Previous Breast Research Articles

Abstract P6-09-10: The comparison of the distribution of breast cancer risk factor between Chinese women, non-Chinese Asian and Caucasian women in the screening cohort of Athena Breast Health Network

Abstract Background: A major area of innovation in breast cancer (BC) is improving risk models for screening efforts. The University of California Athena Breast Health Network uses several risk models, including the Gail model [PMID: 10491430]. The Breast Cancer Surveillance Consortium (BCSC) model [PMID: 18316752] which integrated information on breast density was developed and validated by UCSF investigators and reports Asian-specific risk. The Peking Union Medical College (PUMC) model [PMID: 22662004] is developed from a case-control study in China and reports BC risk in Chinese women. Risk factors and their respective weights included in these models are different. Methods: From December 2012 to April 2014, 2,305 women without previous history of BC and consented to research were enrolled in the UCSF Athena screening cohort. Questions asked included risk factors used in Gail, BCSC and PUMC model, such as age, age of menarche (AOM), age at first live birth, body mass index (BMI), breast biopsy, breast density, hormone replacement therapy (HRT), oral contraceptives (OCP). Women were considered high risk when: Gail > 1.67% 5-year risk, BCSC > 1.67% 5-year risk, PUMC score > 30 (equals >0.20% 1-year risk) respectively. The distribution of the risk factors and the high risk population percentage were compared between Chinese women versus non-Chinese Asian and Caucasian women. Results: 402 Asian women comprise 17.4% of all 2,305 Athena screening cases with 234 Chinese, and 168 non-Chinese Asian (NCA). Differences in risk factor distribution were observed for the following: positive family history was observed 23% for Caucasian, 15% for Chinese and 13% for NCA (p=0.001), and previous breast biopsy was 27%, 17% and 22% respectively (p=0.002). Ever use of HRT was 36% in Caucasian, 17% in Chinese and 11% in NCA (p<0.001). Ever give birth was 68% in Chinese, 65% in NCA, and 57% in Caucasian (p=0.001), while the age at first live birth <30 was 35%, 33%, and 26% correspondingly (p=0.001). Breast density appeared to be higher in Asian women (p=0.095). The high risk proportions by each model are given in Table 1. Table 1 Percentage of high risk population by ethnicity for different risk modelsRisk modelsChinese (n=234)non-Chinese Asian (n=168)Caucasian (n=1,492)P ValueRisklowhighlowhighlowhighGail137 (58.6%)97 (41.4%)107 (63.7%)61 (36.3%)884 (59.2%)608 (40.8%)0.509BCSC211 (90.2%)23 (9.8%)152 (90.5%)16 (9.5%)864 (58.0%)626 (42.0%)0.000PUMC167 (71.7%)66 (28.3%)108 (64.7%)59 (35.3%)781 (52.6%)704 (47.4%)0.000 Conclusion: Chinese and NCA women have a lower proportion of high risk by the BCSC and PUMC model compared to the Caucasian women, whereas by Gail model these proportions appear to be similar. Citation Format: Bo Pan, Jeffrey Tice, Qiang Sun, Celia Kaplan, Zhou Yidong, Yali Xu, Songjie Shen, Changjun Wang, Alexandra Solomon, Lauren Ryan, Paige Kendall, Timothy Henderson, Laura Esserman, Beth Crawford, Athena Breast Health Network, Laura van 't Veer. The comparison of the distribution of breast cancer risk factor between Chinese women, non-Chinese Asian and Caucasian women in the screening cohort of Athena Breast Health Network [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-09-10.

