Suspicion Of Breast Cancer Research Articles

Association of CYP1A2 gene polymorphism (rs762551) with the risk 
 of breast cancer and miscarriage of the first pregnancy

Introduction. Missed pregnancy, as a rule, is caused by a combination of several factors. Exogenous factors can have a teratogenic effect, leading to the occurrence of mutations of varying severity. In such case at the early stages of embryogenesis, serious disturbances occur, leading to a halt in the pregnancy development. The system of their biotransformation is responsible for the elimination of xenobiotics from the body, the inadequate functioning of which increases the activity of mutagenesis, which may raise the risk of breast cancer.
 Materials and methods. One hundred thirty four women were examined. The first group included 63 women, 28 of them were diagnosed with fetal egg death in primigravida young women, in 35 women the first pregnancy ended with physiological childbirth. The second group included 71 woman, 33 of them were diagnosed with a malignant breast neoplasm, 38 had no suspicion of breast cancer (BC) according to the results of mammography. Polymorphisms of the CYP1A2*1F gene of the xenobiotic biotransformation system in these groups were determined by polymerase chain reaction.
 Results. In the group of women with a missed first pregnancy, a statistically reliable association of a high risk of the fetal egg death with the A/A CYP1A2*1F genotype and resistance to this pathology in the case of the C/A CYP1A2*1F polymorphism was revealed. In the group of BC women, the association of a high risk of developing a malignant neoplasm with the A/A CYP1A2*1F genotype and resistance to the development of the disease in the presence of C/A CYP1A2*1F polymorphism was shown.
 Limitations. The study was limited by the number of samples, there is no data on polymorphisms of the BRCA-1, BRCA-2 genes.
 Conclusion. The results obtained will allow not only adjusting the tactics of pregnancy management in women with a high risk of the fetal egg death or the selection of pharmacological drugs in the treatment of BC under the conditions of serious environmental stress, but also developing preventive measures to reduce the risk of these pathologies.

Deep learning model for predicting the presence of stromal invasion of breast cancer on digital breast tomosynthesis.

To develop a deep learning (DL)-based algorithm to predict the presence of stromal invasion in breast cancer using digital breast tomosynthesis (DBT). Our institutional review board approved this retrospective study and waived the requirement for informed consent from the patients. Initially, 499 patients (mean age 50.5years, age range, 29-90years) who were referred to our hospital under the suspicion of breast cancer and who underwent DBT between March 1 and August 31, 2019, were enrolled in this study. Among the 499 patients, 140 who underwent surgery after being diagnosed with breast cancer were selected for the analysis. Based on the pathological reports, the 140 patients were classified into two groups: those with non-invasive cancer (n = 20) and those with invasive cancer (n = 120). VGG16, Resnet50, DenseNet121, and Xception architectures were used as DL models to differentiate non-invasive from invasive cancer. The diagnostic performance of the DL models was assessed based on the area under the receiver operating characteristic curve (AUC). The AUC for the four models were 0.56 [95% confidence intervals (95% CI) 0.49-0.62], 0.67 (95% CI 0.62-0.74), 0.71 (95% CI 0.65-0.75), and 0.75 (95% CI 0.69-0.81), respectively. Our proposed DL model trained on DBT images is useful for predicting the presence of stromal invasion in breast cancer.

Abstract P3-17-06: Telephone triaging during the 1st wave of the COVID 19 Pandemic: Outcomes and proposed pathway for managing patients referred for breast pain

