Recent Diagnosis Of Breast Cancer Research Articles

Preoperative reference values for breast cancer patients using the BREAST-Q

IntroductionThe BREAST-Q can be used to evaluate the health-related quality of life (HRQL) of breast cancer patients. Data interpretation is limited by the lack of previous reference values based solely on patients with a recent breast cancer diagnosis. MethodsA total of 627 patients, all with newly diagnosed breast cancer, were asked to participate in the study. The BREAST-Q modules for mastectomy and breast-conserving surgery were used. The results for the scales were reported as mean with standard deviation (SD). The effect of patient characteristics, including age, body mass index (BMI), and ASA-classification on the HRQL were analyzed with multiple linear regression. ResultsIn total, 315 patients (50.2 %) participated. The mean (SD) age was 60.3 (10.1) years. Mean scores (SD) were the following: Psychosocial Well-being 70.8 (15.0), Sexual Well-being 58.2 (15.1), Satisfaction with Breasts 59.9 (15.6), and Physical Well-being: Chest 81.7 (15.7). The psychosocial well-being, sexual well-being, and satisfaction with breasts were all similar compared to the normative mean scores of the scales. The physical well-being of the chest was lower than the normative mean value (p < 0.001). Psychosocial well-being (p = 0.007), sexual well-being (p = 0.007), and satisfaction with breasts (p < 0.001) were lower in patients with higher BMI. Younger patients reported lower physical well-being of the chest (p < 0.001). ConclusionsThis study established preoperative reference values for the BREAST-Q in breast cancer patients. This data can be used to evaluate the HRQL in breast cancer patients accurately.

6550 National Statin Prescription Trends in Patients With Breast Cancer and Diabetes for Primary Cardiovascular Disease Prevention

Abstract Disclosure: A.B. Yang: None. G. Mhango: None. C. Kong: None. J.J. Lin: None. J.P. Wisnivesky: Consulting Fee; Self; Sanofi, Banook, PPD. Grant Recipient; Self; Sanofi, Regeneron Pharmaceuticals, Axella, Arnold Consultants. A. Leiter: None. Background: Cardiovascular disease (CVD) is the leading cause of death in older early-stage breast cancer (BC) survivors. Due to cardiotoxic BC treatments such as chemotherapy and radiation, patients with BC and diabetes (DM) are at increased risk of CVD. In patients with BC and DM, statins decrease CVD mortality. Since 2013, many clinical guidelines broadened statin indications for primary CVD prevention in patients with DM, making &amp;gt;85% of patients eligible. Little is known about statin prescription (Rx) patterns in older BC survivors with DM, a group at high risk of CVD. Hypothesis: We hypothesized that statin Rxs increased over time, but were less likely in BC survivors with more advanced locoregional BC and lower comorbidity burden. Methods: A population-based, retrospective cohort study was conducted using Surveillance, Epidemiology and End Results (SEER) cancer registry data linked to Medicare claims. We identified women with preexisting DM who were diagnosed with stage 0-III primary BC between 2008-17. We excluded patients with prior CVD who died &amp;lt;1 year after BC diagnosis. Statin Rx (atorvastatin, pravastatin, rosuvastatin, simvastatin, fluvastatin, lovastatin) was defined as ≥1 statin pharmacy claim &amp;lt;1 year after BC diagnosis. Comorbidity burden was assessed with a modified Charlson Comorbidity Index (CCI). We compared patient demographic and clinical characteristics by statin Rx status using the chi-square test. Using a multivariate logistic regression adjusting for age, race, CCI, BC stage, and diagnosis year, independent predictors of statin Rx were identified. Results: Of 8,423 BC patients with pre-existing DM, 5,698 (68%) had a statin Rx. Statin Rx increased over time (BC diagnosis year 2008-10: 66%, 2011-13: 66%, 2014-15: 69%, 2016-17: 70%; p=0.01) and differed by age (66-69: 66%, 70-74: 70%, 75-79: 69%, ≥80: 65%; p&amp;lt;0.01) and race (White: 68%, Black: 62%, Latinx: 66%, Other: 72%; p&amp;lt;0.01). Statin Rx did not differ by comorbidity burden (CCI 0: 68%, 1-2: 67%, ≥3: 67%; p=0.87) and declined with higher BC stage (0: 73%, I: 70%, II: 65%, III: 63%; p&amp;lt;0.01). In adjusted analyses, more recent BC diagnosis (2016-17 vs. 2008-10: odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.04-1.38), age group (70-74 vs. 66-69: OR: 1.24, 95% CI: 1.09-1.41), race (Black vs. White: OR 0.77, 95% CI: 0.66-0.89) and higher BC stages (II vs. 0: OR: 0.76, 95% CI: 0.58-1.00; III vs. 0: OR: 0.72, 95% CI: 0.54-0.97) remained predictors of statin Rx. Conclusions: In a nationally representative cohort analysis of older early-stage BC patients, statin Rx increased between 2008-17 and varied by age, race, and BC stage. Elucidating gaps in statin Rx can potentially improve guideline-concordant Rx in a group at high risk for CVD and reduce disparities. Presentation: 6/2/2024

