Newly-diagnosed Breast Cancer Patients Research Articles

Traditional Chinese Medicine Herbs for Breast Cancer Prevention and Survival: A Narrative Review of Epidemiological Studies from Taiwan.

This review aims to describe the association of integrating traditional Chinese medicine (TCM) herbs into conventional medicine (CM) in preventing breast cancer and improving survival rates among breast cancer patients of Taiwan. Of 7 relevant studies, spanning 2014-2023, 4 investigated breast cancer risk in women with menopausal symptoms and other comorbidities. All 4 reported that TCM herbal use was associated with lower risks of developing breast cancer. Three studies investigated survival in newly-diagnosed breast cancer patients receiving CM. All reported that adjunctive TCM users had lower mortality rates than CM-only patients. However, the heterogeneity of study designs, populations, and interventions may limit the generalizability and robustness of the findings. TCM herbs may promote breast cancer prevention and survival when used alongside CM. More rigorous observational research and clinical trials in specific patient populations are needed to guide clinical decision-making.

Abstract 3458: DNA methylation-predicted blood protein levels and breast cancer risk

Abstract Background: Blood DNA methylation (DNAm) profiles can be used to predict a variety of human physiologic traits that are associated with breast cancer incidence and plasma concentrations of over 100 proteins, including those involved in inflammation, coagulation, metabolism, and growth. DNAm predictions of circulating proteins, here referred to as “DNAm proteins,” may be useful in providing molecular insights into breast cancer etiology and could be a valuable resource for personalizing breast cancer risk prediction. Methods: The Sister Study is a nationwide, prospective cohort of 50,884 women with a family history of breast cancer designed to identify novel environmental and biological risk factors for breast cancer. Epigenome-wide DNAm data were previously generated using the HumanMethylation450 or MethylationEPIC arrays on baseline blood samples collected from two case-cohort samples, for a combined sample of 4,479 women. This sample included 2,151 (48%) women who were selected because they were diagnosed with breast cancer (1,673 invasive cancer and 478 ductal carcinomas in situ) in the 15 years (mean: 7.9 years) following blood draw. Blood levels of 109 DNAm proteins were estimated from DNAm profiles using the method developed by Gadd et al. (eLife, 2022). Weighted Cox regression models were used to estimate associations between these DNAm proteins and incident breast cancer; associations were considered statistically significant at a False Discovery Rate (q) ≤ 0.10. Results: In age and platform adjusted models, higher breast cancer rates were associated with higher DNAm-predicted blood concentrations of RARRES2, IGFBP4, and CCL21 and lower predicted concentrations of F7, SELL, CXCL9, CD48, and IL19. The strongest associations were observed for RARRES2 (per 1-SD increase, HR: 1.24, 95% CI: 1.10, 1.40, P= 6 × 10−4, q= 0.03) and F7 (per 1-SD increase, HR: 0.82, 95% CI: 0.74, 0.91, P= 3 × 10−4, q= 0.03). Estimates were similar after adjustment for known breast cancer risk factors and excluding those diagnosed within two years of their blood draw. Associations appeared stronger for invasive breast cancer. Conclusions: Using novel DNAm-based estimates of blood proteins, we identified associations between circulating proteins and breast cancer incidence. IGFBP4 and RARRES2 have previously been reported to be higher in newly-diagnosed breast cancer patients. We also identify new potential protein biomarkers related to immune response (CCL21, SELL, CXCL9, CD48, and IL19). Citation Format: Jacob K. Kresovich, Brett Reid, Doratha A. Byrd, Katie M. O'Brien, Zongli Xu, Clarice R. Weinberg, Dale P. Sandler, Jack A. Taylor. DNA methylation-predicted blood protein levels and breast cancer risk [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3458.

Does mainstream BRCA testing affect surgical decision-making in newly-diagnosed breast cancer patients?

BackgroundGermline pathogenic variants mutations) in the BRCA1 and BRCA2 genes cause an increased risk of breast cancer and ovarian cancer. Mainstream cancer genetic testing (MCG) was introduced for breast cancer patients in our unit in 2013. Non-geneticist clinicians have been trained to offer genetic testing during initial treatment planning. We assessed the impact of timely test results on surgical decision-making. MethodsWomen who had undergone mainstream genetic testing for breast cancer between September 2013 and September 2018 were identified from a prospective database. Surgical data were collected retrospectively. Results580 eligible women had mainstream genetic testing. For 474 this was their first breast cancer diagnosis. The median age was 46 years (interquartile range (IQR) 38–57). The indications were: age ≤45 years for 233 (49%); triple negative disease for 192 women (40.5%); bilateral breast cancer age <60 for 39 (8%) and other for 72 (14%) women. The median time for test initiation to result was 18 days (IQR 15-21). 302 (64% received results before surgery. 88% of those found to have a BRCA mutation before surgery opted for bilateral mastectomy (compared to 5% with BRCA wild type). An additional 106 patients had a new diagnosis on a background of previous treatment. Of these all with a pathogenic variant chose bilateral mastectomy. ConclusionTimely BRCA gene testing influences surgeons’ and patients’ choice of surgery. It reassures women with a negative result and allows those with a positive result to take an active decision about the management of their future risk.

