Breast Cancer Screening In Patients Research Articles

Plasma-free Amino Acid Profile is Beneficial for Breast Cancer Screening in Women With Dense Breasts

BackgroundAminoIndex™ Cancer Screening (AICS breast) was developed as a breast cancer screening test using multivariate analysis of plasma free amino acid (PFAA) profiles. This study investigated the relationship between the AICS breast rank and breast density on mammography (MMG) for the detection of breast cancer. Materials and MethodsMMG and blood samples were obtained preoperatively from 224 patients with breast cancer who did not receive neoadjuvant chemotherapy between 2017 and 2019. PFAA concentration was measured using liquid chromatography-mass spectrometry, and the AICS breast and AICS ranks were calculated. Detection rates were compared between MMG (categories 3-5) and AICS breasts (ranks B and C) according to breast density. ResultsBreast density was classified as extremely dense in 9.4%, heterogeneously dense in 48.2%, scattered in 29.9%, and fatty in 12.5% of patients. Dense breasts (extremely dense and heterogeneously dense) represented 57.6%. The overall detection rate by MMG was 82.6% and significantly lower in patients with dense breasts (74.4%) compared to non-dense breasts (93.7%). The overall detection rate by AICS breast was 50.0%, with no difference between patients with dense breasts (45.7%) and those with non-dense breasts (55.8%). The combination of MMG and AICS breast increased the detection rate to 91.5% overall, 88.3% in patients with dense breasts, and 95.8% in those with non-dense breasts. ConclusionThis study demonstrated that the detection rate of AICS breast was not associated with breast density, unlike MMG. Adding AICS breast to MMG may be beneficial for breast cancer screening in patients with dense breasts.

Identification of activating somatic mutations in the <i>PIK3CA</i> gene in breast tumors and determination of their minimal set for clinical diagnostic testing

Background: For effective screening of breast cancer patients for candidates for target therapy with alpelisib, it is necessary to identify activating somatic mutations in the PIK3CA gene by allele specific polymerase chain reaction (PCR); this requires that an optimal list of mutations should be compiled. Aim: To determine the spectrum of somatic mutations in the PIK3CA gene in breast cancer tumors by means of high performance sequencing (next generation sequencing, NGS) and to identify their minimal set for clinical diagnostic testing by allele specific PCR. Methods: Targeted NGS was used to identify mutations in the PIK3CA gene in DNA obtained from paraffin blocks with tumor material from 431 patients with HR+HER2- breast cancer. A set of the most common somatic mutations was also detected by allele specific PCR. Results: We have developed a set of reagents and a protocol for targeted NGS of frequently mutating regions of the PIK3CA and ESR1 genes, which was used to analyze samples from 451 HR+/HER2- breast cancer patients. Clinically significant activating mutations in the PIK3CA gene were found in 32.7% of the samples (141/431). The frequency of the mutant allele ranged from 0.15 to 0.65. Six mutations were most common: c.3140AG p.His1047Arg (69), c.1633GA p.Glu545Lys (32), c.1035TA p.Asn345Lys (12), c.1624GA p.Glu542Lys (9), c.3140AT p.His1047Leu (8), Cys420Arg c.1258TC (3). In total, these mutations amounted to 94.3% (133/141). In 3.5% of the samples (15/431), there were clinically significant somatic mutations in the ESR1 gene: c.1613AG p, Asp538Gly (7), c.1610AC p.Tyr537Ser (6), c.1609TA p.Tyr537Asn (1), c.1610AG p.Tyr537Cys (1), causing resistance to hormone therapy in patients with breast cancer. While rare mutations comprised only 5.7% of our sample, we validated a set of reagents to identify the six mutations described above by allele specific PCR. NGS and PCR were completely concordant. Conclusion: PCR testing of activating somatic mutations of the PIK3CA gene meets the requirements for sensitivity ( 90%) and specificity (100%) for a clinical test and can be used in the selection of patients for targeted therapy with PIK3CA inhibitors.

