Previous Diagnosis Of Breast Cancer Research Articles

Follow-up of breast cancer: why is it necessary to start a Consensus in 2024?

In Italy, breast cancer is the most frequently diagnosed cancer in women, with 55,900 new cases in 2023 (over 90% in the early stages). Due to the screening, early diagnosis and adjuvant treatment, these patients have a 5-years survival rate of 87% after the diagnosis. There are 834,154 women in Italy with a previous diagnosis of breast cancer: most of these women require a follow-up. The AIOM, ESMO and ASCO Guidelines recommend for early breast cancer (EBC) a clinical follow-up with only physical examination (and eliciting of symptoms) and an annual X-ray mammography, on the basis of the results of two randomized trials published in 1994 that showed no benefit in overall survival with intensive follow-up. However, an Italian survey reported the application by 80% of oncologists of an intensive follow-up based on the individual patient’s risk of recurrence. In fact, the oncologists believe that an early diagnosis of locoregional or distant recurrence may allow an early start of very effective therapies. In this lack of up-to-date scientific data, many questions about follow-up remain unanswered and the few ongoing studies will provide results in several years. Non-compliance with guideline recommendations leads to increased costs for the healthcare system. Furthermore, management varies widely from centre to centre with regard to guideline recommendations, resulting in inequalities between patients. For these reasons, the follow-up of breast cancer should be reconsidered. In the absence of recent scientific evidence, a multidisciplinary group of breast cancer experts has initiated a Consensus on the follow-up of EBC according to the mini-Delphi methodology. The project will be completed by the end of 2024.

Factors associated with adherence to brca1/2 mutation testing after oncogenetic counseling in patients with a previous diagnosis of breast or ovarian cancer

Factors associated with adherence to brca1/2 mutation testing after oncogenetic counseling in patients with a previous diagnosis of breast or ovarian cancer

Disparities in Breast Cancer Screening Rates Among Adults With and Without Intellectual and Developmental Disabilities.

Individuals with intellectual and developmental disabilities may face barriers in accessing healthcare, including cancer screening and detection services. We sought to assess the association of intellectual and developmental disabilities (IDD) with breast cancer screening rates. Data from 2018 to 2020 was used to identify screening-eligible individuals from Medicare Standard Analytic Files. Adults aged 65-79 years who did not have a previous diagnosis of breast cancer were included. Multivariable regression was used to analyze the differences in breast cancer screening rates among individuals with and without IDD. Among 9,383,349 Medicare beneficiaries, 11,265 (0.1%) individuals met the criteria for IDD. Of note, individuals with IDD were more likely to be non-Hispanic White (90.5% vs. 87.3%), have a Charlson Comorbidity Index score ≤ 2 (66.2% vs. 85.5%), and reside in a low social vulnerability index neighborhood (35.7% vs. 34.4%). IDD was associated with reduced odds of undergoing breast cancer screening (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.74-0.80; p < 0.001). Breast cancer screening rates in individuals with IDD were further influenced by social vulnerability and belonging to a racial/ethnicminority. Individuals with IDD may face additional barriers to breast cancer screening. The combination of IDD and social vulnerability placed patients at particularly high risk of not being screened for breast cancer.

Factors associated with adherence to BRCA1/2 mutation testing after oncogenetic counseling in long-surviving patients with a previous diagnosis of breast or ovarian cancer

BRCA1/2 mutations account for 5 to 10% of breast and 15% of ovarian cancers. Various guidelines on BRCA1/2 genetic counseling and testing have been issued, and the criteria have evolved over the years. Oncogenetic counseling aims to inform patients about the possibility and implications of undergoing predictive testing and risk management programs. We analyzed a cohort of 50 subjects with a previous personal history of breast or ovarian cancer who had not been tested for BRCA1/2 mutations at the time of diagnosis but were found eligible according to the most recent guidelines. All patients were offered pre-test oncogenetic counseling and BRCA1/2 genetic testing. The mean time from cancer diagnosis to genetic counseling was over 10 years. We analyzed socio-demographic and psychological parameters associated with the decision to undergo BRCA1/2 genetic testing or the reasons behind the withdrawal. Thirty-nine patients underwent BRCA1/2 genetic testing. Patients who accept the genetic test communicate more easily with family members than those who refuse. Factors associated with test refusal are having a long-term partner and having a negative perception of life. There is a trend, although not statistically significant, toward younger age at cancer diagnosis, more likely to participate in cancer screening programs (71.8% vs. 45.5%), and more likely to have daughters (63.3% vs. 37.5%) in the group that accepted the test. The offer of BRCA testing was well accepted by our study population, despite the many years since the cancer diagnosis. With the perspective of further broadening the access criteria to genetic testing, it is important to understand how to best approach pre-test counseling in long-surviving patients with a previous diagnosis of cancer.

