Previous Breast Research Articles

P098: Contralateral metachronous breast cancer - Risk of metastasis and subsequent treatment choice following previous breast conservation surgery

Introduction: The incidence of contralateral metachronous breast cancer ranges from 0.5% to 0.75% per annum. Access to effective adjuvant therapies has led to a positive reduction in this incidence, yet data from the USA show a 150% increase in contralateral risk reducing mastectomies. This contrasts with surgical practice in the UK where breast conservation (BCS) rates remain high. When faced with a contralateral metachronous cancer, and in the absence of a known gene mutation, do patients in the UK have a treatment preference?

Transaxillary Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction Using a Simplified Endoscopic Approach: Indications, Cosmetic Outcomes and Technical Refinements.

The increasing demand for further aesthetic outcome improvement in implant-based breast reconstruction after nipple-sparing mastectomy (NSM) leads to major novelties, including endoscopic and robotic NSM with the aim to limit scar visibility. In this paper, we report our experience with a novel and simplified surgical approach-single-axillary-incision non-endoscopic NSM and node surgery followed by an endoscopic DTI breast reconstruction-by focusing on reconstructive indications, technical refinements and aesthetic outcomes. Between June 2016 and October 2019, 14 women underwent this novel technique using definitive anatomical silicone gel filled, totaling 20 breasts. Reconstructive evaluation methods were clinically and photography-based assessment. Breast-Q has been used to quantify patient satisfaction. Feasibility and safety data are also provided. The average follow-up time was 11months (range 3-42months). No local-regional recurrence occurred during follow-up. Median operation time was 340min; mean hospital stay was 4.1days. The average mastectomy specimen weight was on average 139g (ranging from 98 to 182g). The average implant volume for the reconstructed side was 306cc (ranging from 165 to 550cc). Patients' satisfaction was high to very high. Authors' experience suggests that non-endoscopic transaxillary NSM, node surgery and endoscopic direct-to-implant breast reconstruction is a valid, oncological safe, aesthetically sound scarless option in breast cancer patients with small to moderate breast size. It should represent the incision of choice in patient with previous breast surgery with scars that may compromise flap/NAC vascularity using traditional NSM incisions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Diagnostic yield and clinical utility of germline genetic testing following somatic testing in breast cancer patients.

1092 Background: Germline genetic testing is recommended for breast cancer patients with specific presentations or family histories. Separately, tumor DNA sequencing is increasingly used to inform therapy, most often in patients with advanced disease. Recent NCCN and ESMO guidelines recommend germline testing following somatic testing, under specific circumstances and for specific genes. We examined the utility of germline findings in patients referred for both test modalities. Methods: We reviewed somatic and germline mutations in a consecutive series of patients who: (a) had a current or previous breast cancer diagnosis, (b) were referred for germline testing, and (c) previously received tumor sequencing. Diverse reasons for germline testing included: a tumor finding of potential germline origin, treatment or surgical planning, personal or family history, and patient concern. Results: 227 patients met study criteria of whom 88 (39%) harbored a pathogenic germline variant (PGV) in a high or moderate risk cancer predisposition gene. Mutations in certain genes were most likely to be of germline origin, and most PGVs were potentially actionable (Table). 13% of PGVs were not reported by tumor tests as either germline or somatic findings, usually a result of tumor test limitations. Of note, 27 of the patients with PGVs (31%) had these variants uncovered only after presenting with a second, possibly preventable, malignancy. Conclusions: Germline testing following tumor sequencing often yielded findings that may impact care. Indeed, the 39% PGV rate we observed suggests that such testing may be underutilized. We observed actionable PGVs missed by somatic tests, PGVs uncovered in patients’ second malignancies, and PGVs not within germline reflex testing criteria. These results reinforce the utility of germline testing separate from somatic testing in appropriate patients. [Table: see text]

Paget's Disease of the Breast Presenting as Nipple Ulceration With Normal Mammogram

ABSTRACT Paget's disease of the breast (PDB) is a rare disorder of the nipple–areola complex that may present clinically as a unilateral, eczematous, or ulcerated papule or plaque. This case highlights the importance of either punch or incisional wedge biopsy to establish a diagnosis of PDB for patients who present with chronic cutaneous changes of the nipple, areola, or skin of the breast, regardless of any previous normal mammogram or breast ultrasound. Mammography alone cannot rule out a diagnosis of PDB in a patient with cutaneous changes of the breast.

Breast Density of Mammography is Correlated with Reproductive Risk Factors Regardless of Menopausal Status: A Cross-Sectional Study of the Korean National Screening Program.

