Diagnosis Of Breast Cancer Research Articles

Pregnancy and Breast Cancer: A Challenge for the Multidisciplinary Team. A Single Center Experience and Narrative Review.

The diagnosis of breast cancer during pregnancy is a rare event, but it is more frequent in our daily clinical practice due to the progressing aging of pregnant women. The management of a woman affected by pregnancy-associated breast cancer (PABC) remains a challenge for the clinician as it is related to ethical and psychological decisions. Here, we retrospectively described 10 cases of PABC in women treated at our Institution. All cases were discussed in the multidisciplinary team. We reviewed available literature data on the topic. Nine out 10 patients were diagnosed with localized breast cancer. The remaining patients were presented with metastatic de novo disease. Median age was 37.5 years (range 26-42). Seven patients presented with grade 3 tumor and 9 patients had Ki-67 value higher than 30%. All but 2 patients received neoadjuvant chemotherapy consisting of sequential anthracyclines and cyclophosphamide followed by weekly paclitaxel during pregnancy. No safety concerns or complications during delivery for both the mothers and the babies were reported. Breast cancer during pregnancy is a challenging clinical situation and all the decisions need to consider both the patients and the fetus safety. Data from our series and from literature confirm the safety of standard chemotherapy approach starting from the second trimester of gestation. More research and effort are needed to offer these patients excellent outcomes and it is mandatory that cases should be closely followed up by a multidisciplinary team.

Optimization and correction of breast dynamic optical imaging projection data based on deep learning

Breast cancer poses a significant health threat to women, necessitating advancements in diagnostic technologies. Breast dynamic optical imaging (DOI) technology, recognized for its non-invasive and radiation-free properties, is extensively utilized for the early screening and quantitative analysis of breast tumors. The integration of deep learning, a robust technology for automatic image feature extraction, with breast DOI has the potential to enhance tumor detection and diagnosis significantly. This paper introduces a deep learning-enhanced image optimization approach to overcome challenges such as poor image quality and distorted projection data commonly encountered in existing DOI methods. The approach utilizes convolutional neural networks (CNNs) to extract features from raw images and employs generative adversarial networks (GANs) to enhance these images, thereby improving their quality and contrast. Additionally, a novel correction algorithm is developed to address projection data distortion, enabling the reconstruction and correction of this data for more accurate and reliable imaging results. Experimental findings confirm that the proposed method markedly enhances both image quality and projection data accuracy in breast DOI, offering a reliable foundation for clinical diagnosis. This study not only provides a new perspective and methodology for the early screening and diagnosis of breast cancer but also holds substantial clinical importance and prospective applications.

Defining the Need for Services for Patients at High Risk of Breast Cancer at a Safety-Net Hospital: An Approach to Narrowing the Disparities Gap.

The National Accreditation Program for Breast Cancer (NAPBC) standards were recently revised to promote breast cancer (BC) risk assessment and subsequent referral for high-risk services. This project sought to estimate the proportion of patients at high risk for BC in the authors' safety-net hospital system, gauge patient interest in high-risk services, and define resources for program development. Women presenting for breast imaging during 2 weeks in 2023 were surveyed. Thirty-five patients with a history or diagnosis of BC were excluded. The Tyrer-Cuzick (TC) model version 8 was used to calculate BC risk. High/intermediate risk was defined as a 10-year risk of 5% or more, a lifetime risk of 15% or more, or both. The criteria for genetic counseling and testing referral were based on National Comprehensive Cancer Network guidelines. A total of 257 patients had a TC risk assessment showing 14.8% (n = 38) with a 10-year BC risk of 5% or more (consideration of endocrine therapy), 6.2% (n = 16) with a lifetime BC risk of 20% or more (qualifying for annual screening MRI), and 10.5% (n = 27) with a lifetime BC risk of 15% or more (consideration of high-risk screening). The criteria for genetic counseling/testing were met by 61 (23.7%) of the 257 patients. Overall, 31.5% (n = 81) qualified for high/intermediate-risk screening, risk reduction, and/or genetic assessment/testing, 92.8% of whom were interested in referrals for additional information and care. In the authors' community, almost one third of patients undergoing breast imaging qualify for BC high-risk assessment and services. The majority of the patients expressed interest in pursuing such services. These data will be used in financial planning and resource allocation to develop a high-risk program at the authors' institution in line with NAPBC guidelines. They are hopeful that these efforts will improve oncologic outcomes and survival from BC in their community.

