Diagnosis Of Early-stage Breast Cancer Research Articles

Perceived Discrimination and Ethnic Identity Among Breast Cancer Survivors

To examine ethnic identity and socio-demographic factors in minority patients' perceptions of healthcare discrimination in breast cancer care. Mixed methods. Participants' homes in the metropolitan areas of Phoenix and Tucson, AZ. 39 women treated for breast cancer in the past six years: 15 monolingual Spanish-speaking Latinas, 15 English-speaking Latinas, and 9 African Americans. Two questionnaires were administered. Individual interviews with participants were conducted by nurse researchers. Quantitative, qualitative, and matrix analytic methods were used. Ethnic identity and perceptions of discrimination. Eighteen women (46%) believed race and spoken language affected the quality of health care. Perceived dis-respect from providers was attributed to participant's skin color, income level, citizenship status, and ability to speak English. Discrimination was more likely to be described in a primary care context, rather than cancer care. Ethnic identity and early-stage breast cancer diagnosis were the only study variables significantly associated with perceived healthcare discrimination. This article describes the first investigation examining ethnic identity and perceived discrimination in cancer care delivery. Replication of this study with larger samples is needed to better understand the role of ethnic identity and cancer stage in perceptions of cancer care delivery. Identification of ethnic-specific factors that influence patient's perspectives and healthcare needs will facilitate development of more effective strategies for the delivery of cross-cultural patient-centered cancer care.

Stage at Diagnosis and Comorbidity Influence Breast Cancer Survival in First Nations Women in Ontario, Canada

Indigenous populations in Canada and abroad have poorer survival after a breast cancer diagnosis compared with their geographic counterparts; however, the influence of many demographic, personal, tumor, and treatment factors has not been examined to describe this disparity according to stage at diagnosis. A case-case design was employed to compare First Nations (FN) women (n = 287) to a frequency-matched random sample of non-FN women (n = 671) diagnosed with breast cancer within the Ontario Cancer Registry. Women were matched on period of diagnosis (1995-1999 and 2000-2004), age at diagnosis (<50 vs. ≥50), and Regional Cancer Centre (RCC). Stage and other factors were collected from medical charts at the RCCs. Survival was compared using an adjusted Cox proportional hazards model and stratified by stage at diagnosis (I, II, and III-IV). Determinants of survival in FN women stratified by stage at diagnosis were also modeled. Survival was more than three times poorer for FN women diagnosed at stage I than for non-FN women (HR = 3.10, 95% CI = 1.39-6.88). The risk of death after a stage I breast cancer diagnosis was about five times higher among FN women with a comorbidity other than diabetes (HR = 4.65, 95% CI = 1.39-15.53) and was more than five times greater for women with diabetes (HR = 5.49, 95% CI = 1.69-17.90) than for those without a comorbidity. Having a preexisting comorbidity was the most important factor in explaining the observed survival disparity among FN women. Improving the general health status of FN women could increase their survival after an early-stage breast cancer diagnosis.

Potential Impact of USPSTF Recommendations on Early Diagnosis of Breast Cancer

Current US Preventive Services Task Force (USPSTF) guidelines recommend against routine screening mammography in women aged 40-49 years. However, diagnosis of early-stage breast cancer relies on mammographic screening for detection. We hypothesized that screening at younger age may be important for detecting earlier and more treatable cancers for women in different demographic groups. All women with ductal carcinoma in situ (DCIS) or T1N0 breast cancer between 2004 and 2008 in the California Cancer Registry were evaluated. Patients were divided into: (1) women aged 40-49 years, who would be excluded from USPSTF recommendations for screening, and (2) women aged 50-74 years, who are recommended for screening. Patients in the two age groups were compared by race/ethnicity, socioeconomic status (SES), and hormone receptor (HR), human epidermal growth factor receptor 2 (HER-2), and triple-negative (TN) status. Of 46,691 patients identified, 22.6% were aged 40-49 years, and 77.4% were aged 50-74 years. Younger women with DCIS had statistically higher odds of being HR positive and having higher SES, and Hispanic and Asian/Pacific Islander (PI) race/ethnicity, while younger women diagnosed with T1N0 breast cancer had higher odds of being HR positive, HER-2 positive, and triple negative and of having higher SES and non-white race/ethnicity. Young Hispanic, Asian/PI, and non-Hispanic (NH) Black women in California have greater odds of being diagnosed with early breast cancer than their older counterparts. Excluding 40-49-year-old women from screening could impact early diagnosis of HR-positive, HER-2-positive, and TN tumors. Implementation of USPSTF recommendations could disproportionately impact non-white women and potentially lead to more advanced presentation at diagnosis.