Objective:To clarify the limitations of mammography screening for women with dense breasts, we examined breast density and its effects on screening results. Patients and Methods:We performed a cross-sectional, observational study on women who underwent mammography. Data from the National Cancer Screening Program(NCSP) from 2009 to 2013 were used. The study population consisted of participants with high breast density. We used a logistic regression analysis to evaluate the relationships between breast density and reproductive factors and screening results according to menopause status. Results:High breast density was reported for 57.5% of all participants (3,417,319 participants). Screening results indicated breast density of <25%, 25-50%, 51-75%, and ≥76% for 16.4%, 26.3%, 37.8%, and 19.5%, respectively, of participants. According to the screening results, high breast density was correlated with high deferment and recall rates. Reproductive factors, especially parity, breastfeeding, and use of oral contraceptives, had consistent effects on screening results of premenopausal and postmenopausal women. Regardless of menopausal status, age, early onset of menarche (15 years or younger), fewer live births (≤1 birth), and previous benign breast disease were correlated with increased breast density. In postmenopausal women, early-onset menopause and longer-term hormone replacement therapy (≥2 years) also independently increased breast density.Conclusion:Breast density influenced screening results, which could increase the rate of recall. Breast density was also influenced by reproductive factors, with patterns similar to those of breast cancer risk, regardless of menopausal status. We need to identify high-risk women with high density who would probably benefit from supplemental breast cancer screening.

Abstract QS33: Breastfeeding Capability After Benign Breast Surgery

Purpose: Many breast surgeons are fearful of operating on young women due to the potential impact on future lactation ability. Despite these concerns, there is extremely sparse data regarding the effect of benign breast surgery on breastfeeding capability. This study aims to elucidate the impact of benign breast surgery on breastfeeding and lactation performance. Methods: Eligible mothers between the ages of 18 and 45 years and between 6 months and 5 years postpartum were recruited to capture their breastfeeding experiences and prior breast surgery history. All data were self-reported. Results: A total of 85 participants were included in analyses, with a mean age of 33.6 years. Fifteen mothers were previously diagnosed with a breast condition, most commonly breast cysts (6), fibroadenoma (3), and macromastia (2). Sixteen mothers underwent breast surgery: augmentation (5), reduction mammaplasty (4), and biopsy (4). More than 80% of mothers successfully breastfed or fed breast milk from the bottle, regardless of history of breast surgery (p = 0.578). Most mothers with and without previous breast surgical history reported moderate to extreme difficulty while breastfeeding (40% v. 60%, respectively, p = 0.338). Breastfeeding satisfaction did not differ significantly by breast surgery status (p = 0.999). Conclusion: This study is among the first to suggest that breast surgery does not significantly impact breastfeeding ability. Although more data are necessary to generalize results, our findings suggest that benign breast surgery is safe in young women and should not preclude otherwise healthy young women from enjoying the benefits of breast surgery for fear of impairing future lactation.

Feasibility of Breast-Conservation Therapy and Hypofractionated Radiation in the Setting of Prior Breast Augmentation

PurposeCosmetic outcomes and rate of implant loss are poorly characterized among patients with breast cancer with previous breast augmentation (BA) who undergo breast-conservation therapy (BCT). Here we determine capsular contracture and implant loss frequency after BCT among patients receiving contemporary whole-breast radiation therapy (RT). Methods and MaterialsPatients with breast cancer with a history of BA presenting to our institution from January 2006 to January 2017 who elected for BCT were included. Seventy-one breast cancers in 70 patients with a history of BA electing for BCT were retrospectively identified. Clinicopathologic, treatment, and outcome variables were examined. Whole-breast RT included conventional and hypofractionated schedules with and without a boost. Rates of implant loss and cosmetic outcomes among patients who did and did not develop a new/worse contracture based on physician assessment were compared. ResultsIn the study, 54.9% of patients received radiation using hypofractionated whole-breast tangents; 81.7% received a boost. In addition, 18 out of 71 cases (25.4%) developed a new/worse contracture after BCT with a mean follow-up of 1.9 years. Furthermore, 9 out of 71 cases (12.7%) were referred to a plastic surgeon for revisional surgery. There were no implant-loss cases. On univariate analysis, implant location, time from implant placement to diagnosis, RT type, RT boost, body mass index, and tumor size were not associated with new/worse contracture. Of 12 patients with existing contracture, only 2 developed worsening contracture. Physician assessment of cosmetic outcome after BCT was noted to be excellent or good for 87.4% of patients. ConclusionsBCT for breast cancer patients with prior history of BA has a low risk of implant loss. Hypofractionated RT does not adversely affect implant outcomes. Patients should be counseled regarding risk for capsular contracture, but the majority have good/excellent outcome; BA does not represent a contraindication to BCT.

