Benign Breast Disease Research Articles

ANTHROPOMETRIC VARIABLES IN BREAST LESIONS OF WOMEN OF REPRODUCTIVE AGE IN UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL

Background. Benign breast diseases are a potential health concern to a large number of women. The incidence of cancer is increasing worldwide. A steady increase in incidence has been observed in most developed and developing counties. Objective. Thus, our study seeks to investigate the anthropometric variables implicated in breast lesions of women of reproductive age. Methods. This is a descriptive and prospective study with a random sampling method; the data was obtained from the Department of Surgery, Radiotherapy and Oncology Unit of University of Port Harcourt Teaching Hospital. A total number of 146 subjects (18-49 years) were involved into this study. A number of 90 were breast lump patients and 56 were breast cancer patients. Results. Data obtained was analysed with Microsoft Excel. Our results show no statistically significant difference (P> 0.05) in the body mass index (BMI) and waist-hip-ratio (WHR) of both the breast lump and breast cancer patients. This study supports the fact that high BMI is a predictive marker for breast lumps and cancer in women. Conclusion. The study has also identified that high BMI favours the incidence of breast lumps and breast cancers in women of reproductive age.

Metal exposure and breast malignancy: A case-control study of Malwa Region of Punjab

Background: Breast cancer is triggered by uncontrollable breast cell development. These metals may build up in human serum and tissues, causing estrogenic/malignant consequences. Therefore, metals are being studied to investigate whether they enhance the risk of endocrine-related malignancies like breast cancer. Methods: This study assessed the level of metals such as Cd, As, Pb, Ni, Cr, Zn, and Fe in 120 women undergoing breast cancer surgery in the Malwa region of Punjab. Subjects having malignant breast lesions (n=83) were grouped in the cancer case group whereas subjects with benign breast lesions (n=37) were separated as a control group. From each case, blood, breast tumor, surrounding adipose tissue samples were obtained, and metal analysis was carried out using inductively coupled plasma mass spectrometry (ICP-MS). Results: In malignant cases, the amount of metals ranges from 0.04 to 139.18 µg/kg in tumor. Whereas in adipose tissues and blood, it ranges from 0.04 to 1164.0 µg/kg and from 0.02 to 276.61 µg/kg, respectively. In control group, the total amount ranges from 0.05 to 332.72 µg/kg in the tumor, from 0.13 to 125.61 µg/kg in adipose tissues, and from 0.01 to 121.76 µg/kg in the blood. The level of Cd, Cr, Zn, Fe, Ni, and Pb were observed to be statistically significant/extremely significant whereas Arsenic was detected in no groups. Conclusion: The results indicate that Cd, Cr, Zn, Fe, Ni, and Pb may play a significant role in the development of breast cancer. The parenchymal component of tumor tissues accumulates heavy metals at a higher rate.

Abstract P4-03-31: Lifestyle factors are associated with breast cancer risk in women biopsied for benign breast diseases in China: 10-year results of a multi-center, hospital-based, case-control study

Abstract Objective: Benign breast disease (BBD), especially benign proliferative breast disease (BPBD), is related to increased breast cancer risk. However, few studies have examined whether conventional breast cancer risk factors influence risk of breast cancer among women with BBD. The aim of this study was to evaluate the associations of lifestyle factors with risk of breast cancer among women biopsied for BBD within a multi-center, hospital-based, case-control study in China, in order to provide scientific basis of health guidance for BBD patients and lay the foundation for primary prevention of breast cancer. Methods: A multi-center, hospital-based, case-control study was conducted. Patients with BPBD (n=608) and patients with non-proliferative breast disease (NPBD) (n=366) were collected from 23 hospitals in 11 provinces during April 2012 to April 2013. A face-to-face survey, baseline data and fasting blood was collected with all study subjects. Serum adiponectin levels were assayed using ELISA. After 10 years, the cumulative incidence rate of breast cancer in the two groups was counted through follow-up. Logistic regression analysis was used to obtain the association between specific factors and risk of breast cancer. Results: After 10 years’ follow-up, 388 BPBD and 240 NPBD cases were included in the final analysis (Table 1), of which 16 (4.12%) and 3 (1.25%) developed breast cancer, respectively. The cumulative incidence of breast cancer between the two groups was significant difference (P=0.041). Compared with women in the NPBD group, BPBD group were more likely to be central obesity (with higher waist-to-hip ratio (WHR)) (OR 24.98, 95% CI 1.845-336.203, P=0.015) and less likely to have physical activity (OR 0.626, 95% CI 0.416-0.943, P=0.025) and less often to eat carrots (OR 0.616, 95% CI 0.398-0.953, P=0.030) (Table 2). Subgroup analyze indicated that, physical activity, eat carrots and ham sausage, body weight, BMI, waist circumference and WHR were statistical differences in premenopausal BPBD patients, while only physical activity (OR 0.423, 95% CI 0.269-0.665 P < 0.001) was the independent risk factors. Meanwhile, among the factors of Tea consumption, Glycemia, Body weight, BMI, Waist circumference, WHR and HMW/total adiponectin ratio in postmenopausal group, only HMW/total adiponectin ratio (OR 0.041, 95% CI 0.002-0.820 P=0.037) was statistically significant factor. These stratified multivariate logistic regression analysis results are shown in Table 3. Conclusion: In patients with BBD, physical activity may be the protect factor for breast cancer carcinogenesis in premenopausal women while lower HMW/total adiponectin ratio is a risk factor for postmenopausal women, which can provide direction for primary prevention of breast cancer. Table 1. Pathological types of all subjects. Table 2. The results of multivariate Logistic regression analysis. Table 3. Stratified multivariate Logistic regression analysis by menopause status. Citation Format: Chao Zheng, Dandan Ma, Linfeng Zhao, Maolin Guo, Shude Cui, Fuguo Tian, Zhimin Fan, Cuizhi Geng, Xuchen Cao, Zhenlin Yang, Xiang Wang, Hong Liang, Shu Wang, Hongchuan Jiang, Xuening Duan, Haibo Wang, Guolou Li, Qitang Wang, Jianguo Zhang, Feng Jin, Jinhai Tang, Liang Li, Shi-Guang Zhu, Wenshu Zuo, Fei Wang, Lixiang Yu, Fei Zhou, Yujuan Xiang, Mingming Guo, Yongjiu Wang, Wenzhong Zhou, Shuya Huang, Zhaohui Li, Yajie Zhou, Lijuan Hou, Xinyi Yang, Xuan Zhang, Liyuan Liu, Zhigang Yu. Lifestyle factors are associated with breast cancer risk in women biopsied for benign breast diseases in China: 10-year results of a multi-center, hospital-based, case-control study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-31.

