Womenwith Breast Cancer Research Articles

Women's Lived Experiences in the Use of Complementary and Alternative Medicine for Breast Cancer Management: A Phenomenological Study.

This study aimed to explore women with breast cancer (WBC) lived experiences on the use of Complementary and Alternative Medicine (CAM) for breast cancer management. van Manen's phenomenology of practice was used as the methodology and method in this study. In-depth interviews guided by semi-structured questions were conducted with 21 WBC recruited using convenience sampling. The thematic analysis generated four main themes: Access, affordability and support for medical treatment, beliefs in CAM treatment, feeling the potential benefits of CAM, and Acknowledging the negative aspects of CAM. The outcomes from using CAM based on the lived experiences of WBC indicated that some CAM treatments could improve quality of life. However, some fraudulent CAM obtained from unprofessional CAM providers could cause harmful effects, delay medical cancer treatment, and increase breast cancer treatment costs. Therefore, there is an urgent need to enhance the awareness of appropriate treatment, including evidence-based CAM, for WBC. Improved understanding in the use of CAM as a part of quality breast cancer care services could contribute to increasing the quality of life and survival rates of women with breast cancer.

OP70 Treating Patients With Hormone-Sensitive Cancer On Endocrine Therapy With Denosumab (Prolia®): A Systematic Review And Network Meta-Analysis

IntroductionPatients receiving endocrine therapy for hormone-sensitive cancers, such as men with prostate cancer (MPC) on hormone ablation therapy (HAT) and women with breast cancer (WBC) on adjuvant aromatase inhibitor therapy (AAIT), have an increased risk of developing osteoporosis. The aim of this study was to compare the safety and effectiveness of denosumab (Prolia®) with selective estrogen receptor modulators (SERMs) (raloxifene and bazedoxifene), bisphosphonates (zoledronate, ibandronate, alendronate, and risedronate), and placebo for the treatment of osteoporosis in patients receiving endocrine therapy for hormone-sensitive cancer.MethodsSystematic literature searches were conducted in three biomedical databases (PubMed, the Cochrane Library, and Embase) to identify randomized controlled trials (RCTs). Only RCTs that investigated MPC on HAT or WBC on AAIT allocated to denosumab, SERMs, bisphosphonates, or placebo were included. RCTs were appraised using the Cochrane Risk of Bias 2.0 tool. Frequentist network and pairwise meta-analyses were performed on predetermined outcomes of vertebral or nonvertebral fractures, treatment-related adverse events (AEs), bone mineral density (BMD), mortality, withdrawal due to treatment-related AEs, and serious AEs.ResultsA total of 14 RCTs (15 publications, 6,463 participants) were included. Relative to placebo, denosumab was found to prevent vertebral fractures in cancer patients receiving endocrine therapy. Moreover, denosumab, alendronate, and zoledronate increased femoral neck (FN) and lumbar spine (LS) BMD in MPC on HAT, compared with placebo, whereas denosumab, risedronate, and ibandronate improved LS and total hip BMD in WBC on AAIT. Similarly, denosumab and risedronate increased trochanteric BMD in WBC on AAIT, compared with placebo. In WBC on AAIT, only denosumab increased FN BMD relative to placebo.ConclusionsDenosumab was more effective than placebo in preventing vertebral fractures and improving BMD at the LS and FN in MPC on HAT, and in preventing vertebral fractures and improving FN, trochanteric, total hip, and LS BMD in WBC on AAIT. From a policy perspective, the continued reimbursement of denosumab needs to be reviewed.

THE RELATIONSHIP BETWEEN RESILIENCE AND BREAST CANCER

Resilience can be changed and modified over time, it is affected by many different situations and difficulties that a person overcomes during life. Resilience is a newer concept, which should be applied to the patient from the beginning of life with cancer. Clinicians should invest more time and effort in creating interventions that enable patients to foster their resilience. The term resilience or the ability to recover refers to the process of overcoming adverse events, including stress, trauma and illness. Considering the ability to recover as a personality trait imposes the assumption that the ability to recover represents a constellation of personal characteristics that enable individuals to adapt to different circumstances they encounter. Resilience as a complex phenomenon changes over time and circumstances. Understanding resilience as a complex, multidimensional and dynamic process is very important for understanding therapeutic mechanisms and healing mechanisms. Psychological factors are the most important factors that contribute to the development of resilience. It is necessary to work on the development of psychosocial interventions that will target the psychological resilience of cancer patients. Breast cancer is the most common malignant disease in women. In women with breast cancer who manage to develop the ability to resist and accept life's crisis, greater resilience and personal growth is created, thereby reducing the negative impact associated with the disease. The aim of this work is to explain the relationship between resilience and breast cancer. Key words: connection, resilience, cancer, breast

Investigating the Impact of Cognitive-behavioral Stress Management on Adjustment among Females with Breast Cancer