Abstract PO1-12-04: Exploring Factors Associated with Sexual Well-being and Breast Satisfaction Among Women with Early-stage Breast Cancer

Abstract BACKGROUND: Breast cancer affects not only physical health but also psychological and emotional well-being. Among the various aspects that impact the quality of life of breast cancer patients, sexual well-being and body image in terms of breast satisfaction play a crucial role. Unfortunately, these aspects are often overlooked and undervalued in healthcare, leading to inadequate care and support for breast cancer patients. This study delved into the factors that influence breast satisfaction and sexual well-being in early-stage breast cancer patients who have recently received a cancer diagnosis. We aim to offer providers a more patient-centered and comprehensive approach to breast cancer care. METHODS: This prospective questionnaire-based study screened 175 early-stage breast cancer patients recently diagnosed at a university-affiliated community hospital in Michigan from October 2022 to June 2023. Participants with a previous history of chemoradiation and advanced-stage breast cancer were excluded. Structured telephone interviews were conducted to obtain informed consent and assess patients' breast satisfaction and sexual well-being. Participants were interviewed after their recent breast cancer diagnosis and before undergoing surgical intervention. A validated BREAST-Q questionnaire was used, and their scores were converted to equivalent Rasch scores for interpretation (0=worst, 100=best). Pre-existing medical conditions, social history, and other variables were collected through electronic medical records review and confirmed by interview. Statistical analyses were performed using SPSS version 28.0, and a p-value less than 0.05 was considered statistically significant. RESULTS: Of 175 patients initially screened, 56 met the selection criteria. 75% (N=42) participated, while 25% (N=14) were excluded as they declined to participate or were unreachable via telephone. 81% were White, 14% were Black, and 5% were Hispanics. The cancer stages of the patients were Stage 0 (29.3%), I (48.8%), II (12.2%), and III (9.8%). The mean breast satisfaction score of participants was 67.1 (N=42), and the mean sexual well-being score was 44.6 (N=36). The study found that only the type of surgery was observed to be significantly related to the breast satisfaction of patients. Interestingly, patients who chose mastectomy had higher breast satisfaction scores (75.6 vs. 62.9, p&amp;lt; 0.05) and were relatively younger (59 years vs. 67 years, p&amp;lt; 0.05) than those undergoing lumpectomy. No other demographic factors (race, education, marital status, BMI), social history (smoking), bra size, or pre-existing medical conditions (hypertension, diabetes) were found to affect breast satisfaction among these patients. On the other hand, age had a negative correlation with sexual well-being (mean age=64 years, p&amp;lt; 0.05), while income had a positive correlation (mean income=$ 76,170 annually, p&amp;lt; 0.05). No other variables were significantly associated with patients’ sexual well-being. CONCLUSION: The study revealed that the patient's sexual well-being was significantly associated with age and income, while breast satisfaction was only related to the type of surgery. These findings underscore the importance of considering multiple aspects of a patient's life when designing a comprehensive treatment plan following a cancer diagnosis. By providing additional support and resources tailored to these specific needs, healthcare providers can enhance patients' overall quality of life and promote greater satisfaction with their treatment outcomes. Citation Format: Kim Abbegail Aldecoa, Yi Lee, Lisa Deptula, Chioma Mbionwu, Ewomamobuho Eto, Esentur Salamatov, Megan Frame, Andrea Briefs Ferris, Geetha Krishnamoorthy, Amy Kirby, Judie Goodman. Exploring Factors Associated with Sexual Well-being and Breast Satisfaction Among Women with Early-stage Breast Cancer [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 PO1-12-04.

Effect of receiving a customizable brochure on breast cancer patients' knowledge about their diagnosis and treatment: A randomized clinical trial.

Patients' lack of knowledge about their own disease may function as a barrier to shared decision-making and well-being. This study aimed to evaluate the impact of written educational materials on breast cancer patients. This multicenter, parallel, unblinded, randomized trial included Latin American women aged ≥18 years with a recent breast cancer diagnosis yet to start systemic therapy. Participants underwent randomization in a 1:1 ratio to receive a customizable or standard educational brochure. The primary objective was accurate identification of molecular subtype. Secondary objectives included identification of clinical stage, treatment options, participation in decision-making, perceived quality of information received, and illness uncertainty. Follow-up occurred at 7-21 and 30-51 days post-randomization. gov identifier: NCT05798312. One hundred sixty-five breast cancer patients with a median age of 53 years and 61 days from diagnosis were included (customizable: 82; standard: 83). At first available assessment, 52%, 48%, and 30% identified their molecular subtype, disease stage, and guideline-endorsed systemic treatment strategy, respectively. Accurate molecular subtype and stage identification were similar between groups. Per multivariate analysis, customizable brochure recipients were more likely to identify their guideline-recommended treatment modalities (OR: 4.20,p = 0.001). There were no differences between groups in the perceived quality of information received or illness uncertainty. Customizable brochure recipients reported increased participation in decision-making (p = 0.042). Over one third of recently diagnosed breast cancer patients are incognizant of their disease characteristics and treatment options. This study demonstrates a need to improve patient education and shows that customizable educational materials increase patients' understanding of recommended systemic therapies according to individual breast cancer characteristics.