Tumor detection in breast cancer pathology patches using a Multi-scale Multi-head Self-attention Ensemble Network on Whole Slide Images

Breast cancer (BC) is the most common type of cancer among women globally and is one of the leading causes of cancer-related deaths among women. In the diagnosis of BC, histopathological assessment is the gold standard, where automated tumor detection technologies play a pivotal role. Utilizing Convolutional Neural Networks (CNNs) for automated analysis of image patches from Whole Slide Images (WSIs) enhances detection accuracy and alleviates the workload of pathologists. However, CNNs often face limitations in handling pathological patches due to a lack of sufficient contextual information and limited feature generation capabilities. To address this, we propose a novel Multi-scale Multi-head Self-attention Ensemble Network (MMSEN), which integrates a multi-scale feature generation module, a convolutional self-attention module, and an adaptive feature integration and output module, effectively optimizing the performance of classical CNNs. The design of MMSEN optimizes the capture of key information and the comprehensive integration of features in WSIs pathological patches, significantly enhancing the precision of tumor detection. Validation results from a five-fold cross-validation experiment on the PatchCamelyon (PCam) dataset demonstrate that MMSEN achieves a ROC-AUC of 99.01%±0.02%, an F1 Score of 98.00%±0.08%, a Balanced Accuracy (B-Acc) of 98.00%±0.08%, and a Matthews Correlation Coefficient (MCC) of 96.00%±0.16% (p<0.05). These results demonstrate the effectiveness and potential of MMSEN in detecting tumors from pathological patches in WSIs for BC.

Communicating a cancer diagnosis using a human centered design approach.

229 Background: Anticipating and getting "the call" communicating a cancer diagnosis is reportedly one of the most stressful times in a person’s life. If not pre-scheduled patients are often in unfortunate locations, doing distractive activities and are with unsympathetic companions. Additionally, patients ask for a single point of contact, impactful resources, and immediate next steps and appointments scheduling. Methods: Pilot/Study: 120 breast cancer patients: Control group: 30 positive, 30 negative DX Test group: 30 positive, 30 negative DX Test approach: co-designed with 10 patients, 5 physicians and 5 staff. Interviews: 7 care team roles. Data collection: customized patient interview assessment tool. Steady State: sustaining work done. Conducted: January 2019 through December 2022. Evaluation Methods -11 tests: t-Tests, One-Way ANOVA, and Capability. Changes Made: call be at a pre-scheduled time delivered by ongoing point of contact offering immediate next steps and appointment scheduling offering meaningful support and resources delivered with deep empathy/compassion. Results: The project was highly successful based on the results it achieved. Results: Improved by 64% (original goal of 30%) the composite measure of care satisfaction of patients receiving a breast cancer diagnosis call in Kaiser Permanente Maui, Hawaii. Composite: 1) 61% improvement in “satisfaction with your circumstance”, 2) 63% improvement in “satisfaction with the conversation”, and 3) 70% improvement in “feeling supported” using a local measurement tool. Conclusions: The 64% improvement in the patients' experience for cancer diagnosis communication was accomplished by understanding the needs of the patients and care team, establishing new communication protocols and resources, and ensuring the process empowered patients. The study showed that both patients and care teams want a communication process that included the elements in the test approach. This project was deemed a Kaiser Permanente best practice and is in consideration for spread. Improved by 64% (goal was 30%) the composite measure of care satisfaction of patients receiving a breast cancer diagnosis call in Kaiser Permanente Maui, Hawaii. Breast Cancer Diagnosis Communication - Key Improvement Metrics: Control Group Test Group Outcome Measure: the composite measure improvement 64% of care satisfaction of patients receiving a DX Results Call 2.39 3.93 Composite Measure 1: 61% improvement in “satisfaction with your circumstance” 2.35 3.78 Composite Measure 2: 63% improvement in “satisfaction with the conversation” 2.50 4.07 Composite Measure 3: 70% improvement in “feeling supported” 2.33 3.95 Process Measure: the error rate over time had a statistically significant difference between the Control and Test groups 30.3 8.90 Balancing Measure: Negative result patients have a similar experience as the Positive result patients No significant difference No significant difference

Putting the patient voice at the heart of information and education resources: The Respire+ website for radiotherapy following a breast cancer diagnosis.

Putting the patient voice at the heart of information and education resources: The Respire+ website for radiotherapy following a breast cancer diagnosis.

Clinical, histological and receptor profiles of invasive breast cancer and ductal carcinoma in situ in females with germline pathogenic variants in PTEN and implications for germline testing

