Previous History Of Breast Cancer Research Articles

Abstract PO5-02-14: Clinical-pathological determinant factors to choose between four or six cycles of adjuvant chemotherapy with docetaxel/cyclophosphamide (TC) in a retrospective real-world cohort of HER2-negative breast cancer patients

Abstract Introduction: The long-term severe adverse events associated with anthracyclines, including irreversible cardiotoxicity, myelodysplastic syndromes, and therapy-related leukemias, led researchers to question the risk-benefit of anthracycline-based chemotherapy regimens, especially for patients without axillary lymph node involvement, leading to an increasing trend to omit anthracyclines in adjuvant treatment. Docetaxel plus cyclophosphamide (TC) has replaced doxorubicin plus cyclophosphamide (AC) for lower-risk patients that need adjuvant chemotherapy. However, the optimal number of cycles of adjuvant in patients with node-positive or node-negative breast cancer is currently unknown. Methods: We performed a retrospective cohort study of patients with HER2-negative breast cancer, stage I to III, that received adjuvant docetaxel and cyclophosphamide (TC) for four or six cycles, treated from January 2010 to December 2021. Patients were included from four cancer institutions, both private and public, located in the South, Southeast, and Northeast of Brazil. Objectives: To investigate the clinical-pathological characteristics and survival of earlystage HER2-negative breast cancer patients who received four (TC4) or six cycles (TC6) of adjuvant docetaxel and cyclophosphamide (TC). Results: We collected data from six hundred and ninety-eight patients, 98.7% were female with an average age of 52 years, 51.9% were postmenopausal, 14.6% BRCA gene mutation, 66% had some comorbidity, and only 8.4% were not candidates for anthracyclines. Two hundred and twenty-five patients had public and 473 private health insurance. About 13.2% of the patients were hormone receptor negative (HR-) and 86.8% hormone receptor positive (HR+), 57.4% breast-conserving surgery and 77.7% sentinel lymph node (SL). Five hundred sixty-four (80.8%) patients received TC4 and 134 (19.2%) TC6. We observed that patients who received TC 6 had unfavorable prognostic factors such as: (TC4 vs TC6) previous breast cancer (8.7% vs 16.3%) (p=0.002), invasive ductal carcinoma (IDC) (73.4 vs 86.7%) (p=0.009), histological grade 3 (HG3) (34.9 vs 42.9%) (p= 0,085) conservative surgery (59.4% vs 53%) (p=0144), SL (80.9% vs 62.2%) (p =0.001), Lymph node positive (15% vs 42.3%) (p=0.001), pathological stage II (37.5% vs 50%) (p=0.001).Treatment completion rates were 96.5% and 84.3% for TC4 and TC6, respectively (p=0,02). The incidence of grade 3 or higher toxicity with TC6 (14% vs 21.1%; p= 0,043). Febrile neutropenia was observed in 6.7% of both groups. Grade 3 or higher neuropathy was most common with TC6 (2.2% vs 10.3%; p=0,163). Permanent treatment discontinuation was more frequent in the TC6 group (3.4% vs. 9.8%; p=0,004), as well as late toxicity (3.4% vs. 9.2%; p=0,004). Ninety-four percent of the patients completed the proposed cycles of chemotherapy, 72% received adjuvant radiotherapy and 85.4% received adjuvant hormone therapy, with 42% of these receiving an aromatase inhibitor for 5 years. The median follow-up of the entire cohort was 61 months. There was no difference in the 5-year DFS (77.5% vs. 64.7%; p=0.159) or the 5-year OS (89.5% vs. 70.5%; p= 0,06) between patients treated with TC4 and TC6. Conclusion: TC6 was commonly used for patients with unfavorable prognostic factors as history of previous breast cancer, (IDC), HG III, lymph node positive and stage II. Patients who received TC6 had less chance of completing the treatment and more severe toxicity, especially late peripheral neuropathy. There was no difference in DFS or OS. Citation Format: Mila Kraychete, Marcelle Cesca, Guilherme Almeida, Leonardo Santana, Luciana Leite, Solange M. Sanches, Vladmir Cordeiro de Lima, Rafaela Pirolli, Rafael Manea, Felipe Kaneta, Jean Coutinho, Lucas Vian, Waires Zeviani, Marcio Reis, Luciana Landeiro, Clarissa Mathias, Geila Nunez, Tamara Santana, Monique Tavares. Clinical-pathological determinant factors to choose between four or six cycles of adjuvant chemotherapy with docetaxel/cyclophosphamide (TC) in a retrospective real-world cohort of HER2-negative breast cancer patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-02-14.

