Risk Of Breast Cancer Recurrence Research Articles

Searching for the "Holy Grail" of breast cancer recurrence risk: a narrative review of the hunt for a better biomarker and the promise of circulating tumor DNA (ctDNA).

This paper is a narrative review of a major clinical challenge at the heart of breast cancer care: determining which patients are at risk of recurrence, which require systemic therapy, and which remain at risk in the survivorship phase of care despite initial therapy. We review the literature on prognostic and predictive biomarkers in breast cancer with a focus on detection of minimal residual disease. While we have many tools to estimate and refine risk that are used to individualize local and systemic therapy, we know that we continue to over treat many patients and undertreat others. Many patients also experience what is, at least in hindsight, needless fear of recurrence. In this review, we frame this dilemma for the practicing breast oncologist and discuss the search for what we term the "holy grail" of breast cancer evaluation: the ideal biomarker of residual distant disease. We review the history of attempts to address this problem and the up-to-date science on biomarkers, circulating tumor cells and circulating tumor DNA (ctDNA). This review suggests that the emerging promise of ctDNA may help resolve a crticical dilemma at the heart of breast cancer care, and improve prognostication, treatment selection, and outcomes for patients with breast cancer.

Competing risk analysis of cardiovascular disease risk in breast cancer patients receiving a radiation boost

BackgroundThoracic radiotherapy may damage the myocardium and arteries, increasing cardiovascular disease (CVD) risk. Women with a high local breast cancer (BC) recurrence risk may receive an additional radiation boost to the tumor bed.ObjectiveWe aimed to evaluate the CVD risk and specifically ischemic heart disease (IHD) in BC patients treated with a radiation boost, and investigated whether this was modified by age.MethodsWe identified 5260 BC patients receiving radiotherapy between 2005 and 2016 without a history of CVD. Boost data were derived from hospital records and the national cancer registry. Follow-up data on CVD events were obtained from Statistics Netherlands until December 31, 2018. The relation between CVD and boost was evaluated with competing risk survival analysis.Results1917 (36.4%) received a boost. Mean follow-up was 80.3 months (SD37.1) and the mean age 57.8 years (SD10.7). Interaction between boost and age was observed for IHD: a boost was significantly associated with IHD incidence in patients younger than 40 years but not in patients over 40 years. The subdistribution hazard ratio (sHR) was calculated for ages from 25 to 75 years, showing a sHR range from 5.1 (95%CI 1.2–22.6) for 25-year old patients to sHR 0.5 (95%CI 0.2–1.02) for 75-year old patients.ConclusionIn patients younger than 40, a radiation boost is significantly associated with an increased risk of CVD. In absolute terms, the increased risk was low. In older patients, there was no association between boost and CVD risk, which is likely a reflection of appropriate patient selection.

(002) An Update to The Safety of VE Therapy for Genitourinary Syndrome of Menopause in Women with a History of Breast Cancer – A Claims Database Analysis

