Previous Breast Research Articles

Abstract A15: Breast cancer subtype subsequent to a benign breast biopsy among African American women

Abstract Introduction: Most clinical models to estimate risk of invasive breast cancer include history of benign breast disease (BBD) as a covariate, as these women represent a higher risk group compared to the general population. A better understanding of the association between BBD and breast cancer is necessary to improve the utility of these risk models, particularly with respect to tumor subtype. This may be especially important for African American women who are more likely to present with aggressive cancers compared to white women. Here we present tumor subtypes from a higher risk cohort of African American women with a history of BBD. Methods: Benign breast biopsies from 3,865 African American women with BBD diagnosed from 1997-2010 were examined for 14 benign features, and followed for subsequent breast cancers in metropolitan Detroit, Michigan using medical records and data from the Detroit Surveillance, Epidemiology and End Results (SEER) program. Immunohistochemistry analysis was performed for the following 6 markers: estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, epidermal growth factor receptor (EGFR) and cytokeratin 5/6 (CK 5/6) in order to categorize the subsequent breast cancers by subtype. Briefly, ER and PR were utilized to classify tumors as luminal or non-luminal, and then further classification was made based HER2. Luminal tumors were also classified by Ki-67 expression, and triple negative tumors (ER/PR/HER2 negative) were further classified based on expression of either CK5/6 or EGFR, resulting in 6 categories. Results: 210 women (5.4% of the total cohort) with a subsequent breast cancer were identified over a median follow-up time of 12.3 years (range: 0.6 - 18.0). Analysis of all 6 markers is complete for half of the tumors (104). The majority of the subsequent cancers were invasive (n=72, 69.2%). Most of the invasive tumors were luminal B, HER2- (37.5%), followed by luminal A (31.9%), triple negative (19.4%), non-luminal, HER2+ (6.9%) and luminal B, HER2+ (4.2%). Of the 14 triple negative cancers (19.4%), 8 were negative for CK5/6 and EGFR (5 negative phenotype, 57.1%) and 6 were core basal (42.9%). Among the 32 in situ tumors, the majority were luminal A (n=26, 81.3%), followed by luminal B, HER2- (n=5, 15.6%) and there was a single tumor classified as 5 negative. Compared to population-based SEER data from 5,268 African American women with invasive breast cancer and available data on 3 markers (ER, PR, and HER2) diagnosed in 2010, our cohort is similar with respect to tumor subtype. Conclusions: The women with a previous benign breast biopsy in our cohort who develop a subsequent breast cancer have subtypes that are similar to the general African American population in the United States. Thus, our BBD cohort represents the full spectrum of invasive breast cancers with respect to subtype, including triple negative tumors. Citation Format: Julie J. Ruterbusch, Michele L. Cote, Julie Boerner, Eman Abdulfatah, Baraa Alosh, Vishakha Pardeshi, MHD Fayez Daaboul, Woodlyne Roquiz, Rouba Ali-Fehmi, Sudeshna Bandyopadhyay. Breast cancer subtype subsequent to a benign breast biopsy among African American women. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr A15.

Cumulative risk of breast cancer screening outcomes according to the presence of previous benign breast disease and family history of breast cancer: supporting personalised screening

Background:Our aim was to assess the cumulative risk of false-positive screening results, screen-detected cancer, and interval breast cancer in mammography screening among women with and without a previous benign breast disease and a family history of breast cancer.Methods:The cohort included 42 928 women first screened at the age of 50–51 years at three areas of the Spanish Screening Programme (Girona, and two areas in Barcelona) between 1996 and 2011, and followed up until December 2012. We used discrete-time survival models to estimate the cumulative risk of each screening outcome over 10 biennial screening exams.Results:The cumulative risk of false-positive results, screen-detected breast cancer, and interval cancer was 36.6, 5.3, and 1.4 for women with a previous benign breast disease, 24.1, 6.8, and 1.6% for women with a family history of breast cancer, 37.9, 9.0, and 3.2%; for women with both a previous benign breast disease and a family history, and 23.1, 3.2, and 0.9% for women without either of these antecedents, respectively.Conclusions:Women with a benign breast disease or a family history of breast cancer had an increased cumulative risk of favourable and unfavourable screening outcomes than women without these characteristics. A family history of breast cancer did not increase the cumulative risk of false-positive results. Identifying different risk profiles among screening participants provides useful information to stratify women according to their individualised risk when personalised screening strategies are discussed.