Abstract PO2-21-01: Granular Cell Tumors of the Breast: A Case Series

Abstract Objective: Granular cell tumors (GCT) of the breast are rare, Schwann-cell derived tumors that are largely benign in nature, but may present with malignant characteristics in 1-2% of cases. There are few reports highlighting the clinical presentation, cytologic differences, operative management and clinical outcomes of patients with these benign versus malignant GCTs. Here, the authors report the clinical course of 9 patients identified with either benign or malignant GCT of the breast. Methods: The medical records for a total of 9 patients treated for histologically confirmed GCT of the breast between March 2015 and May 2023 at our institution were retrospectively reviewed. Clinical data, imaging findings, immunohistochemical markers, surgical interventions, and clinical follow-up data were collected and analyzed. Results: All patients were female, with a mean age of 46 years (Range: 29-61). 5 (56%) patients presented with left-sided lesions with an average maximum dimension of 1.1 cm (SD: 0.7 cm). All 9 (100%) tumors were positive for S100, 4 (44%) were positive for CD68, and 3 (33%) were positive for Inhibin. 4 (44%) patients underwent local mass excision, 3 (33%) underwent lumpectomy, 1 (11%) underwent lumpectomy with sentinel lymph node biopsy, and 1 (11%) underwent partial mastectomy with sentinel lymph node biopsy. There were no perioperative complications nor complications noted at postoperative follow up visits. 1 patient (11%) had 2 recorded recurrences of GCT after the initial breast mass excision, with each tumor exhibiting different positive immunohistochemical markers. 1 (11%) patient had a previous history of breast cancer at time of GCT diagnosis, and 1 (11%) patient had concurrent breast malignancy with the granular cell tumor being in the lymph node of the same breast. Conclusions: Granular cell tumors of the breast are rare Schwann cell derived tumors that often present near breast scar tissue as spiculated, ill-defined masses with microcalcifications on radiologic imaging, mimicking breast malignancy, leading to overtreatment. This study found that for GCTBs that present in lymph nodes, regardless of low malignant potential seen histologically, there was a higher risk of recurrence, and may require further workup and close follow up after wide local excision. For all other granular cell tumors presenting with normal appearing lymph nodes on imaging, a local mass excision was adequate in management, with low risk of recurrence or malignant potential. Future studies should be performed analyzing long-term follow up for these patients to determine risk of recurrence over longer periods of time, and risk for breast malignancy. Granular Cell Tumor Characteristics Tumor characteristics including laterality, tumor location, maximum dimension in centimeters, and positive immunohistochemistry markers were shown for each patient. Citation Format: Shwetha Kochi, Madeline Karsten, Monika Masanam, Teagan Thorson, Roshanak Derakhshandeh, Patricia Wehner, Lucy De La Cruz, Jennifer Son. Granular Cell Tumors of the Breast: A Case Series [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-21-01.

INITIAL HFRT EXPERIENCE ON TREATING LARGE BRAIN METASTASES LESION: A CASE REPORT

Abstract
 Background: Brain metastases in cancer patients are increasing, due to advances in imaging and systemic treatment. Stereotactic Radiosurgery (SRS) is a high-end radiotherapy technique that is preferred to treat small brain metastases. Hypofractionated Radiotherapy (HFRT) is an alternative technique that demand lower requirements and ideal for treating larger brain metastases. This case report intended to report our institution initial experience using HFRT in limited setting to treat a patient with large brain metastases. 
 Case Presentation: A-43 years old women with previous breast cancer history was admitted with general weakness and severe headache since 2 weeks before admission. A CT scan exam shows multiple metastatic lesions on both parietal lobe, the largest lesion measures ≥ 3cm in diameter with a prominent vasogenic edema that caused lateral ventricle compression and mild midline shift.
 Discussion: SRS is preferred to treat brain metastases due to its efficacy and excellent therapeutic ratio. Unfortunately it has limitation in treating large metastatic lesions. For such lesions, HFRT being a simpler radiation technique can be opted to achieve acceptable local control and low toxicities profile. We use HFRT to treat a patient with large brain metastases lesion using IMRT with 10 x 4Gy fractionation scheme. The evaluation results 6 weeks later shows no viable brain lesion without any cognitive deterioration reported.
 Conclusion: HFRT for large brain metastases treatment is safe and viable to conduct in institution with limited resources. This relatively simpler technique compared to SRS should be considered to achieve acceptable therapeutic ratio with minimal toxicities.

