Large Breast Size Research Articles

The genetic interplay between body mass index, breast size and breast cancer risk: a Mendelian randomization analysis.

BackgroundEvidence linking breast size to breast cancer risk has been inconsistent, and its interpretation is often hampered by confounding factors such as body mass index (BMI). Here, we used linkage disequilibrium score regression and two-sample Mendelian randomization (MR) to examine the genetic associations between BMI, breast size and breast cancer risk.MethodsSummary-level genotype data from 23andMe, Inc (breast size, n = 33 790), the Breast Cancer Association Consortium (breast cancer risk, n = 228 951) and the Genetic Investigation of ANthropometric Traits (BMI, n = 183 507) were used for our analyses. In assessing causal relationships, four complementary MR techniques [inverse variance weighted (IVW), weighted median, weighted mode and MR-Egger regression] were used to test the robustness of the results.ResultsThe genetic correlation (rg) estimated between BMI and breast size was high (rg = 0.50, P = 3.89x10−43). All MR methods provided consistent evidence that higher genetically predicted BMI was associated with larger breast size [odds ratio (ORIVW): 2.06 (1.80–2.35), P = 1.38x10−26] and lower overall breast cancer risk [ORIVW: 0.81 (0.74–0.89), P = 9.44x10−6]. No evidence of a relationship between genetically predicted breast size and breast cancer risk was found except when using the weighted median and weighted mode methods, and only with oestrogen receptor (ER)-negative risk. There was no evidence of reverse causality in any of the analyses conducted (P > 0.050).ConclusionOur findings indicate a potential positive causal association between BMI and breast size and a potential negative causal association between BMI and breast cancer risk. We found no clear evidence for a direct relationship between breast size and breast cancer risk.

Effect of Breast Size on Upper Torso Musculoskeletal Structure and Function: A Cross-Sectional Study.

Research has shown that women with large and hypertrophic breast sizes report an increased prevalence and severity of musculoskeletal pain in the upper torso. Despite this evidence, factors contributing to the development of musculoskeletal pain among these women are poorly understood, and the threshold at which breast size becomes problematic in terms of musculoskeletal pain is currently unknown. Three hundred Australian women (aged 18 to 82 years) who volunteered as participants were divided into four breast size groups (small, breast volume <350 ml; medium, breast volume 350 to 700 ml; large, breast volume 701 to 1200 ml; and hypertrophic, breast volume >1200 ml). The thoracic flexion torque, thoracic kyphosis angle, total upper torso musculoskeletal pain score, and regional upper torso musculoskeletal pain scores derived for participants in the four groups were compared using an analysis of covariance design, controlling for age and body mass index. Thoracic flexion torque significantly increased as breast size group increased. Women with hypertrophic breasts reported significantly higher total upper torso musculoskeletal pain scores compared with women who had small, medium, and large breasts, and this was significant for the upper back, shoulders, neck, and breasts. No significant difference was found in thoracic kyphosis angle among the four groups. Musculoskeletal pain became most pronounced in women with hypertrophic breasts who had the greatest breast volume and displayed the greatest thoracic flexion torque. Clinical and/or surgical treatment for symptomatic relief should aim to either counteract thoracic flexion torque or reduce breast volume. Risk, I.

Updated breast CT dose coefficients (DgNCT ) using patient-derived breast shapes and heterogeneous fibroglandular distributions.

