Improve Breast Cancer Outcomes Research Articles

Breast Cancer Incidence and Mortality by Molecular Subtype: Statewide Age and Racial/Ethnic Disparities in New Jersey.

The objective of this study was to assess breast cancer incidence and mortality rates by molecular subtype for cases diagnosed in New Jersey. Data on all primary, histologically confirmed, invasive breast cancers diagnosed among women between January 1, 2008 and December 31, 2013 were retrieved from the New Jersey State Cancer Registry. Age-adjusted incidence rates were calculated for each subtype, by ageandrace/ethnicity. Logistic regression models, Cox proportional hazards models, and Kaplan Meier curves were used to describe the relative risks for breast cancer incidence, mortality, and survival, respectively. In this population-based sample of 32,770 breast cancer cases, non-Hispanic Blacks (NHBs) had the highest triple-negative breast cancer (TNBC) incidence rate (17.8 per 100,000, 95% CI 16.5-19.2) compared to other races/ethnicities. NHBs had also higher odds of TNBC (OR 2.1, 95% CI 1.95-2.36) and higher hazards of death when diagnosed with TNBC (HR 1.28, 95% CI 1.05-1.56), luminal A (HR 1.64, 95% CI 1.41-1.91), or luminal B (HR 1.54, 95% CI 1.10-2.15) than non-Hispanic Whites (NHWs). Younger women (20-39 years) had higher odds of TNBC (OR 1.77, 95% CI 1.54-2.02) and luminal B (OR 1.56, 95% CI 1.35-1.80) compared to women 50-64 years; minority women had higher odds of non-luminal HER2-expressing and lower odds of luminal A than NHWs. TNBC was associated with the poorest survival rates. These findings highlight a need for enhanced screening to promote earlier diagnosis and improve breast cancer outcomes, particularly in minorities and younger women, which will be essential for achieving health equity.

Pre-surgical oncolytic virotherapy improves breast cancer outcomes

ABSTRACTOncolytic viruses (OVs) are a novel class of cancer biotherapeutics with the ability to kill cancers and trigger anti-tumor immunity. Using murine models of cancer in pre-clinical proof-of-concept studies, we found that neoadjuvant OV administration before surgery efficiently prevents relapse, controls metastases and sensitizes tumors to immune checkpoint inhibitors (ICIs).

Reconstructive utilisation and outcomes following mastectomy surgery in women with breast cancer treated in England.

Breast cancer usually necessitates breast-conserving surgery or mastectomy, which adversely affect appearance and wellbeing. Immediate reconstruction restores the breast mound but its availability and efficacy are uncertain. Two discrete datasets were used to evaluate mastectomies in England: Hospital Episode Statistics to measure overall activity and variation over time and by region and a national prospective audit to evaluate immediate reconstruction decision making, complication rates and patient-reported satisfaction with information, choice and outcomes. The 2005-08 Hospital Episode Statistics analyses identified 20% breast-conserving surgery reoperation rates nationally, frequently involving mastectomy. Rates were higher with in-situ disease present (30% vs 18%) and varied across NHS trusts (10th-90th centiles 12-30%). The 2008-09 national audit examined 18,216 women. The 19% immediate reconstruction rate varied regionally (9-43%), as did 2006-09 Hospital Episode Statistics data (8-32%). A total of 48% of women were offered immediate reconstruction, again varying regionally (24-75%). Offer likelihood fell with increasing age. National immediate reconstruction rates increased from 10% to 23% from 2000 to 2014, but regional variation persisted. Despite high care satisfaction, just 65% of mastectomy patients received the right amount of reconstructive information (90% for immediate reconstruction). Women from deprived areas experienced higher complication rates. Flap-based immediate reconstruction led to greater satisfaction with breast area appearance, emotional and sexual wellbeing and overall outcome than mastectomy; implant-only immediate reconstruction scored no better. Reconstruction is central to improving breast cancer outcomes. The differential outcomes and persistent regional inequalities identified should facilitate decision making, support improved access to all reconstructive options and inform the development of an optimal patient pathway.

