Primary Prevention Of Breast Cancer Research Articles

Tamoxifen for breast cancer prevention among survivors of pediatric lymphoma previously treated with chest radiation: Clinical benefits, harms and tradeoffs.

10025 Background: Survivors of pediatric lymphoma previously treated with chest radiation are at high risk for subsequent breast cancer. Although early initiation of breast cancer screening is recommended, the clinical benefits and harms of adding tamoxifen to reduce breast cancer deaths among these women are unknown. Methods: We adapted a Cancer Intervention and Surveillance Modeling Network (CISNET) breast model using data from the Childhood Cancer Survivor Study (CCSS) to reflect the elevated risks for breast cancer and competing mortality for 5-year survivors previously treated with chest radiation (RT). Breast cancer risk was based on age, chest RT field, timing of RT relative to menarche, menopause status, anthracycline exposure, and family history. Premature menopause risk varied by cumulative ovarian RT and alkylator dose. Based on the US Preventive Services Task Force 2019 Evidence Summary, we assumed tamoxifen (20mg daily for 5 years) reduced estrogen receptor positive (ER+) breast cancer risk by 42% (RR = 0.58 [0.42-0.81]) for 20 years and increased risks for venous thromboembolism, deep vein thrombosis, coronary heart disease, stroke and endometrial cancer during treatment. Strategies included no screening or tamoxifen, annual screening with mammography and MRI starting at age 25, annual screening with mammography and MRI starting at age 25 with the addition of tamoxifen at ages 25, 30 or 35. Model outcomes included cumulative breast cancer risk, number of childbearing years before age 45 (defined as years menstruating without tamoxifen use or a breast cancer diagnosis or having survived breast cancer for at least 3 years), and number of tamoxifen-related side-effects. Results: Among a cohort of 20-year-old 5-year lymphoma survivors previously treated with mediastinal RT without primary ovarian failure, an estimated 20% were projected to develop breast cancer and 2.6% would die from the disease before age 50 in the absence of screening or tamoxifen use. Survivors would have on average 22 childbearing years before age 45. Early initiation of breast cancer screening at age 25 would reduce breast cancer deaths before age 50 by 56.3%. Depending on age at initiation, tamoxifen would further reduce breast cancer deaths by 8.0 to 9.6 percentage points for an overall 64.3% to 65.9% reduction and reduce the average number of childbearing years by 17% to 21%. For each breast cancer death averted, a reduction of 1950 to 3740 childbearing life years and 11 to 20 side-effects would occur and varied by the tamoxifen start age compared to mammography and MRI screening. Conclusions: Tamoxifen use for primary breast cancer prevention among pediatric lymphoma survivors may further reduce breast cancer deaths but decisions might depend on survivor preferences for side effects vs. avoiding breast cancer and consideration of timing for childbearing.

Empowering Health: A Comprehensive Concept Analysis of Breast Self-Examination for Proactive Breast Health Management

The review paper discusses the concept of breast self-examination (BSE), a vital screening method for early detection and diagnosis of breast cancer. It uses the Walker and Avant analysis method to develop an operational definition, identify critical attributes, antecedents, consequences, and empirical referents of BSE. BSE is crucial for early detection and survival rates, especially in developing countries. It is a cheap and accessible technique for detecting abnormal cells in normal breast tissue, making it useful in underdeveloped countries with limited resources. Defining attributes of BSE include breast awareness, breast examination for lumps and changes, a screening measure for detecting breast cancer, recommended timing after the menstrual period, primary prevention of breast cancer, self-awareness aiding in early detection, and cost-effectiveness in resource-poor countries. The paper also discusses antecedents and consequences of BSE, including knowledge and perception about BSE, personal and family history of breast cancer, health literacy campaigns, education level, increasing age, obesity, and reproductive factors. Conclusions of BSE include the practice of BSE and early detection of breast cancer, motivation towards screening, self-awareness, physical activity, and self-efficacy. The paper provides empirical referents for measuring and assessing BSE, such as structured questionnaires, scales based on health belief models, knowledge tests, and health action process approaches.