The purpose of this work was to generate uncompressed heterogeneous breast phantom models using size-dependent fibroglandular distributions derived from a large cohort of breast CT (bCT) datasets, and to compare differences in normalized glandular dose coefficients for bCT "DgNCT " when the realistic heterogeneous model is considered relative to the simple, homogeneous model used in the past. A cohort of 274 segmented bCT datasets were used to quantify the fibroglandular tissue distribution within the breast parenchyma. Each dataset was interpolated to an isotropic voxel size of 0.25mm and the breast center-of-mass was aligned for all coronal slices. Each aligned dataset was converted into two binarized volumes representing voxels containing only glandular tissue "G(x,y,z)" and voxels containing glandular or adipose tissue "AG(x,y,z)". The datasets were classified by volume in accordance with previously reported size-dependent, breast-shaped phantoms. Within the five groups - each containing on average 55 datasets, all G(x,y,z) and AG(x,y,z) volumes were summed separately representing the cumulative distribution of glandular tissue or breast parenchyma (glandular+adipose), respectively. G(x,y,z) was divided by AG(x,y,z) on a voxel-by-voxel basis resulting in a glandular fraction "GF(x,y,z)" distribution for each phantom size. The GF(x,y,z) distributions were used to construct heterogeneous mathematical phantoms for the small, median, and large breast sizes with a 1.5mm skin thickness - based on previously reported measurements from bCT, and a 5mm skin thickness for comparison with outdated assumptions of skin thickness. A subset of 15 bCT datasets from the cohort (five for each breast size) were used to construct voxelized patient models for validation of the heterogeneous phantom models. Monte Carlo techniques were used to estimate monoenergetic DgN(E)C T values for photon energies from 9 to 70keV (in 1keV intervals) using the mathematical phantoms composed of either heterogeneous or homogeneous breast parenchyma. Polyenergetic (pDgNCT ) coefficients were determined by weighting the DgN(E)C T values by x-ray spectra tuned to the beam characteristic of breast CT. Dose coefficients were compared between the two breast compositions for each volume class, breast density, and skin thickness. For photon energies ≲45keV, the homogeneous model overestimates DgN(E) values relative to the realistic heterogeneous model sorted into five volume classes. The 5mm skin thickness underestimates DgN(E) values relative to the realistic 1.5mm thickness for lower energies and the differences diminish up to 70keV. Averaged across all phantom sizes the homogeneous model overestimates pDgNCT by 5.7% and 23.3% for the 60kV W/Cu and 49kV W/Al spectra, respectively. The heterogeneous model was also found to be in agreement with the voxelized bCT patient models with pDgNCT differences less than 2.3% and 5.2% for the 60kV W/Cu and 49kV W/Al spectra, respectively, across all phantom sizes. Anatomically accurate heterogeneous phantom models were developed using bCT image-derived fibroglandular tissue distributions. These new models improve the accuracy of bCT dosimetry, and in conjunction with previous models for mammography, may help in providing a more universally accepted breast dosimetry model.

Glutamate, inflammation, and cognition as predictors of psychological therapy outcome in bipolar disorder II

Waist-to-hip ratio (WHR) and breast size are considered important biological features defining female body attractiveness; but their neurophysiological correlates remain largely unknown. To shed light on this issue, behavioral and electroencephalographic responses were recorded while healthy heterosexual men and women completed an oddball task, which was then followed by an attractiveness judgement task. In both cases participants were presented with female body forms that combined 0.6, 0.7 or 0.8 WHRs with small or large breast sizes. Brain activity dynamics were explored using temporal principal component analysis of the event-related potentials data. Variance in the data was explained mostly by eight temporal factors for the oddball task and six for the attractiveness judgement task. Lower WHRs seemed to gather larger processing resources than higher WHRs at early perceptual-related processes during the oddball task. The less attractive WHRs and breast sizes, in contrast, seemed to boost allocation of resources later in the processing stream, which may be due to a negativity bias enhancing evaluation and decision-making processes. This inference is supported by results from the attractiveness judgement task, although the observer's gender may also play a role. Finally, LORETA analysis of the temporal factors indicate that variations in WHR may modulate activation of frontal regions, such as the anterior cingulate and orbitofrontal cortex, that are related with reward processing and decision-making; while variations in breast size may influence activity in posterior parietal regions involved in human body perception. This paper highlights the biological importance of female body physical features in defining attractiveness, and the neurophysiological correlates that are implicated.

Compare the organs at risk in breast-conserving three- dimensional conformal radiotherapy (3D-CRT) based on patient\'s breast size

Introduction: Breast cancer is the most common cancer among women. Radiotherapy plays an important role in the treatment of breast cancer and essential part of the standard treatment after breast-conserving surgery, routinely done to eliminate the microscopic residual cancer. The heart and lungs are one of the most important organs at risk of breast cancer radiotherapy that their exposure are unavoidable. Pneumonia and Pericardia are the most common complications of lung and heart radiation exposure, respectively. Materials and Methods: In this study, 20 patients undergoing radiotherapy after breast-conserving surgery were studied. The mean age of patients was 45 years old in the range of 30-60 years. Patients were treated by 3D-CRT with a single-isocenter tri-field technique including two apposite tangent fields and a supraclave field. To optimize the dose distribution, the wedge with suitable angle was placed in front of the beam for each field. The heart and right and left lung in each slice were contoured based on RTOG by oncologist and physicist, and was reconstructed in three dimensions by treatment planning system (Isogry version 4.1). Dose-volume histogram (DVH) for organs at risk were calculated and extracted. Parameters V5, V10, V20, V30, V40 and also Dmax and Dmean for organs at risk were extracted. Patients were classified into two groups, large and small breasts; then statistical analysis was performed with the SPSS software. Results: At all levels of the dose for the large breast group, a greater percentage of the heart was involved, but there was no significant statistical difference between the small breast group (p>0.05). In lungs, at all levels examined, the received dose of large breast group was higher than those of the small breasts, but this difference was not statistically significant (p>0.05). Only the Dmax parameter between the two groups was significant (p=0.01). Conclusion: The received dose of organs at risk, better results were obtained in a small breast; but no threshold of exposure risks. Therefore, paying attention to this group of patients is more clinically important. It is recommended that treatment planning for patients with large breast size more carefully done.