Moving HER2-low breast cancer predictive and prognostic data from clinical trials into the real world.

Background: Previous data, mostly from clinical trials, reported that HER2-low status is associated with low pathological complete response (pCR), and favourable prognosis. Since these findings suggest the existence of an additional breast cancer subtype, we questioned if the predictive/prognostic value of HER2-low was also relevant in the real world. Methods: Data from non-metastatic breast cancer patients treated with neoadjuvant chemotherapy and surgery (2009–2020) were retrieved from our institutional prospectively-maintained registry. Univariable and multivariable logistic models were implemented to study the association between pCR and baseline HER2 status. Univariable analysis of disease-free survival (DFS) was performed through Kaplan-Meier survival curves and log-rank tests. Results: Starting from a total of 790 consecutive cases, we identified 444 newly-diagnosed breast cancer patients featuring HER2 immunohistochemistry (IHC) 0 (HER2-0, n = 109), and 1 + or IHC 2+/in situ hybridization negative (HER2-low, n = 335) receiving anthracycline and taxane-based regimens in 88.9% of cases. Most of the patients were diagnosed with stage II (67.3%) and there was no difference of disease presentation according to HER2-status. pCR was attained by 71 (16.0%) patients and was significantly associated with increased DFS (p = 0.031). Compared to HER2-0, HER2-low cases were more likely hormone receptor-positive (81.2% vs. 43.1%, p < 0.001), well-differentiated (47.5% vs. 26.6%, p = 0.001), less proliferative (21.5% vs. 8.3%, p = 0.001) and less responsive to treatment (pCR 11.6% vs. 29.4%, p < 0.0001). There was no difference in DFS according to HER2 status, though hormone-receptor (HR) negative/HER2-low cases tended to have a worse prognosis compared to HR-negative/HER2-0. By pCR achievement, 3-years DFS was 87.5.% (75.1–100%) vs. 71.6% (65.9–77.8%) (p = 0.161) in HER2-low and 89.1% (75.8–100%) vs. 72.1% (59.7–87.0%) (p = 0.092) in HER2-0. Conclusion: Our real-world data show that HER2-low breast cancer patients represent roughly a half of the cases treated with neoadjuvant therapy, and have poor treatment response. In absence of pCR, HER2-low breast cancer patients have a dismal prognosis, especially when primary tumor hormone receptor status is negative. Studies are therefore needed to define the biology of these tumors for new therapeutic targets and to incorporate HER2-targeting agents in early-stage treatment.

Abstract 3219: Changes and intra-individual reliability in computed tomography image-assessed adiposity and skeletal muscles areas after breast cancer surgery

Abstract Background: Levels of adiposity and skeletal muscles are prognostic indicators in breast cancer patients; however, data are limited on temporal changes in body composition, particularly in different densities of muscles, before and after mastectomy. Objectives: We examined the change in CT-assessed adipose tissue and different density of skeletal muscle areas using a high-resolution segmentation method in breast cancer patients before and after surgery. Methods: This study included 50 newly-diagnosed breast cancer patients who had taken CT scans before and after surgery. We analyzed their third lumbar (L3) CT images to measure the areas of adipose tissue and five-level (from very-high-density to very-low-density) skeletal muscle components. We assessed mean and percent changes in areas using paired t-test and calculated the intra-class correlation (ICC). Results: Patients’ mean age at diagnosis was 58.3 (SD=12.5) years. The mean duration between scans was 591 (SD=537) days. There was a significant decrease in the areas of subcutaneous adipose tissue (mean change= -36.17 cm2, 11.72% decrease, p=0.029), total adipose tissue (mean change= -45.64 cm2, 10.18% decrease, p=0.032), and very-high-density muscle (mean change= -0.37 cm2, 11.08% decrease, p=0.010). The ratio of total adipose tissue and total skeletal muscle decreased from 3.67 to 3.32 after surgery (mean change= -0.36, 9.81% decrease, p=0.061). There was a strong correlation in adipose tissues and skeletal muscle areas of pre-and post-surgery scans taken within 3 years apart (ICC=0.802 to 0.999, all p&amp;lt;0.05), but the correlations were attenuated in scans taken &amp;gt;3 years apart (ICC = -0.055 to 0.738, all p&amp;gt;0.05). Conclusion: In this sample of breast cancer patients who have undergone surgery, there was a significant decrease in subcutaneous adipose tissues, total adipose tissues, and very-high-density muscle areas over time. Body composition assessed by CT images is reliable for a 3- year period involving breast cancer surgery. These findings serve as a baseline for prospective studies examining the impact of these changes on breast cancer outcomes. Keywords: Adipose tissue, skeletal muscle, computed tomography scans, breast cancer, surgery Citation Format: Livingstone Aduse-Poku, Dheeraj Gopireddy, Mauricio Henandez, Chandana Lall, Joel Divaker, Sara Falzarano, Shahla Masood, Weizhou Zhang, Susmita Datta, Jiang Bian, Ting-Yuan David Cheng. Changes and intra-individual reliability in computed tomography image-assessed adiposity and skeletal muscles areas after breast cancer surgery [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3219.