Abstract Introduction Systemic therapies for breast cancer (BC) may result in genitourinary syndrome of menopause (GSM) in up to 70% of postmenopausal breast cancer survivors. Though systemic estrogen therapy is usually avoided in these patients, vaginal estrogen (VE) therapy may be prescribed to treat GSM symptoms. However, we recently demonstrated, few eligible patients with GSM and a history of breast cancer are prescribed VE. Objective To assess the recurrence rates of breast cancer in women diagnosed with GSM with a history of breast cancer by VE therapy status using a large US claims database. Methods A US health research network was queried. Our cohort consisted of females diagnosed with BC within five years prior to the initial GSM diagnosis. Patients with active disease within three months prior to diagnosis of GSM were excluded. Recurrence was defined as mastectomy, radiation, chemotherapy, or secondary malignancy within three months to five years after initiating VE therapy for GSM. The study cohort included those with ≥3 VE prescriptions. The control cohort included women with BC without any VE prescriptions after GSM diagnosis. Propensity matching was performed. A sub-analysis evaluating the effect of concurrent aromatase inhibitor (AI) use with VE was also conducted with concurrent AI use defined as ≥3 AI prescriptions. Results We identified 42,113 females with a diagnosis of GSM following BC diagnosis with any ER status; 5.0% received VE. Of the initial cohort, 10,584 patients had ER+ BC; 3.9% of this group received VE. Risk of BC recurrence was comparable between those who received VE and those who did not in both the any-ER (RR 1.03, 95% CI [0.91-1.18]) and ER+ status (RR 0.94, 95% CI [0.77-1.15]) analyses. BC recurrence-free survival was comparable between those who received VE and those who did not in both the any-ER (HR 0.98, 95% CI [0.85 – 1.14]) and ER+ status (HR 0.88, 95% CI [0.69 – 1.12]) analysis. A sub-analysis comparing concurrent VE and AI prescriptions to those with VE-only was performed. Risk of BC recurrence was significantly higher among those who received AI+VE versus VE-only in both the any-ER (RR 5, 95% CI [3.05 – 8.19]) and ER+ status (RR 2.64, 95% CI [1.55 – 4.47]) analysis (Table 1). Significant differences in BC recurrence-free survival were observed between the AI+VE and VE-only groups in both the any-ER (HR 9.88, 95% CI [5.50 – 17.73]) and ER+ status (HR 4.82, 95% CI [2.36 – 9.84]) analysis. (Figure 1). No mortality event was observed at five- or ten-year follow-up in either analysis. Conclusions We found similar BC recurrence risk between BC survivors with and without prescriptions of VE. An increased risk of BC recurrence was seen with concurrent AI and VE use. These results suggest that VE therapy in select patients with GSM is safe. Disclosure No.

Effect of metformin and lifestyle intervention on adipokines and hormones in breast cancer survivors: a pooled analysis from two randomized controlled trials.

We investigated the effect of metformin and lifestyle intervention on metabolic, inflammatory, and steroid biomarkers of breast cancer (BC) recurrence risk in two intervention trials among BC survivors with overweight or obesity. Baseline and follow-up serum samples collected during the two trials were analyzed and data pooled. The USA trial (Reach for Health) included postmenopausal BC survivors (n = 333) randomly assigned to 6-month metformin vs placebo and lifestyle intervention (LSI) vs control (2 × 2 factorial design). The Italian trial (MetBreCS) included BC survivors (n = 40) randomized to 12-month metformin vs placebo. Insulin resistance (HOMA-IR), adipokines, cytokines, and steroids were measured. Metformin compared to placebo showed a favorable decrease in leptin (- 8.8 vs - 3.5ng/mL; p < 0.01) and HOMA-IR (- 0.48 vs - 0.25; p = 0.03), and an increase in SHBG (2.80 vs 1.45nmol/L; p < 0.01). Excluding women taking aromatase inhibitors, metformin (n = 84) compared to placebo (n = 99) decreased estradiol (- 4 vs 0pmol/L; p < 0.01), estrone (- 8 vs 2pmol/L; p < 0.01) and testosterone (- 0.1 vs 0nmol/L-; p = 0.02). LSI favorably affected adiponectin (0.45 vs - 0.06 ug/mL; p < 0.01), leptin (- 10.5 vs - 4.4ng/mL; p < 0.01), HOMA-IR (- 0.6 vs 0.2; p = 0.03), and SHBG (2.7 vs 1.1 nMol/L; p = 0.04) compared to controls. The strongest impact was observed combining metformin with LSI on adipokines, CRP, SHBG, and estrogens. Supportive healthy lifestyle programs combined with metformin to achieve maximal risk reduction among BC cancer survivors are recommended, especially for those with obesity in menopause.

Comment l’activité physique pourrait-elle réduire le risque de survenue et de récidive des cancers du sein ?