Atomically Co-dispersed nitrogen-doped carbon for sensitive electrochemical immunoassay of breast cancer biomarker CA15-3.

The development of an ultrasensitive and precise measurement of a breast cancer biomarker (cancer antigen 15-3; CA15-3) in complex human serum is essential for the early diagnosis of cancer in groups of healthy populations and the treatment of patients. However, currently available testing technologies suffer from insufficient sensitivity toward CA15-3, which severely limits early large-scale screening of breast cancer patients. We report a versatile electrochemical immunoassay method based on atomically cobalt-dispersed nitrogen-doped carbon (Co-NC)-modified disposable screen-printed carbon electrode (SPCE) with alkaline phosphatase (ALP) and its metabolite, ascorbic acid 2-phosphate (AAP), as the electrochemical labeling and redox signaling unit for sensitive detection of low-abundance CA15-3. During electrochemical detection by differential pulse voltammetry (DPV), it was found that the Co-NC-SPCE electrode did not have a current signal response to the AAP substrate; however, it had an extremely favorable response current to ascorbic acid (AA). Based on the above principle, the target CA15-3-triggered immunoassay enriched ALP-catalyzed AAP produces a large amount of AA, resulting in a significant change in the system current signal, thereby realizing the highly sensitive detection of CA15-3. Under the optimal AAP substrate concentration and ALP catalysis time, the Co-NC-SPCE-based electrochemical immunoassay demonstrated a good DPV current for CA15-3 in the assay interval of 1.0 mU/mL to 10,000 mU/mL, with a calculated limit of detection of 0.38 mU/mL. Since Co-NC-SPCE has an excellent DPV current response to AA and employs split-type scheme, the constructed electrochemical immunoassay has the merits of high preciseness and anti-interference, and its clinical diagnostic results are comparable to those of commercial kits.

Design, synthesis and evaluation of 177Lu-labeled inverso and retro-inverso A9 peptide variants targeting HER2-overexpression

Several HER2-specific peptides are being continuously explored to find a candidate with suitable pharmacokinetic properties for development of effective radiopharmaceutical that can find applications for clinical screening of breast cancer patients. In the present work with an aim of preparing a radiopeptide with improved metabolic stability and in vivo pharmacokinetic performance we modified our previously reported [177Lu]DOTA-L-A9 peptide. Here we designed an ‘inverso’ peptide with all d-amino acids and a ‘retro-inverso’ peptide where sequence of d-amino acids was reversed. Higher secondary structure stabilization of retro- inverso A9 variant compared to inverso A9 peptide was evident by circular dichroism studies. The two radiopeptides [177Lu]DOTA-D-A9 and [177Lu]DOTA-rD-A9 exhibited significantly improved in vivo metabolic stability over the original l-peptide. The retro-inverso variant, [177Lu]DOTA-rD-A9 demonstrated better pharmacokinetic behavior with significantly higher tumor uptake than the inverso peptide, [177Lu]DOTA-D-A9 and the original peptide, [177Lu]DOTA-L-A9. In the present case of A9 peptide, reversal of the peptide sequence of d-amino acids boosted the uptake and retention of radioactivity in HER2-positive tumor. The present study can thus guide the design and development of newer and improved versions of peptides.

Pharmacokinetic Analysis of Enhancement-Constrained Acceleration (ECA) reconstruction-based high temporal resolution breast DCE-MRI.

