Breast Cancer Survival Rates Research Articles

Breast Cancer Mortality among Asian-American Women in California: Variation according to Ethnicity and Tumor Subtype.

PurposeAsian-American women have equal or better breast cancer survival rates than non-Hispanic white women, but many studies use the aggregate term "Asian/Pacific Islander" (API) or consider breast cancer as a single disease. The purpose of this study was to assess the risk of mortality in seven subgroups of Asian-Americans expressing the estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2) tumor marker subtypes and determine whether the risk of mortality for the aggregate API category is reflective of the risk in all Asian ethnicities.MethodsThe study included data for 110,120 Asian and white women with stage 1 to 4 first primary invasive breast cancer from the California Cancer Registry. The Asian ethnicities identified were Pacific Islander, Southeast Asian (SEA), Indian Subcontinent, Chinese, Japanese, Filipino, and Korean. A Cox regression analysis was used to compute the risk of breast cancer-specific mortality in seven Asian ethnicities and the combined API category versus white women within each of the ER/PR/HER2 subtypes. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed.ResultsFor the ER+/PR+/HER2- subtype, the combined API category showed a 17% (HR, 0.83; 95% CI, 0.76–0.91) lower mortality risk. This was true only for SEA (HR, 0.75; 95% CI, 0.61–0.91) and Japanese women (HR, 0.60; 95% CI, 0.45–0.81). In the ER+/PR-/HER2- subtype, SEA (HR, 0.57; 95% CI, 0.38–0.84) and Filipino women (HR, 0.71; 95% CI, 0.51–0.97) had a lower risk of mortality. Japanese (HR, 0.49; 95% CI, 0.25–0.99) and Filipino women (HR, 0.74; 95% CI, 0.58–0.94) had a lower HR for the ER-/PR-/HER2+ subtype. For triple-positive, ER+/PR+/HER2+ (HR, 0.84; 95% CI, 0.71–0.98) and triple-negative, ER-/PR-/HER2- (HR, 0.84; 95% CI, 0.74–0.94) subtypes, only the API category showed a lower risk of mortality.ConclusionBreast cancer-specific mortality among Asian-American women varies according to their specific Asian ethnicity and breast cancer subtype.

How do Breast Cancer Mortality Rates Differ between Women who are Screened Annually and Biennially by Mammography?

Context: Breast cancer is the most common non-skin cancer and second deadliest cancer in women. Mammography, an X-ray of the breast, serves as the primary diagnostic tool for breast cancer detection as it reduces the risk of death through early detection and treatment of the disease. The medical community, however, has not agreed on how frequently such screenings should be performed [1]. Various organizations have produced different guidelines regarding the suggested frequency of routine mammograms. For example, the United States Preventive Services Task Force (USPST) endorses biennial mammography screenings for females ages 50-74, whereas the American Cancer Society (ACS) advocates annual mammography screenings for women beginning at age 40. It is this review’s hypothesis that annual mammography is proving to be statistically more beneficial than biennial screening in the reduction of breast cancer mortality rate. Methods: Full text articles from the U.S. National Institute of Health’s Public Medicine’s archives (PubMed) were reviewed in order to compare annual versus biennial mammographic screenings and the diagnostic advantages, detriments and mortality rates of each interval. Results: The majority of articles agree that women between the ages of 40-49 years undergoing biennial screenings are more likely to be diagnosed with late stage disease than women diagnosed during annual screenings. The results for women 50 years and older are less conclusive. While some studies of the over-50 group delineate no difference in the incidence of late-stage disease using either the biennial or annual intervals, the majority of findings suggest the annual interval is more effective than the biennial screening in detecting early stage cancer. Conclusion: Overall, women partaking in annual mammography screening experience decreased false positive “recall” rates. In addition, earlier diagnoses through annual screenings help detect smaller tumors providing a more hopeful prognosis. While these findings support the importance of annual mammography screenings for women 40 years and older, studies indicate that annual screenings only minimally improve estimated breast cancer survival rates for women aged 50-74 years compared to biennial screening.

