Breast Care Center Research Articles

EXPOSURE PARAMETERS OF MAMMOGRAMS WITH AND WITHOUT MASS LESIONS FROM A SOUTH AFRICAN BREAST CARE CENTRE.

In South African breast care centres, full-field digital mammography units provide breast imaging services to symptomatic and asymptomatic women simultaneously. This study evaluated the technical exposure parameters of 800 mammograms of which 100 mammograms had obvious mass lesions in the fibroglandular tissue. The average breast compression force of mammograms with mass lesions in the fibroglandular tissue was 18.4% less than the average breast compression force of mammograms without mass lesions. The average mean glandular dose (MGD), tube potential (kVp) and compressed breast thickness (CBT) values were 2.14 mGy, 30.5 kVp and 63.9 mm, respectively, for mammograms with mass lesions, and 1.45 mGy, 29.6 kVp and 56.9 mm, respectively, for mammograms without mass lesions. Overall, the average MGD and mean CBT of mammograms with mass lesion were significantly higher compared to those without mass lesions (p < 0.05), although there was no significant difference in their tube potentials (p > 0.05).

Point of care high resolution ultrasound in the evaluation of Bangladeshi women presenting to a breast care center

Background: Mammography and ultrasound examinations for diagnosis and staging of breast problems have been traditionally performed in specialized facilities, which circumstances are associated with increased costs and inconvenience for patients. Point of care or clinical office provision of high resolution ultrasound may allow addressing these equity barriers to health services, but there are limited data in Bangladesh about such practice and the associated quality of care.Objective: To ascertain the advantage of ultrasonogram in the diagnosis of breast disease and screening of breast cancer.Methods: From February through November 2014, 1085 women presented to the Amader Gram Breast Care Center in Khulna. In each of these women in addition to standard history and physical examination, a high resolution ultrasound scan was performed of both breasts. Standard clinical and ultrasound practice definitions of breast conditions were applied to each case by an specialist surgeon trained in breast sonology.Results: Two thirds of women had history, physical examination and ultrasound findings consistent with fibrocystic conditions. 12% had fibro adenomas, 5% inflammatory infectious conditions, 2% obvious or strongly suspected breast malignacy, and 1% had masses of uncertain nature. 3% had more than one abnormal breast condition and 3% had no breast abnormalities at all. The overwhelming majority of women benefitted from having ultrasound examination which contributed to prompt, definitive characterization of their breast conditions and which pictorial demonstration contributed to patient education about the clinical diagnosis.Conclusion: Point of care high resolution breast ultrasound can contribute favorably to quality and equity of care for Bangladeshi women with breast problems.Bang Med J (Khulna) 2016; 49 : 3-6

Abstract P6-05-04: Relationship between obesity and breast tumor pathology in a contemporary set of patients

Abstract Background: Obesity is a risk factor for breast cancer in postmenopausal women, and is associated with decreased survival regardless of menopausal status. This outcome disparity has been attributed to clinical factors such as delayed diagnosis, inadequate dosing with chemotherapeutic agents, and co-morbid conditions. Here, we evaluated the association between pathological characteristics and BMI in a cohort of patients enrolled in the Clinical Breast Care Project (CBCP) 2001-2013. Methods: All female patients with invasive breast cancer who had height and weight recorded at the time of diagnosis were identified from the CBCP database. BMI was calculated and patients categorized as normal/lean (&amp;lt;24.9 kg/m2), overweight (25-29.9 kg/m2), or obese (&amp;gt;30.0 kg/m2). Chi-square univariate analysis was performed to determine statistical significance followed by multivariate logistic regression. Statistical significance was defined as p &amp;lt;0.05. Survival analysis was done using Cox proportional hazard regression models. Results: Of the 1,705 patients, 32.4% were normal/lean, 31.6% were overweight and 36.0% were obese. Univariate analysis revealed that obese women were significantly more likely to be older at age at diagnosis, African American, menopausal and treated at Joyce Murtha Breast Care Center, a rural civilian hospital in western-central PA. These factors were thus include in multivariate analysis which showed that obese patients were at an increased risk relative to normal/lean patients of having a higher tumor stage (OR = 1.32, 95% CI [1.043-1.681], p = 0.021), size (OR = 1.42, 95% CI [1.091-1.857], p = 0.009), and grade (OR = 1.37, 95% CI [1.085-1.718], p = 0.008) but at decreased risk of PR- tumors (OR=0.57, 95% CI [0.394-0.837], p = 0.004). Overweight patients did not differ significantly from either normal weight or obese patients. Neither breast cancer-specific nor overall survival differed significantly between groups. Discussion: Higher tumor stage and size may reflect delayed detection in obese women. In contrast, tumor grade and PR status likely reflect underlying biological differences driven by increased adiposity in the breasts of obese women. Despite these differences in pathology, survival did not differ by BMI status, suggesting that factors such as suboptimal dosing may not be relevant in current patient care. Citation Format: Ellsworth RE, Lovejoy L, Costantino N, Sheiver CD. Relationship between obesity and breast tumor pathology in a contemporary set of patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-05-04.