PTEN hamartoma tumour syndrome (PHTS) is an autosomal dominant hereditary cancer syndrome, caused mostly by germline pathogenic variants in PTEN. Female carriers have an up to 80% lifetime risk of breast cancer. Pathologic features of breast cancer in PHTS have seldom been reported.In a collaboration between all histopathology laboratories in our state and our statewide familial cancer service, we tracked the breast biopsies of 12 females with known PTEN pathogenic or likely pathogenic variants (Jan 1990 to Jan 2018). Two further cases were added by a Victorian cancer genetics unit.Breast cancer, inclusive of invasive cancer or ductal carcinoma in situ (DCIS), was diagnosed in 12 of 14 cases (85.7%). One case had a family history of PHTS and six a family history of breast cancer. The mean age at first breast cancer diagnosis was 41.6 years (range 27-63). Six cases developed more than one breast cancer. Five (42%) developed contralateral breast cancer. Ten of the 12 invasive cancers were of no special type, two were reported as lobular carcinomas. None were grade 1. When reported, all cancers were hormone receptor positive and HER2 negative. All were associated with DCIS. The DCIS spanned all grades.The two cases without breast cancer still required surgery for exuberant benign changes, including papillomas, fibroadenomatoid change, florid ductal epithelial hyperplasia, adenosis and stromal fibrosis.We note that the morphology and receptor profiles of breast cancer in individuals with P/LP PTEN variants are not distinctive. Contrary to prevalent beliefs, these cancers do not conform to the contemporary definition of apocrine breast carcinoma. Greater familiarity of healthcare professionals with the overall clinical and pathologic findings in PHTS and the validated Cleveland Clinic PTEN calculator (http://www.lerner.ccf.org/gmi/ccscore) would improve the recognition of female PHTS individuals with breast cancer. Earlier identification of their cancer predisposition syndrome would benefit these patients and their families who are at high risk of a range of cancers.

Experiences of Social Burden amongst Survivors of Breast Cancer in Gaza: A qualitative study

PurposeThis qualitative study explores how social-cultural factors can either amplify or attenuate prospects for social support following a breast cancer diagnosis. The aim is to analyse narratives of individuals diagnosed with breast cancer to examine how the illness influences social support and hence their post-illness experiences. MethodsForty semi-structured interviews, including thirty-eight with breast cancer survivors, are analysed using a grounded theory approach. Data were collected between September 2020 and April 2021. ResultsParticipants' perceptions indicate that three main factors influenced experiences and the level of social support received. The first involves stigmatised cancer-related discourses and practices affecting women's social interactions and roles. The second is specific to (ex)married participants. It reveals how the foundation of marriage prior to the illness is a determining and influencing factor in the experience of women after illness. The third demonstrates how specific social identities enable coping, negotiation, and challenging cancer-related stigma, turning their experiences toward positivity. ConclusionsThe study concludes that breast cancer acts as a figurative magnifying glass, illuminating latent social practices in the community. This highlights the need to nurture existing social bonds or address the fragility of ties within distinct social categories. Implications for Cancer SurvivorsThe research suggests implementing customised support interventions aligned with each group of survivors' unique needs. Furthermore, enhancing awareness within patients' social networks regarding the illness and how to provide support, along with enhancing survivors' financial security through economic empowerment, may contribute to more effective coping with the social consequences of the illness.

Medical misinformation and fear of recurrence in patients with breast cancer.

354 Background: Fear of recurrence is a common yet underappreciated burden patients experience during and after cancer treatment. Medical misinformation about factors that influence risk of cancer progression/recurrence is also common. Little is known about the spread of medical misinformation and how it affects fear of cancer recurrence. Methods: From 7/2023 to 8/2023 patients completed an anonymous online survey administered by Breastcancer.org. Surveys were available in English and Spanish with eligibility: US resident, age ≥18 years, and breast cancer diagnosis within 10 years. Surveys assessed patient awareness of various factors purported to increase or decrease risk of cancer progression/recurrence and fear of recurrence (via validated FCRI-SF, scored 0-36, higher scores indicate greater fear, score ≥22 indicate clinical relevance). Multivariate analysis (MVA) assessed awareness of misinformation after controlling for age, race and ethnicity, marital status, and level of education. Chi-square assessed association between misinformation exposure and fear of recurrence. Results: Overall, 997 completed the survey. Median age was 62 (IQR 53-69), 86% were White, 5% Black, 4% Hispanic, and 3% Asian. 76% were married and 77% had completed a college or advanced degree. 52% were undergoing active cancer treatment at the time of assessment. Most (65%) reported hearing misinformation regarding factors that may INCREASE risk of cancer progression/recurrence. Specifically, patients heard that sugar (61%), deodorant (22%), vaccines (8%), cell phones (8%), and bra type (8%) could increase risk. Half (54%) reported hearing misinformation regarding factors that may DECREASE risk of cancer progression/recurrence. Specifically, patients heard that eating organic food (41%), oral vitamins/supplements (29%), alkaline diet/alkalized water (12%), vitamin infusions (7%), cleanses (5%), essential oils (5%), and oxygen therapy (4%) could decrease risk. Overall, 76% had reported at least one incorrect factor influencing risk of cancer progression/recurrence. On MVA, younger age (OR 0.99/year of age, 95%CI 0.97-1.00, p=0.044) and Hispanic ethnicity (OR 2.98, 95%CI 1.02-8.25, p=0.047) were associated with hearing misinformation. Fear of recurrence score was available for 695 (70%) patients. Median score was 19 (IQR 13-24), 38% had a clinically significant level of fear (≥22). Awareness of medical misinformation was not associated with clinically significant fear (38% vs. 35%, χ 2 0.53, p=0.469). Conclusions: In a large cohort of patients with breast cancer, medical misinformation about risk of progression/recurrence was common. Fear of recurrence was high in over a third of surveyed patients, but was not associated with awareness of false information. Further understanding of how patients perceive and process medical misinformation is essential, especially in populations at highest risk for misinformation spread.