The effect of breast volume on toxicity using hypofractionated regimens for early stage breast cancer for patients

PurposeHypofractionated radiation therapy (HFRT) remains underused, despite multiple randomized trials showing the equivalence of HFRT to conventional fractionated radiation therapy (CFRT). We sought to retrospectively review the relationship between breast volume and toxicity for HFRT versus CFRT. Methods and materialsData from 114 patients who received a diagnosis of early stage breast cancer and were treated with lumpectomy and whole breast radiation alone were reviewed. Breast cancer laterality, stage, grade, estrogen/progesterone receptor and human epidermal growth factor receptor 2 status, and systemic therapy use were recorded. Length of follow-up was calculated using the last day of radiation treatment and the date of the most recent follow-up. ResultsThe median follow-up was 42 months. A total of 83 patients were treated with HFRT and 31 with CFRT. Rates of grade ≥2 skin toxicity were significantly higher in patients undergoing CFRT compared with HFRT (76% vs 28%; P < .0001). In a subset of patients with breast volume ≥1000 cm3, grade ≥2 skin toxicity trended higher for CFRT patients (73% vs 38%; P = .057). For posterior separation >25 cm, the percentage of patients with grade 2 skin toxicity was 43% for HFRT versus 57% for CFRT (P = .67). The volume of breast tissue receiving >105% of the total prescription dose, including boost, was not significantly different for HFRT versus CFRT (P = .70). ConclusionsUse of HFRT resulted in lower acute skin toxicity rates compared with CFRT. Large breast size (volume ≥1000 cm3) was associated with lower acute grade 2 toxicity with the use of HFRT despite achieving similar dosimetry compared with CFRT.

Three-Year Outcomes With Hypofractionated Versus Conventionally Fractionated Whole-Breast Irradiation: Results of a Randomized, Noninferiority Clinical Trial.

The adoption of hypofractionated whole-breast irradiation (HF-WBI) remains low, in part because of concerns regarding its safety when used with a tumor bed boost or in patients who have received chemotherapy or have large breast size. To address this, we conducted a randomized, multicenter trial to compare conventionally fractionated whole-breast irradiation (CF-WBI; 50 Gy/25 fx + 10 to 14 Gy/5 to 7 fx) with HF-WBI (42.56 Gy/16 fx + 10 to 12.5 Gy/4 to 5 fx). From 2011 to 2014, 287 women with stage 0 to II breast cancer were randomly assigned to CF-WBI or HF-WBI, stratified by chemotherapy, margin status, cosmesis, and breast size. The trial was designed to test the hypothesis that HF-WBI is not inferior to CF-WBI with regard to the proportion of patients with adverse cosmetic outcome 3 years after radiation, assessed using the Breast Cancer Treatment Outcomes Scale. Secondary outcomes included photographically assessed cosmesis scored by a three-physician panel and local recurrence-free survival. Analyses were intention to treat. A total of 286 patients received the protocol-specified radiation dose, 30% received chemotherapy, and 36.9% had large breast size. Baseline characteristics were well balanced. Median follow-up was 4.1 years. Three-year adverse cosmetic outcome was 5.4% lower with HF-WBI ( Pnoninferiority = .002; absolute risks were 8.2% [n = 8] with HF-WBI v 13.6% [n = 15] with CF-WBI). For those treated with chemotherapy, adverse cosmetic outcome was higher by 4.1% (90% upper confidence limit, 15.0%) with HF-WBI than with CF-WBI; for large breast size, adverse cosmetic outcome was 18.6% lower (90% upper confidence limit, -8.0%) with HF-WBI. Poor or fair photographically assessed cosmesis was noted in 28.8% of CF-WBI patients and 35.4% of HF-WBI patients ( P = .31). Three-year local recurrence-free survival was 99% with both HF-WBI and CF-WBI ( P = .37). Three years after WBI followed by a tumor bed boost, outcomes with hypofractionation and conventional fractionation are similar. Tumor bed boost, chemotherapy, and larger breast size do not seem to be strong contraindications to HF-WBI.