Time to diagnostic resolution after an uncertain screening mammogram in an underserved population.

BackgroundScreening mammography has reduced breast cancer–associated mortality worldwide. Approximately 10% of patients require further diagnostic testing after an uncertain screening mammogram (Breast imaging reporting and data system [BI‐RADS] = 0), and time to diagnostic resolution varies after BI‐RADS = 0 screening mammogram. There is little data about factors associated with diagnostic resolution in patients of Chinese origin (“Chinese”) receiving care in the US.MethodsWe performed a retrospective analysis to identify patterns of diagnostic resolution in an urban US hospital with a large population of Chinese patients. We evaluated whether location of primary care provider (PCP) impacted time to resolution among Chinese patients, hypothesizing that patients with a PCP outside of the hospital would have longer time to diagnostic resolution than those patients with a PCP within the institution.ResultsBetween 2015 and 2016, 368 patients at Tufts Medical Center (Tufts MC) had resulting BI‐RADS = 0 after screening mammogram. The majority of patients (341/368, 93%) achieved diagnostic resolution with median time to resolution 27 days (Q1: 14, Q3: 40). Seven percent (27/368) never achieved resolution. Among those with diagnostic resolution, 10% of patients required >60 days to achieve resolution. Chinese origin, no previous breast cancer, subsidized insurance, and outside referring physician were associated with longer time to resolution in univariable analysis. In multivariable regression, after adjusting for age, insurance, marital status, and prior breast cancer, Chinese patients with Tufts MC PCP experienced timelier diagnostic resolution vs Chinese patients without a Tufts MC PCP (hazard ratio [HR] = 1.85, P = .02). Location of PCP did not impact time to resolution among non‐Chinese patients.ConclusionWe identified patterns of diagnostic resolution in an urban hospital with a large historically underserved population. We found that Chinese patients without integrated primary care within the institution are at risk for delayed diagnostic resolution. Future interventions need to target at‐risk patients to prevent loss of follow‐up after uncertain screening mammogram.

Occult Tubal Carcinoma After Risk-Reducing Salpingo-oophorectomy: A Systematic Review.

To perform a systematic review of the literature to estimate the prevalence and outcomes of occult tubal carcinoma in BRCA mutation carriers and high-risk patients undergoing risk-reducing salpingo-oophorectomy. A search was done using OVID MEDLINE, EMBASE, and ClinicalTrials.gov between 1946 and March 2019 with keywords and MeSH terms selected by an expert medical librarian and coauthors. Two independent reviewers performed study selection with an initial screen on abstracts and a second on full articles. Articles were rejected if they were irrelevant to the study question, pertained to a different population or did not report occult tubal neoplasia. Quality was assessed using methodologic index for nonrandomized studies criteria. Data were extracted and recorded in an Excel database. Forest plots for the prevalence of occult carcinoma were done using STATA. Among 2,402 studies assessed, 27 met the inclusion criteria for qualitative and quantitative analysis. A total of 6,283 patients underwent risk-reducing salpingo-oophorectomy between 2002 and 2019: 2,894 cases were BRCA1, 1,579 BRCA2, and 1,810 high-risk based on family history. Among these, 75 patients were diagnosed with occult tubal carcinoma at the time of surgery. The pooled prevalence was 1.2% (I=7.1%, P=.363) occurring at a median age of 53.2 years (range 42.4-67). In a subanalysis of 18 studies reporting follow-up data, 10 recurrences (18.7%, 95% CI 7.5-53%) and 24 cases of post-risk-reducing salpingo-oophorectomy peritoneal cancer (0.54%, 95% CI 0.4-1.9%) were reported after a median follow-up of 52.5 months. BRCA1, older age, and previous breast cancer were more often associated with occult malignancy. Occult tubal carcinomas found at risk-reducing salpingo-oophorectomy in high-risk patients and BRCA mutation carriers have significant potential for recurrence despite the frequent administration of postoperative chemotherapy.

Continuation of Annual Screening Mammography and Breast Cancer Mortality in Women Older Than 70 Years.