Abstract 419: Cooperative interactions between p53 and NFκB enhance cell plasticity

Abstract Breast cancer prevention, diagnosis and treatment have improved during recent years. However, despite these scientific and clinical improvements, breast cancer survival rate has not substantially increased, due to cancer recurrence and metastatic spread. It is therefore important to further investigate the mechanisms and causes responsible for breast cancer metastasis. The p53 and NFκB sequence-specific transcription factors (TFs) play crucial roles in cell proliferation and survival with critical, even if typically opposite, effects on cancer progression. To investigate a possible crosstalk between p53 and NFκB driven by chemotherapy-induced responses in the context of an inflammatory microenvironment, we performed a proof of concept study using MCF7 cells. Transcriptome analyses upon single or combined treatments with doxorubicin (Doxo) and the NFκB inducer Tumor Necrosis Factor-alpha (TNFα) were performed. Expression microarrays experiments identified a common set of synergistically up-regulated genes upon combined drug treatments in different cellular models of breast and lung carcinomas. This gene signature was enriched in inflammation, proliferation and metastasis gene functions, according to gene ontology and pathway analysis. Interestingly, the migratory phenotypes exhibited by our cell models significantly differed upon single and combined drug treatments and exhibited cell-type specificity. For a selected group of genes synergistically up-regulated upon Doxo+TNFα we were able to demonstrate by ChIP analysis a direct binding of p53 and NFκB and we uncovered LAMP3 and ETV7 as new p53-NFκB direct target genes. We also demonstrated that the combined Doxo+TNFα treatment was not only able to disrupt the 3D architecture of mammary acini observed with MCF10A primary cells grown within matrigel, but also to stimulate the tube-forming potential of Human Umbilical Vein Endothelial Cells (HUVEC). Furthermore, a signature of 29 Doxo+TNFα (DT-29) highly synergistic genes exhibited prognostic value for luminal breast cancer patients, with adverse outcome correlating with higher relative expression (based on Kaplan-Meier plotter tool). We further used available experimental data sets (RNA-seq measurements from Gene Expression Omnibus) both from breast cancer cell lines (luminal-like vs basal-like breast cancer cells) and breast cancer patients (ER positive vs Triple Negative Breast Cancer, TNBC and vs healthy adjacent tissues). The expression of DT-29 gene signature was analyzed and compared among the different groups of samples. The most statistically relevant genes differentially expressed among the different groups were involved in the STAT3-driven pathways and were prevalently highly expressed in TNBC patients and cell lines. We propose that the crosstalk between p53 and NFκB can lead to the activation of specific gene expression programs that may impact on cancer phenotypes and potentially modify the efficacy of cancer therapy. Citation Format: Federica Alessandrini, Vasundhara Sharma, Alessandra Bisio, Sara Zaccara, Alberto Inga, Yari Ciribilli. Cooperative interactions between p53 and NFκB enhance cell plasticity. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 419. doi:10.1158/1538-7445.AM2015-419

Abstract 4818: Array-CGH and miRNA expression profiling of triple negative breast cancer in African-American women

Abstract In the African-American (AA) population, an increased incidence and shorter survival rate of triple negative breast cancer (TNBC) has been reported when compared to White women, with their cancer usually diagnosed in more advanced stages and with non-localized disease. The main objective of our study is to identify molecular markers in TNBC in AA patients that may be associated with their observed disparity in incidence and mortality rates. Formalin-fixed paraffin-embedded tumor sections were obtained from 26 and 28 cases of TNBC from AA and Caucasian breast cancer patients, respectively, and analyzed for DNA copy number (Agilent-SurePrint G3 Human CGH Microarray 8×60K) and miRNA expression (Nanostring System) alterations. The cases were obtained with clinically annotated data from the Histopathology Shared Resources at the Lombardi Comprehensive Cancer Center. The miRNA data was directly integrated with the array-CGH data from the same cases. Combinatorial target predicted algorithms in conjunction with functional and pathway annotation enrichment systems were performed to identify predicted target functions. A distinct DNA copy number profile was observed between TNBC of AA and Caucasian cases: the cytobands differentially involved in the AA-TNBC cases were 7p22.3-22.1, 12p13.33-p11.1, 17q25.3 and 17p13.3-p11.2. Common cytobands in both groups were 1q21.1-q44, 8q22.1-q24.3, 16p13.33-p11.1 and 20q11.2-q13.12. An average of 30.5 and 16.8 DNA copy alterations were observed between the AA and Caucasian cases respectively and the miRNA profiling revealed 209 miRNAs differentially expressed between the groups. Unsupervised hierarchical clustering analysis separated the cases by ethnicity (with the exception of 6 cases). Among the miRNAs observed with higher and lower expression levels in the AA cases were miR150-5p, miR4286, miR29b3p and miR1283, miR1253, miR378e, respectively. Ingenuity pathway analysis identified molecular and cellular functions mostly related to cellular development, growth, proliferation and movement, and cell death and survival. Clinical pathological data analysis revealed higher tumor grades and stages in the TNBC of AA women when compared to Caucasians; association of these parameters with the genomic and expression miRNA data is being performed. In conclusion, a distinct DNA copy number and miRNA profile was observed in the AA-TNBC cases when compared to the Caucasians cases of our study. These initial findings will provide the basis for the functional analysis of the identified molecular markers and their potential prognostic and therapeutic impact for this group. In addition to providing a better understanding of the biology of their tumors, these analyses can reveal molecular targets for tailored and ethnic-based clinical trials, which can ultimately lead to the reduction of the observed cancer disparity. Support: FDA U01 FD004319, NIH-NIGMS GM101997 and Susan Komen Foundation. Citation Format: Kenny Regis, Michelle Jaldin, Akanksha Mahajan, Anju Duttargi, Laura Sheahan, Yuriy Gusev, Subha Madhavan, Luciane R. Cavalli. Array-CGH and miRNA expression profiling of triple negative breast cancer in African-American women. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4818. doi:10.1158/1538-7445.AM2015-4818

