Prior Breast Research Articles

Breast Density Knowledge in a Screening Mammography Population Exposed to Density Notification.

Women are increasingly informed about their breast density due to state density reporting laws. However, accuracy of personal breast density knowledge remains unclear. We compared self-reported with clinically assessed breast density and assessed knowledge of density implications and feelings about future screening. From December 2017 to January 2020, we surveyed women aged 40 to 74 years without prior breast cancer, with a normal screening mammogram in the prior year, and ≥1 recorded breast density measures in four Breast Cancer Surveillance Consortium registries with density reporting laws. We measured agreement between self-reported and BI-RADS breast density categorized as "ever-dense" if heterogeneously or extremely dense within the past 5 years or "never-dense" otherwise, knowledge of dense breast implications, and feelings about future screening. Survey participation was 28% (1,528 of 5,408), and 59% (896 of 1,528) of participants had ever-dense breasts. Concordance between self-report versus clinical density was 76% (677 of 896) among women with ever-dense breasts and 14% (89 of 632) among women with never-dense breasts, and 34% (217 of 632) with never-dense breasts reported being told they had dense breasts. Desire for supplemental screening was more frequent among those who reported having dense breasts 29% (256 of 893) or asked to imagine having dense breasts 30% (152 of 513) versus those reporting nondense breasts 15% (15 of 102) (P= .003, P= .002, respectively). Women with never-dense breasts had 6.3-fold higher odds (95% confidence interval:3.39-11.80) of accurate knowledge in states reporting density to all compared to states reporting only to women with dense breasts. Standardized communications of breast density results to all women may increase density knowledge and are needed to support informed screening decisions.

Update on Pregnancy Following Breast Cancer Diagnosis and Treatment.

Survivorship has become a crucial component in breast cancer care. For women who have not completed their family planning, conceiving at the end of anticancer treatments should not be discouraged but might be challenging. Oncofertility counseling should be offered at the time of diagnosis to all patients, in order to inform them about the potential treatment-induced gonadotoxicity as well as the available strategies for fertility preservation, thus allowing to increase the chances of a future pregnancy. This article reports an updated overview on the current state of the art on pregnancy in women with prior breast cancer diagnosis and treatment, with a main focus on the issues faced by patients with history of hormone receptor-positive disease and BRCA carriers.

A Concise Review on the Utilization of Abbreviated Protocol Breast MRI over Full Diagnostic Protocol in Breast Cancer Detection.

Breast MRI possesses high sensitivity for detecting breast cancer among the current clinical modalities and is an indispensable imaging practice. Breast MRI comprises diffusion-weighted imaging, ultrafast, and T2 weighted and T1 weighted CE (contrast-enhanced) imaging that may be utilized for improving the characterization of the lesions. This multimodal evaluation of breast lesions enables outstanding discrimination between the malignant and benign and malignant lesions. The expanding indications of breast MRI confirm the far superiority of MRI in preoperative staging, especially in the estimation of tumour size and identifying tumour foci in the contralateral and ipsilateral breast. Recent studies depicted that experts can meritoriously utilize this tool for improving breast cancer surgery despite their existence of no significant long term outcomes. For managing the, directly and indirectly, associated screening cost, abbreviated protocols are found to be more beneficial. Further, in some of the patients who were treated with neoadjuvant chemotherapy, breast MRI is utilized for documenting response. It is therefore essential to realise that oncological screening must be easily available, cost-effective, and time-consuming. Earlier detection of this short sequence protocol leads to prior and early breast cancer disease in high risky female populations like women with dense breasts, prehistoric evidence, etc. This proper utilization of AP reduces unnecessary mastectomies. Hence, this review focused on the explorative information for strongly suggesting the benefits of AP breast MRI compared to full diagnostic protocol MRI.

Breast Cancer in Thyroid Cancer Patients, can One lead to Another?

Aims: To demonstrate the increased risk of developing a second primary thyroid or breast cancer in patients with prior breast or thyroid cancer and to study the clinicopathological characteristic of breast cancer (B2) as a secondary malignancy following a diagnosis of thyroid cancer (T1) or thyroid cancer (T2) following a diagnosis of breast cancer (B1) to find a common aetiology.
 Study Design: Retrospective cohort study
 Place and Duration of Study: Breast & Endocrine Surgery Unit, Surgery Department Hospital Putrajaya between January 2008 and December 2018.
 Methodology: Data of patients with breast cancer as first primary malignancy and thyroid cancers as second primary malignancy, and vice versa, between January 2008 to December 2018 was extracted using electronic search through the hospital information system database and compared for their tumor’s histological type, size, hormonal status (ER/PR), presence of locoregional lymph node and distant metastasis. We also examine any history of radiotherapy for first primary breast cancer patients and history of radioactive iodine ablation for first primary thyroid cancer.
 Results: 1.1% (n:4) of T1 develops B2 while 0.5% (n:8) of B1 develops T2 but we are unable to demonstrate a significant correlation between hormonal status of the tumour, radioiodine ablation or radiation therapy and the risk of developing second primary malignancy.
 Conclusion: There is an increased risk of thyroid cancer as a secondary malignancy following breast cancer and an increased risk of breast cancer as a secondary malignancy following thyroid cancer. No common aetiology can be demonstrated from this study.