Abstract 5058: The association between smoking status at diagnosis and breast cancer specific mortality in Ireland: A population based study

Abstract Background: Breast cancer is the most commonly diagnosed cancer worldwide and is a leading cause of breast cancer mortality in females. In recent years, 5 year survival rates have greatly improved for breast cancer however a clear disparity exists between survival in countries of high income compared to low and middle income. Disparity in survival also exists within individual countries. The identification of modifiable lifestyle factors can be an impactful and cost effective way to improve breast cancer outcomes worldwide, particularly in low income counties. An association between active smoking at diagnosis and breast cancer specific mortality has been reported by a number of studies to date. However, there is a paucity of studies undertaken in European populations. This large study was conducted to investigate whether smoking status at diagnosis is an independent prognostic factor for breast cancer specific mortality in the Irish female population. Methods: All data was derived from the National Cancer Registry Ireland database which records all incident cancers in the Republic of Ireland. Completeness of case ascertainment at 5 years after diagnosis is estimated to be at 98%. Multivariable Cox proportional Hazards models were used to compare breast cancer specific mortality in current smokers, ex-smokers and never smokers. Subgroup analyses by breast cancer molecular subtype was also conducted. Results: Data for women with known smoking status at time of diagnosis included 37,711 invasive breast cancer cases that accrued 263,626 women-years. Current smokers had a significantly increased risk of breast cancer specific mortality compared to never smokers (multi-variable HR, 1.3; 95% CI, 1.19, 1.41). Ex-smokers did not have a significantly different hazard ratio compared to never smokers (HR, 1.02; 95% CI, 0.92, 1.12). In subgroup analyses, risk of dying from breast cancer was increased most for current smokers with HER2+ disease compared to never smokers in the 5 years post diagnosis (HR, 1.53; 95% CI, 1.11, 2.12). This was followed by luminal A disease (HR, 1.39: 95% CI, 1.17, 1.65). Conclusion. Breast cancer patients who are current smokers at diagnosis have a statistically significant increased risk of breast cancer specific mortality. This risk differs depending on molecular subtype of disease. Citation Format: Maeve Kiely, Joesph McDevitt, Linda Sharp. The association between smoking status at diagnosis and breast cancer specific mortality in Ireland: A population based study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5058.

Modifiable patient-related barriers and their association with breast cancer detection practices among Ugandan women without a diagnosis of breast cancer.

Most women with breast cancer in sub-Saharan Africa (SSA) are diagnosed with late-staged disease. The current study assesses patient-related barriers among women from a general SSA population to better understand how patient-related barriers contribute to diagnostic delays. Using convenience-based sampling, 401 Ugandan women without breast cancer were surveyed to determine how prior participation in cancer detection practices correlate with patient-related barriers to prompt diagnosis. In a predominantly poor (76%) and rural population (75%), the median age of the participants was 38. Of the women surveyed, 155 (46%) had prior exposure to breast cancer education, 92 (27%) performed breast self-examination (BSE) and 68 (20%) had undergone a recent clinical breast examination (CBE), breast ultrasound or breast biopsy. The most commonly identified barriers to prompt diagnosis were knowledge deficits regarding early diagnosis (79%), economic barriers to accessing care (68%), fear (37%) and poor social support (24%). However, only women who reported knowledge deficits—a modifiable barrier—were less likely to participate in cancer detection practices (p<0.05). Women in urban and rural areas were similarly likely to report economic barriers, knowledge deficits and/or poor social support, but rural women were less likely than urban women to have received breast cancer education and/or perform BSE (p<0.001). Women who have had prior breast cancer education (p<0.001) and/or who perform BSE (p = 0.02) were more likely to know where she can go to receive a diagnostic breast evaluation. These findings suggest that SSA countries developing early breast cancer detection programs should specifically address modifiable knowledge deficits among women less likely to achieve a diagnostic work-up to reduce diagnostic delays and improve breast cancer outcomes.

Cardiotoxicities of Modern Treatments in Breast Cancer.