Abstract P2-06-05: Development and validation of a new non-parametric breast cancer risk assessment model on US and European screening populations

Abstract Background: Stratified breast cancer (BC) prevention is a major option for the future but requires clinically meaningful internationally validated risk models. Non parametric models may be alternate methods for modeling in very large cohorts. We have previously shown that a non-parametric similarity-based k-nearest neighbors' (kNN) model performs better than the BCRAT/Gail model to on 65 000 women of the E3N French national cohort (Dartois et al 2015). We used this method to develop and validate a mammographic density-based model in larger general screening populations (pops). Methods: A modified version of a data-mining based algorithm, the kNN method, was implemented and adapted as previously described [ref Dartois]. Core concept of kNN algorithm is to gather similar profiles using a distance computation. We developed a BC risk prediction model on 629 229 women (wn) from the US Breast Cancer Research Consortium (BCSC), with 5 times random selection of learning and validation sets (75/25 %) within the cohort. 5 parameters were included: age, family history, previous breast biopsy, mammographic density and race. The model's performances (discrimination using c-stat (AUC) and calibration using E/0 ratio) were evaluated and compared to the parametric model developed on the same pop (param/BCSC)(Tice et al 2008). This kNN/BCSC model was then tested on two French screening pops after adjustment on French BC incidence: an urban area (Paris suburbs, N=316 775) and a rural area (Côte d'Or, N=32 930). Its performances were compared to those of a model directly developed (same methods) on the Paris cohort (kNN/Paris). Levels of individual risks assessed by the models were assigned into 4 risk categories. The sensitivity of the models was defined as the number of wn who had BC whose 5 yrs-risk category was intermediate (median risk at 50-yrs - 1.66%), high (> 1.66%) or very high (> 20% lifetime) divided by the total number of wn who had BC. Results: The performances of the different models are shown in Table 1. The kNN model developed on BCSC performed well (c-stat 0.653 and E/0 1.001). It had equivalent performances as the parametric model developed previously on the same pop. This kNN/BCSC had a good discrimination on French pops, although slightly lower than that on US pops. This is expected since French screening starts at 50 (vs 40 in BCSC) and French parameters do not include race. The calibration of such model was excellent on Paris, while it overestimated the risk on Côte d'Or, in which BC incidence is lower. It performed as well as the kNN/Paris model directly developed on Paris' pop. The sensitivity of the kNN/BCSC on US and French pops was good. Conclusions: A new non parametric kNN breast cancer risk model developed on an American screening cohort (BCSC) was successfully validated on two French screening cohorts. This new international model could allow stratified prevention. Performances of the models Param/BCSC on BCSCParam/BCSC on PariskNN/BCSC on BCSCkNN/BCSC on PariskNN/BCSC on Cote d'OrkNN/Paris on ParisN629 229313 817629 229313 81732 930313 817c-statistic0.6580.6020.6530.6020.5930.605E/0 global1.031.071.0011.061.521.00Sensitivity--76.18%72.87%72.58%- Citation Format: Ragusa S, Gauthier E, Dartois L, Tice J, Dancourt V, Arveux P, Brixi Z, Bernoux A, Soyer P, Delattre H, Brechenade S, Catajar N, Kaufmanis A, Hélin VM, Clavel F, Kerlikowske K, Miglioretti D, Delaloge S. Development and validation of a new non-parametric breast cancer risk assessment model on US and European screening populations [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 P2-06-05.

Abstract P3-02-06: Magnetic resonance imaging (MRI) surveillance for patients with dense breasts and a previous breast cancer (BC) and/or high risk lesion