Abstract PD8-08: Employment status change in a cohort of young women with breast cancer in Mexico

Abstract Background: Breast cancer diagnosis and treatment generates disruption in multiple aspects in the life of patients, including work-related outcomes. The disruption in employment may exacerbate the economic burden on patients and their families, contributing to financial toxicity and ultimately impacting quality of life, especially in young women. However, the evidence of employment status at diagnosis for this group and its trajectory thereafter is limited. This study aims to document the first change in employment experienced by Mexican young women with a recent diagnosis of breast cancer and determine which factors are associated with a decrease in work activities. Methods: Mexican women from the Joven &amp; Fuerte prospective multicenter cohort, aged ≤40, diagnosed with stage I-III breast cancer between 2015-2021 with at least 6 months of follow-up were included. Participants with a documented disease recurrence, missing employment status information, diagnosis of a new primary breast cancer or a second type of cancer were excluded from the analysis. Patients completed surveys at baseline, 6 months, and yearly for up to 5 years to assess sociodemographic characteristics, employment status, medical and treatment data. Employment status was categorized on a scale as follows: full-time &amp;gt; part-time &amp;gt; student &amp;gt; medical leave &amp;gt; unemployed. Only the first employment status change was included in this analysis. The Kaplan-Meier failure estimate was employed to calculate the increase or decrease in employment status at 1 year and 2 years post-diagnosis. Competing risk regression models were undertaken to explore variables associated with a decrease in employment status. Results: A total of 142 women with a median age at diagnosis of 36.5 years (IQR 33-39) and median follow-up of 17 months were included in the analysis. Baseline employment status for these patients was: employed - full time (27%), employed - part time (14%), student (1%), medical leave (4%) and unemployed (54%). At 12 months, 18.5% of participants had a reduction in their work activity (95% CI 12.8 - 26.4%) and this proportion further increased to 25.8% at 24 months (95% CI 18.7 - 34.8%). In contrast, 11.8% (95% CI 7.3 - 19.0%) and 23.2% (95% CI 15.9 - 33.2%) of participants exhibited an increase in their work activity at 12 and 24 months, respectively. The most common patterns in first employment status change were from unemployed to employed - full time (19%), employed - full time to employed - part time (13%) and employed - full time to unemployed (13%). In univariable analysis, having a partner at diagnosis demonstrated a lower hazard for experiencing a decrease in work activities; in contrast, postmenopausal status at 1 year was associated with a higher hazard of experiencing a decrease in employment status. However, in a competing-risks model including both partner and menopausal status, only the latter was associated with a higher hazard for experiencing a reduction in work activity (SHR=3.05, 95% CI 1.38 - 6.72, p=0.006). Age, education, monthly income, number of people who contribute to the household, having a partner at diagnosis, number of children, being financially responsible for another person, mastectomy, chemotherapy, radiotherapy and endocrine treatment were not associated with a higher probability of reduction in work activity. Conclusion: This cohort is one of the few initiatives assessing the impact of diagnosis and treatment of BC in young patients, specifically Latin American women. Our results show that there are relevant employment status changes after BC, possibly as a consequence of their treatment. Physical and psychological elements of menopause might influence the decrease in work status. Further studies are needed to deepen our understanding of employment changes in Latin American young women and guide interventions that address unintended limitations of work activities. Citation Format: Cynthia Villarreal-Garza, Ana Ferrigno, Misael Salazar, Luis F. Enriquez, Alan Fonseca, Alejandra Platas, Lucero Labra, Marlid Cruz-Ramos, Melina Miaja, Bryan Vaca-Cartagena, Andrea Becerril-Gaitan, Fernanda Mesa-Chavez, Enrique Bargallo-Rocha, Alejandro Mohar. Employment status change in a cohort of young women with breast cancer in Mexico [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-08.

Abstract P5-07-06: Prospective cohort of breast cancer patients exposed to a navigation program for timely access to referral services in Mexico

