Previous Diagnosis Of Breast Cancer Research Articles

Knowledge, Barriers, and Motivation Related to Breast and Cervical Cancer Screening Among Women in Bojonegoro, East Java: A Qualitative Study

Background: Breast and cervical cancer remain a major cause of morbidity and mortality for wo­men in Indonesia. Although this cancer can be de­tected early, women are still less active in self-detecting breast and cervical cancer, so both cancers are found at an advanced stage. This study aimed to explore how women's knowledge, barriers, and motivations are related to early detection of breast and cervical cancer. Subjects and Method: This was a qualitative study, with focus group discussions (FGDs) and interviews with key informants. Discussions and in­terviews were conducted in the community within Ledok Kulon village, Bojonegoro Regency, East Java, Indonesia. Participants: FGD partici­pants involved 20 women, 10 women underwent FDG about cervical cancer and 10 other women conducted FGD about breast cancer. Three key informants interviewed with health worker and administrator that allow triangulation of res­pon­ses thereby increasing the validity of the findings. Participants were aged 20 to ≥60 years, with no history of symptoms or previous diagnosis of breast or cervical cancer. The women were inter­viewed in October-November 2019. The trans­cri­bed data were analyzed using content analysis. Results: Participants' knowledge about under­stan­ding, risk factors, signs and symptoms of breast and cervical cancer was still lacking. Par­ticipants attributed the cause of cervical cancer to the vaginal wound resulting in cervical cancer and signs of symptoms such as heartburn. Whe­reas for breast cancer participants were not know the signs and symptoms, they only said there was a lump in the breast. Barriers to screening were ashamed to be examined by health workers, afraid of testing procedures, feeling healthy and there were no signs of cancer. Screening motiva­tion were experiencing signs and symptoms of can­cer, family history of the disease and aware­ness of the disease/screening service. Conclusion: The study participants' knowledge of breast and cervical cancer was still lacking. To improve breast and cervical cancer screening, efforts must focus on reducing identified barriers and increasing motivation. Keyword s : knowledge, barriers, motivation, breast and cervical cancer screening Correspondence: Afriza Umami. Diploma III of Medical Records, School of Health Sciences Muhammadiyah Bojone­go­ro, Jl. A.Yani No.14, Bojonegoro, Indonesia. Email: afrizaumami20@gmail.com. Mobile: +62­8­225­4348041. Journal of Health Promotion and Behavior (2020), 5(1): 1-10 https://doi.org/10.26911/thejhpb.2020.05.01.01

ASSESSING RISK FOR ENDOMETRIAL CANCER AMONG HISPANIC FEMALES AGE 50 YEARS AND OLDER

Endometrial cancer is the most common gynecological cancer in the US, with most women diagnosed between 55 and 64 years old. Seventy-five percent of women with endometrial cancer are postmenopausal, and the most common symptom is postmenopausal bleeding. Only a few studies have addressed the lack of knowledge and awareness of risk factors and/or health care utilization for early signs and symptoms of endometrial cancer. The objective of this study was to evaluate health care utilization among Hispanic women aged ≥50 years who are at risk for endometrial cancer. This retrospective cohort study used a combination of diagnosis and procedure codes from UTMB’s electronic health records to identify Texas Hispanic females who had a health encounter at ≥50 years of age between 2012 and 2016. Risk factors included conditions/treatments affecting hormone levels, age, body mass index, diabetes, gravidity, parity, family history of endometrial or colorectal cancer, previous diagnosis of breast or ovarian cancer or endometrial hyperplasia, smoking or alcohol use, and treatment with radiation therapy in the pelvis area. Multivariate logistic regression models evaluated for predictors of endometrial cancer. The study included 11,563 Hispanic females aged ≥50 years (median age=57). Most women were overweight. Currently, we identified 705 Hispanic females (6.1%) with possible endometrial cancer with validation underway. Females who have a history of vaginal spotting/bleeding, pelvic bleeding, and pelvic pain are at higher risk for endometrial cancer. It is important for physicians to educate patients on recognizing the signs and symptoms of endometrial cancer.

1644P - Continuation of annual screening mammograms and breast-cancer mortality in women over 70