The high spatial and temporal resolution of dynamic contrast-enhanced MRI (DCE-MRI) can improve the diagnostic accuracy of breast cancer screening in patients who have dense breasts or are at high risk of breast cancer. However, the spatiotemporal resolution of DCE-MRI is limited by technical issues in clinical practice. Our earlier work demonstrated the use of image reconstruction with enhancement-constrained acceleration (ECA) to increase temporal resolution. ECA exploits the correlation in k-space between successive image acquisitions. Because of this correlation, and due to the very sparse enhancement at early times after contrast media injection, we can reconstruct images from highly under-sampled k-space data. Our previous results showed that ECA reconstruction at 0.25 seconds per image (4 Hz) can estimate bolus arrival time (BAT) and initial enhancement slope (iSlope) more accurately than a standard inverse fast Fourier transform (IFFT) when k-space data is sampled following a Cartesian based sampling trajectory with adequate signal-to-noise ratio (SNR). In this follow-up study, we investigated the effect of different Cartesian based sampling trajectories, SNRs and acceleration rates on the performance of ECA reconstruction in estimating contrast media kinetics in lesions (BAT, iSlope and Ktrans) and in arteries (Peak signal intensity of first pass, time to peak, and BAT). We further validated ECA reconstruction with a flow phantom experiment. Our results show that ECA reconstruction of k-space data acquired with 'Under-sampling with Repeated Advancing Phase' (UnWRAP) trajectories with an acceleration factor of 14, and temporal resolution of 0.5 s/image and high SNR (SNR ≥ 30 dB, noise standard deviation (std) < 3%) ensures minor errors (5% or 1 s error) in lesion kinetics. Medium SNR (SNR ≥ 20 dB, noise std ≤ 10%) was needed to accurately measure arterial enhancement kinetics. Our results also suggest that accelerated temporal resolution with ECA with 0.5 s/image is practical.

Psychological Factors Associated With Mental Adjustment to Breast Cancer: A Hospital-Based Observational Study

This study examined mental adjustment to breast cancer, that is, coping strategies. Participants were 130 women undergoing breast cancer treatment in two medical settings in Accra, Ghana. They completed questionnaires assessing mental adjustment to cancer, psychological distress (anxiety and depression), negative religious coping, body change stress, and illness perceptions. Data were analyzed using hierarchical linear regression. Results showed that patients who reported higher depression were more likely to engage in anxious preoccupation (worry and thinking about breast cancer). Higher depression was associated with a greater sense of helplessness/hopelessness. Moreover, patients higher in negative religious coping were more likely to experience a greater sense of helplessness/hopelessness. Illness perception facets of personal control and emotional response were positively associated with fatalism and anxious preoccupation, respectively. The results suggest that screening breast cancer patients for psychological morbidity could help identify patients with increased risks for maladaptive adjustment to the disease.

Advances in Electrochemical Biosensor Technologies for the Detection of Nucleic Acid Breast Cancer Biomarkers.

Breast cancer is the second leading cause of cancer deaths in women worldwide; therefore, there is an increased need for the discovery, development, optimization, and quantification of diagnostic biomarkers that can improve the disease diagnosis, prognosis, and therapeutic outcome. Circulating cell-free nucleic acids biomarkers such as microRNAs (miRNAs) and breast cancer susceptibility gene 1 (BRCA1) allow the characterization of the genetic features and screening breast cancer patients. Electrochemical biosensors offer excellent platforms for the detection of breast cancer biomarkers due to their high sensitivity and selectivity, low cost, use of small analyte volumes, and easy miniaturization. In this context, this article provides an exhaustive review concerning the electrochemical methods of characterization and quantification of different miRNAs and BRCA1 breast cancer biomarkers using electrochemical DNA biosensors based on the detection of hybridization events between a DNA or peptide nucleic acid probe and the target nucleic acid sequence. The fabrication approaches, the biosensors architectures, the signal amplification strategies, the detection techniques, and the key performance parameters, such as the linearity range and the limit of detection, were discussed.