Characteristics of multifocality/multicentricity in breast cancer and its effect on axillary lymph node metastasis

Multifocal (MF) and multicentric (MC) breast cancers are seen with increasing frequency with advances in imaging methods. However, there is no consensus on the behavior and management of these tumors. In this study, we aimed to investigate the characteristics of MF/MC breast cancers and their relationship with axillary lymph node metastasis (ALNM). Patients who underwent surgery for breast cancer between January 2015 and January 2023 were retrospectively scanned. Exclusion criteria were as follows; male breast cancer, second primary cancer diagnosis, previous breast cancer history, previous excisional/incisional breast biopsy, neoadjuvant chemotherapy, and occult breast cancer. Multiple tumors that were closer than 5 cm to each other were defined as MF, and the others were defined as MC. T stage was determined in two different ways, using the largest tumor diameter (Tmax) and the aggregate tumor diameter (Tsum), and two different multivariate analysis models were applied. A total of 156 patients were enrolled in the study, including 130 unifocal (UF), 17 MF and 9 MC. Lymphovascular invasion (LVI) (p=0.43), ALNM (p=0.23), younger age (<50) (p=0.41) and invasive lobular carcinoma (ILC) (p<0.001) were higher in MF/MC tumors than in UFs. When comparing MF and MC, no difference was seen except progesterone receptor positivity (p=0.017). In both multivariate analyses, LVI and ILC had an effect on ALNM, while no effect of MF/MC was seen. In addition, while T stage had a significant effect on ALNM in the model using Tsum, it did not have a significant effect in the Tmax model. Our retrospective data supports that MF/MC is not a direct risk factor for ALNM and that the main factor affecting ALNM is the total tumor burden.

Endometrioid type adenocarcinoma in situ as a potential precursor lesion for extremely rare invasive endometrioid type adenocarcinoma of the cervix

HPV-independent in situ adenocarcinomas have been only recently added to the WHO 2020 classification. To date, little information has been published about HPVindependent precursor lesions. In particular, regardiong the extremely rare cervical endometrioid type adenocarcinoma thought to arise in the setting of cervical endometriosis, a premalignant lesion is still not well defined. In this short communication we describe a possible precursor to invasive cervical endometrioid type adenocarcinoma in a 39-yr-old patient, with a previous history of breast cancer.

Axillary lymph nodes enlargement after Sars-CoV-2 vaccine in patients undergoing breast examination: a single-centre experience in 285 women.

To assess the incidence of axillary lymphadenopathy over established time ranges after COVID-19 vaccination and lymph node pathologic features (i.e. size increase and qualitative characteristics) in subjects undergoing axillary evaluation during a breast imaging examination. The institutional review board approved this prospective study. women undergoing mammography and breast ultrasound between July and October 2021; information about the COVID-19 vaccine and infection, if any. known metastatic lymphadenopathy. Participants were divided into 5 subgroups according to time between vaccine and imaging: < 6weeks; 7-8weeks; 9-10weeks; 11-12weeks; > 12weeks. Evaluation of axillary lymph nodes was performed with ultrasound. Descriptive statistical analysis was performed. p < 0.05 was considered significant. A total of 285 women were included. Most of the patients underwent Moderna vaccine (n = 175, 61.4%). 63/285 patients had a previous history of breast cancer (22.1%). 13/17 (76.5%) patients with previous COVID-19 infection had no previous history of cancer, whereas 4/17 had a previous history of cancer (p < .001). 41/285 (14.4%) women showed lymphadenopathy, and they were significantly younger (46.9 ± 11.6years) than women with borderline (54.0 ± 11.9years) or no lymphadenopathy (57.3 ± 11.9years) (p < .001). Lymphadenopathy and borderline lymphadenopathy were more frequently observed in the Moderna-vaccinated women and in the subgroup of patients evaluated < 6weeks after vaccination (p < 0.001). The most common pathologic feature was cortical thickening, followed by complete or partial effacement of fatty hilum. A lymphadenopathy within 12weeks after vaccination is a common finding particularly in younger women and after Moderna vaccine and no further assessment should be required.

221 Prevalence of breast cancer patients with distant metastases at the time of presentation – A retrospective cohort study

Abstract Introduction About 8% of new breast cancer patients have distant metastases at presentation.[1] Current local practice is to perform staging CT on selected patients. The aim of this study was to investigate the prevalence of distant metastases in a cohort of newly diagnosed breast cancer. Methods A single-institution retrospective analysis of prospectively collected database of all newly diagnosed patients between January and June 2019 (pre-covid era). Patients with previous history of breast cancer were excluded. Data was collated from hospital medical records. SPSS version 21 was used for analysis. Results A total of 85 patients with a mean age of 66±15.593 were included. Tumour size ranged from 1.4 to 83mm. 22.4% were ER Negative, 14.8% HER2 positive and 37.3% node positive. Almost half of the patients (49.4%) underwent staging investigations at first presentation. The incidence of distant metastases within 1 year of presentation was 10.6% (9/85). 4/9 (44.4%) presented late with symptoms greater than 3 months duration. On applying one-way ANOVA to compare means, distant metastases at presentation was significantly related to grade (p-value= 0.002) and nodal status (p-value=0.006). There was no statistically significant relationship to age, ER/HER-2 status, tumour size or duration of symptoms. Conclusions Metastatic breast cancer at presentation in our cohort appears concordant with the literature. Distant metastases within a year of presentation is significantly related to grade independent of nodal status, and staging investigations should be considered in early breast cancer patients with higher tumour grade irrespective of other factors. 1. https://pubmed.ncbi.nlm.nih.gov/35018787/