Abstract Background: Patient navigation (PN) is an essential component of cancer care that reduces barriers and enhances the provision of comprehensive, patient-centered care. PN programs and evidence regarding their effectiveness in low- and middle-income countries are limited. This study aimed to assess whether a PN program for the systematic identification of breast cancer (BC) patients’ medical and support needs facilitated referral and timely access to the specialty and supportive care services they required. Methods: This prospective cohort included women ≥18 years with a recent BC diagnosis (≤3 months [m]), treated at Hospital Zambrano Hellion TecSalud in Mexico, and who provided signed informed consent to participate in the PN program from Apr-21 to Jul-22. Participants completed a series of target questions and validated questionnaires to systematically identify their health needs at baseline, 3 m and 6 m since diagnosis. Subsequently, the navigator had a face-to-face or remote meeting with each patient to inform them about the needs detected at each timepoint. According to these needs, the navigator provided referral to the required services. However, it was each patient’s decision whether she attended to the recommended services. Patients’ attendance to referrals provided at baseline and 3 m were assessed at 3 m and 6 m, respectively. Descriptive statistics were employed. Results: During the analyzed period, 263 patients were invited to participate in the study. Of these, 161 (61%) agreed to participate, 57 (22%) agreed but did not complete any survey, and 45 (17%) denied participation. At the time of the analysis, 148, 119 and 86 patients had completed baseline, 3 m and 6 m navigation, respectively. Median time from BC diagnosis to the baseline navigation meeting post survey-completion was 46 days (12-90). Patients’ median age at baseline was 48 years (24-88). Most had ≥high school education (93%), were unemployed (51%) and were married/in domestic partnership (73%). As for medical insurance, most had public (32%) or both public and private coverage (32%), while the rest had private (26%) or no insurance (9%). Patients’ referrals according to their needs and the rate of attendance to those services are detailed in the Table. The main barriers that were qualitatively identified for non-attendance to referral services were time restrictions, patient-provider miscommunication, medical coverage limitations, and financial constraints. Feedback regarding the PN program was provided in 72 cases. All respondents were very satisfied (97%) or satisfied (3%) with the program; affirmed the navigator had facilitated their referral to all (97%) or some (3%) of the services they believed they needed; and stated that the program aided to better cope with their illness (100%). Conclusion: Patients experienced diverse health needs during their trajectory through BC, mainly in terms of psychological support, genetic counseling, maintenance of an adequate weight and access to support groups. However, a suboptimal proportion of patients received attention by the required services. This PN program effectively detected patients’ needs and provided referrals to specific services. Moreover, patients were highly satisfied with the program and believed it aided their coping process. Yet, several barriers that hinder attendance to the referral services might exist and should be identified to enhance the provision of timely, comprehensive care. Table. Patients’ referral and attendance to specialty and supportive care services. Citation Format: Fernanda Mesa-Chavez, Emmeline Rochelle-Palacios, Mauricio Canavati-Marcos, Cynthia Villarreal-Garza. Prospective cohort of breast cancer patients exposed to a navigation program for timely access to referral services in Mexico [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-06.

752 CARDIOGENIC SHOCK AS THE FIRST PRESENTATION OF ACUTE ANTRACYCLINE CARDIOTOXICITY: A CLINICAL CASE

Abstract Background Several therapeutic strategies are available for cancer patients, leading to a longer life expectancy; however, each drug might have different side effects, which increase morbidity and mortality. Cardiovascular diseases are one of the most frequent and dramatic of these side effects, leading to interruption of a potentially lifesaving treatment or hesitating into heart failure. Clinical Case A 50 year-old female with recent diagnosis of breast cancer presented to our Emergency Department (ED) for asthenia, vomiting and dyspnea. A first dose of epirubicin and cyclophosphamide as neoadjuvant chemotherapy (CT) was administered three days before the onset of symptoms. Screening echocardiogram performed before starting the CT showed normal systolic ejection fraction, normal diastolic function and no valvular disease. At ED admission, the patient presented hypotension, tachycardia, sweating and mental confusion. The ECG showed sinus tachycardia with diffuse ST segment elevation and diffuse low QRS voltages. Echocardiogram proved severe left dysfunction (LVEF 15%) with low cardiac output (LVOT VTI 6 mm) and elevated ventricular filling pressure (E/e’ 26). EAB showed severe hyperlactacidemia. The diagnosis of cardiogenic shock was done and high doses of dobutamine and noradrenaline were started. Laboratory values confirmed multiorgan involvement, in absence of any signs of inflammation and infection. The coronary angiography performed revealed normal coronary arteries and elevated left ventricular end-diastolic pressure (LVEDP 29 mmHg). Despite pharmacological therapy, the patient's condition worsened so we proceeded to IMPELLA CP implantation and started methylprednisolone 10 mg/kg for three days with subsequent tapering doses. After 24 hours, we obtained hemodynamic stability and hyperlactacidemia clearance. Unfortunately, myelotoxicity and marked piastrinopenia (until 16 000*10 9/L) complicated the clinical course; for this reason, we stopped unfractionated Heparin (UHF) and no anticoagulant therapy, other the one in purge solution, was performed. CMR revealed diffuse signal enhancement during the T2w sequences associated with a global enhancement of T2 Mapping values due to general edema, a global intramyocardial strengthening, a significant enhancement of the T1 mapping values and extracellular volume were described at the delayed enhancement sequences. The hemodynamic conditions progressively improved during the hospitalization and the IMPELLA pump was removed. Serial echocardiograms documented an improvement of the ejection fraction and further mild reduction of ventricular filling pressure (E/e’ 8) normal right ejection fraction and initial inferior vena cava collapsibility. All the inotropic supports were suspended; we introduced beta-blocker, ACE-inhibitors, subsequently replaced with sacubitril/valsartan, well tolerated. Conclusion Acute cardiotoxicity with possible life-threatening conditions regardless of the basal cardiovascular risk class is a rare clinical condition, but needs further investigation. Future researches are warranted to determine the molecular mechanisms underlying cardiotoxicity to contain the side effects, maximize the benefit of the oncological therapy and, when necessary, select the best therapeutic option.