Abstract OT1-15-01: SWOG 1904: Cluster-randomized controlled trial of patient and provider decision support to increase chemoprevention informed choice among women with atypical hyperplasia or lobular carcinoma in situ (MiCHOICE)

Abstract Background: Despite evidence of substantial breast cancer risk reduction, few high-risk women adopt chemopreventive medications such as selective estrogen receptor modulators (SERMs) or aromatase inhibitors (AIs). Women with benign breast disease, such as atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS), have an increased risk of developing breast cancer and derive a greater benefit from antiestrogens compared to other high-risk women. Reasons for low uptake of chemoprevention include insufficient patient and clinician knowledge about antiestrogens, time constraints during the clinical encounter, and concerns about side effects. To address these barriers, we have developed patient and provider web-based decision support tools to improve informed choice about breast cancer chemoprevention among women with AH or LCIS. Study design: We are conducting a cluster-randomized controlled trial of clinical decision support to improve chemoprevention informed choice among women with AH or LCIS and their treating providers. Twenty-six U.S. sites through the SWOG Cancer Research Network were randomly assigned 1:1 to standard educational materials alone or in combination with the patient-centered decision aid (RealRisks) and provider decision support tool (BNAV). A total of 415 patients and 200 healthcare providers will be recruited from these sites. RealRisks consists of interactive modules to calculate personalized breast cancer risk and elicit preferences on chemoprevention. The modules are available in English and Spanish. BNAV is comprised of self-directed case-based learning modules on breast cancer risk assessment and chemoprevention. Patients complete questionnaires at baseline, 6 and 12 months. Providers complete surveys at baseline and after their enrolled patient’s 6-month clinical encounter. The primary endpoint is chemoprevention informed choice at 6 months, using a measure combining knowledge, attitude, and intention scales. Secondary endpoints include perceived breast cancer risk/worry, chemoprevention knowledge/intention, decision conflict/regret, shared decision-making, and chemoprevention uptake. For patients who begin chemoprevention, adherence and reasons for discontinuation are assessed annually for up to 5 years. Barriers and facilitators to implementing RealRisks and BNAV into clinic workflow will be assessed by conducting patient and provider interviews at baseline and mid-implementation. Eligibility criteria: Eligible patients include women, age 35-74 years, with AH or LCIS, no history of breast cancer, no prior use of SERMs or AIs, no bilateral mastectomies, English or Spanish-speaking, and access to the internet. Eligible providers include breast surgeons, medical oncologists, primary care providers, and physician extenders who see patients with AH or LCIS. Statistical methods: We have 90% power to detect a 15% increase in the frequency of chemoprevention informed choice with a 1-sided 0.025 level test, assuming an intraclass correlation (ICC) of 0.02 to account for clustering, roughly equal accrual at each site, 10% loss to follow-up, and ≤10% event rate in the control arm. Current/target accrual: The trial was activated on 9/1/2020. As of 7/7/2022, all 26 sites have been randomized, 157/200 providers and 184/415 patients have been enrolled. Discussion: Our hybrid effectiveness/implementation study seeks to evaluate the effectiveness of a multi-level intervention in promoting informed decision-making about breast cancer chemoprevention. Study results will provide valuable insights on how the decision support tools are integrated in diverse clinical settings. Citation Format: Katherine D. Crew, Garnet Anderson, Kathryn Arnold, Andrew Stieb, Jacquelyn N. Amenta, Cynthia Law, Ana Sandoval-Leon, Sarah Colonna, Tari King, Debra Mangino, Sandhya Pruthi, Maria Grosse Perdekamp, Christa Braun-Inglis, Stacy Krisher, Lisa Yee, Danielle Bertoni, Samantha Seaward, Kari B. Wisinski, Justin Floyd, Corrine Zarwan, Tarah J. Ballinger, Lindi VanderWalde, Masey M. Ross, Preston Steen, Shelly Lo, Alison Conlin, Kathleen Yost, John Ellerton, Erin Lin, Holly J. Pederson, Sagar Sardesai, Cheryl Jernigan, Dawn Hershman, Marian L. Neuhouser, Banu K. Arun, Rita Kukafka. SWOG 1904: Cluster-randomized controlled trial of patient and provider decision support to increase chemoprevention informed choice among women with atypical hyperplasia or lobular carcinoma in situ (MiCHOICE) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-15-01.