8.Prevalence of Transmissible Infections Among Breast Cancer Patients in Calabar, Nigeria

Introduction: Transmissible infections including those of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and syphilis remain public health challenges. The co-existence of these infections with other disease conditions of medical importance can be quite challenging, particularly if there is no prior knowledge of the infection status. Apart from the direct impact on the affected patient, there is also the concern of safety for care givers as well as the risk of nosocomial transmission to other patients. This study focused on pre-operative screening of breast cancer patients to determine the prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and syphilis infections. Materials and Methods: This study was conducted among breast cancer patients in Calabar, Cross River State of Nigeria. A structured questionnaire was administered by two trained interviewers to obtain biodata and socio-demographic characteristics. Screening for antibodies to HIV, HBV, HCV and Syphilis were performed by standard serological techniques. Results: General prevalence for all the screened infections was 18%. Distribution of specific infections revealed hepatitis B viral infection to be highest (8%), followed by HIV infection (6%). Hepatitis C virus infection and syphilis were the least with 2% rates each. Among participants living with these infections, 33% had previous knowledge of their status, while the remaining 67% had no prior knowledge. Conclusion: Hepatitis B virus had the highest prevalence while the lowest were HCV and syphilis. Greater percentage of infected subjects were not aware of their status prior to the pre-operative screening.

Correlation between CA-15-3 and Bone Scan findings in patients with Carcinoma Breast

Objectives: Breast cancer is the most common malignant tumor of females; the incidence increases with age. Bone is the most common site to which breast cancer metastasizes. Between 30% to 85% of patients with metastatic breast cancer develop bone metastases during the course of the disease. Carbohydrate antigen (CA) 15-3 is a circulating human breast cancer associated antigen used as a tumor marker in the screening of breast cancer patients for metastasis. The objective of this study was to compare the levels of CA 15-3 and bone scan findings in patients with breast cancer. Material and Methods: This cross-sectional analytical study was carried out at Rajshahi medical college hospital, Rajshahi, from January 2018 to December 2019. A total of 90 diagnosed breast cancer patients were enrolled in this study. Among them 45 patient was with normal CA 15-3 level and 45 patient was with elevated CA 15-3 level. All of them underwent bone scan. The tumor maker CA 15-3 was compared with bone scan findings. Results: Mean age of the patients was 46.62 ± 8.67 years (range 33 to 67 years). Among 45 patients with normal CA 15-3 level, bone scan was negative for metastasis in 39 (86.66%) patients with CA 15-3 level 14.96 ± 9.72U/ml and positive for metastasis in 6 (13.33%) patient with CA 15-3 level 23.3 ± 2.96U/ml. Out of 45 patients with elevated CA 15-3 level 11 (24.44%) had negative bone scan with CA 15-3 level 92.5 ± 19.89 U/ml whereas 34 (75.55%) patient had positive bone scan findings with CA 15-3 level 413.83 ± 362.83U/ml. In current study, Pearson’s correlation coefficient test showed positive relation, for elevated CA 15-3 level and Bone scan findings there was (r = 0.853, p = 0.00001) and for normal CA15-3 level and bone scan finding (r = 0.449, p = 0. 0019). Conclusion: The result of this study showed positive relationship between the bone scan findings and CA 15-3 level of breast carcinoma patients.

Using the Indocyanine Green (ICG) Lymphography to Screen Breast Cancer Patients at High Risk for Lymphedema.

Background: Indocyanine green (ICG) lymphography is a newer technique for diagnosing lymphedema. Our study aimed to find whether the abnormality of ICG lymphography can predict the occurrence of early lymphedema and then select candidates at high risk of developing lymphedema. Methods: Postoperative breast cancer patients who visited the lymphedema clinic of Peking University People’s Hospital from December 2016 to September 2019 were consecutively enrolled and received ICG lymphography and circumference measurement. Data were collected on the patients’ characteristics and correlation between ICG lymphography and the occurrence of lymphedema. Results: The analysis included 179 patients. There were 91 patients in the lymphedema group and 88 patients in the non-lymphedema group. By multivariate analysis, age, axillary surgery, radiotherapy, and time since breast cancer surgery were regarded as risk factors for lymphedema (p < 0.05). According to the results of ICG lymphography, patients in the non-lymphedema group (n = 88) were divided into ICG-positive (n = 47) and ICG-negative (n = 41) groups. The incidence of lymphedema in the ICG-positive group was significantly higher than that in the ICG-negative group (19.1% vs. 2.4%, p = 0.027). Conclusion: Lymphatic disorder can be detected before circumference change using ICG lymphography. Abnormal ICG lymphography is an independent risk factor for lymphedema. Patients with abnormal dermal backflow patterns are considered to be a high-risk group for lymphedema and should undergo early interventions to prevent lymphedema.