Abstract BACKGROUND AND PURPOSE The benefits of breast MRI for screening women at high risk of developing BC is established, but its role in women with a personal history of BC or dense breasts is unknown. We sought to estimate the performance of annual surveillance MRI added to mammography in women at moderately increased BC risk due to a personal history of breast cancer and/or a high-risk breast lesion and dense breasts. METHOD AND MATERIALS We performed a retrospective chart review of the clinical, radiological, and pathological parameters of women who received annual, concurrent surveillance breast MRI and mammography between 04/2013 and 12/2015. We included women who met all of the following criteria: age<69; prior diagnosis of high-risk lesion (ADH, ALH, LCIS), DCIS, or invasive BC; heterogeneously (50-75%) or extremely dense (>75%) breasts; and did not qualify for our provincial MRI screening program for high risk women (calculated lifetime BC risk ≥ 25%). Results of each scan were analyzed using descriptive statistics and Chi squared for comparisons between subgroups. RESULTS A total of 199 patients (267 MRI exams) were included in this study. The mean age at initial diagnosis was 45 years and at subsequent diagnosis of DCIS or invasive cancer was 53 years. Mean time to new diagnosis was 86 months (range 14-202). All 15 cancers diagnosed during the study period were MRI detected: 11 invasive stage I (66% IDC, 7% ILC) and 4 DCIS (27%). Of these 15, all but 1 were mammographically occult. Five (33%) were found in the breast ipsilateral to the original lesion. The cancer detection rate was 6% (12/199) on the first screening round and 4.7% (3/64) on the second screening round. Specificity and positive predictive value respectively for MRI exams increased from 77% and 22% on the first screening round to 88% and 30% on the second round. Of women who developed BC, 57% had a history of breast or ovarian cancer in a first degree relative. None of the 72 women who were on hormonal therapy at the time of surveillance imaging had a new cancer detected compared to 11% (14/125) of those who were not on hormonal therapy (p=0.0025). CONCLUSIONS The incremental early-stage BC detection rate and specificity of MRI in this population are comparable to what is observed in screening women at high risk. The addition of annual MRI to mammography should be considered for surveillance of women with a personal history of BC / premalignant lesion and heterogeneous / extremely dense breasts, particularly if they have a family history of BC and are not on hormonal therapy. Citation Format: Nadler M, Al Attar H, Curpen B, Martel AL, Balasingham S, Zhang L, Eisen A, Warner E. Magnetic resonance imaging (MRI) surveillance for patients with dense breasts and a previous breast cancer (BC) and/or high risk lesion [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 P3-02-06.

Abstract OT1-03-01: The UK LORIS trial: Randomizing patients with low or low intermediate grade ductal carcinoma in situ (DCIS) to surgery or active monitoring

Abstract Background: The independent review of the UK National Health Service Breast Screening Programme reported (The Lancet, Volume 380, Issue 9855, Page 1778, 17 Nov 2012) on the benefits and harms of breast screening. It concluded that breast screening saves lives and acknowledged the existence of overtreatment. It encouraged randomized trials to elucidate the appropriate treatment of screen-detected DCIS to gain a better understanding of its natural history. The LORIS trial addresses the possible overtreatment of low and low/intermediate grade screen-detected (low risk) DCIS by randomizing patients to standard surgical treatment or active monitoring, each with long term follow up. Trial Design: LORIS is a phase III, multicentre, 2 arm study, with a built in 2 year Feasibility Phase, in patients confirmed to have low risk DCIS defined by strict criteria and determined by central pathology review. Patients will be randomized between standard surgery and active monitoring with annual mammography. Patients will be followed up for a minimum of 10 years. Eligibility Criteria: 1) Female, age ≥ 46 years 2) Screen-detected or incidental microcalcification (with no mass lesion clinically or on imaging) 3) Low risk DCIS on large volume vacuum-assisted biopsy, confirmed by central pathology review 4) Patient fit to undergo surgery 5) No previous breast cancer or ipsilateral DCIS diagnosis 6) Written informed consent Specific Aims: The LORIS Trial aims to establish whether patients with newly diagnosed low risk DCIS can safely avoid surgery without detriment to their wellbeing (psychological and physical) and whether those patients that do require surgery can be identified by pathological and radiological means. Primary endpoint: Ipsilateral invasive breast cancer free survival time Secondary endpoints: Overall survival; mastectomy rate; time to mastectomy; time to surgery; patient reported outcomes; health resource utilisation and assessment of predictive biomarkers. A digital image data repository and tissue bank will provide a prospective resource for both translational and imaging studies. Statistical Methods: A total of 932 patients will be randomized to a non-inferiority design to test the null hypothesis that active monitoring of women diagnosed with low risk DCIS is not non-inferior in terms of ipsilateral invasive breast cancer free survival (iiBCFS) time compared to treatment with surgery. The iiBCFS time will be compared across the two arms on a per protocol and intent-to-treat basis, using a 1-sided (α=0.05) log-rank test for non-inferiority. The iiBCFS rate is assumed to be 97.5% in the surgery arm at 5 years, utilizing 80% power to exclude a difference of more than 2.5% in the active monitoring arm. Present Accrual and Target Accrual: 32 UK centres are open for the Feasibility Phase of the trial which is nearing completion. The web-based central pathology review process is functioning efficiently, with a one week maximum turn around. Registrations and sites randomizing patients are on or above target. Randomizations are currently approximately 70% of target. A total of 60 centres will open in the main trial. Contact Information: For further information, please email the LORIS Trial Office LORIS@trials.bham.ac.uk. Citation Format: Francis A, Bartlett J, Billingham L, Bowden S, Brookes C, Dodwell D, Evans A, Fairbrother P, Fallowfield L, Gaunt C, Hanby A, Jenkins V, Matthews L, Pinder S, Pirrie S, Rea D, Reed M, Roberts T, Thomas J, Wallis M, Wilcox M, Young J. The UK LORIS trial: Randomizing patients with low or low intermediate grade ductal carcinoma in situ (DCIS) to surgery or active monitoring [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 OT1-03-01.