ObjectivesBreast cancer is the most frequent and deadly cancer among women. In France, 50% of adults are currently overweight, mostly as a result of a sedentary lifestyle. Numerous studies have highlighted overweight, obesity and lack of physical activity as risk factors for the occurrence and prognosis of cancers, particularly breast cancer. The aim of this study was to understand the extent to which physical activity can improve this prognosis, and what the pathophysiology is. MethodsThe Senology Commission of the Collège national des gynécologues et obstétriciens français (CNGOF) based its responses on an analysis of the international literature using a Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) methodology conducted on the PubMed database between 1994 and 2023. ResultsA total of 70 articles were selected, demonstrating the role of regular physical activity in reducing the risk of breast cancer occurrence and recurrence. This role in controlling carcinogenesis is mediated by metabolic factors such as leptin, adiponectin and insulin, sex hormones and inflammation. The signaling pathways deregulated by these molecules are known carcinogenic pathways which could be used as therapeutic targets adapted to this population, without replacing the essential hygienic-dietary recommendations. ConclusionPhysical activity has a protective effect on breast cancer risk and prognosis. We must therefore continue to raise awareness in the general population and promote physical activity as a means of primary, secondary, and tertiary prevention.

Feasibility of Intraoperative Radiotherapy Tumor Bed Boost in Patients with Breast Cancer after Neoadjuvant Chemotherapy.

This study aimed to assess the feasibility and safety of administering intraoperative radiotherapy (IORT) as a boost during breast-conserving surgery (BCS) following neoadjuvant chemotherapy for patients at high risk of breast cancer recurrence. Patients who underwent neoadjuvant chemotherapy received a single 20-Gy dose of IORT during BCS, followed by external beam radiotherapy 4-6 weeks after surgery. The median follow-up duration was 31.0 months (range, 18.0-59.0 months). Initial tumor sizes had a median of 2.6 cm (range: 0.8-5.3 cm), reducing to 0.3 cm (range: 0-4.0 cm) after neoadjuvant chemotherapy. The most common neoadjuvant chemotherapy regimen was doxorubicin and cyclophosphamide, followed by paclitaxel (n=42, 73.7%). Among 57 patients who received neoadjuvant chemotherapy before BCS and IORT, 2 patients (3.5%) required secondary surgery to achieve negative resection margins due to initially positive margins. Regional lymph node irradiation was performed in 37 (64.9%) patients. There was no grade 3 or higher adverse events, with 4 patients (7.0%) experiencing grade 2 acute radiation dermatitis and 3 (5.3%) having less than grade 2 breast edema. Binary correlation analysis did not reveal statistically significant associations between applicator size or radiation therapy modality and the risk of treatment-related toxicity. Furthermore, chi-square analysis showed that the grade of treatment-related toxicity was not associated with the fractionated regimen (p=0.375). Most patients successfully received IORT as a tumor bed boost after neoadjuvant chemotherapy. Thus, IORT may be a safe and feasible option for patients with advanced-stage breast cancer receiving neoadjuvant chemotherapy.

Use of Antibody-Drug Conjugates in the Early Setting of Breast Cancer.

Antibody-drug conjugates (ADCs) are anticancer agents with the capacity to selectively deliver their payloads to cancer cells. Antibody-drug conjugates consist of a monoclonal antibody backbone connected by a linker to cytotoxic payloads. Antibody-drug conjugate effect occurs either by directly targeting cancer cells via membrane antigen or through "bystander effect." Antibody-drug conjugates have demonstrated efficacy against various types of tumors, including breast cancer. Ado-trastuzumab emtansine is presently the only approved ADC for the treatment of breast cancer in the early setting, while several ADCs are now approved for metastatic breast cancer. Due to the transformative impact that several ADCs have reported in the setting of advanced breast cancer, researchers are now testing more of such compounds in the early setting, to portend benefits to patients through highly potent anticancer drugs. Ongoing trials hold the potential to transform treatment protocols for early breast cancer in the near future. These trials are aiming at evaluating different treatment modulation approaches, as informed by breast cancer risk of recurrence, including toward treatment de-escalation. Efforts are provided in ongoing clinical trials to identify the patients who will benefit most, to pursue paradigms of precision medicine with the novel ADCs. This review focuses on the potential role of ADCs in early breast cancer, providing an overview of the latest progress in their development and how they are implemented in ongoing clinical trials.