BackgroundRandomized clinical trials (RCTs) have shown that initiating breast cancer (BC) screening between ages 50 to 69 and continuing it for 10 years decreases BC mortality. None of the existing RCTs included women over 74 and all included few women aged 70-74, such that the 95% confidence interval (CI) ranged from preventing 32.1 deaths to causing 17.2 deaths. However, there is no RCT data on when a woman should stop receiving BC screening, yet an estimated 52% of women over 75 receive screening mammograms in the US. A future randomized trial to study when to stop screening may be infeasible and potentially unethical. We used insurance claims data to emulate a (hypothetical) target trial of the effect of continuing screening on BC mortality among Medicare beneficiaries aged 70-74 or 75-84 years. MethodsWe emulated a hypothetical trial using a population-based cohort study with 20% random sample of Medicare (1999-2008). We selected 1,058,013 Medicare beneficiaries aged 70 to 84 with a life expectancy of at least 10 years and no previous diagnosis of BC, and who received a BC screening. We compared the following two strategies: continuing annual screening vs. stopping screening mammograms. The main outcome was 8-year standardized risk of BC mortality by age group (70-74, 75-84). Estimates are standardized by baseline and time-varying variables. ResultsIn the 70-74 age group, the estimated 8-year BC-specific death risk difference (95% CI) of continuing vs. stopping screening was -1.0 deaths per 1000 women (-2.3 to 0.1); hazard ratio 0.78 (0.63 to 0.95). In the 75-84 age group, the corresponding risk difference was 0.07 deaths per 1000 women (-0.93 to 1.3); hazard ratio 1.00 (0.83 to 1.19). The estimated 8-year risk of BC was 5.5% under the continue screening strategy (5.3% in the 70-74 age group, 5.8% in the 75-84 age group), and 3.9% under the stop screening strategy (3.9% in the 70-74 age group, 3.9% in the 75-84 age group). ConclusionsAmong women who have received at least one screening mammogram, we estimated that, compared with stopping BC screening, continuing screening past the age of 75 years results in no material difference in cancer-specific mortality over the following 8-year period. Our results in the age range of 70-74 match those of existing randomized clinical trials. Legal entity responsible for the studyThe authors. FundingUS National Institutes of Health. DisclosureAll authors have declared no conflicts of interest.

1013P - Incidental early occult ovarian cancer after risk-reducing salpingo-oophorectomy in BRCA1/2 mutation carriers followed in a community public hospital

BackgroundCarriers of germline BRCA1/2 mutations are at high risk of developing ovarian, tubal or peritoneal cancer. Actually, risk-reducing bilateral salpingo-oophorectomy (RRSO) is the only definite preventive strategy. The aim of this study is to characterize the clinical and pathological features of early occult malignancies incidentally diagnosed after a RRSO in carriers of BRCA1/2 mutations followed at a high risk familial cancer clinic in a community public hospital in NW Spain. MethodsData were prospectively collected from 95 consecutive BRCA-positive women diagnosed at our high risk familial cancer clinic from March 2014 to March 2017. ResultsAmong 95 BRCA1/2 carriers (median age 45 years) 38 women were healthy and 57 have had a previous breast cancer diagnosis. Half of the carriers hold the founder mutation R71G in BRCA1 (69 in BRCA1, 25 in BRCA2, and 1 was a carrier of a mutation in both genes). RRSO was performed in 29 cases (21 in BRCA1 and 8 in BRCA2; median age 50 years). Three BRCA1/2 carriers older than 45 years-old refused to undergo a RRSO. After RRSO two patients (6.4%), both BRCA1-positive, were found to have an early occult adnexal malignancy upon pathology study. One 64-year-old carrier had an invasive serous fallopian tube carcinoma stage I with no involvement of the ovaries plus a stage I endometrial endometrioid carcinoma on the staging hysterectomy. The second 44-year-old women were found at the time of the RRSO a stage Ia invasive high grade serous ovarian carcinoma with no fallopian tubes involvement. ConclusionsA 6.4% incidence of early occult adnexal malignancy after RRSO was found in our cohort of BRCA1/2 carriers. This incidence is similar to that previously published in studies done at international reference centers. The coordinated management of BRCA1/2 mutation carriers between different departments of our institution allows results comparable to international standards. Greater efforts must be made to improve the acceptance of RRSO by BRCA carriers, especially after the age of 40. Legal entity responsible for the studyAuthor: Begoña Graña Suárez. FundingHas not received any funding. DisclosureB. Grana Suarez: Research grant / Funding (institution), Travel / Accommodation / Expenses: Amgen; Travel / Accommodation / Expenses: Celgene; Travel / Accommodation / Expenses: Roche; Travel / Accommodation / Expenses: Servier. All other authors have declared no conflicts of interest.

Metástasis intraorbitárias de cáncer de mama

Objetivo: Describir un caso raro de una paciente previamente diagnosticada con cáncer de mama que evolucionó después de algunos años con metástasis intraorbitaria. Métodos: Relato del caso y revisión de literatura. Resultados: La correlación del diagnóstico previo de neoplasia de mama y la presencia de múltiples lesiones en la órbita y regiones adjacentes ha permitido concluir que la paciente presentaba enfermedad metastásica. Las metástasis se presentan como manifestaciones cada vez más frecuentes en enfermos oncológicos. La órbita y estruturas próximas constituyen topografías poco usuales de diseminación de células neoplásicas y manifestaciones iniciales pueden mimetizar otras condiciones, retrasando el diagnóstico. Como se trataban de pequeñas lesiones, se ha optado por radioterapia como tratamiento único. Después del término la paciente evolucionó con regresión de sintomatología. Conclusiones: Aunque infrecuentes, manifestaciones oculares pueden ocurrir en enfermos oncológicos y la investigación de enfermedad metastático de la órbita es esencial para el seguimiento adecuado.

