living in counties with an FEI ≥ 8.8 (at or above median) were significantly less likely to experience weight gain (aOR 0.09; 95% CI 0.01-0.77). Stage, age at diagnosis, years since BC diagnosis, and BC treatments were not significantly associated with weight gain.

Conclusion: Postdiagnosis weight gain is associated with poorer food environments among Black BC survivors in Maryland. Our findings will inform larger prospective studies and future interventions among this population.

Purpose: To compare mammography, breast ultrasound (US), high-resolution diffusion-weighted magnetic resonance imaging (DW-MRI), dynamic contrast-enhanced breast MRI (DCE-MRI), and their combinations for detecting clinically occult early breast cancers (EBCs), including ductal carcinoma in situ (DCIS).

Methods: Three hundred and three consecutive women with screening imaging-detected early breast cancers (60 pure DCIS, 36 DCIS with microinvasion, and 207 invasive carcinoma less than 20 mm) who underwent breast MRI at 3 T including DW-MRI (b-values of 0, 800 and 1200 s/mm²; in-plane resolution, 1.1 × 1.1 mm² or 1.3 × 1.3 mm²; section thickness, 3 mm) were retrospectively reviewed. Three radiologists independently reviewed each examination. Statistical analysis included Chi-square test, McNemar test for comparison of cancer detection rates, and Fleiss' Kappa for interreader agreement. Mixed-effect logistic regression analysis was employed to evaluate factors associated with cancer detection on DW-MRI.

Results: The overall cancer detection rates were 54.8% on mammography, 71.0% on breast US, 81.5% on DW-MRI, and 87.1% on DCE-MRI. On McNemar test, DW-MRI detected more cancers than mammography (adjusted p < 0.001), and its combination with mammography showed a similar cancer detection rate to DCE-MRI combined with mammography (adjusted p = 0.808). On multivariable analysis, histologic type, lesion size, ADC and CNR on DW-MRI were independent factors for cancer detection on DW-MRI. The interreader agreement for cancer detection was moderate to substantial (Fleiss' kappa: 0.52-0.65) across each modality.

Conclusion: High-resolution DW-MRI plus mammography showed comparable cancer detection rate to DCE-MRI plus mammography for detecting clinically occult EBCs including DCIS.