Partial Breast Reirradiation for Patients With Ipsilateral Breast Tumor Recurrence After Initial Treatment With Breast Conservation for Early Stage Breast Cancer

PurposeAccelerated partial breast irradiation (APBI), including intraoperative radiation therapy (IORT), is an evidence-based treatment option in patients undergoing breast conserving surgery (BCS) for early-stage breast cancer. However, literature regarding reirradiation for patients with ipsilateral breast tumor recurrences (IBTR) is limited. This prospective study assessed the feasibility and efficacy of using APBI in patients who had prior whole breast irradiation. Methods and MaterialsThis was a single institution, prospective study of patients who were previously treated with BCS and adjuvant whole breast radiation. At the time of enrollment, all had unifocal IBTR, histologically confirmed invasive ductal carcinoma with negative margins after repeat BCS. Patients received either IORT in a single fraction at time of BCS or MammoSite brachytherapy twice daily over 5 days. Follow-up data and patient surveys were collected at 1, 3, 6, 9, and 12 months, then annually for at least a 5-year period. ResultsFrom 2008 to 2014, 13 patients were enrolled. Median time to recurrence after initial course of radiation was 12.5 years. Median follow-up after retreatment was 7.8 years. One patient in the IORT group had a subsequent tumor bed recurrence, yielding a local control of 92%. One patient had distant recurrence. At baseline, 680 reported excellent-good cosmesis compared with 42% at 5 years. All patients indicated total satisfaction with overall treatment experience. ConclusionsAPBI using IORT was well tolerated with excellent local control and may be a reasonable alternative to mastectomy for IBTR. Further study is needed to determine the most suitable candidates for this approach.

Downstream Mammary and Extramammary Cascade Services and Spending Following Screening Breast Magnetic Resonance Imaging vs Mammography Among Commercially Insured Women

Increasing use of screening breast magnetic resonance imaging (MRI), including among women at low or average risk of breast cancer, raises concerns about resulting mammary and extramammary cascades (downstream services and new diagnoses) of uncertain value. To estimate rates of cascade events (ie, laboratory tests, imaging tests, procedures, visits, hospitalizations, and new diagnoses) and associated spending following screening breast MRI vs mammography among commercially insured US women. This cohort study used 2016 to 2018 data from the MarketScan research database (IBM Corporation), which includes claims and administrative data from large US employers and commercial payers. Participants included commercially insured women aged 40 to 64 years without prior breast cancer who received an index bilateral screening breast MRI or mammogram between January 1, 2017, and June 30, 2018. We used propensity scores based on sociodemographic, clinical, and utilization variables to match MRI recipients to mammogram recipients in each month of index service use. Data were analyzed from October 8, 2020, to October 28, 2021. Breast MRI vs mammography. Mammary and extramammary cascade event rates and associated total and patient out-of-pocket spending in the 6 months following the index test. In this study, 9208 women receiving breast MRI were matched with 9208 women receiving mammography (mean [SD] age, 51.4 [6.7] years). Compared with mammogram recipients, breast MRI recipients had 39.0 additional mammary cascade events per 100 women (95% CI, 33.7-44.2), including 5.0 additional imaging tests (95% CI, 3.8-6.2), 17.3 additional procedures (95% CI, 15.5-19.0), 13.0 additional visits (95% CI, 9.4-17.2), 0.34 additional hospitalizations (95% CI, 0.18-0.50), and 3.0 additional new diagnoses (95% CI, 2.5-3.6). For extramammary cascades, breast MRI recipients had 19.6 additional events per 100 women (95% CI, 8.6-30.7) including 15.8 additional visits (95% CI, 10.2-21.4) and no statistically significant differences in other events. Breast MRI recipients had higher total spending for mammary events ($564 more per woman; 95% CI, $532-$596), extramammary events ($42 more per woman; 95% CI, $16-$69), and overall ($1404 more per woman; 95% CI, $1172-$1636). They also had higher overall out-of-pocket spending ($31 more per woman; 95% CI, $6-$55). In this cohort study of commercially insured women, breast MRI was associated with more mammary and extramammary cascade events and spending relative to mammography. These findings can inform cost-benefit assessments and coverage policies to ensure breast MRI is reserved for patients for whom benefits outweigh harms.

Trends in Annual Surveillance Mammography Participation Among Breast Cancer Survivors From 2004 to 2016.

Annual mammography is recommended for breast cancer survivors; however, population-level temporal trends in surveillance mammography participation have not been described. Our objective was to characterize trends in annual surveillance mammography participation among women with a personal history of breast cancer over a 13-year period. We examined annual surveillance mammography participation from 2004 to 2016 in a nationwide sample of commercially insured women with prior breast cancer. Rates were stratified by age group (40-49 vs 50-64 years), visit with a surgical/oncology specialist or primary care provider within the prior year, and sociodemographic characteristics. Joinpoint models were used to estimate annual percentage changes (APCs) in participation during the study period. Among 141,672 women, mammography rates declined from 74.1% in 2004 to 67.1% in 2016. Rates were stable from 2004 to 2009 (APC, 0.1%; 95% CI, -0.5% to 0.8%) but declined 1.5% annually from 2009 to 2016 (95% CI, -1.9% to -1.1%). For women aged 40 to 49 years, rates declined 2.8% annually (95% CI, -3.4% to -2.1%) after 2009 versus 1.4% annually in women aged 50 to 64 years (95% CI, -1.9% to -1.0%). Similar trends were observed in women who had seen a surgeon/oncologist (APC, -1.7%; 95% CI, -2.1% to -1.4%) or a primary care provider (APC, -1.6%; 95% CI, -2.1% to -1.2%) in the prior year. Surveillance mammography participation among breast cancer survivors declined from 2009 to 2016, most notably among women aged 40 to 49 years. These findings highlight a need for focused efforts to improve adherence to surveillance and prevent delays in detection of breast cancer recurrence and second cancers.