Correlation ofKi-67 proliferative index with oncotype DX recurrence score in hormone receptor-positive, human epidermal growth factor receptor 2-negative early breast cancer with low-burden axillary nodal disease - areview of137 cases.

Theuse ofchemotherapy in breast cancer management has significantly contributed to thedecrease in its mortality. Currently, theprognosis is determined by molecular biomarkers, such as oestrogen receptors, and human epidermal growth factor receptor 2. However, theincreasing use ofadvanced molecular technologies, including oncotype DX recurrence score (ODX-RS), has provided theability to estimate therisk ofrecurrence. Research has demonstrated that theODX-RS helps to predict recurrence risk and thepotential benefit ofchemotherapy in breast cancer. As aresult, it can assist clinicians in making decisions regarding using thechemotherapy. Thegoal ofwork is to explore thecorrelation between theODX-RS and Ki-67 proliferative index (Ki-67-PI). This study included 137 patients with oestrogen positive, human epidermal growth factor receptor 2-negative early breast cancer, and had non- or early axillary disease. Patients with low Ki-67-PI were as follows: low ODX-RS in 17%, intermediate ODX-RS in 80%, and high ODX-RS in 2%. In thehigh Ki-67-PI group: low ODX-RS in 12%, intermediate ODX-RS in 48%, and high ODX-RS in 40%. In conclusion, theresults show no significant correlation between theODX-RS and Ki-67-PI (r = 0.511, p-value < 0.9).

Androgen Receptor Influenced Recurrence Score Correlation in Hormone Positive and HER2 Negative Breast Cancer Indian Patients: A Comparative Approach

Breast cancer (BC) recurrence is a major concern for both patients and healthcare providers. Accurately predicting the risk of BC recurrence can help guide treatment decisions and improve patient outcomes for a disease-free survival. There are several approaches and models that have been developed to predict BC recurrence risk. These include derived clinical assays such as genetic profiling (Oncotye Dx, MammaPrint, CanAssist and others), and algorithm derived open access tools such as Magee equations (ME), CTS5 Calculator and Predict Breast cancer. All the clinical assays are well accepted, but affordability and feasibility remain the challenge due to a noteworthy price tag of USD 3000. As per The American Society of Clinical Oncology (ASCO) updates, open access tools are possible substitutes but the availability of limited information on their applicability is a concern. These tools take into consideration the histopathologic parameters and immunohistochemistry (IHC) biomarkers data for estrogen receptor/progesterone (ER/PR), human epidermal growth factor receptor 2 (HER2), and Ki67. The current study focuses on the application of these tools in a subset of 55 Indian BC patients considering the influence of the androgen receptor (AR) IHC expression profile. AR is a potent target and a close interacting neighbor protein to ER and available literature also suggests their crosstalk expression in BC clinical models. Our comparative recurrence scores (RSs) predictive data showed a statistically significant AR expression correlation with average ME scores. No significance was noted across different prediction tools. The findings are suggestive that ME predictive scores are more relevant and informative compared to other online tools and with an additional AR IHC expression analysis the recurrence prediction might prove to be beneficial and feasible to many deprived BC patients.

Assessment of Background Parenchymal Enhancement at Dynamic Contrast-enhanced MRI in Predicting Breast Cancer Recurrence Risk.