Tantalum oxide nanoparticles as versatile and high-resolution X-ray contrast agent for intraductal image-guided ablative procedure in rodent models of breast cancer

AbstractThere are limited options for primary prevention of breast cancer (BC). Experimental procedures to locally prevent BC have shown therapeutic efficacy in animal models. To determine the suitability of FDA-approved iodine-containing and various metal-containing (bismuth, gold, iodine, or tantalum) preclinical nanoparticle-based contrast agents for image-guided intraductal (ID) ablative treatment of BC in rodent models, we performed a prospective longitudinal study to determine the imaging performance, local retention and systemic clearance, safety profile, and compatibility with ablative solution of each contrast agent. At least six abdominal mammary glands (>3 female FVB/JN mice and/or Sprague-Dawley rats, 10–11 weeks of age) were intraductally injected with commercially available contrast agents (Omnipaque® 300, Fenestra® VC, MVivoTM Au, MVivoTM BIS) or in-house synthesized tantalum oxide (TaOx) nanoparticles. Contrast agents were administered at stock concentration or diluted in 70% ethanol (EtOH) and up to 1% ethyl cellulose (EC) as gelling agent to assess their compatibility with our image-guided ablative procedure. Mammary glands were serially imaged by microCT for up to 60 days after ID delivery. Imaging data were analyzed by radiologists and deep learning to measure in vivo signal disappearance of contrast agents. Mammary glands and major organs were ultimately collected for histopathological examination. TaOx-containing solutions provided best imaging performance for nitid visualization of ductal tree immediately after infusion, low outward diffusion (<1 day) and high homogeneity. Of all nanoparticles, TaOx had the highest local clearance rate (46% signal decay as stock and 36% as ablative solution 3 days after ID injection) and exhibited low toxicity. TaOx-containing ablative solution with 1% EC caused same percentage of epithelial cell death (88.62% ± 7.70% vs. 76.38% ± 9.99%, p value = 0.089) with similar minimal collateral damage (21.56 ± 5.28% vs. 21.50% ± 7.14%, p value = 0.98) in mouse and rat mammary glands, respectively. In conclusion, TaOx-nanoparticles are a suitable and versatile contrast agent for intraductal imaging and image-guided ablative procedures in rodent models of BC with translational potential to humans.

Anastrozole for the prevention of breast cancer in high-risk postmenopausal women: cost-effectiveness analysis in the UK and the USA

PurposeThe effectiveness of anastrozole for breast cancer prevention has been demonstrated. The objective of this study was to evaluate the cost-effectiveness of anastrozole for the prevention of breast cancer in women with a high risk of breast cancer and to determine whether anastrozole for the primary prevention of breast cancer can improve the quality of life of women and save health-care resources.MethodsA decision-analytic model was used to assess the costs and effects of anastrozole prevention versus no prevention among women with a high risk of breast cancer. The key parameters of probability were derived from the IBIS-II trial, and the cost and health outcome data were derived from published literature. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for the two strategies,One-way and probabilistic sensitivity analyses were performed.ResultsIn the base case, the incremental cost per QALY of anastrozole prevention was £125,705.38/QALY in the first 5 years compared with no prevention in the UK, above the threshold of WTP (£3,000/QALY),and in the 12-year period, the ICER was £8,313.45/QALY, less than WTP. For the US third-party payer, ICER was $134,232.13/QALY in the first 5 years and $8,843.30/QALY in the 12 years, both less than the WTP threshold ($150,000/QALY).ConclusionIn the UK and US, anastrozole may be a cost-effective strategy for the prevention of breast cancer in high-risk postmenopausal women. Moreover, the longer the cycle of the model, the higher the acceptability. The results of this study may provide a scientific reference for decision-making for clinicians, patients, and national medical and health care government departments.

Systemic and Local Strategies for Primary Prevention of Breast Cancer.

One in eight women will develop breast cancer in the US. For women with moderate (15-20%) to average (12.5%) risk of breast cancer, there are few options available for risk reduction. For high-risk (>20%) women, such as BRCA mutation carriers, primary prevention strategies are limited to evidence-based surgical removal of breasts and/or ovaries and anti-estrogen treatment. Despite their effectiveness in risk reduction, not many high-risk individuals opt for surgical or hormonal interventions due to severe side effects and potentially life-changing outcomes as key deterrents. Thus, better communication about the benefits of existing strategies and the development of new strategies with minimal side effects are needed to offer women adequate risk-reducing interventions. We extensively review and discuss innovative investigational strategies for primary prevention. Most of these investigational strategies are at the pre-clinical stage, but some are already being evaluated in clinical trials and others are expected to lead to first-in-human clinical trials within 5 years. Likely, these strategies would be initially tested in high-risk individuals but may be applicable to lower-risk women, if shown to decrease risk at a similar rate to existing strategies, but with minimal side effects.

Development of a breast cancer risk assessment and primary prevention pathway for women aged 30-39 years: Views of UK primary care providers on the role of primary care.