This paper will focus on novel breast cancer therapies used in clinical practice today, as well as review our understanding of standard therapies and their potential impact on cardiovascular health. Established and novel treatments such as anthracyclines, HER2-targeted agents, and immunotherapy have contributed to improvements in breast cancer outcomes; however, these treatments may be associated with an increased risk of cardiovascular injury. The number of available breast cancer treatments continues to expand, as does the need for health care providers to understand the potential impact of these treatments on cardiovascular health. Collaborative approaches in the development of risk stratification, prevention, and surveillance strategies for patients exposed to established and novel breast cancer treatments will facilitate improvements in patient outcomes without compromising their cardiovascular health.

Obesity and the Effects of Weight Reduction: A Spotlight on Women with Hormone Receptor-Positive Breast Cancer and Heart Disease

Obesity is a common overlapping risk factor for cancer and cardiovascular disease (CVD), and the long-term consequences of these chronic, interconnected diseases are severe. The importance of CVD in breast cancer (BC) patients and survivors has been well-established, and the potential impact of some BC treatments (such as cardiotoxic effects related to chemotherapy or targeted therapy with the use of doxorubicin or trastuzumab, and radiation therapy, especially in cases of left breast tumours) on the cardiovascular condition necessitates ongoing cardiological surveillance. In addition, the possible reduction of some underlying risk factors is critical to long-term protection of BC patients and survivors. The concept of obesity dynamically interacting with both BC and CVD is important because it is a modifiable risk factor, and the modern management of obesity deserves emphasis. In particular, for many BC patients and survivors, an effective weight reduction programme integrated with standard anticancer and cardiology therapies can improve patient outcomes. This review presents the complex relationships between overweight, obesity, CVD, and BC risk and highlights outcomes in post and premenopausal women, focussing on patients with hormone receptor-positive BC. The review provides evidence from epidemiologic, observational, and weight loss intervention trials which have examined the effects of weight reduction programmes on BC outcomes. Such studies have indicated that moderate weight loss, with regular physical exercises or stress reduction, can significantly improve BC outcomes. Future lifestyle intervention trials could support the incorporation of weight loss interventions as an integral element of comprehensive management for BC patients and survivors.

An analysis of the sociodemographic factors contributing to patient nonadherence to recommendations for screening mammograms.

e13077 Background: There were 2 million newly diagnosed cases of breast cancer in the United States during 2018 with 40,920 associated deaths1. The number of deaths has been decreasing over time due to effective breast cancer screening by mammogram. Routine mammograms lead to early recognition and treatment of breast cancer leading to an overall improvement in breast cancer outcomes. However, not all patients are adherent to screening mammogram schedules. The main aim of this study is to explore the current prevalence of breast cancer screening among women in the US. A secondary aim is to determine whether cancer screening is associated with identifiable sociodemographic determinants and cigarette smoking. Methods: Data were drawn from the Health Information National Trends Survey- (HINTS), a cross-sectional, nationally representative survey (N = 3,527) conducted in 2018. Responses from women aged 18-74 were used in this study. Descriptive analyses and chi-squared tests were conducted to estimate the prevalence of breast cancer screening by mammogram, as well as its association with certain sociodemographic characteristics and smoking status. Results: The survey sample included 1,722 women. The majority of the respondents were aged 45 years or older. A total of 5% of women had previously been diagnosed with breast cancer, most of them being between 65 and 74 years old. Overall, 22.1% of respondents reported that they had never had a mammogram. Breast cancer screening was significantly lower among young women aged 18 to 34 (76.0%), Hispanic (28.2%) and Asian (39.7%), and current smokers (24.6%). Conclusions: This study shows that there is a significant percentage of women in the US that do not adhere to screening recommendations for breast cancer. This study provides new and continuing evidence, regarding the profiles of women with poor adherence to these screening mammogram schedules. Overall, the findings from this study emphasize the importance of addressing racial and sociodemographic factors in an effort to improve screening mammogram adherence.

Effect of tart cherry on aromatase inhibitor-induced arthralgia (AIA) in nonmetastatic hormone-positive breast cancer patients: A randomized double-blind placebo-controlled trial.