ORAL CARCINOMA IN A PATIENT WITH SYSTEMIC SCLEROSIS

Systemic sclerosis (SSc) is a rare autoimmune connective tissue disorder characterized by fibrosis, vasculopathy, and inflammation. SSc's disease-related characteristics include skin tightness, puffy fingers, open ulcers, and multi-organ involvement. Studies have also identified a higher risk for the development of malignancy in SSc patients. A 56-year-old woman with SSc presented an asymptomatic white plaque of 20 × 25 mm in the right lower lip. Medical history revealed a previous diagnosis of breast cancer and current diagnosis of colorectal cancer. An incisional biopsy was performed, and histological examination showed architectural and cytological atypia of the full epithelial thickness, consistent with those of a severe, in situ dysplasia/carcinoma. The patient was referred to oncology services. Early localized stage diagnosis of in situ carcinoma of the oral cavity brings more favorable prognosis with better overall management, especially in individuals with SSc who presented systemic overlapping complications. Funding: CAPES. Systemic sclerosis (SSc) is a rare autoimmune connective tissue disorder characterized by fibrosis, vasculopathy, and inflammation. SSc's disease-related characteristics include skin tightness, puffy fingers, open ulcers, and multi-organ involvement. Studies have also identified a higher risk for the development of malignancy in SSc patients. A 56-year-old woman with SSc presented an asymptomatic white plaque of 20 × 25 mm in the right lower lip. Medical history revealed a previous diagnosis of breast cancer and current diagnosis of colorectal cancer. An incisional biopsy was performed, and histological examination showed architectural and cytological atypia of the full epithelial thickness, consistent with those of a severe, in situ dysplasia/carcinoma. The patient was referred to oncology services. Early localized stage diagnosis of in situ carcinoma of the oral cavity brings more favorable prognosis with better overall management, especially in individuals with SSc who presented systemic overlapping complications. Funding: CAPES.

A prospective observational study for a Federated Artificial Intelligence solution for moniToring mental Health status after cancer treatment (FAITH): study protocol

BackgroundDepression is a common condition among cancer patients, across several points in the disease trajectory. Although presenting higher prevalence rates than the general population, it is often not reported or remains unnoticed. Moreover, somatic symptoms of depression are common in the oncological context and should not be dismissed as a general symptom of cancer. It becomes even more challenging to track psychological distress in the period after the treatment, where connection with the healthcare system typically becomes sporadic. The main goal of the FAITH project is to remotely identify and predict depressive symptoms in cancer survivors, based on a federated machine learning (ML) approach, towards optimization of privacy.MethodsFAITH will remotely analyse depression markers, predicting their negative trends. These markers will be treated in distinct categories, namely nutrition, sleep, activity and voice, assessed in part through wearable technologies. The study will include 300 patients who have had a previous diagnosis of breast or lung cancer and will be recruited 1 to 5 years after the end of primary cancer. The study will be organized as a 12-month longitudinal prospective observational cohort study, with monthly assessments to evaluate depression symptoms and quality of life among cancer survivors. The primary endpoint is the severity of depressive symptoms as measured by the Hamilton Depression Rating Scale (Ham-D) at months 3, 6, 9 and 12. Secondary outcomes include self-reported anxiety and depression symptoms (HADS scale), and perceived quality of life (EORTC questionnaires), at baseline and monthly. Based on the predictive models gathered during the study, FAITH will also aim at further developing a conceptual federated learning framework, enabling to build machine learning models for the prediction and monitoring of depression without direct access to user’s personal data.DiscussionImprovements in the objectivity of psychiatric assessment are necessary. Wearable technologies can provide potential indicators of depression and anxiety and be used for biofeedback. If the FAITH application is effective, it will provide healthcare systems with a novel and innovative method to screen depressive symptoms in oncological settings.Trial registrationTrial ID: ISRCTN10423782. Date registered: 21/03/2022.