Abstract P3-07-02: Circulating lipids and breast cancer risk – Effects of ApoB

Abstract Background: Obesity in relation to breast cancer risk reveals different impact on women, warranting studies on circulating lipids and risk for breast cancer. Apolipoprotein A (ApoA), and apolipoprotein B (ApoB) are recognized actors in cardiovascular disease as the major protein components of High-Density-Lipoprotein (HDL) and Low-Density-Lipoprotein (LDL), respectively. LDL and HDL particles transport cholesterol from the liver to peripheral tissues and back. Blood levels of circulating lipoproteins and obesity are positively correlated. However the epidemiological evidence for the lipoprotein-cancer linkage has been mixed. Aim: The aim of this study was to investigate pre-diagnostic levels of ApoA, ApoB, LDL and HDL in relation to breast cancer risk. Methods and Material: The prospective cohort, Malmö Diet and Cancer Study was initiated in 1991 and enrolled 17035 women. These were followed-up until 31st of December 2011 and 1024 women were diagnosed with breast cancer. Blood samples were collected at baseline. Lipid quartiles (ApoA, ApoB, HDL, LDL) were constructed based on the entire female cohort, excluding women with a prevalent breast cancer. Associations between circulating lipids and patient characteristics; age at baseline, body mass index (BMI) and socioeconomic index were described with ANOVA. A multivariate Cox Proportional Hazards analyses was applied to study breast cancer risk in relation to levels of circulating lipids and a trend analysis was performed. Results: Age at baseline was evenly distributed among quartiles of ApoA (mean 56.4 SD 8.0- 58.0 SD 7.6) and HDL (mean 57.7 SD 6.1 – 57.4 SD 5.8) For ApoB (mean 53.7 SD 7.2 - 60.3 SD 7.3 and LDL (mean 54.9 SD 5.8 – 59.5 SD 5.2), age increased with levels of lipids. BMI was negatively associated with ApoA; women in the lowest quartile had the highest BMI (kg/m2) (mean BMI in ApoA-quartiles 1-4 (26.5, 25.7, 25.0, 24.4). The same pattern was seen for quartiles of HDL whilst a reversed relationship was seen for ApoB and LDL. Socioeconomic status was evenly distributed between all measured lipid quartiles. The multivariate Cox analyses revealed a statistically significant risk reduction for women with increasing levels of ApoB. Compared with the first quartile, the risk for incident breast cancer in quartiles 2-4 was 1.01 (95%CI, 0.85-1.20); 0.82 (95%CI, 0.68-0.99); 0.73 (95%CI, 0.60-0.89), P-trend<0.0003. A similar trend was seen for LDL, however only statistically significantly in the unadjusted analyses (P-trend <0.016). Levels of ApoA and HDL were not significantly associated with breast cancer risk. Conclusions: This study confirms previous studies indicating an inverse association between ApoB and breast cancer risk. Studies addressing total cholesterol have similarly shown risk-reducing effects on breast cancer risk with increasing levels of cholesterol. However, BMI does not seem to explain this association. Previous breast cancer studies on circulating lipids including all separate components, ApoA, ApoB, HDL, and LDL are sparse, and the association is still insufficiently elucidated. It is possible that ApoB and LDL as risk factors for cardiovascular events have diverse effects in breast cancer. The interaction between circulating levels of lipids and breast cancer needs to be further investigated. Citation Format: Talha Butt, Olle Melander, Peter Almgren, Dov Shiffman, Jonas Manjer, Signe Borgquist. Circulating lipids and breast cancer risk – Effects of ApoB [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-07-02.

Relation between Mastalgia and Anxiety in a Region with High Frequency of Posttraumatic Stress Disorder.

Mastalgia, the most important breast-related symptom, refers to the pain that arises from breast tissue. Not only hormonal reasons but also psychogenic factors may cause mastalgia. Mastalgia is a subjective complaint and includes emotional components. The present study aimed to investigate the relation between mastalgia and level of anxiety in females. This case-control study had consisted of premenopausal females over the age of 20 years. Control group consisted of premenopausal females over the age of 20 years without mastalgia participated. The case and control groups each included 70 females. Females who had a previous breast surgery for any reason, were pregnant or in lactation period, or had a family history of breast cancer were excluded. The case and control groups each examined VAS and GAD-7 questionnaires. The GAD-7 scale was performed for both the case and control groups to assess the level of anxiety. Test indicated that the level of anxiety was significantly higher in the cases with mastalgia than in the controls. The VAS and GAD-7 scale scores were compared in the case group to assess the relation between degree of pain and level of anxiety. There was no significant relation between these scores, which indicated that pain, contrary to expectations, was not increased as the level of anxiety increased. Psychological factors such as anxiety, stress, and depression should be kept in mind after eliminating organic reasons via physical and necessary radiological examinations. A psychiatrist should be consulted since mastalgia is a condition that influences quality of life.