Factors influencing the time of sentinel node visualization in breast cancer patients using intradermal injection of the radiotracer

BackgroundThe objective of our study was to determine the important factors that have influence on the time of sentinel node visualization using intradermal injection of 99mTc-antimony sulfide colloid. MethodsTwo hundred fifty consecutive patients with the diagnosis of early-stage breast cancer were evaluated. Anterior and lateral views were acquired in various intervals after intradermal injection of the tracer until 180 minutes or visualization of the sentinel node. The effect of several variables on the time of sentinel node visualization was evaluated by univariate and multivariate analyses. ResultsThe time of sentinel node visualization was significantly correlated with age, body mass index (BMI), and interval between biopsy and sentinel node mapping. Standardized beta values for these variables were .1, .3, -.55 respectively. ConclusionsOlder age and higher BMI can result in slow sentinel node visualization. Longer interval between biopsy and sentinel node mapping can be associated with rapid sentinel node detection.

Preoperative breast MRI in early-stage breast cancer: A decision analysis.

6035 Background: Rapid uptake of new imaging technology is a major contributor to rising health care costs. Preoperative breast magnetic resonance imaging (MRI) for patients with early-stage breast cancer has dramatically increased in use without evidence of improved outcomes compared to standard triple assessment (clinical examination, imaging with mammography and/or ultrasonography, and needle biopsy) and is associated with higher rates of mastectomy. Methods: A decision analytic model was developed to evaluate the impact of adding breast MRI to the preoperative evaluation of women with early-stage breast cancer who were candidates for breast-conserving therapy (BCT) on patient outcome measures in quality-adjusted-life-years (QALYs). Model inputs including survival, recurrence rates, and health utilities were obtained from a comprehensive literature review. One-way sensitivity analyses were performed to estimate threshold values for key parameters at which adding MRI would become the optimal imaging strategy over standard triple assessment. Results: Preoperative breast MRI was associated with a decrease of 0.094 QALYs compared with no MRI, based on a 20-year life expectancy after diagnosis of early-stage breast cancer. In order for routine preoperative breast MRI to become the optimal strategy, the conversion rate to mastectomy after preoperative MRI would need to be <1% (vs. range of 3.6-54% reported in the literature) Across a wide range of local recurrence rates following BCT, MRI remained inferior to no MRI. Conclusions: Routine preoperative breast MRI appears to confer no advantage over standard diagnostic evaluations for early-stage breast cancer and may lead to worse outcomes.

Role of the general practitioner during the active breast cancer treatment phase: an analysis of health care use