Comparative study of ultrasound-guided microwave ablation and traditional surgery in the treatment of plasma cell mastitis: a multicenter study.

Plasma cell mastitis (PCM) is a benign breast disease that is refractory and difficult to cure. We integrated microwave ablation into the treatment of PCM to compare the clinical value of ultrasound-guided microwave ablation and traditional surgery in the treatment of PCM. A total of 68 patients with PCM who were admitted to 3 centers (Zhejiang Cancer Hospital, Hebei Province Hospital of Traditional Chinese Medicine, and Yantai Affiliated Hospital of Binzhou Medical university) from January 2017 to June 2019 were selected. All patients were diagnosed with PCM after pathological and clinical manifestations. Among these, 38 cases were treated with ultrasound-guided microwave ablation, and 30 cases were treated with traditional surgery. The operation time, hospitalization time, incision healing, intraoperative blood loss, postoperative pain degree, evaluation of breast shape effect, time taken for postoperative lesion disappearance, effective rate, and recurrence were recorded in the follow-up, and the clinical efficacy was compared and observed. The effective rate of the ablation group was 86.8% (33/38), that of the operation group was 46.7% (14/30), and the difference was statistically significant (95% CI: 2.311-24.618; P<0.05). The average time of the lesion completely disappearing was 75.55±43.59 days in the ablation group and 103.87±45.98 days in the operation group, and the difference was statistically significant (P<0.05). The hospital stays, operation time, and intraoperative blood loss of patients in the ablation group were less than those of the operation group, and the difference was statistically significant (95% CI: -10.69 to -6.27, 95% CI: -77.06 to -51.26, and 95% CI: -21.54 to -13.64; P<0.05). The postoperative pain scoring, operative incision healing at 14 days after the operation, and breast appearance evaluation after treatment in the ablation group were better than those of the operation group, and the difference was statistically significant (P<0.05). Compared with traditional surgery, ultrasound-guided microwave ablation is a more effective treatment option for PCM.

Abstract PD14-01: PD14-01 A model to assess the utility of risk-based screening algorithms

Abstract PD14-01: PD14-01 A model to assess the utility of risk-based screening algorithms

Diagnostic Value of Ultrasound Elastography in the Differentiation of Breast Invasive Ductal Carcinoma and Ductal Carcinoma In situ.

Ultrasound elastography (US-E) has been shown superior to the conventional US in diagnosing benign and malignant breast lesions. In contrast, the role of US-E in the differentiation of breast invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS) has been poorly described. This study was designed to examine the diagnostic value of US-E in the differentiation of IDC and DCIS. Medical records of all patients who underwent preoperative US-E evaluation and were diagnosed with IDC or DCIS at our hospital from April-December 2019 were retrieved and analyzed. Those who had prior surgical treatment, chemotherapy or radiotherapy were excluded. Twenty women with DCIS and 111 women with IDC were included in this study. There were no significant differences in age, maximum lesion diameter and tumor volume between the two groups. While shear wave velocity (SWV) inside the lesion and in the surrounding tissue, strain ratio and tumor area ratio were not substantially different between the two groups, SWV at the edge of the lesion was significantly higher in IDC cases, which had an AUC value of 0.66 with a sensitivity of 65.8% and a specificity of 60.0% for the differential diagnosis of IDC and DCIS. Edge SWV is significantly higher in IDC than that in DCIS, which had a moderate diagnostic value for the differentiation of IDC and DCIS, similar to the performance of diffusion-weighted magnetic resonance imaging as reported in the literature. In terms of cost-effectiveness, US-E could be very useful while waiting for further evaluations to determine whether US-E combined with other diagnostic modalities improves the diagnostic performance.