Abstract P6-08-15: Deconstructing the TNM staging system for breast cancer

Abstract Background The TNM staging system is a standard classification for recording extent of disease in breast cancer. However, with progress in understanding tumor biology, it is unknown how new prognostic factors that will eventually be integrated with the TNM will affect its predictive ability. Our objective was to show the impact on 10-year survival rates for breast cancer as different combinations of prognostic factors are integrated into the TNM. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute for the years 1991 through 2000. After exclusions, 132,339 cases of female breast cancer were available. An ensemble clustering algorithm was used to calculate survival after including additional prognostic factors listed in SEER in the TNM. Combinations of the following 6 factors were sequentially added to the TNM: tumor grade, ER/PR status, age at diagnosis, racial/ethnic group, and histological tumor type. Results: Survival rates amongst some tumors with the same TNM stage varied as new factors were integrated into the TNM. Factors associated with favorable outcome usually were associated with better survival than factors associated with less favorable outcome for each stage group with varying degrees. There were 4 different tumor combinations that represented 4 different TNM stages that all corresponded to a 90% 10-year survival when additional factors were added to the TNM stage. Integration of additional prognostic factors led to a crossover in survival of some stage groups. In one combination (T1, N2, grade 1, ER+, PR+, age <50: 131111) patients who were assigned stage IIIA had a 10-year rate of 90%, which qualifies for a stage I category. Survival Crossover in TNM Staging10-year Survival (%)Prognostic Factor CombinationTNM StageNumber of Patients90113IA1899390112222IA22469021211IIA510190122112IIA40199031111IIB68290131111IIIA82582232221IIB11035822322213IIB92583331111IIIA1285814211111IIIC64**Abbreviated table. Prognostic Factor Combination in order from left to right: T, N, grade, ER status, PR status, age, race, histological type. * T1 = 1; T2 = 2; T3 = 3; N0 = 1; N1= 2; N2 = 3; N3 = 4; Grade 1 = 1; Grade 2 = 2; Grade 3 = 3; ER+ = 1; ER- = 2; PR+ = 1; PR- = 2; Age <= 50 = 1; Age >50 = 2; Conclusions: Integrating new prognostic factors into the TNM always changed the outcome. Survival rates, therefore, are relative and depend on the selection of prognostic factors. Adding new factors selected different cohorts from the population which had a heterogeneous population of cancer survivors. These cohorts usually had different survival rates compared with the overall population from which they were drawn. Integrating combinations of prognostic factors revealed frequent crossover of stage groups at 10 years, which is a violation of a staging system and could impact the interpretation of clinical trials. Citation Format: Jigar A Patel, Matthew T Hueman, Dechang Chen, Donald E Henson. Deconstructing the TNM staging system for breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-08-15.

Abstract P5-17-01: Development and validation of the Penn arthralgia aging scale among breast cancer survivors on aromatase inhibitors