Breast Cancer and Risk of Depression: A Comparative Cross-Sectional Study Among Women With and Without Breast Cancer in Addis Ababa, Ethiopia.

The extent of symptoms of depression among patients with breast cancer compared with those without the disease is not well documented in Ethiopia and other sub-Saharan African countries. This study examines the prevalence of symptoms of depression in women with breast cancer (n = 436) compared with those without breast cancer (n = 856) in Addis Ababa, Ethiopia, through a comparative cross-sectional study using a validated questionnaire, the Patient Health Questionnaire-9. The association between breast cancer diagnosis and symptoms of depression was evaluated using a multivariable binary logistic regression model. About 39.2% of women with breast cancer had some level of symptoms of depression compared with 23.8% of women without the disease. By severity of symptoms of depression, 13.1% of women with breast cancer reported moderate to severe symptoms of depression compared with 6.8% of women without the disease. Sixty-three percent of women with breast cancer reported difficulties performing routine daily activities, compared with 36.7% of women without the disease. In the multivariable-adjusted model, women with breast cancer were 2 times (adjusted odds ratio, 2.26 [95% CI, 1.49 to 3.44]) more likely to report symptoms of depression compared with those without the disease. Likewise, women with breast cancer were 4.78 (95% CI, 3.51 to 6.52) times more likely to report difficulty in performing routine daily activities compared with women without the disease. Four in 10 women with breast cancer in Addis Ababa reported having symptoms of depression, which was considerably higher than women in the general population. This finding emphasizes the importance of addressing psychosocial needs among women with breast cancer to enhance quality of life and potentially extend longevity.

Multi-Gene Panel Testing for Hereditary Cancer Predisposition Among Patients Sixty-Five Years and Above Diagnosed With Breast Cancer.

The availability and affordability of germline genetic testing (GGT) has resulted in a broader utilization in daily clinical practice. However, adherence to testing guidelines is low, especially among older patients, where testing is often not offered. In this study, consecutive, newly diagnosed patients with breast cancer (BC) aged ≥ 65 years and eligible for GGT, as per the National Comprehensive Cancer Network (NCCN) guidelines (version 1, 2021), were invited to participate, from March 2021 to December 2022. Patients were offered a restricted (two- or 20-gene panel), or an expanded 84-gene panel. During the study period, 204 patients were enrolled. The mean (standard deviation (SD)) age at BC diagnosis was 70.5 (5.13) years, ranging 65 - 81 years. All patients were Arab and the majority were Jordanian. The majority (n = 188, 92.2%) had early-stage (stages I and II) disease. One hundred three (50.5%) patients were tested with a restricted two-gene (n = 13) or 20-gene (n = 90) panel, while the remaining 101 (49.5%) patients had an expanded 84-gene panel. Family history of close blood relative(s) with BC was the most common indication for testing (n = 110, 53.9%). Among the entire study cohort, 22 (10.8%) had pathogenic/likely pathogenic germline variants (PGVs) and another 97 (47.5%) had ≥ 1 variants of uncertain significance (VUS). PGV rates were significantly higher with the expanded panel (14.9%) compared to restricted testing (6.8%) (P = 0.032). Similarly, VUS rates were significantly higher with the expanded panel (64.4%) compared to the restricted panel (31.1%) (P < 0.001). The most prevalent genes with PGVs were BRCA1/2 (31.3% of all PGV-positive patients), CHEK2 (23.1%) and ATM (19.2%). GGT should not be overlooked in older BC patients, as this study demonstrates that > 10% of patients have PGVs, largely in potentially actionable genes.

S2896 An Atypical Colon Polyp Leading to Diagnosis of Metastatic Breast Cancer

S2896 An Atypical Colon Polyp Leading to Diagnosis of Metastatic Breast Cancer

Delays in receipt of neoadjuvant chemotherapy compared to upfront surgery in patients with operable breast cancer.