Abstract P5-04-03: Analyzing the performance of Thermalytix, an AI-based breast cancer screening solution, in a community setting

Abstract Background: Despite improvements in treatment strategies, breast cancer survival rates remain low in India due to a lack of awareness and late stage of presentation. If diagnosed and treated early, breast cancer survival rates improve. Screening mammography, the gold standard in cancer diagnosis, is not feasible in a resource-constrained setting. Niramai’s novel breast cancer screening technology, Thermalytix™, applies Artificial Intelligence (AI) over thermography, to give an automated interpretation of the breast thermal images. The portable Thermalytix test has been so far used to screen 60000 women in community settings across India and Kenya. This study is a recent evaluation of the test in rural setting. Methods: Women who provided written consent and who underwent Thermalytix tests in community-based screening camps at primary health centers (PHCs) in Afzalpur Taluk of Gulbarga District, Karnataka, India between 01 August 2021 to 15 June 2022 were included in this study. Five thermal images in multiple views were analyzed using Niramai’s patented algorithm. Automated analysis of the thermal images produced a screening report and triaged the participants for follow-up. In case of abnormal thermal activity, Thermalytix triaged women as ‘red’ and were referred to the district hospital for follow-up with breast ultrasound and/or other investigations and and were recorded into the following three categories: Normal (BI-RADS 1), Abnormal - benign (BI-RADS 2/3) and Abnormal - malignant (BI-RADS 4/5). If no abnormal thermal patterns were detected by Thermalytix, women would be recommended routine screening. Findings: The analysis included 3531 women were included in the analysis and the median age in the cohort was 42 years. Of them, 97 (2.74%) women were triaged ‘red’ by Thermalytix indicating a suspicion of breast abnormality. As on 15 June 2022, 29 (30%) out of 97 women underwent standard follow-up investigations of which two cases of carcinoma breast, one case of phyllodes, one case of tuberculosis mastitis and seven other benign cases were identified, indicating that Thermalytix has a positive predictive value of 35.71% (11/29) in detecting benign and malignant breast lesions. Furthermore, a Patient experience questionnaire was used to asses their experience. 98.71% women were being screened for breast cancer for the first time in their lives. 93.9% women said they were very satisfied with Thermalytix screening experience and remaining 6.1% said they were satisfied, thus aiding in strong acceptability and adoption of the test. Interpretation: In resource-constrained settings such as India, where less than 2% of the women in the country have ever got screening for breast cancer, the portable, no-radiation Thermalytix test is an accessible breast cancer screening solution. Thermalytix’s patient-friendly features - privacy-aware, painless, comfortable, and radiation-free make it favorable for population screening in India, and thus, can increase the uptake of breast cancer screening. With the device’s capacity to fit into a backpack, it can make breast cancer screening accessible to even remote areas with limited resources. However, following up on women who were found to be Thermalytix positive still remains a challenge. Future studies will emsure that follow-up after abnormal breast screening is part of the approved clinical protocol. Results of the screening program 3 malignancies and 8 benign lesions found in 29 Thermalytix RED patients Citation Format: Geetha Manjunath, Lakshmi Krishnan, Gargi Deshpande, Purnima Madhivanan, Karl Francis Krupp. Analyzing the performance of Thermalytix, an AI-based breast cancer screening solution, in a community setting [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-04-03.

A GIANT FIBROADENOMA – AN UNUSUAL CASE IN A MATURE WOMAN

Introduction: Common benign breast tumours called broadenomas are frequently observed in young patients. Giant broadenomas are uncommon benign lesions that are described as broadenomas which are &gt;5 cm in size and are typically detected in women aged 15-25 years. Fibroadenomas typically appear as rm, movable, painless nodules with distinct boundaries. Giant broadenomas, which are dened as broadenomas larger than 5 cm in size or 500 g, are uncommon benign breast lesions that make up between 0.5% and 2% of all broadenomas. They typically affect women who are pregnant, nursing, or in their adolescent years

Abstract PD12-06: PD12-06 Longitudinal analysis of breast density change assessed by digital mammogram is associated with breast cancer