Experiences and interpretations of BRCA1/2 testing among women affected by breast or ovarian cancer who received a negative result.

The aim of this study was to retrospectively describe the genetic testing motives and experiences of women with a previous breast and/or ovarian cancer diagnosis, who received negative BRCA1/2 results including variants of unknown significance and no pathogenic variant detected. One hundred and thirteen women (mean age 56.17years) were recruited from a familial cancer centre in metropolitan Australia, an average 3.4years after undergoing testing. Participants completed a self-report questionnaire focusing on the retrospective experience of and motives for undergoing BRCA1/2 testing. The study found that the primary motives for undergoing BRCA1/2 testing were (a) to know more about whether their cancer was hereditary, and (b) to have more certainty about the risk of their children developing cancer. In terms of perceptions of personal risk, 35% of women perceived that their risk of breast cancer to be the same or lower than the general population and 80% believed the negative test result to mean that a risk-conferring gene had not been detected. Yet, the average estimate of the likelihood that their cancer was hereditary was 48 out of a possible 100. Psychologically, women did not interpret the negative BRCA1/2 result as a positive outcome. Half were not relieved by the result and were as or more worried than before. Psychological morbidity was high with 17%, 100%, and 36% experiencing clinically significant depression, anxiety, and cancer-specific distress, respectively. Self-ratings of the likelihood that their cancer was hereditary were more closely associated with their personal family cancer histories than with measures of psychological distress. These results have implications for adherence to risk-reducing behaviours and quality of life. Given that these women are not routinely followed up in clinical practice, these findings highlight the importance of post-test genetic counselling and longer-term follow-up for women with negative BRCA1/2 results. Additional time and emotional support from genetic counsellors may help this group of women make sense of the meaning of their test result and adjust psychologically, particularly to uncertainty around the cause of their family history.

Body image problems in women with and without breast cancer 6–20 years after bilateral risk-reducing surgery – A prospective follow-up study

PurposeTo prospectively follow-up and investigate women's perceptions of the cosmetic outcome of their implant-based breast reconstruction, body image, sexuality, anxiety/depressive symptoms, and health-related quality of life (HRQoL) 6–20 years after bilateral risk-reducing mastectomy (RRM), or complementary RRM after breast cancer diagnosis, due to increased risk of hereditary breast cancer. Patients and methodsWomen with and without previous breast cancer diagnosis that underwent RRM between March 1997 and September 2010 were invited (n = 200). We compared 146 (73%) sets of long-term questionnaire responses (e.g., EORTC QLQ-BRR26, Body Image Scale, Sexuality Activity Questionnaire, Hospital Anxiety and Depression Scale, and SF-36) with responses one year after surgery. Women with and without previous breast cancer were compared at the long-term assessment point. ResultsThe HRQoL and anxiety/depressive symptoms remained unchanged compared with one year after surgery, and there were no between-group differences. The negative impact on body image persisted in both groups for most of the items. ‘Sexual discomfort’ increased significantly for women with previous breast cancer (p = 0.016). Women with previous breast cancer also reported more problems with ‘Disease treatment/surgery related symptoms’ (p = 0.006) and ‘Sexuality’ (p = 0.031) in the EORTC QLQ-BRR26 questionnaire. ConclusionProblems with body image appeared to persist long time post-RRM. No differences in HRQoL were found at the long-term follow-up between women with and without previous breast cancer. The results of this investigation might be of use in improving future counselling before risk-reducing surgery for women in the decision-making process.

Prevalence of BRCA1 and BRCA2 pathogenic and likely pathogenic variants in non-selected ovarian carcinoma patients in Brazil

BackgroundBRCA1/2 pathogenic (P) and likely pathogenic (LP) germline variants are frequent among patients with ovarian carcinoma. However, these variants have not been extensively characterized in patients with ovarian cancer in Brazil.MethodsIn this retrospective study we evaluated clinical characteristics and BRCA1/2 genetic test results from patients with ovarian carcinoma who underwent genetic counseling at A.C.Camargo Cancer Center (Brazil) between 2015 and 2017 and had performed germline genetic testing of BRCA1/2 genes.ResultsAmong 158 patients, 33 P and LP variants and were found (20.8%), 27 in BRCA1 and six in BRCA2, and six variants of unknown clinical significance (VUS). Thirteen percent of the patients did not have Multiplex Ligation-dependent Probe Amplification (MLPA) results. Three P variants in BRCA1 were found in more than one patient: c.5266dupC (p.Gln1756Profs*74), c.3331_3334delCAAG (p.Gln1111Asnfs5*), and c.211A > G (p.Arg71Gly). One LP variant in BRCA1 had not been previously described, c.4153_4154delCT (p.Leu1385Ilefs*5). Patients with previous diagnosis of breast cancer were carriers of P or LP variant in 8 of 12 cases (66.7%), and patients with a family history of ovarian or breast cancer in first- or second-degree relatives were carriers of P or LP variant in 26.7% of cases compared to 16.9% for patients without family history (p = 0.166).ConclusionPrevalence of BRCA1/2 germline P and LP variants is slightly higher than previously described by the largest occidental studies, with a high prevalence of variant c.5266dupC (p.Gln1756Profs*74) in BRCA1 observed. Moreover, we identified a new LP variant.