Identifying women aged 30-39 years at increased risk of developing breast cancer would allow them to receive screening and prevention offers. For this to be feasible, the practicalities of organising risk assessment and primary prevention must be acceptable to the healthcare professionals who would be responsible for delivery. It has been proposed that primary care providers are best placed to deliver a breast cancer risk assessment and primary prevention pathway. The present study aimed to investigate a range of primary care provider's views on the development and implementation of a breast cancer risk assessment and primary prevention pathway within primary care for women aged 30-39 years. Twenty-five primary care providers working at general practices in either Greater Manchester or Cambridgeshire and Peterborough participated in five focus groups (n = 18) and seven individual interviews. Data were analysed thematically and organised using a framework approach. Three themes were developed. Challenges with delivering a breast cancer risk assessment and primary prevention pathway within primary care highlights that primary care are willing to facilitate but not lead delivery of such a pathway given the challenges with existing workload pressures and concerns about ensuring effective clinical governance. Primary care's preferred level of involvement describes the aspects of the pathway participants thought primary care could be involved in, namely co-ordinating data collection for risk assessment and calculating and communicating risk. Requirements for primary care involvement captures the need to provide a training and education package to address deficits in knowledge prior to involvement. Additionally, the reservations primary care have about being involved in the management of women identified as being at increased risk are discussed and suggestions are provided for facilitating primary care to take on this role. Despite optimism that primary care might lead a breast cancer risk assessment and primary prevention pathway, participants had a range of concerns that should be considered when developing such a pathway.

Awareness and Candidacy for Endocrine Prevention and Risk Reducing Mastectomy in Unaffected High-Risk Women Referred for Breast Cancer Risk Assessment.

Primary prevention of breast cancer in women at elevated risk includes several strategies such as endocrine prevention and risk-reducing mastectomy (RRM). The objective of this study was to evaluate awareness of different preventive strategies across high-risk subgroups. Women referred for high risk evaluation between 2020 and 2023 completed an initial risk-assessment questionnaire that included questions around perceived lifetime risk and consideration of preventive strategies. One-way analysis of variance (ANOVA) and chi-squared tests were used to compare differences across different high-risk subgroups. 482 women with a median age of 43 years (20-79 years) met inclusion criteria; 183 (38.0%) germline pathogenic variant carriers (GPV), 90 (18.7%) with high-risk lesions (HRL) on breast biopsy, and 209 (43.4%) with strong family history (FH) without a known genetic predisposition. Most high-risk women reported that they had considered increased screening and surveillance (83.7%) and lifestyle strategies (80.6%), while fewer patients had considered RRM (39.8%) and endocrine prevention (27.0%). Prior to initial consultation, RRM was more commonly considered in GPV carriers (59.4%) relative to those with HRL (33.3%) or strong FH (26.3%, p < 0.001). Based on current guidelines, 206 (43%) patients were deemed eligible for endocrine prevention, including 80.5% with HRL and 39.0% with strong FH. Prior consideration of endocrine prevention was highest in patients with HRL and significantly lower in those with strong FH (47.2% HRL versus 31.1% GPV versus 18.7% FH, p = 0.001). Endocrine prevention is the least considered preventive option for high-risk women, despite eligibility in a significant proportion of those presenting with HRL or strong FH.

Attitude of BRCA1/2 mutation carriers towards fertility preservation, family planning and preimplantation genetic testing for primary prevention of breast and ovarian cancer in the next generation.

To study the attitude of BRCA1/2 mutation carriers regarding family planning, fertility preservation, and preimplantation genetic testing (PGT). A national cross-sectional study was conducted by the distribution of an anonymous questionnaire, from August 2022 to January 2023. The main outcomes measures were discussion, acceptance, and performance rates of fertility preservation and PGT. The questionnaire was completed by 530 BRCA1/2 mutation carriers. The mean (SD) age at mutation detection was 36.4 (9.6) years. At the time of mutation detection, 40% did not have children. Following mutation detection, 37% of responders changed their family planning, mostly choosing to have children earlier or to have less children than planned. Twenty-eight percent of BRCA carriers discussed the option of fertility preservation with a physician, 72% agreed that fertility preservation is an acceptable option for BRCA1/2 mutation carriers and finally 11% underwent oocyte/embryo vitrification before RRBSO. 44% of BRCA carriers discussed the option of PGT, 58% agreed that PGT is justified in BRCA1/2 mutation carriers and finally 8% underwent PGT to select non-carrier embryos. In a multivariate analysis, age under 35 years and the a priori need for fertility treatments were both found significant factors increasing the likelihood of performing fertility preservation and PGT. This study emphasizes that despite a substantial proportion of women admitting that mutation detection affected their family planning and high acceptance rates, performance of fertility preservation and PGT remained exceedingly low. Increasing the knowledge and awareness of these issues is important and should be included in multidisciplinary counselling.