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 >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.

Dermal biomarkers in cancer patients: Monitoring subjective health objectively

205 Background: Breast cancer is the most prevalent malignancy among women worldwide. Increased levels of oxidative stress are associated with breast cancer incidence. This study assesses physical, behavioral, and subjective health correlates of oxidative stress and associations between oxidative stress and breast cancer stage. Methods: Current and previous breast cancer patients were asked to participate in this cross-sectional study. After assessing Electronic Medical Record (EMR), a sample of 149 patients met the inclusion criteria. A final sample of 102 (68%) were enrolled. Patients’ skin carotenoid scores (SCS), a dermal measure of oxidative stress, were recorded. Patient demographics, physical health (breast cancer stage, treatment status, weight, height) health behaviors (smoking status, diet) and subjective health (anxiety and self-rated health) were ascertained. Results: No correlation between breast cancer stage and SCS was found. SCS was associated with behavioral health, weight and height (p<0.05), a finding consistent with previous research. A multivariate linear regression analysis, controlling for all covariates, found the two subjective health measures to be associated with SCS scores; the presence of anxiety was associated with lower SCS scores, a novel finding (β=-0.48, 95% CI -0.93, -0.035). Moreover, self-rated health was inversely correlated with SCS, showing those with lower self-reported quality levels paradoxically had higher levels of SCS (β=19.89, 95% CI 6.12, 33.67). Conclusions: Although oxidative stress as measured by SCS may not be associated with breast cancer staging, future research should explore the causal relationship between oxidative stress and subjective stress. Results suggest an unknown biochemical mechanism linking increased levels of oxidative stress with lower subjective health scores. Findings of the study indicate the possibility of utilizing SCS as an objective correlate to gauge an individual’s subjective stress levels in order to optimize cancer treatment.

Prevalence of preterm, low birthweight, and small for gestational age delivery after breast cancer diagnosis: a population-based study

BackgroundBlack-white disparities in breast cancer incidence rates and birth outcomes raise concerns about potential disparities in the reproductive health of premenopausal breast cancer survivors. We examined the prevalence of preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) by breast cancer history and effect modification by race.MethodsWe analyzed linked North Carolina birth records and Central Cancer Registry files from 1990 to 2009 (n = 2,325,229). We used multivariable negative log-binomial regression to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between breast cancer history and PTB, LBW, and SGA.ResultsOf 1,912,269 eligible births, 512 births were to mothers with a previous breast cancer diagnosis history. Average age at breast cancer diagnosis was 31.8 years (SD = 4.7). Mean time from diagnosis to delivery was 3.3 years (SD = 2.8). After multivariable adjustment, the PR was 1.67 (95% CI, 1.42–1.97) for PTB, 1.50 (95% CI, 1.23–1.84) for LBW, and 1.30 (95% CI, 1.05–1.61) for SGA comparing women with a breast cancer history to the general population. Among black mothers, the PRs associated with breast cancer history for PTB, LBW, and SGA were 1.31 (95% CI, 1.00–1.72), 1.49 (95% CI, 1.14–1.94), and 1.44 (95% CI, 1.11–1.87), respectively. The corresponding PRs among white mothers were 2.06 (95% CI, 1.67–2.54), 1.53 (95% CI, 1.12–2.08), and 1.10 (95% CI, 0.77–1.58), respectively. The interaction between breast cancer history and race was statistically significant for associations with PTB, but not for LBW or SGA.ConclusionsIn our data, women with a breast cancer history were at higher risk of delivering a PTB, LBW, or SGA infant, especially if they received chemotherapy or gave birth within 2 years of their breast cancer diagnosis date.

Life satisfaction of women of working age shortly after breast cancer surgery

PurposeTo explore, among women of working age, satisfaction with life as a whole and with different life domains, and its associations with social and health variables, shortly after breast cancer surgery.MethodsThis cross-sectional study included 605 women, aged 20–63 years, who had had breast cancer surgery with no distant metastasis, pre-surgical chemotherapy, or previous breast cancer. Associations between LiSat-11 and demographic and social factors as well as health- and treatment-related variables were analysed by multivariable logistic regression.ResultsCompared with Swedish reference levels, the women were, after breast cancer surgery, less satisfied with life, particularly sexual life. Women working shortly after breast cancer surgery were more often satisfied with life in provision domains compared with the reference population. Although most included variables showed associations with satisfaction, after adjustment for all significantly associated variables, only six variables—having children, being in work, having emotional and informational social support, and having good physical and emotional functioning—were positively associated with satisfaction with life as a whole. The odds ratios for satisfaction were higher in most life domains if the woman had social support and good emotional and cognitive functioning.ConclusionsOne month after breast cancer surgery, satisfaction with different life domains was associated primarily with social support and health-related functioning. However, this soon after surgery, treatment-related variables showed no significant associations with life satisfaction. These results are useful for planning interventions to enhance e.g. social support and emotional as well as cognitive functioning.