Abstract Background: Aromatase inhibitors (AIs) have been shown to decrease the recurrence rate and increase the overall survival rate of hormone receptor positive breast cancer among post-menopausal women. Unfortunately, arthralgia is a frequently experienced side effect of AIs, leading some women to discontinue AIs prematurely. Qualitative investigations suggest that joint pain may cause women on AIs to feel they are aging faster than they should be. Since general perceptions of aging have been shown to predict important health outcomes, such as adherence and mortality, aging perceptions related to joint pain are worth further exploration. Objective: The purpose of this study was to develop and validate a measure that captures perceptions of aging related to joint pain. A psychometrically validated tool will advance our ability to quantify and further understand the importance of this construct. Method: We developed the eight-item Penn Arthralgia-Aging Scale (PAAS) from interviews with 67 patients on AIs. The scale was pilot-tested, and changes to items were made based on patient feedback, as well as feedback from oncologists, nurses, and physical therapists. To validate the scale, participants suffering from joint pain were selected from a larger study examining the genetic determinants of symptom distress and disease outcomes among women on AIs. Five hundred and fifty-six breast cancer survivors completed the PAAS, as well as the Hospital Anxiety and Depression Scale, the pain interference and pain intensity subscales of the Brief Pain Inventory, and a demographic questionnaire. Exploratory factor analysis using oblique rotation was conducted to examine the factor structure of the scale. Convergent validity was assessed by correlating the PAAS with joint-pain severity. To determine whether the scale provides important information beyond existing measures, we used hierarchical regressions to calculate whether it predicted incremental variance in anxiety, depression, and pain interference outcomes. Results: The resulting scale had a one-factor structure (eigenvalue = 6.21), high internal consistency (Cronbach’s alpha = 0.94), and strong convergent validity (Spearman r = .55, p < 0.01 for joint pain). Additionally, the PAAS was found to explain additional variance in anxiety (7%, p < 0.001) and depression (28%, p < 0.001) after pain severity and age were controlled. The PAAS also explained additional variance (5%, p < 0.001) in joint pain interference above and beyond the variance accounted for by anxiety, depression, joint pain severity, and age. Conclusions: These findings suggest that the PAAS is a reliable and valid tool that captures a meaningful construct of perceptions of aging attributable to arthralgia. With further research, the PAAS may advance our understanding of breast cancer survivors’ emotional, behavioral, and clinical outcomes. Citation Format: Moriah J Brier, Dianne L Chambless, Laura Lee, Angela DeMichele, Jun J Mao. Development and validation of the Penn arthralgia aging scale among breast cancer survivors on aromatase inhibitors [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-17-01.

Abstract P4-14-11: National trend in African American women breast cancer research productivity from 1992-2012

Abstract INTRODUCTION: Despite extensive progress in breast cancer prevention, diagnosis and treatment over the past 20 years, African American women suffer disproportionate breast cancer morbidity and mortality. In 1998, breast cancer deaths among African American women were 28% higher than in white women and the five-year survival rate for African American women was 71% compared with 86% for white women. The purpose of this bibliometric study is to assess our national research efforts to combat this racial disparity by analyzing breast cancer research productivity in the United States focusing on African American women from 1992 to 2012. METHODS: This retrospective bibliometric analysis of public data was exempt from Institutional Review Board approval. Articles with "Breast Neoplasm" as a major medical subject heading (MeSH) term published between 1992 and 2012 were identified in the National Library of Medicine MEDLINE database. In addition, articles with "African Continental Ancestry Group" which included African American as a major MeSH term were identified. Country of origin, methodology, journal name, first author specialty and funding sources were recorded. Growth in number of publications was analyzed using linear and nonlinear regression statistical analysis. RESULTS: A total of 113,721 journal articles were identified with "Breast Neoplasm" as a major MeSH term worldwide, of which 34,155 (30.0%) were published from the United States. Among United States publications, 668 (2.0%) were specific to African ancestral populations. From 1992 to 2012, both African ancestral and non-African ancestral specific articles displayed linear growth patterns (p < 0.0001). National Institute of Health (NIH) funded studies displayed an exponential growth pattern (p < 0.0001) for African ancestral specific articles and displayed a linear growth pattern (p < 0.0001) for non-African ancestral articles. The largest specialty contributor of African ancestral specific articles was Epidemiology and Public Health (33.2%), followed by Medicine (internal medicine, family medicine, obstetrics & gynecology, nursing) (24.7%), Basic Sciences (17.4%), Surgery (15%), Medical and Radiation Oncology (4.7%), Pathology (2.9%) and Radiology (2.1%). African ancestral specific articles were most frequently published in Cancer (10.8%). CONCLUSION: Among breast cancer publications from the United States, only 2% of the articles were specific to African ancestral population, which is concerning given recent data indicating the persistent ethnic disparity in survival. However, the trend in research productivity in this population is encouraging, largely due to the exponential growth of NIH-funded studies specific for African American women in the past 20 years. NIH-funded research accounts for 52% of all published African American specific breast cancer studies as compared to 40.5% of studies that are non-specific to this population. Ultimately, improvements in breast cancer incidence, mortality, and survival rates in African American women will undoubtedly result from quality research and should continue to be a priority in our nation’s breast cancer research agenda. Citation Format: Ralph T Wynn, Daniel S Chow, Victoria L Mango, Lauren C Friedlander, Richard Ha. National trend in African American women breast cancer research productivity from 1992-2012 [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-14-11.