Mammography Adherence among High-Risk Women with Breast Cancer and Either a Non-Pathogenic Mutation Identified or Untested BRCA1/2 Genetic Status

Background: Little is known about the illness perceptions of women with a previous breast cancer diagnosis and either no access to a personal BRCA1/2 test or tested and a no pathogenic mutation identified result and how this might impact their mammography adherence. Objective: The aim of this study was to assess the impact of illness beliefs, specifically those relating to emotional representations and cure and control beliefs about breast cancer, and socio-economic status (SES) on mammography adherence of these women. The traditional health belief model (HBM) was compared to a modified model which allowed for the contribution of emotions in health surveillance decision-making. Method: Mailed self-report questionnaires were completed by 193 women recruited from an Australian Familial Cancer Centre. Step-wise logistic regression analyses were conducted on n=150 [aged 27-89 years (M=56.9)] for whom complete data were available. Results: The questionnaire response rate was 36%. Higher levels of emotional representations of breast cancer were associated with greater mammography adherence (OR = 1.18, 95% CI = 1.03-1.36, p =.019). Middle income was six times more likely to predict mammography adherence than lower income (OR = 6.39, 95% CI = 1.03 – 39.63, p =.047). The modified HBM was superior to the traditional HBM in predicting mammography adherence (X2 [15, N = 118] = 26.03, p =.038). Conclusions: Despite a modest response rate, our data show that emotional illness representations about breast cancer and middle income status were found to significantly predict mammography adherence. Therefore, providing surveillance services and delivering information considerate of financial status and constructed around emotional motivators may facilitate mammography adherence among women like those described in this study.

Abstract A62: Differences in sexual dysfunction between lesbian, bisexual, and heterosexual female breast cancer survivors

Abstract Purpose: The purpose of this study was to examine (1) differences in sexual dysfunction between lesbian, bisexual, and heterosexual female breast cancer survivors including (2) patient-provider communication regarding sexual problems, and (3) receipt of treatment for sexual complaints. Methods: Dr. Susan Love Research Foundation's The Health of Women (HOW) Study™ is a cohort study of approximately 40,000 women with and without breast cancer who have responded to one or more online, self-administered surveys. This study includes data from women who completed the baseline and quality-of-life surveys. Women were included if they had a previous diagnosis of breast cancer and if they self-identified as lesbian, bisexual, or heterosexual (N=3,833). Sexual dysfunction was defined as “ever [having] significant problems with change in sexual interest.” We also examined whether women (1) thought that their cancer/cancer treatment was “the primary cause of [her] most significant problems with changes in sexual interest”, (2) “talked to [her] doctor about [her] problems with change in sexual interest”, and (3) “received treatment for [her] problems with change in sexual interest.” Analyses included chi-square test of independence and bivariate logistic regression. Differences were considered significant at p<0.10. Results: Distribution of sexual orientation was as follows: heterosexual (96%), lesbian (3%), and bisexual (1%). Over a third of women reported sexual dysfunction (34%); 78% of them attributed these changes in sexual interest to their breast cancer treatment. Bisexual women were most likely to report changes in sexual interest (48%) when compared to lesbian (34%) and heterosexual (34%) women. Bisexual women were 77% more likely to report changes in sexual interest compared to heterosexual women (OR=1.77; 95%CI: 0.99-3.17, p<0.10); however, bisexual women were less likely than heterosexual women to talk to their doctor about this (OR=0.40; 95% CI: 0.16-0.94, p<0.10). All women reported similar levels of bother from changes in sexual interest (62% reporting being bothered by changes in sexual interest “quite a bit” or “very much”). Irrespective of sexual orientation, less than 20% of women received treatment for changes in sexual interest. Conclusion: Sexual dysfunction was a common issue identified by women breast cancer survivors, particularly among bisexual women who were also less likely to report sexual dysfunction to their provider. Overall, treatment for sexual dysfunction was low for all women, suggesting a potential gap in survivorship care more broadly. These findings suggest that experiencing problematic changes in sexual interest was more common among bisexual breast cancer survivors, who may face unique challenges in receiving needed survivorship care. Targeted interventions for these women may be warranted to increase patient-provider communication about sexual dysfunction and to improve the burden of sexual dysfunction among bisexual women. Citation Format: Christopher W. Wheldon, Megan C. Roberts, Michelle I. Silver, Ulrike Boehmer. Differences in sexual dysfunction between lesbian, bisexual, and heterosexual female breast cancer survivors [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A62.