Evaluation of Breast Cancer Risk Levels and Its Relation with Breast Self-Examination Practices in Women.

This study was performed to determine the breast cancer risk levels and its relation with the frequency of breast self-examination practices in women who were 20 years old and over. This descriptive study was conducted on 867 women, who were 20 years old and over presenting to a family medicine outpatient clinic for any reasons. The participants filled in the "Breast Cancer Risk Assessment Form" which is recommended to assess the risk of breast cancer by the Ministry of Health. The participants' risk levels have been classified as low, medium, high, and the highest risk. The mean age of the participating women was 38.2±13.4 years, 69.7% (n=604) were married, 54.8% (n=475) were housewives, 33.9% (n=294) were working, 42.7% were graduated from primary school. The average risk score of the patients for breast cancer was 131.26 ±45.11 (50-325). As a result of this study, 87.3% (n=757) of the women were identified as having a low breast cancer risk, 12.6% (n=109) medium and 0.1% (n=1) of them were identified as having a high risk. The data demonstrated that 75.5% (n=655) of the women weren't doing breast self-examination (BSE). The rate of previous breast USG or mammography screening was 33.7% (n=292). There were no statistical relations between the breast cancer risk levels and BSE (p=0.396). The risk of developing breast cancer was low among the women in the study group and breast self-examination rates were insufficient. In addition to training women by emphasizing the importance of breast self-examination in early diagnosis, the breast cancer risk questionnaire - an easy to implement, simple and costless tool - is recommended to be administered in the primary health care centers.

Awareness of Breast self-examination and risk factors of Breast Cancer among Women

Background: Performing breast self-examination (BSE) every month, starting at age 20 is an important tool in the early detection of breast cancer. Early detection of breast cancer plays a leading role in reducing mortality rates and improving patients' prognosis. Aim: The purpose of the current study was to determine women’s' practice of BSE and knowledge about risk factors of breast cancer. Method and Material: A descriptive study design was used, with a sample of convenience 112 women in pachampalyam community area between January and March 2015. A self administered questionnaire was used for data collection. Results: mean age of the respondents was 29.5; (SD=8.3) years and ranged from 35 to 45 years. More than half of the studied group married and 47.3% worked for more than 5 years 95.5% had no previous breast health problems and family history of breast cancer was reported by 12.5%. Only 19.4% of the studied sample performed BSE regularly. The practice of BSE was not significantly associated with socio demographic characteristics. Conclusion: study findings suggested that there were gaps between knowledge and practice of BSE among women’s.

Perceived Barriers to Breast Cancer Screening among Saudi Women at Primary Care Setting

Background:Screening for breast cancer (BC) is of low rate in Saudi Arabia; although it is provided in the country free of charge to the population. This cross-sectional study aimed at investigating the perceived barriers towards BC screening in Al Hassa, Saudi Arabia. It is crucial for increasing the rate of utilization of screening to identify the possible barriers for seeking BC screening in order to enhance early diagnosis and improve outcome.Materials and Methods:A total of 816 adult Saudi women aged ≥ 30 years attending for routine primary health services or accompanying patients at the selected primary health care centers (PHCs) were randomly selected from 12 PHCs (8 urban and four rural) using multi-stage sampling method. Participants were invited to personal interview using semi-structured data collection instrument including inquiries about socio-demographics, reproductive history, previous histories of diagnosed breast lesions and breast cancer. The perceived individual barriers towards screening, their attitudes, the reasons for not attending previously held screening campaigns in Al Hassa, were also included.Results:Low utilization of BC screening has being significantly associated with woman’s age (OR=2.55; 95% CI= 1.71-3.83), higher educational status (OR=2.98; 95% CI=2.05-4.34), higher family income (OR=1.96; 95% CI=1.31-2.93), using hormonal contraception (OR=1.46; 95% CI=0.99-2.13) and positive history of previous breast (OR=12.16; 95% CI=6.89-21.46), as shown by the results of the logistic regression model. Exploratory factor analysis showed that personal fears (especially fear of doctors/examiners, fear of hospitals and health facilities and fear of consequences/results) were the major factors that hinder women from utilizing the free of charge BC screening with high loading eigenvalue of 3.335, explaining 30.4% of the barriers.Conclusion:Educational interventions aim at improving breast cancer knowledge and addressing barriers should be incorporated as core component of the screening program in Saudi Arabia.