Ethnicity differences in breast cancer stage at the time of diagnosis in Norway.

Several studies have demonstrated that breast cancer survival rates differ with ethnicity. Most of these studies analyzed discrepancies between African-American and Caucasian-American women and were performed in the United States. There are increasing concerns about differences in breast cancer survival among immigrants from Asia and Africa living in Europe, including those living in Scandinavian countries. There are few data on breast cancer survival in relation to race or ethnicity in Scandinavian countries, even though immigrants from Asia and Africa have lived in Scandinavian countries for decades. The aim of this study was to identify variations in breast cancer incidence, treatment modalities, relapse, and survival among women from Pakistan, Sri Lanka, and Somalia compared to ethnic Norwegian women. The incidence, treatment modalities, relapse, and survival of breast cancer were analyzed in women from Pakistan, Sri Lanka, and Somalia in a nation-based study over a period of 7 ears. Results for women from Pakistan, Sri Lanka, and Somalia were compared with those from a group of ethnic Norwegian women during the same period. In our study, 63 patients from Pakistan, Sri Lanka, and Somalia were diagnosed with breast cancer during the period 2002-2009 in Norway. Comparison between women from Pakistan, Sri Lanka, and Somalia and ethnic women from Norway revealed significant differences in cancer stage at the time of diagnosis, age at diagnosis, type of surgical treatment, and relapse and breast cancer mortality rates. The findings of this study demonstrate that the outcome after a breast cancer diagnosis is significantly worse for women from Pakistan, Sri Lanka, and Somalia than for ethnic Norwegian women. In addition, the mean age at the breast cancer diagnosis was lower for women from Pakistan, Sri Lanka, and Somalia, especially those from Sri Lanka and Somalia, than for ethnic Norwegian women.

Clinical significance of serum CA15-3 as a prognostic parameter during follow-up periods in patients with breast cancer.

PurposeTo assess the relationship between the kinetics of the serum CA15-3 level and the five-year disease-free survival rate of breast cancer patients.MethodsThe subjects of this study, 297 women who were diagnosed with breast cancer, were the subset of patients operated on at Kosin University Gospel Hospital from January 2008 to December 2010. We evaluated the change of serum CA15-3 levels during outpatient follow-up period. The changing patterns of serum CA15-3 level were divided into 5 categories; surge without decline, surge with incidental decline, decline without surge, decline with incidental surge, and no change. Clinicopathologic factors were evaluated for each group.ResultsThe number of patients in surge without decline, surge with incidental decline, decline without surge, decline with incidental surge, and no changes groups were 30 (10.1%), 85 (28.6%), 80 (26.9%), 73 (24.6%), and 29 (9.7%), respectively. The clinicopathologic characteristics were not significantly different among these groups. The log rank test found that 5-year disease-free survival rate according to the kinetics of serum CA15-3 levels were significant (P = 0.004) particularly for the surge without decline group.ConclusionAccording to the findings of this study, the surge without incidental decline pattern of serum CA15-3 levels during the follow-up period is associated with poor prognosis. Significant association was found among changing patterns of serum CA15-3 levels and breast cancer recurrence rate.

Combined Positron Emission Tomography and Computed Tomography: Option or necessity?

Combined Positron Emission Tomography and Computed Tomography: Option or necessity?

Stromal matrix metalloproteinase 2 regulates collagen expression and promotes the outgrowth of experimental metastases.

Breast cancer survival rates decrease from 99% for patients with local disease to 25% for those with distant metastases. Matrix metalloproteinases (MMPs), including MMP2, are associated with metastatic progression. We found that loss of host MMP2 reduces the proliferation of experimental metastases in the lungs and identified fibroblasts in tumour-bearing lungs as the major source of MMP2. In vitro, spheroidal mammary tumour growth was increased by co-culture with control fibroblasts isolated from tumour-bearing lungs, but not when fibroblasts with stable Mmp2 knockdown were used. This result prompted us to assess whether MMP2 was responsible for a tumour-proliferative, activated fibroblast phenotype. To test this, we evaluated: (a) fibroblasts from wild-type tumour-bearing lungs, with or without shRNA-mediated MMP2 knockdown; and (b) normal, quiescent fibroblasts isolated from either WT or Mmp2(-/-) mice. Quantitative PCR revealed that Mmp2 knockdown attenuated expression of two markers of activation (α-smooth muscle actin and vimentin), but there was minimal expression in quiescent WT or Mmp2(-/-) fibroblasts, as expected. Placing quiescent fibroblasts under activating conditions led to increases in activation-associated transcripts in WT but not Mmp2(-/-) fibroblasts. Additionally, Mmp2 knockdown fibroblasts showed significantly decreased expression of the matrix transcripts collagen I, collagen IV and fibronectin. Addition of active TGFβ was sufficient to rescue the MMP2-dependent collagen I and IV expression, while MMP2-induced collagen expression was blocked by the addition of TGFβ1-neutralizing antibody. Gene expression data in stromal cells of human breast cancers reveal that MMP2 expression is also positively correlated with activation and matrix transcripts. Thus, we present a model whereby MMP2 production in tumour fibroblasts is important for TGFβ1 activity and subsequent activation of fibroblasts to a matrix-producing, proliferation-supportive phenotype. Overall, our results reveal a previously undefined role for MMP2 in metastatic outgrowth mediated by fibroblasts, and extend the mechanisms by which MMPs contribute to tumour progression.