P60. PATIENT FACTORS THAT AFFECT PRE-OPERATIVE PATIENT REPORTED OUTCOMES IN WOMEN UNDERGOING BREAST CANCER SURGERY

PURPOSE: Understanding the impact of patient, disease, and treatment factors on pre-operative patient reported outcomes (PROs) is important to guide surgical decision-making with breast cancer. METHODS: This prospective cohort study evaluates PROs in women undergoing breast cancer treatment at a metropolitan health care system. New cases undergo tumor board discussion and same-day consultations with various specialties. Women choose to complete pre- and post-operative Breast-Q© Breast Conserving Surgery(BCS), Mastectomy(M), or Reconstruction(R) modules and demographic surveys. Individual associations to pre-operative Breast-Q survey scores were assessed using linear regression models (one for each Breast-Q survey type). Variables significant for at least one survey were included in multiple linear regression models. RESULTS: 375 women completed the pre-operative surveys (BCS=244, M=39, BR=92). Procedure choice, laterality, race, marital status, employment, prior breast cancer, neoadjuvant chemotherapy, or history of radiation or chemotherapy did not impact PROs. Breast satisfaction decreased with higher BMI (est=-0.367, p=0.045) and stage 2 disease (est=-11.011 (vs. stage 0), p=0.008). Lower psychosocial score was associated with younger age (est=0.271, p=0.002), higher BMI (est=-0.367, p=0.014), and income <35k (est=0.172 (vs. 35k+), p=0.016). Similarly, lower physical well-being of the chest was associated with younger age (est=0.207, p=0.011), higher BMI (est=-0.285, p=0.039), and income <35k (est=0.218 (vs. 35k+, p=0.039). Sexual well-being decreased with higher BMI (est=-0.545, p=0.004) and income <35k (est=0.135 (vs. 35k+), p=0.016). CONCLUSION: While factors such as age, BMI, and stage of disease are difficult to change prior to surgery, patients with lower income may need special interventions to assist them through the treatment process.

Incidental liver lesions on baseline breast MRI: Outcomes on subsequent abdominal imaging

PurposeTo examine outcomes of incidental liver lesions on baseline breast magnetic resonance imaging (MRI) that were further evaluated with dedicated abdominal imaging. MethodsConsecutive breast MRI reports from 2011 to 2016 were retrospectively reviewed to identify incidental liver lesions. Only patients without prior breast MRI, without prior abdominal imaging, and with subsequent abdominal imaging were included. Patient demographics, breast MRI indication, and final liver lesion diagnosis were recorded. ResultsOf 131 women (mean age 53.8 years), 94/131 (71.8%) underwent breast MRI for extent of disease evaluation, 25/131 (19.1%) for high-risk screening, 11/131 (8.4%) for implant evaluation, and 1/131 (0.8%) for problem-solving. Of 131 liver lesions (6–80 mm), 117/131 (89.3%) were deemed benign on subsequent abdominal imaging; 10/131 (7.6%) probably benign; and 4/131 lesions (3.1%) were confirmed breast cancer metastases. Metastatic liver lesions identified on breast MRI were more likely for women with a current diagnosis of breast cancer than for women without a current diagnosis of breast cancer: 4.3% vs 0%. Similarly, metastatic liver lesions identified on breast MRI were more likely for those with a higher prognostic stage (2 or 3) vs a lower prognostic stage (0 or 1) or no current breast cancer: 11.1% vs 0%. ConclusionBaseline breast MRIs showing incidental liver lesions showed unsuspected liver metastases only in women with a current diagnosis of clinical stage 2 or 3 breast cancer. This suggests breast MRI indication and clinical staging of current breast cancer, if present, can help plan management and decisions to obtain follow-up of liver lesions.

Abstract P2-10-02: Random periareolar fine-needle aspiration (RPFNA) cell number, prior precancerous breast disease and subsequent uptake of a prevention intervention predict short-term breast cancer risk

Abstract Introduction: In 2000 we published initial observations from a high-risk cohort of 480 women that cytologic evidence of hyperplasia with atypia in benign breast tissue obtained by random periareolar fine-needle aspiration (RPFNA) was associated with a five-fold increased risk of developing DCIS or invasive breast cancer at a median follow-up of 45 months [Fabian, JNCI 2000]. Few women in the initial cohort had any exposure to prevention agents, as NSABP-P1 was not reported until 1998. We began a new high-risk cohort in 2002 as the tissue processing changed from a filter technique to Thin PrepTM. The superior nuclear detail permitted assessment of cytologic atypia in the absence of high cellularity. Women in the second cohort were told that RPFNA atypia was a risk factor for developing breast cancer and in addition to standard prevention options were offered participation in clinical trials, if applicable. The purpose of this subsequent analysis was to determine if the predictive value of RPFNA atypia was maintained with change in tissue processing and availability of prevention options. Methods: A total of 1,135 high-risk women, eligible on the basis of family history, BRCA1/2 mutation status, prior biopsy indicating LCIS or atypical hyperplasia (AH), prior contralateral breast cancer and/or high mammographic breast density, underwent baseline RPFNA and were enrolled in our second cohort between 2002 and 2015. As in the earlier study published in 2000, if women had 2 aspirations without an intervening intervention within 21 months the worse result was utilized as baseline. In addition to cytomorphology, breast tissue was also categorized by cellularity of the aspirate (10-100, 100-1000, 1000-5000, and &amp;gt;5000 cells per cytology slide). The primary aspirator (CJF) and cytopathologist (CMZ) were the same for both cohorts. Women were censored at the time of prophylactic mastectomy, development of other site cancer, or death. Kaplan-Meier hazard plots and Cox-regression analysis were used to analyze time to development of DCIS or invasive breast cancer and effect of joint variables, respectively. Results: At a median follow-up of 86 months, 79 cases of DCIS or invasive breast cancer had been diagnosed. By univariate analysis, RPFNA atypia at entry was not predictive of subsequent breast cancer (p=0.58; log-rank test). However, breast cancer risk was increased by a prior breast biopsy with LCIS or AH (HR 2.6, 95% CI 1.6-2.4, p&amp;lt;0.001) or by high RPFNA cellularity, defined as &amp;gt;5000 epithelial cells per RPFNA cytomorphology slide (HR 2.1, 95% CI 1.3-3.5, p=0.0034). Thirty-six percent of women subsequently chose to undergo a prevention intervention, including a standard drug, enrollment in a prevention clinical trial of 6-12 months duration, or a prophylactic bilateral salpingo-oophorectomy (BSO) prior to age 45. Prevention interventions were more prevalent in women with RPFNA atypia (49% vs 30%, p&amp;lt;0.001). Not only was uptake of a prevention intervention associated with reduced breast cancer risk on univariate analysis (p=0.043), it was retained on multivariate analysis. The final Cox Regression risk model included prior breast biopsy with LCIS or AH (HR 2.4, 95% CI 1.5-3.9; p&amp;lt;0.001), high RPFNA cellularity (HR 2.2, 95% CI 1.3-3.7; p=0.003) and prevention intervention (HR 0.54, 95% CI 0.33-0.89; p=0.015). Conclusions: In a second large cohort of high-risk women for whom RPFNA acquired cells were processed to slides via ThinPrep™, high RPFNA cellularity (&amp;gt;5000 epithelial cells/slide) but not cytologic atypia predicted short-term breast cancer risk. However, women with atypia were significantly more likely than women without atypia to participate in a prevention intervention, which in turn was associated with reduced breast cancer risk Citation Format: Whitney L Hensing, Carol J Fabian, Carola M Zalles, Priyanka Sharma, Amy L Kreutzjans, Kandy R Powers, Lynn Chollet-Hilton, Bruce F Kimler. Random periareolar fine-needle aspiration (RPFNA) cell number, prior precancerous breast disease and subsequent uptake of a prevention intervention predict short-term breast cancer risk [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 P2-10-02.