Use a web-app to improve breast cancer risk factors and symptoms knowledge and adherence to healthy diet and physical activity in women without breast cancer diagnosis (Precam project)

PurposeThis study aimed to evaluate the preliminary effectiveness of an educational intervention using a web-app to improve knowledge of breast cancer risk factors and symptoms and adherence to healthy eating and physical activity among women without breast cancer diagnosis in Asturias (Spain).MethodsA pragmatic randomized pilot trial was conducted to evaluate the impact of a web-app-based intervention for women without breast cancer diagnosis. Women in the intervention group participated in a 6-month intervention web-app based on the Behaviour Change Wheel Model. The web-app includes information about breast cancer risk factors, early detection, physical activity and diet.ResultsTwo hundred and eighty-fifth women aged 25–50 were invited to join the study. Two hundred and twenty-four were randomly assigned to either the intervention group (IG = 134) or control group (CG = 90) according to their place of residence. Adherence among women in the IG increased significantly from pre- to post-intervention for eight of the 12 healthy behaviors and for the identification of six risk factors and six symptoms compared to women in the CG and, among whom adherence only increased for two behaviors, the identification of one risk factor and 0 symptoms. The intervention significantly improved the mean number of risk factors + 1.06 (p < 0.001) and symptoms + 1.18 (p < 0.001) identified by women in the IG.ConclusionsThe preliminary results of this study suggest that an educational intervention using a web-app and based on the Behaviour Change Wheel model could be useful to improve knowledge of breast cancer risk factors and symptoms and to improve adherence to a healthy diet and physical activity in women without a previous breast cancer diagnosis.

Clinical Utility of Universal Germline Genetic Testing for Patients With Breast Cancer

National Comprehensive Cancer Network guidelines currently recommend germline testing for high-risk genes in selected patients with breast cancer. The clinical utility of recommending testing all patients with breast cancer with multigene panels is currently under consideration. To examine the implications of universal testing of patients with breast cancer with respect to clinical decision-making. Patients from a previously reported cohort were assessed as in-criteria or out-of-criteria according to the 2017 guidelines and underwent testing with a multigene germline panel between 2017 to 2018. Patients were women and men aged 18 to 90 years, with a new and/or previous diagnosis of breast cancer who had not undergone either single or multigene testing. Clinicians from 20 community and academic sites documented patient clinical information and changes to clinical recommendations made according to test findings. Association between prevalence of pathogenic or likely pathogenic germline variants and previously unreported clinical features, including scores generated by the BRCAPRO statistical model, was determined. Data were analyzed from April 2020 to May 2022. New and/or previous diagnosis of breast cancer. Disease management recommendations that were changed as a result of genetic testing results are reported. Clinicians were asked to assess changes to clinical management as a result of germline genetic testing for 952 patients. Informative clinician-reported recommendations were provided for 939 (467 in-criteria and 472 out-of-criteria) of the patients with breast cancer (936 [99.7%] female; 702 [74.8%] White; mean [SD] age at initial diagnosis, 57.6 [11.5] years). One or more changes were reported for 31 of 37 (83.8%) in-criteria patients and 23 of 34 (67.6%) out-of-criteria patients with a pathogenic or likely pathogenic variant. Recommendations were changed as a result of testing results for 14 of 22 (63.6%) out-of-criteria patients who had a variant in a breast cancer predisposition gene. Clinicians considered testing beneficial for two-thirds of patients with pathogenic or likely pathogenic variants and for one-third of patients with either negative results or variants of uncertain significance. There was no difference in variant rate between patients meeting the BRCAPRO threshold (≥10%) and those who did not (P = .86, Fisher exact test). No changes to clinical recommendations were made for most patients with negative results (345 of 349 patients [98.9%]) or variants of uncertain significance (492 of 509 patients [96.7%]). In this cohort study, germline genetic testing was used by clinicians to direct treatment for most out-of-criteria patients with breast cancer with pathogenic or likely pathogenic germline variants, including those with moderate-risk variants. Universal germline testing informs clinical decision-making and provides access to targeted treatments and clinical trials for all patients with breast cancer.

BREAST CANCER ASSOCIATED ANTI YO-ANTIBODY MEDIATED PARANEOPLASTIC CEREBELLAR DEGENERATION: CASE SERIES AND REVIEW OF LITERATURE

Paraneoplastic cerebellar degeneration (PCD) is a rare immune mediated disorder characterized by progressive cerebellar ataxia in presence of onconeural antibodies which occurs due to an indirect effect of underlying malignancy i.e. small cell lung cancer (SCLC), breast and gynecologic cancer, and Hodgkin lymphoma. In about 50% of patients neurological manifestation of Paraneoplastic cerebellar degeneration occurs prior to detection of carcinoma. Anti-Yo Antibody is the commonest antibody present in patients with Paraneoplastic cerebellar degeneration which is associated with breast carcinoma. We describe 3 female patients with anti YO antibody mediated PCD with breast cancer. One patient had a previous diagnosis of breast cancer with post mastectomy status one year back. Two of them presented with ataxia and on further examination, breast lump was found. All three patients had symmetrical ataxia with one patient had severely debilitating ataxia and was not able to walk unassisted. Magnetic resonance imaging brain showed cerebellar atrophy in two patients while one patient had normal MRI. Anti- YO antibody was strongly positive in all the three patients. All patients were given immunotherapy (corticosteroids in 2, Intravenous immunoglobulin in 1) with 1 patient showed modest improvement These case highlights the need to consider for workup for paraneoplastic cerebellar degeneration in female patients presenting with subacute to chronic progressive ataxia, so that the tumors can be detected and treated in early stage with a good outcome.