Altered Expression Levels of MicroRNA-155 and SOCS-1 in Peripheral Blood Mononuclear Cells of Newly Diagnosed Breast Cancer Patients

MicroRNA-155 (miR-155) has a critical role in pro-inflammatory activation and tumor progression. In addition, miR-155 has various oncogenic effects in the tumor microenvironment by targeting the suppressor gene of cytokine signaling-1(SOCS-1) and interleukin-6 (IL-6). This study investigated the association of inflammatory changes with the variations of miR-155 expression in newly diagnosed breast cancer (NDBC) patients. Seventy NDBC patients were categorized as lobular and ductal subgroups and forty healthy individuals participated in this study. The expression rate of miR-155 and its downstream target gene, SOCS-1, as well as the plasma levels of IL-6, were evaluated in peripheral blood mononuclear cells of NDBC patients; using real-time PCR and enzyme-linked immunosorbent assay, respectively. Our results indicated an over-expression of miR-155 in the PBMCs of NDBC patients which was significantly associated with the tumor grade and the type of ductal carcinoma. In contrast, a significant downregulation of SOCS-1 was observed in NDBC patients compared to control group, however, there was no significant difference between two subtypes of BC. Furthermore, a higher concentration of plasma IL-6 was detected in NDBC patients compared to the healthy control group which had an inverse correlation with the SOCS-1 levels. According to the potential effects of miR-155 on regulating the expression of SOCS-1 and IL-6, we suggest this small transcript as a promising diagnostic marker for various types of BC patients.

Dysregulation of soluble immune checkpoint proteins in newly-diagnosed early breast cancer patients.

556 Background: Checkpoint proteins regulate the immune system. Breast cancer (BC) cells exploit the up-regulation or down-regulation of these proteins to evade anti-tumor immune responses. Soluble forms of immune checkpoint molecules (ICM) can be measured in human plasma, however their biological and clinical significance remains essentially unknown. The aim of the present analysis was to measure the pre-treatment ICM in newly- diagnosed BC patients (pts) and compare them to healthy controls. Methods: Soluble forms of ICM, as well as cytokines and chemokines, were measured using Multiplex bead array and ELISA technologies. Plasma samples from 98 BC pts and 45 healthy controls were analyzed for each protein. Data was prospectively obtained. Measured levels were compared between BC pts and healthy controls using a non-parametric test (Mann-Whitney). P-values below 0.05 were considered statistically significant. Results: Soluble stimulatory molecules GITR (p &lt; 0,000002), GITRL (p &lt; 0,007), CD27 (p &lt; 0,002), CD28 (p &lt; 0,003), CD40 (p &lt; 0,003), CD80 (p &lt; 0,009), ICOS (p &lt; 0,0006), as well as inhibitory molecules PD-L1 (p &lt; 0.0000001), CTLA-4 (p &lt; 0,005), TIM-3 (p &lt; 0,00006), HVEM (p &lt; 0,00002) TLR-2 (p &lt; 0,05), levels were significantly lower in early BC pts compared to healthy controls. When analyzed according to BC characteristics (TNBC vs. non-TNBC, tumor size, stage, nodal status and age) no significant difference was detected between the soluble levels of these ICM between the different subsets. Additionally, serum CXCL5 (p &lt; 0,000001), CCL23 (p &lt; 0,04), IL-16 (p &lt; 0,00005), interferon-α (p &lt; 0,03) and IL1-RA (p &lt; 0,03) were significantly lower compared to healthy controls. Serum CX3CL1 or fractalkine (p &lt; 0,024465) was significantly higher compared with healthy controls. Serum interferon-γ (p &lt; 0,2), IL-6 (p &lt; 0.6) and IL-2 (p &lt; 0.6) levels were not significantly different between the BC pts and the healthy controls. Conclusions: We identified low levels of both the stimulatory and inhibitory immune checkpoint molecules, in newly-diagnosed, non-metastatic BC pts compared to healthy controls. These results indicate that early BC is associated with a down-regulation of both soluble stimulatory and inhibitory immune-checkpoint pathways. Newly-diagnosed early BC pts have a generalized immune-suppression independent of subtype (TNBC vs non-TNBC) and stage, which, to our knowledge, is the first study to describe soluble immune checkpoints in early BC pts.