Background Background parenchymal enhancement (BPE) at dynamic contrast-enhanced (DCE) MRI of cancer-free breasts increases the risk of developing breast cancer; implications of quantitative BPE in ipsilateral breasts with breast cancer are largely unexplored. Purpose To determine whether quantitative BPE measurements in one or both breasts could be used to predict recurrence risk in women with breast cancer, using the Oncotype DX recurrence score as the reference standard. Materials and Methods This HIPAA-compliant retrospective single-institution study included women diagnosed with breast cancer between January 2007 and January 2012 (development set) and between January 2012 and January 2017 (internal test set). Quantitative BPE was automatically computed using an in-house-developed computer algorithm in both breasts. Univariable logistic regression was used to examine the association of BPE with Oncotype DX recurrence score binarized into high-risk (recurrence score >25) and low- or intermediate-risk (recurrence score ≤25) categories. Models including BPE measures were assessed for their ability to distinguish patients with high risk versus those with low or intermediate risk and the actual recurrence outcome. Results The development set included 127 women (mean age, 58 years ± 10.2 [SD]; 33 with high risk and 94 with low or intermediate risk) with an actual local or distant recurrence rate of 15.7% (20 of 127) at a minimum 10 years of follow-up. The test set included 60 women (mean age, 57.8 years ± 11.6; 16 with high risk and 44 with low or intermediate risk). BPE measurements quantified in both breasts were associated with increased odds of a high-risk Oncotype DX recurrence score (odds ratio range, 1.27-1.66 [95% CI: 1.02, 2.56]; P < .001 to P = .04). Measures of BPE combined with tumor radiomics helped distinguish patients with a high-risk Oncotype DX recurrence score from those with a low- or intermediate-risk score, with an area under the receiver operating characteristic curve of 0.94 in the development set and 0.79 in the test set. For the combined models, the negative predictive values were 0.97 and 0.93 in predicting actual distant recurrence and local recurrence, respectively. Conclusion Ipsilateral and contralateral DCE MRI measures of BPE quantified in patients with breast cancer can help distinguish patients with high recurrence risk from those with low or intermediate recurrence risk, similar to Oncotype DX recurrence score. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Zhou and Rahbar in this issue.

Influence of postdiagnostic aspirin use on clinical outcomes of women with breast cancer: a meta-analysis

ABSTRACT We examined the association between postdiagnostic aspirin use and recurrence and disease-specific mortality among women with breast cancer in a meta-analysis. The PubMed, Embase, and Web of Science databases were searched to identify observational studies with longitudinal follow-ups according to the aim of the meta-analysis. Combining the results was achieved using a random-effects model that included inter-study heterogeneity. Fifteen cohort studies with 131,636 women with breast cancer were included. Based on a meta-analysis, women who took aspirin after being diagnosed with breast cancer had a lower risk of breast cancer recurrence (adjusted risk ratio [RR]: 0.77, 95 percent confidence interval [CI]: 0.63 to 0.95, P = .02; I2 = 72 percent) and breast cancer specific mortality (adjusted RR: 0.73, 95 percent CI: 0.60 to 0.90, P = .004; I2 = 80 percent) than those who did not use aspirin. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluations scoring system showed moderate certainty for both the outcomes because significant inconsistency was observed. In conclusion, aspirin use after diagnosis might be associated with reduced recurrence and disease-specific mortality in women with breast cancer.

Matrix Metalloproteinase as Predictors of Local Recurrence in Early-Stage Breast Cancer After Mastectomy and Chemotherapy A Cross-Sectional Study in Single Centre