When to stop? Mammographic surveillance in breast cancer survivors aged 70 years and older

To assess the rates of breast cancer detected in postoperative surveillance mammograms in women >70 Years and overall mortality in this age group. Four hundred and ninety-eight patients were identified retrospectively from a database from a single large UK hospital. Patients were included in the study if they were female, aged >70 years at diagnosis of either invasive breast cancer or ductal carcinoma in situ (DCIS), had surgical treatment between 1 January 2010 and 31 December 2014, and no previous diagnosis of breast cancer. Statistical analysis was performed using Excel, using the X2 test, with p≤0.05 considered statistically significant. The mean age of women included in this study was 77 years. The mean number of postoperative surveillance mammograms performed per patient was 4.2. In the 5-year follow-up, there was a local recurrence rate of 1.9% (n=6) and a contralateral breast cancer rate of 1% (n=6). The 5-year overall mortality rate was 17.7% (n=88), and the 5-year breast cancer-specific mortality rate was 7.2% (n=36). This study demonstrated low local recurrence and contralateral breast cancer rates during the 5-year follow-up period. Clear discussions therefore need to be held with older patients about the value of postoperative mammographic surveillance. Further research is required regarding patient opinion and experience to help develop more consistent guidelines.

Associations of Plasma Bioactive Adrenomedullin Levels with Cardiovascular Risk Factors in BRCA1/2 Mutation Carriers

Background Cardiovascular disease (CVD) is an important cause of morbidity and mortality in breast cancer survivors. Effective screening modalities to identify CVD risk are lacking in this population. Adrenomedullin (ADM) has been suggested as a biomarker for subclinical cardiac dysfunction in the general population. Levels of ADM have been proven to be responsive to lifestyle changes that lead to improved cardiovascular health. As BRCA1/2 mutation carriers are deemed to be at an increased risk for CVD, the aim of this study was to examine plasma ADM levels in a cohort of BRCA mutation carriers and to assess their association with cardiovascular risk factors. Methods Plasma ADM concentrations were measured in 292 female BRCA1/2 mutation carriers with and without a history of breast cancer. Subjects were classified into high versus low ADM levels based on the median ADM level in the entire cohort (13.8 pg/mL). Logistic regression models were used to estimate the odds ratios (OR) of having elevated ADM levels by several cardiovascular risk factors. Results Of all women (median age: 43 years), 57.5% had a previous diagnosis of breast cancer. The median time between diagnosis and study entry was three years (range: 0 – 32 years). Women presenting with metabolic syndrome had 22-fold increased odds of having elevated ADM levels (p < 0.001). Elevated ADM levels were associated with lower cardiorespiratory fitness (OR = 0.88, p < 0.001) and several parameters of obesity (p < 0.001). ADM levels were higher in women who have ever smoked (OR = 1.72, p = 0.02). ADM levels were not associated with a previous diagnosis of breast cancer (p = 0.28). Conclusions This is the first study in BRCA mutation carriers that has linked circulating ADM levels to traditional cardiovascular risk factors. The long-term clinical implications of these findings are yet to be determined.

Improving quality of life by promoting patient-provider communication and optimizing social support using a digital health platform.