Abstract P6-11-12: Access to certified breast cancer centers in the mainly rural state of Bavaria, Germany: A structural health geographical analysis

Abstract Background: In Germany, evidence- and consensus-based recommendations for the treatment of breast cancer patients are available from the national guideline. To ensure implementation of these standards in clinical routine care, two different certification programs for breast cancer exist in Germany: 1) accreditation ‘Organ Cancer Center’ of the German Cancer Society (“Deutsche Krebsgesellschaft” DKG); 2) Disease Management Program (DMP) developed by Health Insurance Companies. For our analysis we focused on Bavaria due to its mainly rural character, which can lead to challenges in patients’ medical supply with long travel distances. We aimed to investigate the accessibility of certified Breast Cancer Centers (cBCC) in rural and urban areas of Bavaria and to estimate how many inhabitants and potentially breast cancer patients might be affected. Methods: Accessibility of cBCC was defined according to travel time by car (or taxi) within 30 minutes. Addresses of cBCCs were identified through the homepages of the DKG, the Bavarian Association of Statutory Health Insurance Physicians (KVB), and a health insurance company. Data collection took place between August and December 2018. Only cBCC located in Bavaria with valid certification at point of search were eligible. Using ArcGIS, a routing network was created to identify clear catchment areas for each facility. The modeled speeds on which the traffic is based are street specific and consider the average regional traffic situations. The latter was then combined with the disaggregated 100 × 100 meters population data for the Census 2011, which allowed analyzing absolute population on a fine spatial resolution. Aggregated data on incident and prevalent breast cancer rates (women only) were obtained from the Epidemiological Bavarian Cancer Registry and merged on district level. As only aggregated data from the Bavarian Cancer Registry were utilized, a formal ethics committee (EC) review was not required. A declaration of no objection by the EC of the University of Würzburg is available (#2019042402). Results: A total of 58 cBCC (both DKG/DMP: n=44, DMP only: n=14) were identified and included in our analysis. The predefined accessibility coverage comprises 76% of Bavaria. Focusing on all Bavarian administrative areas (n=96) we identified following categories: n=38 had full access, n=56 partial access and n=2 no access. On population level, n=5,533,166 (87.5%) females reach a cBCC within 30min travel time. Whereas about 800.000 (12.5%) women have hampered access with about 3/4 living in rural regions. Data from the Bavarian Cancer Registry reveal that non-accessibility might affect ca. 5.000 prevalent and ca. 1.500 newly-diagnosed female breast cancer patients - based on a hypothetical stable age-standardized (EU) incidence and 5-yrs prevalence rate. Conclusion: Our analysis revealed that there is no Bavaria-wide accessibility to cBCC and that disparities between rural and urban areas exist. Integrating GIS methods to health care service research allows 1) identifying regions with limited access to evidence-based structures (e.g. cBCC) and 2) planning of structures needed from a public health point of view. Our findings can be used to inform policy makers about injustice regarding health care accessibility. Furthermore, results can serve for developing and evaluating telemedical strategies to deliver high quality health care to all inhabitants regardless of residence. Citation Format: Stephanie Stangl, Sebastian Rauch, Jürgen Rauh, Martin Meyer, Jacqueline Müller-Nordhorn, Manfred Wildner, Peter U. Heuschmann, Achim Wöckel. Access to certified breast cancer centers in the mainly rural state of Bavaria, Germany: A structural health geographical analysis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-12.

Health disparities among breast cancer patients with/without disabilities in Germany

BackgroundPrevalence and incidence of cancer are increasing in people with disability. Nevertheless, little is known about cancer care for people with disabilities. ObjectiveThe goal of this study was to examine the quality of care of breast cancer patients with pre-existing disabilities regarding diagnosis and type of breast surgery in Germany. MethodsWithin the framework of quality assurance of breast cancer centers, a patient survey was conducted by the University of Cologne. Survey data from 4626 newly-diagnosed breast cancer patients treated in 86 hospitals were analyzed using multilevel modeling. Data about socio-demographics, disability specific data as well as data about diagnosis and type of surgery were collected. ResultsAbout 13% (n = 568) of the patients indicated they had a pre-existing disability prior to their breast cancer. The majority of patients with disabilities have physical impairments (PI n = 385; 68.0%) or sensory impairments (SI n = 131; 23.1%). 16.7% of the patients indicated they have a mental illness (MI n = 95; 16.7%) and 8 patients indicated to have an intellectual disability (ID n = 8; 1.4%).Patients with PI and SI are less often diagnosed for cancer through a mammography screening (OR PI = 0.70; p < 0.05; OR SI = 0.58; p < 0.05). Patients with PI are less likely to receive breast conserving treatment (OR = 0.58; p < 0.00) and more likely to have a mastectomy without reconstruction (OR = 1.96; p < 0.00) compared to patients without disabilities. ConclusionOur data show that there are differences in the frequency of cancer diagnosis through mammography screening and in surgery applied between breast cancer patients with and without disabilities.