Abstract Mammographic breast density is a well-established and strong risk factor for breast cancer. Widespread use of digital mammography has opened new potential for assessment of density changes over time. The underlying premise is that changes in breast tissue due to evolving structures that support cancer development should translate to quantifiable differences between the two breasts over time. To address this hypothesis, we draw on extensive digital mammography data and bring repeated measures over up to 10 years to evaluate the association between change in mammographic breast density and risk of breast cancer. Women were recruited from November 2008 to April 2012 through the mammography service at the Joanne Knight Breast Health Center at Washington University in St Louis. Baseline questionnaire risk factors and screening mammograms were collected from 12,153 women. Of these, 1,672 were excluded for prior history of any cancer (except non-melanoma skin) or diagnosis of breast cancer within 6 months of registration for the study, for a total of 10,481 women. Follow-up is through linking to electronic health records, tumor registry and death register. Routine screening mammograms are collected every 1 to 2 years. Follow-up of cohort participants through December 2020 was: 78% seen in 2019 or 2020; a further 4.4% seen most recently in 2018 and a further 2.4% in 2017 giving over 80% active follow-up for women seen within the last 36 months. The median number of mammograms is 5 (min = 1, max = 10; sd = 2.43). The average person-years of follow-up through most recent contact is 9.2 person-years. We have excluded women who are diagnosed within the first 6 month of baseline mammogram date in all analyses, leaving 259 cases and 695 controls with a total number of 8,966 crandiocaudal (CC) view mammograms for analysis. For these 954 women, the mean number of years between mammograms is 1.3 (10th percentile: 1.0, 90th percentile: 2.0). For the cases, the mean number of years from last mammogram date to diagnosis date was 2.0 years (10th percentile: 1.0, 90th percentile: 3.9) after excluding mammograms that are within 6 months of diagnosis. The percentage volumetric density (MD) within each digital CC-view mammogram is estimated with an automated pixel-thresholding algorithm ADAPT implemented within the Division of Public Health at WashU. The skin around the breast is automatically removed using a boundary detection algorithm prior to estimating the dense areas. The percent density (MD) is then estimated using the dense area divided by the total breast area which normalizes the difference in breast size across women. The correlation between average MD generated from our automated algorithm with Volpara is 0.82. Initial analyses use linear mixed effects with average density between breasts (fitted with R package lmer). We performed test of assumptions for all linear mixed effects models, including the normality of residuals, linearity, and homogeneity of residual variance. Assessing the averaging density between 2 breasts controlling for age, BMI, histology confirmed benign breast disease, family history, parity, and alcohol, MD decreases significantly over follow-up (time in years) (P &amp;lt; 0.01). At baseline, postmenopausal women had lower density than premenopausal women after controlling for the same set of risk factors. The average MD over all time points was significantly different for the case vs. control women (P &amp;lt; 0.01). For overweight women, the trajectory of MD over time was significantly different for the case vs. control women (P &amp;lt; 0.01). Drawing on over 10 years of follow-up we observe, for the first time, a dynamic effect for breast density such that divergence in density over time is related to risk for breast cancer. Citation Format: Graham A. Colditz, Shu Jiang. PD12-06 Longitudinal analysis of breast density change assessed by digital mammogram is associated with breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD12-06.

Abstract PD14-04: PD14-04 Whole mammogram image-based Cox regression improves 5-year breast cancer prediction

Abstract To efficiently capture data from mammographic breast images and classify long-term risk of breast cancer, we developed FLIP, a novel Cox regression-based framework that fully utilizes data in the mammograms beyond current density measures. FLIP use the extensive existing data that are currently ignored in the context of breast cancer risk stratification. More than 20 studies support texture features add value to risk prediction beyond breast density. However, the entire mammogram imaging data has a high dimension of pixels (~13 million per image), greatly exceeding the number of women in a cohort. FLIP was fitted and cross-validated within the Joanne Knight Breast Health Cohort excluding cases diagnosed in the first 6 months of entry. The Joanne Knight Breast Health Cohort is comprised of over 10,000 women undergoing repeated mammography screening at Siteman Cancer Center and followed since 2010. All women had baseline mammogram at entry, provided a blood sample and completed a risk factor questionnaire. Mammograms are all using the same technology (Hologic). During follow-up through October 2020, we identified 246 incident breast cancer cases (pathology confirmed) and matched them to controls from the perspective cohort based on month of mammogram and age at entry. We obtained an AUC of 0.68 (SE 0.03) including the whole mammogram image, age and BI-RADS (4th edition) density category; and AUC of 0.72 (SE 0.04) by adding in BMI and menopausal status to this model. These 5-year prediction performances exceed that of well-developed models based on epidemiologic risk factors (P &amp;lt; 0.001). FLIP offers standard statistical solutions and removes barriers to wider clinical use without prohibitive training data and extensive computational requirements, providing a transparent workflow ensuring high reproducibility. It should be accessible anywhere mammograms are used. We conclude that using full mammogram images for breast cancer risk prediction captures additional information on breast tissue characteristics that relate to cancer risk, and improves prediction classification. This prediction algorithm can run efficiently in real time (in seconds) with processing of digital mammograms. Thus, this model can be easily implemented in mammography screening services and other clinical settings to guide real-time risk stratification to improve precision prevention of the leading cancer in women world-wide. Further analysis will quantify the value of adding other breast cancer risk factors, including polygenic risk scores. Addition of repeated mammogram images over time should further increase classification performance. This approach has the potential to improve risk classification by using data already available for the vast majority of women already having repeated screening mammograms. Schema overview of FLIP The raw images are in the form of .dcm files before entering into FLIP. After automated processing and image alignment, the two CC-views (left and right) are average between the two breasts for characterization. The inputted 2D mammograms are first characterized with bivariate splines over triangulation to preserve spatial distribution of pixels and accommodate the irregular semi-circular breast boundary. The characterization is further optimized (see Supplemental Material) which provides a unique and closed-form solution. b. A simple Cox proportional hazards model is adopted using well-established risk factors (RF), including age, breast density (BI-RADS), BMI, menopausal status, parity, family history, and history of benign breast disease. The mammogram image acts as an additional risk factor in the Cox regression accompanied with a 2D coefficient surface. All inferential procedures with Cox regression are applicable to FLIP which provides a transparent workflow ensuring high reproducibility. h_i (t) denotes the hazard function at time t for individual i, and h_0 (t) denotes the nonparametric baseline hazard function. c. Women who are diagnosed with breast cancer within the first 6 month of their mammogram date have been removed from this analysis and we focus on the 5-year risk. Discriminatory performance is assessed with AUC and validated via a 10-fold cross-validation. Citation Format: Shu Jiang, Graham A. Colditz. PD14-04 Whole mammogram image-based Cox regression improves 5-year breast cancer prediction [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD14-04.