Background and Aim: This study aimed to investigate the effect of cognitive-behavioral stress management (CBSM) on adjustment among females with breast cancer. Materials and Methods: This randomized clinical trial study was conducted on 104 women with breast cancer who visited Hamedan Imam Khomeini Clinic between Feb 3 and Oct 26, 2016, and met the inclusion criteria. The inclusion criteria included being 20 to 60 years old, being married, and having grade 1-3 breast cancer with a history of recent surgery. The subjects were randomly assigned to two groups of 52 subjects, using a permuted block size of 4. The intervention group participated in 4 sessions of CBSM, each 90 minutes long, for a duration of 4 weeks. Data collection was done using a demographic information questionnaire and Bell adjustment questionnaire. The statistical analyst remained unaware of the intervention assignment. Data analysis was done using descriptive statistics, paired t-test, and repeated measures ANOVA. Results: There was a significant difference in the mean scores of the total adjustment (P = 0,0001) between the two groups after the intervention. Each variable was calculated three times, prior to the intervention, immediately after and 2 weeks after the intervention. Regardless of the time of measurement, there was a significant difference in the mean score of total adjustment between the two groups (P = 0.0001). Conclusion: The cognitive-behavioral stress management program improved the adjustment immediately and 2 weeks after the intervention was done among women with breast cancer. This method can be implemented as a complementary approach along with medical therapies provided by oncology centers. Trial Registration: This study was approved by the Student Research Center of Hamadan University of Medical Sciences (proposal No. IRCT2016051224468N1, code of ethics: IR.UMSHA.REC.1395.32).

Association Between Imaging Features Using the BI-RADS and Tumor Subtype in Patients with Invasive Breast Cancer.

Different molecular breast cancer subtypes present different biologic features, treatment options, and clinical prognoses. The breast cancer imaging phenotype may help precisely classify breast cancer in a non-invasive manner. To identify the association between the imaging and clinicopathologic features of invasive breast cancer according to the molecular subtype. We retrospectively reviewed the electronic medical records of 313 consecutive women with breast cancer who underwent surgery between March 2018 and February 2019. Preoperative imaging studies were also reviewed and the association between the clinicopathologic and imaging features was evaluated according to the molecular subtype. On mammography, the presence of microcalcifications was correlated with the human epidermal factor receptor 2-positive subtype (67%, 14/21). Luminal A and B tumors were more likely to have a spiculated margin (57% [63/110] and 41% [34/81]), while human epidermal factor receptor 2-positive and triple-negative breast cancers were more likely to have an indistinct margin (56% [10/18] and 35% [17/48]). On ultrasonography, luminal A tumors were likely to be depicted as masses with an irregular shape (85%, 115/136) and spiculated margin (49%, 66/136). On magnetic resonance imaging, triple-negative breast cancer appeared as a mass (n=13) that frequently had an irregular shape (62%, 8/13) but was more likely to be oval or round (39%, 5/13) than other subtypes. Some imaging features on mammography, ultrasonography, and magnetic resonance imaging could be useful predictors of the molecular subtype of breast cancer and may aid precision medicine development for patients with breast cancer according to the subtype.

Identify the Risk Factors of Osteoporosis Knowledge and Practices Regarding Prevention of Osteoporosis among Postmenopausal and Postmenopausal With Breast Cancer Women in Selected Tertiary Care Hospital

Background: Osteoporosis is defined as a decline in bone strength that raises the risk of fracture.Because the number of people in this area is so much higher than those in the osteoporosis range. Morethan 50% of the all the fractures among postmenopausal women, including hip fractures, occur in thisgroup with low density. Due to the lack of awareness about osteoporosis, many post - menopausalwomen do not take preventative actions to protect the osteoporosis.Materials and Methods: The study was conducted using an evaluative method and a non-probabilitypurposive sampling technique. The study was conducted as a descriptive one. A tertiary care hospitalwas chosen for the investigation. 50 postmenopausal women 25 postmenopausal women and 25 postmenopausalwomen with breast cancer), they were included in the study.Result : 14 (28.0%) were between the ages of 46 and 50 years. The high risk was 4 (16.0 %) and themoderate risk was 21(84.0 %) in women with breast cancer. The high risk is 1 (4.0 %) in women withoutca – breast cancer, and the moderate risk is 4 (96.0 %). The majority of postmenopausal women withbreast cancer had average knowledge, with 12 (48.0 %) having an average knowledge, 14 (56.0 %) hadaverage knowledge, and 10 (40.0%) had poor knowledge.The knowledge for postmenopausal womenwithout breast cancer (36.0%) were poor. 3 (12.0%) had good knowledge, whereas 2 (8.0%) had goodknowledge. The overall mean percentage is (40.1%). The majority of postmenopausal women withbreast cancer 18 (72.0%) and 20 (80.0%) had moderate practises for osteoporosis prevention, whereaspostmenopausal women without breast cancer had moderate practises. The overall mean percentage is(58.1%)Conclusion:The findings suggest that an awareness campaign should be conducted among womenduring the post-menopausal period to prevent complications arising due to osteoporosis.