Novel germline variants of MUC3A in a patient with ER+ breast cancer and signet-ring cell stomach adenocarcinoma

BackgroundPrimary gastric cancer after breast cancer surgery and chemotherapy is rare and their genetic factors are poorly understood. In this case study, the exonic sequences of a gastric cancer (GC) patient with a previous history of breast cancer were explored. Materials and methodsThe study involves a 58-year-old diabetic patient from Mizoram, Northeast India underwent surgery and chemotherapy for estrogen receptor-positive breast cancer. The patient contracted tuberculosis and was later diagnosed with metastatic GC after 5 years and underwent subtotal gastrectomy followed by chemotherapy. Genomic DNA was isolated from the patient blood, whole exome sequencing was performed, and analyzed for germline variants. The variants were compared with exome data from additional 21 GC patients and 27 healthy controls. Statistical analysis was performed to compare the occurrence of variants between cancer and healthy control datasets. ResultsThe patient had CDH1, BRCA1, and BRCA2 mutations, while a rare variant rs750547893 in SMARCA4 was observed. Furthermore, an unusual phenomenon was observed in the MUC3A with 80 missense variants, including 19 novel variants. One-way ANOVA revealed a significant difference in the mean number of missense MUC3A variants observed between GC and healthy controls (F = 317.92, P = 1.50e-22). Fisher's exact test on the number of MUC3A missense variants in GC and healthy controls revealed 70 variants that were significantly associated with cancer (P < 0.05) and out of which 20 variants were present exclusively in the case, including 9 novel variants. ConclusionsThe rare variant, rs750547893 in SMARCA4 was not reported in the database of over 1000 healthy Indians (IndiGenomes database). Due to conflicting clinical interpretation, the variant is classified as the variant of uncertain significance (VUS), although it is reported for hereditary cancer predisposing syndrome in ClinVar. Furthermore, Statistical analysis revealed that these MUC3A variants could be a significant factor in cancer. The presence of such missense variants in MUC3A could affect the mucus integrity and might contribute to multiple types of cancer development in the patient. Due to the unavailability of pathogenicity information from the clinical point of view, the variants are classified as VUS. This is the first report of such a large number of variants in the MUC3A gene and future efforts may reveal the clinical significance.

Mammographic calcifications undergoing percutaneous biopsy: outcome in women with and without a personal history of breast cancer

PurposeTo compare the positive predictive values (PPVs) of BI-RADS categories used to assess pure mammographic calcifications in women with and without a previous history of breast cancer (PHBC).Materials and methodsIn this retrospective study, all consecutive pure mammographic calcifications (n = 320) undergoing a stereotactic biopsy between 2016 and 2018 were identified. Mammograms were evaluated in consensus by two radiologists according to BI-RADS and blinded to patient history and pathology results. Final pathologic results were used as the standard of reference. PPV of BI-RADS categories were compared between the two groups. Data were evaluated using standard statistics, Mann–Whitney U tests and Chi-square tests.ResultsTwo hundred sixty-eight patients (274 lesions, median age 54 years, inter-quartile range, 50–65 years) with a PHBC (n = 46) and without a PHBC (n = 222) were included. Overall PPVs were the following: BI-RADS 2, 0% (0 of 56); BI-RADS 3, 9.1% (1 of 11); BI-RADS 4a, 16.2% (6 of 37); BI-RADS 4b, 37.5% (48 of 128); BI-RADS 4c, 47.3% (18 of 38) and BI-RADS 5, 100% (4 of 4). The PPV of BI-RADS categories was similar in patients with and without a PHBC (P = .715). Calcifications were more often malignant in patients with a PHBC older than 10 years (47.3%, 9 of 19) compared to 1–2 years (25%, 1 of 4), 2–5 years (20%, 2 of 10) and 5–10 years (0%, of 13) from the first breast cancer (P = .005).ConclusionPPV of mammographic calcifications is similar in women with or without PHBC when BI-RADS classification is strictly applied. A higher risk of malignancy was observed in patients with a PHBC longer than 10 years.

An Underrated Diagnosis of Superior Mesenteric Artery Syndrome: A Case Report.