Abstract Introduction/Background• The sudden outbreak of the COVID 19 pandemic led to increased stress on healthcare systems across the globe. They struggled to continue to provide other essential clinical services whilst dealing with the rapid surge of COVID 19 cases. It was therefore essential to optimize patient-centred care safely in a risk adapted environment without compromising outcomes.• We present our experience of telephone triaging of new symptomatic patients referred to a single, tertiary, academic large volume breast unit. Based on our observed outcomes, we propose a novel pathway for management of patients referred with Breast Pain. Methodology• We conducted an audit of patients triaged for telephone consultation at Guy’s and St Thomas’ NHS foundation Trust, UK between 1st April 2020 to 30th June 2020. Data was collected retrospectively from hospital records following approval from the Trust Audit Committee. Two week wait (2WW) referrals determined to be of low index of suspicion for breast cancer were triaged to telephone consultation. Criteria for low index of suspicion was breast pain, non-suspicious skin changes, bilateral non pathological nipple discharge, gynaecomastia, patients < 30. Patients > 70 were initially offered telephone consultation for risk assessment to avoid potential exposure to COVID19 ( shielding of vulnerable cohort ). Follow up data was recorded up to October 2020. Results• There were a total of 685 new 2WW referrals during this time. The total number of patients that were triaged to telephone consultation were 111. The median age of this cohort was 34. There were 105 women and 6 men in this cohort. When classified by symptoms, 47 were referred for breast pain, 46 for suspected breast lumps, 6 for nipple discharge and 12 for other miscellaneous reasons.• The total number of patients that were invited back for imaging or face to face (F2F) consultation or both were 67 (60%) .Total number that came back for F2F consultation were 50, out of which 14 were purely for F2F. The total number of patients that came back for imaging were 53, out of which 17 came for imaging only. Total number that came back for F2F and imaging both were 36.• 44 patients were discharged without a F2F consultation or imaging (40%)• F2F consultations (50) when classified by symptoms, 70% presented with breast lump, 14% with breast pain, 6% with nipple discharge, 2% with breast infections and 8% with other benign causes.• Total number of biopsies performed were 9, out of which 2 were cancers and the rest were benign.• There were 3 patients that came back with new referrals after a few months of being discharged following a telephone consultation. They presented with the same symptoms, or their symptoms had worsened or they had new symptoms. However, none of them had any significant finding on F2F consultations or imaging and were reassured and discharged. Conclusion• Our audit ( although a small cohort ), some published data ( Cancer Waiting Times data in the UK comparing 1st 6 months from 2019 with 2020 ) and literature support the effectiveness of this tool in unprecedented times.• Breast pain is not the most alarming symptom. None of the patients in our cohort with breast pain were found to have any significant finding on imaging or were diagnosed with breast cancer.• Any breast lump or pathological nipple discharge irrespective of age should undergo triple assessment as gold standard.• Our proposal is to design a separate pathway for patients with breast pain as they do not necessarily need a F2F consultation or imaging ( can be elicited by the clinician and called only if deemed necessary ). This will in turn decrease the strain of 2WW referrals and increased burden on radiology. Citation Format: Urvashi Jain, Robyn Coombe, Georgina Bitsakou, Ashutosh Kothari. Telephone triaging during the 1st wave of the COVID 19 Pandemic: Outcomes and proposed pathway for managing patients referred for breast pain [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-17-06.

ASSESSING BREAST DISORDERS AND FEASIBILITY OF BREAST-I LED MACHINE AMONG WOMEN OF RURAL AREA OF CHANDIGARH, INDIA

Background: Breast cancer is the most common cancer in India causing highest cancer deaths in India as per GLOBOCAN 2018. Early diagnosis and treatment helps in improving prognosis and prolonging life. BREAST-i LED machine is one of the technology, for screening breast cancer at early stage. The present study was undertaken to evaluate the feasibility of BREAST-i LED machine to screen breast cancer. Methods: Across-sectional study was conducted on 300 convenient selected women in the age group of 30-60 years. Data was collected by house-to-house survey and all the women in surveyed house were registered for the study. They were interviewed as per the interview schedule comprised of a) Socio-demographic profile b) reproductive profile c) cancer related history and sign/symptoms. . By using BREAST-i LED machine the breast examination was done and the clinical breast examination was done there after to screen any sign of breast cancer. Identified cases were referred for confirmation of diagnosis. The data entry and analysis was done on SPSS (version 20). Results: The majority of the participants were between the age of 40-50years (42%) and majority of them (89.33%) began their menstruation between the age of 11-15 years. More than half (53.66%) had their first pregnancy between the age of 21-30years More than half (58%) had not attained their menopause and 99.3% had no family history of breast cancer. A high level of suspicion of breast cancer using Breast-i-LED instrument was found among four women (1.33%). Same results were observed by clinical breast examinations as well. These women were referred for further confirmation of diagnosis. Conclusion: BREAST-i LED machine can be used in community for quick screening of suspicion of breast cancer.