Abstract B25: Empowering Latinas to obtain breast cancer screenings: Comparing intervention effects, part 1

Abstract Purpose: Latinas suffer disproportionately from breast cancer relative to non-Latina Whites (NLWs), partially due to lower guideline-concordant screening. In response, a significant body of work first sought to characterize disparities and associated determinants. Second, multiple approaches were developed to address this disparity, including community health worker (CHW)-driven education to the target population and empowerment interventions, wherein CHWs train a subset of the population to disseminate education to other members of the target population and mobilize in the context of health. The next logical step is to compare the relative effectiveness of interventions for future large-scaled implementation. Objective: We report emerging evidence from an ongoing, quasi-experimental trial that compares the effects of education and empowerment approaches on Latinas who are nonadherent to US Preventive Services Task Force breast cancer screening guidelines. Methods: The setting for this trial is in two Latino, lower-income communities in Chicago (Pilsen/Little Village, East Side/Chicago). Women are recruited via two community-based organizations (The Resurrection Project, Centro Comunitario Juan Diego) and snowball sampling. Eligibility criteria include: 1) age of 50-74; 2) lack of screening within past 2 years; 3) no previous breast cancer diagnosis; and 4) no prior health volunteerism experience. After screening and providing informed consent, women are assigned to a cohort (6-10 sessions) and participate in a three-week intervention (three 2-hour sessions). The education intervention is administered in East Side/Chicago and the empowerment intervention is administered in Pilsen/South Chicago to avoid contamination effects. The education intervention consists of a session focused on breast cancer and methods of early detection, a session focused on diet as a method of prevention, and a session focused on physical activity as a method of prevention. The empowerment intervention consists of a session focused on breast cancer and methods of early detection, a session focused on one-on-one conversations with family and friends about breast cancer, and a session focused on health-related volunteerism. For women who wish to obtain mammography (from either arm), study team provides navigation to free/low-cost services and tracks participants throughout the continuum of care. Three questionnaires are given: baseline (before Session #1), postintervention (after Session #3), and a follow-up (6 months after Session #3). Receipt of screening is confirmed by study and medical records for women who have completed HIPAA forms. Participants are compensated $80 for their participation. As well, during and after the intervention, participants may refer other nonadherent Latinas to the study for a small incentive ($15). Results: Our current sample is 37 women (20 education; 17 empowerment). The average age was 61.62 years old (SD = 6.02). Approximately 89% of participants were born in Mexico and approximately 81% had less than a high school education. The median annual household income was <$15,000. A greater proportion of empowerment participants have scheduled a mammogram relative to education participants (20% vs. 76%; p=.001). Relative to education participants, a greater proportion of empowerment participants have discussed breast cancer with other nonadherent Latinas and referred them to the study (5% vs 33%; p = .05). Discussion: Preliminary findings suggest the empowerment approach may be more effective in promoting breast cancer screening among nonadherent Latinas and disseminating information to their peers. Limitations concern generalizability due to a non-probability based sample and limited ability for causal inferences due to a lack of randomization. Next steps include comparing receipt of screening and characterizing diffusion of information throughout participants' social networks. Citation Format: Yamile Molina, Liliana G. San Miguel, Lizeth Tamayo, Sylvia Gonzalez, Rosa de la Torre, Kryztal Peña, Araceli Lucio, Oliva Hernandez, Juanita Arroyo, Maria C. Medina, Nora Coronado. Empowering Latinas to obtain breast cancer screenings: Comparing intervention effects, part 1 [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B25.

Risk-reducing mastectomy rates in the US: a closer examination of the Angelina Jolie effect

PurposeIn 2013, Angelina Jolie disclosed in the New York Times (NYT) that she had undergone risk-reducing bilateral mastectomy (RRBM) after learning that she was a BRCA1 mutation carrier. We examined the rates of BRCA testing and RRBM from 1997 to 2016, and quantified trends before and after the Jolie op-ed.MethodsThis observational study of insurance claims data representative of the commercially-insured US population (Truven MarketScan® database) measured BRCA testing and RRBM rates among females ≥ 18 years. Censoring events were breast cancer or ovarian cancer diagnosis, last follow-up date (September 2016), or death. Interrupted time series analyses were used to quantify trends before and after the op-ed.ResultsAngelina Jolie’s NYT op-ed led to a statistically significant increase in the uptake of genetic testing and in RRBM among women without previous diagnosis of breast or ovarian cancer in the US population, and in women who did not undergo testing for BRCA (P < 0.0001 for both). The rate (slope) of RRBM among women who were previously tested for BRCA (P = 0.70) was unchanged. After excluding women with in-situ tumors, the editorial’s effect became less pronounced, suggesting that high-risk women with in-situ breast cancers were most influenced by Jolie’s announcement.ConclusionThe Angelina Effect—a term coined by Time magazine to describe the rise in internet searches related to breast cancer genetics and counseling—represents a long-lasting impact of celebrity on public health awareness as significant increases in genetic testing and mastectomy rates were observed and sustained in subsequent years.