Introduction: The prognosis for early-stage breast cancer is generally favourable. However, in cases when a recurrence manifests after therapy, the prognosis becomes significantly poor. To determine early breast cancer recurrence risk, a marker is needed. Currently, previous tumour markers are used to predict general breast cancer, lacking specificity in the context of early breast cancer. Matrix Metalloproteinase1 (MMP1) is already acquainted with the local recurrence process of invasive ductal carcinoma (IDC). MMP1 expression may better predict early recurrence in early-stage IDC than other approaches. This research examined the potential predictive value of MMP1 expression in early-stage IDC for early local recurrence and its correlation with clinicopathological factors. Methods: This study was a cross-sectional analysis of a single center's medical records. The sample size was 25 subjects for the group without recurrence and 25 subjects with recurrence. Mastectomy and chemotherapy were performed from January 2014 through December 2019. Using immunohistochemistry, paraffin blocks of surgical specimens were examined for MMP1. The data processing was done utilising the trial version of IBM SPSS 25. and Openepi 3.0 programs and analysed using Bivariate, which is performed using the Chi-square test or Fisher's exact test. Result: The statistic test showed a significant difference (p &lt; 0.000) in the average expression of MMP1 for non-recurrence cases (3,95±5,36) compared to recurrence cases (14,95±5,36). We also found a statistically significant correlation between recurrence and high expression of MMP1 (odd ratio [OR]= 60.38, 95% confidence interval [CI]=10.01-364.3, p&lt;0.001). Clinicopathological variables and MMP1 expression did not have a significant correlation. Conclusions: In early-stage IDC, MMP1 expression had the potential to predict and could be an independent prognostic factor for early recurrence.

Dual-Modality Imaging-Guided Manganese-Based Nanotransformer for Enhanced Gas-Photothermal Therapy Combined Immunotherapeutic Strategy Against Triple-Negative Breast Cancer.

Activating the stimulator of the interferon gene (STING) is a promising immunotherapeutic strategy for converting "cold" tumor microenvironment into "hot" one to achieve better immunotherapy for malignant tumors. Herein, a manganese-based nanotransformer is presented, consisting of manganese carbonyl and cyanine dye, for MRI/NIR-II dual-modality imaging-guided multifunctional carbon monoxide (CO) gas treatment and photothermal therapy, along with triggering cGAS-STING immune pathway against triple-negative breast cancer. This nanosystem is able to transfer its amorphous morphology into a crystallographic-like formation in response to the tumor microenvironment, achieved by breaking metal-carbon bonds and forming coordination bonds, which enhances the sensitivity of magnetic resonance imaging. Moreover, the generated CO and photothermal effect under irradiation of this nanotransformer induce immunogenic death of tumor cells and release damage-associated molecular patterns. Simultaneously, the Mn acts as an immunoactivator, potentially stimulating the cGAS-STING pathway to augment adaptive immunity, resulting in promoting the secretion of type I interferon, the proliferation of cytotoxic T lymphocytes and M2-macrophages repolarization. This nanosystem-based gas-photothermal treatment and immunoactivating therapy synergistic effect exhibit excellent antitumor efficacy both in vitro and in vivo, reducing the risk of triple-negative breast cancer recurrence and metastasis; thus, this strategy presents great potential as multifunctional immunotherapeutic agents for cancer treatment.

Role of ovarian suppression in adjuvant treatment of breast cancer

Adjuvant endocrine therapy is an integral component of treatment for resectable luminal breast cancer. Tamoxifen or aromatase inhibitors monotherapy has been the standard of practice for many years. However, recent studies have shown that the addition of ovarian suppression statistically significantly increases survival rates in patients at high risk for recurrence and with poor prognosis factors. In this literature review, we summarized recent data regarding the role of ovarian suppression in adjuvant therapy for hormone-positive breast cancer. Suppression of ovarian function was most effective in young patients (&lt; 35 years) in the premenopausal stage when adverse prognostic factors were present (indications for (neo)adjuvant CT, G3, etc.) The authors noted that using of aromatase inhibitors instead of tamoxifen in this subgroup significantly reduced the risk of breast cancer recurrence. Ovarian suppression, especially in combination with aromatase inhibitors, was accompanied by an increase in the incidence of adverse side effects, particularly osteoporosis and bone fractures, which can be reduced by prescribing adequate accompanying therapy with OMA. The optimal duration of ovarian function suppression has also not been determined, but a two-year course seems optimal, given the results of large clinical trials. In the protocols performed, there was no significant effect of temporary ovarian suppression on the likelihood of subsequent pregnancy.

Alcohol, Smoking, and Risks of Breast Cancer Recurrence and Mortality among Women with Luminal, Triple-Negative, and HER2-Overexpressing Breast Cancer.