Study to Evaluate the Role of Computer aided Detection Using Full Field Digital Mammography in Breast Cancer Imaging

Background: Mammography is acknowledged as the single most effective method of screening for breast cancer and is credited with helping to reduce breast cancer mortality by approximately 30%. CAD systems are a new tool in detecting breast cancers on screening mammograms and in detecting potentially suspicious abnormalities on a mammogram. The aim & objective is to main aim of the present study to evaluate the performance of Computer Aided Detection using Full Field Digital Mammography in Breast Cancer imaging. Subjects and Methods:In the present study, Cases with lump breast with clinical suspicion of breast cancer and post op recurrence of breast cancer were imaged with FFDM and images were read on the viewing monitor without and with the aid of CAD software. The present study confirms that the diagnosis of breast cancer is made only following histopathology of respected specimen. Results: The maximum incidence was in 41-50 years and 51-60 years which was 13 cases in each group (30 %). There were 25 cases out of 40 (62.5%) in which the lesion was marked by CAD. Out of which in 20 cases (50%) only one lesion was marked by CAD and in 4 cases (10%) two lesions were marked by CAD. The total number of lesions marked by CAD was 25 (62.5%). Majority of patients had scattered fibro glandular density of breast. This was present in 19 patients (47.5%). 10 patients (20%) had heterogeneously dense breast, 07 patients (17.5%) had fatty breast and 04 patients (10%) had extremely dense breast. In majority of cases the lesion type was mass alone which was present in 26 cases (60%). While 10 cases (25%) presented as mass with microcalcifications and 4 cases (10%) presented with microcalcifications alone. In 24 cases there was no spread of cluster of micro calcification (60%). In 7 cases (17.5%) the spread of cluster of micro calcification was <10mm, in 4 cases (10%) the spread of cluster of micro calcification was 21-30 mm and in 5 cases ( 12.5%) the spread of cluster of micro calcification was > 40mm. In majority of cases the HPE revealed DCIS which was seen in 22 cases (55%), 08 cases (20%) were invasive ductal carcinoma and 02 cases was invasive lobular carcinoma. In 22 cases (55%) the BIRADS for the breast affected with cancer was BIRADS-V. While in 14 cases (35%) the score was BIRADS-IV, 04 cases (10%) the score was BIRADS-VI and in 02 case (5%) the score was BIRADS-III. The sensitivity, specificity and accuracy of CAD for detection of mass were 70%, 100% and 85% respectively and for detection of cluster of microcalcification were 100% respectively. Conclusion: CAD with FFDM is good at detection of Microcalcifications. Detection of masses is better without the aid of CAD as compared to CAD. However detection of lesion improves if reading of mammogram is done both with and without CAD.

The long-term course of fatigue following breast cancer diagnosis

PurposeFatigue following breast cancer is a well-known problem, with both high and persistent prevalence. Previous studies suffer from lack of repeated measurements, late recruitment and short periods of follow-up. The course of fatigue from diagnosis and treatment to the long-time outcome status is unknown as well as differences in the level of fatigue between treatment regimens. The purpose of this study was to describe the long-time course of fatigue from the time of clinical suspicion of breast cancer, its dependence of patient characteristics and treatment regimens and the comparison with the course of fatigue among women with the same suspicion, but not diagnosed with breast cancer.MethodsThree hundred thirty-two women referred to acute or subacute mammography was followed with questionnaires from before the mammography and up to 1500 days. Fatigue was measured by the Multidimensional Fatigue Inventory (MFI-20). The women reported their initial level of fatigue before the mammography and thus without knowledge of whether they had cancer or not. Both women with and without cancer were followed. Women with cancer were identified in the clinical database established by Danish Breast Cancer Cooperative Group (DBCG) to collect information on treatment regimen.ResultsCompared to fatigue scores before diagnosis, women with breast cancer reported a large increase of fatigue, especially in the first 6 months, followed by a slow decrease over time. Despite the long follow-up period, the women with breast cancer did not return to their level of fatigue at time of the mammography. Women without breast cancer, experienced a rapid decrease of fatigue after disproval of diagnosis followed by a steadier period.ConclusionsFatigue is a persistent problem in women diagnosed with breast cancer, even several years following diagnosis and treatment. The women with breast cancer were most affected by fatigue in the first 6 months after diagnosis.

Identification of Cell-Free Circulating MicroRNAs for the Detection of Early Breast Cancer and Molecular Subtyping.