A Simple Cardiac Sparing Strategy for Left Breast Radiation Therapy Using Right Semi-Decubitus Positioning

Radiotherapy for left-sided breast cancer is associated with increased risk of heart disease. Prone, lateral decubitus, and deep inspiration breath hold (DIBH) treatments can reduce the heart dose. However, use of these techniques may be limited by requirements for specialized equipment, patients’ intolerance or inability to comply, and the need for nodal irradiation. Notably, 65% of U.S. radiation oncologists offered DIBH in the 2017 ASTRO Workforce Survey. We examined the right semi-decubitus position as a strategy to reduce heart dose in breast radiotherapy and compared cardiac and lung exposure for treatment in the supine (S) and right semi-decubitus (SD) positions. Left breast patients undergoing CT simulation who had unfavorable cardiac dosimetry in the S position were rescanned in either prone (favored for large breast size) or SD position. For the SD position, the patient is rolled up on the right side with the entire left torso from shoulder to hip elevated 25-35 degrees by a foam wedge. SD was well tolerated, and set up reproducibility and treatment time equaled those of S treatment. Whole breast plans (40.05 Gy, 2.67 Gy per fraction) were created on the S and SD scans using segmented tangents with no blocking. Target and OAR delineations followed the RTOG Breast Atlas and Feng's heart atlas. Concordance in breast and lumpectomy cavity V90% across the 2 plans was assessed with Pearson correlation coefficients. Heart and lung dosimetric parameters were compared using the Wilcoxon signed rank test. Paired analysis was performed for 31 patients treated between March 2016 and February 2018. Breast and lumpectomy cavity V90% were concordant across S and SD plans (correlation coefficients 0.860 and 1.000 respectively.) SD was associated with significantly lower median cardiac dosimetry parameters (Table). Mean heart dose in SD was lower by >15 cGy in 20 (65%) patients, lower by <15 cGy in 6 (19%), unchanged in 3 (10%), and higher in 2 (6%). Lung dosimetry parameters were similar in the two positions (Table). The SD position was associated with reduced cardiac exposure. The effect was seen in most though not all patients. It is easily performed, stable, and well tolerated. Further study of this approach is warranted.Abstract TU_11_3424: mTable 1Supine median (range)Right Semi-Decubitus median (range)p-valueHeart mean dose (cGy)168.75 (95.7-436.5)135.1 (82.4-274.0)<0.0001Heart V5 (%)3.3 (0.1-14.5)2.0 (0.0-7.9)<0.0001Heart V20 (%)0.5 (0.0-6.2)0.0 (0.0-2.9)<0.0001Lung mean dose (cGy)469.5 (136.2-864.1)426.8 (156.8-804.1)0.288Lung V5 (%)18.4 (4.9-31.7)17.3 (5.7-32.5)0.477Lung V20 (%)7.7 (0.3-18.9)6.5 (0.7-16.8)0.165 Open table in a new tab

TRANSESOPHAGEAL ECHOCARDIOGRAPHY: METHODOLOGY, INDICATIONS, OPPORTUNITIES

With transthoracic echocardiography, many pathologies can certainly be seen, but in a number of cases, due to the anatomical and physiological characteristics of the patient (thick layer of subcutaneous fat, large breast size in women, lung disease, chest deformation, etc.) hearts can not be fully explored. The use of a transoesophageal sensor can overcome all these difficulties. The review highlights the methodology, indications, and possibilities of transesophageal echocardiogram in the main heart diseases (coronary heart disease, congenital and acquired heart defects, arrhythmias) and acute pathological conditions (acute dissection of the aorta, air embolism).

Abstract P2-11-02: Three-year outcomes with hypofractionated (HF) versus conventionally fractionated (CF) whole breast irradiation (WBI)