Mastectomy skin necrosis after microsurgical breast reconstruction

BackgroundMastectomy skin necrosis represents a significant clinical morbidity after immediate breast reconstruction. In addition to aesthetic deformity, necrosis of the native mastectomy skin may require debridement, additional reconstruction, or prolonged wound care and potentially delay oncologic treatment. This study aims to evaluate patient and procedural characteristics to identify predictors of mastectomy skin necrosis after microsurgical breast reconstruction. MethodsA retrospective review was performed of all immediate microsurgical breast reconstructions performed at a single academic center. Patient records were queried for age, diabetes, active smoking, previous breast surgery, preoperative radiation, preoperative chemotherapy, body mass index, mastectomy type, mastectomy weight, flap type, autologous flap type, and postoperative mastectomy skin flap necrosis. ResultsThere were 746 immediate autologous microsurgical flaps performed by three plastic surgeons at our institution during the study period. The incidence of mastectomy skin flap necrosis was 13.4%. Univariate analysis revealed a significantly higher incidence of mastectomy skin necrosis in patients with higher mastectomy weight (P < 0.001), higher autologous flap weight (P < 0.001), higher body mass index (0.002), and diabetes (P = 0.021). No significant association was found for age, smoking, prior breast surgery, preoperative chemotherapy or radiation, or mastectomy type. Multivariate analysis demonstrated statistically significant associations between mastectomy skin necrosis and both increasing mastectomy weight (odds ratio 1.348 per quartile increase, P = 0.009) and diabetes (odds ratio 2.356, P = 0.011). ConclusionsIncreasing mastectomy weight and coexisting diabetes are significantly associated with postoperative mastectomy skin necrosis after microsurgical reconstruction. These characteristics should be considered during patient counseling, procedure selection, operative planning, and intraoperative tissue viability assessment.

Effect of life style (exercise and nutrition) on occurrence of breast cancer in women: A retrospective study in Babylon governorate

Objective To identify the effect of exercise and nutrition on breast cancer occurrence and to find the relationship between life style and somedemographic and reproductive variables.Methods A retrospective study (case control study) of a purposive sample of 400 women; 200 women diagnosed with breast cancer visitedthe Merjan Teaching Hospital Oncology Cancer Center in Babylon Governorate as a study group and 200 women free of breast cancer as acontrol group. An assessment tool was constructed for the purpose of the study. It comprised of socio-demographic data, reproductivedata, information related to breast cancer (stage, side, period, family history) and information related to their life style: exercise (5 items) andnutrition (14 items) of 10 years previous breast cancer occurrence, physical measurements for measuring obesity and overweight (BMI) aswell as medical records to explain in the stage of breast cancer and other details which may be assisting this study Data were collected from4 May 2013 to 4 July 2013. Analysis of data was performed through the application of descriptive and inferential statistical data analysisapproach.Results The study demonstrates that the highest percentage (39.5%) of study sample was in age group 50–54 years in comparison with theother age groups for both the study and control groups. There was a high significant difference at P &lt; 0.01 between the life aspects(exercise and nutrition) and breast cancer in women while no relationship between life aspects and demographical and reproductivevariables except with interval between pregnancies and duration of contraception of study group was noted.Conclusion Establishing an activation media and Ministry of Health role for guiding women and their families about the importance ofexercise and healthy nutrition which contributes to reducing the incidence of breast cancer occurrence and the importance of earlydetection of breast cancer.

Pain-preventing strategies in mammography: an observational study of simultaneously recorded pain and breast mechanics throughout the entire breast compression cycle.

BackgroundMany women consider mammography painful. Existing studies on pain-preventing strategies only mention pain scores reported before and after breast compression. Studying the pain dynamics during the entire compression cycle may provide new insights for effective pain-preventing strategies.MethodsThis observational study included 117 women who consented to use a custom turning knob to indicate their pain experience during standard mammographic breast compressions in the Academic Medical Center in Amsterdam, The Netherlands. The breast thickness, compression force, contact area, contact pressure and pain experience were recorded continuously. Breast volume was calculated retrospectively from the mammograms. We visualized the progression of pain in relation to breast mechanics for five groups of breast volumes and we performed multivariable regressions to identify factors that significantly predict pain experience.ResultsBreast compressions consisted of a deformation phase for flattening, and a clamping phase for immobilization. The clamping phase lasted 12.8 ± 3.6 seconds (average ± standard deviation), 1.7 times longer than the 7.5 ± 2.6 seconds deformation phase. During the clamping phase, the average pain score increased from 4.75 to 5.88 (+24%) on a 0 – 10 Numerical Rating Scale (NRS), and the proportion of women who reached severe pain (NRS ≥ 7) increased from 23% to 50% (more than doubled). Moderate pain (NRS ≥ 4) was reported up to four days after the mammogram. Multivariable analysis showed that pain recollection of the previous mammogram and breast pain before the compression, are significant predictors for pain. Women with smallest breasts experienced most pain: They received highest contact pressures (force divided by contact area) and the pressure increased at the highest rate.ConclusionWe suggest further research on two pain-preventing strategies: 1) using a personalized compression protocol by applying to all breasts the same target pressure at the same, slow rate, and 2) shortening the phase during which the breast is clamped.

The prevalence of medical reasons for non-participation in the Scottish breast and bowel cancer screening programmes.