This study evaluates the relationship between smoking, alcohol, and breast cancer outcomes according to molecular subtype. This population-based prospective cohort consisted of 3,876 women ages 20 to 69 diagnosed with a first primary invasive breast cancer from 2004 to 2015 in the Seattle-Puget Sound region. Breast cancer was categorized into three subtypes based on estrogen receptor (ER), progesterone receptor (PR), and HER2 expressions: luminal (ER+), triple-negative (TN; ER-/PR-/HER2-), and HER2-overexpressing (H2E; ER-/HER2+). We fit Cox proportional hazards models to assess the association between alcohol consumption and smoking status at diagnosis and risks of recurrence, breast cancer-specific mortality, and all-cause mortality. Histories of ever smoking [HR, 1.33; 95% confidence interval (CI), 1.01-1.74] and current smoking (HR, 1.59; 95% CI, 1.07-2.35) were associated with greater risk of breast cancer recurrence among TN cases. Smoking was also associated with greater risk of recurrence to bone among all cases and among luminal cases. Elevated risks of breast cancer-specific and all-cause mortality were observed among current smokers across all subtypes. Alcohol use was not positively associated with risk of recurrence or mortality overall; however, TN patients who drank four or more drinks per week had a decreased risk of recurrence (HR, 0.71; 95% CI, 0.51-0.98) and breast cancer-specific mortality (HR, 0.73; 95% CI, 0.55-0.97) compared with non-current drinkers. Patients with breast cancer with a history of smoking at diagnosis have elevated risks of recurrence and mortality. These findings underscore the need to prioritize smoking cessation among women diagnosed with breast cancer.

Machine learning-based models for the prediction of breast cancer recurrence risk

Breast cancer is the most common malignancy diagnosed in women worldwide. The prevalence and incidence of breast cancer is increasing every year; therefore, early diagnosis along with suitable relapse detection is an important strategy for prognosis improvement. This study aimed to compare different machine algorithms to select the best model for predicting breast cancer recurrence. The prediction model was developed by using eleven different machine learning (ML) algorithms, including logistic regression (LR), random forest (RF), support vector classification (SVC), extreme gradient boosting (XGBoost), gradient boosting decision tree (GBDT), decision tree, multilayer perceptron (MLP), linear discriminant analysis (LDA), adaptive boosting (AdaBoost), Gaussian naive Bayes (GaussianNB), and light gradient boosting machine (LightGBM), to predict breast cancer recurrence. The area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and F1 score were used to evaluate the performance of the prognostic model. Based on performance, the optimal ML was selected, and feature importance was ranked by Shapley Additive Explanation (SHAP) values. Compared to the other 10 algorithms, the results showed that the AdaBoost algorithm had the best prediction performance for successfully predicting breast cancer recurrence and was adopted in the establishment of the prediction model. Moreover, CA125, CEA, Fbg, and tumor diameter were found to be the most important features in our dataset to predict breast cancer recurrence. More importantly, our study is the first to use the SHAP method to improve the interpretability of clinicians to predict the recurrence model of breast cancer based on the AdaBoost algorithm. The AdaBoost algorithm offers a clinical decision support model and successfully identifies the recurrence of breast cancer.

Communication with physicians and family about breast Cancer recurrence

ObjectiveAdequate physician-patient communication about cancer recurrence is vital to quality of life and to informed decision-making related to survivorship care. The current study was guided by a cognitive-affective framework to examine communication with family and physicians about breast cancer recurrence risk. MethodsA survey of recently-diagnosed, early-stage breast cancer patients in Appalachia investigated physician-patient and familial communication about breast cancer recurrence risk. ResultsOver 30% of participants reported not talking to family or physicians about breast cancer recurrence risk. Younger patients reported more conversations, and speaking with physicians was associated with greater perception risk factors associated with recurrence risk. Greater worry about recurrence was associated with more communication with family and plans to talk to family, physicians, and friends about recurrence risk in the future. ConclusionAdditional supports for patients and physicians are needed to improve understanding of breast cancer recurrence risk and risk factors for recurrence. InnovationFamily communication about breast cancer recurrence risk is understudied. The combination of physician and family communication adds novelty to our analysis.