100 Background: Delays in time from breast cancer (BC) diagnosis to BC treatment initiation (BCTI) including upfront breast surgery (UBS) or neoadjuvant chemotherapy (NACT), can negatively impact BC survival. We evaluated odds of delay in BCTI among patients (pts) who received NACT compared to pts who received UBS. Methods: We conducted a retrospective cohort study using the National Cancer Database. Eligibility included age ≥18 years, diagnosis of non-metastatic BC between 1/1/2010 – 12/31/2020, who were treated with NACT followed by surgery or UBS followed by adjuvant chemotherapy (AC). Pts who did not receive NACT or UBS within 180 days of diagnosis were excluded. The cohort was stratified by first BC treatment (NACT or UBS), and time to NACT (TTNACT) or time to surgery (TTS) was recorded for each patient in days. Pts were categorized into sub-cohorts by receptor status and clinical stage: 1) Hormone Receptor positive/HER-2 negative (HR+/HER2-) lymph node (LN)+; 2) HER-2 positive (HER2+) cT2+ or LN+; and 3) triple negative BC (TNBC) cT2+ or LN+. Logistic regression adjusted for demographic, socioeconomic, and tumor characteristics was used to identify delays in BCTI &gt; 60 days. Multiple imputation was used for missing data. Inverse probability treatment weighting (IPTW) was done as a sensitivity analysis. Results: We identified 218,049 eligible pts, 75% were White, 18% were Black, and 8.6% were Hispanic. Median age was 53 years (range 18-90). There were 145,697 (67%) pts who received NACT with median TTNACT of 32days (range 0-180), and 9.8% had a delay &gt; 60 days (Table). There were 72,353 (33.0%) pts who received UBS followed by AC, with a median TTS of 33 days (range 0-180), and 13% with a delay &gt; 60 days. In multivariable analysis, pts who received UBS had higher odds of BCTI delays compared to NACT, with OR 1.50 (95%CI 1.42-1.57) [HR+/HER2-], OR 1.49 (95%CI 1.41-1.58) [HER2+], and OR 1.26 (95%CI 1.18-1.34) [TNBC]. Results from IPTW analysis were similar, groups were well balanced, and pts who received UBS had higher odds of BCTI OR 1.50 (95%CI 1.44-1.57) [HR+/HER2-], OR 1.75 (95%CI 1.67-1.83) [HER2+], and OR 1.46 (95%CI 1.38-1.53) [TNBC]. Conclusions: Among high clinical risk BC patients who received surgery and chemotherapy, those who underwent NACT were less likely to experience delays in BCTI compared to pts who received UBS first. Among eligible pts, use of NACT may reduce delays in BCTI. Patients who received NACT and UBS and associated delays by sub-cohort (n = 218,050). Neoadjuvant Chemotherapy Upfront Surgery N (%) Median TTNACT in Days N (%) Delayed &gt;60 Days N (%) Median TTS in Days N (%) Delayed &gt;60 days Total Cohort 145,697 (67.0) 32 14,221 (9.8) 72,353 (33.0) 33 9,725 (13) HR+/HER2 40,345 (27.7) 34 4,773 (11.8) 29, 676 (41.0) 36 4,754 (16.0) HER+ 56,868 (39.0) 32 5,135 (9.0) 21,759 (30.1) 32 2,771 (12.7) TNBC 48,484 (33.3) 31 4,313 (8.9) 20,917 (28.9) 30 2,200 (10.5)

The global and regional disease burden of breast cancer from 1980 to 2021: An analysis of GBD study 2021.

146 Background: Breast cancer (BC) is the most common malignancy in women and presents a huge disease burden worldwide. Early detection, via mammographic screening, improves outcomes significantly. We present estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, delineating the trajectory of BC from 1980 - 2021. This analysis considers the impact of screening practices on the incidence and mortality of patients worldwide, offering comprehensive examination of trends over the past 4 decades. Methods: Data were methodically retrieved from GBD study, which included age-standardized death rates and Disability-Adjusted Life Years (DALY). Dataset was stratified globally and by continent, with further regional analysis of the African continent into Northern, Southern, Eastern, Western, and Central, and by World Bank income classifications of countries. We examined global age-standardized mortality rates (ASMR), followed by an analysis of global disability-adjusted life years (DALY). Finally, we identified which countries, stratified by income levels, demonstrate the highest rates. Analytical processing was conducted using Joinpoint regression to determine average annual percentage changes (AAPC). Results: Globally, Age Adjusted Death Rates (ASDR) continuously declined from 1980-2021. In 1980, the ASDR was 16.33 (95% UI: 15.39-17.22) and it declined continuously to 14.54 (AAPC: -0.28; 95% CI: -0.3, -0.27) in 2021. Globally, DALYs rate was 503.8 (95% UI: 475.9-532.2) per 100,000 people in 1990 and it decreased to 455.5 (AAPC: 3.22; 95% CI: -0.33, -0.30) in 2021. In geographical analysis, America and Europe had uniformly declining ASDRs while Africa and Asia had a steady rise in ASDR. From 1980 to 2021, America had decreasing death rates with an AAPC of -0.78 (95% CI: -0.80, -0.76). Europe also had a declining trend, albeit nonsignificant, with an AAPC of -0.53 (95% CI: -0.55, -0.49). Conversely, the AAPC for Asia was 0.42 (95% CI: 0.41-0.43) showing a continuous incline in deaths related to BC from 1980 to 2021. The highest increase in ASDRs was observed in Africa with an AAPC of 0.90 (95% CI: 0.89-0.91). Upon sub-analysis of Africa, we observed Western and Southern Africa had highest ASDRs compared to other parts of Africa. According to World Bank income levels, high income countries had declining death rates while upper-middle, lower-middle, and low-income countries all had increasing deaths rates with the highest rise in lower middle income countries. Conclusions: Asia and Africa have limited implementation of BC screening protocols and correspondingly exhibit higher BC associated mortality. Enhanced screening programs are imperative for the timely diagnosis and management of BC, ultimately improving survival rate. The enormous discrepancy in mortality rates underscores the critical importance of accessible and comprehensive BC screening initiatives globally.