PurposeLittle is known about the actual involvement of the general practitioner (GP) during the active breast cancer treatment phase. Therefore, this study explored (disease-specific) primary health care use among women undergoing active treatment for breast cancer compared with women without breast cancer.MethodsA total of 185 women with a first diagnosis of early-stage breast cancer between 1998 and 2007 were identified in the primary care database of the Registration Network Groningen and matched with a reference population of 548 women without breast cancer on birth year and GP.ResultsSince diagnosis, patients with breast cancer had twice as many face-to-face contacts compared with women from the reference population (median 6.0 vs 3.0/year, Mann–Whitney (M-W) test p < 0.001). The median number of drug prescriptions and referrals was also significantly higher among patients than among the reference population (11.0 vs 7.0/year, M-W test p < 0.001 and 1.0 vs 0.0/year, M-W test p < 0.001). More patients than women from the reference population had face-to-face contacts or were prescribed drugs for reasons related to breast cancer and its treatment, including gastrointestinal problems, psychological reasons and endocrine therapy.ConclusionsDuring the active breast cancer treatment phase, GPs are involved in the management of treatment-related side effects and psychological symptoms, as well as in the administration of endocrine therapy. Based on the findings of this study, interventions across the primary/secondary interface can be planned to improve quality of life and other outcomes in patients undergoing breast cancer treatment.

Menopausal symptoms and fertility concerns in premenopausal breast cancer survivors

Many young breast cancer survivors experience menopausal symptoms and feel concerned about infertility due to oncologic treatment. However, there has been little research to date comparing young survivors’ concerns and symptoms with those of young women of the same age and gravidity in the general population. We surveyed breast cancer survivors with regular menses after adjuvant chemotherapy and compared them with age-matched, gravidity-matched controls as part of a study to evaluate the effects of chemotherapy on ovarian reserve. All survivors were 1 year or more from diagnosis of early-stage breast cancer, without evidence of recurrence. The survey assessed menopausal symptoms and infertility concerns. The study was stopped after a planned interim analysis of the first 20 matched pairs revealed significantly diminished measures of ovarian reserve in survivors compared with controls. Mean age was 37 years for both groups(range, 31-43 y). Eighty percent of survivors and 25% of controls expressed some concern regarding fertility at the time of the survey (P = 0.001). Survivors were more likely to report bothersome menopausal symptoms than were controls (P = 0.05). An exploratory analysis revealed that menopausal symptoms were greatest in the survivor staking tamoxifen. Young women who remained premenopausal after breast cancer chemotherapy expressed greater concern about fertility and reported more menopausal symptoms than did age- and gravidity-matched controls. This may have been due to cancer diagnosis or treatment, or it may reflect other differences between the survivors and controls in this study. Additional research is warranted to determine how to most effectively address fertility concerns and reduce symptom burden in this population.

PS3-16: The Influence of Travel Time on Breast Cancer Diagnosis and Treatment

Background and Aims: Longer travel time to health care services has been shown to be associated with more advanced stage at diagnosis and differences in surgical care for women with breast cancer. The influence of travel time on other disease characteristics at diagnosis and on use of other breast cancer treatments is not known. We examined travel time in relation to stage, nodal involvement, tumor size, primary and adjuvant treatments, and receipt of surveillance mammography to provide a more detailed examination of the role of travel time in access and utilization of breast cancer services to help further understand barriers to recommended care. Methods: Using an established cohort of women enrolled at Group Health, with an early stage breast cancer diagnosis from 1990–1999 (N=1306), we linked travel time estimates with tumor and treatment data. Travel time was estimated for each census block in Washington to the nearest radiology facility and was then attributed to women based on geocoded residence data. Tumor and treatment data were abstracted from chart review and from SEER data. We modeled bivariate relations between travel time and outcomes using log binomial generalized linear regression (glm). Results: Most women (90%) lived within 30 minutes of the nearest radiology facility. Travel time >45 min. was associated with a greater likelihood of mastectomy vs. breast conserving surgery (Referent group:travel time <10min: RR=1.48; 95%CI:1.03–2.13) and with use of adjuvant chemotherapy (RR=1.65; 95% CI:1.01–2.70). Travel time did not significantly influence stage at diagnosis, tumor size, radiation treatment, or receipt of surveillance mammography in the first two years following cancer treatment. Conclusions: In the Group Health population, travel time appears to differentially influence patterns of care for women with early stage breast cancer and does not appear to be related to tumor characteristics at diagnosis.