A polyphenol-rich diet is associated with decreased platelet aggregation in breast cancer patients

It is well documented that plant polyphenols have both anti-cancer and anti-platelet effects. Hence, the aim of this work was to investigate a relationship between dietary intake of polyphenols and platelet aggregation in newly-diagnosed breast cancer patients. The nutritional value of a diet, including dietary intake of plant polyphenols was estimated. Platelet aggregation was induced with arachidonic acid (0.5 mmol/l), collagen (3.2 μg/ml) or ADP (6.4 μmol/l) and measured using multiple electrode aggregometry (Multiplate&lt;sup&gt;®&lt;/sup&gt;) in whole blood. It was found that platelet aggregation was significantly higher in the low polyphenol intake group than the high intake group: the respective values (area under the aggregation curve recorded in units; U) were arachidonic acid: 84.8 vs. 65.3, P=0.003; ADP: 76.5 vs. 67.8, P=0.006; collagen 79.5 vs. 64.3, p=0.024 respectively. The study indicates, for the first time, an association between diet rich in polyphenols and reduced platelet reactivity in breast cancer patients.

Psychophysiological stress response of newly-diagnosed breast cancer patients with and without risk of metabolic syndrome

Introduction. Little is known about how metabolic comorbidity affects stress response during breast cancer (BRCa) after a recent diagnosis. Objective. To evaluate the physiological and psychological differences between the BRCa-RSxM groups and those with BRCa alone, and the influence of psychological variables and comorbidity in terms of stress response. Method. Comparative non-experimental causal-descriptive study. Fifty patients recently diagnosed with BRCa (25 with BRCa and 25 with BRCa-RSxM) in a convenience sample participated. Frontal muscle activity and skin conductance were recorded in response to stressful conditions. Quality of life, perceived stress, and coping strategies scales were used. Results. The presence of comorbidity (p = .001; p = .02), perceived stress (p = .004; p = .03), and social quality of life (p = .01; p = .01) influenced muscle activation and conductance during the emotional stressor (ES). Putting the stressful situation into perspective as a cognitive coping strategy was related to a decrease in activation (p = .04). An increase in physiological activation during the cognitive stressor (CS) was influenced by comorbidity (p = .05) and quality of social life (p = .01; p = .01). In turn, a decrease was influenced by the increase in age (p = .02). Discussion. Physiological vulnerability, coping strategies (behavioral and cognitive), and prior learning influenced the resulting reaction during the stressful situation. Conclusion. A metabolic disease, as a prelude to an oncological, may cause physiological vulnerability to respond adequately to stressful conditions.

Assessment of Gene Expression Level of ATP Binding Cassette G Member 2 (ABCG2) Transporter in Newly Diagnosed Breast Cancer Patients Receiving Adjuvant Chemotherapy

The efficacy of cancer chemotherapy is limited by cellular mechanisms of resistance that result in increased drug efflux of chemotherapeutic agents thereby reducing intracellular drug levels and causing drug resistance. Overexpression of some members of ATP binding cassette transporter superfamily, including ATP binding cassette G member 2 (ABCG2), which mediates energy-dependent transport of drugs out of the cells against concentration gradient, is one of the major mechanisms responsible for multidrug resistance in the treatment of breast cancer. In the current study, the expression of ABCG2 mRNA gene was evaluated in the peripheral blood of newly diagnosed breast cancer (NDBC) patients immediately before surgical resection of the breast and in extirpated breast tumors, then sequentially in the blood of patients after receiving three and six cycles of chemotherapy. Compared to normal breast, cancerous specimens expressed higher levels of ABCG2 gene expression (p&lt;0.001). In addition, a gradual significant increase in the expression of peripheral blood ABCG2 gene of NDBC patients among different treatment periods was recorded. Furthermore, a significant positive correlation between peripheral blood ABCG2 gene expression of NDBC patients receiving chemotherapy and disease progression was found. In conclusion, assessment of ABCG2 gene expression may be a prerequisite in evaluating the effectiveness of chemotherapy-treated breast cancer patients.