CLINICAL PROFILE OF BENIGN BREAST DISEASES AND MANAGEMENT- A HOSPITAL BASED STUDY

Background: Benign breast disease is the most common cause of breast problems. The aim of the study is to look at the different types, age distribution, modes of presentation of the various benign breast diseases and management. Methods: A hospital based cross sectional study was carried out in 50 female patients presenting with benign breast diseases to the Department of General Surgery, Jorhat Medical College &amp; Hospital from May 2021 to April 2022. After detailed clinical history they were subjected to clinical examination and investigations and they were managed accordingly. Results: The most common benign breast disease encountered in this study was fibroadenoma (62%) followed by fibrocystic disease(18%) mainly occurring in the 3rd(52%) and 2nd(34%) decade of life. All the cases presented with lump in the breast and 98% of the affected female were in pre-menopausal period. Out of the 50 cases, 36 patients were treated surgically. Conclusion: Benign breast diseases constitute the majority of breast complains and it has psychological impact on the patients. The biggest fear of such lump is turning out to be malignant. Appropriate evaluation is needed so that patients are not unduly alarmed and reassured.

Investigating the expression of cytokeratin 5/6 in benign and malignant breast lesions

Introduction: Breast cancer (BC) is the most common cancer in women, which is the second most common malignancy in terms of mortality and prevalence after lung cancer. BC is a group of very diverse diseases that can be detected at a molecular, histopathological and clinical level. Objectives: The aim of the present study was to evaluate the expression of CK5/6 and its relationship to some of the factors affecting prognosis, such as tumor grade, lymph node involvement. Patients and Methods: In this cross-sectional study with descriptive and analytical aspects, 40 malignant and 20 benign tumors were collected in 2020 from the archives of the pathology department of two educational hospitals in the city of Ahvaz. The demographic and clinical characteristics of each specimen, including age, patient, lymphovascular and perineural invasion, lymph node involvement, tumor grade and tumor type were extracted from the patients’ record. Then the expression of CK5/6 intensity staining was examined by immunohistochemistry. Results: All benign breast lesions had positive expression for CK5/6 and staining intensity between six and nine. In the malignant group, 33 samples showed negative expression of CK5/6 and only seven samples (17.5%) showed positive expression with a low-staining index. A positive expression with a low-staining index. All seven positive specimens were invasive ductal carcinoma (IDC) lesions with staining index 2, 4, and 6. Additionally, none of the ductal carcinoma in situ (DCIS) specimens which immunostained were positive for CK5/6. In the present study, all IDCs with weak expression of CK5/6 were grade III. No statistically significant relationship was observed between perineural and lymphovascular invasion and lymph node involvement with the intensity of CK5/6 expression. Conclusion: Our study showed that cytokeratin immunohistochemical intensity is able to distinguish benign lesions from malignant IDC and DCIS lesions and accordingly in determining of tumor grade after weak staining in high-grade IDC, which may be due to squamous metaplasia in these tumors; however, more extensive research with a larger sample size are required to assess its effect in lymphovascular and perineural invasion and also lymph node involvement.

Spectrum of breast diseases in North Western India: an analysis of 8604 pathologies

Background: There is paucity of data on the spectrum of breast diseases in India due to lack of reporting system. This study was conducted to understand the pattern of breast diseases in northwest India. It is by far the largest study to provide epidemiological data on breast disease spectrum in India. Methods: Total of 8604 breast pathological reports were obtained from four major diagnostic centers in North West India. These included benign and malignant breast lesions. Results: There were 5985 (69.56%) lesions in the benign group and 2619 (30.43%) lesions in malignant group. Women formed 92.73% (7978) of the study group. Among benign lesions, most common were discrete benign lumps 59.19% (3543) followed by fibrocystic changes 16.02% (959). The most common age group was ≤20 years for discrete benign lumps and gynecomastia whereas 31-40 years for fibrocystic changes. Among malignant lesions, the most common was infiltrating duct carcinoma (not otherwise specified) with 32.72% (857) followed by infiltrating duct carcinoma (moderately differentiated) 26.84% (703) with the most common age group of 41-50 years. Among breast lesions in men, male breast carcinoma formed 2.25% (59) of malignant breast lesions. Gynecomastia formed 0.65% (560) of all breast lesions. Conclusions: Most common breast lesions were discrete breast lumps. Benign lesions are more common in early 20’s while malignant lesions are more common in the 5th decade. The study revealed a higher proportion of male breast carcinoma.