Abstract P5-10-10: Predictors of breast density among Black and Hispanic women presenting for mammographic screening

Abstract Background: Increased breast density has been associated with elevated breast cancer risk and complicating mammographic interpretation. Although previous studies have investigated population variations in breast density, Black and Hispanic women are often underrepresented in these analyses. Moreover, it is unclear how breast density differs between these ethnicities. We report on the mammographic density distribution of Black and Hispanic women having breast cancer screening at the Capital Breast Care Center (CBCC) and analyze factors associated with high breast density. Methods: Retrospective data from electronic medical records at a population-based mammography screening center were abstracted. From 2010 to 2014, data from women undergoing their first breast cancer screening were reviewed. Patient demographics including race, age at screening, education and menopausal status were abstracted in addition to body mass index (BMI) and Breast Imaging-Reporting and Data System (BI-RADS) density category:1- “fatty”, 2- “scattered fibroglandular densities”, 3- “heterogeneously dense” and 4- “extremely dense”. Logistic regression was used to investigate factors associated with breast density. Results: Density categorization was recorded for 1747 women over the five-year period, with 855 (49%) Black and 892 (51%) Hispanic. Patient characteristics associated with high density (categories 3 and 4) were younger age, Hispanic ethnicity, nulliparity, premenopausal status, and BMI &amp;lt; 30 kg/m2. On multivariate logistic regression, Hispanic ethnicity, premenopausal status, and BMI &amp;lt; 30 kg/m2 were predictive of high mammographic density. Conclusion: In a sample of women presenting for mammographic screening at CBCC, Hispanic women were more likely to have higher breast density compared to Black women. After controlling for ethnicity, postmenopausal and obese women were less likely to have dense breasts. Additional investigation is needed to further study the impact of obesity on breast density in underserved minority women. Citation Format: Oppong BA, Dash C, Li Y, Makambi K, Coleman T, Adams-Campbell L. Predictors of breast density among Black and Hispanic women presenting for mammographic screening [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-10-10.

Abstract A40: Capital Breast Care Center: A Patient Navigation Exemplar

Abstract Introduction. Breast cancer is the second leading cause of cancer deaths for American women. Washington, DC, has one of the highest incidence and mortality rates for breast cancer in the U.S. Patient navigation coupled with informational and community resources are important strategies that assist patients' access and help them understand the complex world of cancer care. Aims.The Georgetown Lombardi Comprehensive Cancer Center's Capital Breast Care Center (CBCC) serves as an exemplary community-embedded facility that develops multiple intra community partnerships to improve patient access to health care. The aim of this study is to detail the role of patient navigation at the Capital Breast Care Center, with an emphasis on community engagement and community-based partnerships. Program process description. We describe the development and application of the CBCC patient navigation process and navigation components: (a) creating partnerships; (b) educating members of the community about mammograms; (c) providing patient navigation into screening assistance; and (d) helping women with coordination of diagnostic follow-up. Data were collected from 2004-2015 and analyzed in 2015. Program process evaluation results. CBCC established 41 community partnerships categorized by different organizational types that include transitional housing facilities, health service providers, neighborhood associations, churches, senior centers, and local neighborhood recreation centers. Application of the CBCC navigation model yielded important lessons; in general, partnerships and patient navigation. Discussion. Partnerships, community engagement, and informational resources are all crucial to the patient navigation process in providing access to quality care for all patients. Citation Format: Sherrie Flynt Wallington, Bridget Oppong, Chiranjeev Dash, Tesha Coleman, Holly Greenwald, Tanya Torres, Marquita Iddirisu, Lucile Adams-Campbell. Capital Breast Care Center: A Patient Navigation Exemplar. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A40.

A Community-Based Outreach Navigator Approach to Establishing Partnerships for a Safety Net Mammography Screening Center.

Washington, DC, has one of the highest incidence and mortality rates for breast cancer in the USA. Patient navigation coupled with informational and community resources are important strategies that assist patients' access and help them understand the complex world of cancer care. The Georgetown Lombardi Comprehensive Cancer Center's Capital Breast Care Center (CBCC) is a safety net mammography screening center that utilizes a community-based navigation program. In addition to providing assistance with coordination of clinical services, navigators at CBCC are integral in establishing intra-community partnerships to educate members of the community about breast cancer screening. The aim of this study was to detail the role of patient navigation at the CBCC, with an emphasis on community engagement and community-based partnerships. We describe the process by which CBCC established partnerships with multiple community organizations between 2004 and 2015 and analyzed data of women screened in relationship to the evolution of the patient navigation services. Application of the CBCC navigation model that integrates individual patient outreach with community engagement has yielded viable and lasting community partnerships that have resulted in an increase in mammography uptake, especially among medically underserved minority women.