525 Background: Aromatase inhibitors (AI) are the standard treatment for hormone receptor‐positive breast cancer in postmenopausal women. About half of patients (pts) taking AI suffer from AIA which can be severe enough to cause noncompliance. Suboptimal AI adherence is associated with decreased disease-free and overall survival, suggesting that improving adherence will lead to improved breast cancer outcomes. Effective interventions for AIA are still limited. In clinical trials, tart cherry (TC) showed beneficial effect on musculoskeletal pain associated with osteoarthritis, gout, and strenuous exercise. The flavonoids and anthocyanins in TC reportedly exert an anti-inflammatory effect that may lessen adverse effects of estrogen deficiency. This trial aimed to investigate whether TC can reduce AIA in non-metastatic hormone positive breast cancer (NMHPBC) pts. Methods: This is a randomized, placebo-controlled, double-blind trial. Eligible Pts with NMHPBC on AI for at least 4 weeks were randomized to TC concentrate (equivalent to 50 tart cherries) versus placebo (P) [syrup] in a 1:1 model. Pts were instructed to take 1 Oz of TC or P in 8 Oz water daily for 6 weeks, and to document their pain intensity at baseline, weekly and at study completion in a diary using a Visual Analog Scale (VAS), with 0 mm indicating no pain, and 100 mm indicating highest pain. Results: 60 pts were enrolled from May 2016 to August 2018. 2 pts did not complete the study due to diarrhea. 10 pts were non-compliant. 48 pts were included in the final analysis. TC group (23 pts) had 34.7% mean decrease in pain compared to 1.4% in P group (25 pts). This difference was statistically significant (Mann-Whitney U Test P = 0.034). Conclusions: Tart cherry can significantly improve AIA in non-metastatic breast cancer patients.

Surgical Therapy for Women with Multiple Synchronous Ipsilateral Breast Cancer (MIBC): Current Evidence to Guide Clinical Practice

Based on retrospective, historic data, surgeons have long recommended mastectomy as the surgical approach for women with multiple ipsilateral synchronous (multifocal or multi-centric) breast cancer (MIBC). In the modern era, however, local recurrence rates have significantly decreased due to improved imaging techniques and earlier detection through breast cancer screening, more accurate delivery of radiation, and the advent of targeted systemic therapies. Given the significant non-surgical advancements in the field of breast cancer care, the role of maximally invasive surgery in improving breast cancer outcomes has diminished. This raises the question as to whether the routine recommendation for mastectomy in MIBC is rooted in current evidence or archaic data. This review summarizes data regarding surgical options for women with MIBC. The incidence of MIBC is increasing as a result of improved imaging modalities and the use of breast MRI for breast cancer screening and staging. MIBC tends toward more aggressive biology and higher rates of nodal positivity but recent data contradict the notion that more aggressive surgery improves outcomes. Retrospective studies and meta-analyses performed in the current era of targeted therapy and more sensitive breast cancer detection have demonstrated equivalent rates of local regional recurrence (LRR) in women with MIBC undergoing breast-conserving therapy (BCT) when compared stage to stage with women with unifocal disease. Alliance Z11102, the first national, prospective trial of breast conservation in the MIBC population in the USA, demonstrated the feasibility of BCT in this patient population with acceptable rates of conversion to mastectomy in the MIBC cohort. Prospective data regarding LRR and cosmetic outcomes for women undergoing BCT from completed clinical trials continue to mature, and new randomized clinical trials investigating the biology and treatment of MIBC are under design. The incidence of MIBC is increasing due to screening mammography, improved quality of imaging, and the utilization of breast MRI for breast cancer screening and staging. Local regional recurrence rates in women with unifocal disease have decreased due to earlier detection and improved regional and systemic therapy. As adjuvant therapy improves, the extent of surgery is less impactful on LRR and long-term survival. Current data demonstrate acceptable LRR in women undergoing BCT for MIBC for whom negative surgical margins are achieved and appropriate adjuvant therapy is administered. While additional prospective data regarding biology, LRR, cosmesis, and long-term survival in women with MIBC continue to be collected, current evidence supports the role of patient choice in deciding between breast conservation and mastectomy in this population.

Establishing Cohorts to Generate the Evidence Base to Reduce the Burden of Breast Cancer in Sub-Saharan Africa: Results From a Feasibility Study in Kenya.