Abstract P2-10-03: Improving breast cancer risk prediction using a convolutional neural network-based mammographic evaluation in combination with clinical risk factors

Abstract Background: Accurate assessment of a woman’s individualized breast cancer risk is necessary to inform shared decision-making regarding screening and risk-reducing strategies. Recently, deep learning techniques, including convolutional neural networks (CNN), have shown better predictive potential for breast cancer risk compared to mammographic density (MD). We evaluated whether combining clinical factors in the Breast Cancer Surveillance Consortium (BCSC) model, including MD, with a novel CNN-based mammographic evaluation more accurately predicts breast cancer risk than the BCSC model alone in a cohort of racially/ethnically diverse women. Methods: We conducted a retrospective cohort study of 23,552 women, age 35-74 years, who underwent screening mammography from 2014 to 2018 at Columbia University Irving Medical Center in New York City. We extracted data from the electronic health record (EHR) on breast cancer risk factors (age, race/ethnicity, prior benign breast biopsy, first degree family history of breast cancer, and MD). From this cohort, we identified 206 women who developed breast cancer by linkage to the tumor registry. We calculated 5-year invasive breast cancer risk using the BCSC model. We applied CNN-based breast cancer risk model to full-field craniocaudal mammographic views of both breasts, with an output of a risk score (range, 0-1). We used logistic regression models with breast cancer status as the outcome and predictors including clinical factors only (BCSC model) or combined with CNN risk score (hybrid model). We compared the prediction performance of these models via area under the receiver operating characteristics curves (AUCs) based on the DeLong test. We also calculated each model’s AUC for subgroups of age and race/ethnicity. Results: Among 23,552 evaluable women, mean age was 55.9 years (standard deviation [SD], 9.5) with 27% non-Hispanic White, 9% non-Hispanic Black, 36% Hispanic, 5% Asian, and 23% Other/Unknown race/ethnicity. Four percent had a first-degree family history of breast cancer, 10% had a prior benign breast biopsy, 45% had heterogeneously or extremely dense breasts on mammography, and 22% met high-risk criteria based upon a 5-year invasive breast cancer risk 1.67% according to the BCSC model. Mean CNN risk score was higher among breast cancer cases compared to unaffected controls (0.477 vs. 0.466, p=0.077). We found that the hybrid model outperformed the BCSC model (AUC of 0.676 vs. 0.640, respectively; p=0.003). In subgroup analyses, the hybrid model more accurately predicted breast cancer risk compared to the BCSC model among women age&amp;lt;50 (AUC of 0.713 vs. 0.645, respectively; p=0.078) and age&amp;gt;=50 (AUC of 0.663 vs. 0.625, respectively; p=0.026); non-Hispanic Black women (AUC of 0.794 vs. 0.663, respectively; p=0.028) and Hispanic women (AUC of 0.666 vs. 0.621, respectively; p=0.060). Conclusion: Among women undergoing screening mammography, a hybrid model incorporating a CNN-based mammography evaluation with clinical factors from the BCSC model more accurately predicted breast cancer risk relative to the BCSC model alone, particularly among racial and ethnic minorities. Combined with clinical risk factors, our CNN model may be used to efficiently predict breast cancer risk and inform risk-stratified breast cancer screening and prevention strategies. Comparing prediction performance for breast cancer risk of the BCSC model vs. hybrid modelBCSC ModelHybrid ModelP-value*AUC95% CIAUC95% CIAll patients0.6400.602-0.6830.6760.640-0.7110.003Age (years)&amp;lt;500.6450.562-0.7280.7130.648-0.7780.078&amp;gt;=500.6250.579-0.6710.6630.623-0.7030.026Race/ethnicityNon-Hispanic White0.6880.623-0.7540.7040.643-0.7660.230Non-Hispanic Black0.6630.539-0.7880.7940.704-0.8830.028Hispanic0.6210.560-0.6860.6660.597-0.7330.060Asian0.6160.440-0.7910.6510.461-0.8410.694 Citation Format: Alissa Michel, Vicky Ro, Julia E McGuinness, Simukayi Mutasa, Richard Ha, Katherine D Crew. Improving breast cancer risk prediction using a convolutional neural network-based mammographic evaluation in combination with clinical risk factors [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 P2-10-03.