Empowering Latinas to Obtain Breast Cancer Screenings: Comparing Intervention Effects, Part 2

Abstract We compare the effects of breast cancer education and empowerment approaches on non-adherent Latinas' breast health behaviors and dissemination of health information. Methods: The setting for this ongoing, quasi-experimental trial is two Latino, lower income communities in Chicago. Women were recruited via two community-based organizations and snowball sampling. Eligibility criteria were: 1) age of 52–74; 2) lack of screening within past 2 years; 3) no previous breast cancer diagnosis; and, 4) no health volunteerism experience. Women were assigned to a three week group intervention (3 2 hour sessions). The education intervention is administered in East Side/South Chicago and the empowerment intervention is administered in Pilsen/Little Village to avoid contamination effects. The education intervention has 3 sessions focused on early detection and prevention (diet, physical activity). The empowerment intervention has 3 sessions focused on early detection, sharing information with family/friends, and health volunteerism. Navigation is provided if women wish to obtain mammograms. Three questionnaires are given at baseline, post-intervention, and a 6 month follow-up. Results: Among our 68 participants (34 education; 34 empowerment), 87% were born in Mexico; 59% had &amp;lt;9th grade education; 52% had a median household income of &amp;lt;$10K; and, 51% were uninsured. The average age was 61.21 (SD = 6.20). Relative to education participants, more empowerment participants have scheduled mammograms (94% vs. 74%; P = 0.05) and obtained mammograms (77% vs. 38%, P = 0.001). Empowerment participant also spoke to more individuals about breast health relative to education participants (M = 6.24, SD = 5.30 vs. M = 3.00, SD = 3.04, P = 0.003). A greater proportion of engagement participants also spoke about specific types of breast cancer screening (58% vs. 38%, P = 0.01) and discussed breast cancer across multiple settings (58% vs. 24%, P = 0.003). Discussion: The empowerment approach may be particularly effective in changing non-adherent Latinas' screening behaviors and promoting them to become agents of change in their communities. Limitations concern generalizability due a non-probability based sample, and limited ability for causal inferences due to a lack of randomization.

Mutational landscape of radiation-associated angiosarcoma of the breast.

PurposeRadiation-associated breast angiosarcomas are a rare complication of radiation therapy for breast carcinoma. With relatively little is known about the genetic abnormalities present in these secondary tumors, we examined genomic variation in biospecimens from radiation-associated breast angiosarcomas.Experimental DesignPatients were identified that had a previous breast cancer diagnosis, received radiation therapy, and developed angiosarcoma in the ipsilateral breast as the earlier cancer. Tumor regions were isolated from archival blocks using subsequent laser capture microdissection. Next generation sequencing was performed using a targeted panel of 160 cancer-related genes. Genomic variants were identified for mutation and trinucleotide-based mutational signature analysis.Results44 variants in 34 genes were found in more than two thirds of the cases; this included 12 variants identified as potentially deleterious. Of particular note, the BRCA1 DNA damage response pathway was highly enriched with genetic variation. In a comparison to local recurrences, 14 variants in 11 genes were present in both the primary and recurrent lesions including variants in genes associated with the DNA damage response machinery. Furthermore, the mutational signature analysis shows that a previously defined IR signature is present in almost all of the current samples characterized by predominantly C→T substitutions.ConclusionsWhile radiation-associated breast angiosarcomas are relatively uncommon, their prognosis is very poor. These data demonstrate a mutational pattern associated with genes involved in DNA repair. While important in revealing the biology behind these tumors, it may also suggest new treatment strategies that will prove successful.

Use of Single-Nucleotide Polymorphisms and Mammographic Density Plus Classic Risk Factors for Breast Cancer Risk Prediction

Single-nucleotide polymorphisms (SNPs) have demonstrated an association with breast cancer susceptibility, but there is limited evidence on how to incorporate them into current breast cancer risk prediction models. To determine whether a panel of 18 SNPs (SNP18) may be used to predict breast cancer in combination with classic risk factors and mammographic density. This cohort study enrolled a subcohort of 9363 women, aged 46 to 73 years, without a previous breast cancer diagnosis from the larger prospective cohort of the PROCAS study (Predicting Risk of Cancer at Screening) specifically to evaluate breast cancer risk-assessment methods. Enrollment took place from October 2009 through June 2015 from multiple population-based screening centers in Greater Manchester, England. Follow-up continued through January 5, 2017. Genotyping of 18 SNPs, visual-assessment percentage mammographic density, and classic risk assessed by the Tyrer-Cuzick risk model from a self-completed questionnaire at cohort entry. The predictive ability of SNP18 for breast cancer diagnosis (invasive and ductal carcinoma in situ) was assessed using logistic regression odds ratios per interquartile range of the predicted risk. A total of 9363 women were enrolled in this study (mean [range] age, 59 [46-73] years). Of these, 466 were found to have breast cancer (271 prevalent; 195 incident). SNP18 was similarly predictive when unadjusted or adjusted for mammographic density and classic factors (odds ratios per interquartile range, respectively, 1.56; 95% CI, 1.38-1.77 and 1.53; 95% CI, 1.35-1.74), with observed risks being very close to expected (adjusted observed-to-expected odds ratio, 0.98; 95% CI, 0.69-1.28). A combined risk assessment indicated 18% of the subcohort to be at 5% or greater 10-year risk, compared with 30% of all cancers, 35% of interval-detected cancers, and 42% of stage 2+ cancers. In contrast, 33% of the subcohort were at less than 2% risk but accounted for only 18%, 17%, and 15% of the total, interval, and stage 2+ breast cancers, respectively. SNP18 added substantial information to risk assessment based on the Tyrer-Cuzick model and mammographic density. A combined risk is likely to aid risk-stratified screening and prevention strategies.