e13622 Background: The patient experience, including symptom burden, is often disease-specific and dependent on host factors, the environment, and the tumor itself. Patients with a previous diagnosis of breast cancer are often subjected to multiple and aggressive treatment modalities compounding the already existing symptom burden related to the disease. Digital health can potentially increase patient engagement, close communication gaps between patients and providers, improve providers’ ability to stratify patient populations and adapt services, enable patients and families to access convenient and cost-effective care, and improve decision-making by patients and providers. The primary purpose of this pilot study was to evaluate if the use of a digital health platform can improve quality of life in patients with breast cancer. Methods: Patients with diagnosis of breast cancer were enrolled in a nonblinded, randomized, controlled trial of a digital health platform in self-reporting and monitoring of cancer and cancer-treatment related symptoms compared with usual care. All participants were asked to register in an online mobile application called CancerLife. This novel cancer social network experience provides patients social support through their care journey while at the same time collects patient-reported outcomes displayed inside reports that they can share with their providers. CancerLife automatically randomized each participant and assigned them to the experimental or control arms. The control arm received usual care provided for in the clinics. This group did not have access to the social network, reports or any other intervention or digital tools associated with CancerLife. Participants were asked to self-report their quality of life using the European Quality of Life Survey (EQ-5) every three weeks. Participants in the treatment arm were asked use the CancerLife at least 1 times per week for up to 24 weeks. Participants were also asked to share their print-out report directly with their care team and were instructed to email the report to their care team via their patient portal. Welch’s Two Sample t-test was performed to measure any statistical difference in the mean scores within each group for each time period. Results: CancerLife users had significant improvements in their scores at 9, 12, and 18 weeks; the improvement at 15 weeks was not significant. By contrast, the control group did not have significant improvements in their scores in any of the time periods. Conclusions: Breast cancer patients who were users of CancerLife’s app have more improvement in their Quality-of-Life Scores than randomly assigned non-users. The improvements seen with the use of CancerLife center on two things: improving communication from patient to physician about symptoms and offering patients social support which creates emotional resiliency. Clinical trial information: NCT03094741.

Inflammatory, Oxidative Stress, and Cardiac Damage Biomarkers and Radiation-Induced Fatigue in Breast Cancer Survivors.

Studies examining biomarkers associated with fatigue in breast cancer survivors treated with radiation are limited. Therefore, we examined the longitudinal association between serum biomarkers and post-breast cancer fatigue in survivors treated with radiation: [oxidative stress] 8-hydroxyguanosine, myeloperoxidase; [inflammation] interleukin-6 (IL-6), c-reactive protein, growth differentiation factor-15 (GDF-15), placental growth factor, transforming growth factor-beta, [cardiac damage] cystatin-C, troponin-I. In a secondary analysis, we included participants from the Women's Health Initiative if they had: a previous breast cancer diagnosis (stages I-III), no prior cardiovascular diseases, pre-and post-breast cancer serum samples drawn approximately 3years apart, and fatigue measured using the Short-Form 36 vitality subscale at both serum collections. Biomarkers were measured using ELISA or RT-qPCR and modeled as the log2 post-to pre-breast cancer ratio. Overall, 180 women with a mean (SD) age of 67.0 (5.5) years were included. The mean (SD) vitality scores were 66.2 (17.2) and 59.7 (19.7) pre- and post-breast cancer, respectively. Using multivariable weighted linear regression, higher biomarker ratios of cystatin-C, IL-6, and GDF-15 were associated with a lower vitality score (i.e., higher fatigue). For example, for each 2-fold difference in cystatin-C biomarker ratio, the vitality score was lower by 7.31 points (95% CI: -14.2, -0.45). Inflammatory and cardiac damage biomarkers are associated with fatigue in breast cancer survivors treated with radiation; however, these findings should be replicated in a larger sample. Biomarkers could be measured in clinical practice or assessed in risk prediction models to help identify patients at high risk for fatigue.

Women\u2019s perceptions of PERSPECTIVE: a breast cancer risk stratification e-platform

BackgroundBreast cancer risk stratification categorizes a woman’s potential risk of developing the disease as near-population, intermediate, or high. In accordance, screening and follow up for breast cancer can readily be tailored following risk assessment. Recent efforts have focussed on developing more accessible means to convey this information to women. This study sought to document the relevance of an informational e-platform developed for these purposes.ObjectiveTo begin to assess a newly developed breast cancer risk stratification and decision support e-platform called PERSPECTIVE (PErsonalised Risk Stratification for Prevention and Early deteCTIon of breast cancer) among women who do not know their personal breast cancer risk (Phase 1). Changes (pre- and post- e-platform exposure) in knowledge of breast cancer risk and interest in undergoing genetic testing were assessed in addition to perceptions of platform usability and acceptability.MethodsUsing a pre-post design, women (N = 156) of differing literacy and education levels, aged 30 to 60, with no previous breast cancer diagnosis were recruited from the general population and completed self-report e-questionnaires.ResultsMean e-platform viewing time was 18.67 min (SD 0.65) with the most frequently visited pages being breast cancer-related risk factors and risk assessment. Post-exposure, participants reported  significantly higher breast cancer-related knowledge (p < .001). Increases in knowledge relating to obesity, alcohol, breast density, menstruation, and the risk estimation process remained even when sociodemographic variables age and education were controlled. There were no significant changes in genetic testing interest post-exposure. Mean ratings for e-platform acceptability and usability were high: 26.19 out of 30 (SD 0.157) and 42.85 out of 50 (SD 0.267), respectively.ConclusionsAn informative breast cancer risk stratification e-platform targeting healthy women in the general population can significantly increase knowledge as well as support decisions around breast cancer risk and assessment. Currently underway, Phase 2, called PERSPECTIVE, is seeking further content integration and broader implementation .