Breast Cancer Incidentally diagnosed during Implantable Pulse Generator Replacement in a Patient treated with Deep Brain Stimulation : Importance of Breast Cancer Screening in Patients with Implantable Pulse Generator

Breast Cancer Incidentally diagnosed during Implantable Pulse Generator Replacement in a Patient treated with Deep Brain Stimulation : Importance of Breast Cancer Screening in Patients with Implantable Pulse Generator

COVID-19 Screening of Breast Cancer Patients During Treatment: A Single Center Experience in Japan.

Breast cancer treatment mainly involves interventional methods such as surgical resection and chemotherapy. How to best perform these treatments during the COVID-19 pandemic remains to be established. Patients with breast cancer who received SARS-CoV-2 PCR screening before cancer treatment from December 2020 to April 2021 were included. PCR screening was performed within 72 hours of the scheduled admission time and treatment. A total of 19 tests in 15 patients were analysed. Fourteen cases displayed no symptoms, and five cases had some symptoms. COVID PCR tests were negative in all cases. COVID-19 screening can ensure that breast cancer patients do not miss scheduled treatments as a result of the pandemic. Diagnosis of patients with symptoms that are shared by COVID-19 infection, chemotherapy, and breast cancer recurrence must be performed carefully.

MiR-875 Serves as A Candidate Biomarker for Detection and Prognosis and Is Correlated with PHH3 Index Levels in Breast Cancer Patients

BackgroundmiRNAs play crucial roles in cancers. This study investigated the potential value of miR-875 to be a detective or/and prognostic marker and evaluate the correlation between its expression and PHH3 index levels in breast cancer. MethodsmiR-875 expression was determined in breast cancer serum and tissues by a quantitative real-time reverse transcription-polymerase chain reaction. The detective value of serum miR-875 expression for breast cancer was assessed by receiver operating characteristic analysis. Then the associations of miR-875 expression with clinical characteristics of patients and overall survival were evaluated by χ2 test and Kaplan-Meier curve methods, respectively. ResultsThe expression of miR-875 was increased in both breast cancer serum and tissues compared with respective controls. The high miR-875 expression in serum and tissues was associated with positive lymph node metastasis and advanced TNM stages. Besides, miR-875 expression in tissues was positively associated with the PHH3 index. And serum miR-875 could screen breast cancer patients from healthy individuals. Moreover, breast cancer patients with both high expression of miR-875 and PHH3 index had shorter overall survival. ConclusionThis study suggested that miR-875 expression may be suitable as a potential breast cancer detection and prognosis biomarker. And the miR-875 expression in tissues was positively associated with the PHH3 index, suggesting that miR-875 expression may be involved in tumor proliferation of breast cancer.