Implications of Mobility Impairment on the Diagnosis and Treatment of Breast Cancer

Among women with chronic, preexisting mobility impairments, we sought to explore how their mobility difficulties affected the diagnosis and treatment of early-stage breast cancer This is a qualitative analysis of transcripts from in-depth in-person or telephone interviews with 20 English-speaking women who had early-stage breast cancer, were <60 years of age, and had chronic difficulty walking or used wheeled mobility aids at the time of their breast cancer diagnoses Nine women were disabled by polio as children or had postpolio syndrome, 3 had cerebral palsy, 3 had spinal cord injury, and 5 had other conditions. Most women reported difficulty obtaining mammograms, primarily because of inaccessible equipment, positioning problems, and difficulties with uncontrollable movements. Many women made decisions about surgical approach and chemotherapy by explicitly considering how various therapies would affect their arms, which are essential to their mobility (they use ambulation aids, self-propel manual wheelchairs, or otherwise rely on their arms for mobility or safety). Managing at home after surgery posed major mobility challenges, especially for women who lived alone. Several women reported feeling they suffered more chemotherapy side effects than do women without mobility problems. Weight gains with endocrine therapy compromised the mobility of several women. Increasing numbers of American women are living with mobility disabilities and entering age ranges with increased risks of breast cancer. Mobility impairments can affect women at every point during early-stage breast cancer diagnosis, therapy, and recovery. Clinicians must consider women's mobility functioning in making therapeutic recommendations to women with impaired mobility who develop breast cancer.

Abstract A45: Patterns of care regarding surgical choice and application of adjuvant radiation therapy for preinvasive and early-stage breast cancer in rural Appalachia

Abstract Objective: To conduct a cross-sectional registry analysis of women in Appalachian Kentucky with the diagnosis of early-stage breast cancer to identify factors affecting surgical choice [breast conserving surgery (BCS) versus mastectomy] and appropriate use of adjuvant radiation therapy (RT). Methods: Database collection was performed through the Kentucky Cancer Registry. Inclusion criteria included female breast cancer patients diagnosed between 1998 and 2007. All patients were ≥ 20 years of age diagnosed with DCIS or AJCC stage I or II disease as a first primary diagnosis. Database search was limited to Appalachian residents and were stratified by Beale codes 1-3 for urban locales and 4-9 for rural. Statistics including univariate, multivariate, and Cox survival analyses were performed to identify factors affecting surgical choice, receipt of RT and variables relating to survival. Results: Analysis was based on 5541 evaluable Appalachian patients, of whom 86.2% lived in a rural location and 13.8% were urban. The overall distribution of primary surgery slightly favored BCS (54.1 %) over mastectomy (45.9%). On multivariate analysis, the most significant factors for mastectomy as the initial surgical procedure were advanced stage (OR 2.571, P&amp;lt;0.0001), rural location (OR 2.075, p&amp;lt;0.0001), and insurance status (OR 1.546, p&amp;lt;0.0001). Of patients choosing BCS, 56.2% received adjuvant RT. On multivariate analysis age &amp;gt;70 (OR 2.506, p&amp;lt;0.0001), rural location (OR 2.416, p&amp;lt;0.0001), and lack of insurance (OR 1.651, p=0.0168) were the strongest predictors for not receiving adjuvant RT. Cox survival analysis correlated with receipt of RT after BCS, ER/PR status, age, smoking history, insurance status, stage, and tumor size. Conclusions: The rate of mastectomy remains higher and the rate of RT after BCS is significantly lower in Appalachian women compared to other contemporary studies of women with preinvasive and early stage breast cancer. Within the Appalachian population, these disparities are most apparent among rural and uninsured women. Further studies are needed to advance awareness of and access to health care initiatives to improve quality of breast cancer care for the underserved. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A45.