Early detection is crucial for achieving a reduction in breast cancer mortality. Analysis of circulating cell-free microRNAs present in the serum of cancer patients has emerged as a promising new noninvasive biomarker for early detection of tumors and for predicting their molecular classifications. The rationale for this study was to identify subtype-specific molecular profiles of cell-free microRNAs for early detection of breast cancer in serum. Fifty-four early-stage breast cancers with 27 age-matched controls were selected for circulating microRNAs evaluation in the serum. The 54 cases were molecularly classified (luminal A, luminal B, luminal B Her2 positive, Her-2, triple negative). NanoString platform was used for digital detection and quantitation of 800 tagged microRNA probes and comparing the overall differences in serum microRNA expression from breast cancer cases with controls. We identified the 42 most significant (P ≤ 0.05, 1.5-fold) differentially expressed circulating microRNAs in each molecular subtype for further study. Of these microRNAs, 19 were significantly differentially expressed in patients presenting with luminal A, eight in the luminal B, ten in luminal B HER 2 positive, and four in the HER2 enriched subtype. AUC is high with suitable sensitivity and specificity. For the triple negative subtype miR-25-3p had the best accuracy. Predictive analysis of the mRNA targets suggests they encode proteins involved in molecular pathways such as cell adhesion, migration, and proliferation. This study identified subtype-specific molecular profiles of cell-free microRNAs suitable for early detection of breast cancer selected by comparison to the microRNA profile in serum for female controls without apparent risk of breast cancer. This molecular profile should be validated using larger cohort studies to confirm the potential of these miRNA for future use as early detection biomarkers that could avoid unnecessary biopsy in patients with a suspicion of breast cancer.

Amyloid tumor of the breast

BackgroundAmyloid tumor of the breast is a rare disease, which was first reported in 1973. To date, only six cases have been reported in Japan.Case presentationA 45-year-old woman who had a medical history of Sjogren’s syndrome presented with a lump of 3 cm in diameter on the outer side of the right breast. Mammography showed no abnormality. Ultrasonography showed a well-defined and rough hypoechoic mass of 32 mm in diameter at the site of the lump. With suspicion of breast cancer, an ultrasound-guided vacuum-assisted breast biopsy was performed. For pathological diagnosis, hematoxylin and eosin staining showed deposits of nonstructural substances in the interstitium. The specimen stained red with Congo red staining and showed green birefringence under a polarizing microscope. Thus, the mass was diagnosed as an amyloid tumor. Since the patient had Sjogren’s syndrome, it was considered a breast finding of autoimmune disease. We considered further therapy to be unnecessary, and annual follow-up was recommended.ConclusionsWe diagnosed the mass as an amyloid tumor by an ultrasound-guided vacuum-assisted breast biopsy without resection. The patient had no systemic symptoms suspected systemic amyloidosis, and we diagnosed localized amyloidosis. An amyloid tumor of the breast may show findings suggestive of breast cancer. Pathological diagnosis before surgery is important to avoid excessive invasion. If deposits of nonstructural substances are observed by hematoxylin and eosin staining, Congo red staining should be added.

Abstract P5-13-12: Breast cancer in Colombia: A growing challenge for the health care system