Abstract Background: Adoption of HF-WBI remains low due in part to concerns regarding its safety when used with a tumor bed boost or in patients who have received chemotherapy or have large breast size. To address this, we conducted a randomized, multicenter trial to compare CF-WBI (50Gy/25fx+10-14Gy/5-7fx) to HF-WBI (42.56Gy/16fx+10-12.5Gy/4-5fx). Methods: From 2011 and 2014, 287 women with stage 0-II breast cancer, age ≥40 years, were randomized to CF-WBI or HF-WBI, stratified by chemotherapy and breast size. The primary outcome was the proportion of patients with adverse Breast Cancer Treatment Outcomes Scale (BCTOS) cosmetic score three years post-WBI, defined as a score of ≥2.5 (a score of 1 indicates no difference between the treated breast and contralateral breast, 2-slight difference, 3-moderate difference, 4-large difference). Secondary patient-reported outcomes included BCTOS functional status, BCTOS breast pain, Body Image Scale (BIS), and the FACT-B Trial Outcome Index (TOI). Additional secondary outcomes included photographically-assessed cosmesis scored by a 3-physician panel blinded to randomization arm using the RTOG scale, physician-assessed CTCAEv4.0, overall survival (OS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS). Chi-square, Fisher's exact, Wilcoxon's rank sum, logistic regression, and log-rank tests evaluated differences by treatment arm; survival was measured using the Kaplan-Meier method. All analyses were intention-to-treat. Results: Of 287 patients enrolled, 286 received the protocol-specified radiation dose. Thirty percent received chemotherapy (73% anthracycline, 92% taxane, 22% trastuzumab), 37% had large breast size (D cup or larger), and 44% were obese (BMI≥30). All baseline characteristics were well-balanced by treatment arm (P&amp;gt;0.05). Median follow-up is 4.1 years. For the primary outcome, adverse BCTOS cosmetic score at 3 years was noted in 13.6% (n=15/110) of CF-WBI and 8.2% (n=8/97) of HF-WBI patients (P=0.22). There were trends for lower risk of adverse BCTOS cosmetic score with HF-WBI, compared to CF-WBI, among patients who did not receive chemotherapy (OR=0.25, 95%CI 0.06-1.03; Pinteraction=0.07) or with large breast size (OR=0.26, 95%CI 0.07-0.98; Pinteraction=0.08). There were no patient subgroups where risk of adverse BCTOS cosmetic outcome was significantly higher with HF-WBI compared to CF-WBI. For secondary outcomes, there was no difference by treatment arm for BCTOS functional status (P=0.83), BCTOS breast pain (P=0.69), BIS (P=0.45), or FACT-B TOI (P=0.79). Poor-fair cosmetic outcome at 3 years assessed by the 3-physician panel was noted in 28.8% of CF-WBI patients and 35.4% of HF-WBI patients (P=0.31). In total, 19% CF-WBI patients and 20% of HF-WBI patients had a grade 2-3 toxicity at the three-year evaluation, with no difference by treatment arm (P=0.84). Five-year OS, LRFS, and DMFS were 99%, 98%, and 99%, respectively, with no difference by treatment arm (P=0.68, 0.37, 0.62). Conclusions: Three years after WBI followed by a tumor bed boost, outcomes with HF and CF are similar. Tumor bed boost, modern chemotherapy, and large breast size do not appear to be clinically meaningful contraindications to HF-WBI. Citation Format: Shaitelman SF, Lei X, Thompson A, Schlembach P, Arzu I, Bloom ES, Buchholz DJ, Chronowski GM, Dvorak T, Grade EJ, Hoffman KE, Kelly P, Perkins GH, Reed V, Shah S, Stauder MC, Strom EA, Tereffe W, Woodward WA, Baumann D, Amaya D, Guerra W, Morrison M, Hortobagyi G, Hunt KK, Buchholz TA, Smith BD. Three-year outcomes with hypofractionated (HF) versus conventionally fractionated (CF) whole breast irradiation (WBI) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-02.

Abstract P2-11-08: Risk factors for fibrosis after whole breast radiation therapy in lateral position : A large scale single center experience

Abstract Background and Purpose: We previously confirmed the efficacy and safety of our technique of whole breast radiation therapy (WBRT) in isocentric lateral decubitus (ILD) position. The purpose of this work is to evaluate the risk factors for long-term fibrosis in patients treated in ILD position. Material and methods: We studies 832 consecutive female patients with early stage BC treated by conservative surgery followed by 3D-conformal WBRT at Institut Curie between 2005 and 2010. Fibrosis and deformation were evaluated at the end of the treatment and subsequently every 6 months during at least 5 years, using NCI CTC v3.0 scale. Different fractionation schedules were used: 66Gy in 33 fractions, 50Gy in 25 fractions, 40Gy in 15 fractions, 41.6Gy in 13 fractions and 30Gy in 5 weekly fractions. Results: Median age is 61.5 years (range: 29 - 90); median follow up is 6.4 years (range: 1.5 - 12.4). During the follow-up, 308 patients (38.9%) had grade 1 fibrosis, and 36 patients (4.3%) only, had grade 2-3 fibrosis. Among patients with grade 1 to 3 fibrosis, the median time to development of fibrosis was 1.6 years (range: 9 days – 8.3 years). In univariate and multivariate analysis, age, cup size and chemotherapy administration had no significant influence on development of breast fibrosis. The hypo fractionated schedule of 30Gy in 5 fractions significantly increased the fibrosis rate (OR=12.5; [2.7; 57.1] p=0.001). On the other hand, 40 Gy/15 fr and 41.6 Gy/13 fr had no significative influence (OR=2.2 [0.5; 11.1] p=0.32) as well as the 66 Gy/33 fr schedule (OR=3.6 [0.8; 15.4] p=0.09) compared to standard scheme of 50 Gy/25 fr. The cosmetic result was good or excellent for 84.8% of cases at the first evaluation. The 30 Gy in 5 fractions schedule significantly influenced the cosmetic result in the multivariate analysis (OR=11.2 [3.1; 43.9]; p&amp;lt;0.001), with increased rates of breast deformation. The risk of breast deformity was also worse for large breast size (OR=2.7 [1.3; 5.8]; p=0.02). Conclusion: Whole breast radiation therapy in ILD position is well tolerated with good cosmesis and low rates of fibrosis, except for the 30 Gy in 5 weekly fractions schedule. Large breast size has a significantly negative influence on cosmetic results and fibrosis. Citation Format: Bronsart E, Dureau S, Xu HP, Costa E, Poortmans P, Chilles A, Berger F, Stilhart A, Fourquet A, Kirova Y. Risk factors for fibrosis after whole breast radiation therapy in lateral position : A large scale single center experience [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-08.