Axillary Ultrasound as Preoperative Staging in Clinical Negative Axillary Lymph Node Breast Cancer Patient

Objective: To determine the diagnostic accuracy of axillary US as a preoperative investigation by comparing it with the histology outcome of nodal status. Methods: This validation analysis was conducted in Mater Misericordia university hospital, Dublin Ireland form Feb 2007 to Feb 2015. All female patients with impalpable axillary lymph node and histology proven unifocal breast cancer between ages 18 to 75 years were included. Patients with the diagnosis of breast cancer were followed with Ultrasound imaging and results in Picture Archiving and communication system (PACS) and histology was confirmed using the patient center data base in both preoperative and postoperative course of breast cancer, including both sentinel lymph nodes and axillary lymph nodes. Results: A total of 625 patients had axillary ultrasound (US) to assess the preoperative axillary nodal status with mean age of 56±12 years. cN0 was diagnosed in 469 (75%) cases, cN1 in 136 (21.8%) cases and cN2 in 20 (3.2%) cases. After negative axillary ultrasound cN0 pathology shows positive pN2 and pN3 disease in 14 (2.9%) cases with the NPV of 97.01%. Axillary ultrasound had shown cN1 disease in 136 cases with the pathology outcome of pN2 and pN3 in 41 (30.14%) cases with the negative predictive value (NPV) of 69.85%. The overall sensitivity and specificity of the axillary US in detection of the positive node was 51.6% and 92.8% with PPV of 82.69% and NPV of 74.2%. Conclusion: Axillary US is a useful modality for screening of breast cancer patients. The negative US findings exclude the presence of advanced nodal disease. However, it cannot accurate distinguish between pN1 and pN2 or pN3 nodal disease. Keywords: Axillary ultrasound, Axillary lymph nodes, Breast cancer.

Evaluate the effectiveness of breast cancer decision aids: A systematic review and meta-analysis of randomize clinical trails.

AimTo assess the effectiveness of decision aids in the treatment, prevention and screening of breast cancer patients.DesignA systematic review and meta‐analysis.MethodsThe review protocol was registered in the CRD Prospero database(CRD42020173028).A literature search was carried out in five databases: PubMed, Cochrane, EMBASE, Scopus and Web of science data in January 2020. We used The Cochrane risk bias assessment tool to evaluate the literature quality of included trials and the Review Manager 5.2 software to analyse data.ResultsWe included 22 studies. Compared with the conventional methods, decision aids reduced treatment decision conflicts and had no significant effect on screening decision conflicts (WMD=−2.25, 95% CI = ‐ 2.64,‐1.87, p < .0001; WMD=−1.37, 95% CI = ‐ 3.57,0.83, p = .22). Three were no statistical differences in participants' anxiety, decision regret, knowledge, informed choice and decision‐making satisfaction between the two groups.

Contrast-Enhanced Mammography for Screening Women after Breast Conserving Surgery.

Simple SummaryBreast cancer survivors are at risk for recurrence, and the early detection of recurrence improves survival. Therefore, imaging surveillance is performed for women who have breast-conserving surgery. The aim of our retrospective study was to compare routine mammography with contrast-enhanced mammography in the screening (asymptomatic) post-treatment setting. We confirmed that when screening women with breast conservation surgery, contrast-enhanced mammography had a higher cancer detection rate (15.4/1000) and positive predictive value of biopsies (42.9%) than full-field digital mammography (6.2/1000 and 37.5%, respectively).To investigate the value of contrast-enhanced mammography (CEM) compared to full-field digital mammography (FFDM) in screening breast cancer patients after breast-conserving surgery (BCS), this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved retrospective, single-institution study included 971 CEM exams in 541 asymptomatic patients treated with BCS who underwent screening CEM between January 2013 and November 2018. Histopathology, or at least a one-year follow-up, was used as the standard of reference. Twenty-one of 541 patients (3.9%) were diagnosed with ipsi- or contralateral breast cancer: six (28.6%) cancers were seen with low-energy images (equivalent to FFDM), an additional nine (42.9%) cancers were detected only on iodine (contrast-enhanced) images, and six interval cancers were identified within 365 days of a negative screening CEM. Of the 10 ipsilateral cancers detected on CEM, four were detected on low-energy images (40%). Of the five contralateral cancers detected on CEM, two were detected on low-energy images (40%). Overall, the cancer detection rate (CDR) for CEM was 15.4/1000 (15/971), and the positive predictive value (PPV3) of the biopsies performed was 42.9% (15/35). For findings seen on low-energy images, with or without contrast, the CDR was 6.2/1000 (6/971), and the PPV3 of the biopsies performed was 37.5% (6/16). In the post-BCS screening setting, CEM has a higher CDR than FFDM.