Polyphenol-rich diet is associated with decreased level of inflammatory biomarkers in breast cancer patients

The study investigated the relationship between dietary intake of polyphenols and inflammatory markers: CRP, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), medium platelet volume/lymphocyte ratio (MPVRL), in newly-diagnosed breast cancer patients. The aim of this work was to verify whether diet rich in plant polyphenols affects inflammatory markers in breast cancer patients. 78 patients (55.3±14.5 years) treated surgically for breast cancer were studied. A modified FFQ and authorial worksheet based on the Phenol Explorer database was used to measure the amount of plant polyphenols in a diet. Basing on the median of polyphenols intake (1780 mg/day), the group was divided into two subgroups: low- and high- dietary intake of polyphenols (LDIP and HDIP, respectively). Plasma CRP level was measured and NLR, PLR and MPVLR were calculated using results from peripheral blood morphology. LDIP was associated with significantly higher CRP (elevated in 34.5% LDIP patients vs. 8.3% HDIP, p<0.003), NLR (elevated in 46.2% LDIP patients vs. 25.6% HDIP, p<0.006) and PLR level (elevated in 25.6% LDIP patients vs. 12.8% HDIP, p<0.03). MPVLR was not significantly different between both the subgroups. High dietary intake of polyphenols remarkably reduced process of inflammation in breast cancer patients, which has important clinical implications. The study demonstrated also an usefulness of simple, cheap and commonly available biomarkers for monitoring anti-inflammatory effects of diet.

Interactive Role of Metabolic Syndrome on The Pathogenesis and Severity of Breast Cancer, The Impact of Treatment Exposure

The evidence that link Metabolic Syndrome (MS) risks and Breast Cancer (BC) is highly controversial. This study was carried out to evaluate the MS among a group of newly and recently-diagnosed BC Jordanian women, according to harmonized criteria using the Jordanian cut-off points of obesity. A total of 396 BC patients aged 30–65 years attending BC clinics at the Jordanian Royal Medical Services in Jordan for management and follow-up of their conditions were screened for the presence of MS using the harmonized criteria. They were either newly-diagnosed before any medical intervention (n=134) or recently-diagnosed who received medical intervention during the first 3 months of diagnosis (n=262) BC patients. The latter were sub divided into chemo (n=176) and non-chemo (n=86) sub-groups. Pre-and postmenopausal status and BC severity [early stage (n=189) and advanced stage (n=207)] of BC patients were also studied. The MS prevalence in the whole BC patients using harmonized cut-off points (64.1%) was higher than that using Jordanian group cut-off points (52.0%). The MS was more prevalent, but insignificant, in recently-diagnosed (66.0%) than newly-diagnosed patients (60.0%). The MS prevalence was associated with increased severity of BC; it was 67.1% in advanced stage and 60.8% in early stage. The risk of MS in postmenopausal BC patients was higher (34.8%) than premenopausal (29.3%) patients. The risk of MS was increased with age. According to aforementioned results, it could be concluded that MS was markedly prevalent among BC patients. The MS prevalence tended to be higher among recently-diagnosed than newly-diagnosed BC patients using the harmonized definition, however, this prevalence decreased when the Jordanian group cut-off points were used. The MS was more prevalent in postmenopausal than premenopausal BC patients and it was associated with increased BC severity.

Fear of cancer recurrence trajectory during radiation treatment and follow-up into survivorship of patients with breast cancer

BackgroundFear of cancer recurrence (FCR) has been shown to be higher in patients treated with external beam radiotherapy (RT) compared to those untreated. However, little is known about the dynamics of patient’s FCR during and after RT. The aim of this study was to examine FCR levels in a longitudinal panel design with breast cancer patients receiving RT.MethodsConsecutive newly-diagnosed breast cancer patients (n = 94) attending a single cancer centre were invited to complete a 7-item FCR scale (FCR7) that was collected weekly by paper instrument and at a follow-up phone call 6–8 weeks after completion of RT. Descriptive statistics, and Latent Growth Curve Modelling (LGCM) were utilised to analyse the data.ResultsWomen who were younger, single/separated, had chemotherapy, had extra boost radiation treatment, taking Herceptin and treated by 4-field technique reported higher recurrence fear at baseline. There was strong evidence of substantial variation in the trajectory of FCR (z = − 3.54, p < .0001). The average trajectory of FCR over RT was negative (unstandardized estimate = − 0.59) and associated with FCR follow-up level (standardised estimate = 0.36, z = 3.05, p < .002), independent of baseline recurrence fears.ConclusionPatients vary in their trajectory of recurrence fears over RT which predicts FCR approximately 2 months following treatment. Review appointments by therapy radiographers presents an opportunity to intervene in FCR trajectories.Trial registrationClinicalTrials.gov: NCT02599506. Prospectively registered on 11th March 2015.