Preferences for multigene panel testing for hereditary breast cancer risk among ethnically diverse BRCA-uninformative families.

Until recently, genetic testing for hereditary breast cancer has primarily focused on pathogenic variants in the BRCA1 and BRCA2 (BRCA) genes. However, advances in DNA sequencing technologies have made simultaneous testing for multiple genes possible. We examined correlates of interest in multigene panel testing and risk communication preferences in an ethnically diverse sample of women who tested negative for BRCA mutations previously but remain at high risk based on their family history (referred to as "BRCA-uninformative") and their at-risk female family members. Two-hundred and thirteen women with a previous breast cancer diagnosis and a BRCA-uninformative test result and their first-degree relatives completed a survey on interest in multigene panel testing, communication preferences, and sociodemographic, psychological, and clinical factors. Stepwise logistic regression was used to identify factors associated with testing interest. Chi-square analyses were used to test differences in risk communication preferences. Interest in multigene panel testing was high (84%) and did not considerably differ by cancer status or ethnicity. In multivariable analysis, factors significantly associated with interest in genetic testing were having had a mammogram in the past 2years (odds ratio (OR)=4.04, 95% confidence interval (CI) 1.80-9.02) and high cancer worry (OR=3.77, 95% CI 1.34-10.60). Overall, the most commonly preferred genetic communication modes were genetic counselors, oncologists, and print materials. However, non-Hispanic women were more likely than Hispanic women to prefer web-based risk communication (p<0.001). Hispanic and non-Hispanic women from BRCA-uninformative families have a high level of interest in gene panel testing. Cancer-related emotions and communication preferences should be considered in developing targeted genetic risk communication strategies.

The prevalence of unmet needs in 625 women living beyond a diagnosis of early breast cancer

Background:There are over half a million women with a previous breast cancer diagnosis living in the UK. It is important to establish their level of unmet physical and psychosocial needs, as many are not routinely seen for follow-up under current models of care.Methods:We conducted a retrospective analysis of early breast cancer survivors entering an Open Access Follow-Up (OAFU) programme in 2015. Unmet needs were assessed using the Holistic Needs Assessment (HNA) or extracted directly from the electronic patient record (EPR), when the HNA had not been completed.Results:Six hundred and twenty-five patients were eligible. Sixty-one per cent of the survivors had at least one unmet need and 18% had ⩾5 needs. Consistently higher levels of unmet needs were identified using the formal HNA checklist as opposed to extraction from EPR (P<0.001). Physical and emotional needs were the most frequently reported (55 and 24% respectively). Patients receiving endocrine therapy and those who had received chemotherapy were more likely to report unmet needs (both P<0.001).Conclusions:Unmet physical and emotional needs are common in breast cancer survivors. It is vital that the services are available for these patients as they transition from hospital-based follow-up to patient-led self-management models of care.

Management of Axillary Web Syndrome after Breast Cancer: Evidence-Based Practice.

Axillary web syndrome is characterized as a physical-functional complication that impacts the quality of life of women who have undergone treatment for breast cancer. The present study aims to verify the physiotherapy treatment available for axillary web syndrome after surgery for breast cancer in the context of evidence-based practice. The selection criteria included papers discussing treatment protocols used for axillary web syndrome after treatment for breast cancer. The search was performed in the MEDLINE, Scopus, PEDro and LILACS databases using the terms axillary web syndrome, lymphadenectomy and breast cancer, focusing on women with a previous diagnosis of breast cancer who underwent surgery with lymphadenectomy as part of their treatment. From the 262 studies found, 4 articles that used physiotherapy treatment were selected. The physiotherapy treatment was based on lymphatic drainage, tissue mobilization, stretching and strengthening. The four selected articles had the same outcome: improvement in arm pain and shoulder function and/or dissipation of the axillary cord. Although axillary web syndrome seems to be as frequent and detrimental as other morbidities after cancer treatment, there are few studies on this subject. The publications are even scarcer when considering studies with an interventional approach. Randomized controlled trials are necessary to support the rehabilitation resources for axillary web syndrome.