Superior mesenteric artery syndrome (Wilkie’s syndrome) is a rare cause of intestinal obstruction caused by a congenital or acquired reduction of the aorto-mesenteric angle leading to duodenal compression. We present the case of a 51-year-old female patient with a previous history of breast cancer. She was admitted to the Emergency Department with acute onset of recurrent vomiting, intense abdominal pain especially in the epigastric region, and abdominal distension. The ultrasound showed an absence of lower abdominal quadrants with an enlarged and distended stomach reaching the pelvis. The computer tomography scans confirmed the diagnosis of superior mesenteric artery syndrome. Conservative management was implemented, and using a nasogastric tube, and upped endoscopy approximately 4000 mL of fluid were aspirated with clinical improvement shortly after. The patient resumed a high-calorie diet and five months later, the patient was completely asymptomatic.

Breast cancer patients are at increased risk of developing uterine serous cancer: Implications for counseling - SEER analysis (402)

<b>Objectives:</b> Several studies have investigated whether patients with prior breast cancer (BC) are at increased risk for endometrial cancer/uterine serous cancer (USC). We aimed to study the relationship between previous BC and uterine serous carcinoma (USC) and analyze the effect of prior BC on the incidence and prognosis of USC patients. <b>Methods:</b> With permission of the Surveillance, Epidemiology and End Results (SEER) program of the United States National Cancer Institute, clinical-pathologic information of women diagnosed with BC and following USC were analyzed. The recorded data included age at diagnosis, stage of disease, cause of death, interval time between BC and USC diagnosis, and overall survival. Further analysis was performed according to estrogen receptor status. <b>Results:</b> The SEER database included 10021 patients with USC during the years 1975-2015. Among the patients, 698 (6.96%) had been previously diagnosed with breast cancer (BC). The incidence of USC in patients with BC history was 57 times higher than in women without BC history (p value < 0.001). The incidence of USC did not differ between ER positive and ER negative BC patients (p. value 0.94). The mean survival of USC patients with previous BC history was eight years (96 months, 95% CI: 85.7-106.2), while for USC patients with no BC history the mean survival was 10.6 years (127 months, 95% CI: 124.0-130.8), suggesting a superior survival rate for USC patients with no history of BC (p. value=0.002). Fig. 1 <b>Conclusions:</b> Our results highlight the relationship between BC and USC, suggesting an increased risk for USC among BC patients. This clinical association should be introduced to BC patients, and physicians should be alert to any EC presenting symptom in BC survivors.

Breast Cancer Patients Are at Increased Risk of Developing Uterine Serous Cancer: Implications for Counseling – A SEER Analysis

Introduction: Several studies have investigated whether patients with prior breast cancer (BC) are at an increased risk for endometrial cancer (EC)/uterine serous cancer (USC). We aimed to study this relationship and analyze the effect of prior BC on the incidence and prognosis of USC patients. Methods: With permission of the Surveillance, Epidemiology, and End Results (SEER) program of the US National Cancer Institute, clinicopathological information of women diagnosed with BC and following USC were analyzed. The recorded data included age at diagnosis, stage of disease, cause of death, interval time between BC and USC diagnosis, and overall survival. Results: The SEER database included 10,021 patients with USC during the years 1975–2015. 698 (6.96%) of these patients had been previously diagnosed with BC. The incidence of USC in patients with BC history was 57 times higher than in women without BC history (p value <0.001). The incidence of USC did not differ between estrogen receptor (ER)-positive and ER-negative BC patients (p value 0.94). The mean survival of USC patients with previous BC history was 8 years (96 months, 95% CI: 85.7–106.2), shorter than in USC patients with no BC history, presenting a mean survival of 10.6 years (127 months, 95% CI: 124.0–130.8) (p value = 0.002). Conclusion: Our results highlight the relationship between BC and USC, suggesting an increased risk for USC among BC patients. This clinical association should be introduced to BC patients, and physicians should be alert to any EC presenting symptom in BC survivors.

Breast cancer incidence in patients with BRCA-related advanced ovarian cancer receiving olaparib-based maintenance therapy: A pooled analysis from phase III clinical trials.