Breast Cancer Survival in Cameroon: Analysis of a Cohort of 404 Patients at the Yaoundé General Hospital

This study aimed to estimate the survival rate of breast cancer in a group of patients followed up at the Yaounde General Hospital in Cameroon. A retrospective review of records of patients managed for breast cancer between 1995 and 2007 was carried out at the Yaounde General Hospital. Survival analysis was carried out with survival defined as the time between the date of unequivocal diagnosis of cancer and the date of last follow-up or death. Survival curves were plotted in R.3.1.1 software. Mean age of the patients was 47.5 ± 12.36 years. Most of the patients (67.9%) presented with advanced breast cancer disease (stage III and IV). Overall patient survival rate was 30% at 5 years and 13.2% at 10 years. Median overall survival time was 2 (1.9 - 3) years. There was a correlation between survival and the stage of disease. The highest survival rates were recorded in stages I and II while the lowest rates were recorded in stage IV. There was no statistically significant difference in survival among the age groups (p = 0.15). Overall survival rates of breast cancer are 30% at 5 years and 13.2% at 10 years among Cameroonian patients and are lower compared with 90% and 82% respectively at 5 years and 10 years in some developed countries.

Factors associated with return to work of breast cancer survivors: a systematic review.

BackgroundThe breast cancer survival rate is the highest among all types of cancers, and survivors returning to work after completing treatment is extremely important in regards to economy and rehabilitation. The aim of this systematic review study is to identify the prevalence of breast cancer survivors who return to work (RTW) and the factors associated to RTW.MethodsA computer based literature search was carried out. "PubMed, Cochrane Library, Embase, Web of Science, and Science Direct" databases were searched systematically. Our search strategy identified a total of 12,116 papers of which 26 studies met the inclusion criteria and quality assessment. These were original papers published between January 2003 and January 2013.ResultsThe trends in RTW differ among countries for the breast cancer survivors. The time to RTW after successful cancer treatment also varies among the countries and by ethnicity. The prevalence of the RTW varies from 43% to 93% within one year of diagnosis. The prevalence of the RTW for the Netherland is the lowest in the world (43%). The United States survivors showed the highest RTW (93%) within 12 months of the diagnosis. Numerous barriers and facilitators were identified as factors that affect RTW. For instance, socio-demographic factors such as education and ethnicity; treatment oriented factors such as chemotherapy; work related factors such as heavy physical work; disease related factors such as poor health condition and fatigue; and psychological factors such as depression and emotional distress, act as barriers of RTW. In contrast, social, family, employer support, and financial independency emerge as key facilitators in enabling breast cancer survivors to return and continue work.ConclusionMinimising these identified barriers and strengthening these facilitators could further improve the work condition and increase the percentage of RTW among the breast cancer survivors.

Oral health after breast cancer treatment in postmenopausal women

OBJECTIVE:Oral health can affect a patient's general health and quality of life. Given the increase in breast cancer survival rates, investigations of factors influencing the quality of life of survivors have gained importance. Therefore, the objective of our study was to characterize oral health in postmenopausal breast cancer survivors.METHODS:We conducted a matched case-control study. Forty-eight women who survived breast cancer (age 62.1±9.1 years) and 48 healthy controls (age 61.8±8.6 years) were included. For each case and control, a complete oral evaluation chart was completed.RESULTS:The prevalence of chronic periodontal disease was 98% in breast cancer survivors and 87% in controls. The breast cancer survivors had a median of 16 remaining teeth, whereas controls had a median of 22 remaining teeth (p = 0.03). The percentage of sites with gingival bleeding was 16.05% (0-100%) in breast cancer survivors and 0% (0-72%) in controls (p = 0.04).CONCLUSION:Chronic periodontal disease and tooth loss were highly prevalent in postmenopausal breast cancer survivors. To improve survivors' quality of life, a preventive oral health evaluation should be available prior to cancer treatment.