Mastalgia: Imaging Work-up Appropriateness

Radiologists frequently image women with the sole complaint of mastalgia (breast pain). We hypothesized that whereas the vast majority of women ultimately have no imaging explanation for their breast pain, a small percentage of patients may have a correlative imaging finding and confirm the current American College of Radiology Appropriateness Criteria recommendations. In this Health Insurance Portability and Accountability Act (HIPAA)-compliant, institutional review board-approved retrospective review, we evaluated 236 women between the ages of 18 and 83 years who presented to our Breast Care Center in 2013 with the sole complaint of breast pain or tenderness. Patients' clinical presentation, diagnostic imaging work-up, and clinical and radiographic follow-up were documented. Outcomes of the diagnostic work-up were compared with the American College of Radiology Appropriateness Criteria recommendations. Of the 236 patients, 10 women had cyclical breast pain, 116 had noncyclical, nonfocal breast pain, and 110 had noncyclical, focal breast pain. No imaging correlates were discovered to explain the etiology of cyclical pain, supporting the American College of Radiology Appropriateness Criteria rating values. A definitive imaging correlate for breast pain was identified in seven women (3%) with noncyclical, focal pain, one of which was a cancer diagnosis (0.4%), which correlates with the American College of Radiology Appropriateness Criteria ratings. No imaging correlates were found in women with noncyclical, nonfocal pain, supporting the American College of Radiology Appropriateness Criteria ratings. There was no radiological imaging finding to explain the etiology of mastalgia in most women. Diagnostic imaging may be an appropriate diagnostic evaluation in patients with noncyclical, focal breast pain, supporting the American College of Radiology Appropriateness Criteria recommendations.

Time to Diagnostic Evaluation After Mammographic Screening in an Urban Setting.

The Capital Breast Care Center (CBCC), a screening facility established to serve minority women, developed a culturally sensitive patient care paradigm that would address concerns of adherence to follow-up of abnormal results after initial mammogram. Women with abnormal mammograms are assigned a Black or Latina navigator who facilitates the additional workup needed by scheduling follow-up, arranging transportation, providing counsel/emotional support, and even accompanying them to diagnostic imaging or biopsy appointment. We present data on follow-up rates after breast cancer screening. All patients seen at CBCC are entered into a prospectively collected database. We calculated intervals (in days) between the screening and diagnostic visits. Descriptive statistics and median time to follow-up are reported. Differences between Black and Hispanic women on time interval were tested by t-test. From January 2010 to December 2012, 4605 digital screening mammograms were performed. Fifty-two percent of the women self-identified as Black, 41% as Hispanic, 4% White, 2% Asian, and 1% as "other." Of the screening studies, 451 (9.8%) required additional workup, out of which 362 (80%) of the women returned for the recommended diagnostic imaging. The median interval between screening and diagnostic imaging was 39 days (range: 6-400). Of the 162 women recommended to have a core needle biopsy, 81.5% underwent biopsy within a median of 21 days (range: 0-221 days). At the CBCC, time to patient follow-up after initial mammographic screening is within the CDC-recommended performance standard of less than 60 days. For a population that historically has low rates of clinical follow-up, we attribute this reduction in delays to breast cancer diagnostic resolution to a culturally sensitive patient navigation program. Additional studies are needed to assess how the existing navigation program can be individualized/tailored to target the remaining 20% of women who did not adhere to the recommended workup.

Abstract P1-10-22: Evaluating the incidence of supportive care referrals generated using patient reported data from the Athena health questionnaire system