Can breast characteristics predict upper torso musculoskeletal pain?

BackgroundSeveral studies have associated a large breast size with an increased prevalence and severity of musculoskeletal pain, particularly pain in the upper torso. Despite this evidence, no research has explored whether breast size or related characteristics are risk factors for upper torso musculoskeletal pain. MethodsA backward multiple regression analysis was performed to identify whether characteristics of the breasts and upper torso, as well as physical factors known to be associated with musculoskeletal pain, could predict musculoskeletal pain among a cohort of 378 Australian women aged 18 years and over who had a wide range of breast sizes. FindingsThe model identified that breast volume, age and nipple-to-nipple distance predicted 23% of the variance in upper torso musculoskeletal pain reported by the participants. InterpretationWomen with a larger breast volume, lower age and a greater nipple-to-nipple distance were predicted to report a higher upper torso musculoskeletal pain score.

Breast-i Is an Effective and Reliable Adjunct Screening Tool for Detecting Early Tumour Related Angiogenesis of Breast Cancers in Low Resource Sub-Saharan Countries.

Background What cheaper alternative breast screening procedures are available to younger women in addition to clinical breast examination (CBE) in Sub-Saharan countries? In 2009, we first described BreastLight for screening and reported high sensitivity at detecting breast cancer. Due to limitations of BreastLight, we have since 2014 been using the more technologically advanced Breast-i to screen 2204 women to find cheaper screening alternatives. Methodology First, the participant lies down for CBE and then, in a darkened room, Breast-i was placed underneath each breast and trained personnel confirm vein pattern and look out for dark spot(s) to ascertain the presence of suspicious angiogenic lesion(s). Results CBE detected 153 palpable breast masses and Breast-i, which detects angiogenesis, confirmed 136. However, Breast-i detected 22 more cases of which 7 had angiogenesis but were not palpable and 15 were missed by CBE due to large breast size. Overall confirmed cases were 26, with Breast-i detecting 7 cases missed by CBE. Breast-i and CBE gave sensitivities of 92.3% and 73%, respectively. Conclusion Breast-i with its high sensitivity to angiogenesis, reliability, and affordability will be an effective adjunct detection device that can be used effectively to increase early detection in younger women, thereby increasing treatment success.

Shared Medical Appointments for Adolescent Breast Reduction

Adolescents with macromastia face serious physical, emotional, and social burdens because of their large breast size. Studies have shown that reduction mammoplasty results in improvement in physical symptoms and quality of life for these patients. Shared medical appointments (SMAs), defined as individual patient-physician encounters that occur in a group setting, have been successfully applied to clinics for adult patients seeking breast reduction for this condition. We decided to apply the SMA model to our clinic for preoperative evaluation of adolescent patients with macromastia. The purpose of this article is to describe how our clinic implemented SMAs, evaluate changes in clinic efficiency, measure patient quality of life before surgery, and assess patient and provider satisfaction with the SMA model.From February to June 2016, our department instituted SMAs for preoperative evaluation of female adolescent patients with macromastia. We measured days from referral to appointment for 25 patients who attended SMAs and compared this with a retrospective cohort of 21 patients who attended traditional visits from 2013 to 2015.Clinic efficiency was measured in new patients per hour. During SMAs, we also administered the BREAST-Q, Pediatric Quality of Life Inventory, and patient and provider satisfaction surveys. Mean days between referral and office visit was reduced from 75.3 with traditional visits to 40.3 with shared appointments, although this finding was not statistically significant (P = 0.69). New patients per hour increased from 1.33 with traditional visits to 3 with SMAs, without reducing time spent on education or with the surgeon. The mean preoperative BREAST-Q scores were less than 40 for the 4 tested domains, and the mean (SD) total Pediatric Quality of Life Inventory score was 56.7 (14.8). Patients and the provider reported high satisfaction with SMAs, and the provider wishes to continue using SMAs in the clinic.In conclusion, SMAs resulted in high patient and provider satisfaction and increased clinic efficiency, without sacrificing time spent on education or with the surgeon. Low quality-of-life scores demonstrate a need for these patients to be evaluated and treated for their condition. Measuring patient-reported outcomes with validated surveys and improving clinic efficiency without sacrificing patient care have the potential to increase value at our institution.