Randomized trials have shown that initiating breast cancer screening between ages 50 and 69 years and continuing it for 10 years decreases breast cancer mortality. However, no trials have studied whether or when women can safely stop screening mammography. An estimated 52% of women aged 75 years or older undergo screening mammography in the United States. To estimate the effect of breast cancer screening on breast cancer mortality in Medicare beneficiaries aged 70 to 84 years. Large-scale, population-based, observational study of 2 screening strategies: continuing annual mammography, and stopping screening. U.S. Medicare program, 2000 to 2008. 1058013 beneficiaries aged 70 to 84 years who had a life expectancy of at least 10 years, had no previous breast cancer diagnosis, and underwent screening mammography. Eight-year breast cancer mortality, incidence, and treatments, plus the positive predictive value of screening mammography by age group. In women aged 70 to 74 years, the estimated difference in 8-year risk for breast cancer death between continuing and stopping screening was -1.0 (95% CI, -2.3 to 0.1) death per 1000 women (hazard ratio, 0.78 [CI, 0.63 to 0.95]) (a negative risk difference favors continuing). In those aged 75 to 84 years, the corresponding risk difference was 0.07 (CI, -0.93 to 1.3) death per 1000 women (hazard ratio, 1.00 [CI, 0.83 to 1.19]). The available Medicare data permit only 8 years of follow-up after screening. As with any study using observational data, the estimates could be affected by residual confounding. Continuing annual breast cancer screening past age 75 years did not result in substantial reductions in 8-year breast cancer mortality compared with stopping screening. National Institutes of Health.

Abstract OT3-09-03: The PREDICT registry: A prospective registry study to evaluate the effect of the DCISionRT test on treatment decisions in patients with DCIS following breast conserving therapy

Abstract Background: The benefits of adjuvant radiation therapy (RT) in DCIS patients treated with breast conserving surgery (BCS) remains controversial. Although there is level I evidence supporting the role of RT in reducing the risk of local recurrence, the incremental absolute benefit is variable. Current treatment guidelines generally recommend RT for all patients having BCS. When considered in the context of the economic, health-related, and quality-of-life costs associated with RT, it is critical to identify patients who are at low enough risk to consider foregoing RT. It is important to develop prognostic tools to better assess risk and understand the impact such a tool would have on treatment decisions. The DCISionRT™ Test (PreludeDx, Laguna Hills, CA) is a biologic signature that provides a validated score for assessing 10-year risk of recurrence and RT benefit using individual tumor biology in conjunction with clinical and pathologic risk factors. Trial Design: This is a prospective cohort study for patients diagnosed with ductal carcinoma in situ (DCIS) of the breast. Treating physicians complete a treatment recommendation survey before and after receiving DCISionRT test results. Test results, treatment recommendations, patient preferences and clinicopathologic features are stored in a de-identified registry for future analysis of data across participating institutions from a variety of geographic regions in the US. The study will also collect 5- and 10-year recurrence and survival data. Eligibility Criteria: The study includes females over the age of 25 who are candidates for BCS and eligible for RT and/or systemic treatment with sufficient tissue to generate test results. Subjects must not have been previously treated for DCIS or have previous or current invasive or micro-invasive breast cancer. Specific Aims: The primary objective of this study is to create a de-identified database of patients, test results, treatment decisions and outcomes that can be queried to determine the clinical utility of the DCISionRT Test in actual clinical use for the management of DCIS. The primary endpoints are changes in treatment recommendations for surgical, radiation and hormonal therapy after the physician and patient have reviewed the DCISionRT test results, including subgroup analysis by physician type (surgeon, radiation oncologist or tumor board). Secondary endpoints are identification of the key drivers for treatment recommendations, including age, size, grade, architecture, necrosis, palpability, presentation, hormone receptor status, race, ethnicity, family history, etc. Statistical Methods: Study results will be analyzed by summary descriptive statistics, such as patient counts, percentages, means, etc. Changes in treatment recommendations will be assessed using McNemar's chi-squared test for symmetry of rows and columns in a two-dimensional contingency table with an alpha level of 0.05. Differences in recurrence-free and overall survival will be evaluated by Kaplan-Meier survival analysis using the logrank test and/or the Cox Proportional Hazards model. A planned early interim analysis based on the first 200 patients has been recently completed and reported - data are available upon request (contact Steven Shivers, PhD, sshivers@preludedx.com.) Accrual: As of July 1, 2019, 319 patients have been accrued from 56 physicians at 25 institutions. Twenty-two additional institutions are currently in the process of joining the study. We are planning to accrue up to 2,500 patients from up to 100 institutions. Contact Information: We are actively recruiting institutions for participation. For more information, please contact: Mary Kay Hardwick, mkhardwick@tmebcn.com. Citation Format: Steve C Shivers, Pat Whitworth, Rakesh Patel, Troy Bremer, Charles E Cox. The PREDICT registry: A prospective registry study to evaluate the effect of the DCISionRT test on treatment decisions in patients with DCIS following breast conserving therapy [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 OT3-09-03.