Prevalence of Modifiable Breast Cancer Risk Factors and Potential Opportunities for Primary Prevention Among Women Engaged in Screening Mammography: National Health Interview Survey Results.

To determine the prevalence of modifiable breast cancer risk factors among women engaged in screening mammography using nationally representative cross-sectional survey data and to inform potential opportunities for breast facilities to contribute to primary prevention. 2018 National Health Interview Survey respondents who were women ages 40-74 years without history of breast cancer were included and then categorized based on whether they reported screening mammography within the prior two years. Proportions of these women reporting evidence-based modifiable breast cancer risk factors, including elevated body mass index (BMI), lack of physical activity, or moderate or heavy alcohol consumption were calculated and stratified by demographics. Multivariable logistic regression was used to estimate the association between these risk factors and sociodemographic characteristics. Among 4989 women meeting inclusion criteria and reporting screening mammography, 79% reported at least one modifiable risk factor. Elevated BMI was the most reported risk factor (67%), followed by lack of physical activity (24%) and alcohol consumption (16%). The majority of each race/ethnicity category reported at least one modifiable risk factor, with the highest proportion reported by Black respondents (90%). Asian, college educated, and higher-income participants were less likely to have at least one modifiable risk factor. Modifiable breast cancer risk factors are prevalent among women engaged in screening mammography. This provides potential opportunities for breast imaging facilities to contribute to the primary prevention of breast cancer by providing resources for lifestyle modification at the time of screening mammography.

P-738 Attitude of BRCA1/2 mutation carriers towards fertility preservation, family planning and preimplantation genetic testing (PGT) for the next-generation primary prevention of breast and ovarian cancer

Abstract Study question What is BRCA1/2 mutation carriers' attitude toward preimplantation genetic testing (PGT) in attempt to prevent their offspring burden that comes with a known mutation status? Summary answer Less than ten percent of BRCA1/2 mutation carriers chose to perform PGT to avoid the birth of a child who is also a carrier. What is known already BRCA1/2 mutation carriers encounter many dilemmas during their life such as whether to undergo fertility preservation, when and how to plan their family, when to undergo risk reduction surgeries and whether to perform PGT for the selection of non-carrier embryos. Awareness and attitudes toward PGT are different across countries and has been shown to be associated with the degree of suffering from the knowledge of being a carrier, from personal or familial BRCA1/2 associated breast and ovarian cancer. Study design, size, duration This cross-sectional study was conducted by the distribution of an anonymous questionnaire in BRCA1/2 carriers social media platforms and clinics from August 2022 to January 2023. Participants/materials, setting, methods Female respondents of the questionnaire with a positive germline BRCA1/2 mutation at any age or marital status. Main results and the role of chance The questionnaire was completed by 494 BRCA1/2 mutation carriers. The median age of responders was 43 years old (range 22-79), 90% of them Ashkenazi (full or partial) Jewish ethnicy. 63% of patients were carriers of the BRCA1 mutation, while 37% were carriers of the BRCA2 mutation. 76% of patients became aware of their mutation status following a family history of malignancy. 35% of responders did not have children at the time of mutation discovery. 15% of patients had a fertility issue regardless of their BRCA mutation status. Following mutation discovery, 38% of responders changed their family planning, mostly choosing to have children earlier in life or to have less children than planned. 28% of BRCA carriers have been discussed about their option for fertility preservation and 11% underwent the oocyte or embryo vitrification. 45% of BRCA carriers admitted they have discussed the option of PGT and only 8% underwent the in vitro fertilization and preimplantation genetic testing to select non- carrier embryos. 14% of responders were firmly against the option of PGT. The need for fertility treatment regardless of the mutation status did not significantly change the PGT performance rates (p = 0.09). Limitations, reasons for caution This study’s limitations mostly stem from online distribution of the questionnaire. Responders' bias may cause an overestimation of treatment rates as responders may be those who encounter their physicians more frequently and maintain their follow-up as recommended. Nevertheless, the study represents 494 BRCA1/2 carriers and portrays an important healthcare view. Wider implications of the findings Physicians should discuss PGT, family planning and fertility preservation options with BRCA1/2 carriers enabling a personal based decision. It seems that among BRCA carriers, known mutation status largely affects family planning and to a much lesser degree affects fertility preservation and performance of PGT to select non carrier offsprings. Trial registration number Not applicable