Abstract Background Patients at risk for or diagnosed with breast cancer have many symptoms and need for supportive care services. As part of the Athena Breast Health Network (a University of California-wide collaboration), the UCSF Breast Care Center (BCC) has incorporated an electronic health questionnaire system (HQS) prior to new patient and follow-up clinic visits, allowing patients to provide information on their personal health and family history, physical and psychological symptoms, and lifestyle. Based on these patient-reported outcomes (PRO), automated referrals for services including genetic counseling, psycho-oncology, social work, fertility preservation, and smoking cessation are generated. Algorithms defining thresholds to trigger these referrals were developed by clinicians and supportive care providers to proactively meet patients' needs. Objectives To evaluate the incidence and outcomes of supportive care referrals based on existing algorithms, and identify reasons for non-utilization of the services offered. The ultimate goal for this evaluation is to modify the existing algorithms to better meet patients' needs. Methods Patients initiating care at the UCSF BCC are invited by email to complete an HQS that provides information relevant to their clinical care. Patients sign an electronic consent, agreeing to have their PRO stored and accessed for research purposes. Family history, health behaviors, desired services, and responses to National Cancer Institute Patient Reported Outcomes Measurement Information System (PROMIS) items are processed through algorithms, generating referrals based on defined thresholds. A clinician summary report is generated and scanned into the electronic medical record (EMR), identifying services for which the patient has met thresholds. Referrals are sent to the clinician as pended orders through the EMR. Once signed by the care provider (physician or nurse practitioner), the order is routed through the EMR to the appropriate service and the patient is offered a visit or phone consultation when appropriate. Results Between 1/1/14 and 12/31/14, 1297 patients initiating care at the UCSF BCC completed an HQS prior to their clinic visit. 1108 patients (85.4%) agreed to have their data used for research. 623 patients (56.2%) were referred to at least one supportive care service. The table below summarizes the percentage of patients who met the defined referral thresholds: Referrals Made, 2014Referral TypeNumber of ReferralsPercent of Patients Referred (n=1108)Genetic Counseling Services44340.0%Psychological Services25723.2%Social Work13712.4%Smoking Cessation343.1%Fertility Preservation292.6% Ongoing analyses are underway to determine the percentage of patients who received services, explore barriers to accessing these services, and evaluate patients' preferences regarding provision of services in alternate formats, including webinars, online content, and group sessions. Conclusions Effective use of PRO identifies a high percentage of patients in need of supportive care services. Through analysis of utilization of services based on our existing thresholds, we hope to optimize our algorithms to better serve our patients' needs throughout the continuum of cancer care. Citation Format: Wong EC, Kaplan CP, Shumay DM, Leykin Y, Etzel KA, Stover Fiscalini A, van't Veer LJ, Esserman LJ, Melisko ME. Evaluating the incidence of supportive care referrals generated using patient reported data from the Athena health questionnaire system. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-22.

Patient utilization of supportive care services identified through the Athena Breast Health Questionnaire System.

226 Background: Psychological wellbeing and lifestyle changes are important factors in long-term health of cancer survivors. As part of the Athena Breast Health Network, the UCSF Breast Care Center (BCC) incorporated an electronic health questionnaire system (HQS) that collects patient-reported data on physical and psychological symptoms, medical conditions, family history, and lifestyle to identify patients’ supportive care needs. Methods: Through a semi-automated process, patients whose HQS responses meet pre-established thresholds are referred to Psycho-Oncology, social work, genetic counseling, and Onco-Fertility. Referrals generated within the HQS are signed and routed by clinicians at the time of a BCC visit. When patients decline appointments with these services, staff members document reasons within the electronic medical record (EMR). A retrospective chart review identified patients who did not receive supportive care services to which they were referred and a qualitative analysis was performed. Results: From 7/1/14-12/31/14, 525 patients completed an HQS and agreed to have their data used for research. The table summarizes referral information. 45 patients referred to Psycho-Oncology did not complete an appointment. Of these, ten did not respond to phone contact to schedule visits. 35 were reached, but declined an appointment. 25 (71.4%) were not ready to make an appointment; 5 (14.3%) cited distance as a primary barrier; 3 (8.6%) were satisfied with the psychological services they were receiving elsewhere; and 2 (5.7%) did not have insurance coverage. Reasons women disregarded referrals for genetic counseling and fertility are being evaluated. Conclusions: HQS can assist in identifying patient supportive care needs, but despite automation of referrals, many patients do not follow through to use supportive care and clinical resources. Timing and resource accessibility may be key. Through analysis of reasons for non-utilization, we hope to better tailor the delivery of supportive care services, when indicated, to better serve patient needs. [Table: see text]

Informed shared decision-making supported by decision coaches for women with ductal carcinoma in situ: study protocol for a cluster randomized controlled trial.

BackgroundWomen with breast cancer want to participate in treatment decision-making. Guidelines have confirmed the right of informed shared decision-making. However, previous research has shown that the implementation of informed shared decision-making is suboptimal for reasons of limited resources of physicians, power imbalances between patients and physicians and missing evidence-based patient information. We developed an informed shared decision-making program for women with primary ductal carcinoma in situ (DCIS). The program provides decision coaching for women by specialized nurses and aims at supporting involvement in decision-making and informed choices.In this trial, the informed shared decision-making program will be evaluated in breast care centers.Methods/DesignA cluster randomized controlled trial will be conducted to compare the informed shared decision-making program with standard care. The program comprises an evidence-based patient decision aid and training of physicians (2 hours) and specialized breast care and oncology nurses (4 days) in informed shared decision-making. Sixteen certified breast care centers will be included, with 192 women with primary DCIS being recruited.Primary outcome is the extent of patients’ involvement in shared decision-making as assessed by the MAPPIN-Odyad (Multifocal approach to the ‘sharing’ in shared decision-making: observer instrument dyad). Secondary endpoints include the sub-measures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient and MAPPIN-Qphysician), informed choice, decisional conflict and the duration of encounters.It is expected that decision coaching and the provision of evidence-based patient decision aids will increase patients’ involvement in decision-making with informed choices and reduce decisional conflicts and duration of physician encounters. Furthermore, an accompanying process evaluation will be conducted.DiscussionTo our knowledge, this is the first study investigating the implementation of decision coaches in German breast care centers.Trial registrationCurrent Controlled Trials ISRCTN46305518, date of registration: 5 June 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0991-8) contains supplementary material, which is available to authorized users.