Negative-pressure wound therapy as an adjunct to treating pyoderma gangrenosum

Negative-pressure wound therapy has been shown to be effective in re-epithelialisation in recalcitrant pyoderma gangrenosum. This case documents a patient whose co-morbidities limited the standard treatment options and required an alternative management plan. The STOP GAP randomised control trial found that both oral prednisolone and ciclosporin were equally effective in the treatment of pyoderma gangrenosum. However, in this case, the patient had type 2 diabetes and prednisolone resulted in persistently elevated blood glucose levels. Lower doses were ineffective and it was subsequently stopped once other treatments showed a clinical improvement. A recent diagnosis of breast cancer prevented the use of ciclosporin and other immunosuppressive treatments. After multidisciplinary discussion, involving breast surgeons, oncology, dermatology and tissue viability, doxycycline was commenced alongside a portable negative-pressure device with twice weekly tissue viability input. The introduction of this device resulted in a rapid reduction in the wound size and facilitated healing with an excellent outcome.

Axillary lymph node characteristics in breast cancer patients versus post-COVID-19 vaccination: Overview of current evidence per imaging modality

BackgroundAxillary lymph node characteristics on axillary ultrasound (US), breast MRI and 18F-FDG PET/CT are relevant at breast cancer diagnosis. Axillary lymphadenopathy after COVID-19 vaccination has been frequently reported. This may cause a diagnostic dilemma, particularly in the ipsilateral axilla in women who have a either a recent diagnosis of breast cancer or a history of breast cancer. This review provides an overview of the current evidence regarding axillary lymph node characteristics at breast cancer diagnosis versus “post-COVID-19 vaccination”. MethodsA non-systematic narrative review was performed. Studies describing axillary lymph node characteristics per imaging modality (axillary US, breast MRI and 18F-FDG PET/CT) in breast cancer patients versus post-COVID-19 vaccination were selected and used for the current study. ResultsThe morphologic characteristics and distribution of abnormal nodes on US may differ from the appearance of metastatic adenopathy since diffuse cortical thickening of the lymph nodes is the most observed characteristic after vaccination, whereas metastases show as most suspicious characteristics focal cortical thickening and effacement of the fatty hilum. Current evidence on MRI and 18F-FDG on morphologic characteristics of axillary lymphadenopathy is missing, although it was suggested that vaccine related lymphadenopathy is more likely to be present in level 2 and 3 nodes than metastatic nodes. Reported frequencies of lymphadenopathy post-COVID-19 vaccination range from 49% to 85% (US), 29% (breast MRI) and 14.5% to 53.9% (18F-FDG PET/CT). Several factors may impact the presence or extent of lymphadenopathy post-COVID-19 vaccination: injection site, type of vaccine (i.e., mRNA versus vector), time interval (days) between vaccination and imaging, previous history of COVID-19 pneumonia, and first versus second vaccine dose. ConclusionAlthough lymph node characteristics differ at breast cancer diagnosis versus post-COVID-19 vaccination, clinical information regarding injection site, vaccine type and vaccination date needs to be documented to improve the interpretation and guide treatment towards the next steps of action.

Obesity, Psychological Distress, and Resting State Connectivity of the Hippocampus and Amygdala Among Women With Early-Stage Breast Cancer.

ObjectiveOverweight and obesity [body mass index (BMI) ≥ 25 kg/m2] are associated with poorer prognosis among women with breast cancer, and weight gain is common during treatment. Symptoms of depression and anxiety are also highly prevalent in women with breast cancer and may be exacerbated by post-diagnosis weight gain. Altered brain function may underlie psychological distress. Thus, this secondary analysis examined the relationship between BMI, psychological health, and resting state functional connectivity (rsFC) among women with breast cancer.MethodsThe sample included 34 post-menopausal women newly diagnosed with Stage 0-IIa breast cancer (Mage = 63.59 ± 5.73) who were enrolled in a 6-month randomized controlled trial of aerobic exercise vs. usual care. At baseline prior to randomization, whole-brain analyses were conducted to evaluate the relationship between BMI and seed-to-voxel rsFC of the hippocampus and amygdala. Connectivity values from significant clusters were then extracted and examined as predictors of self-reported depression and anxiety.ResultsMean BMI was in the obese range (M = 31.83 ± 6.62). For both seeds examined, higher BMI was associated with lower rsFC with regions of prefrontal cortex (PFC), including ventrolateral PFC (vlPFC), dorsolateral PFC, and superior frontal gyrus (z range = 2.85–4.26). Hippocampal connectivity with the vlPFC was negatively correlated with self-reported anxiety (β = 0.47, p < 0.01).ConclusionHigher BMI was associated with lower hippocampal and amygdala connectivity to regions of PFC implicated in cognitive control and emotion regulation. BMI-related differences in hippocampal and amygdala connectivity following a recent breast cancer diagnosis may relate to future worsening of psychological functioning during treatment and remission. Additional longitudinal research exploring this hypothesis is warranted.