Predicting early breast cancer recurrence from histopathological images in the Carolina Breast Cancer Study

Approaches for rapidly identifying patients at high risk of early breast cancer recurrence are needed. Image-based methods for prescreening hematoxylin and eosin (H&E) stained tumor slides could offer temporal and financial efficiency. We evaluated a data set of 704 1-mm tumor core H&E images (2–4 cores per case), corresponding to 202 participants (101 who recurred; 101 non-recurrent matched on age and follow-up time) from breast cancers diagnosed between 2008–2012 in the Carolina Breast Cancer Study. We leveraged deep learning to extract image information and trained a model to identify recurrence. Cross-validation accuracy for predicting recurrence was 62.4% [95% CI: 55.7, 69.1], similar to grade (65.8% [95% CI: 59.3, 72.3]) and ER status (66.3% [95% CI: 59.8, 72.8]). Interestingly, 70% (19/27) of early-recurrent low-intermediate grade tumors were identified by our image model. Relative to existing markers, image-based analyses provide complementary information for predicting early recurrence.

Dietary Isoflavone Intake and Breast Cancer Prognosis: A Prospective Analysis and Meta-Analysis

We aimed to examine the association between dietary isoflavone intake and the risk of breast cancer recurrence and summarize evidence on the role of dietary isoflavone intake in breast cancer prognosis. This prospective study included 592 breast cancer survivors who completed a dietary assessment. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models. Of the studies published until May 31, 2023, that were searched in PUBMED and EMBASE databases, 14 studies were selected. Adjusted HRs were combined using fixed- or random-effects models. During the median follow-up of 4.3 years, 47 recurrences were identified. The HR (95% CI) for recurrence comparing the highest versus the lowest tertile of isoflavones intake was 1.29 (0.60–2.78). In a meta-analysis of previously published data and ours, dietary isoflavone intake was associated with a better breast cancer prognosis. The combined HRs (95% CIs) comparing the extreme categories were 0.81 (0.67–0.98) for recurrence and 0.85 (0.76–0.96) for all-cause mortality. A nonlinear inverse association was observed between isoflavone intake and the risk of recurrence and all-cause mortality. Our study suggests that dietary isoflavone intake is associated with a favorable prognosis in breast cancer survivors and warrants further investigation.

Diet and nutrition strategies for cancer prevention: A comprehensive review

Maintaining a healthy diet is crucial for preventing cancer, as it provides the essential nutrients needed for proper physiological functioning. It is predicted that simple lifestyle and dietary changes can lessen the risk of developing 30-40% of all malignancies. Obesity, the consumption of nutrient-deficient foods such as sugary and refined flour products, which can lead to impaired glucose metabolism and, eventually, diabetes, a lack of dietary fiber, an excess of red meat, and an imbalance in the consumption of omega-3 and omega-6 fats are all risk factors for cancer. To reduce your risk of cancer, include flax seeds, a variety of fruits and vegetables, and dietary fiber in your diet. Additionally, there is proof that nutritional supplements may help lower the risk of breast cancer recurrence. To prevent various types of cancer, it is important to include vegetables, fruits, whole grains, and specific fatty acids in your diet, alongside engaging in regular physical exercise. Furthermore, it is crucial to use advances in genetics and molecular biology to extend nutritional research from observational studies to demonstrating causative linkages. Cancer prevention strategies that involve dietary changes targeted at specific groups should be based on a thorough understanding of these fundamental principles. Such dietary methods can be effective as well as in cancer prevention but also cancer rehabilitation. This review investigates the relationship between cancer and diet, examines straightforward approaches to incorporating cancer-preventive foods into one’s diet, investigates the impact of dietary variables and lifestyle choices on the risk of cancer, and investigates clinical studies focused on nutrition and cancer prevention.