Abstract 5259: Bazedoxifene plus conjugated estrogen improves metabolic health and reduces mammary gland epithelial proliferation in an ovary intact rat model of obesity and breast cancer risk

Abstract Background: The majority of women risk eligible for primary breast cancer prevention with tamoxifen or aromatase inhibitors refuse uptake due to concerns about side effects, especially vasomotor symptoms. Tamoxifen may also have detrimental metabolic effects in overweight/obese women. Duavee™, a complex of bazedoxifene (BZA) and conjugated estrogen (CE), is FDA approved for relief of hot-flashes and prevention of osteoporosis. Preclinical studies suggest favorable metabolic effects in ovariectomized animals and potential for breast cancer risk reduction. A single arm clinical trial found reduction in Ki-67 and mammographic density such that BZA+CE is being further evaluated in a Phase IIB trial of peri and early postmenopausal women with vasomotor symptoms who are at high risk for breast cancer. Here, in a companion study, we assessed the effect of BZA+ CE on metabolic health and cancer risk in a rat model of carcinogen induced ER+ tumors and high fat diet induced obesity. Methods: Rats received 50 mg/kg N-methylnitrosourea at 7 weeks to increase mammary tumor risk and were fed a high fat diet (46% kcal fat) to promote obesity. At 16 weeks lean and obese rat were selected based on % body fat and were then randomized to 8 weeks of daily oral vehicle control or 3mg BZA + 0.07mg CE/kg body weight. Systemic metabolic variables were measured at 16 and 24 weeks, and RNA from mammary glands analyzed by gene expression microarray (Affymetrix). Results: BZA+CE resulted in systemic as well as mammary changes indicative of improved metabolic health, including: reduction in total and visceral fat (p&amp;lt;0.01), glucose (p&amp;lt;0.05), cholesterol (p&amp;lt;0.001), and triglycerides(p=0.08), as well as an increase in the adiponectin:leptin ratio (p&amp;lt;0.01). BZA+CE vs control increased the ratio of small (insulin sensitive) to large adipocytes in the mammary gland. Gene set enrichment analysis (GSEA) showed BZA+CE downregulated proliferation-associated pathways which had been upregulated in obese rats, consistent with anti-cancer effects. Obese rats treated with BZA+CE also had upregulation of metabolic pathways, including adipocyte differentiation, fatty acid metabolism, and inflammatory response pathways. Conclusions: Unlike tamoxifen, BZA+CE improved whole body and mammary gland metabolic health, particularly in obese rats. Transcriptional profiling and GSEA demonstrated a blunting of cell cycle and proliferation and enrichment of metabolic and immune-related pathways. Together this supports BZA+CE (Duavee) as an agent to be explored for breast cancer risk reduction in obese individuals. Funding: This work was supported in part by P30 CA168524, R00 CA169430, and R25 CA203650. Citation Format: Ramsey M. Jenschke, Karen A. Corleto, Carol J. Fabian, Stephen D. Hursting, Bruce F. Kimler, Danilo Landrock, Tara N. Mahmood, Katherine L. Cook, Erin D. Giles. Bazedoxifene plus conjugated estrogen improves metabolic health and reduces mammary gland epithelial proliferation in an ovary intact rat model of obesity and breast cancer risk. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5259.

Abstract P4-03-31: Lifestyle factors are associated with breast cancer risk in women biopsied for benign breast diseases in China: 10-year results of a multi-center, hospital-based, case-control study