Obstetric complications at time of delivery amongst breast cancer survivors: A population-based cohort study.

PurposeOur aim was to determine whether breast cancer survivors are at increased risk of obstetric and maternal complications at time of delivery.MethodsThe USA ‘National Inpatient Sample’ database was queried for hospitalizations associated with deliveries, between 2015 and 2018. The incidence of maternal and fetal complications was compared between women with, and without, a personal history of breast cancer.ResultsOf the 2,103,216 birth related admissions, 617 (0.03%) of the women were breast cancer survivors, with the proportion increasing over time (from 0.02% in 2015 to 0.04% in 2018). Breast cancer survivors had a higher socioeconomic status (p < 0.001) and were significantly older compared to other mothers (34 vs. 28 years, p < 0.001). Additionally, they were more likely to suffer from preexisting chronic diseases including cardiopulmonary disease and diabetes mellitus, and had a higher incidence of multiple gestation (4.4% vs. 1.6%) [OR 2.7, 95% CI 1.9–4.0, p < 0.001]. The incidence of acute adverse events at time of delivery including fetal distress, preterm labor, cesarean section and maternal infection was higher amongst the breast cancer survivors. On multivariate analysis age, ethnic group, comorbidities, multiple gestations, and a previous breast cancer diagnosis, but not cancer treatment, were associated with an increased risk of an obstetric adverse event.ConclusionBreast cancer survivors have more comorbidities and are at increased risk of acute obstetrical complications at time of delivery. Further studies are required to validate these findings, and evaluate the ability of interventions to improve obstetrical outcomes amongst breast cancer survivors.

Comparison of p63 immunohistochemistry and shear wave elastography in the diagnosis of indeterminate breast lesions: A prospective study.

To evaluate the accuracy of breast shear wave elastography (SWE) and p63 immunohistochemistry (IHC) in the diagnosis of indeterminate breast lesions. Based on detailed clinical examination and a combination of X-ray mammography/B-mode ultrasound with SWE, a total of 40 patients with breast lumps (BI-RADS 4) were included. Patients with previous diagnosis of breast cancer and a previous history of surgery, chemotherapy, or radiotherapy in the same breast as the present lesion were excluded. Core needle biopsy of the breast lesion was performed, and p63 IHC staining was performed. A final histopathological report of the definitive procedure was considered as the gold standard. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy were calculated for each modality. The mean age of the patients included in the study was 50.85 ± 13.53 years. Of the 40 patients recruited, 23 were clinically malignant and 17 were benign. The sensitivity, specificity, PPV, NPV, and accuracy of SWE were 91.3%, 94.1%, 95.5%, 88.9%, and 92.5% and those of p63 IHC were 95.7%, 100%, 100%, 94.4%, and 97.5%, respectively. Overall, the parametric values were higher for p63 IHC as compared to clinical examination and elastography. The area under the ROC curve (AUC) for p63 IHC (.978) was higher than those for SWE (.927) and clinical examination (.898). SWE and p63 IHC are highly reliable novel modalities that demonstrate enhanced diagnostic accuracy of indeterminate breast lesions aiding in the early initiation of appropriate treatment and reducing the number of women subjected to biopsy or short-term follow-up for benign-appearing solid breast lesions.

S1811 Cecal Ulceration as the Presenting Finding of Metastatic Breast Cancer: A Case Report and Review of Literature