'Breast cancer won't kill ya in the breast': Broaching a rationale for chemotherapy during the surgical consultation for early-stage breast cancer

ObjectiveTo examine how, and for what interactional purpose, a surgeon raises the risk of death with an early-stage breast cancer patient. MethodSingle-case analysis of a recorded surgical consultation, using conversation analysis. ResultsThe surgeon not only negotiates the surgical treatment decision with the patient, she provides an overview of what her non-surgical treatment is likely to entail. Analysis reveals how the surgeon addresses interactional challenges when providing this overview, including how to broach the rationale for administering chemotherapy, the possibility that cancer could spread to vital organs and prove fatal. To do this, the surgeon orients to the possibility that the patient has misconceptions about her risk of dying from breast cancer. She uses negatively-formulated assertions to invoke these possible misconceptions, making correction relevant and providing a point of entry into delicate interactional territory. ConclusionThe surgeon draws upon possible patient misconceptions to broach the rationale for administering adjuvant chemotherapy. Practice ImplicationsThe surgical consultation is typically the first treatment-related consultation newly-diagnosed breast cancer patients have and represents an opportunity to educate patients and prepare them for future treatment decisions. The challenges of providing and receiving such overviews, and how they may influence future treatment decisions, merit consideration.

Impact of Chemotherapy Treatments on Dietary Intakes of Macro and Micronutrients among Jordanian Women with Breast Cancer

Background: Breast cancer (BC) is the leading cause of cancer related deaths among women worldwide. Nutritional factors may account for the large variation in BC incidence around the world. Most studies have shown no link between dietary intakes and increased risk of BC.Objective: To evaluate the dietary intake of macro and some micronutrients among BC patients with respect to chemotherapy treatment.Methods: A total of 168 BC patients aged 20-70 years attending BC clinics at the Jordanian Royal Medical Services, Jordan were evaluated for dietary intake. The study design permitted to include 60 newly-diagnosed BC patients who were not exposed to any type of interventions and 108 recently-diagnosed BC patients (up to three months). Recently group member were sub-divided in two sub-groups to control exposure to chemotherapy. The Chemo group (have exposed to chemotherapy) and the non-chemo group (have exposed to other types of treatments interventions). Calculations were based on the computerized nutrient analysis program (the food processor nutrition and fitness analysis software (ESHA), version 10.6/.3, Salem, USA).Results: Energy, macronutrients and micronutrients intakes were not significantly different considering exposure to chemotherapy. However, they were less than recommended in all BC patients.Conclusion: The possible risk of dietary undernutrition among BC patients that need a careful monitoring, evaluation and managements care plan.

Value of Systemic Staging in Asymptomatic Early Breast Cancer.

Metastases are rare in early breast cancer (EBC), and international guidelines recommend against routine systemic staging for asymptomatic patients. However, imaging exams remain widely employed in the clinical practice. The aim of the present study is to evaluate the value of imaging for systemic staging in EBC. A retrospective analysis of newly-diagnosed breast cancer (BC) patients was performed. Clinical data including BC subtype, stage, presence of symptoms at diagnosis and instrumental procedures performed for staging were recorded. A total of 753 patients were included, with a median age of 57 years. The majority of the patients underwent at least 1 imaging procedure (91%); had invasive ductal carcinoma (83.5%); histological grade 2 (51.4%); stage II (61.8%); and luminal subtype (67.9%). Among the 685 (91%) patients who underwent any radiologic staging, distant metastases (DMs) were detected in 32 (4.7%). In the univariate analyses, stage IIb and pathological lymph node involvement (pN1) showed a statistically significant association with the presence of DMs, versus only a trend for triple negative and human epidermal growth factor receptor 2 (Her2) positive subtype. In an exploratory analysis performed in this same subgroup, when unfavorable biology (triple negative or Her2 positive) was present, patients had a DM rate of 14.4%, one of the highest reported at this stage of the disease. Early breast cancer has a low prevalence of DM at the initial evaluation, and systemic staging of asymptomatic, unselected patients is not warranted as a routine practice. However, we have identified subgroups of patients to whom a full staging could be indicated.