Abstract INTRODUCTION Colombia has a population of roughly 49 million people of predominantly Mestizo ethnicity. Cancer has become a growing public health problem in Colombia with nearly 71,000 newly diagnosed malignant tumors per year. It is expected that by 2035, 150,000 new cases of cancer will be diagnosed, making Colombia an intermediate country with regards to global cancer incidence according to IARC. METHODS Epidemiological data on breast cancer is scarce and varied due to multiple sources of information. These numbers are obtained thru population-based cancer registries that represent 4 distinct regions of the country. Other data originate from non-governmental institutions and healthcare providers within Colombia. The Colombian National Cancer Institute publishes a Cancer Mortality Atlas annually. RESULTS Local cancer registries have shown increases in breast cancer incidence in Colombia. In 2007, age-standardized incidence rate was 27.8 per 100,000 persons increasing to 49.7 cases per 100,000 persons in 2012. Approximately, 2200 women die every year in Colombia due to breast cancer with rates increasing historically, but now are stabilizing. Advanced breast cancers are most frequently found among women without health insurance, while early breast cancers are usually found among working women and those covered by private health insurance. Early breast cancer screening was made mandatory as public policy in the year 2000. However, only 30% of health care coverage was reported, translating to very low coverage by opportunistic screening programs with only 33% of women having had a mammography. In 2012, a National Cancer Control Plan was planned and implemented. It aims to increase early stage cancer diagnosis, increase biannual screening coverage, and guarantee timely access to diagnosis and treatment. A national health survey in 2015 showed only 48% of women had an annual mammographic screening. Multiple disparities have been found with regards to screening and early diagnosis such as economic strata, health insurance coverage, origin, and accessibility. Specifically, data shows that 23% needed to travel in order to obtain access to mammography. Often it is necessary for some patients to sue healthcare insurance systems to obtain specific health care, causing an increase in time to diagnosis and treatment. In 2016, on average a 90-day period was reported from time of onset of symptoms to suspected diagnosis of breast cancer, while the time to the initiation of treatment was 100 days for chemotherapy and close to 120 days for surgery. DISCUSSION These data serve to impact the landscape of breast cancer and improve patient outcomes in Colombia. While the National Cancer Plan has led to major changes, a big challenge remains related to the delays between suspicion of breast cancer and diagnosis and treatment. Quality of care provided by private and public insurance administrators is also of concern. General practitioners should receive more detailed training in breast cancer detection and management. The healthcare system should provide quality cancer care with urgent improvement in mammography, especially in more rural areas. Widely, more timely and appropriate follow-up is needed. Citation Format: Duarte C, Salazar A, Strasser-Weippl K, de Vries E, Wiesner C, Krush L, Goss PE. Breast cancer in Colombia: A growing challenge for the health care system [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-12.

Performance Analysis of ANN and Naive Bayes Classification Algorithm for Data Classification

Classification is an important data mining technique with a wide range of applications to classify the various types of data existing in almost all areas of our lives. The purpose of this discovery study can be used to estimate the potential of having breast cancer by taking advantage of anthropometric data and collected routine blood analysis parameters. The study was performed using data from patients who were admitted to the clinic with the suspicion of breast cancer. The values of Age (years), BMI (kg/m2), Glucose (mg/dL), Insulin (µU/mL), HOMA, Leptin (ng/mL), Adiponectin (µg/mL), Resistin (ng/mL), MCP-1(pg/dL) were used. In our study, classification algorithms were applied to the data and they were asked to estimate the disease diagnosis. The classification performance of Artificial neural networks and Naive Bayes classifiers which were applied to data with 9 inputs and one output were calculated and theperformance results were compared. This article sheds light on the performance evaluation based on correct and incorrect data classification examples using ANN and Naive Bayes classification algorithm. When we look at the performances obtained, it is predicted that using the anthropometric data and the collected routine blood analysis parameters, the potential for diagnosing breast cancer is high using these data.

How Many of the Biopsy Decisions Taken at Inexperienced Breast Radiology Units Were Correct?

In this study, we aimed to determine the need for biopsy in patients referred from other clinics for the performance of biopsy with the suspicion of breast cancer. 112 patients were included in the study. It was decided that their biopsies be performed following examinations in other clinics and they presented to the breast radiology unit of our hospital for a second opinion. The demographic characteristics, diagnostic studies completed in the other centers, properties of lesions, decision made as a result of examinations and BI-RADS (Breast Imaging Reporting and Data Systems) categorizations were recorded on the registration forms of the study patients. In addition, the quality of examinations, reasons of repeat tests, additional tests features and the last decision of our clinic were documented. The obtained data were analyzed in terms of re-examination, additional tests and change in the biopsy decision. Changes in the biopsy decisions for patients were specifically inquired. The biopsy decisions were cancelled in our breast radiology unit for 63 out of 112 patients (56.3%) whose biopsy decisions were made at an external institute. For 42 patients, examinations made by the other clinics were deemed adequate, yet there was no need for biopsy in 22 of them. The biopsy decisions were cancelled for 27 out of 47 patients (57.4%) with repeat examination and 18 out of 28 patients (64.3%) with additional tests because of the insufficient test quality. Incorrect, inadequate breast screening and false positivity were higher at inexperienced institutes.

Diagnostic yield of primary circulating tumor cells in women suspected of breast cancer: the BEST (Breast Early Screening Test) study.