Introduction: Breast cancer is the second most common malignancy worldwide and the second leading cause of cancer mortality in women. Despite routine screening, early detection, and evolving treatment modalities, recurrence and metastatic disease often occur. While breast cancer metastases are traditionally identified in the lung, liver, and bone, metastases to the gastrointestinal tract are rare. Metastases to the stomach are more commonly identified than to the colon and rectum. Prior cases of metastatic breast cancer to the gastrointestinal tract are reported in individuals with an established diagnosis of breast cancer. We describe a case of an ulcerated lesion in the cecum as the initial presenting sign of metastatic primary breast cancer. Case Description/Methods: A 64-year-old-woman with hypertension and chronic constipation was referred to our institution for evaluation of seven weeks of fatigue, one week of urinary symptoms, and lower extremity edema. The patient had undergone ten years of unremarkable screening mammograms. On admission, laboratory workup was notable for markedly elevated liver enzymes. Computerized tomography scan indicated evidence of an ileocecal valve mass and extensive diffuse hepatic metastases. Endoscopic evaluation revealed a benign appearing 30mm sessile polyp in the proximal rectum 15cm from the anal margin and a 3mm ulcer in the cecum (A, B, C, D). Pathologic evaluation and immunohistochemical analysis of the cecal ulceration tissue was suggestive of a diagnosis of primary breast cancer with metastasis to the colon (E, F, G, H).The polyp in the proximal rectum was benign. The patient elected to be discharged to home and had close follow-up. The rapidly progressive nature of the patient’s presentation prevented further workup and ultimately the patient expired less than a month after diagnosis. Discussion: We present an unusual case of metastatic carcinoma of the breast to the colon and liver in an individual without a previous diagnosis of breast cancer who is treatment naïve. The accelerated time course from presentation to patient death was noteworthy. Accurate identification and differentiation between primary gastrointestinal cancer and metastatic breast cancer is paramount to proper management and treatment of the disease. This can be achieved through engaging a multidisciplinary team. This case highlights the need to maintain a high index of suspicion for colon ulcers and lesions as potential sites of metastasis of other primary malignancies such as breast cancer.Figure 1.: A 30mm sessile polyp in the proximal rectum 15cm from the anal margin (A), rectal polyp resected and retrieved (B), and 3mm ulcer in the cecum (C, D). Medium power (40x) and high power (100x) views of a H&E stained slide shows a biopsied fragment of colonic mucosa with metastatic carcinoma involving the deep mucosa and superficial submucosa. The moderately to poorly differentiated malignant epithelial cells infiltrate in nests and cords without forming clear glandular structures (E, F). Nuclear hyperchromasia is seen on higher magnification (F). Immunohistochemical staining, essential in the characterization of this tumor, supports the diagnosis of a carcinoma metastatic from the breast. CK7 shows strong, diffuse positivity, highlighting tumor cells (G). GATA3 shows scattered but strong, nuclear positivity (H). Tumor cells are negative for CK20, CDX2, and S100.

Associations between multimorbidity and depression among breast cancer survivors within the UK Biobank cohort: a cross-sectional study

BackgroundAdvances in the early detection of cancer and its treatment have resulted in an increasing number of people living with and beyond breast cancer. Multimorbidity is also becoming more common in this population as more people live longer with breast cancer and experience late effects of cancer treatment. Breast cancer survivors have heightened risk of depression, but to what extent multimorbidity affects the mental health of this population is less clear. This study aims to investigate the association between multimorbidity and depression among women living with and beyond breast cancer in the UK Biobank cohort.MethodsData from UK Biobank (recruitment during 2006 to 2010, aged 40–70 years) were used to identify 8438 women with a previous diagnosis of breast cancer via linked cancer registries in England, Scotland and Wales. The lifetime number of chronic conditions was self-reported and multimorbidity defined as 0, 1, 2, 3, 4 or 5+. The Patient Health Questionnaire (PHQ-2) was used to define participants that were likely to have depression based on their symptom reporting at baseline. Logistic regression models were used to analyse the associations between multimorbidity and depression, accounting for a number of potential sociodemographic confounding variables (including age, ethnicity, socioeconomic deprivation, education level and marital status) and characteristics related to the cancer (number of years since diagnosis and recurrence/secondary cancer).ResultsMultimorbidity was common among breast cancer survivors, with 32.9% of women experiencing one and 30.1% experiencing two or more chronic health conditions. Hypertension (25.8%), painful conditions (18.3%), and asthma (11.6%) were the three most common co-morbid conditions. 5.3% of participants had current depression. A strong, dose-response relationship was found between multimorbidity and the likelihood of depression (OR = 2.09, 95% CI: 1.56–2.79 for two conditions and OR = 6.06, 95% CI: 3.63–10.14 for five or more conditions).ConclusionsMultimorbidity and depression were strongly associated among female UK Biobank participants with a previous breast cancer diagnosis. This association became increasingly pronounced as the number of chronic comorbid conditions increased. As more people survive cancer for longer, increasing recognition and support for multimorbidity and its impact on mental health is needed.