Abstract A21: Exploring the social networks of newly diagnosed breast cancer patients

Abstract Background: Minority women in the United States continue to experience inferior breast cancer outcomes compared with white women, in part due to delays in care delivery. Emerging cancer care delivery models such as patient navigation focus on the social causes of disparities, but evidence demonstrating how these interventions increase social support is lacking. Social network analysis provides a method to understand the complex social dynamics that contribute to better cancer outcomes. The purpose of this pilot study is to describe the social networks of newly-diagnosed breast cancer patients and explore the contributing role of patient navigators to those networks. Methods: This descriptive pilot study explores the social networks of newly-diagnosed cancer patients enrolled in an active RCT comparing standard patient navigation versus patient navigation enhanced by legal advocacy. Eligible women were enrolled in the parent RCT, spoke English or Spanish, and agreed to complete the interview 3-7 months post-diagnosis. A convenience sample of 25 women was recruited to participate in a one hour interview to elicit information about their social networks related to cancer care support. Preliminary analysis visualized network structures to qualitatively identify patterns of network support (network types) and characterize the contributing role of types of support received (i.e. emotional and moral support, household help, access to resources). Secondly, network metrics (centrality, density, diversity, and knowledge exclusivity) were produced to quantify important structural attributes, influential individuals and critical types of supports. Comparisons using ANOVA identified potential differences between network types based on social network metrics. Results: Participants had a mean age of 56.9 years (40-80). Forty six percent were Black, 21% White, 21% Hispanic and 12% Other. Three distinct network types were qualitatively identified: 1) Networks with predominantly kinship ties; 2) Networks with predominantly role-based and affective ties (i.e. health care workers and friends); and 3) Heterogeneous networks with multiple tie types. Examining network metrics in relation to network types indicated that role/affect-based networks were characterized by patients who had higher betweenness centrality, compared to kinship networks (p&amp;lt;0.05), indicating patients played a key role in connecting other network members. No other network-level metric was significantly associated with network type. In terms of types of support received, 21 of 24 networks had moral and emotional support holding the highest degree centrality (mean=0.743, SD=0.13), suggesting sampled patients received emotional/moral support from many sources. Patient navigators were identified in 6 of the 24 networks, despite all patients being assigned a patient navigator. In 4 of the 6 networks in which navigators were identified, they held the highest knowledge exclusivity, indicating that navigators provided types of support not found elsewhere in patient social networks. Conclusions: Emotional and moral support is provided to cancer patients from many sources within their social networks. Among patients who identified navigators within their network, we found that they were able to provide distinctive support not found elsewhere in the network, suggesting they play a crucial role in the delivery of cancer care aimed at reducing disparities. Services and systems that identify and address deficits in specific types of support in patient social networks should be explored for their potential to reduce cancer health disparities. Citation Format: Christine M. Gunn, Sharon M. Bak, Tracy A. Battaglia, Naomi Ko, Vanesa Noel, Victoria A. Parker. Exploring the social networks of newly diagnosed breast cancer patients. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A21.

Do nurse-navigated TSSCPs improve treatment and follow up compliance in underserved populations?

72 Background: Multiple cancer organizations advocate for the use of treatment summaries and survivorship care plans (TSSCPs) in cancer patients. To better quantify the benefits of a nurse-navigated, culturally and linguistically responsive TSSCP in underserved breast cancer patients, we compared rates of compliance with treatment and follow up in 26 patients who were treated with TSSCPs to 38 similar controls who were treated without TSSCPs. Methods: We prospectively enrolled 26 consecutive, newly-diagnosed breast cancer patients who were given nurse-navigated TSSCPs under an IRB-approved protocol. At their first clinic visit, a trained nurse educated and assisted the patient in the use and completion of the TSSCP. Nurse-navigated TSSCPs were completed at each subsequent visit through 12 months of surveillance. Rates of compliance with treatment and follow up guidelines were compared to 38 similar control patients using a two group Fisher’s exact chi-square test. Statistical significance was set at p-value &lt; 0.05. Results: All patients were treated under Medicaid insurance and 47% were racial and/or ethnic minorities. Time from diagnosis to treatment and time from initial clinic visit to treatment were similar across groups. The rate of compliance with first treatment recommendations was 96% (25/26) in the TSSCP group compared to 79% (30/38) in the non-TSSCP group (p = 0.07). The number of patients compliant with all follow up visits was similar: 22/25 (88%) of TSSCP patients and 22/30 (73%) in non-TSSCP patients (p = 0.31). Of the recommended total follow up appointments, 6/67 in the TSSCP group and 25/120 in the no TSSCP group were “no shows” (p = 0.04). Conclusions: Although the use of nurse-navigated TSSCPs may not improve time to treatment in medically underserved patients, adherence to first treatment recommendations and follow up appointment attendance shows some improvement in patients who participate in nurse-navigated TSSCPs. Further study is needed to fully assess the role of nurse-navigated TSSCPs in improving treatment and surveillance compliance rates and how these rates impact clinical outcomes. Acknowledgement: Funded by a Community Grant from the Los Angeles County Affiliate of Susan G. Komen.