PURPOSEBy 2025, Kenya is estimated to experience a two-thirds increase in the incidence of breast cancer. Local research is necessary to generate evidence to inform policy, public health, and medical practice. There have been no longitudinal cohort studies in sub-Saharan Africa of women with and without breast cancer. Our aim is to assess the feasibility of conducting cohort studies in Kenya that consider clinical characteristics, socioeconomic factors, and self-care behaviors.METHODSWe initiated a short-term follow-up cohort study of women with and without a diagnosis of breast cancer with baseline face-to-face data collection and one follow-up interview (at approximately 3 months by telephone). We developed tailored instruments to capture demographics, socioeconomic factors, breast cancer risk, ability to identify breast cancer symptoms, treatments received for breast cancer, and quality of life of survivors.RESULTSWe recruited 800 women between the ages of 20 and 60 years and successfully collected baseline data. Completeness of the data was high for demographic variables, but there was a larger proportion of missing information for specific variables required for assessing breast cancer risk. Respondents were able to complete standardized instruments to assess breast cancer knowledge among those without breast cancer and identification of symptoms among survivors. We were able to successfully contact approximately 80% of the participants for follow-up.CONCLUSIONThis short-term follow-up study provides evidence that women can be successfully tracked and contacted for follow-up in the Kenyan setting and offers lessons to establish future longitudinal cohorts to identify approaches to improve breast cancer outcomes.

Discontinuation of adjuvant hormone therapy among breast cancer patients not previously attending mammography screening

BackgroundBreast cancer patients who have not previously attended mammography screening may be more likely to discontinue adjuvant hormone therapy and therefore have a worse disease prognosis.MethodsWe conducted a population-based cohort study using data from Stockholm Mammography Screening Program, Stockholm-Gotland Breast Cancer Register, Swedish Prescribed Drug Register, and Swedish Cause of Death Register. Women in Stockholm who were diagnosed with breast cancer between 2001 and 2008 were followed until December 31, 2015. Non-participants of mammography screening were defined as women who, prior to their breast cancer diagnosis, were invited for mammography screening but did not attend.ResultsOf the 5098 eligible breast cancer patients, 4156 were defined as screening participants and 942 as non-participants. Compared with mammography screening participants, non-participants were more likely to discontinue adjuvant hormone therapy, with an adjusted hazard ratio (HR) of 1.30 (95% CIs, 1.11 to 1.53). Breast cancer patients not participating in mammography screening were also more likely to have worse disease-free survival, even after adjusting for tumor characteristics and other covariates (adjusted HR 1.22 (95% CIs, 1.05 to 1.42 for a breast cancer event).ConclusionsTargeted interventions to prevent discontinuation of adjuvant hormone therapy are needed to improve breast cancer outcomes among women not attending mammography screening.

A review of home-based physical activity interventions for breast cancer survivors.

As breast cancer relative survival continues to increase, many breast cancer patients face many issues, including recurrence of cancer and cancer-related side effects that impact several aspects of their quality of life. With breast cancer patients living longer, there is more of a concern for negative breast cancer outcomes. Although physical activity is an affordable and relatively convenient way to improve breast cancer outcomes, only about one-third of breast cancer survivors engage in the recommended level of physical activity. This article reviews articles published to date to examine whether home-based physical activity interventions are effective in improving physical activity and other outcomes among breast cancer survivors who have completed primary therapy for the disease. The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from 1980 through February 28, 2019 were identified. A total of 360 article citations were identified in PubMed and non-duplicates in CINAHL. After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, 20 studies that met the eligibility criteria. Three of the studies were pre-/post-test trials and 17 were randomized controlled trials. home-based exercise programs are effective in improving physical activity among breast cancer survivors who have completed primary therapy for the disease. Home-based exercise programs such as walking programs offer a convenient and affordable option for women who wish to increase their physical activity and maintain a healthy lifestyle.