Surgical decisions of newly diagnosed breast cancer patients following genetic referral.

40 Background: In response to many recent publications and mandates to assure referrals to genetic counseling for oncology patients, the Royal Oak (RO) Breast Care Center (BCC) at Beaumont Health System (BHS) evaluated the surgical outcomes of genetic referral(GR) in breast cancer (BC) patients. The goal of this study was to determine the impact of GR on surgical decision making and evaluate outcomes in this population. Methods: A retrospective chart review was performed, to identify patients who had a BC diagnosis and met criteria for GR from July 2012- July 2014. Age, histology, laterality of cancer, prior history of cancer, neoadjuvant chemotherapy, plastic surgery consultation, MRI, reason for MRI, additional testing, type of surgery, laterality of surgery, reconstruction, lymph node surgery, and time from diagnosis to surgery were evaluated using Chi Square analysis. Results: A total of 506 patients with a new BC diagnosis seen at the RO BCC at BHS within the inclusion dates were analyzed. There were 191 patients referred to the GP for counseling and possible genetic testing. Eighty percent of the referred patients underwent genetic testing. Twelve patients tested positive for deleterious mutations in BRCA 1 or 2. A statistically significant difference was found in the BC patients referred to the GP with respect to age, MRI usage, neoadjuvant chemotherapy, type and laterality of surgery, ALND, plastic surgery consult &amp; reconstruction, and time from diagnosis to surgery. MRI usage in patients referred to GP was 43.5% vs. 12.7% in those not referred. Mastectomy rate in patients referred to GP was 51.3% vs. 25.5% (p&lt;0.001) in those not referred. Bilateral mastectomy was 30.9% vs. 5.8% (p&lt;0.001). Conclusions: We have found that patients referred to the GP have increased the use of MRI testing, which in itself has been shown to increase mastectomy rates. We also identified a trend in these patients toward bilateral mastectomy. According to our outcomes, there are multiple possible reasons for this trend, including family history, physician bias, stage at diagnosis, age and factors intrinsic to the patient. Furthermore, a multivariate analysis is needed to assess the relationship between a GR and a patient’s surgical decision.

Abstract A23: Addressing men's health disparities in the District of Columbia

Abstract The Georgetown University Lombardi Comprehensive Cancer Center Office of Minority Health and Health Disparities Research is a community based center located in Ward 8 of the District of Columbia, which has some of the highest incidence and death from cancer in the city. Programs addressing men's health are very limited in these communities. Our location is easily accessible to the residents in Wards 6, 7, and 8 which are designated by the Department of Health and Human Services as medically underserved. Our mission is to facilitate, stimulate, and to promote synergy in addressing the biological and environmental basis of cancer health disparities via research, training, communication and education. Current programs include breast cancer prevention studies for African American and Hispanic Women, HPV Education, Environmental Justice, exercise studies to relieve the effects of cancer treatments for men and women. The Health Disparities Initiative also conducts community based boot camps, and regular focus groups to engage community support for our programs, and to give the residents the opportunity to let us know what their community needs are. The nearby Capitol Breast Care Center provides women with mammograms and cervical exams and needed follow-up regardless of a woman's ability to pay. As a Community Health Educator I am a liaison between the residents of these communities and the Health Disparitiess Initiative. I actively participate in community activities that help promote healthy lifestyles and the reduction of chronic diseases. I am actively involved in the recruitment of residents from the community to form our Community Advisory Board and Environmental Justice Advisory Board. And I have accepted the invitation to sit on community boards and committees. Citation Format: Everett Dodson. Addressing men's health disparities in the District of Columbia. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A23.