Abstract P4-07-04: Bc cancer ipsilateral breast tumor recurrence (BCC IBTR) nomogram

Abstract INTRODUCTION:. Local and systemic treatments for breast cancer have evolved in the past decades. This study reports the development of a modern population-based nomogram to individualize local recurrence (LR) risk estimates for patients treated with breast conservation surgery (BCS). The magnitude of benefit of adjuvant breast radiotherapy (BRT) depends on individual patient, tumor, and treatment characteristics (1). Nomograms can provide accurate predictions of LR and the absolute LR benefit of BRT that can assist patients in making informed decisions regarding BRT. This nomogram is based on a large cohort of women with prospectively captured biomarker data and modern systemic therapies including anti-human epidermal growth factor receptor 2 (HER2) therapy. METHOD:. Study Population:. The study cohort included women treated curatively for newly diagnosed breast cancer between 1st January 2005 and 31st December 2014. Inclusion criteria were: age &amp;gt;16 years, invasive ductal or lobular carcinoma, stage I-III, and BCS. Patients with metastatic disease, prior or synchronous contralateral breast cancer, unknown tumor or treatment characteristics, or treated with neoadjuvant therapy or mastectomy were excluded. Nomogram Development and Validation:. Age, tumor size, number of positive lymph nodes, grade, margin status, lymphovascular invasion (LVI), extensive intraductal component (EIC), estrogen receptor (ER), progesterone receptor (PR), HER2 status, use of chemotherapy, hormonal therapy, and radiotherapy with or without boost were recorded for each patient. The endpoint was LR as the first event. Fine and Gray’s competing risk model, with distant recurrence and death as competing risks, was used for the multivariable analysis, adjusting for demographics, tumor, and treatment factors. Hazard ratio (HR) and 95% confidence interval (CI) for each variable were calculated. The multivariable model forms the basis for the nomogram, which is being internally validated using the bootstrap and cross-validation. RESULTS:Of 11,310 patients, there were 429 LR (crude risk = 3.8%). The HR and 95% CIs from the Fine and Gray model for each of the variables in the nomogram are presented in the table. Age, number of positive nodes, grade, ER, LVI, margins, hormone therapy, chemotherapy, and radiotherapy were independent prognostic factors for LR. For patients treated with RT, the predicted 10-year cumulative incidence of LR ranged from 2.4% in patients with low-risk disease to 12.5% in patients with high-risk disease. CONCLUSION:A new nomogram for local recurrence, based on patients who had ER/PR/HER2 testing and who received modern systemic therapies is being developed. It will assist clinicians and patients individualize estimates of local recurrence risk and improve shared decision-making regarding the use of BRT in contemporary practice. REFERENCES:. (1)Sanghani, M., et al J Clin Oncol.,2010; 28(5), 718-722. Cox regression hazard ratios and confidence intervals for variablesCharacteristicHR95%CIp-valueAge0.980.970.99&amp;lt;0.01T-size1.011.001.010.14No. nodes1.041.011.070.005GradeGrade1---Grade21.751.322.33&amp;lt;0.001Grade32.541.813.56&amp;lt;0.001ERNeg---Pos1.441.012.060.046PRNeg---Pos0.790.611.030.084Her2Neg---Pos0.960.731.250.8LVINeg---Pos1.961.552.47&amp;lt;0.001Unk1.360.722.580.3Margin StatusNeg---Close1.411.081.840.011Pos1.681.082.590.200Extensive DCISNo---Yes1.140.841.550.4HTNo---Yes0.520.410.65&amp;lt;0.001ChemoNo---Yes0.540.420.71&amp;lt;0.001RTNo---Yes0.330.260.42&amp;lt;0.001BoostNo---Yes0.800.621.040.094 Citation Format: Dylan Narinesingh, Alan Nichol, Pauline Truong, Lovedeep Gondara, Caroline Speers, Laveniya Kugathasan, Caroline Lohrisch, Dave Voduc, Nafisha Lalani. Bc cancer ipsilateral breast tumor recurrence (BCC IBTR) nomogram [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 P4-07-04.

Abstract P5-14-03: National claims data analysis of breast cancer diagnosis and treatment before versus during the COVID-19 pandemic