Current Practices in Pathologic Assessment of Breast Tissue in Female-to-Male Transgender Top Surgery

Purpose: All genetically female at birth individuals are at risk for developing breast cancer. No guidelines exist for the surveillance of breast cancer in these patients particularly for those choosing to undergo female-to-male transgender top surgery. We aim to investigate current experiences and perioperative practices among American Society of Plastic Surgery (ASPS) member surgeons performing top surgery. Method: An anonymous, 19 question electronic survey was sent to ASPS surgeons. General proportions were calculated from the survey responses. Results: Of the 107 respondents, only 71 (67%) perform top surgery. 28% routinely remove all breast tissue that they encounter and 74% send all specimens for pathologic analysis. High cost to patients was the greatest barrier to sending specimens to pathology. 8.7% reported having had a diagnosis of breast cancer or pre-cancerous finding within a specimen, and 4.4% have had a patient or cared for a patient diagnosed with breast cancer after top surgery. DCIS and atypical ductal hyperplasia were the most commonly found pathologic diagnoses. 85% require breast imaging prior to top surgery in patients over 40 years old. Only 70% counsel patients on postoperative breast cancer screening. Most commonly recommended screening regimens were self and medical professional breast exams. Conclusions: Wide variation exists in the management of pre-, intra-, and postoperative breast cancer screening for patients undergoing female-to-male transgender top surgery. Our data highlights the need for standardization of care and further studies documenting the risk, incidence, and prevalence of breast cancer in the transmasculine population before and after chest surgery.

Using the axillary reverse mapping technique to screen breast cancer patients with a high risk of lymphedema

BackgroundPreventing breast cancer-related lymphedema (BCRL) by preserving upper lymphatic drainage is still controversial. Our study aimed to use the axillary reverse mapping (ARM) technique in patients who underwent axillary surgery to analyse the correlation between postoperative residual ARM nodes and the occurrence of lymphedema, select candidates at high risk of developing lymphedema, and analyse the oncologic safety of ARM nodes.MethodsPatients undergoing sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) from October 2015 to February 2016 at the Peking University People’s Hospital Breast Center were prospectively recruited for the study. ARM was performed in all patients before surgery. ARM nodes were separated from SLNB and ALND specimens. Data were collected on the identification of ARM nodes before surgery, number of residual ARM nodes after surgery, nodal status, crossover rate, and correlation between residual ARM nodes and the occurrence of lymphedema.ResultsThe analysis included 78 patients. Of the 53 patients who underwent SLNB, crossover between ARM nodes and breast sentinel lymph nodes (SLNs) was seen in 22 specimens. The incidence of ARM node metastasis was 1.89% (1/53) and 25% (9/36) in the SLNB and ALND groups, respectively. The number of positive axillary lymph nodes was associated with the involvement of ARM nodes (P = 0.036). The incidence of residual ARM nodes was significantly higher in the SLNB group than in the ALND group (67.6% vs. 37.9%, P = 0.016). The incidence of lymphedema was significantly higher in the ALND group than in the SLNB group (33.3% vs. 5.4%, P = 0.003).ConclusionsFor SLNB, the ARM technique can help to resect SLNs more accurately. However, we do not recommend using the ARM technique to preserve ARM nodes in patients undergoing ALND due to oncologic safety issues. Nevertheless, we can predict patients undergoing axillary surgery who are more likely to have a high risk of lymphedema by assessing residual ARM nodes.Trial registrationThis study was registered on ClinicalTrials.gov in February 2016.The clinical trial registration number is NCT02691624.