Abstract Objective: Benign breast disease (BBD), especially benign proliferative breast disease (BPBD), is related to increased breast cancer risk. However, few studies have examined whether conventional breast cancer risk factors influence risk of breast cancer among women with BBD. The aim of this study was to evaluate the associations of lifestyle factors with risk of breast cancer among women biopsied for BBD within a multi-center, hospital-based, case-control study in China, in order to provide scientific basis of health guidance for BBD patients and lay the foundation for primary prevention of breast cancer. Methods: A multi-center, hospital-based, case-control study was conducted. Patients with BPBD (n=608) and patients with non-proliferative breast disease (NPBD) (n=366) were collected from 23 hospitals in 11 provinces during April 2012 to April 2013. A face-to-face survey, baseline data and fasting blood was collected with all study subjects. Serum adiponectin levels were assayed using ELISA. After 10 years, the cumulative incidence rate of breast cancer in the two groups was counted through follow-up. Logistic regression analysis was used to obtain the association between specific factors and risk of breast cancer. Results: After 10 years’ follow-up, 388 BPBD and 240 NPBD cases were included in the final analysis (Table 1), of which 16 (4.12%) and 3 (1.25%) developed breast cancer, respectively. The cumulative incidence of breast cancer between the two groups was significant difference (P=0.041). Compared with women in the NPBD group, BPBD group were more likely to be central obesity (with higher waist-to-hip ratio (WHR)) (OR 24.98, 95% CI 1.845-336.203, P=0.015) and less likely to have physical activity (OR 0.626, 95% CI 0.416-0.943, P=0.025) and less often to eat carrots (OR 0.616, 95% CI 0.398-0.953, P=0.030) (Table 2). Subgroup analyze indicated that, physical activity, eat carrots and ham sausage, body weight, BMI, waist circumference and WHR were statistical differences in premenopausal BPBD patients, while only physical activity (OR 0.423, 95% CI 0.269-0.665 P &amp;lt; 0.001) was the independent risk factors. Meanwhile, among the factors of Tea consumption, Glycemia, Body weight, BMI, Waist circumference, WHR and HMW/total adiponectin ratio in postmenopausal group, only HMW/total adiponectin ratio (OR 0.041, 95% CI 0.002-0.820 P=0.037) was statistically significant factor. These stratified multivariate logistic regression analysis results are shown in Table 3. Conclusion: In patients with BBD, physical activity may be the protect factor for breast cancer carcinogenesis in premenopausal women while lower HMW/total adiponectin ratio is a risk factor for postmenopausal women, which can provide direction for primary prevention of breast cancer. Table 1. Pathological types of all subjects. Table 2. The results of multivariate Logistic regression analysis. Table 3. Stratified multivariate Logistic regression analysis by menopause status. Citation Format: Chao Zheng, Dandan Ma, Linfeng Zhao, Maolin Guo, Shude Cui, Fuguo Tian, Zhimin Fan, Cuizhi Geng, Xuchen Cao, Zhenlin Yang, Xiang Wang, Hong Liang, Shu Wang, Hongchuan Jiang, Xuening Duan, Haibo Wang, Guolou Li, Qitang Wang, Jianguo Zhang, Feng Jin, Jinhai Tang, Liang Li, Shi-Guang Zhu, Wenshu Zuo, Fei Wang, Lixiang Yu, Fei Zhou, Yujuan Xiang, Mingming Guo, Yongjiu Wang, Wenzhong Zhou, Shuya Huang, Zhaohui Li, Yajie Zhou, Lijuan Hou, Xinyi Yang, Xuan Zhang, Liyuan Liu, Zhigang Yu. Lifestyle factors are associated with breast cancer risk in women biopsied for benign breast diseases in China: 10-year results of a multi-center, hospital-based, case-control study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-31.

Effectiveness of Prophylactic Mastectomy

Introduction: The growing incidence and recurrence rate of breast cancer has influenced multiple strategies such as surgical interventions that serve as preventive measures for women at high risk. Prophylactic mastectomy seems to be the most effective tool in the primary prevention of breast cancer, but opinions are not uniform, especially among specialists. The goal of this presentation is to examine the effect of risk-reducing mastectomy, including breast cancer incidence, breast cancer mortality, disease-free survival, physical morbidity, and psychosocial outcomes in cohort of patients who underwent prophylactic mastectomy. Materials and Methods: We retrospectively reviewed the outcomes of 20 years of experience with prophylactic mastectomies performed at the department from 1999 to 2019. In this study were included patients who underwent bilateral prophylactic mastectomy with no breast cancer, and patients with breast cancer, if they underwent contralateral risk-reducing mastectomy, however, only the prophylactic side was considered in the analysis. Patients with bilateral breast cancer were excluded. Results: A total of 749 risk-reducing prophylactic mastectomy in 545 patients were performed at our department from 1999 to 2019. Bilateral prophylactic mastectomies were performed in 204 patients (37,4%), and 341 (62,6%) underwent a unilateral risk-reducing mastectomy secondary to cancer in the contralateral breast. Overall, 243 patients with BRCA1 mutations and 113 with BRCA2 mutations were included. Conclusion: Prophylactic mastectomy is highly preventive against breast cancer. Although further clinical studies are needed to determine the effectiveness of prophylactic mastectomies in individual indications. With the effectiveness of prophylactic mastectomy should also be taken into consideration the quality of life after the immediate breast reconstruction, and the associated complications.