ObjectiveIncreasing uptake of cancer screening is a priority for health systems internationally, however, some patients may not attend because they are undergoing active treatment for the cancer of interest or have other medical reasons that mean participation would be inappropriate. This study aims to quantify the proportion of non-participants who have a medical reason for not attending cancer screening.MethodsMedical reasons for not participating in breast and bowel screening were defined a priori on the basis of a literature review and expert opinion. The notes of 700 patients at two GP practices in Scotland were reviewed, to ascertain the prevalence of medical reasons amongst non-participants. Simple proportions and confidence intervals were calculated.Results17.4% of breast and 2.3% of bowel screening non-participants had a medical reason to not participate. The two most common reasons were previous breast cancer follow up (8.86%) and recent mammogram (6.57%).ConclusionThese patients may not benefit from screening while also being distressed by receiving an invitation. This issue also makes accurate monitoring and target-setting for improving uptake difficult. Further work is needed to estimate robustly the extent to which medical reasons account for screening non-participation in a larger population.

“NACsomes”: A new classification system of the blood supply to the nipple areola complex (NAC) based on diagnostic breast MRI exams

Breast MRIs have become increasingly common in breast cancer work-up. Previously obtained breast MRIs may facilitate oncoplastic surgery by delineating the blood supply to the nipple-areola complex (NAC). The aim of this study was to identify and classify the invivo blood supply to the NAC using breast MRI exams. Breast MRIs obtained over a one-year period were retrospectively reviewed. Patients with negative MRI findings (BI-RADS category 1) were included; patients with diagnoses of breast cancer or previous breast surgery were excluded. Twenty-six patients were evaluated. Dominant blood supply was determined by maximum filling at 70s post-contrast. Blood supply to the NAC was classified into five anatomic zones: medial (type I), lateral (type II), central (type III), inferior (type IV) and superior (type V). Patient age ranged from 33 to 70 years. Fifty-two breasts were evaluated and 80 source vessels were identified (37 right, 43 left). Twenty-eight breasts had type I only blood supply, 22 breasts had multi-zone blood supply (type I+II, n=20; type I+III n=2), one breast had type II only blood supply, and a single breast had type III only blood supply. Anatomic symmetry was observed in 96% of patients. This study utilized MRI to evaluate invivo vascular anatomy of the NAC, classify NAC perfusion ("NACsomes"), and assess vascular symmetry between breasts. Superomedial source vessels supplying the NAC were predominant. Preoperatively defining NAC blood supply may aid planning for oncoplastic procedures.

Retrospective analysis of 14 cases of disseminated Penicillium marneffei infection with osteolytic lesions.

BackgroundPenicillium marneffei disseminates hematogenously and can infect most organs, though infection leading to osteolysis is extremely rare. We describe the clinical and laboratory features, management, and outcomes of patients with penicilliosis marneffei (PSM) with osteolytic lesions.MethodsThis retrospective study was conducted between January 1, 2003 and May 1, 2014 at the First Affiliated Hospital of Guangxi Medical University. Patients who presented with culture and/or histopathologic proof of disseminated PSM within osteolytic lesions were included.ResultsP. marneffei infection was diagnosed in 100 patients (65 HIV-infected and 35 HIV-negative). Fourteen patients, all HIV-negative, (14/35, 40%) had osteolytic lesions. The most common comorbidity was diabetes mellitus, though previous glucocorticoid therapy, β-thalassemia, breast cancer, and Langerhans cell histiocytosis also occurred. Five patients had no comorbidity. Fever, malaise, ostealgia, weight loss, and anemia were the most common symptoms, followed by cutaneous lesions, lymphadenopathy, hepatosplenomegaly, cough, sputum, and stethalgia. Ostealgia, joint pain, and joint disorders were also recorded. White blood cell and neutrophil counts were increased (mean 22.3 ± 7.4 × 109 cells/L; mean 18.84 ± 4.5 × 109 cells/L, respectively). The most common sites were the vertebrae, skull and femur, ribs and ilium, though the clavicle, scapula, humerus, and tibia were also involved. Radiography and computed tomography (CT) showed multiple radiolucencies with moth-eaten bone destruction, periosteal proliferation, bone fracture, and surrounding soft-tissue swelling. Emission CT showed significantly increased uptake in many skeletal regions. Positron emission tomography/CT showed generalized lymphadenopathy, bone metabolic activity, and bone destruction. The 18 F-FDG standard uptake value was increased in the entire skeleton (mean 6.16). Twelve patients received antifungal therapy, four of whom died during treatment, and eight recovered, though four of these eight relapsed within 3–24 months. Two patients discontinued treatment because of severe multiple organ failure and died.ConclusionsOsteolysis is often overlooked in HIV-negative individuals with disseminated P. marneffei infection. However, P. marneffei involving the bone and leading to osteolysis may indicate severe systemic disturbance, and is characterized by a poor prognosis, high recurrence rate, and the need for prolonged antifungal treatment.