Abstract P5-08-20: A real-world evidence study to define the prevalence of endocrine therapy-naïve hormone receptor-positive locally advanced or metastatic breast cancer in the US

Abstract BACKGROUND The recently completed FALCON trial (NCT01602380) compared the efficacy of the selective estrogen receptor degrader (SERD) fulvestrant 500 mg with anastrozole in postmenopausal women with hormone receptor (HR)-positive locally advanced or metastatic breast cancer (LA/MBC) who had received no prior endocrine therapy (ET). To better understand the size of the US population to which the results of the FALCON trial are applicable, this study estimated the proportion of postmenopausal patients with HR-positive, human epidermal growth factor receptor (HER)2-negative LA/MBC who had received no prior ET, using data from a US medical record database. METHODS This observational study retrospectively analyzed data from the Optum Electronic Health Record Database, obtained from provider groups across the US. Women over 40 years of age with breast cancer diagnoses (January 2008–March 2015) were included, provided they had at least 12 months of recorded medical history prior to index, and at least one recorded physician office visit in that time. Incident (newly diagnosed) and prevalent (previous diagnosis of early or advanced breast cancer) cases were identified. Free-text clinical notes were reviewed using natural language processing to identify a target patient population of postmenopausal women with HR-positive, HER2-negative LA/MBC who had received no prior ET (similar to the FALCON entry criteria); additionally, diagnostic codes or treatment history were also used to identify HR status in the absence of confirmation from the free-text notes. The results of this analysis were extrapolated to estimate the size of the target population at a national level, using statistics from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database. Results are presented descriptively. RESULTS Overall, 63,962 women with breast cancer were identified, of whom 11,831 had discernible information on menopausal status, HER2 status, HR status, and disease stage. Of these, 1,923 patients were identified with postmenopausal, HR-positive, HER2-negative (or unknown) LA/MBC. Within this population of patients, 70.7% (1,360/1,923) had not previously received ET (88.5% [920/1,040] incident cases; 49.8% [440/883] prevalent cases), representing 11.5% (1,360/11,831) of the total breast cancer population with known menopausal status, HER2 status, HR status, and cancer disease stage information. The proportion of patients with postmenopausal, HR-positive, HER2-negative LA/MBC who had received no prior ET in this sample was extrapolated using US national estimates of the size of the postmenopausal, HR-positive, HER2-negative LA/MBC population taken from SEER. This approach suggests a 5-year limited-duration prevalence of postmenopausal patients with HR-positive, HER2-negative LA/MBC who have received no prior ET of approximately 50,000 cases and an annual incidence of about 15,000 patients. CONCLUSIONS These real-world data provide an estimate of the number of postmenopausal patients with HR-positive, HER2-negative, LA/MBC in the US who have not previously received ET. This population corresponds to the recently completed Phase 3 FALCON trial of fulvestrant compared with anastrozole. Citation Format: Nunes AP, Green E, Dalvi T, Lewis J, Jones N, Seeger JD. A real-world evidence study to define the prevalence of endocrine therapy-naïve hormone receptor-positive locally advanced or metastatic breast cancer in the US [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-20.

Abstract P2-13-03: Breast cancer education, counseling, and support for Jewish women: Preliminary results of a CDC program evaluation

Abstract Background: Information and social support for women at risk for and surviving breast cancer are essential components of comprehensive clinical and public health practice in breast cancer prevention, control, and treatment. Jewish women in the US are a population of special concern due to their increased hereditary breast cancer risk for carrying BRCA1/2 gene mutations, and the dearth of culturally-relevant resources for breast cancer education and counseling. As part of a CDC initiative, Sharsheret (a non-profit breast cancer support and advocacy organization) is scaling-up its programs and services for women of all Jewish backgrounds to better meet these needs, guided by program evaluation data on client engagement practices. This abstract describes these practices and survey results. Methods: Evaluation surveys were individually-administered via e-mail using a secure online platform. Survey invitations were sent to participants ~30 days following their utilization of Sharsheret program services. Evaluation domains included program engagement and satisfaction, health-related quality of life, and resource needs. Results: The survey response rate was &amp;gt;65% (N=111), and a majority of respondents reported that they were Jewish (75%), married (76%), either or 35-45 years old (35%) or 46-64 years old (48%), and from the northeast region of the US (56%). Most respondents (88%) reported a previous breast or ovarian cancer diagnosis, and 7% indicated they carried a genetic mutation known to increase breast cancer risk. Based on the CDC's 'Health Days' measures, respondents reported a higher number unhealthy days (M=12 days per month) relative to general population averages for adult women (M=6.9 days). Respondents rated their experience with the organization highly (M=4.7 out of 5) for overall satisfaction with the quality of services utilized. There was also strong agreement among respondents (M =4.6 out of 5) about the availability and utility of patient navigation services, and the survivorship program garnered the highest level of engagement (71%) as it was utilized most often by respondents for its healthy living and nutrition resources. Conclusion: Nonprofit organizations devoted to cancer support and advocacy fill important roles in educating and counseling women about breast cancer prevention, control, and treatment. In an era of precision medicine and discussion of population-based screening for hereditary breast cancer risk, these organizations must scale-up their information and support services. This is necessary to be available for a greater number of women, and can be expected to perform even more important and essential roles, especially for Jewish women at risk for and surviving breast cancer. Citation Format: Fleischmann A, Silber E, Dubitsky S, Stahl S, Kravitz S, Johnson A, Murphy S, Tercyak KP. Breast cancer education, counseling, and support for Jewish women: Preliminary results of a CDC program evaluation [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-13-03.