Breast-conserving therapy for breast cancer: Cosmetic results and options for delayed reconstruction

Optimisation of the cosmetic outcome after breast-conserving therapy (BCT) is important. We aimed to determine the cosmetic outcome following BCT and factors influencing this cosmesis and identify the most favourable options for delayed breast reconstruction. Four reconstructive surgeons evaluated the cosmetic outcome of 109 patients after BCT. Additionally, the surgeons indicated which patients were amenable for delayed reconstruction and the preferred type of reconstruction. The inter- and intra-observer agreement of the surgeons was rated. The mean overall cosmetic outcome was rated as fair (2.7/4.0, SD 0.9, 1.0-4.0). Risk factors for a poor cosmesis were larger breast size (OR 3.81, p=0.040), larger tumour (OR 1.63, p=0.028) and axillary lymph node dissection (ALND) (OR 3.09, p=0.013). Reconstruction of the ipsilateral side was recommended in 55.6% and 94.5% and contralateral reconstruction in 16.7% and 73.3% of patients with good and poor cosmesis, respectively. Flap reconstruction and lipofilling were most commonly reported for the ipsilateral, and breast reduction for the contralateral breast, with reasonable improvement expected (2.2/4.0, SD 0.5, 1.08-3.3). The inter- (0.5-0.7) and intra-observer (0.63-0.79) agreement of the cosmesis was moderate to good, however, poor regarding the recommended reconstruction techniques (mainly<0.50). Cosmetic outcome after BCT is influenced by breast and tumour size and ALND. Although several reconstructive options are available, the optimal method for revision surgery has not yet been determined. Future studies are necessary to obtain evidence-based guidelines for reconstructive surgery after BCT.

Translating the 2-dimensional mammogram into a 3-dimensional breast: Identifying factors that influence the movement of pre-operatively placed wire.

Pre-operative measurements from the skin to a wire-localized breast lesion can differ from operating room measurements. This study was designed to measure the discrepancies and study factors that may contribute to wire movement. Prospective data were collected on patients who underwent wire localization lumpectomy. Clip and hook location, breast size, density, and direction of wire placement were the main focus of the analysis. Wire movement was more likely with longer distance from skin to hook or clip, larger breast size (especially if "fatty"), longer time between wire placement and surgery start time, and medial wire placement in larger breast. Age, body mass index, presence of mass, malignant diagnosis, tumor grade, and clip distance to the chest wall were not associated with wire movement. A longer distance from skin to hook correlated with larger specimen volume. Translation of the lesion location from a 2-dimensional mammogram into 3-dimensional breasts is sometimes discrepant because of movement of the localizing wire. Breast size, distance of skin to clip or hook, and wire exit site in larger breasts have a significant impact on wire movement. This information may guide the surgeon's skin incision and extent of excision.

Breast size impacts spine motion and postural muscle activation.

While it is generally accepted that large breast sizes in females contribute to back pain and poor posture, the effects of breast size on spinal motion and muscle activation characteristics are poorly understood. This study examined the relationship between breast size, spine motion, and trunk muscle activation. Fifteen university-aged females, free of back pain symptoms, were tested. Breast sizes were calculated, and three-dimensional spine motion and activation from five trunk muscles bilaterally were measured during standing and trunk flexion movements. Correlations between breast size and motion and muscle activation measures were assessed. Head and trunk angles were strongly, negatively correlated to breast size during upright standing; thoracic angles were moderately, positively correlated to breast size during thoracic flexion movements. Trunk muscles showed positive, moderate-strength relationships with breast size during upright standing and some trunk movements. These findings provide a preliminary indication that increasing breast sizes are associated with altered postures and increased muscle activation in a non-clinical population, and constitute a baseline for the study of females with a full range of breast sizes. Further research is required to confirm the generalizability of these findings to other sizes, in order to inform strategies for the prevention or reduction of back pain, as well as diagnosis, treatment, and rehabilitation techniques associated with breast size and back pain.