Clinicians’ experiences and perspectives of breast cancer and possible integration of breast cancer prevention and early detection into palliative care

BackgroundLate presentation of breast cancer (BC) is a public health concern due to its impact on survival and mortality, especially, in low-resourced countries. Prevention and early detection of breast cancer are required to improve breast cancer outcomes in developing countries. ObjectiveThis study explores clinicians’ experiences and perspectives of breast cancer and possible the integration of breast cancer prevention and early detection into palliative care. MethodA qualitative exploratory design was employed to understand the subject of interest. In-depth-interviews were conducted using a semi-structured interview guide to generate data from seven clinicians who provided symptomatic care to patients and families diagnosed with advanced breast cancer in a developing country. The data were collected at the palliative care clinic of the Komfo Anokye Teaching hospital. The data were analyzed concurrently with data collection using thematic analysis. ResultsThree main themes emerged from the data and these were: breast cancer presentation, barriers to achievement of early detection and lastly, the need for an intervention. The themes also had sub-themes. ConclusionsThe study recommend the development of a model to guide the integration of breast cancer prevention and early detection into palliative care.

Effects of immunization against PCSK9 in an experimental model of breast cancer.

IntroductionInhibition of proprotein convertase subtilisin/kexin 9 (PCSK9) is an efficient strategy for lowering low-density lipoprotein cholesterol (LDL-C). There are, however, scant data on the efficacy and safety of PCSK9 inhibitors in non-cardiovascular diseases, particularly cancer. The present study aimed to evaluate the effect of PCSK9 inhibition using a nanoliposomal antiPCSK9 vaccine on cancer behavior and endpoints in mice bearing breast tumor.Material and methodsTo induce antiPCSK9 antibody in vivo, a nanoliposomal antiPCSK9 vaccine absorbed on 0.4% alum adjuvant was used. To induce tumor, BALB/c mice were subcutaneously inoculated with 4T1 breast carcinoma cells. After the tumor mass was palpable (approximately 10 mm3), the mice were randomly divided into four groups and subjected to different treatment protocols: (1) PBS (untreated control), (2) vaccine group, (3) combination of vaccine and Doxil, and (4) Doxil (positive control) group. Vaccine was subcutaneously administered to mice four times at 2-week intervals. Two weeks after the last administration, the vaccinated and non-vaccinated mice were subcutaneously inoculated with 4T1 breast carcinoma cells. To evaluate therapeutic efficacy, mouse body weight, tumor size, and survival were monitored every other day for 60 days.ResultsThe nanoliposomal antiPCSK9 vaccine was found to efficiently induce specific antibodies against PCSK9 in BALB/c mice, thereby decreasing plasma levels of PCSK9 and inhibiting its function. Tumor size analysis showed that time to reach endpoint (TTE) of the vaccine, combination, Doxil, and control groups was 47 ±10, 57 ±4, 60 ±4 and 39 ±9 days, respectively. Rate of tumor growth in vaccine, combination and Doxil groups was decreased by 21%, 48% and 53%, respectively, compared to the control group. Lifespan was increased by 4.2% in the vaccine group, compared with the control group. Additionally, the survival in the combination and Doxil groups was significantly higher than the vaccine and control groups.ConclusionsOur results revealed that PCSK9 inhibition may moderately improve breast cancer outcomes while having no harmful effects in tumor-bearing mice.

The Feasibility and Performance of the Patient Navigation Programme in Improving Breast Cancer Care in Malaysia