Factors associated with delays in receipt of neoadjuvant chemotherapy in patients with operable breast cancer.

126 Background: Delays in neoadjuvant chemotherapy initiation (NACTI) after breast cancer (BC) diagnosis have been associated with worse outcomes. We evaluated incidence and predictors of delays of NACTI among high clinical risk patients treated with NACT on a national level. Methods: We conducted a retrospective cohort study using the National Cancer Database. Eligibility included age ≥18 years, diagnosis of non-metastatic BC between 1/1/2010 – 12/31/2020, who were treated with NACT within 180 days of diagnosis. Patients who received neoadjuvant endocrine therapy were excluded. Time to chemotherapy (TTC) in days was recorded. Patients were categorized into sub-cohorts by receptor status and clinical stage: 1) Hormone Receptor positive/HER-2 negative (HR+/HER2-) and were lymph node (LN) LN+; 2) HER-2 positive (HER2+) cT2+ or LN+; and 3) triple negative BC (TNBC) cT2+ or LN+. Multivariable logistic regression, adjusted for demographic, socioeconomic and tumor characteristics, was used to identify characteristics associated with delays &gt; 60 days from diagnosis to NACTI. Multiple imputation was used for missing data. Results: We identified 145,697 eligible patients, 74% were White, 18% were Black, 3.3% were Asian, and 4.6% were Other/Unknown. Across all racial categories, 9.2% were Hispanic. Median age at diagnosis was 52 years (range 18-90), median TTC was 32 days (range 0-180), and 10% had a delay &gt; 60 days. There were 40,345 patients in the HR+/HER2- cohort, 56,868 in the HER2+ cohort, and 48,484 in the TNBC cohort; 12%, 9.0%, and 8.9% (p &lt; 0.001) had a delay in NACTI, respectively. In multivariable analysis among the HR+/HER2- sub-cohort, characteristics associated with delays in NACTI included Black race (OR 1.71, 95%CI 1.57-1.86) and Hispanic ethnicity (OR 1.76, 95%CI 1.60-1.94) compared to White and non-Hispanic patients. Patients with Medicare, Medicaid, or who were uninsured were more likely to be delayed (OR 1.44 95%CI 1.30-1.58, 2.10, 95%CI 1.92-2.29, 2.28, 95%CI 1.99-2.61) compared to those with commercial insurance. Results were similar in the HER2+and TNBC cohorts, as seen (Table). Conclusions: Among patients with operable BC who received NACT, patients who were Black, Hispanic, had Medicaid or no insurance had as high as a twofold increase in odds of a delay in NACTI. Targeted interventions to address these racial and socioeconomic disparities are necessary to ensure equitable care. Multivariable logistic regression adjusted for demographic, socioeconomic, and tumor characteristics variables (n = 145,697). HR+/HER2-N= 40,345 HER2+N= 56,868 TNBCN= 48,484 OR 95%CI OR 95%CI OR 95%CI Black Race 1.71 1.57-1.86 1.89 1.74-2.04 1.90 1.76-2.06 Hispanic Ethnicity 1.76 1.60-1.94 2.18 2.00-2.36 2.00 1.80-2.21 Medicare 1.44 1.30-1.58 1.46 1.34-1.61 1.45 1.32-1.61 Medicaid 2.10 1.92-2.29 2.13 1.96-2.31 2.14 1.96-2.34 No Insurance 2.28 1.99-2.61 2.36 2.07-2.70 2.25 1.96-2.59

Association between food insecurity and healthcare utilization among patients at a breast oncology center.