Abstract P1-20-12: Robotic versus conventional or endoscopic-assisted nipple sparing mastectomy with immediate prosthesis breast reconstruction in the management of breast cancer- A case control comparison study with analysis of clinical outcomes, patient-reported aesthetic results, and medical cost

Abstract Background: Nipple-sparing mastectomy (NSM), which preserved the nipple areolar complex (NAC) and skin flap during mastectomy, was increasingly performed in breast cancer patients due to better cosmetic outcome, higher patient satisfaction, and maintained oncologic safety. Minimal invasive surgery had become the main stream of operations, and new surgical innovations of NSM, like endoscopic nipple sparing mastectomy (E-NSM) or robotic nipple sparing mastectomy (R-NSM), were emerging and applied in the surgical treatment of breast cancer. However, evidence comparing R-NSM to conventional NSM (C-NSM) or E-NSM was lacking. A case control comparison study was conducted for patients with breast cancer underwent C-NSM, E-NSM, or R-NSM with IPBR at a single institution to compare the clinical outcomes, patient-reported cosmetic results and medical cost. Methods: To compare the efficacy and benefit between R-NSM, C-NSM and E-NSM, a case control comparison study was conducted. Patients with primary operable breast cancer who underwent NSM from January 2011 to May 2019 were retrieved from a prospectively maintained breast cancer database at Changhua Christian Hospital (CCH), a tertiary medical center in Taiwan. To reduce sampling bias from surgical technique or related factors, only patients operated by HWL were enrolled for this comparison analysis. In addition, in order to reduce the possible variations in cosmetic outcomes derived from different types of breast reconstruction, only patients who received immediate cohesive gel implant breast reconstructions were retrieved. Patients who had received previous breast conserving surgery or previous radiation to chest wall were excluded. Results: Altogether, there were a total of 57 patients in the R-NSM with IPBR group, 65 C-NSM and IPBR, and 100 patients in E-NSM with IPBR group in this case control comparison study. The three groups were comparable in terms of age, location of tumor, pathologic tumor size, grade, resected mastectomy weight, and stage of disease. Compared with C-NSM, R-NSM was associated with less blood loss (mean 35 ± 32 versus 104 ± 71 ml, P&amp;lt;0.01) and higher overall satisfaction (96.4% excellent and 3.6% good versus 75.6% excellent and 24.4% good, P=0.02) in patients’ reported cosmetic results. There is a trend (though statistically not significant) of lesser complication rate, and NAC ischemia/necrosis rate of R-NSM if compared with C-NSM. However, longer operation time (mean 247 ± 61 versus 197 ± 80 minutes, P&amp;lt;0.01), and higher over medical cost (10,877 ± 796 versus 5,702 ± 661 US Dollars, P&amp;lt;0.01) was observed in R-NSM group. The surgical margin involvement rate in both R-NSM (1.8%) and E-NSM (4%) procedures were relatively low (P=0.52). R-NSM group was associated with higher satisfaction rates in terms of scar appearance, scar length, and surgical wound position if compared with E-NSM group. Compared with E-NSM, R-NSM took longer operation time (241 ± 61 versus 215 ± 70 mins, P=0.01), less blood loss (32 ± 29 versus 79 ± 62 ml, P&amp;lt;0.01), and higher medical cost (10,587 ± 554 versus 6,855 ± 936 US Dollars, P&amp;lt;0.01). There was no statistically significant difference in nipple ischemia/necrosis or overall complication between R-NSM and E-NSM. Conclusion: R-NSM compared favorably to C-NSM with comparable clinical outcomes, minimal blood loss and higher patients’ satisfaction but at the expense of higher cost and longer operation time. R-NSM was associated with higher would related satisfaction and lesser blood loss if compared with E-NSM, however, at the price of longer operation time and higher medical cost. Citation Format: Hung-Wen Lai, Shou-Tung Chen, Dar-Ren Chen. Robotic versus conventional or endoscopic-assisted nipple sparing mastectomy with immediate prosthesis breast reconstruction in the management of breast cancer- A case control comparison study with analysis of clinical outcomes, patient-reported aesthetic results, and medical cost [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 P1-20-12.