Skin-Reducing Subcutaneous Mastectomy Using a Dermal Barrier Flap and Immediate Breast Reconstruction with an Implant: A New Surgical Design for Reconstruction of Early-Stage Breast Cancer

The development of skin-sparing mastectomy techniques for early-stage breast cancer has opened a new era in reconstructive breast surgery. Because of improved early diagnoses, the demand for skin-sparing techniques continues to increase more than ever. Between March 2006 and April 2008, skin-reducing subcutaneous mastectomy (SRSM) using the dermal barrier flap technique and simultaneous breast reconstruction with silicone implants was performed for 15 patients (a total of 26 breasts) who had either a diagnosis of early-stage breast cancer or indications for prophylactic mastectomy. Of the 15 patients, 11 underwent bilateral reconstruction. The remaining four patients underwent unilateral reconstruction using SRSM with the dermal barrier flap technique. The average age of the patients who underwent SRSM with the dermal barrier flap was 45.7 years. All the patients were discharged from the hospital on postoperative day 1. The mean follow-up period was 12 months, and the recovery time was 35 days. Excellent aesthetic results and uneventful healing were obtained for 23 breasts. Partial nipple-areola necrosis occurred in two breasts. Total skin necrosis in the bilateral nipple-areola and central breast region occurred for one patient who underwent bilateral SRSM. Prosthesis exposure was not observed for any of these patients. The authors present their early results with SRSM using the dermal barrier flap and silicone implants for early-stage breast cancer. The dermal barrier flap became a reliable procedure by providing a decreased breast envelope, eliminating the risk of implant exposure, and forming a double layer of dermal tissue at the incision line.

Physical health and cancer-free survival in women diagnosed with breast cancer.

Abstract Abstract #1114 Background: A protective effect of physical activity (PA) after breast cancer diagnosis is not a consistent finding across studies. It is possible that a beneficial effect from higher PA levels may be limited to a sub-group defined by level of physical health (PH). We investigated the role of PA and PH in predicting breast cancer free survival.&amp;#x2028; Methods: The Women's Healthy Eating and Living (WHEL) Study enrolled 3088 women within 4 years of early stage breast cancer diagnosis from 1995 to 2000. At study entry, participants completed the RAND-36 Health Survey that includes a physical health summary score comprised of physical functioning, general health, pain, and role limitations due to PH subscales. PA was assessed with a questionnaire developed for the Women's Health Initiative and validated for the WHEL Study. Additional breast cancer events (recurrence or new breast primary; n = 518) were queried semi-annually through June 2006 and confirmed by oncologist review of medical records. Multivariate Cox modeling was used to associate PA and PH with additional breast cancer events, adjusting for demographic, lifestyle, tumor, and treatment-related covariates.&amp;#x2028; Results: In the unadjusted analysis, quartiles of PA were not related to additional breast cancer events, whereas the PH summary score was [Hazard ratios (HR) for quintiles (Q), Q1 (reference): Q2= 0.90, Q3 =0.69, Q4=0.55, and Q5=0.74; p-values = 0.45, 0.01, &amp;lt;0.0001, and 0.03 respectively]. For further analysis, we grouped the bottom two quintiles (“poor” PH) and the upper three quintiles (“adequate” PH). In the adjusted Cox model, poor PH was associated with a 42% higher risk of additional breast cancer events (HR: 1.42, 95% CI: 1.15, 1.74).&amp;#x2028; We compared participants in poor versus adequate PH group. Those in the poor PH group were much more likely to report role limitations (91% vs. 17%) and bodily pain (44% vs. 4%). They were much more likely to be minimally physically active (&amp;lt;90 MET-minutes/week) (23% vs. 12%, p&amp;gt;0.0001) and obese (37% vs. 19%; p &amp;lt;0.0001). We included an interaction term into the Cox model using the binary PH measure and a binary PA measure (540 ≥ vs. &amp;lt; 540 MET-minutes/week, equivalent to 30 minutes moderate walking 6 days/week). Compared to those with adequate PH and higher PA, only those with poor PH and lower PA were at increased risk (HR 1.46, 95% CI: 1.15, 1.74).&amp;#x2028; Among those in this higher risk subgroup (poor PH, lower PA), the majority indicated that they would not be limited a lot in walking a mile (79%) or climbing several flights of stairs (73%) and a substantial proportion indicated that they could undertake vigorous activity (37%).&amp;#x2028; Discussion: Breast cancer survivors categorized as in poor PH had a 42% worse prognosis than those in adequate PH. This was particularly the case for those in poor PH who did less PA. This suggests that a motivational intervention to increase physical activity in this subgroup may improve their prognosis following breast cancer. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1114.