143 Background: A breast cancer (BC) diagnosis often creates or exacerbates financial stress. As a result, many patients with BC struggle with a lack of consistent access to nutritious food due to limited resources, a condition termed “food insecurity” (FI). We investigated the association between FI and healthcare utilization among breast oncology patients at our urban academic medical center. Methods: Screening for health-related social needs (HRSN) was conducted primarily through the electronic patient portal, at appointment registration for a breast oncology clinic visit. The 8-item HRSN survey included 2 questions on access to food resources and 1 question quantifying emergency department (ED) visits over the past year. Any level of food hardship or concern constituted a positive FI screen. We conducted a retrospective analysis among patients evaluated between 11/2/22 and 4/20/24. Clinical and demographic data were obtained from the electronic health record (EHR). We evaluated the association between FI and health care utilization measures (ED visits, inpatient admissions) with a Pearson's Chi-squared test and univariate logistic regression. Results: A total of 2820 patients were screened for HRSN and provided responses to at least 1 FI question, of which 19.7% (555) reported some level of FI. Food-insecure patients self-reported significantly higher rates of ED visits in the past 12 months compared to food-secure patients: 43.2% vs 22.6% reported at least 1 ED visit, respectively (p&lt;0.001), and 25.0% vs 8.45% reported multiple ED visits, respectively (p&lt;0.001). Overall, FI was associated with 2.5 times the odds of self-reporting at least 1 ED visit (univariate OR 2.47, p&lt;0.001). Similarly, on review of EHR data, 33.3% of food-insecure patients had at least 1 ED visit (vs 20.0% of food-secure patients, p&lt;0.001), and 6.13% had 3 or more ED visits (vs 2.83%, p&lt;0.001) during the study period. On univariate analysis, food-insecure patients had double the odds of having at least 1 ED visit documented in the EHR (univariate OR 2.00, p&lt;0.001). We examined reasons for ED presentations among 186 food-insecure patients with ED visits during the study period, and found that 23.8% had at least 1 cancer-related complaint (oncological treatment-related (16.8%) and/or BC symptom-related (8.6%)). The incidence of inpatient admissions during the study period was similar among food-insecure vs food-secure patients (19.8% vs 18.4%, p=0.467). Conclusions: In this analysis of FI and health care delivery measures, ED utilization was significantly higher among food-insecure patients. A quarter of food-insecure patients who presented to the ED had oncological complaints. FI may be a marker of unmet healthcare needs in patient with cancer, and targeted interventions focused on symptom monitoring and management are warranted to optimize healthcare utilization.

Is federal housing assistance associated with earlier-stage cancer diagnosis? Evidence from the new SEER-Medicare and US Department of Housing and Urban Development data linkage.

85 Background: Despite growing awareness that stable and affordable housing is a key social determinant of health, little research has examined the role of federal housing assistance in cancer outcomes. This study uses a novel data linkage to examine the association of federal housing assistance (i.e. various rent subsidy programs) on stage at diagnosis for the 4 most common cancers in the US. Methods: Individuals aged 66-95 years newly diagnosed with breast, colorectal, non-small cell lung (NSCLC) or prostate cancer in 2006-2019 with fee-for-service coverage were selected from SEER-Medicare Housing and Urban Development (HUD) administrative data. After identifying individuals with housing assistance at diagnosis, controls without housing assistance at diagnosis were propensity score matched in a 3:1 ratio by cancer site, age, sex, race/ethnicity, marital status, registry, year of diagnosis, area-level Yost socioeconomic status index, dual Medicaid eligibility, rural/urban residence, reason for Medicare entitlement, and pre-diagnosis comorbidity. Associations of housing assistance and diagnosis stage (SEER summary stage: localized vs. regional/distant) were examined with separate logistic regression models by cancer type. Results: A total of 7335 individuals with breast, 5660 with colorectal, 7399 with NSCL and 4309 with prostate cancer received housing assistance at diagnosis (Table). Compared to matched controls, a smaller percentage of individuals with housing assistance were diagnosed with regional/distant breast (36% vs. 33%), colorectal (59% vs. 57%), and NSCL (71% vs. 69%) cancers. Individuals receiving housing assistance were less likely to be diagnosed with later-stage breast (OR: 0.87; 95% CI: 0.83, 0.92) and NSCL (OR: 0.93; 95% CI: 0.88, 0.99) cancers. Housing assistance was not significantly associated with stage for individuals with colorectal or prostate cancers. Conclusions: Federal housing assistance is associated with earlier-stage breast and NSCL cancer diagnosis, highlighting its potential role in mitigating the adverse effects of housing insecurity on cancer outcomes. Housing assistance and cancer diagnosis stage. No Housing Assistance at Dx,N (%) Housing Assistance at Dx,N (%) OR [95% CI], P Breast Localized 14291 (64) 4890 (67) 1.0 (ref) Regional/Distant 8179 (36) 2445 (33) 0.87 [0.83, 0.92] P&lt;0.001 Colorectal Localized 7046 (42) 2422 (43) 1.0 (ref) Regional/Distant 9934 (59) 3238 (57) 0.95 [0.89, 1.01] P=0.09 NSCLC Localized 6572 (30) 2298 (31) 1.0 (ref) Regional/Distant 15625 (71) 5101 (69) 0.93 [0.88, 0.99] P=0.02 Prostate Localized 10293 (80) 3401 (79) 1.0 (ref) Regional/Distant 2634 (20) 908 (21) 1.04 [0.96, 1.14] P=0.33 Dx=Diagnosis; OR=Odds Ratio; CI=Confidence Interval.