Invasive Ductal Carcinoma Breast: How Neoadjuvant Chemotherapy Affects the Status of Estrogen Receptor, Progesterone Receptor and HER2/Neu-A Tertiary Care Centre Study.

Determination of Estrogen Receptor (ER), Progesterone Receptor (PR) and HER2/neu in primary Invasive Ductal Carcinoma (IDC) breast is the standard of care parameter for determining treatment options. Whether or not Neoadjuvant Chemotherapy (NAC) affects the receptor status is still an unanswered question. To compare immunohistochemical (IHC) profiles of ER, PR and HER2/neu in primary IDC breast before and after NAC to assess the subsequent effects on receptor status. Thirty two patients diagnosed with primary IDC breast who had a previous breast core biopsy with complete IHC profile followed by NAC and Modified Radical Mastectomy (MRM) were included. For each case demographic and histologic data was collected, including age, grade, amount of necrosis post NAC and IHC panel for ER, PR and HER2/neu in core biopsies. The same IHC panel was applied on Post NAC MRM specimen. Pre- and post NAC IHC expression was compared. Patients ranged from 30 years to 75 years in range. ER, PR and HER2/neu status of core biopsies and MRM specimen were compared and overall agreement was noted. Comparison for each receptor was done using McNemar's test and significance was calculated. There was no statistically significant difference in ER and Her2/neu expression between pre- and post-NAC specimens. However, a statistically significant loss of PR expression was noted between the two groups. Accurate determination of ER, PR and Her2/neu status in primary IDC breast is important to guide further treatment. Change in receptor status post NAC may warrant corresponding change in hormonal therapy.

P3.04-003 Incidence and Outcome of Female Patients with Previous Breast Cancer Undergoing Curative Resection for Lung Cancer: Topic: Miscellaneous I

P3.04-003 Incidence and Outcome of Female Patients with Previous Breast Cancer Undergoing Curative Resection for Lung Cancer: Topic: Miscellaneous I

Standardizing the complication rate after breast reduction using the Clavien-Dindo classification

Published complication rates for breast reduction surgery, also known as reduction mammaplasty, vary between 4% and 54%. This wide range of complication rates could be attributable to the lack of a standardized classification of complications in plastic surgery. The aim of this study was to analyze our single-center complication rates after reduction mammaplasty using the Clavien-Dindo classification. We performed a retrospective chart review studying 804 patients between the ages of 18 and 81years old who underwent breast reduction between 2005 and 2015 at our institution. Patients with a history of breast cancer, a previous breast operation, who did not undergo bilateral reduction mammaplasty, or who required systemic immunodeficiency/immunosuppressive drugs were excluded from our analysis. Complications were classified according to the Clavien-Dindo classification from Grades I to V. A total of 486 patients met the inclusion criteria for the analysis. Patients had an age (mean±standard deviation) of 39±13years and a body mass index of 26±4kg/m2. Median follow-up was 274days (interquartile range: 90.5-378). The overall rate of complications of reduction mammaplasty was 63%, with the majority of those being Grades I (48%) and II (9%), comprising 92% of all the complications. Operative revisions were required in 6% (1% Grade IIIA and 5% Grade IIIB). There were no complications graded in categories IV and V. Although complications occurred in more than half of the cases, the majority did not require operative reintervention. The Clavien-Dindo classification can classify the severity of complications and serve as a benchmark to compare complication rates between different practices. We believe that grading of complications should distinguish between those that do and do not require operative reinterventions.

Etiologic revelation and outcome of the surgical management of idiopathic granulomatous mastitis; An Egyptian centre experience.

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition that is confused with cancer. It usually affects women in child bearing age. The exact aetiology and pathogenesis are still unknown, and the optimal therapeutic modality has not yet been established. Treatment most frequently includes Antibiotics, corticosteroids and immunosuppressant, surgical excision, and even mastectomy. We studied a thirty cases diagnosed with IGM in our locality to find out the leading risk factors and the outcome of our surgical approach which involves excision of the lesion in continuity with duct system. Patients demographic data, history related to lactation and outcome were recorded. All patients were parous women with history of previous breast feeding for all kids. Twenty-six patients (86.66%) had a history of early incomplete nursing care to the affected breast. After our surgical approach, Twenty eight (93.3%) patients showed fast recovery with no detectable recurrences in the median follow up period (18 months) with acceptable cosmoses. History of breast feeding together with early failure of complete nursing from a single breast is the most important risk factors for development of IGM in young aged women. Surgery plays an important role in treating IGM, however, it should be directed towards excision of the present mass (s) together with the pathological and colonized duct system.