Factor structure, internal consistency and distribution of Female Sexual Function Index among Mexican women with early diagnostic of breast cancer

Background: Female Sexual Dysfunction (FSD) occurs frequently in women with breast cancer due to oncologic treatments. It is essential to have a validated instrument to diagnose and quantify FSD in this population accurately. Objective: To validate the Female Sexual Function Index (FSFI). Method: The FSFI was applied to 272 sexually active Mexican women with recent diagnosis of breast cancer who had not initiated systemic cancer treatment. Results: The FSFI six-factor model is valid by confirmatory factor analysis, and the inventory and its factors have adequate internal consistency reliability. Conclusions: This study provides enough evidence about the reliability and factor structure of the FSFI questionnaire in the context of breast cancer clinical practice in Mexico.

Axillary lymph node status in BIRADS 4-5 female patients: can shear wave and strain ultrasound elastography help?

BackgroundThe status of axillary nodes is a determining factor of management and prognosis for patients having a recent diagnosis of breast cancer. Axillary nodes are usually evaluated by ultrasonography (US) and biopsy, if indicated. Ultrasound-guided sampling and intraoperative or sentinel nodal sampling are available options, however, are invasive and hold risks of potential complications, calling for reliable, non-invasive axillary imaging. In the current prospective study, we assessed the performance of shear wave (SWE) and strain (SE) ultrasound elastography regarding preoperative axillary assessment. Sixty axillary nodes from 60 patients (age 28–65 years, mean 49.88 ± 7.61 SD) were included, all scoring BIRADS 4–5 on sonomammography.ResultsFor US, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 100%, 66.67%, 84.78%, 100%, and 88.33%, respectively. Cortical thickness and vascularity were the most sensitive. For qualitative SWE, indices were 76.92%, 80.95%, 88.24%, 65.38% and 78.33%, respectively. Calculated cut-off for Emax was 59.3 and for Eratio was 4.56, giving statistical indices of 76.9%, 90.5%, 93.75%, 67.86%, and 81.67% for Emax and 76.9%, 100%, 100%, 70% and 85% respectively for Eratio. Both Emax and Eratio were greater for malignant (Emax 81.77 ± 1.904, Eratio 8.95 ± 5.69) than for benign nodes (Emax 37.59 ± 33.37, Eratio 2.5 ± 1.37) (P values < 0.001). For qualitative SE, sensitivity and specificity were 92.31% and 57.14%, while PPV, NPV, and accuracy were 80% each (P values < 0.001). The calculated cut-off value for SR was 3.85, giving indices of 87.2%, 76.2%, 76.19%, 87.18% and 83.33% respectively.ConclusionAdding elastography evaluation to conventional US positively impacts the specificity and accuracy of the preoperative axillary nodal status assessment in patients having newly diagnosed breast cancer.

The COVID-19 Vaccines Can Lead to False Positive Mammograms and Breast MRI. How Can we Decrease the Impact Caused by Post-Vaccination Lymphadenopathy in Breast Cancer and Oncology Patients?

There has been an increase in reporting clinical or radiological axillary lymphadenopathy after the coronavirus disease (COVID-19) vaccination. Cancer care is complex and multidisciplinary, which requires care events to be orchestrated promptly; radiology often serves a key role in diagnosis, post-diagnosis and is sometimes the patient’s first step in cancer care initiation, especially in breast cancer. Radiologists are also a key role in other Multidisciplinary Teams (MDT) dealing with different departments. Therefore, identifying unnecessary management within the health system can generally enhance the patient’s experience, reduce the pressure from providing extra health services, and reduce health costs. Based on personal observation and previous literature, the author concludes that patients having breast cancer or recent breast cancer diagnosis in the pre- or peri-treatment setting could benefit from receiving a vaccination, if possible, in the anterolateral thigh or contralateral arm regardless if this vaccine is for influenza, HPV, etc. Whether this is applicable for the COVID-19 vaccine remains unanswered. This approach will potentially reduce the patient anxiety from having a recurrence or failure of treatment and decrease the strain of the health care system both functionally and economically. In addition, this approach can potentially reduce or eliminate cancellations, delays, and rescheduling of relevant imaging modalities. Also, the author suggests adding a history of vaccinations to all the imaging request forms; countries with digital health services can reap the benefit of generating extensive epidemiological data of post-vaccination lymphadenopathy. Thus, creating new base-evidence guidelines for managing reactive post-vaccination lymphadenopathy, and potentially avoiding duplicating unnecessary imaging and patient over-treatment.