Abstract Background: The COVID-19 pandemic imposed great burden on the healthcare system and required patients and their physicians to make unprecedented choices about cancer care. Hospital-based retrospective reviews suggested changes in breast cancer management during 2020 compared to previous years, including greater use of preoperative therapy. We used insurance claims data to understand the impact of the pandemic on breast cancer diagnosis and treatment at a national level. Methods: We identified new diagnoses of breast cancer from 2017-2020 in the Optum data set, consisting of claims records linked to electronic health records. The overall population (enrolled in Optum for at least 6 months with at least one diagnosis of any condition and no prior breast cancer diagnosis) included an average of 8 million adult Americans per year. A breast cancer diagnosis was defined as a first-ever ICD code for breast cancer with a breast diagnostic biopsy procedure code (considered the cancer diagnosis date) within 6 months before to 3 months after that ICD code. Each year’s cohort of breast cancer cases was limited to those diagnosed between February 1 and May 30, with follow-up through June 30 of the diagnosis year. First treatment after diagnosis was classified as either endocrine therapy, chemotherapy, or surgery. Geographic area was defined by the 9 Census Bureau regions. We used a Poisson regression to compare the rate of breast cancer diagnosis in 2020 versus 2017-2019 and a Chi-squared test to compare the distributions of first treatment. To investigate differences in the impact of the pandemic on rate of diagnosis (Poisson regression) or use of preoperative therapy (logistic regression) by race/ethnicity, income, or geographic area, we included each of these covariates as well as its interaction with year (2020 vs 2017-2019) in separate models. Results: There were 2,841 breast cancer diagnoses February-May 2020 (0.037% of overall population), compared to 3,880 in 2019 (0.045%), 3,509 in 2018 (0.043%), and 2,999 in 2017 (0.041%). In 2020 compared to 2017-2019, new breast cancer diagnoses decreased by 12.3% (95% CI 8.6%-15.9%; p &amp;lt; 0.0001). No significant differences were observed in this reduction in diagnoses by race/ethnicity, income level, or geographic area. Median date of diagnosis was earlier in 2020 (March 11) compared to 2017-2019 (March 29-April 1), a result of the diagnosis rate dropping more in later months. Among patients who received treatment during follow-up (83.1% in 2017-2019 vs 86.2% in 2020, a difference likely reflecting this shift in diagnosis date), there was a marked reduction in surgery as first treatment in 2020 compared to previous years (88.7% in 2017-2019 vs 69.3% in 2020), while both preoperative chemotherapy (6.1% in 2017-2019 vs 10.7% in 2020) and preoperative endocrine therapy (5.2% in 2017-2019 vs 20.1% in 2020) increased (p &amp;lt; 0.0001). There were no differences in the shift toward preoperative therapy by race/ethnicity or income, but there was a significant difference by geographic area (p=0.0003): the Mountain region had the least change in use of preoperative therapy (odds ratio 2.46 [95% CI 1.75-3.47] of preoperative therapy during vs before the pandemic) while the Middle Atlantic region had the greatest (odds ratio 5.64 [95% CI 3.79-8.38]). Conclusions: Among insured U.S. patients, new breast cancer diagnoses decreased by 12.3% during February-May 2020 compared to the same period in the previous three years, and use of preoperative therapy, largely endocrine, increased by 2.7-fold. The impact of the pandemic on choice of first treatment differed by geographic area, but not by race/ethnicity or income in this insured population. We will monitor with continued follow-up of claims data to assess the longer-term impact of these pandemic-related changes on treatment patterns, cost, and patient outcomes. Citation Format: Jennifer L Caswell-Jin, Maryam N Shafaee, Lan Xiao, Mina Liu, Natasha Purington, Esther M John, Melissa L Bondy, Allison W Kurian. National claims data analysis of breast cancer diagnosis and treatment before versus during the COVID-19 pandemic [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 P5-14-03.

Abstract P5-14-01: National claims data analysis of breast cancer diagnosis and treatment before versus during the COVID-19 pandemic

Abstract Background: The COVID-19 pandemic imposed great burden on the healthcare system and has required patients and their physicians to make unprecedented choices about cancer care. Hospital-based retrospective reviews have suggested changes in breast cancer management during 2020 compared to previous years, including greater use of preoperative therapy. We used insurance claims data to understand the impact of the pandemic on breast cancer diagnosis and treatment at a national level. Methods: We identified new diagnoses of breast cancer from 2017-2020 in the Optum Clinformatics claims data set, consisting of claims records linked to electronic health records. The overall population (enrolled in Optum for at least 6 months with at least one diagnosis of any condition and no prior breast cancer diagnosis) included an average of 8 million adult Americans per year. A new breast cancer diagnosis was defined as a first-ever ICD code for breast cancer with a breast diagnostic biopsy procedure code (considered the cancer diagnosis date) within 6 months before to 3 months after that ICD code. Each year’s cohort of breast cancer cases was limited to those diagnosed between February 1 and May 30, with follow-up through June 30 of the diagnosis year. First treatment after diagnosis was classified as either endocrine therapy, chemotherapy, or surgery. Geographic area was defined by the 9 Census Bureau regions. We used a Poisson regression to compare the rate of breast cancer diagnosis in 2020 compared to 2017-2019 and a Chi-squared test to compare the distribution of first treatment in 2020 compared to 2017-2019. To investigate differences in the impact of the pandemic on rate of diagnosis (Poisson regression) or use of preoperative therapy (logistic regression) by race/ethnicity, income, or geographic area, we included each of these covariates as well as its interaction with year (2020 vs 2017-2019) in separate models. Results: There were 2,841 breast cancer diagnoses February-May 2020 (0.037% of overall population), compared to 3,880 in 2019 (0.045%), 3,509 in 2018 (0.043%), and 2,999 in 2017 (0.041%). In 2020 compared to 2017-2019, new breast cancer diagnoses decreased by 12.3% (95% CI 8.6%-15.9%; p &amp;lt; 0.0001). No significant differences were observed in this reduction in diagnoses by race/ethnicity, income level, or geographic area. Median date of diagnosis was earlier in 2020 (March 11) compared to 2017-2019 (March 29, April 1, and April 1 respectively), a result of a larger drop in diagnoses later in the time interval in 2020. Among patients who received treatment during follow-up (83.1% in 2017-2019 vs 86.2% in 2020, a difference likely reflecting this shift in diagnosis date), there was a marked reduction in surgery as first treatment in 2020 compared to previous years (88.7% in 2017-2019 vs 69.3% in 2020), while both preoperative chemotherapy (6.1% in 2017-2019 vs 10.7% in 2020) and preoperative endocrine therapy (5.2% in 2017-2019 vs 20.1% in 2020) increased (p &amp;lt; 0.0001). There were no differences in the shift toward preoperative therapy by race/ethnicity or income, but there was a significant difference by geographic area (p=0.0003): the Mountain region had least change in use of preoperative therapy (odds ratio 2.46 [95% CI 1.75-3.47] of preoperative therapy during vs before the pandmic) while the Middle Atlantic region had the greatest (odds ratio 5.64 [95% CI 3.79-8.38]). Conclusions: Among insured U.S. patients, new breast cancer diagnoses decreased by 12.3% during February-May 2020 compared to the same period in the previous three years, and use of preoperative therapy, largely endocrine, increased by 2.7-fold. The impact of the pandemic on choice of first treatment differed by geographic area, but not by race/ethnicity or income in this insured population. We will monitor with continued follow-up of claims data to assess the longer-term impact of these pandemic-related changes on treatment patterns, cost, and patient outcomes. Citation Format: Jennifer L Caswell-Jin, Maryam N Shafaee, Lan Xiao, Mina Liu, Natasha Purington, Esther M John, Melissa L Bondy, Allison W Kurian. National claims data analysis of breast cancer diagnosis and treatment before versus during the COVID-19 pandemic [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 P5-14-01.