Comorbid status of patients with hypertension

To establish age and gender characteristics, nosological structure of comorbidity among persons 20-99 years with hypertension. The study is based on data from 21 514 electronic health records of the population (20-99 years old) with hypertension, mean age 63.0 years, 68.2% women. Diseases associated with hypertension with a frequency above 10% were analyzed. In the sample of people with hypertension, concomitant diseases were detected in 82.7% of cases, 1 disease accompanies 21.0% of the sample with hypertension, 2 diseases 17.9%, 3 diseases 14.0%, 4+ diseases 29.8%. The frequency of association of hypertension with ≥1 concomitant disease at the 20-29 years is 60.8% of cases, at 30-39 years - 65.1%, at 40-49 years - 73.9%, at 50-59 years - 81.1%, 60-69 years - 85.8%, 70-79 years - 87.3%, 80+ years - 86.2% of cases. Among women with hypertension, the average number of concomitant diseases is higher compared to men (3.47 vs 2.4 cases; p<0.001). Among young and middle-aged people, hypertension in most cases is associated with osteochondrosis, osteoarthritis, chronic pancreatitis, gastritis and duodenitis, retinal diseases, thyroid diseases, the female with hypertension accompanied by benign breast disease and menopausal disorders. Hypertension in the elderly is most often associated with cerebrovascular disease, coronary heart disease, diabetes mellitus, senile cataract, but osteochondrosis and osteoarthritis also do not lose their relevance. The existing system of organization of medical care cannot meet the needs of patients with comorbidity, which indicates the need to reorient medical care towards patient-centered care.

Intraobserver and Interobserver Reproducibility of Breast Diffusion-Weighted Imaging Quantitative Parameters: Readout-Segmented vs. Single-Shot Echo-Planar Imaging.

The recommended technique for breast diffusion-weighted imaging (DWI) acquisitions is not sufficiently standardized in clinical practice. To investigate the intraobserver and interobserver reproducibility of DWI measurements, diffusion-kurtosis imaging (DKI) parameters, and image quality evaluation in breast lesions between single-shot echo-planar imaging (ss-EPI) and readout-segmented echo-planar imaging (rs-EPI). Prospective. A total of 295 women with 209 malignant and 86 benign breast lesions. A 3-T; fat-saturated T2-weighted MR imaging (T2WI); multi-b-value DWI with both ss-EPI and rs-EPI readouts; T1-weighted dynamic contrast-enhanced MRI (DCE-MRI). Mean kurtosis (MK), mean diffusion (MD), and apparent diffusion coefficient (ADC) values were measured for each lesion on ss-EPI and rs-EPI, respectively. Image quality was visually evaluated regarding image sharpness, geometric distortion, lesion conspicuity, visualization of anatomic structures, and overall quality. Quantitative and qualitative analyses were performed twice with a time interval of 2 weeks. Intraobserver and interobserver reproducibility wereevaluated using intra-class correlation coefficients (ICC), within-subject coefficient of variation (wCV), and Bland-Altman plots. MK, MD, and ADC quantitative parameters for breast lesions showed excellent intraobserver and interobserver reproducibility, with ICCs >0.75 and wCV values ranging from 2.51% to 7.08% for both sequences. The wCV values in both intraobserver and interobserver measurements were higher in the ss-EPI sequence (3.63%-7.08%) than that of the rs-EPI sequence (2.51%-3.62%). The wCV values differed in subgroups with different histopathological types of lesions, breast density, lesion morphology, and lesion sizes, respectively. Furthermore, rs-EPI (ICCs, 0.76-0.97; wCV values, 2.41%-6.04%) had better intraobserver and interobserver reproducibility than ss-EPI (ICCs, 0.54-0.90; wCV values, 6.18%-13.69%) with regard to image quality. Compared to the ss-EPI, the rs-EPI sequence showed higher intraobserver and interobserver reproducibility for quantitative diffusion-related parameters and image quality assessments measured in breast DWI and DKI. 2. Stage 2.

Potential Early Markers for Breast Cancer: A Proteomic Approach Comparing Saliva and Serum Samples in a Pilot Study.

Breast cancer is the second leading cause of death for women in the United States, and early detection could offer patients the opportunity to receive early intervention. The current methods of diagnosis rely on mammograms and have relatively high rates of false positivity, causing anxiety in patients. We sought to identify protein markers in saliva and serum for early detection of breast cancer. A rigorous analysis was performed for individual saliva and serum samples from women without breast disease, and women diagnosed with benign or malignant breast disease, using isobaric tags for relative and absolute quantitation (iTRAQ) technique, and employing a random effects model. A total of 591 and 371 proteins were identified in saliva and serum samples from the same individuals, respectively. The differentially expressed proteins were mainly involved in exocytosis, secretion, immune response, neutrophil-mediated immunity and cytokine-mediated signaling pathway. Using a network biology approach, significantly expressed proteins in both biological fluids were evaluated for protein-protein interaction networks and further analyzed for these being potential biomarkers in breast cancer diagnosis and prognosis. Our systems approach illustrates a feasible platform for investigating the responsive proteomic profile in benign and malignant breast disease using saliva and serum from the same women.