Longitudinal Analysis of Patient-Reported Outcomes and Cosmesis in a Randomized Trial of Conventionally Fractionated Versus Hypofractionated Whole-Breast Irradiation

PURPOSE There are few prospective data on predictors of patient-reported outcomes (PROs) after whole breast irradiation (WBI) plus a boost. We sought to characterize longitudinal PROs and cosmesis in a randomized trial comparing conventionally fractionated (CF) vs hypofractionated (HF) WBI. METHODS From 2011 to 2014, women age ≥40 years with Tis-T2 N0-N1a M0 breast cancer who underwent lumpectomy with negative margins were randomized to CF-WBI (50Gy/25 fractions plus boost) vs HF-WBI (42.56Gy/16 fractions plus boost). At baseline (pre-radiation), 6 months, and yearly thereafter through 5 years, PROs included the Breast Cancer Treatment Outcome Scale (BCTOS), Functional Assessment of Cancer Therapy-Breast (FACT-B), and Body Image Scale; cosmesis was reported by the treating physician using Radiation Therapy Oncology Group cosmesis. Multivariable mixed effects growth curve models evaluated associations of treatment arm and patient factors with outcomes and tested for relevant interactions with treatment arm. RESULTS A total of 287 patients were randomized, completing a total of 14,801 PRO assessments. Median age was 60 years, 37% had bra cup size ≥D, 44% were obese, and 30% received chemotherapy. Through 5-years, there were no significant differences in PROs or cosmesis by treatment arm. Bra cup size ≥D was associated with worse BCTOS cosmesis (P<0.001), BCTOS pain (P=0.001), FACT-B Trial Outcome Index (P=0.03), FACT-B Emotional Well-being (P=0.03), and Body Image Scale (P=0.003). Physician-rated cosmesis was worse in patients who were overweight (P=0.02) or obese (P<0.001). No patient subsets experienced better PROs or cosmesis with CF-WBI. CONCLUSIONS Both CF-WBI and HF-WBI confer similar longitudinal PROs and physician-rated cosmesis through five years follow up, with no relevant subsets that fared better with CF-WBI. This evidence supports broad adoption of hypofractionation with boost including in patients receiving chemotherapy and in a population with high prevalence of obesity. The associations of large breast size and obesity with adverse outcomes across multiple domains highlights the opportunity to engage at-risk patients in lifestyle intervention strategies as well as consideration of alternative radiation treatment regimens.

Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions&lt;div&gt;&lt;br /&gt;&lt;/div&gt;

Implant-based procedures are the most commonly performed method for postmastectomy breast reconstruction. While donor-site morbidity is low, these procedures are associated with a higher risk of reconstructive loss. Many of these are related to infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, and unsatisfactory results. This review combines a summary of the recent literature regarding implant-related breast-reconstruction infections and combines this with a practical approach to the patient and surgery aimed at reducing this risk. Prevention of infection begins with appropriate reconstructive choice based on an assessment and optimization of risk factors. These include patient and disease characteristics, such as smoking, obesity, large breast size, and immediate reconstructive procedures, as well as adjuvant therapy, such as radiotherapy and chemotherapy. For implant-based breast reconstruction, preoperative planning and organization is key to reducing infection. A logical and consistent intraoperative and postoperative surgical protocol, including appropriate antibiotic choice, mastectomy-pocket creation, implant handling, and considered acellular dermal matrix use contribute toward the reduction of breast-implant infections.

Does breast composition influence late adverse effects in breast radiotherapy?

BackgroundLarge breast size is associated with increased risk of late adverse effects after surgery and radiotherapy for early breast cancer. It is hypothesised that effects of radiotherapy on adipose tissue are responsible for some of the effects seen. In this study, the association of breast composition with late effects was investigated along with other breast features such as fibroglandular tissue distribution, seroma and scar. MethodsThe patient dataset comprised of 18 cases with changes in breast appearance at 2 years follow-up post-radiotherapy and 36 controls with no changes, from patients entered into the FAST-Pilot and UK FAST trials at The Royal Marsden. Breast composition, fibroglandular tissue distribution, seroma and scar were assessed on planning CT scan images and compared using univariate analysis. The association of all features with late-adverse effect was tested using logistic regression (adjusting for confounding factors) and matched analysis was performed using conditional logistic regression. ResultsIn univariate analyses, no statistically significant differences were found between cases and controls in terms of breast features studied. A statistically significant association (p < 0.05) between amount of seroma and change in photographic breast appearance was found in unmatched and matched logistic regression analyses with odds ratio (95% CI) of 3.44 (1.28–9.21) and 2.57 (1.05–6.25), respectively. ConclusionsA significant association was found between seroma and late-adverse effects after radiotherapy although no significant associations were noted with breast composition in this study. Therefore, the cause for large breast size as a risk factor for late effects after surgery and optimally planned radiotherapy remains unresolved.