Abstract P1-12-13: Factors associated with adherence to adjuvant endocrine therapy in patients with hormone receptor positive breast cancer

Abstract Background/Purpose Adjuvant endocrine therapy in patients with hormone receptor positive breast cancer reduces recurrence and mortality, but many patients are non-adherent to anti-hormonal medication. In order to increase the adherence, it is important to know about factors associated with adherence. So we investigated factors associated with adherence to anti-hormonal medication using variable questionnaires. Methods We carried out a cross-sectional survey of a sample of women who underwent surgery due to breast cancer in the Seoul National University Hospital Breast Care Center from 2007 to 2011 and treated with anti-hormonal medication. Questionnaires were sent to 1,000 patients. The questionnaire booklet included the Medication Adherence Report Scale-5(MARS-5), Women’s Health Questionnaire(WHQ), Beliefs about Medicine Questionnaire(BMQ), Satisfaction with Information about Medicines Scale(SIMS). And to identify patient’s clinical characteristics, we reviewed electronic medical records, retrospectively. Result The response rate of questionnaire was 40.8%(408/1000). Of the answered patients, 263 patients were treated with tamoxifen and 145 patients were treated with aromatase inhibitors(AIs). 197 of 408 answered patients(48.3%) were classified as non-adherence. The rate of non-adherence was 132/263(50.1%) and 65/145(44.8%) in patients treated with tamoxifen and AIs. Of the all answered patients, non-adherent patients had more depressed mood (p&amp;lt;0.001). Non-adherent patients scored lower on positive beliefs as measured on BMQ-necessity (OR = 0.65, 95% CI 0.51 to 0.82) and higher on negative beliefs as measured on BMQ-overuse (OR=1.81, 95% CI 1.29 to 2.54). Non-adherent patients also scored lower on satisfaction with information about action and usage of anti-hormonal treatment as measured on SIMS-action and usage (OR = 0.47, 95% CI 0.38 to 0.65). Of the patients treated with tamoxifen, non-adherent patients had more depressed mood (p=0.003), scored higher on BMQ-overuse (OR=1.97, 95% CI 1.22 to 3.20) and scored lower on SIMS-action and usage (OR = 0.33, 95% CI 0.22 to 0.50). Of the patients treated with AIs, non-adherent patients had more depressed mood (p=0.014), scored lower on BMQ-necessity (OR=0.52, 95% CI 0.36 to 0.75). Conclusion This study showed associations between depressive mood of breast cancer patients treated with anti-hormonal therapy and adherence. And beliefs and satisfaction with information about medication also associated with adherence. To improve adherence, we should evaluate and correct patient’s mood. And we should provide proper information about medications. Citation Format: Jongjin Kim, Wonshik Han, Hyeong-Gon Moon, Min Kyoon Kim, Eunshin Lee, Tae-Kyung Yoo, Han-Byoel Lee, Young Joon Kang, Yun-Gyoung Kim, Tae Ryung Kim, Dong Young Noh. Factors associated with adherence to adjuvant endocrine therapy in patients with hormone receptor positive breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-12-13.

Abstract P1-09-14: Improved outcome of breast cancer survivors participating in a multidisciplinary cancer survivorship program at Texas Tech University Health Sciences in El Paso, TX

Abstract Introduction: Breast Cancer (BC) survivors in El Paso, TX include a majority of Hispanics. We have previously reported that these survivors have decreased mental and physical health related Quality of Life (QOL). We sought to determine whether BC survivors would benefit from participating in a comprehensive multidisciplinary BC Survivorship Program at the Garbar Breast Care Center (GBCC), as determined by improvement of performance on the following validated questionnaires: 1) Patient Health Questionnaire 9(PHQ9), 2) General Anxiety Disorder 7 (GAD 7), and SF36 QOL questionnaires. Methods: After IRB approval, we recruited consecutive patients at our institution over 6 months starting October, 2013, and who are within the first 5 years post-diagnosis with Stages I-III BC and have completed surgery, chemotherapy and/or radiation therapy. Survivors were enrolled in the survivorship program staffed by an oncologist, a nurse practitioner, a nutritionist and a clinical psychologist. They participate in individual as well as group sessions. Survivors are initially screened for depression and generalized anxiety disorder using PHQ9 and GAD 7, in addition to assessing the patient’s QOL at baseline, and every 3 months. Survivors are provided with a personalized summary of all received treatment and follow up care plans; dietary counselling and individual meal plans, in addition to in-depth psychological assessment and an intervention using Mindfulness Based Stress Reduction. Results: 47 patients have been recruited so far and all but one completed baseline questionnaires;17 and 7 respectively had 3 and 6 months follow up visits. 94% were Hispanics. Mean age 54 years. 38% of participants were younger than 50 years of age; Stage 1 BC (36%), Stage 2 (36%), and stage 3 (28%) . 80% received chemotherapy ; and 68% had hormone receptor positive BC and received endocrine therapy. The scores at baseline were : PCS representing the mean for the SF-36 QOL Physical Health was 46.0, and the MCS for Mental Health was 44.0, both below the population norm (50.0). Mean scores for GAD 7 was 7.54 and for PHQ 9 7.33, both abnormal (&amp;lt;5 on PHQ9 and GAD 7 are considered normal scores). At 3 months the scores were as follows: PCS 49.71, MCS 45.34, both improved (the higher the better); GAD7 5.18; and PHQ9 6.82 (both improved, the lower the better). At 6 months, same favorable trend continues: PCS 50.07 [SD 5.54, 44.29-53.35]; MCS 49.66 [SD 7.73, 38.93-62.41]; GAD7 5.00 (SD 3.70); and PHQ9 4.57 (SD 3.64). Conclusion: BC survivors are benefiting from participating in the new BC Survivorship Program launched at Texas Tech in El Paso, TX. They have experienced improved mental and physical health related QOL, improved anxiety and depression by GAD7, and PHQ9, with scores reaching near normal values at 6 months into the program which continues to enroll BC survivors. This program represents a culturally appropriate model for Hispanic BC survivors. It is expected to continue to improve the quality of life of these patients, empower them in their transition from cancer treatment to survivorship and lead to improved psychosocial adjustment and normal social functioning with significant implication not only on survivors, but also on their families and the community. Citation Format: Zeina Nahleh, Rebecca Pasillas, Alok Dwivedi, Azadeh Nasrazadani, Rosalinda Heydarian, Luis Sanchez, Indika Mallawaarachchi, Cecilia Ochoa, Edward Saltzstein. Improved outcome of breast cancer survivors participating in a multidisciplinary cancer survivorship program at Texas Tech University Health Sciences in El Paso, TX [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-14.