Fertility-related information received by young women and men with cancer – a population-based survey

Background Infertility is a well-known sequela of cancer treatment. Despite guidelines recommending early discussions about risk of fertility impairment and fertility preservation options, not all patients of reproductive age receive such information. Aims This study aimed to investigate young adult cancer patients’ receipt of fertility-related information and use of fertility preservation, and to identify sociodemographic and clinical factors associated with receipt of information. Materials and Methods A population-based cross-sectional survey study was conducted with 1010 young adults with cancer in Sweden (response rate 67%). The inclusion criteria were: a previous diagnosis of breast cancer, cervical cancer, ovarian cancer, brain tumor, lymphoma or testicular cancer between 2016 and 2017, at an age between 18 and 39 years. Data were analyzed using logistic regression models. Results A majority of men (81%) and women (78%) reported having received information about the potential impact of cancer/treatment on their fertility. A higher percentage of men than women reported being informed about fertility preservation (84% men vs. 40% women, p < .001) and using gamete or gonadal cryopreservation (71% men vs. 15% women, p < .001). Patients with brain tumors and patients without a pretreatment desire for children were less likely to report being informed about potential impact on their fertility and about fertility preservation. In addition, being born outside Sweden was negatively associated with reported receipt of information about impact of cancer treatment on fertility. Among women, older age (>35 years), non-heterosexuality and being a parent were additional factors negatively associated with reported receipt of information about fertility preservation. Conclusion There is room for improvement in the equal provision of information about fertility issues to young adult cancer patients.

Abstract PS8-11: Recruitment strategies for enrollment of high-risk women to a randomized controlled trial of web-based decision support tools to increase breast cancer chemoprevention

Abstract Background: Less than 10 % of those identified as eligible for clinical trials are recruited. Recruitment for chemoprevention trials poses challenges as it is often difficult to identify unaffected patients at high risk for cancer. Barriers to recruitment include personal perceptions of the benefits, fear of trials, low recruitment of minorities, language barriers, transportation costs, and complex study designs. In this study, we identified five potential sources of recruitment that could be collectively leveraged to identify women at high risk for breast cancer to improve recruitment yield. Methods: A total of 300 high-risk women and 50 healthcare providers were recruited and randomized to access web-based decision support tools in combination with standard educational materials or standard educational materials alone. Patient inclusion criteria included: 1) women, age 35-75 years; 2) English or Spanish-speaking; 3) no previous breast cancer diagnosis; 4) no prior use of selective estrogen receptor modulators (SERMs) or aromatase inhibitors (AIs). Five broad strategies were considered for identification and recruitment of women at high risk for breast cancer: 1) in-person recruitment during routine screening mammography with survey administration for breast cancer risk assessment according to the Gail model; 2) collection of breast cancer risk factors from the electronic health record (EHR) for risk assessment according to the Breast Cancer Surveillance Consortium (BCSC) risk calculator; 3) identification of women with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS) using ICD-9/10 diagnostic codes from the EHR; 4) high-risk women with clinic appointments and referred by enrolled providers; 5) women who responded to recruitment flyers and online recruitment distributed throughout the medical center and community. Results: A total of 6229 high-risk women were identified using these recruitment sources, of which 3663 were contacted by email, mailed letter, and/or phone for participation in our clinical trial. Of these contacted women, 16.4% were identified through in-person recruitment during screening mammography, 35.8% through breast cancer risk factors in the EHR, 14.5% had a diagnosis of AH or LCIS identified in the EHR, 28.7% had appointments with enrolled providers, and 4.5% responded to recruitment flyers or online recruitment. Women from the different recruitment sources varied by mean age (64.7 years for mammography and 44.9 years for recruitment flyers), race/ethnicity (73.7% non-white from mammography and 45.5% from breast cancer risk factors in the EHR), and mean 5-year breast cancer risk (2.56% identified from the EHR and 1.34% from recruitment flyers). Of 300 consented patients, 44.7% came from provider referrals (12.7% recruitment yield [number consented/number contacted]) and 27.3% from mammography (13.6% recruitment yield). Comparing enrolled to unenrolled patients, there were significant differences in mean age (57.3 vs. 58.7 years, p=0.027), proportion of non-whites (41.5% vs. 54.7%, p&amp;lt;0.001), and mean 5-year breast cancer risk (3.0% vs. 2.2%, p&amp;lt;0.001). Conclusions: We were able to identify a large cohort of women at high risk from breast cancer from multiple different recruitment sources. Our recruitment yield was highest among direct referrals from healthcare providers and in-person recruitment from mammography. Consented patients tended to be younger, include more non-Hispanic whites, and have a higher risk of breast cancer compared to the overall pool of high-risk women identified. We were able to successfully recruit a racially-ethnically diverse study population to a randomized controlled trial of decision support for breast cancer chemoprevention. Citation Format: Gauri Bhatkhande, Thomas Silverman, Jennie Mata, Ashlee Guzman, Ting He, Jill Dimond, Tarsha Jones, Rita Kukafka, Katherine Crew. Recruitment strategies for enrollment of high-risk women to a randomized controlled trial of web-based decision support tools to increase breast cancer chemoprevention [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-11.