Sentinel Lymph Node Dissection in Locally Recurrent Breast Cancer

The aim of this study was to investigate the use of sentinel lymph node dissection (SLND) in the treatment of patients with locally recurrent breast cancer. A total of 147 patients with locally recurrent breast cancer were included from five different breast surgery departments in Denmark. Data on previous breast and axillary surgery, adjuvant treatment, second operation in the breast and axilla, and lymphoscintigraphy were collected retrospectively from the original patient files. SLND after recurrence (SLNDAR) was successful in 72 of 144 patients (50%). The detection rate was significantly higher after previous SLND (66%) compared with previous ALND (34%) [p=0.0001]. Thirty-seven patients (51%) who had previous SLND had a negative sentinel node. These patients could be spared an ALND. Six patients (8%) who had a previous ALND had a metastatic sentinel node at recurrence; 17% of patients had a sentinel node located outside the ipsilateral axilla; and eight patients with negative sentinel node at SLNDAR underwent completion ALND. None of these patients had metastases at completion ALND, corresponding to a false negative rate of 0%. SLNDAR seems to be a feasible procedure in locally recurrent breast cancer and can spare a clinically significant number of patients an unnecessary ALND and the following risk of sequelae. In patients who had previous ALND, SLNDAR identified metastases that would have been overlooked following the current guidelines. A large proportion of patients had aberrant drainage, suggesting a need for lymphoscintigraphy.

Risk-reducing salpingectomy with delayed oophorectomy in BRCA1/2 mutation carriers: Patients' and professionals' perspectives

ObjectiveTo identify influencing factors of BRCA1/2 mutation carriers and their professionals for risk-reducing salpingectomy (RRS) with delayed oophorectomy (RRO) as a substitute for risk-reducing salpingo-oophorectomy (RRSO) and for study participation on this concept. MethodsA qualitative study was performed by four focus group interviews with 39 BRCA1/2 mutation carriers and semi-structured in-depth interviews with 23 professionals in the field of hereditary cancer. We used a theoretical framework of determinants of innovation within healthcare organizations to classify influencing factors (barriers and facilitators). ResultsAmong BRCA1/2 mutation carriers, main barriers for RRS with delayed RRO were seriousness of ovarian cancer, family history, and previous breast cancer. Among professionals, delay of risk-reducing effect of oophorectomy on breast cancer risk and a second operation were recognized as main barriers. Both BRCA1/2 mutation carriers and professionals found uncertainty about the effect of RRS with delayed RRO and ease of the decision to undergo RRSO important barriers. The main facilitator mentioned by both was longer maintenance of ovarian function thereby delaying negative effects of early surgical menopause. For study participation, BRCA1/2 mutation carriers mentioned a randomized study design as the main barrier, whereas professionals identified two facilitators, namely willingness of BRCA1/2 mutation carriers for study participation and uniform counseling. Furthermore, most BRCA1/2 mutation carriers and professionals were willing to consider participation in a future non-randomized study. ConclusionsWe identified several barriers and facilitators for RRS with delayed RRO, and for study participation which can be addressed to optimize the design and implementation of a non-randomized study.

Screening Ultrasound in Women with Negative Mammography: Outcome Analysis

PurposeTo show the results of an audit of screening breast ultrasound (US) in women with negative mammography in a single institution and to analyze US-detected cancers within a year and interval cancers.Materials and MethodsDuring the year of 2006, 1974 women with negative mammography were screened with US in our screening center, and 1727 among them had pathologic results or any follow up breast examinations more than a year. We analyzed the distribution of Breast Imaging Reporting and Data System (BI-RADS) category and the performance outcome through follow up.ResultsAmong 1727 women (age, 30-76 years, median 49.5 years), 1349 women (78.1%) showed dense breasts on mammography, 762 (44.1%) had previous breast US, and 25 women (1.4%) had a personal history of breast cancers. Test negatives were 94.2% (1.627/1727) [BI-RADS category 1 in 885 (51.2%), 2 in 742 (43.0%)]. The recall rate (=BI-RADS category 3, 4, 5) was 5.8%. Eight cancers were additionally detected with US (yield, 4.6 per 1000). The sensitivity, specificity, and positive predictive value (PPV1, PPV2) were 88.9%, 94.6%, 8.0%, and 28.0%, respectively. Eight of nine true positive cancers were stage I or in-situ cancers. One interval cancer was stage I cancer from BI-RADS category 2.ConclusionScreening US detected 4.6 additional cancers among 1000. The recall rate was 5.8%, which is in lower bound of acceptable range of mammography (5-12%), according to American College of Radiology standard.