Abstract P5-19-05: Successful participation of veterans affairs patients in precision medicine research through passive recruitment efforts

Abstract Background Access to clinical trials and other research opportunities is important to discovering new disease treatments and better ways to detect, diagnose, and reduce disease risk. The WISDOM (Women Informed to Screen Depending on Measures of risk) Study is a multi-site, pragmatic trial with web-based participation based at the University of California at San Francisco (UCSF) that aims to move breast cancer screening away from its current one-size-fits-all approach to one that is personalized based on each woman’s individual risk. We sought to evaluate passive recruitment efforts of Veterans Affairs (VA) patients into a precision medicine research program. Methods We created a hub and spoke recruitment model with the San Francisco VA Medical Center (SFVAMC) serving as the central hub of passive recruitment activities and eligible VA facilities that agreed to participate serving as the spoke recruitment sites. Eligible facilities had at least 3,000 women patients, VA clinical genetic services available, a site lead from the VA Women’s Health-Practice-Based Research Network, and mammography on site. Site participation involved permission for the research team to email eligible patients (women age 40-74 without a prior breast cancer diagnosis) about the WISDOM Study. We evaluated the effectiveness of the recruitment by assessing trends in enrollment and monitoring participation of VA patients in the WISDOM Study. The participating sites were determined to be non-engaged in human subjects research. Results Between May 24th, 2021 and June 30th, 2021, we emailed 29,470 eligible VA patients from seven participating VA facilities. Prior to the VA emailing, 2% of the total WISDOM Study population had served or was currently serving in active duty in any of the United States Armed Forces. After the first month of emails, this percentage increased to 50%. The month following VA emailing was one of the highest accruing months for the study with 2175 women registering, doubling the average of the prior three months, with VA participation accounting for over 50% of total enrollment that month. VA enrollment population was racial and ethnically diverse and changed the demographics of study enrollment. Prior to the VA emailing, the WISDOM Study population (n= 32,3278) included women who are 79% non-Hispanic White, 3% Black/African American and 9% Hispanic/Latina. Between the May 24th, 2021 and June 30th, 2021 emailing period, of the 1665 women enrolled, 64% of which were non-Hispanic White, 16% Black/African American and 12% Hispanic/Latina. Most women veterans enrolled in the study were between the ages of 40-50 (45%), which represented a younger population than the general WISDOM Study population (28%, aged 40-50). Both the VA population and general WISDOM Study population had similar levels education: 72% of the VA population had obtained a college graduate degree compared to 76% of the WISDOM study population with a college graduate degree. Conclusions The VA has recently approved email contact as a method for passively recruiting research participants. Our results demonstrate that there is substantial interest among female veterans in the WISDOM Study, and that emailing VA patients was not only feasible but an effective approach to increased study recruitment and diversity of participants. This data provides a unique opportunity for future trials to engage women veterans as precision medicine becomes a growing area of research in the VA and at academic affiliates. Citation Format: Maren Scheuner, Paloma Sales, Susan M. Frayne, Marcelo Palmieri, Rashna Soonavala, Allison Stover Fiscalini, WISDOM Study/Athena Investigators, Advocate Partners, Laura Esserman. Successful participation of veterans affairs patients in precision medicine research through passive recruitment efforts [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 P5-19-05.

Gender-affirming Mastectomy with Concurrent Oncologic Mastectomy.

Background:Transmasculine individuals may not have undergone gender-affirming mastectomy and retain natal breast tissue. Our center offers simultaneous oncologic mastectomy with gender-affirming reconstruction to patients who are diagnosed with breast cancer. This study is the first reported series of concurrent gender-affirming and oncologic mastectomies.Methods:A retrospective chart review of all patients undergoing gender-affirming mastectomy at a single institution from February 2017 to October 2021 was performed. Patients were included who had breast cancer diagnoses or pathologic lesions preoperatively. Demographic factors, comorbidities, surgical details, and oncologic history were collected. Both plastic surgery and breast surgery were present for the gender-affirming oncologic mastectomies.Results:Five patients were identified who presented for gender-affirming mastectomy in the context of breast pathologies. Average patient age was 50.2 ± 14.8 years, and no patients used testosterone at any time. Two (40%) patients had a prior breast surgery that included a breast reduction in one patient and breast conserving lumpectomies in another. Sentinel lymph node biopsies were performed in all patients. Only one patient had a positive sentinel lymph node and was subsequently referred for postoperative radiation and chemotherapy. No oncologic recurrence has been detected with 20.6 and 10.0 months of mean and median follow-up.Conclusions:When performed in a multidisciplinary and collaborative setting with breast surgeons and plastic surgeons, oncologic mastectomy can be performed safely while concurrently offering patients an aesthetic gender-affirming reconstructive outcome.