Neurological complications of breast cancer: study protocol of a prospective cohort study

IntroductionThe improvement in breast cancer survival rates, along with the expected overdiagnosis and overtreatment associated with breast cancer screening, requires a comprehensive assessment of its burden. Neurological complications can have...

Abstract 4827: Investigation of the survival of circulating breast tumor cells using biomimetic microfluidic circulation system

Abstract Distant metastases are the cause of about 90% of breast cancer patient death and the overall survival rate for metastatic breast cancer is only about 16%. Circulating tumor cells (CTCs) shed from the primary tumor, travel through the blood to distant anatomic sites and cause metastasis. The survival of CTCs in blood vascular system is a challenging pre-requisite of successful metastasis, as the biochemical and mechanical environment of circulation is vastly different from the primary tumor sites. Studies related to the fate of CTCs in circulation are mainly limited by lack of well-controlled and realistic experimental models. We have developed a microfluidic device that mimics the human blood circulatory system in order to study the mechanism underlying the survival of cancer cells in the blood circulation. The circulation device integrates a network of channels with a self-contained micropump can generate pulsatile fluid flow pattern and corresponding fluidic forces, which can represent the nature of blood flow and haemodynamic forces in the vasculature. The survival rate of breast cancer cell line MCF7 in circulation was measured via this microfluidic platform. MCF-7 cells in circulation device had a much lower survival rate compared with those in control device. The survival rate of MCF-7 cells after circulating 1, 2 and 4 hours are respectively 48.8%, 36.3% and 10.7%, while the survival rate in control device after 1, 2 and 4 hours are 93.7%, 77.6% and 94.30%. We further compared the survival rate of MCF-7 cells with SUM-159 cells. We hypothesize that by assessing the differential survival ability of breast cancer cells with varied EMT traits can reveal the key signatures of the metastatic tumor cells. Citation Format: Yang Wang. Investigation of the survival of circulating breast tumor cells using biomimetic microfluidic circulation system. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4827. doi:10.1158/1538-7445.AM2014-4827

The challenges of long-term follow-up data collection in non-commercial, academically-led breast cancer clinical trials: the UK perspective.

BackgroundImproved survival rates in early breast cancer and the chronic nature of disease relapse result in a large cohort of patients being available for long-term follow-up (LTFUP) in randomised controlled trials. Whilst of recognised scientific value to assess long-term treatment-related sequelae, the volume of this activity can be challenging for trialists and participating sites, and comes at a considerable cost to research funders and the National Health Service (NHS). A National Cancer Research Institute Breast Clinical Studies Group supported project aimed to characterise UK LTFUP data collection procedures in order to propose improvements.MethodsProtocols and case report forms for UK non-commercial National Institute for Health Research portfolio early breast cancer randomised controlled trials were reviewed and a questionnaire sent to associated participating NHS sites. Responders were asked to give opinions on issues with follow-up and LTFUP data collection procedures and to suggest potential improvements to practice. Results were used to inform design of a proposed standard LTFUP case report form.ResultsThirty-four trials, involving eight Clinical Trials Units were eligible for inclusion in the review. All trials requested follow-up at least annually up to 5 years, with two-thirds requesting LTFUP after that time point. Information relating to efficacy endpoints was captured for all trials via case report forms; however, precise detail on recording of recurrence, second malignancies and death varied. Separately, questionnaires were returned from 66 NHS sites. Main concerns identified included difficulties in identifying all adverse events from hospital notes, volume of work, bureaucratic data management practices in Clinical Trials Units and perceptions of prioritisation of recruitment over follow-up.ConclusionVariation has existed with respect to detail of LTFUP information requested for UK trials. Improved communication, simplification and standardisation of data and associated collection methods are possible without compromising data requirements for efficient and effective trial reporting. Future use of routinely collected data, captured via electronic means, could transform practices and alleviate resource usage.Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-379) contains supplementary material, which is available to authorized users.