NRG Oncology/RTOG 1014: 3 Year Efficacy Report From a Phase II Study of Repeat Breast Preserving Surgery and 3D Conformal Partial Breast Re-Irradiation (PBrI) for In-Breast Recurrence

Abstract Purpose Trial**** is a prospective phase II trial of 3D-CRT PBrI following repeat lumpectomy for in-breast recurrence following previous whole breast irradiation (WBI). The primary goal of the trial was to determine the associated toxicity, tolerance and safety of PBrI. Materials and Methods Eligibility criteria included in-breast recurrence occurring >1 year following WBI, Results Between 2010 and 2013, 65 patients were accrued and the first 55 eligible and with 1 year follow-up were analyzed. Median age is 68 years. 22 patients had DCIS and 33 invasive disease; 19 ≤1cm, 13 >1 to ≤2cm and 1 >2cm. All patients were clinically node-negative. Systemic therapy was delivered in 51%. All treatment plans underwent quality review for contouring accuracy and dosimetric compliance. All treatment plans scored acceptable for tumor volume (TV) contouring and TV dose volume analysis (DVA). Only 4 (7%) scored unacceptable for organs at risk (OAR) contouring and OAR DVA. Treatment-related skin, fibrosis, and/or breast pain AEs were recorded as grade 1 in 64%, grade 2 in 7% with only 1 ( Conclusion PBrI with 3D-CRT following second lumpectomy for patients experiencing in-breast failures after WBI is safe and feasible with acceptable treatment quality achieved. Skin, fibrosis and breast pain toxicity was acceptable and grade 3 toxicity was rare.

Risk of hospitalisation and death due to bone fractures after breast cancer: a registry-based cohort study.

Background:Bone fractures may have an impact on prognosis of breast cancer. The long-term risks of bone fracture in breast cancer patients have not been thoroughly studied.Methods:Poisson regression was used to investigate the incidence of hospitalisation due to bone fracture comparing women with and without breast cancer based on Swedish National registers. Cox regression was used to investigate the risk of being hospitalised with bone fracture, and subsequent risk of death, in a regional cohort of breast cancer patients.Results:For breast cancer patients, the 5-year risk of bone fracture hospitalisation was 4.8% and the 30-day risk of death following a bone fracture hospitalisation was 2.0%. Compared with the general population, breast cancer patients had incidence rate ratios of 1.25 (95% CI: 1.23–1.28) and 1.18 (95% CI: 1.14–1.22) for hospitalisation due to any bone fracture and hip fracture, respectively. These ratios remained significantly increased for 10 years. Comorbidities (Charlson Comorbidity Index ⩾1) were associated with the risk of being hospitalised with bone fracture. Women taking aromatase inhibitors were at an increased risk as compared with women taking tamoxifen (HR=1.48; 95% CI: 0.98–2.22). Breast cancer patients hospitalised for a bone fracture showed a higher risk of death (HR=1.83; 95% CI: 1.50–2.22) compared with those without bone fracture.Conclusions:Women with a previous breast cancer diagnosis are at an increased risk of hospitalisation due to a bone fracture, particularly if they have other comorbidities.

External Validity of a Risk Stratification Score Predicting Early Distant Brain Failure and Salvage Whole-Brain Radiation Therapy After Stereotactic Radiosurgery for Brain Metastases