To determine the diagnostic yield of primary circulating tumor cells in women with suspicion of breast cancer, detected as a result of an abnormal mammography. Consecutive women presenting for breast biopsy as a result of a mammogram BiRADs of 3 or more, had an 8 ml blood sample taken for primary circulating tumor cell (CTC) detection. Mononuclear cells were obtained using differential gel centrifugation and CTCs identified using standard immunocytochemistry using anti-mammoglobin. A test was determined to be positive if 1 CTC was detected. A total of 144 women with a mean age of 54.7 ± 15.6 years participated, 78/144 (53.0%) had breast cancer on biopsy, 65/140 (46.3%) benign pathologies and 1(0.7%) non-Hogkins lymphoma. Increasing BiRADs scores were associated with increased cancer detection (p=0.004, RR 1.00, 4.24, 8.50). CTC mammoglobin positive had a sensitivity of 81.1% and specificity of 90.9%, with positive and negative predictive values of 90.9% and 81.1% respectively. Mammoglobin positive CTCs detected 87% of invasive cancers, while poorly differentiated cancers were negative for mammoglobin. Only 50% of in situ cancers and none of the intraductal cancers had CTCs detected. Menopausal status did not affect the diagnostic yield of the CTC test, which was higher in women with BiRADS 4 mammograms. There was a significant trend (p<0.0001 Chi squared for trends) in CTC detection frequency from intraductal, in situ and invasive (OR 1.00, 8.00, 472.00). The use of primary CTC detection in women suspected of breast cancer has potential uses, especially with invasive cancer, but it failed to detect intra-ductal cancer and 50% of in situ cancer. There was no difference in the diagnostic yield between pre and post menopausal women. To confirm its use in reducing biopsies in women with BIRADs 4a mammagrams and in the detection of interval invasive breast cancer, larger studies are needed.

Comparison of Sonography versus Digital Breast Tomosynthesis to Locate Intramammary Marker Clips.

Introduction: This study aimed to compare the accuracy of sonography versus digital breast tomosynthesis to locate intramammary marker clips placed under ultrasound guidance. Patients and Methods: Fifty patients with suspicion of breast cancer (lesion diameter less than 2 cm [cT1]) had ultrasound-guided core needle biopsy with placement of a marker clip in the center of the tumor. Intramammary marker clips were subsequently located with both sonography and digital breast tomosynthesis. Results: Sonography detected no dislocation of intrammammary marker clips in 42 of 50 patients (84 %); dislocation was reported in 8 patients (16 %) with a maximum dislocation of 7 mm along the x-, y- or z-axis. Digital breast tomosynthesis showed accurate placement without dislocation of the intramammary marker clip in 48 patients (96 %); 2 patients (4 %) had a maximum clip dislocation of 3 mm along the x-, y- or z-axis (p < 0.05). Conclusion: The use of digital breast tomosynthesis could improve the accuracy when locating intramammary marker clips compared to sonography and could, in future, be used to complement or even completely replace sonography.

Ultrasound-guided core biopsy of breast lesions in Ibadan: Our initial experience

Background and Objectives: Ultrasound-guided core needle or tru-cut biopsy is a new concept in breast cancer diagnosis and treatment in developing countries, including Nigeria. A tru-cut biopsy is less invasive surgery, replacing diagnostic surgical biopsies in many institutions. It has a known sensitivity of 94-100%, whether performed with ultrasound or stereotactic guidance. The technique is reliable, simple, reproducible, and relatively cheap. Aims: This is a premier report of ultrasound- guided core biopsy of the breast in Nigeria. This study will evaluate the sampling adequacy and diagnostic accuracy of sonomammographic-guided tru-cut biopsies in determining the nature of a breast lump sent for histopathological analysis. Materials and Methods: A prospective study involving 40 women with clinical suspicion of breast cancer and/or Breast Imaging-Reporting and Data System (BI-RADS) category 3-5 referred for breast imaging at the Department of Radiology of the University College Hospital, Ibadan. Core biopsy was performed with a manual BARD Magnum™ gun, a General Electric GE Logiq P5 ultrasound unit with a high frequency linear transducer. Statistical Package for social sciences [SPSS] Software version 17.0 was used for statistical analysis. Results: Forty core needle biopsies (CNB) were performed on palpable masses. Histopathology confirmed cancer in 24 (60%), while 10 (25%) were benign. Invasive ductal carcinoma accounted for 88% of cancers. Sensitivity and specificity of the core biopsies was found to be 100% and 80%, respectively. Conclusion: Ultrasound-guided biopsy for breast lesion assessment in our center shows high accuracy in determining the nature of a breast lump. Its routine use in countries with limited resources is recommended.