Management and prognosis of esophageal carcinosarcoma

Management and prognosis of esophageal carcinosarcoma

Failure to Engage in Breast Screening and Risk Assessment Results in More Advanced Stage at Diagnosis

Background: Although well established, population based screening and family risk assessment for breast cancer have come under increasing scrutiny. The concept of over diagnosis is increasingly cited in cancer publications. This study assessed the impact of failure to screen or risk assess patients attending with a new diagnosis of breast cancer. Methods: A retrospective review was undertaken of 200 consecutive patients diagnosed with breast cancer between January 2010 and September 2012 at Letterkenny Hospital. Appropriate screening was defined as biennial in those aged 50 - 66 and in those 40 - 49 with moderate/high family history risk (NICE criteria or IBIS criteria). Patient demographics, screening history, diagnosis date and stage (TNM) were documented. Patients with previous breast cancer were not included (n = 17). Results: 200 consecutive patients, whose mean age was 61 (range 28 - 99), were studied. 112/200 (56%) met no criteria for screening or family history assessment, and 88/200 (44%) met criteria for either screening (in 56) or family history assessment (in 32). 61/88 (69.3%) meeting criteria did not have a mammogram or risk assessment. The stage of breast cancer was significantly earlier in those screened appropriately, with early stage cancer in n = 111/139 (79.9 %) and late in n = 28/139 (20.1%), compared with 38/61 (62.3%) and 23/61 (37.7%) in those failing to be screened appropriately (p = 0.01 χ2 df1). Conclusion: Failure to engage in breast screening and risk assessment resulted in more advanced stage at diagnosis.

Pregnancy related breast diseases in a developing African country: Initial Sonographic Evaluation.

Benign diseases are more common than malignant diseases in pregnant and lactating women. Fibroadenomas are the most commonly identified benign breast tumour in pregnant and lactating women. Pregnancy related breast cancer is defined as breast cancer that occurs during pregnancy or within 1 year of delivery. Its incidence is estimated at 1 in 3000 to 1 in 10 000 pregnancies. Several reproductive factors like age at menarche, age at menopause, age at full-term pregnancy, parity, age at any birth and spacing of pregnancies, breast feeding, characteristics of the menstrual cycle, infertility, spontaneous and induced abortions, characteristics of the menstrual cycle and infertility are some of the factors that have been incriminated as risk factors for breast cancer. We sought to describe the predominant breast pattern, sonographic array of pregnancy related breast diseases in women referred to the breast imaging unit in the department of Radiology at the University College Hospital, Ibadan south west Nigeria. Socio-demographic characteristics in these women were also evaluated. Archived images were reviewed and documented and data was analysed with SPSS version 17 and presented with descriptives. In this descriptive study, we retrospectively retrieved the sonomammographic records of 21 women (pregnant or lactating) referred to and imaged in the department of radiology, University college hospital Ibadan, between 2006 and 2013. Diagnostic breast sonograms performed by MO and ATS; Consultant radiologists with 7-10 years’ experience utilized a 7-10 MHz transducer of the General electric GE Logiq P5 machine for the scans. Twenty-one women with ages between 22-42 years (Mean 31.4 ±5.4 SD) pregnant or lactating were referred to the radiology department for sonomammographic evaluation. Majority of the women were in the 3rd decade. Referral was mainly (11) by family Physicians from the general outpatient clinic, 5 were self-referred, 2 from radiotherapy department, 2 from obstetrics and gynaecology department and 1 from the surgical outpatient clinic. Nineteen (89.5%) were lactating and breastfeeding while 2 (10.5%) were pregnant. Nipple discharge (89.5%) was the predominant presenting complaint in the study. They were all married with the majority attaining menarche at age 14.6±2.1 SD years. Most of the women were multi-parous 17(89.5%) and possessed higher level of Education 17 (81.0%). Twenty (96.0%) women had no previous breast disease while only 1 (4.0%) woman had a positive family history of breast cancer. They weighed between 44-102kg (mean 69.84kg±15.33SD). Their mean height was 159.8cm. Waist hip ratio was between 0.69-0.93 (Mean 0.83). The heterogeneous fibroglandular pattern was predominant in 15 (71.4%) women. Final BIRADS assessment of 2 was most frequent (11/21) 52.4% while 19.0% were assigned to BIRADS categories 0 and 1 (4/21). Histological diagnosis of Invasive ductal carcinoma was made in the 3 women with final BIRADS of 5 breast diseases found in most pregnant and lactating women were benign. It is important to note that malignant breast lesions can also occur in this group of women who may assume that the changes noted in their breast are due to lactation.