5566 Background: As the prognosis of BRCA-related advanced ovarian cancer (AOC) continues to improve thanks to the introduction of targeted therapies like poly ADP-ribose polymerase inhibitors (PARPi) and bevacizumab, the occurrence of second primary tumors, in particular breast cancer (BC), is assumed to be more common. Despite this, data on the incidence of BC in this population are poor and guidelines for BC screening or risk reducing strategies are lacking. Methods: Published data from recent PARPi-based, phase III clinical trials involving germline BRCA mutated AOC were reviewed and analyzed. Only studies in which the incidence of at least one second primary solid tumor was reported were included. Cases of second primary BC cancers were pooled to calculate cumulative incidence according to the median follow-up period for each trial. 95% confidence interval (CI) was considered. Results: Four trials (SOLO1, PAOLA1, SOLO2 and SOLO3) involving 1186 germline BRCA 1-2 mutated AOC patients were included ( BRCA1, n = 816; BRCA2, n = 360; BRCA1 + BRCA2, n = 4; missing, n = 6). In all trials, patients were randomized to receive olaparib +/- bevacizumab (n = 788) versus placebo or standard therapies (n = 398). Median age at diagnosis of AOC was 56 years (range, 29-87). With a follow-up ranging from 3.9 months to 5 years, 16 new cases of BC were recorded, 10 in PARPi-based arms and 6 in control arms. Only two patients had a previous history of BC. The total cumulative incidence of BC was 1.37% (95% CI, 0.77-2.18), while cumulative incidences were 1.26% (95% CI, 0.61-2.31) and 1.51% (95% CI, 0.55-3.25) in PARPi-based arms and control arms, respectively. In a sensitivity analysis excluding the SOLO3 trial with the shortest follow-up, the total cumulative incidence was 1.63% (95% CI, 0.92-2.67). Other 20 cases of second primary solid tumors were registered, including 4 cases of non-small cell lung cancer. Conclusions: Patients with germline BRCA-related AOC receiving PARPi-based maintenance therapy can be reassured about the risk of second primary BC and intensive screening should be avoided at least in early treatment phase. More data with long term follow-up are needed.

Abstract P4-11-26: The importance of physical exercise in cardiovascular fitness in breast cancer survivors. A cross sectional study: WIM 2.0

Abstract Introduction: Cardiorespiratory Fitness (CRF) has been described as an independent factorassociated with better survival in Breast Cancer Survivors (BCS). In addition, an altered BodyComposition (BodComp) impacts in a worst prognosis and increase treatment side effects.Despite this, BCS present lower levels of CRF than women without previous history of breastcancer (BC) and around 3% of BCS are obese, with an average of 1.8 to 5.0 kg of weight gainduring chemotherapy treatments and weight keeps rising during hormonotherapy.Exercise has been proved as an effective tool to help BCS not only to reduce treatments sideeffects improving significantly CRF, but also, to allow controlling and improving BodCom duringand after treatments.However, it is not clear if active BCS could achieve similar values of CRF and BodCom than activehealthy women and the impact of a sedentary behavior in them. Purpose: To establish the impact of physical exercise in CRF and BodComp recovery in BCS withinthe last five years compared to women without a BC diagnosis. Material and Methods: in this cross-sectional study, women with and without BC were invitedinto a sport centre in Madrid, (Spain) to evaluate their general physical condition and bodycomposition. Participants were classified into four different groups: sedentary-BC, active-BC,sedentary healthy and active healthy (Sed-BCW, Act-BCW, Sed-HW, Act-HW, respectively).VO2max, speed level, isometric strength, lower body maximum strength, explosive strength andbalance were assessed with different physical test. Body composition was measured bybioimpedance.In terms of statistical analysis, analyses of variance (ANOVA) were used with continuousvariables to compare groups and post- hoc comparisons used Bonferroni test. Results: A total of ninety two women were recruited (23 in each group).In terms of VO2max, significant differences were found between active and sedentary BC (Difmean (ΔM)= 5.86, IC 95% 3.16 - 8.55; p&amp;lt;0.001). No differences in VO2max were observed betweenthe active groups (ΔM = 0.42, IC 95% -2.26 to 3.12; p= 0.753). In terms of BodCom, it wasobserved significant differences in FM% comparing Act-BCW with Act-HW (ΔM= -11.57; IC 95%-16.80 - -6.33), Sed-BC (ΔM= -6.78; IC 95% -12.52 to -1.54) and Sed-HW (ΔM= -12.07; IC 95% -17.31 to -6.83). In terms of percentage lean mass (LM%), results are presented in (table 1).Active-BC showed significant better results than sedentary groups in other parameters of thephysical condition compared with sedentary women, but not with the Active healthy group(Table 1).Significant differences between Active-BC and sedentary groups were found regarding totalweight, water and visceral mass (p&amp;lt;0,01 for all). Table 1. Mean differences, significance and CI 95% in physical and body composition variablesbetween groups.Act-BCW- Sed-BCWAct-BCW - Act-HWAct-BCW - Sed-HW6MWT (m)71.52**37.36 -105.68-3.04-37.20 - 31.1176.57**42.41 - 110.7235m (sec)-1.87*-3.44 - 0.300.17-1.40 - 1.74-2.39**-3.96 - -0.82Jump (cm)5.48**1.47 - 9.49-2.87-6.88 - 1.144.91*0.90 - 8.92Strength Index0.63**0.31 - 0.95-0.09-0.40 - 0.210.376*0.07 - 0.68LM(%)5.20*-1.62 - 8.780.72-2.86 - 4.38.59**3.72 - 13.45*=p&amp;lt;0,05; **=p&amp;lt;0,01. Conclusions: This study provide two main contributions related to the importance of physicalactivity in BC survivors: BC women who maintain an active lifestyle can achieve the same valuesin physical condition as active healthy women, and significant better values than the sedentarygroups. These results suggest than physical exercise might be a stronger determinant of bodycomposition than a previous history of BC. Citation Format: Lucía Gil Herrero, Marina Pollán Santamaría, Miguel Martín Jimenez, Sara López Tarruella, Mónica Castellanos Montealegre, Soraya Casla Barrio. The importance of physical exercise in cardiovascular fitness in breast cancer survivors. A cross sectional study: WIM 2.0 [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-26.