Inappropriate colorectal and breast cancer screening in patients with advanced cancer.

e19197 Background: Despite the low five-year expected survival of patients with advanced cancer, it has been suggested that up to 1.7% of patients aged 65 and older with advanced cancer may continue to undergo screening for colorectal cancer and up to 8.9% of female patients 65 and older with an advanced cancer may receive a screening mammography.1 The intent of our study was to determine the rate of colorectal and breast cancer screening in men ages 50-75 and women ages 40-75 after these patients were diagnosed with an advanced cancer. Methods: The medical records of 208 patients (median age 63.5, range 42-75) with a diagnosis of stage IV colorectal, prostate, breast, liver, gastroesophageal, skin, uterine, bladder, kidney and stage III-IV pancreatic and lung cancer were reviewed for documentation of a screening mammography, colonoscopy or FIT-DNA testing after the patient was diagnosed with an advanced cancer. Results: Overall, 4.8% of patients were screened for colorectal cancer and 10% of the females received at least one mammogram. The screening mammography rate in patients less than 64 years of age was 13.3% and the colorectal screening rate in this age group was 4.4%. In patients 65 and older, the screening mammography rate was 7% and the colorectal screening rate was 5.2%. Conclusions: Colorectal and breast cancer screening rates in patients with advanced cancer were higher within our fully integrated healthcare system in comparison to previously reported findings in patients 65 and older. In addition, the rate of screening with mammography may be more prevalent amongst patients 64 or younger with advanced cancer in comparison to patients 65 and older with a similar diagnosis. The next phase of this quality improvement project involves disabling health maintenance prompts within the electronic medical record of patients with advanced cancer.

Glycosylated Hemoglobin A1c Is Associated with Anthropometric Measurements and Tumor Characteristics in Breast Cancer Patients.

PurposeTo investigate the association between glycosylated hemoglobin A1c (HbA1c) with anthropometric measurements and clinicopathologic characteristics of breast cancer patients. Such data are lacking in Arabian countries.Patients and MethodsA cross-sectional study was conducted at the Outpatient Oncology Unit at King Hussein Medical Center at the Royal Medical Services (RMS) and 223 breast cancer patients were included. Blood levels of HbA1c were measured and patients were classified into normal/non-diabetic (HbA1c <5.7%), prediabetic (HbA1c 5.7–6.4%), and diabetic (HbA1c ≥6.5%).ResultsThe average age of patients was 49.9±10.3 years. Most patients had waist circumference equal to or more than 80 cm (91.9%) and more than half (55.2%) had waist-hip ratio equal to or more than 0.85. Mean body mass index (BMI) was 29.9±5.7 kg/m2. The mean level of HbA1c was 6.2±1.4% (range 4.7% to 12.6%). HbA1c levels revealed that most patients in this study classified as prediabetics (44.4%). There was a significant positive correlation between HbA1c levels and each of patient's age (r=0.267, p<0.001), waist circumference (r=0.180, p=0.008), and waist-hip ratio (r=0.278, p<0.001). Compared with premenopausal breast cancer patients, postmenopausal patients had significantly higher HbA1c blood levels (t=–3.542, p=0.003). HbA1c was significantly associated with stage (p=0.044) and grade (p=0.016) of carcinoma in premenopausal breast cancer patients. Among postmenopausal cases, HbA1c was significantly associated with molecular subtype of the disease (p=0.039).ConclusionThe majority of Jordanian breast cancer patients in this study are prediabetic, obese, and had visceral obesity. HbA1c levels are increased among older patients and those who have greater waist circumference and waist-hip ratio. HbA1c is associated with advanced stage and grade of breast carcinoma in premenopausal patients and with molecular subtype in postmenopausal cases. These findings urge the need to screen breast cancer patients for glycemic status upon disease presentation and to further consider treatments to control hyperglycemia in order to reduce the impact of metabolic derangements on disease prognosis and outcomes.