The effect of web based and traditional self breast examination education on nursing students’ knowledge, skills and self-directed learning skills: A randomised controlled study

AimThe aim of this study is to examine the effect of web based self-breast examination education on nursing students’ knowledge, skills, and self-directed learning skills in self-breast examination. BackgroundBreast cancer is the most prevalent type of cancer among women, mortality rates are still high today. It is critical to improve the knowledge and skills and raise the self-awareness and health consciousness of individuals and society about self-breast examination, which is important in the early diagnosis of breast cancer, in order to lower mortality rates. Accordingly, one of the basic nursing skills aimed to be acquired by nursing students future nursing professionals is a self-breast examination. DesignThis study was conducted with a randomised, controlled, and experimental trial. MethodsA total of 90 students were included in the study: the intervention group (n=43) and the control group (n=47). Intervention group students participated in web-based SBE Education.Control group students participated in SBE Education based on a traditional learning model.A Student Information Form, the Self-Breast Examination Knowledge Test, the Self-Breast Examination Skill Rubric, and the Self-Directed Learning Skills Scale were used in the study. Descriptive statistics, Mann-Whitney U test, and Wilcoxon test were run to analyse the data. ResultsIt was observed that the control group had a higher score in self-breast examination knowledge than the intervention group during the intervention period and the follow-up period after 15 days. No difference was noticed between the groups after the intervention for self-breast examination skill score, but the intervention group had a higher score than the control group for self-breast examination skill during the follow-up period after 15 days. No significant difference was noted between the groups for self-directed learning scores. This result validated hypothesis H4. This result refuted hypothesis H1, H2, H3, H5. ConclusionsWeb based education on self-breast examination improves students’ breast self-examination skills and self-directed learning skills, but not their knowledge level of self-breast examination.

Breast cancer: do the current policies mean anything?

Aim Breast cancer remains one of the most prevalent malignancies globally with a high mortality rate. South Africa has a number of policies in place designed to ensure that minimum delays are experienced by patients from first symptom to initial treatment. This study was initiated to determine where the longest delays occurred during the patient’s journey, from the first symptom to the first treatment. This information, combined with the existing policy, identifies shortfalls in the breast cancer diagnostic and treatment pathways that must be addressed. Methods A cross-sectional study was undertaken in the Department of Medical Oncology, University of Pretoria/Steve Biko Academic Hospital between April 2020 and August 2021, analysing six timelines from first symptom to first treatment in patients with newly diagnosed breast cancer. Data was obtained by the researchers from the patients on their first visit relating to the delays experienced from first symptom to final biopsy. Clinical information was obtained from the patients’ source records once a treatment decision had been reached and treatment started where applicable. Results The longest delays experienced were between the patients’ first visit to any medical facility to date of diagnostic biopsy. Delays due to COVID-19 were in the minority with 13/79 (16.4%) patients reporting having experienced COVID-19 related delays. Key Area 2 of the Breast Cancer Prevention and Control Policy makes provision for patients to be referred directly to a regional/tertiary/quaternary medical facility for further screening, diagnosis and treatment within 21-60 days from the first visit. In the study’s cohort, a mean of four months from first visit to diagnostic biopsy was recorded. Overall delays of longer than 12 months due to non-representative biopsies (range 1-3) were recorded in three patients. Twenty-nine patients (36.7%) presented to three medical facilities prior to diagnostic biopsy with 10/79 (12.6%) and 1/79 (1.2%) presenting to four and five institutions, respectively, before the diagnostic biopsy. Conclusions The delays patients experienced highlights the lack of knowledge about the urgency and correct referral of suspected malignancy cases. Despite the number of promulgated policies relating to fast track systems via specialist breast units, fiscal and human capital deficiencies negatively impact the attempts to diagnose and treat patients timeously and increase survival.

Associations Between Domain-specific Physical Activity Levels And Physical Characteristics Of Behavior In Newly Diagnosed Breast Cancer Patients

Associations Between Domain-specific Physical Activity Levels And Physical Characteristics Of Behavior In Newly Diagnosed Breast Cancer Patients