Cost-effectiveness of non-invasive assessment in the Dutch breast cancer screening program versus usual care: a randomized controlled trial.

Increased recall rates in the Dutch breast cancer screening program call for a new assessment strategy aiming to reduce unnecessary costs and anxiety. Diagnostic work-up (usual care) includes multidisciplinary hospital assessment and is similar for all recalled women, regardless of the radiologist's suspicion of breast cancer. This is similar in many Canadian settings. We developed a novel assessment strategy that offers women with a low suspicion of breast cancer a quick and non-invasive assessment by a screening radiologist (intervention). We compared these two strategies in a cost-effectiveness analysis based on a randomized controlled trial: multicentre randomized controlled trial (MASS trial, Netherlands National Trial Register: NTR1480). Participants were enrolled between August 2010 and December 2012 and were randomly assigned to either the intervention or control group (allocation ratio 2:1). Fourteen assessment centres participated in the study. Questionnaires were used to record quality of life (EuroQol-5D), health care use and costs after recall. Our study comprised 366 women, of whom 288 were randomly assigned to the intervention group and 88 to the control group. The mean difference in cost was €153/CAD $226 (95% confidence interval €107-199/CAD $158-294, p&lt;0.001). We found no significant differences in quality of life. The bootstrapped incremental cost-effectiveness ratios in the cost-effectiveness plane showed that the intervention was the efficient, cost-saving modality. Our data show the benefits of tailoring diagnostic assessment to the screening radiologist's suspicion of breast cancer. Scenarios of implementing such a strategy in the Dutch screening or health care system are currently being discussed with various stakeholders.

EVOLUCIÓN EN LA FORMA DE SOSPECHA Y EXTENSIÓN DE LA CIRUGÍA DEL CÁNCER DE MAMA EN UN CENTRO DE RADIO-ONCOLOGÍA

Abstract Evolution in breast cancer suspicion and extent of surgery at a radio-oncology center Introduction: Breast cancer diagnosis and treatment had evolved over the past quarter century. From self-examination to mammography as main suspicion tool and from radical to conservative surgery plus radiotherapy as prefered treatment. The aim of this review was to assess the evolution of presentation and local management of breast cancer at a Chilean radio-oncology center. Materials and Methods: We analyzed 1.204 breast cancer patients who received postoperative irradiation on two four-years periods. The first period included 223 patients and coincides with the introduction of mammography and conservative surgery. The second included 981 patients managed according to current guidelines. The variables analyzed were type of clinical suspicion, time between clinical suspicion and diagnosis confirmation, type of surgery, histology and tumor size. Data were obtained from medical records and analyzed using STATA 12.

Moderators of Psychological Recovery from Benign Cancer Screening Results

The sudden confrontation of a potential health threat such as cancer, even after the diagnosis turns out to be benign, can have enduring adverse psychological consequences, including persistent anxiety, cancer fears, and other manifestations of psychological distress. The present study examines factors that potentially moderate psychological recovery among women who face a breast cancer threat. Participants were adult women had just received a benign outcome from a breast cancer diagnostic procedure that had been conducted because of suspicion of breast cancer (a non-conclusive mammography or ultrasonography result, a referral from their doctor because of pain or family history, detection of a lump, a 6-month follow-up appointment after a breast abnormality from a previous screening or diagnostic procedure, or a fluid leak from one or both breasts). We measured several psychological traits at Time 1 (right after receipt of the "no cancer" feedback) and then each month for the next 3 months. Analyses examined the factors that hindered or facilitated psychological recovery from the cancer threat. Results showed that trait anxiety and family history of cancer hindered recovery and that older age and optimism facilitated recovery and lessened adverse psychological consequences. Self-regulatory strategies such as planful problem-solving, positive reappraisal, and mastery facilitated recovery. Our findings shed light on the factors that are implicated in psychological recovery from a benign breast cancer outcome after a diagnostic procedure (ultrasonography, repeat or initial mammography, stereotactic biopsy, fine-needle aspiration, or ultrasound-guided biopsy). Those factors could be used to identify women who may experience prolonged psychological distress, so as to assist them when they face stressful diagnostic concerns.

OT3-02-03: Patient Empowerment by Group Medical Consultations in the Follow-Up of Breast Cancer Survivors and Surveillance of Women with a BRCA Mutation.