Abstract P4-12-24: Evaluation of partial breast irradiation suitability in early stage breast cancer patients

Abstract Purpose: Partial Breast Irradiation (PBI) treats the tumor bed plus a margin in low risk early stage breast cancers, reducing exposure to organs at risk. Randomized trials have shown that PBI with external beam radiotherapy is non-inferior to whole breast irradiation in terms of local control with fewer late normal tissue adverse events. We aimed to determine the proportion of women with early stage breast cancer suitable for external beam PBI at our institution using adapted ASTRO guidelines for accelerated PBI whereby both clinical-pathological factors and visualization of the tumor bed/cavity on planning scans were determined to quantify PBI eligibility. Methods: Patients were identified retrospectively from January 1, 2013 to November 1, 2018 based on age (≥55), tumor size (≤2cm invasive, ≤2.5cm DCIS), nodal negativity and grade (1 or 2). Cases identified were unifocal, lymphovascular invasion negative, ER positive, HER2 negative, with margins ≥2mm (invasive) and ≥3mm (DCIS), no chemotherapy, non-lobular, no extensive intraductal component, no previous/ bilateral cancers and endocrine therapy optional. Planning scans were reviewed to assess for presence of surgical clips and assigned cavity visualization scores (CVS); CVS 1=cavity not visualized, CVS 2=cavity visualized with indistinct margins, CVS 3=cavity visualised with some distinct margins and heterogeneous appearance, CVS 4= cavity visualised with mostly distinct margins and mildly heterogeneous appearance, CVS 5= all cavity margins clearly defined and homogeneous appearance. These features were used to determine if cases were considered radiologically suitable for PBI. Results: Thirty-seven percent (1051/2824) of cases identified were deemed eligible based on age, grade and T1N0/Tis. Of the 1051, 306 (29%) met all the pathologic criteria; the main reasons for exclusion were previous breast cancer, lobular histology, or multifocality. Median age of eligible cases was 65 years (range 55-88 years). The majority (254) had invasive disease (T1mi: 6, T1a: 17, T1b: 98, T1c: 133); 52 had DCIS. There were 169 right-sided and 137 left-sided cases. Endocrine therapy was documented in 55% of cases. CVS (1-5) were: 11%, 22%, 30%, 29%, 8%. Overall, 66% (201/306) of cases were considered radiologically suitable for PBI (of the 201 cases, 97% had CVS ≥3). Seventy-two cases (72/306; 24%) had tumor bed clips, of which, 34 were considered suitable for PBI (91% CVS ≥3; 9% CVS 2). Conclusions: Overall, a low proportion of all patients were eligible for PBI based on clinical features, but two-thirds of eligible cases were suitable for PBI based on CVS score alone. In contrast, the suitability for PBI within the cohort with surgical clip placement was low. Visualization of the tumor bed is essential to safely deliver PBI and is guided by identification of the cavity seroma and/or surgical clips. Development of standard practice guidelines for surgical clip positioning to identify the tumor bed will potentially assist in increasing the proportion of early stage breast cancer patients suitable to receive PBI, even if the CVS is less favorable. Citation Format: Christine Anne Koch, Gemma Corey, Kathy Han, Grace Lee, Tom Purdie, Chris McIntosh, Patricia Lindsay, Fei-Fei Liu, Anthony Fyles, Wilf Levin, Jennifer Croke, Aisling Barry, Danielle Rodin, Nhu Tram Nguyen, Tatiana Conrad. Evaluation of partial breast irradiation suitability in early stage breast cancer patients [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 P4-12-24.

Protective Association Between Calcium Channel Blocker Use and Breast Cancer Recurrence in Postsurgical Women: A Population-Based Case-Control Study in Taiwan.

Neoadjuvant chemotherapy induces metastasis of residual breast cancers through activation of tumor-associated macrophages. Previous studies have indicated that calcium channel blockers (CCBs) exert anti-inflammatory and antimigratory effects on macrophages via attenuating Ca2+ entry into macrophages. However, no existing empirical research has addressed the relationship between previous CCB use and breast cancer recurrence. In this study, 4840 Taiwanese women aged ≥20years with breast cancer who underwent breast surgery from January 1, 2007, to December 31, 2015, were enrolled. The date of cancer recurrence was defined as the index date. Logistic regression was performed to evaluate the relationship between previous CCB exposure and cancer recurrence among female patients who underwent surgery for breast cancer. After adjusting for demographic characteristics, comorbidities, and tumor-node-metastasis stage, the adjusted odds ratio (OR) for CCB exposure within 5years before the index date in women with recurrence compared with nonrecurrent controls was 0.73 (95% confidence interval [CI], 0.53-0.97). Further analysis revealed that the adjusted OR for CCB exposure between the surgery and index dates in women with recurrence relative to nonrecurrent controls was 0.72 (95%CI, 0.66-0.95). In particular, prior CCB use was significantly associated with a lower risk (34%) of breast cancer recurrence among women 20 to 54years old (OR, 0.66; 95%CI, 0.47-0.83). This study uncovered a protective association between previous CCB use and breast cancer recurrence.

Multicentre study of prepectoral breast reconstruction using acellular dermal matrix.