Correcting Shape and Size Using Temporary Filler after Breast Augmentation with Silicone Implants

Breast contour deformities, lack of volume and asymmetry are common confronted problems after breast augmentation with implants. These problems can be corrected by using temporary fillers or autologous fat grafts. The purpose of this study was to introduce our experience using long lasting temporary filler (Aquafilling®) for the correction of unfavorable results after breast augmentation with silicone implants. Two non-pregnant, non-breastfeeding women unsatisfied with previous breast augmentation with silicone implants were recruited for this study. All procedures were performed under local anesthesia with sedation. Efficacy and safety assessments were carried out at follow-up visits (1, 3, and 6 months). The study showed that Aquafilling® could provide satisfactory improvement in breast shape and volume. Also it showed that the corrected volume and shape were lasting without affecting the breasts' original volume. Patients reported high satisfaction as Aquafilling® was generally well tolerated with no inflammatory reactions or serious adverse events. We recommend that Aquafilling® as a new option for the correction of minor problems after breast augmentation surgery with implants. However, further follow-up studies are required to observe long-term results. Keywords: Breast implants, Mammaplasty, Silicones

Evaluation of Breast Cancer Awareness among Female University Students in University of Sharjah, UAE

Objective: The objectives of this study were to assess the knowledge of breast cancer among female students at the College of Pharmacy at the University of Sharjah, UAE, and to evaluate the impact of the intervention program designed by the researchers on the student’s knowledge on the disease risk factors, screening methods, and their perception towards its treatment outcomes. Method: A cross-sectional questionnaire survey of a convenience sample of 166 pharmacy students ((n = 110; the 4th year) and (n = 56; the 5th year)) in the University of Sharjah, Sharjah, UAE. The 26-item questionnaire covered the personal information and socio-demographic characteristics, breast cancer general knowledge, knowledge of breast cancer risk factors, knowledge of breast cancer symptoms and screening tests, and perception of management and outcomes of breast cancer. Key Findings: A total of 120 pharmacy students from the 4th year (n = 70) and the 5th year (n = 50) had completed the survey for the pre-intervention phase of the study. For the post intervention phase of the study, only 63 students from the 4th year and 48 students from the 5th year returned their completed questionnaire, giving a response rate of 90% and 96% respectively. Almost one quarter (59 (25.5)) of the students included in the study reported that they have had a history of breast cancer in their family respectively. A high proportion (206 (89.2%)) of the students from both levels showed their interest in participating in activities to promote breast awareness, despite the fact that almost three quarters (161 (70%)) of the students reported that they have never been participated in any previous breast awareness programs. The awareness of students under investigation about self-examination was clearly improved at the end of the study period. Eighty (66.7%) of the students from both levels reported that the breast self-examination is recommended for female “once a month”. This figure was increased to 103 (92.8%) post the intervention sessions (P value χ2 < 0.001). Conclusion: The high incidence of breast cancer in the UAE may be attributed to the low level of awareness of the disease among females. Our findings can be used to promote discussion in the profession and with stakeholders about the future role of pharmacists in breast cancer care.

Abstract B11: Replication of previously identified breast cancer susceptibility loci in a breast cancer case-control study on women of African ancestry