Survival among women with triple receptor-negative breast cancer and brain metastases.

Abstract Abstract #6077 Background&amp;#x2028; The purpose of this study was to determine the incidence of brain metastases in a cohort of women with early stage triple-receptor negative breast cancer and to evaluate the survival outcomes of these patients.&amp;#x2028; Method&amp;#x2028; Six hundred and seventy nine patients with early stage triple-receptor negative breast cancer diagnosed between 1980 and 2006 were identified. Cumulative incidence of brain metastases at 2- and 5-years following a diagnosis of early-stage triple receptor-negative breast cancer considering death as a competing risk was computed. Time to brain metastases was computed from the date of breast cancer diagnosis to the date of development of brain metastases. Cox proportional hazards models, adjusted for various patient and tumor characteristics, were then fitted to explore factors that could predict for the subsequent development of brain metastases in this cohort. Survival following a diagnosis of brain metastases was measured from the date of brain metastases diagnosis to the date of death from any cause. All survival outcomes were computed using the Kaplan – Meier product limit method and compared across groups using log rank statistic.&amp;#x2028; Results&amp;#x2028; Median age was 50 years (range 22 to 97 years) and median follow-up was 26.9 months (range 1.1 to 321.3 months. Overall 42 (6.2%) patients developed brain metastases of whom 16 (38.1%) had 3 brain lesions or less, 19 (45.2%) had more than 3 brain lesions and number of brain lesions was unknown in 7 (16.7%) patients. Overall cumulative incidence at 2- and 5-years was 5.6% (95% CI 3.8%-7.9%) and 9.6% (95% CI 6.8% - 13%) respectively. Twenty –four (3.5%) patients developed brain metastases as the first site of recurrence with cumulative incidence at 2- and 5-years observed to be 2.0% (95% CI 2.6% -6.0%) and 4.9% (95% CI 3.2%-7.0%) respectively. In the multivariable model factors such as age at primary tumor diagnosis, initial clinical stage, histological tumor grade, number of lymph nodes examined and tumor lymph-vascular invasion were not significantly associated with time to brain metastases. For the whole group of patients who developed brain metastases median survival was 2.9 months (95% CI 2.0 – 7.6 months). Among those who developed brain metastases as the first site of recurrence median survival was 5.8 months (95% CI 1.7 – 11.0 months).&amp;#x2028; Conclusion&amp;#x2028; Data from published studies have reported a 5-year cumulative incidence of brain metastases of approximately 5 % in an unselected breast cancer population. In our large single institutional study patients with triple-receptor-negative breast tumors we report higher early cumulative incidence compared to historical controls associated with poor survival. Patients with triple-receptor negative breast tumors may be an ideal cohort to target brain metastases preventive strategies. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6077.