BackgroundSingle‐stage reconstruction is used widely after mastectomy. Prepectoral implant placement is a relatively new technique. This multicentre audit examined surgical outcomes following prepectoral reconstruction using acellular dermal matrix (ADM).MethodsAll patients who had a mastectomy with prepectoral breast reconstruction and ADM in the participating centres between January 2015 and December 2017 were included. Demographic and treatment details, and short‐ and long‐term operative outcomes were recorded. Factors affecting complications and implant loss were analysed: age, BMI, smoking status, diabetes, vascular disease, laterality of surgery, previous ipsilateral breast surgery or radiotherapy, indication for surgery (invasive versus in situ carcinoma, or risk reduction), type of mastectomy, axillary clearance, breast volume, implant volume, and neoadjuvant and adjuvant chemotherapy.ResultsA total of 406 reconstructions were performed across 18 centres. Median follow‐up was 9·65 months. Median hospital stay was 1 day. The 90‐day unplanned readmission rate was 15·7 per cent, and the return‐to‐theatre rate 16·7 per cent. Some 15·3 per cent of patients had a major complication, with a 90‐day implant loss rate of 4·9 per cent. A further six patients had delayed implant loss. In multivariable analysis, no factor was significantly associated with complications or implant loss.ConclusionPrepectoral breast reconstruction with ADM has satisfactory surgical outcomes. The duration of follow‐up needs to be extended to examine outcomes in patients who received adjuvant radiotherapy.

Predicting Ischemic Complications in the Inframammary Approach to Nipple-Sparing Mastectomy: The Midclavicular-to-Inframammary Fold Measurement.

The authors refine their anatomical patient selection criteria with a novel midclavicular-to-inframammary fold measurement for nipple-sparing mastectomy performed through an inframammary approach. Retrospective review was performed of all nipple-sparing mastectomies performed through an inframammary approach. Exclusion criteria included other mastectomy incisions, staged mastectomy, previous breast operation, and autologous reconstruction. Preoperative anatomical measurements for each breast, clinical course, and specimen weight were obtained. One hundred forty breasts in 79 patients were analyzed. Mastectomy weight, but not sternal notch-to-nipple distance, was strongly correlated with midclavicular-to-inframammary fold measurement on linear regression (R = 0.651; p < 0.001). Mastectomy weight was not correlated with ptosis. Twenty-five breasts (17.8 percent) had ischemic complications: 16 (11.4 percent) were nonoperative and nine (6.4 percent) were operative. Those with mastectomy weights of 500 g or greater were nine times more likely to have operative ischemic complications than those with mastectomy weights less than 500 g (p = 0.0048). Those with a midclavicular-to-inframammary fold measurement of 30 cm or greater had a 3.8 times increased incidence of any ischemic complication (p = 0.00547) and a 9.2 times increased incidence of operative ischemic complications (p = 0.00376) compared with those whose midclavicular-to-inframammary fold measurement was less than 30 cm. Breasts undergoing nipple-sparing mastectomy by means of an inframammary approach with midclavicular-to-inframammary fold measurement greater than or equal to 30 cm are at higher risk for having ischemic complications, warranting consideration for a staged approach or other incision. The midclavicular-to-inframammary fold measurement is useful for assessing the entire breast and predicting the likelihood of ischemic complications in inframammary nipple-sparing mastectomies. Risk, III.

An Evaluation of Safety and Patient Outcomes for Hand Surgery following Prior Breast Cancer Treatment: Establishing New Recommendations in Lymphedema.

Injuries to the upper extremity lymphatic system from cancer may require measures to prevent secondary lymphedema. Guidelines were established relating to the use of tourniquet and elective hand and upper extremity surgery. However, reports in the setting of hand surgery have indicated that prior guidelines may not be protective to the patient. The study systematically reviewed the current literature evaluating elective hand surgery in breast cancer patients. The authors evaluated the risk of complications, including new or worsening lymphedema and infection. One hundred ninety-eight abstracts were identified, and a bibliographic review was performed. Nine studies pertained to our subject, and four were included for final review. All studies included patients with prior breast cancer treatment involving breast surgery and axillary lymph node dissection. Pneumatic tourniquets were used during nearly all operations. Patients without presurgery ipsilateral lymphedema had a 2.7 percent incidence of developing new lymphedema and a 0.7 percent rate of postoperative infection. Patients with presurgery lymphedema had a 11.1 percent incidence of worsening lymphedema and a 16.7 percent rate of infection. However, all cases of new or exacerbated lymphedema resolved within 3 months. Tourniquet use was not found to increase rates of lymphedema. Based on the available evidence, there is no increased risk of complications for elective hand surgery in patients with prior breast cancer treatment. Breast cancer patients with preexisting ipsilateral lymphedema carry slightly increased risk of postoperative infection and worsening lymphedema. It is the authors' opinion and recommendation that elective hand surgery with a tourniquet is not a contradiction in patients who have received previous breast cancer treatments.