Background: Breast cancer is the most common cancer in Malaysia and it is anticipated that incidence will increase by 49% from 2012 to 2025. Unfortunately, survival remains poor because of late presentation and poor adherence to evidence-based medicine. Barriers to early presentation include inadequate knowledge about the disease, financial issues, negative influence of relatives and perceived poor quality of care and services in state-run hospitals. Poor adherence to treatment is also a common struggle, and is further exacerbated by the use of traditional, alternative healing methods. While patient navigation (PN) programs have been shown to improve breast cancer outcomes in the US, its implementation and performance in low and middle income countries is not well studied. Aim: We sought to determine the impact of a PN program in reducing treatment delays and improving adherence to treatment and patient satisfaction, as well as to evaluate the barriers faced by women seeking breast cancer care in Malaysia. Methods: We established a nurse-led patient navigation center at a secondary government hospital in Klang. This clinical team involved the surgery, pathology, radiology and nursing departments and provided patient-centered care, including patient tracking and call reminder systems, family counseling, health education and decision aids. The community team involved a Patient Navigator Program Coordinator and a Community Navigator. We compared treatment delays and adherence to treatment between navigated patients and patients registered in the year prior to the PN program. We used Student t-tests and Pearson χ2 or Fisher's Exact tests to compare timeliness between navigated patients and patients registered in the year prior. Results: Of the 136 Malaysian women enrolled in the PNP in 2015, 48.9% were diagnosed with advanced disease (stage 3 or 4). Women with advance disease had a lower median monthly household income compared with women with early disease (USD $350 vs $540, P = 0.023). Women with advance disease were also less likely to have personal transportation to the hospital (36.4% vs 56.5%, P = 0.048). Compared with the year before PN, more navigated patients underwent mammography within 7 days of their first visit (96.4% vs 74.4%, P &lt; 0.001) and received their diagnosis within 14 days of their first visit (80.0% vs 58.5%, P &lt; 0.001). The proportion of women who met timeliness to treatment initiation was similar for navigated patients and patients in the year prior. The proportion of defaulters were marginally lesser among navigated patients compared with the year prior (4.4% vs 11.5%, P = 0.048). Conclusion: We found that integrating PN within a breast clinic of a middle income country is feasible, and in the long run, could improve outcomes for breast cancer patients. Long-term follow-up is needed to assess the impact of the PN program on improving treatment completion and survival.

Assessment and Improvement Strategies for a Breast Cancer Early Detection Program in Rural South Africa

Purpose More than one half of breast cancer deaths occur in low- and middle-income countries, where survival rates are 60% at best. Appropriate programs that improve detection, diagnosis, and treatment in low- and middle-income countries are essential to improving breast cancer outcomes. The sustainability of such programs requires ongoing efforts, yet there remains a lack of literature on follow-up to assure long-term program success. Our study aimed to understand what needs developed in the year after the implementation of an early detection program and to evaluate potential solutions. Methods A WHO-endorsed RAD-AID Radiology Readiness Assessment evaluated clinic resources. In addition, in 5 weeks of observation we identified resource deficiencies and reviewed existing documentation methods. On the basis of stakeholders’ input and the Breast Imaging Reporting and Data System, we developed new documentation systems. Training was followed by a survey that assessed feasibility and provider acceptance. Results Resource limitations included a lack of computers, unpredictable electrical supply, and inconsistent Internet. Assessment revealed incomplete documentation of breast clinical examinations and history, breast lesions, and follow-up. In addition, limitations negatively impacted communication between providers. Three solutions were developed: a paper patient history form, a paper clinical findings form, and a computerized patient-tracking database that was compliant with the Breast Imaging Reporting and Data System. Three nurses, three nursing assistants, and one counselor completed the survey. Seventy-one percent (five of seven respondents) indicated positive or very positive general attitudes. One hundred percent of respondents agreed or strongly agreed to the following statement: the documentation system is easy, useful, and improves overall quality of care, follow-up, decision making, access to clinical information, and communication between clinicians and patients. Five of seven providers reported that the system increased visit time, but three of these five felt that the process was valuable. Conclusion Implementing a breast cancer early detection program in resource-limited regions is challenging and continued assessment is essential. As a result of identified needs, we developed a documentation system that was broadly accepted. Potential future steps should focus on increasing efficiency, evaluating provider attitudes on a long-term basis, and clinical impact. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Susan C. Harvey Honoraria: Hologic Inc, IBM Watson Imaging Consulting or Advisory Role: IBM Watson, Hologic Inc Research Funding: IBM Watson

Data mining of digitized health records in a resource-constrained setting reveals that timely immunophenotyping is associated with improved breast cancer outcomes