Demographic and Socioeconomic Risk Factors for Granulomatous Mastitis in the United States: A Case-Control Study.

Granulomatous mastitis (GM) is a benign breast disease that can have an extended clinical course impacting quality of life and causing breast disfigurement. Granulomatous mastitis has been studied throughout the world; however, less is known about GM patients in the United States. We aim to identify demographic and socioeconomic factors associated with GM in the United States. An IRB-approved retrospective case-control study was performed of 92 patients with biopsy-proven GM at two institutions in Los Angeles, California: a safety-net hospital and an academic institution. Age-matched controls were selected from patients presenting for diagnostic breast imaging. Demographic and socioeconomic characteristics were collected. Data were analyzed using univariable test for odds ratios (ORs) with 95% confidence intervals (CIs) and multivariable conditional logistic regression. Patients with GM were more likely to prefer Spanish language (OR 6.20, 95% CI: 2.71%-14.18%), identify as Hispanic/Latina (OR 5.18, 95% CI: 2.38%-11.30%), and be born in Mexico (OR 3.85, 95% CI: 1.23%-12.02%). Cases were more likely to have no primary care provider (OR 3.76, 95% CI: 1.97%-7.14%) and use California Medicaid for undocumented adults (OR 3.65, 95% CI: 1.89%-7.08%). In the multivariable analysis, participants who preferred Spanish language had four times higher odds of GM versus those who preferred English language (OR 4.32, 95% CI: 1.38%-13.54%). Patients with GM may have barriers to health care access, such as preferring Spanish language, being an undocumented immigrant, and not having a primary care provider. Given these health care disparities, further research is needed to identify risk factors, etiologies, and treatments for this subset of GM patients.

Study on the correlation between B vitamins and breast cancer

BackgroundRelevant studies suggest that serum vitamin level is related to the risk of breast cancer, and dietary pattern and drug supplementation can significantly affect the level of vitamin in the body. Therefore, intervention of vitamin level in the body is expected to be a potential strategy to reduce the risk of breast cancer. However, the current epidemiological findings of serum vitamin levels and breast cancer risk are inconsistent, and the relationship between serum vitamin and breast cancer is still controversial. In this study, we compared the serum vitamin expression levels of healthy people, benign breast patients, and breast cancer patients, and evaluated the relationship between B vitamin levels and breast cancer risk.MethodsThe study used liquid chromatography-tandem mass spectrometry to determine the serum vitamin levels of 520 people who attended Yunnan Cancer Hospital from September 2020 to December 2020. After screening by exclusion criteria, 38 patients with benign breast diseases, 87 patients with breast cancer and 91 healthy controls were finally included. The kruskal–wallis H test was used to compare the differences in serum vitamin levels of subjects. Χ2 test was used to evaluate the relationship between B vitamin level and age,BMI,TNM staging,Ki-67,Her-2,surgery and chemotherapy, and other baseline characteristics and through binary logistic regression analysis, calculating odds ratio and 95% confidence interval (CI) to evaluate the relationship between B vitamins and breast cancer risk.ConclusionThe levels of VitB1 and VitB5 in the serum of breast cancer patients and patients with benign breast diseases were higher than those in the healthy control group, while the expression levels of VitB3 in breast cancer patients were lower than those in the healthy control group and the breast benign disease groups. The level of VitB1 was positively correlated with breast cancer risk. The VitB3 level was negatively correlated with breast cancer risk. The VitB5 level is not significantly related to the risk of breast cancer.

Blood-Based mRNA Tests as Emerging Diagnostic Tools for Personalised Medicine in Breast Cancer.

Molecular diagnostic tests help clinicians understand the underlying biological mechanisms of their patients' breast cancer (BC) and facilitate clinical management. Several tissue-based mRNA tests are used routinely in clinical practice, particularly for assessing the BC recurrence risk, which can guide treatment decisions. However, blood-based mRNA assays have only recently started to emerge. This review explores the commercially available blood mRNA diagnostic assays for BC. These tests enable differentiation of BC from non-BC subjects (Syantra DX, BCtect), detection of small tumours <10 mm (early BC detection) (Syantra DX), detection of different cancers (including BC) from a single blood sample (multi-cancer blood test Aristotle), detection of BC in premenopausal and postmenopausal women and those with high breast density (Syantra DX), and improvement of diagnostic outcomes of DNA testing (variant interpretation) (+RNAinsight). The review also evaluates ongoing transcriptomic research on exciting possibilities for future assays, including blood transcriptome analyses aimed at differentiating lymph node positive and negative BC, distinguishing BC and benign breast disease, detecting ductal carcinoma in situ, and improving early detection further (expression changes can be detected in blood up to eight years before diagnosing BC using conventional approaches, while future metastatic and non-metastatic BC can be distinguished two years before BC diagnosis).