Aspirin for the primary prevention of breast cancer: an unforeseen advantage

Aspirin for the primary prevention of breast cancer: an unforeseen advantage

The Correlation between Knowledge with Primary and Secondary Prevention (BSE) of Breast Cancer in Midwifery Students at UNAIR

Cancer is the third leading cause of death after heart disease and stroke in Indonesia, where the most dominant type of cancer is breast cancer. Primary and secondary prevention practices (BSE) as a preventive approach can reduce the global incidence of cancer by 10-20% within 10-25 years. The purpose of this study was to examine the relationship between knowledge and primary and secondary prevention (BSE) of breast cancer in midwifery students at Airlangga University. This type of research is quantitative with an observational analysis design using a cross-sectional approach. Data collection in this study was carried out using a questionnaire distributed online in the form of a google form. The analysis used in this study is univariate analysis and bivariate analysis using the Spearman Rank test. The results of the analysis showed that there was no relationship between knowledge and primary and secondary prevention (BSE) of breast cancer in midwifery students at Universitas Airlangga with a P-value of 0.360. Thus, breast cancer prevention efforts need to be improved by means of a healthy lifestyle such as consuming low-fat foods, consuming enough vegetables and fruit, maintaining an ideal Body Mass Index, adequate physical activity, and doing breast self-examination (BSE) regularly.

Eating Habits, Risk of Breast Cancer, and Diet-Dependent Quality of Life in Postmenopausal Women after Mastectomy.

The present study examined dietary risk factors for breast cancer, their association with quality of life, and changes in eating habits in postmenopausal women after mastectomy. The study included 210 women with histologically confirmed invasive breast cancer and 225 women without a cancer diagnosis. Questionnaire data on frequency of intake of 40 different foods, the Block Food Frequency Questionnaire, and SF-36 for evaluation of quality of life were used. All questionnaire data in the patient group were collected after diagnosis. Questions about eating habits covered two time points—before breast cancer diagnosis and after completion of treatment. Logistic regression was applied to calculate the odds ratios of breast cancer risk and 95% confidence intervals. A significant positive association was found between the risk of breast cancer and more frequent intake of red meat, smoked products, offal, animal fat, white bread, potatoes, and sweets, high intake of total fat, and low consumption of dietary fibre. Foods that were inversely associated with the risk of breast cancer included fish, vegetables, fruit, wholemeal bread, and groats. The relationship between quality of life and dietary habits according to the Block Eating Frequency Questionnaire was analysed using multiple regression. It was shown that high intake of total fat reduces the quality of life in its mental components. We observed a positive change in eating habits after cancer diagnosis, albeit not always to the level in the control group. As an important lifestyle component, the diet is of great significance for primary prevention of breast cancer as well as for improving the quality of life of breast cancer patients.

Intraductal Delivery and X-ray Visualization of Ethanol-Based Ablative Solution for Prevention and Local Treatment of Breast Cancer in Mouse Models

Breast cancer is the most prevalent cancer and the second-leading cause of cancer-related death for women in the USA. For high-risk women, prophylactic mastectomy is the most effective primary prevention strategy. Prophylactic mastectomy is an aggressive surgical procedure that completely removes the mammary epithelial cells from which breast cancer arises along with the surrounding tissue. We seek to develop a minimally invasive intraductal procedure as an alternative to prophylactic mastectomy to locally ablate the mammary epithelial cells before they can become malignant. We and others have developed an intraductal delivery procedure to reach and treat these epithelial cells in rodent models of breast cancer. While the mouse mammary gland with a single non-anastomosed ductal tree opening at the nipple has a much less complex and tortuous architecture than the human breast, chemically induced and genetically engineered mouse models of breast cancer are valuable to produce proof-of-concept studies of new preventative strategies. Here, we describe a procedure for intraductal delivery of an ethanol-based ablative solution containing micro-CT/X-ray tantalum-based contrast agent within the mouse mammary ductal tree for the therapeutic purpose of primary prevention of breast cancer. Intraductal delivery of aqueous reagents (e.g., cytotoxic compounds, siRNAs, AdCre) has been previously described in mouse models. Thus, we focus our protocol description on methodological modifications and unique experimental considerations for optimizing delivery of ethanol, for minimizing local and systemic side effects of ethanol administration, and for in vivo visualization of ductal tree filling via micro-CT/fluoroscopy imaging. Visualization of the ductal tree immediately after injection of a contrast-containing solution allows for confirmation of complete filling or unsuccessful outcomes such as underfilling or overfilling. This procedure can be applied for delivery and imaging of other ablative compounds aimed at either preventing tumor formation or locally treating early-stage tumors accessible via the ductal tree.