Is Yoga Associated With Improved Sleep Amongst Breast Cancer Survivors?

Breast cancer survivors may experience sleep disturbances that can affect their physical and mental well-being. We sought to determine the association, if any, between yoga and sleep among breast cancer survivors in a population-based cohort. The National Health Interview Survey is designed to be representative of the US civilian non-institutionalized population. We evaluated breast cancer survivors in the 2017 cohort to determine the association between yoga and self-reported quality of sleep. Of the 25,905 people surveyed, representing 238,738,039 in the population, 1.59% reported a previous history of breast cancer. Breast cancer survivors were less likely to report having practiced yoga in the preceding 12months, compared to those without a history of breast cancer (9.98% vs 13.78%, P = .011). In addition, they were more likely to report having had trouble falling asleep (44.64% vs 36.32%, P = .002), staying asleep (53.72% vs 39.43%, P < .001), and using sleep medication on at least 1day within the previous week (23.80% vs 13.49%, P < .001) than those without breast cancer. Among breast cancer survivors, there were no significant differences in difficulty falling asleep (39.16% vs 44.98%, P = .482), difficulty staying asleep (61.17% vs 52.70%, P = .305), and needing sleep medication (19.03% vs 24.53%, P = .395) between those who practiced yoga and those who did not. Controlling for sociodemographic factors, there remained no association between yoga and difficulty falling or staying asleep among breast cancer survivors. There is no direct association between yoga and sleep quality in breast cancer survivors.

Axillary adenopathy after COVID-19 vaccine in patients undergoing breast ultrasound.

After COVID-19 vaccination, a spectrum of axillary lymphadenopathy were observed in patients undergoing routine breast ultrasound. Malignancy remains the most serious differential in cases of unilateral axillary adenopathy. Knowledge of axillary ultrasound findings after COVID-19 vaccination is essential to prevent unnecessary biopsy or change in therapy in oncological patients. From March to May 2021, 10 female patients underwent breast ultrasound in our Department for the evaluation of axillary lumps. All the patients received their first or second dose of COVID-19 vaccine 20–30 days before the exam in the same extremity of the ultrasound evaluation where lymphadenopathy was found. Five patients had a personal history of previous breast cancer, and the radiologist decided to perform a core biopsy (the histology was negative for malignancy). The other five patients with no personal history of cancer underwent ultrasound and returned after a short-term follow-up. Regression of the enlarged lymph nodes was found.

Risk of breast cancer in women treated with ovarian stimulation drugs for infertility: a systematic review and meta-analysis

To evaluate the evidence addressing the association between the use of ovarian stimulation drugs and the risk of breast cancer. Systematic review and meta-analysis. Not applicable. Women without any previous history of breast cancer undergoing ovarian stimulation. Electronic databases were searched from 1990 until January 2020. All cohort studies reporting new incidences of breast cancer in infertile women using ovarian stimulating drugs were included. Treated (exposed) infertile women were compared with the unexposed general population with unexposed infertile women as controls. New diagnosis of breast cancer within an infertile and general population after exposure to ovarian stimulation drugs. Overall, the quality of evidence was very low because of the serious risk of bias and indirectness (nonrandomized studies). There was no significant increase in the risk of breast cancer among women treated with any ovarian stimulation drug for infertility compared with that in unexposed controls from the general population and the infertile population (pooled odds ratio 1.03, 95% Confidence interval 0.86 to 1.23, 20 studies, I2 = 88.41%, very low quality of evidence). Furthermore, no significant increase in the risk of breast cancer was found with the use of clomiphene citrate or gonadotropins, alone or in combination. The current study found that the use of clomiphene citrate and gonadotropins in infertile women was not associated with an increased risk of breast cancer.