The risk-reducing mastectomy: unnecessary hysteria or life-saving prophylaxis?

The prophylactic (risk-reducing) mastectomy is a world-wide recognized method for specifically treating the increased breast cancer risk in patients showing a BRCA1 and/or BRCA2 mutation as well as other patient groups at increased breast cancer risk. This option should be offered to all patients having the pertinent risk profile. Breast reconstruction is an integral part of the risk-reducing mastectomy procedure and all possible methods of breast reconstruction, especially autologous tissue reconstruction should be offered to all patients having a medical indication and desiring this surgical treatment. These patients are best managed in certified Breast Care Centres where the different medical and surgical specialists can address interdisciplinary all aspects of genetic counselling, preoperative counselling, mastectomy and reconstructive techniques as well as the necessary postoperative surveillance.

Lymphedema care for the breast cancer patient: An integrative approach

Lymphedema is a serious complication that involves the accumulation of protein-rich fluid in the interstitial space. Lymphedema is common after treatment for breast cancer, especially for those patients receiving axillary lymph node dissection. Severe lymphedema is associated with serious morbidities such as swelling, fibrosis, decreased function, reduced range of motion, infection, and pain. Here, we discuss a unique, multi-disciplinary approach to effectively manage patients during and after breast cancer therapy. In this approach, patient education and screening are implemented in various departments throughout the health care system, including Physical Therapy and Rehabilitation, Integrative Medicine, and the Breast Care Center, which houses the Lymphedema Clinic. Early patient education and regular screening are combined with aggressive treatment for overt disease to effectively manage lymphedema in the at-risk population.

BI-RADS 4 and 5 breast lesions: correlation between sonographic findings and histopathological results following ultrasound-guided FNAC

Background: clinical application of breast imaging reporting and data system (BI-RADS) lexicon for breastultrasound useful to characterization of breast lesion and to inform the level of likelihood of malignancy. Objectives: to correlate between the ultrasound findings and pathological results of BIRADS 4 and 5 lesions on thebasis of the imaging-pathologic concordance or discordance. Methodology: This prospective study enrolled 185 patients classified as BI-RADS-4 and BI-RADS-5, who were referred for breast ultrasound examination at breast clinic in oncology hospital-medical city complex-Baghdad that obtained between January 2013-August 2013 who had palpable breast lump on clinical examination or mass detected by mammography. Ultrasound findings were reviewed by board-certified radiologist and description of ultrasound finding bases on fourth edition BI-RADS lexicon; BI-RADS 4 and 5 was selected for breast lesions that were features suggesting malignancy, category 5 having more likelihood of malignancy than category 4. In both cases, ultrasound guided fine needle aspiration cytology (FNAC) were performed then pathological diagnoses were obtained. Finally, five possible results illustrated for ultrasound-pathology correlation according the concordance and discordance between ultrasound findings and pathological results and malignancy rates were estimated. Results: Over a period of 8 months, 185 patients with BI-RADS 4 and 5 breast lesions were included in this study; the age at presentation ranged between 20 to 73 years. The mean age was 39 years. High resolution ultrasound with Doppler facility applied on all patient and results are categorized according breast imaging and reporting data system and category 4 and 5 were ended by fine needle aspiration cytology with ultrasound guidance and subsequently the histopathology was done. FNAC results revealed 68.35% (n=108) of BI-RADS 4 patients had benign pathologies, 18.99% (n=30) had malignancy and just 12.66% (n=20) showing borderline or high risk lesions. The majority (85.18%) of women with BI-RADS 5 displayed malignant lesion and benign lesions were 2% and rest were borderline. following imaging-pathology correlation, the concordant malignancy in BI-RADS 4 was 18.9% versus 85.18% in BI-RADS 5 and discordant benign in BI-RADS 4 noted in 68.3% of patients while only in 7.4% in BI-RADS 5 and borderline high-risk lesion identified in 12.6% in BI-RADS 4 and 7.4% in BI-RADS 5. Conclusion: the current study shows high agreement with the likelihood of malignancy after application of BI- RADS terminology in category 4 and 5. Careful imaging-pathologic correlation is integral part of multidisciplinary team and very important in establishing the concordance. Recommendation: the previous knowledge about fourth edition of ACR BI-RADS lexicon and practicing it in daily work recommended for radiologist who working in dedicated breast care centers to avoid delays in diagnosis of breast malignancy