Intraductal Delivery and X-ray Visualization of Ethanol-Based Ablative Solution for Prevention and Local Treatment of Breast Cancer in Mouse Models.

Breast cancer is the most prevalent cancer and the second-leading cause of cancer-related death for women in the USA. For high-risk women, prophylactic mastectomy is the most effective primary prevention strategy. Prophylactic mastectomy is an aggressive surgical procedure that completely removes the mammary epithelial cells from which breast cancer arises along with the surrounding tissue. We seek to develop a minimally invasive intraductal procedure as an alternative to prophylactic mastectomy to locally ablate the mammary epithelial cells before they can become malignant. We and others have developed an intraductal delivery procedure to reach and treat these epithelial cells in rodent models of breast cancer. While the mouse mammary gland with a single non-anastomosed ductal tree opening at the nipple has a much less complex and tortuous architecture than the human breast, chemically induced and genetically engineered mouse models of breast cancer are valuable to produce proof-of-concept studies of new preventative strategies. Here, we describe a procedure for intraductal delivery of an ethanol-based ablative solution containing micro-CT/X-ray tantalum-based contrast agent within the mouse mammary ductal tree for the therapeutic purpose of primary prevention of breast cancer. Intraductal delivery of aqueous reagents (e.g., cytotoxic compounds, siRNAs, AdCre) has been previously described in mouse models. Thus, we focus our protocol description on methodological modifications and unique experimental considerations for optimizing delivery of ethanol, for minimizing local and systemic side effects of ethanol administration, and for in vivo visualization of ductal tree filling via micro-CT/fluoroscopy imaging. Visualization of the ductal tree immediately after injection of a contrast-containing solution allows for confirmation of complete filling or unsuccessful outcomes such as underfilling or overfilling. This procedure can be applied for delivery and imaging of other ablative compounds aimed at either preventing tumor formation or locally treating early-stage tumors accessible via the ductal tree.

Assessment of repeated reference measurements to inform the validity of optical breast spectroscopy.

Mammographic breast density is a strong breast cancer risk factor, and its routine clinical measurement could potentially be used to identify women at higher risk of breast cancer and/or monitor primary prevention strategies. Previous reports of optical breast spectroscopy (OBS), a novel approach to measuring breast density, demonstrated that it is safe (no ionizing radiation), portable, low-cost, and does not require image interpretation but have been limited to small, single-center studies. Reference measurements taken on a phantom breast prior to and after each woman's OBS assessment are required for the calibration of the system transfer function as a part of processing participant data. To inform the validity of participant data, a detailed description of the reference measurements and a repeatability analysis of these measurements taken before and after participant assessment is presented. Reference measurements for OBS from 539 women aged 18-40 years were obtained as a part of a high-throughput epidemiological pilot study. Of these, measurements from 20 women with no useable data due to device failure (3.7%) were excluded and from another 12 women due to user error. The intra-class correlation (ICC) within complete pairs of reference data (taken before and after assessment) was high (all ICC > 0.84). The analysis presented here confirms the OBS participant data as valid for use in ongoing epidemiological research, providing further supporting evidence of OBS as a measure of breast density. A novel method of measuring breast density is needed to bridge large gaps in the knowledge of breast density in younger women and its relation to later-life breast cancer risk.

Knowledge, attitude, practice and awareness of students on breast self-examination: a cross-sectional study

Background: Breast cancer is the leading cause of cancer related deaths globally. it is the common malignancy in women. Lack of early detection leads to low survival rates. Breast self-examination (BSE) is a screening technique that involves examining the breasts for lumps. The aim of the study was to assess the knowledge, attitude and practice of breast self-examination, among the students.Methods: A cross sectional study was carried out in Noida International University, Greater Noida, Uttar Pradesh, India. Quantitative data was collected using a structured questionnaire, filled by 100 female university students that were selected by convenient sampling method. Descriptive analysis of data was done using SPSS version 17.0 (Chicago USA).Results: Out of the 100 participants 83% were in the age group of 15-25 years, 25% of them had family history of breast cancer, and it was revealed that majority of them (94%) have heard of breast cancer and 85% of them heard of breast examination. Despite the high knowledge that was cited among the participants, only 43% of them were having good attitudes towards BSE and only 51% among them have ever practiced BSE.Conclusions: The study revealed good knowledge, negative attitude and low practice towards BSE among the students of Noida International University, Greater Noida, UP State, India. Therefore, there is need to plan and prepare materials for educating the students on BSE to improve primary prevention of breast cancer.