The Role of redo-Sentinel Lymph Node Biopsy in Patients With Prior Ipsilateral Breast Cancer Surgery

BackgroundSentinel Lymph Node Biopsy (SLNB) is used to stage the axilla, but there is limited data in patients with prior ipsilateral breast cancer. This study compares redo-SLNB (reSLNB) and Axillary node sample (ANS) in this sub-cohort of patients. Materials and MethodsThis is a retrospective study looking at patients with a new ipsilateral primary or recurrence with history of breast-conserving surgery. Planned and performed surgery, patient demographics and previous treatments were recorded. Node positivity and success rate of reSLNB was analyzed. ResultsA total of 86 patients were identified that had mastectomy for ipsilateral recurrent disease with radiologically negative axilla. Out of the 48 that had reSLNB, 35(72.9%) were successful. Nineteen percent of the reSLNB had positive axillae and 20% of the ANS patients. reSLNB success rate was significantly lower amongst patients with previous axillary surgery (P = .014) and previous positive nodes(P = .001). ConclusionreSLNB should be considered to restage the axilla in patients with previous history of ipsilateral cancer especially that there is growing evidence showing good identification rate.

The role of redo-Sentinel Lymph Node Biopsy in patients with prior ipsilateral breast cancer surgery

Background: Sentinel Lymph Node Biopsy (SLNB) has been used to stage the clinically node-negative axillae supported by many randomised controlled trials. Unfortunately, there is limited published data looking at SLNB in those with prior ipsilateral breast cancer.

Diagnostic Accuracy of Whole-Body Computed Tomography for Incidental Ovarian Tumors in Patients with Prior Breast Cancer.

Whole-body computed tomography (WBCT) serves as the first-line imaging modality for breast cancer follow-up. To investigate the imaging characteristics and diagnostic accuracy of WBCT for incidental ovarian tumors in patients with prior breast cancer, we retrospectively reviewed a consecutive cohort of 13,845 patients with breast cancer, of whom 149 had pathologically-proven ovarian lesions. We excluded patients with ovarian diagnosis before breast cancer, CT scan not including ovary, CT-pathology interval >30 days, and severe CT artifact. Among our 60 breast cancer patients (median age, 46 years) with pathologically proven ovarian lesions, 49 patients had benign diseases, seven had primary ovarian cancer and four had ovarian metastasis from breast cancer. The histologic types of breast cancer with ovarian metastases included invasive ductal carcinoma, lobular carcinoma and angiosarcoma. Cystic ovarian lesions identified on WBCT during the breast cancer follow-up are more likely to be benign, while solid-cystic lesions are likely to be primary ovarian cancers, and solid lesions may indicate ovarian metastasis. The diagnostic accuracy, sensitivity, specificity, and areas under the receiver operating characteristic curve of WBCT were 98.3%, 100.0%, 98.0%, and 0.99 (malignant vs. benign); 90.0%, 100.0%, 85.7%, and 0.93 (metastasis vs. primary ovarian cancer), respectively. The only false positive solid lesion was a Sertoli–Leydig tumor. In conclusion, WBCT may help diagnose incidental ovarian tumors in patients with prior breast cancers and guide disease management.

P235 The natural history of COVID-19 in vaccinated Inflammatory Bowel Disease patients

BackgroundPatients with Inflammatory Bowel Disease (IBD), especially those on immunosuppressive (IMS) treatment should be vaccinated against SARS-CoV-2 to prevent hospitalization, mechanical ventilation, and death. However, IMS may adversely affect vaccination, raising concerns as to how vulnerable these patients are to break through COVID-19 infections. Thus, we aimed to assess the proportion of IBD patients who despite complete vaccination developed COVID-19, as well as the course of the infection.MethodsThis study was an initiative of the Hellenic Group for the study of IBD which involved seven IBD referral Centers. Patients attending these Centers who reported a COVID-19 infection at least 3 weeks after vaccination completion were asked to complete an on-line anonymous questionnaire which included patient demographics and IBD clinical and therapeutic data, a detailed vaccination history, and the course and outcome of COVID-19, especially the need for hospitalization, oxygen supply, and admission to ICU. In patients with grave outcome information was sought by family membersResultsOn estimate, 2940 patients reported full vaccination (Pfizer vaccine) in the 7 centers. Between 1st May 2021 and 30th October 2021, 46 (1.5%) fully vaccinated IBD patients reported COVID-19 infection [25 male, 32 CD, 14 UC, mean (SD) age 40.8 (13.7) years, mean (SD) IBD duration mean, 11.2 (10.8) years]. Five patients were receiving 5-ASAs, 2 corticosteroids, 5 azathioprine/methotrexate, 23 anti-TNFs as monotherapy and 3 in combination with azathioprine/methotrexate, and 1 with corticosteroids, 3 vedolizumab and 1 each ustekinumab, tofacitinib and rizakinzumab at the time of COVID-19 diagnosis; one patient was receiving no treatment. IBD was in remission in 37/46 patients (80.4%). Comorbidities were seen in 21 patients (thyroid disease 11; diabetes mellitus 2; hypertension 2; psoriasis 1; prior breast cancer 1; spondyoartropathy 2; dyslipidemia 1; and PSC 1 patient). The mean (SD) time between last vaccination dose and infection was 3.2 (1.4) months. Overall, 40 (86.9%) patients reported mild constitutional and respiratory symptoms, 4 (8.7%) were asymptomatic and only 2 patients (4.3%) required hospitalization which was uneventful in both. None needed high flow oxygen supply or ICU admission, and none reported symptoms of long COVID. No deaths were reported by patient relatives. IBD medications were stopped in 21 patients (45.6%) during the COVID-19 infection.ConclusionA minority of fully vaccinated IBD vaccinated patients developed COVID-19 which was relatively mild and uneventful. These results reinforce the importance of vaccination especially in vulnerable populations.