Feasibility of anomaly detection and characterization using trans-admittance mammography with 60 × 60 electrode array

Electrical impedance imaging has the potential to detect an early stage of breast cancer due to higher admittivity values compared with those of normal breast tissues. The tumor size and extent of axillary lymph node involvement are important parameters to evaluate the breast cancer survival rate. Additionally, the anomaly characterization is required to distinguish a malignant tumor from a benign tumor. In order to overcome the limitation of breast cancer detection using impedance measurement probes, we developed the high density trans-admittance mammography (TAM) system with 60 × 60 electrode array and produced trans-admittance maps obtained at several frequency pairs. We applied the anomaly detection algorithm to the high density TAM system for estimating the volume and position of breast tumor. We tested four different sizes of anomaly with three different conductivity contrasts at four different depths. From multifrequency trans-admittance maps, we can readily observe the transversal position and estimate its volume and depth. Specially, the depth estimated values were obtained accurately, which were independent to the size and conductivity contrast when applying the new formula using Laplacian of trans-admittance map. The volume estimation was dependent on the conductivity contrast between anomaly and background in the breast phantom. We characterized two testing anomalies using frequency difference trans-admittance data to eliminate the dependency of anomaly position and size. We confirmed the anomaly detection and characterization algorithm with the high density TAM system on bovine breast tissue. Both results showed the feasibility of detecting the size and position of anomaly and tissue characterization for screening the breast cancer.

Trends in 5-year survival rates among breast cancer patients by hormone receptor status and stage

Improvement in breast cancer survival has been observed in recent decades in the U.S., but it is unclear if similar survival gains are consistent across breast cancer subtypes, especially with regards to more advanced stages of the disease. Data were from 13 population-based cancer registries participating in the surveillance, epidemiology, and end results (SEER) program, consisting of women between 20 and 79 years of age diagnosed with invasive breast cancer between 1992 and 2008. 2-year (1992-2008) and 5-year (1992-2006) breast cancer cause-specific survival rates were calculated and stratified by estrogen receptor (ER)/progesterone receptor (PR) status, stage, and race. Annual percent changes in survival rates were assessed. From 1992 through 1998-1999, 5- and 2-year cause-specific survival rates significantly improved across ER+/PR+, ER-/PR-, and ER+/PR- subtypes, with an annual increase ranging from 0.5 to 1.0 % in the 5-year rates. From 1998-1999 to 2006, different patterns were observed by ER/PR subtypes with survival rates slightly improving for ER+/PR+, continuing to improve at a rate of 0.5 % per year for ER-/PR-, and dropping 0.3 % annually for ER+/PR-. No significant survival gains were experienced by patients with ER-/PR+ cancer during the study period. In terms of advanced diseases, greatest annual increases in survival rates were seen for patients with stage III-IV ER+/PR+ and ER-/PR- tumors but less progress was observed for advanced ER+/PR- breast cancers. Steady improvements in survival rates for breast cancer have been achieved over the past several decades. However, 5-year survival rates for stage IV disease remained dismally below 20 % for most ER/PR subtypes.

Expressions of FOXC1 and MMP-7 in molecular subtypes of breast cancer and their association with clinicopathological characteristics

To investigate the expressions of FOXC1 and matrix metalloproteinase 7 (MMP-7) in different molecular subtypes of breast cancer and their association with clinicopathological characteristics of the disease. Based on immunohistochemical results of ER, PR, HER2, CK5/6, CK14 and EGFR, 105 breast cancer patients were classified as 4 subtypes: luminal, HER2 positive, basal-like subtype (BLs) and normal breast-like subtype (NBLs). The association of FOXC1 and MMP-7 expressions with clinicopathological parameters in different molecular subtypes was analyzed. Out of 105 patients with breast cancer, the subtypes of luminal, HER2 positive, BLs and NBLs accounted for 52.4% (55/105), 16.2% (17/105), 17.1%(18/105) and 14.3% (15/105), respectively. Patients with luminal and/or NBLs subtypes had significantly higher 5-year survival rate than those with HER2 positive and/or BLs did (log-rank=22.161, P<0.01). The overall positive expression rate of FOXC1 was 26.7% (28/105) and the expression was higher in BLs patients than that in other subgroups (χ²=30.108, P<0.01). The expression of FOXC1 was correlated with histological grade, tumor size, distant metastasis and 5-year survival rate of breast cancer. The overall positive expression rate of MMP-7 was 67.6% (71/105) and the expression of MMP-7 was also higher in BLs patients than that in other molecular subtypes (χ²=11.328, P<0.05). The positive expression of MMP-7 was correlated with metastasis in ipsilateral axillary lymph nodes, distant metastasis and 5-year survival rate of the patients. FOXC1 was correlated with MMP-7 (r=0.325, P<0.01). Patients with luminal and/or NBLs breast cancer have more favorable prognosis than those with HER2 positive and/or BLs subtypes. The expressions of FOXC1 and MMP-7 are closely correlated with the clinicopathological features of breast cancer patients.