Preliminary Results of Electron Intraoperative Therapy Boost and Hypofractionated External Beam Radiotherapy After Breast-Conserving Surgery in Premenopausal Women

To report the acute and preliminary data on late toxicity of a pilot study of boost with electron intraoperative therapy followed by hypofractionated external beam radiotherapy (HEBRT) of the whole breast. Between June 2004 and March 2007, 211 women with a diagnosis of early-stage breast cancer were treated with breast-conserving surgery. During surgery, an electron intraoperative therapy boost of 12 Gy was administered to the tumor bed. Adjuvant local treatment was completed with HEBRT, consisting of a course of 13 daily fractions of 2.85 Gy to the whole breast to a total dose of 37.05 Gy. Acute toxicity of the breast was evaluated at the end of HEBRT and at 1 month of follow-up. Late toxicity was recorded at 6 and 12 months of follow-up. We report the data from 204 patients. The maximal acute skin toxicity was observed at the end of HEBRT (182 patients evaluable) with 7 (3.8%) Grade 3, 52 (28.6%) Grade 2, 123 (67.6%) Grade 1, and no Grade 0 or Grade 4 cases. A total of 108 patients were evaluated for late toxicity. The recorded late skin toxicity was Grade 4 in 1 patient (0.9%), Grade 3 in 1 patient, and Grade 2 or less in 106 patients (98.2%). The results of this study have shown that electron intraoperative therapy followed by HEBRT allows for the delivery of a high dose to the tumor bed and an adequate dose to the whole breast. This treatment is feasible, compliance is high, and the rate of acute toxicity and the preliminary data on chronic toxicity seem acceptable.

Racial Segregation and Disparities in Cancer Stage for Seniors

Disparities in cancer survival may be related to differences in stage. Segregation may be associated with disparities in stage, particularly for cancers for which screening promotes survival. The objective of the study was to examine whether segregation modifies racial/ethnic disparities in stage. The design of the study was analysis of Surveillance, Epidemiology, and End Results Medicare data for seniors with breast, colorectal, lung, and prostate cancer (n = 410,870). The outcome was early- versus late-stage diagnosis. Area of residence was categorized into 4 groups: low segregation/high income (potentially the most advantaged), high segregation/high income, low segregation/low income, and high segregation/low income (possibly the most disadvantaged). Blacks were less likely than whites to be diagnosed with early-stage breast, colorectal, or prostate cancer, regardless of area. For colorectal cancer, the black/white disparity was largest in low-segregation/low-income areas (black/white odds ratio [OR] of early stage 0.51) and smallest in the most segregated areas (ORs 0.71 and 0.74, P < .005). Differences in disparities in stage by area category were not apparent for breast, prostate, or lung cancer. Whereas there were few Hispanic-white differences in early-stage diagnosis, the Hispanic/white disparity in early-stage diagnosis of breast cancer was largest in low-segregation/low-income areas (Hispanic/white OR of early stage 0.54) and smallest in high-segregation/low-income areas (OR 0.96, P < .05 compared to low-segregation/low-income areas). Disparities in stages for cancers with an established screening test were smaller in more segregated areas.

An Unusual Presentation of Locally Recurrent Breast Cancer: A Case Report

Recurrent breast carcinoma is usually detected by imaging studies and biopsy. We present a case with unusual clinical presentation and discuss the diagnosis and treatment. While core needle biopsy and fine-needle aspiration are important in the diagnosis of early-stage breast cancer, physical examination and close follow-up are important in the absence of a diagnosis.