BackgroundOrganizations that issue guidance on breast cancer recommend the use of immunohistochemistry (IHC) for providing appropriate and precise care. However, little focus has been directed to the identification of maximum allowable turnaround times for IHC, which is necessary given the diversity of hospital settings in the world. Much less effort has been committed to the development of digital tools that allow hospital administrators to monitor service utilization histories of their patients.MethodsIn this retrospective cohort study, we reviewed electronic and paper medical records of all suspected breast cancer patients treated at one secondary-care hospital of the Mexican Institute of Social Security (IMSS), located in western Mexico. We then followed three years of medical history of those patients with IHC testing.ResultsIn 2014, there were 402 breast cancer patients, of which 30 (7.4% of total) were tested for some IHC biomarker (ER, PR, HER2). The subtyping allowed doctors to adjust (56.7%) or confirm (43.3%) the initial therapeutic regimen. The average turnaround time was 56 days. Opportune IHC testing was found to be beneficial when it was available before or during the first rounds of chemotherapy.ConclusionsThe use of data mining tools applied to health record data revealed that there is an association between timely immunohistochemistry and improved outcomes in breast cancer patients. Based on this finding, inclusion of turnaround time in clinical guidelines is recommended. As much of the health data in the country becomes digitized, our visualization tools allow a digital dashboard of the hospital service utilization histories.

Role of Family Obligation Stress on Ugandan Women's Participation in Preventive Breast Health.

The purpose of this study is to determine the role of family obligation stress on Ugandan women's participation in preventive breast health through the receipt of breast cancer education and health check-ups. A validated survey was conducted on a community sample of Ugandan women, providing a multi-item scale to assess preventive breast-health-seeking behaviors and measure family obligation stress (FO; range 6-18). Univariate and multivariate linear regression was used to assess associations between sociodemographic factors and FO. Univariate and multivariate linear regression (used in conjunction with the robust sandwich estimator for standard errors) and probability differences (PDs) were used to evaluate associations between preventive breast-health-seeking behaviors, sociodemographic factors, and FO. A total of 401 Ugandan women ages 25-74 participated in the survey. Most had three or more children in the home (60%) and were employed full time (69%). Higher FO was associated with increasing number of children and/or adults in the household (p < .05), full-time employment (p < .001), and being single (p = .003). Women with higher FO were less likely to participate in breast cancer education (PD = -0.02 per 1-point increase, p = .008) and preventive health check-ups (PD = -0.02, p = .018), associations that persisted on multivariate analysis controlling for sociodemographic factors. Ugandan women with high FO are less likely to participate in preventive breast cancer detection efforts including breast cancer education and preventive health check-ups. Special efforts should be made to reach women with elevated FO, because it may be a risk factor for late-stage presentation among women who develop breast cancer. High family obligation stress (FO) significantly reduces women's participation in preventive health check-ups and breast cancer education. These findings support research in U.S. Latinas showing high FO negatively affects women's health, suggesting that FO is an important factor in women's health-seeking behavior in other cultures. Addressing family obligation stress by including family members involved in decision-making is essential for improving breast cancer outcomes in low- and middle-income countries, such as Uganda.

Impact of vitamin D on pathological complete response and survival following neoadjuvant chemotherapy for breast cancer: a retrospective study

BackgroundThere has been interest in the potential benefit of vitamin D (VD) to improve breast cancer outcomes. Pre-clinical studies suggest VD enhances chemotherapy-induced cell death. Vitamin D deficiency was associated with not attaining a pathologic complete response (pCR) following neoadjuvant chemotherapy (NAC) for operable breast cancer. We report the impact of VD on pCR and survival in an expanded cohort.MethodsPatients from Iowa and Montpellier registries who had serum VD level measured before or during NAC were included. Vitamin D deficiency was defined as < 20 ng/mL. Pathological complete response was defined as no residual invasive disease in the breast and lymph nodes. Survival was defined from the date of diagnosis to the date of relapse (PFS) or date of death (OS).ResultsThe study included 327 women. Vitamin D deficiency was associated with the odds of not attaining pCR (p = 0.04). Fifty-four patients relapsed and 52 patients died. In multivariate analysis, stage III disease, triple-negative (TN) subtype and the inability to achieve pCR were independently associated with inferior survival. Vitamin D deficiency was not significantly associated with survival in the overall sample; however a trend was seen in the TN (5-years PFS 60.4% vs. 72.3%, p = 0.3), and in the hormone receptor positive /human epidermal growth factor receptor 2 negative (HER2-) subgroups (5-years PFS 89% vs 78%, p = 0.056).ConclusionVitamin D deficiency is associated with the inability to reach pCR in breast cancer patients undergoing NAC.