Abstract To date, more than 100 single nucleotide polymorphisms (SNPs) have been found to be associated with breast cancer susceptibility in large genome-wide association studies (GWAS) conducted predominantly in women of European and Asian ancestries. To identify breast cancer susceptibility alleles in populations of African ancestry, we performed a GWAS in 3,686 subjects from Nigeria, Barbados and the United States (Baltimore, Chicago, Detroit, Philadelphia and the Southern Community Cohort Study), using the Illumina HumanOmni2.5 array. Using stringent quality control criteria, a total of 1,657 cases (777 with known estrogen receptor [ER] status) and 2,029 controls were successfully genotyped for 2,116,365 SNPs. Subsequently, imputation was conducted using reference panels from The 1000 Genomes Project and logistic regression models controlling age and global ancestry were applied to examine the association of 78 known breast cancer GWAS index SNPs and 44 iCOGS (Illumina iSelect genotyping array for Collaborative Oncological Gene-Environment Study) SNPs with breast cancer risk in our study population. Only 4 SNPs were statistically significant (unadjusted P&amp;lt;0.01) associated with breast cancer in women of African descent: rs3112612 (16q12.1, P=0.0021), rs3817198 (11p15.5, P=0.0049), rs10069690 (5p15.33, P=0.0056), and rs1978503 (18q21.2, P=0.0066). Additional five SNPs were found to be associated with breast cancer at the unadjusted P&amp;lt;0.05 significance level: rs458685 (12q21.3), rs361147 (4q31.3), rs4322600 (14q31.3), rs616488 (1p36.22), and rs17356907 (12q22). We also observed positive associations for ER-negative breast cancer: rs3817198 (11p15.5, P=0.0029), rs6762644 (3p26.1, P=0.0036), rs10069690 (5p15.33, P=0.0048), and rs3803662 (16q12.1, P=0.0050); and ER-positive breast cancer: rs12355688 (10q22.3, P=0.011), rs1978503 (18q21.2, P=0.020), rs3112612 (16q12.1, P=0.032), and rs4784227 (16q12.1, P=0.038). In conclusion, our observations highlight the necessity of validating previous breast cancer GWAS findings across diverse populations. Different environmental factors, allele frequencies and linkage disequilibrium patterns may influence the genetic risk profiles in different populations. Larger genetic studies in women of African ancestry hold promise to reveal additional risk variants for developing polygenic risk models for breast cancer susceptibility in this population. Citation Format: Yonglan Zheng, Dezheng Huo, Temidayo O. Ogundiran, Adeyinka G. Falusi, Oladosu Ojengbede, Clement Adebamowo, William J. Blot, Wei Zheng, Qiuyin Cai, Lisa B. Signorello, Katherine L. Nathanson, Susan M. Domchek, Timothy R. Rebbeck, Michael S. Simon, Anselm J.M. Hennis, Barbara Nemesure, Suh-Yuh Wu, Maria Cristina Leske, Stefan Ambs, Abayomi Odetunde, Imaria Anetor, Stella Akinleye, Qun Niu, Jing Zhang, Anna Pluzhnikov, Anuar Konkashbaev, Lin Chen, Eric R. Gamazon, Younghee Lee, Nancy J. Cox, Olufunmilayo O. Olopade. Replication of previously identified breast cancer susceptibility loci in a breast cancer case-control study on women of African ancestry. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B11. doi:10.1158/1538-7755.DISP13-B11

Complicated and complex: the management of older cancer patients, a frame of reference to approach clinical complexity

In this article, we propose a frame of reference to approach complexity in clinical practice. Complexity is becoming a more and more common issue, due to the aging of the population, increased prevalence of polymorbidity, dwindling pool of home caregivers, and the social and economic issues associated with age. The case of a 79-year-old woman with hemiparesis from a previous stroke, breast cancer, and chronic myelogenous leukemia is analyzed. From the analysis of the case, we concluded that: there was an urgent need of a person charged with making the final medical recommendations to an older individual with multiple medical problems; patient autonomy may be limited by the need of a caregiver able to assist in the activity of daily living; active life expectancy is a major goal in the management of an older person; several courses of actions may be acceptable toward such goal.

Histological Assessment of Breast Lesions Identified Exclusively by Magnetic Resonance

Radiologic-pathologic correlation of lesions diagnosed by magnetic resonance (MR) is precluded by insufficient data on histological characteristics of lesions suspicious on MR but not visible on concurrent mammogram or ultrasound. The objective of this study was to describe histological features of breast lesions diagnosed exclusively by MR. The participants underwent MR-guided breast biopsy between 2007 and 2012 for a suspicious lesion not identified by mammography or ultrasound. Histology slides were interpreted retrospectively by a breast pathologist. Of 126 patients (126 lesions), 34 (27%) had new breast cancer, 51 (40.5%) previous breast cancer, and 41 (32.5%) dense breasts or a significant family history of breast cancer. MR identified 23 (18.3%) invasive cancers: 20 were Grade 1 and 17 were ductal. Of the 126 lesions, 16 (13%) were ductal carcinoma in situ (DCIS), four were atypical ductal hyperplasia and atypical lobular hyperplasia (3%), and 68 (54%) were benign. Fifteen biopsies (12%) had no significant pathology. Five DCIS lesions were upgraded to T1 invasive cancers. Approximately 30 per cent of suspicious lesions detected exclusively by MR are invasive or in situ cancers that are predominantly low grade. Further studies are needed to determine if malignant lesions can be prospectively distinguished by MR characteristics.