Abstract Background: During usual follow-up care for breast cancer patients only little time is left for psychosocial support, while most patients experience several complaints, which may increase levels of distress or effect the quality of life. BRCA mutation carriers have a 40–80% life-time risk of developing breast cancer. They have a complex choice to make between yearly breast cancer surveillance or prophylactic mastectomy. Both options show increased survival rates. To fulfill the needs for psychosocial support and information we have introduced group medical consultations (GMCs). A GMC provides individual medical visits conducted within a group. This 90 minute group-visit with 8–12 patients gives patients the opportunity to spend more time with their clinician and a behavioral health professional and learn from other patients experiencing similar topics. However, it should be noted that group sessions may increase fear in some patients. Trial design: This multicenter randomized controlled trial will assess the effect of GMCs compared to individual visits for patients in the follow-up after breast cancer and for women with a BRCA mutation. The intervention group will participate in a GMC once, while the control group will have usual care. Eligibility criteria: Inclusion criteria for the follow-up of breast cancer patients are: histologically proven breast cancer; age ≥18 years; primary treatment completed maximally 5 years ago. For BRCA mutation carriers inclusion criteria are: carrier of a BRCA1 or BRCA2 mutation; diagnosed maximally 2 years ago; age ≥25 years. Exclusion criteria for both groups are: currently involved in a diagnostic work-up because of a suspicion of breast cancer; metastatic breast cancer; current psychiatric disorder; insufficient command of the Dutch language. A history of prophylactic mastectomy is an exclusion criteria only for BRCA mutation carriers. Study endpoint: Primary outcomes in this study are empowerment and psychological distress. In addition, the effects on cancer worry, information needs and information giving, self-examination of the breasts, treatment compliance, patient satisfaction, quality of life and costs of care (secondary outcome measures) will be studied. Statistical methods: To assess a clinically relevant effect of GMCs on psychological distress with a power of 80%, a two-side significance of 5%, and a standard deviation of 45, 80 patients need to be included in each group. Randomization will take place per patient in blocks of 16 patients. Differences between baseline and post-test between the two groups will be compared by using ANCOVA for primary outcomes and ANOVA or mixed model for secondary analysis. Accrual: Patients are currently being recruited at the Radboud University Nijmegen Medical Center. In the future other centers in the Netherlands will participate. Presently (21th june 2011) a total number of 37 patients have been included since start of the study (april 2011). The expected end of accrual of 320 patients will be December 2012. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT3-02-03.

Delay for diagnosis and treatment of breast cancer in Bogotá, Colombia

Establish provider delay for breast cancer and related factors. 1,106 women with breast cancer were approached in health care institutions of Bogota, Colombia. According to the history of first consultation, we established diagnostic and treatment incidence rates, which were compared for different variables. A Cox hazard model was established. Median time from first consultation to diagnosis and start of treatment were 91 days (CI95%:82-97 days) and 137 days (CI95%:127-147 days) respectively. Diagnosis and treatment were faster in women with higher educational level, affiliated to the "special" social security, with better socioeconomic conditions and in screening-detected breast cancers. Provider delay is excessive. There are clear inequities in access to services and a need of reducing the waiting times for women with a suspicion of breast cancer.

Histological study correlated with imunohistochemical techniques for characterization and selection of a battery of biomarkers useful in the management of steroido-dependent mammary tumors in bitches.

This study was conducted on thirteen bitches, with clinical suspicion of breast cancer. Excisional tumors obtained by surgery methods were subjected to histopathological and immunohistochemical exams was preceded by preoperative clinical and thermographic examination. The purpose of this research was to study the correlation between histology and immunohistochemistry techniques for characterization and selection of a battery of biomarkers useful in the management of canine mammary tumors, the model determined in human clinical practice. A goal of this work was also to evaluate the immunohistochemical techniques used in human oncology for the characterization of prognostic markers in veterinary oncological value. In this research were analyzed a series of markers of epithelial, myoepithelial, and neuroendocrine proliferation, summarizing the results of immunohistochemical techniques in our casuistry, the techniques used in humans could be extrapolated successfully in canine pathology for AE1/AE3 (pancitokeratina), Ck5/6, SMA, CD56, Ki67. Immunohistochemical techniques and histopathological diagnosis can increase accuracy without additional information on tumor aggressiveness and prognosis, in conjunction with your class and clinical pathology.