Computer-Aided Mass Detection Based on Ipsilateral Multiview Mammograms

Recent reports on advances in computer-aided detection (CAD) indicate that current schemes miss early-stage breast cancers and result in a relatively large false-positive detection rate in order to achieve a high sensitivity rate for mass detection. This paper is inspired by the interpretation procedure from mammographers. The abnormal diagnosis can be derived from multiple views but is not available through single-view image analysis. A new multiview CAD system for early-stage breast cancer detection, which is based on modifying the optimized CAD algorithms from our prior single-view CAD system for constructing an adaptive ipsilateral multiview concurrent CAD system, is presented in this paper. The selection and design for the training and testing ipsilateral multiview mammogram databases are described here. The performance evaluation of the developed ipsilateral multiview CAD system using free-response receiver operating characteristic analysis and computerized receiver operating characteristic experiments are presented. The results indicated that the proposed multiview CAD system is significantly superior to the single-view CAD systems based on statistically standard P-values. This paper addresses a very important and timely project. It is related to two main problems regarding the development of breast cancer detection and diagnosis: early-stage detection and diagnosis of breast cancer with digital mammogram, and overall improvement of CAD system performance for clinical implementation. In order to improve the efficacy, accuracy, and efficiency of the current CAD scheme, an entirely new class of CAD method is required. This paper is unique in that a comprehensive and state-of-the-art approach is proposed for the CAD scheme of digital mammography. From the design aspect of the CAD scheme, the proposed ipsilateral multiview CAD method is innovative and quite different from current single-view CAD methods.

Minimally Invasive Approaches for Diagnosis and Treatment of Early-Stage Breast Cancer

Breast cancer management has been evolving toward minimally invasive approaches. Image-guided percutaneous biopsy techniques provide accurate histologic diagnosis without the need for surgical biopsy. Breast conservation therapy has become the treatment standard for early-stage breast cancer. Sentinel lymph node biopsy is a new procedure that can predict axillary lymph node status without the need of axillary lymph node dissection. The next challenge is to treat primary tumors without surgery. For this purpose, several new minimally invasive procedures, including radiofrequency ablation, interstitial laser ablation, focused ultrasound ablation, and cryotherapy, are currently under development and may offer effective tumor management and provide treatment options that are psychologically and cosmetically more acceptable to the patients than are traditional surgical therapies. In this review, we give an overview of minimally invasive approaches for the diagnostic and therapeutic management of early-stage breast cancer.

Aromatase Inhibitors — A Triumph of Translational Oncology

Great strides have been made in the diagnosis and treatment of early-stage breast cancer, thanks to advances in molecular medicine, interdisciplinary treatment, and rapid electronic communication. Hormonal therapy, the first and most successful targeted therapy for breast cancer, has saved many thousands of lives. Moreover, screening and adjuvant (postoperative) therapy have increased survival among women with breast cancer.1,2 The improvement in survival can be attributed to both adjuvant tamoxifen therapy and adjuvant chemotherapy and has been found in all subgroups of patients regardless of the presence or absence of tumor cells in draining lymph nodes, including women who are . . .

Fertility- and Menopause-Related Information Needs of Younger Women With a Diagnosis of Early Breast Cancer

The use of chemotherapy and endocrine therapies in the treatment of premenopausal women carries with it reproductive and gynecologic implications that young women may find distressing and discordant with plans for childbearing. This multicenter study aimed to investigate fertility- and menopause-related information needs among young women with a diagnosis of early-stage breast cancer. Two hundred twenty-eight women with a diagnosis of early-stage breast cancer who were aged 40 years or younger at diagnosis and who were 6 to 60 months after diagnosis were entered onto the trial. Participants completed a mailed self-report questionnaire that included a purposely designed fertility- and menopause-related information needs survey and standardized measures of distress, anxiety, quality of life, menopausal symptoms, and information-seeking style. Seventy-one percent of participants discussed fertility-related issues with a health professional as part of their breast cancer treatment, and 86% discussed menopause-related issues. Consultation with a fertility or menopause specialist was the most preferred method of obtaining this information. Receiving fertility-related information was rated as being significantly more important than receiving menopause-related information at time of diagnosis (P < .001) and at treatment decision making (P = .058). Receiving menopause-related information was rated as being significantly more important than receiving fertility-related information during adjuvant treatment (P < .05), at completion of adjuvant treatment (P < .001), and during follow-up (P < .001). Common questions, sources of information, and correlates of perceived importance were identified. The results of this study suggest that younger women have unmet needs for fertility- and menopause-related information and provide preliminary empirical data to guide the development of better fertility- and menopause-related patient education materials for younger women with a diagnosis of early breast cancer.