Comparison between the Patterns of Common Breast Diseases Presenting as Breast Lumps in Pregnant and Non-Pregnant Married Women

Background: Breast lump is one of the most common prevalent complaint of patients attending breast clinics.&#x0D; Objective: To determine if there is any change in the pattern of common breast, diseases presenting as breast lumps between pregnant and non-pregnant women among patients attending Al-Elwiya Breast Clinic.&#x0D; Methods: This is a cross – sectional study, with convent's patient sampling setting in AL-Elwiya Breast Cancer Early Detection Clinic from 1st Feb. to 1st May 2018, we collected data from patients with breast lumps including the age groups, pregnancy status, parity status, previous breast diseases, hormonal drugs, menstrual cycle, breast feeding. Breast lump was examined, sonography and needle biopsy, and histopathology.&#x0D; Results: This study involves 306 married patients, fibro adenoma was the commonest pathology in the age group 20-29 year-old (29.9%) followed by Aberration of Normal Development and Involution which was found mainly in 30-39-year-old age group (36.1%). Carcinoma found mainly in the &gt;40-year-old age group (10.3%).&#x0D; Aberration of Normal Development and Involution was the main pathology in non-pregnant patients (36.1%), in pregnant patients fibro adenoma is the commonest (35.7%).&#x0D; Conclusion: The majority of breast lumps are benign. In pregnant women, fibro adenoma is the commonest, while in non-pregnant women, Aberration of Normal Development and Involution is the main cause of breast lumps

Radiographic Surveillance of Patients with Non-BRCA1/2 Pathogenic Variants.

The National Comprehensive Cancer Network (NCCN) developed clinical practice guidelines for germline pathogenic variants in highly penetrant genes, such asTP53andPTEN, and in moderately penetrant genes, such asCHEK2, ATM andPALB2. Whether the practice of radiographic surveillance of patients with pathogenic variants in genes other than BRCA1/2 complies with current NCCN guidelines remains unclear. Retrospective review of patients identified with pathogenic variants in genes other than BRCA1/2 from 2007 through 2017 to determine if radiographic surveillance was in accordance with NCCN guidelines for mammography and consideration of magnetic resonance imaging (MRI). Exclusions included variants of unknown significance, pathogenic variants not associated with an increased risk of breast cancer, and previous breast cancer diagnosis. After exclusions, 35 patients with pathogenic variants in ATM, CDH1, CHEK2, NBN, PALB2, PTEN, and STK11 genes were reviewed to assess whether radiographic surveillance was in accordance with NCCN guidelines. Guidelines for those with variants in ATM, CHEK2 and NBN includes annual mammography with tomosynthesis and consideration of breast MRI at age 40, variants in CDH1 and PALB2 at age 30, variants in PTEN at age 30-35 or 5-10 years before the earliest family breast cancer, and variants in STK11 at age 25. Of these 35 patients, 11 (31%) received mammography only; 11 (31%) received mammography and MRI, and 13 (37%) received no radiographic surveillance. Two of the 35 (6%) patients who received radiographic surveillance were diagnosed with ductal carcinoma in situ or invasive breast cancer. Thirty-one percent of patients with pathogenic variants in genes other than BRCA1/2 received both mammography and MRI. Thirty-seven percent of patients with these highly penetrant and moderately penetrant genes received no radiographic follow-up, clearly demonstrating an opportunity for improvement.

Assessment of Risk Factors of Breast Cancer among Women Attending Tertiary Care Hospital of CHATTISGARH: a Case Control Study

Breast cancer is a multifactorial disease. This study was undertaken to study various risk factors associated with breast cancer. This was a case control study conducted between August 2017 to August 2018 at Department of surgery, Dr.B.R.A.M Hospital and Pt.JNM Medical college, Raipur, (C.G.). Cases were women with histopathologically confirmed breast cancer. Controls were age-matched women without any current breast problem or previous breast cancer. A total of 138 cases and 138 controls were enrolled. They were interviewed for menstrual history, breast feeding history, abortion history, family history etc. after obtaining informed written consent. The significant risk factors were age > 25 years at first child birth (OR 2.80, 95%CI 1.13–6.95), breast feeding history of 25 years, breast feeding duration of <2 years, history of abortion and comorbidities increases the risk of developing breast cancer.