Influential Factors on Risk-reduction Mastectomy in a High-risk Breast Cancer Population With Genetic Predispositions

BackgroundCarriers of deleterious mutations in breast cancer predisposition genes are presented with critical choices regarding cancer risk management. Risk-reduction mastectomy is a major preventative strategy in this population. Understanding the decision-making process for prophylactic mastectomy is essential in patient-centered care for high-risk carriers and patients with breast cancer. We sought to provide insight into influential factors underlying preventative surgery decisions among individuals with high breast cancer risk. Materials and MethodsWe conducted a retrospective chart review of pathogenic carriers of high-risk breast cancer genes who presented to the Moffitt GeneHome clinic between March 2017 and June 2020. Associations between preventative mastectomy choice and influence variables were analyzed via unadjusted and adjusted logistic regression models. ResultsOf 258 high-risk mutation carriers, 104 (40.3%) underwent risk-reduction mastectomy. A significantly higher proportion of mastectomy patients reported prior history of breast cancer (68.9% vs. 16.5%; P < .001) and history of other risk-reduction or noncancer-related surgeries (61.7% vs. 25.8%; P < .001). Significant predictors affecting surgery decision included previous breast cancer history (adjusted odds ratio [aOR], 10.48; 95% confidence interval [CI], 5.59-19.63; P < .0001), other risk-reduction or noncancer-related surgical history (aOR, 4.65; 95% CI, 2.28-9.47; P < .0001), and age at presentation to the genetics clinic (< 35 years old: aOR, 2.77; 95% CI, 1.04-7.4; P = .042; 35-55 years old: aOR, 2.48; 95% CI, 1.19-5.18; P = .016). ConclusionsPreventive mastectomy decisions are highly personal and complex. In our sample, we observed prior history or concurrent breast cancer, history of other risk-reduction surgery or noncancer-related surgery, and younger age at presentation to the GeneHome clinic to be predictive of mastectomy uptake.

Complete remission from peritoneal metastasis of late recurrent breast cancer by endocrine therapy: a case report

BackgroundPeritoneal dissemination associated with the postoperative recurrence of breast cancer is relatively low (3–6%). Although the prognosis of patients with peritoneal metastasis is generally short (7–26 months), we experienced a unique case in which complete remission was achieved for more than 6 years with endocrine therapy alone.Case presentationAn 81-year-old woman presented an upper abdominal tumor and loss of appetite. Computer tomography (CT) scan revealed a tumor in the duodenum and the head of pancreas, which malignant lymphoma was suspected. The exploratory laparotomy demonstrated a tumor located in the greater curvature of the pylorus to the transverse colon, and peritoneal dissemination. Because of the previous history of breast cancer 11 years ago and the immunopathological findings, recurrence of breast cancer was diagnosed. Lung metastasis was also detected postoperatively and the endocrine therapy using letrozole was introduced. After a year, CT scan confirmed complete remission from the metastasis. Two years later, tumor markers fell within the normal limit.ConclusionsA rare case of late-phase metachronous peritoneal metastasis of the breast cancer where complete remission was obtained by a single endocrine agent was presented.

Granulomatous inflammation in pulmonary pathology of 2019 novel coronavirus pneumonia: case report with a literature review

BackgroundCoronavirus disease 2019 (COVID-19), which started in Wuhan, China, in late December 2019, was declared a pandemic, infecting more than twelve million people worldwide. Few studies have reported the findings of lung biopsies in COVID-19. Here, granulomatous inflammation was reported for the first time in COVID-19 lung biopsy.Case presentationA 54-year-old woman presented to a primary care facility with fever, dry cough, and fatigue. Antibiotherapy was administered for 10 days with the diagnosis of upper respiratory tract infection. However, her condition did not improve and she was admitted to the hospital. In physical examination, crepitant rales were heard in both lungs. Anemia and thrombocytopenia were detected in laboratory tests and she was referred to the hematology clinic. Bone marrow aspiration and flow cytometry showed she had acute myeloid leukemia. Computed tomography-integrated positron emission tomography with a history of previous breast cancer revealed a heterogeneous mass-like lesion in the left lung. The primary malignancy could not be ruled out and tru-cut biopsy was performed. Tests for tuberculosis were negative. Throat swab sample was taken and a real-time polymerase chain reaction confirmed that she had COVID-19. Radiological findings were evaluated as the progression of COVID-19 pneumonia on computed tomography 6 days after biopsy. Alveolar damage, edema, vascular congestion, mild inflammatory infiltration, type-2 pneumocyte hyperplasia, interstitial fibrosis, early fibrotic changes, fibrinous, organized pneumonia pattern, noncaseating granulomatous inflammation, and desquamation in alveolar epithelial cells were noted in lung biopsy.ConclusionsThere were only a few case reports that described lung biopsy findings in COVID-19 at the time of manuscript preparation. This was the first case of noncaseating granulomatous inflammation described in a COVID-19 case.