Early distant brain failure (DBF) after stereotactic radiosurgery (SRS) and need for early salvage whole brain radiation therapy (WBRT) for patients (pts) with brain metastases (BM) remains a substantial clinical problem. A risk stratification score (Emory score) was recently published for predicting risk of early DBF and salvage WBRT (“early” defined as ≤6 months from SRS) using pre-treatment factors (Press et al., Cancer 2015). The purpose of this study was to determine the external validity of this scoring system using an independent validation cohort. The records of consecutive pts with BM treated with SRS between 2010-2013 from Levine Cancer Institute (LCI, Charlotte, NC) were reviewed. The Emory score uses number of BM, tumor histology, total BM volume, and prior WBRT as factors. This score was applied to the LCI validation cohort to determine low (LR), intermediate (IR), and high-risk (HR) groups. DBF and salvage WBRT rates were estimated using cumulative incidence with competing risk analysis. Pts with previous WBRT were excluded from the salvage WBRT analyses. Multivariate analysis (MVA) used Fine and Gray method. Overall, 247 consecutive pts underwent SRS for BM, of which 41 had previous WBRT. Early DBF rates (n = 247) were 22.6%, 42.2%, and 44% for LR, IR, and HR groups, respectively. Relative to the HR group (reference), the LR group had significantly lower risk of early DBF (hazard ratio [HR] 0.52, P = 0.004), but there was no difference for the IR group (HR 0.95, P = 0.79). Early salvage WBRT rates (n = 206) were 8.9%, 19.3%, and 19.4%, respectively. Similarly, relative to the HR group (reference), the LR group had lower risk of early salvage WBRT (HR 0.53, P = 0.09), but there was no difference for the IR group (HR 1.19, P = 0.53). Applying the Emory MVA model for early DBF to the LCI cohort confirmed the prognostic significance for higher risk of early DBF for higher number of BM (≥ 3, P<0.001), melanoma histology (P = 0.007), and smaller total BM volume (<0.3cc, P = 0.004), however neither previous WBRT (P = 0.69) nor breast histology (P = 0.8) retained prognostic significance. The AUC of the Emory MVA model applied to the LCI cohort was 0.622. The Emory risk score was able to stratify risk of early (≤ 6 months) DBF and salvage WBRT between 2 levels (LR and IR/HR groups), but not between IR and HR in the independent LCI validation cohort. Additionally, the prognostic value of number of BM, melanoma histology, and total BM volume for early DBF was confirmed, but was not for prior WBRT and breast histology. These results serve to refine the predictive use of the Emory score for early DBF after SRS and reinforce the importance of validating predictive models in independent cohorts.

Reply: Full Facial Feminization Surgery: Patient Satisfaction Assessment Based on 180 Procedures Involving 33 Consecutive Patients.

Sir: We would like to thank you for the possibility of further discussing our article published in the February issue of Plastic and Reconstructive Surgery.1 Pavlidis et al. refer to “high resistance” to perform facial feminization procedures, reserving these procedures for selected cases to respect human nature. According to this principle, all cosmetic procedures would be affected because they influence patients lifelong; this “working” principle cannot guide surgeons to indicate surgical procedures to avoid possible reoperative surgery. Psychological imbalance affects all patients undergoing cosmetic surgery, not only transgender patients. On this principle, we fully agree that there is a possible increase of bias that could be corrected by proper preoperative evaluation by specialized medical or paramedical staff, but certainly not by the same surgeon who will perform surgery (conflict of interest). Rules to engage patients undergoing transgender surgery have been widely discussed and accepted, but guidelines to identify diseases such as body dysmorphic disorder have not been developed.1,2 Body dysmorphic disorder, in particular, is a well-established psychiatric disorder characterized by an excessive concern with a nonexisting or slight defect in physical appearance, and diagnosing it during a preoperative consultation remains challenging. Body dysmorphic disorder is usually associated with poor quality of life, extremely high rates of suicide and, following cosmetic surgery, high rates of dissatisfaction, occasionally manifesting as aggressiveness.3,4 As further proof of an emerging point of discussion, it is notable how four epidemiologic studies have examined mortality among women with cosmetic silicone gel–filled breast implants and have found that risk of death from suicide is twofold to threefold higher in this group than among women of comparable age in the general population.5–7 The same authors, pending further investigations, suggest supporting patients undergoing cosmetic surgery by psychiatric consultation, which is the only means, in this difficult field, of making the proper diagnosis.4 Furthermore, de Brito et al. analyzed the level of body dissatisfaction and prevalence of body dysmorphic disorder in patients seeking abdominoplasty (n = 90), rhinoplasty (n = 151), and rhytidectomy (n = 59), based on the Body Dysmorphic Disorder Examination, which was administered preoperatively. The authors conclude that abdominoplasty candidates showed the highest prevalence; rhytidectomy candidates exhibited the highest percentage of severe cases, and rhinoplasty candidates had the lowest percentage of severe cases.6 On these considerations, transgender patients should receive proper psychiatric and psychological support with respect to the other patients undergoing cosmetic procedures because they are involved in proper referral centers. As further support, we would like to emphasize that our patients met specific criteria for facial feminization surgery (we did not record any suicides), 16 (48.4 percent) had undergone previous breast augmentation, and six (18.1 percent) had undergone surgery of the genitalia.1 DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Mirco Raffaini, M.D., D.D.S.Department of Maxillofacial SurgeryUniversity of FlorenceFlorence, ItalyFace Surgery CenterParma, Italy Alice Sara Magri, M.D.Face Surgery CenterParma, Italy Tommaso Agostini, M.D.Department of Maxillofacial SurgeryUniversity of FlorenceFlorence, Italy