Ductal carcinoma in situ in Chinese women undergoing opportunistic breast cancer screening

AimBefore the introduction of breast cancer screening in 1990, ductal carcinoma in situ (DCIS) was a rare disease, representing less than 2 per cent of all breast cancers in Chinese. With the availability of screening mammography, DCIS, which is believed to be the precursor of invasive breast cancers, is diagnosed with increasing frequency. In the present study, we evaluated the impact of breast cancer screening by comparing the clinicopathological differences between screen‐detected and symptomatic DCIS in the largest cohort of Chinese women.Patients and MethodsBetween March 2003 and March 2008, 206 Chinese women with DCIS were treated in the Hong Kong Sanatorium and Hospital Breast Care Centre. They were divided into two groups according to the mode of discovery: 87 (42 per cent) women were allocated to the screen‐detected DCIS group, and 119 (58 per cent) women were allocated to the symptomatic DCIS group. Clinical records and pathological reports were recorded prospectively in our multidisciplinary breast conference and reviewed retrospectively. Differences in demographic information, clinical data and breast cancer prognostic markers between the two groups were evaluated.ResultsOnly 8.2 per cent of women with screen‐detected DCIS were under the age of 40, but it was not uncommon in women with symptomatic DCIS (23.7 per cent, P = 0.002). Women with screen‐detected DCIS also had a stronger family history of breast cancer (21.8 per cent), while only 8.4 per cent of women with symptomatic DCIS had a family history (P = 0.006). The tumour size of the screen‐detected DCIS was smaller (mean and median: 21.9 mm and 15 mm, respectively) than the symptomatic DCIS (28.8 mm and 26 mm, respectively; P = 0.004). The tumour grade showed no difference (P = 0.639) between the two groups. Women with screen‐detected DCIS were more likely to undergo breast‐conserving surgery (odds ratio = 2.185, 95 per cent confidence interval: 1.225–3.900, P = 0.008). There was no difference demonstrated in terms of oestrogen receptor (ER) (P = 0.929) expression, progesterone receptor (PR) (P = 0.578) expression, C‐erb B‐2 score (P = 0.089), Ki‐67 index (P = 0.312) and triple negative for the ER/PR/C‐erb B‐2 score (P = 0.201).ConclusionBreast cancer screening allows for the early detection of high‐grade DCIS, which are considered more prone to develop into invasive cancer. Further studies are needed to review if mass screening will be translated into cost‐effectiveness and reduced mortality of breast cancer in Hong Kong.

Identification of patient subgroups and risk factors for persistent arm/shoulder pain following breast cancer surgery

PurposeIn this prospective, longitudinal study, we extend our findings on persistent breast pain in patients (n = 398) following breast cancer surgery and evaluate the prevalence and characteristics of persistent pain in the arm/shoulder. In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the arm pain classes, were evaluated. Methods and samplePatients were recruited from Breast Care Centers located in a Comprehensive Cancer Center, two public hospitals, and four community practices. Patients were assessed prior to and monthly for six months following breast cancer surgery. ResultsUsing growth mixture modeling, patients were classified into no (41.6%), mild (23.6%), and moderate (34.8%) arm pain classes based on ratings of worst arm/shoulder pain. Compared to the no pain class, patients in the moderate pain class were significantly younger, had a higher body mass index, and were more likely to report preoperative breast pain and swelling in the affected breast. In addition, patients in the moderate pain class reported higher levels of depression, anxiety, and sleep disturbance than the no pain class. ConclusionsFindings suggest that approximately 35% of women experience persistent levels of moderate arm/shoulder pain in the first six months following breast cancer surgery. Moderate arm/shoulder pain is associated with clinically meaningful decrements in functional status and quality of life.