Unveiling the histopathologic spectrum of MRI-guided breast biopsies: an institutional pathological-radiological correlation.

Breast magnetic resonance imaging (MRI) has high sensitivity but suffers from low specificity, resulting in many benign breast biopsies for MRI-detected lesions. We sought to compare histologic findings between patients who underwent MRI-guided breast biopsy versus biopsy via other imaging modalities as well as to examine features associated with malignancy in the MRI cohort to help inform MRI-biopsy practice. A 2-year (2018-2019) retrospective review of breast biopsies at our enterprise was conducted. Biopsies were categorized as stereotactic, ultrasound, MRI, or palpation guided. Pathology was categorized as benign (further divided into nine categories), atypical, or malignant (subdivided into in situ and invasive carcinoma). Pathology was compared between biopsy groups. Clinical, pathologic, and imaging features were compared between pathology groups within the MRI cohort. 5828 biopsies from 4154 patients were reviewed, including 548 MRI-guided biopsies with stratification of MRI-biopsy pathology as follows: 69% benign, 13.8% atypical, and 17.2% malignant. Among benign MRI biopsies, there was higher frequency of "clustered cysts with papillary apocrine metaplasia" (56/548; 10.2%) and lower rate of fibroadenoma/fibroadenomatous change (55/548; 10%) compared to other modalities (158 or 3% and 1144 or 21.7% of 5280 biopsies, respectively). Multivariate analysis revealed indication of breast cancer (p < .0001), ipsilateral cancer (p < .0001) and rapid initial phase kinetics (p = .017) to remain significantly associated with malignant MRI-biopsy pathology. A concurrent or recent breast cancer diagnosis was most predictive of malignancy on MRI-guided breast biopsy. Combined MRI feature evaluation and radiologic-pathologic concordance activities may allow for prognostic refinement and improved risk stratification.

Ecthyma gangrenosum with Pseudomonas aeruginosa bacteremia in an immunocompromised patient

Abstract Rationale: Ecthyma gangrenosum is an uncommon cutaneous manifestation and recognized for its association with Pseudomonas aerugninosa sepsis in immunocompromised patients, particularly if there is neutropenia. These lesions follow a certain pattern of presentation, from erythematous nodules to necrotizing ulcers with surrounding erythema. Patient concerns: We describe a case of an immunocompromised woman with recent breast cancer diagnosis, under chemotherapy treatment, who on admission presented painful erythematous nodules on her right thigh with 5 days of evolution and hemodynamically stable. The computed tomography scan of chest, abdomen, and pelvis showed nodular areas of densification of the subcutaneous tissue predominantly in the abdominal wall and nodular peripheral lesions in the pulmonary parenchyma, with recent onset, suggestive of possible septic embolization. Diagnosis: The diagnosis of ecthyma gangrenosum was confirmed after the isolation of Pseudomonas aeruginosa from the blood and wound culture samples, while a punch biopsy excluded other possible etiologies. Interventions: The patient completed 30 days of antibiotherapy, initially with piperacillin/tazobactam that was narrowed after 14 days of treatment to ciprofloxacin. Outcomes: Favorable evolution with complete clinical resolution was observed after 3months. Lessons: The early recognition and the prompt treatment with broad spectrum empiric antibiotic are the key for a good outcome in patients with ecthyma gangrenosum.

Laughing at pink ribbon culture: Tig Notaro’s comedic subversion of the she-ro

ABSTRACT In this essay, I conduct an ideological performance critique of Tig Notaro’s now-famous 2012 stand-up comedy performance, Live, in which she discloses her recent breast cancer diagnosis. Doing so places her firmly within the realm of dominant pink ribbon culture, which valorizes the she-ro, an attractive, all-conquering superhero. I argue that Notaro utilizes the literary and rhetorical trope bathos to subvert the she-ro ideal. Her subversion demonstrates the potential power of stand-up comedy to intervene in harmful and oppressive ideologies on behalf of marginalized and misunderstood populations and renegotiate these populations’ positions in the dominant culture.

Employment status and information needs of patients with breast cancer: a multicentre cross-sectional study of first oncology consultations

ObjectivesTo investigate the early information needs of women with a recent diagnosis of breast cancer (BC) according to their employment status.DesignCross-sectional.SettingSecondary-care patients attending three outpatient oncology clinics in northern Italy.Participants377...

Hypnosis in Women with Breast Cancer: Its Effects on Cytokines

The aim of the present study was to evaluate the effects of hypnosis on the cytokine levels of women with breast cancer during chemotherapy. Patients with a recent breast cancer diagnosis were assigned to either a control group (n = 20) or to a hypnosis group (n = 20). The control group received standard medical care, while the hypnosis group received 24 sessions of hypnosis over 6 months as an adjuvant therapy to standard medical care. Three blood samples were obtained, one before the initiation of chemotherapy, the second a month after beginning treatment, and the third at the end of treatment. At the end of chemotherapy treatment, the control group showed significantly higher levels of tumor necrosis factor alpha (TNF-α) and granulocyte colony stimulation factor (G-CSF) compared to the hypnosis group. Stabilized G-CSF and TNF-α levels during chemotherapy in the hypnosis group could be considered as beneficial because high levels of these cytokines have been associated with increased levels of tumor growth and metastasis in cancer patients.

Metabolic syndrome and obesity as factors of good procnostic oncology in women in post-menopause with recent diagnosis of breast cancer

Objective: To evaluate the association between metabolic syndrome (MS), obesity, and central fat deposition with the immunohistochemical profile (IHC) of breast cancer (BC) in postmenopausal women. Methods: A comparative cross-sectional clinical study was carried out with 63 women with recent BC and MS, compared to 126 women with recent BC, without MS (control group). Inclusion criteria were: women aged 45-75 years, amenorrhea &gt;12 months, without previous cancer treatment, attended at a University Hospital. The groups were matched for age, time since menopause, and body mass index (BMI), in the proportion of 1 case for 2 controls, according to the sample calculation of at least 186 women in their entirety. Clinical and anthropometric data were collected; tumor size and grade and the IHC profile (ER, PR, HER2, and Ki67). By IHC convention, tumors were grouped into five subtypes: Luminal A (ER+, PR+, HER-2 -, and Ki-67 &lt;14%); Luminal B HER-2 - (ER+, PR+ or -, HER-2 -, and Ki-67≥14%); Luminal B HER-2+ (ER+, PR+ or -, HER-2+, and any Ki-67); Non-luminal HER-2 (ER-, PR-, HER2+, and any Ki-67); and Triple-negative (ER-, PR-, HER2-, and any Ki-67). Women with three or more diagnostic criteria were considered with MS: waist circumference (WC)&gt;88 cm; TG≥150 mg/dL; HDL cholesterol&lt;50 mg/dL; blood pressure ≥130/85 mmHg; glucose ≥100 mg/dL. For statistical analysis, the Student’s t-test, Gamma Distribution, χ2 test and logistic regression (odds ratio–OR) were used. Results: Among the participating women, the mean age, time since menopause and BMI were: 59.0±10.6 years, 11.4±9.6 years, and 28.5±5.5 kg/m2, respectively; there was no statistical difference in the comparison between the groups. Women with MS had a higher occurrence of tumors ≤2cm when compared to those without MS (49.2 vs. 31.8%, respectively) (p=0.038). Women with MS had a higher incidence of tumors with PR-positive (p=0.046), HER2-negative (p=0.038), when compared to women without MS (79.4 vs. 65.8% and 44.5 vs. 27.8%, respectively). In obese patients (BMI≥30 kg/m2), a higher proportion of HER2 negative tumors (p=0.047) was observed when compared to non-obese women (43.9 vs. 27.7%, respectively). In the multivariate analysis, a higher risk for tumors of the Luminal B HER-2 negative subtype was observed among women with MS (OR 2.00, 95%CI 1.03‒3.89), obese (OR 2.03, 95%CI 1.06‒3.90), and with central deposition of fat (OR 1.96, 95%CI 1.01‒4.03). Conclusion: Metabolic syndrome, obesity, and central fat deposition correlate with factors of good prognosis for breast cancer, such as tumors ≤2 cm, PR+ and HER2-, in postmenopausal women.

Distress: Characterizing What Causes the Thermometer to Shift in Patients with Newly Diagnosed Breast Cancer Attending a Multidisciplinary Clinic.

A diagnosis of breast cancer (BC) can result in multifactorial stress. If not addressed, distress can have a negative impact on outcomes. The experience of patients with newly diagnosed BC has not been sufficiently investigated. This study characterizes distress among new patients in a multidisciplinary care (MDC) clinic. The study aimed to determine the degree of distress at presentation, to characterize the sources, and to evaluate the impact of an MDC visit. A retrospective review was performed from January 2015 to November 2017. Charts were accessed for demographics, tumor characteristics, and treatment data. Distress scores (DS) and problems as captured using the National Comprehensive Cancer Network (NCCN) Distress Thermometer were completed before evaluation and in a subgroup after an MDC visit. Predictors of severe distress (DS ≥4) were investigated using multivariable logistic regression. The paired t test was used to determine the impact of an MDC visit. The mean initial DS (n=474) was 4.98. The top four sources of distress were worry, anxiety, fears, and sadness. Age younger than 65 years was significantly associated with a higher DS at presentation (p<0.003). Among the patients queried before and after MDC (n=137), a significant reduction in distress was identified (5.58-2.94; p<0.0005). Severe distress was found in 66 % of the patients with a recent diagnosis of BC, with younger age related to higher distress scores at presentation. Emotional stressors were the predominant factors accounting for distress. A same-day MDC visit was associated with a significant reduction in DS. These data indicate the importance and feasibility of proactively screening patients. Our research lends support to the value of multidisciplinary evaluation in this setting.