Therapeutic Options for the Management of Aromatase Inhibitor- Associated Bone Loss.

Breast cancer is the most commonly occurring cancer in women worldwide. Early breast cancer is a kind of invasive neoplasm that has not proliferated beyond the breast or the axillary lymph nodes. Current therapeutic strategies for breast cancer mainly include local therapies such as surgery or radiotherapy and systemic therapies like chemotherapy, endocrine, and targeted therapy. Nowadays, the adjuvant treatment for hormone receptor-positive early breast cancer in postmenopausal women remains the main effective systemic therapy which can improve disease- free survival and overall survival; it involves several endocrine treatment regimens, including Selective Estrogen Receptor Modulators (SERMs), Aromatase Inhibitors (AIs), or a combination of them. AIs have been shown to be more effective in preventing recurrence in postmenopausal women with early breast cancer when compared with tamoxifen, thus representing the standard of care for adjuvant endocrine therapy. Although AIs are usually well-tolerated, they can have some side effects. Apart from the appearance of arthralgias or myalgias and cardiovascular events, AI therapies, reducing already low endogenous postmenopausal estradiol levels, cause increased bone loss and increase fracture risk in postmenopausal women. The objective of this review is to evaluate the therapeutic options in the management of Aromatase Inhibitor-Associated Bone Loss (AIBL). We reviewed the current literature dealing with different therapeutic options in the treatment of AIBL. Clinical practice guidelines recommend a careful evaluation of skeletal health in all women with breast cancer before AI therapy initiation. Adequate calcium and vitamin D intake have also been suggested. Pharmacological attempts to minimize AI-related bone loss have focused on the use of antiresorptive agents, such as bisphosphonates and denosumab to protect bone integrity and reduce the risk of fractures. Furthermore, clinical trials have shown that by making the bone microenvironment less susceptible to breast cancer metastasis, these drugs are able to increase disease- free survival. AI, that are the pillar of the systemic treatment for patients with hormone receptorpositive breast cancer, are associated with different side effects, and in particular, osteoporosis and fractures. Both bisphosphonates and denosumab are able to prevent this negative effect.

Reductions in sleep quality and circadian activity rhythmicity predict longitudinal changes in objective and subjective cognitive functioning in women treated for breast cancer

PurposeTo examine long-term cognitive effects of chemotherapy and identify predictors among women with breast cancer (WBC).Patients and methodsSixty-nine WBC scheduled to receive chemotherapy, and 64 matched-controls with no cancer, participated. Objective and subjective cognition, total sleep time, nap time, circadian activity rhythms (CAR), sleep quality, fatigue, and depression were measured pre-chemotherapy (Baseline), end of cycle 4 (Cycle-4), and one-year post-chemotherapy (1-Year).ResultsWBC showed no change in objective cognitive measures from Baseline to Cycle-4 but significantly improved from both time points to 1-Year. Matched-controls showed an increase in test performance at all time points. WBC had significantly higher self-reported cognitive dysfunction at Cycle-4 and 1-Year compared to baseline and compared to matched-controls. Worse neuropsychological functioning was predicted by less robust CARs (i.e., inconsistent 24 h pattern), worse sleep quality, longer naps, and worse cognitive complaints. Worse subjective cognition was predicted by lower sleep quality and higher fatigue and depressed mood.ConclusionObjective testing showed increases in performance scores from pre- and post-chemotherapy to one year later in WBC, but matched-controls showed an increase in test performance from baseline to Cycle-4 and from Cycle-4 to 1-Year, likely due to a practice effect. The fact that WBC showed no practice effects may reflect a form of learning deficit. Compared with the matched-controls, WBC reported significant worsened cognitive function. In WBC, worse objective and subjective cognitive functioning were predicted by worse sleep and sleep-related behaviors (naps and CAR). Interventions that target sleep, circadian rhythms, and fatigue may benefit cognitive function in WBC.

Investigatand#305;on of BDNF and TAQI Gene Polymorphand#305;sms in Patients wand#305;th Breast Cancer with Metabolic Syndrome

Many studies have shown that BDNF and TaqI can play a role in metabolic pathogenesis. This study aims to investigate the possible relationship between BDNF and TaqI gene polymorphisms, susceptibility to metabolic disease and psychopathological symptoms in female breast cancer patients. The potential pathophysiological relationship between metabolic syndrome (MetS) and breast cancer can be affected by the hormonal status of the cancer. For MetS, it is clinically important to determine the potential effects of different diagnostic criteria created by the hormone receptors (HR) status on the results of the metaanalysis. This large-scale prospective study was analyzed as a case-control study to determine the relationship between MetS and clinical outcomes in women with breast cancer, with 80 patients and 45 controls enrolled only in women. There was no significant difference in the genotype and allele distributions of polymorphism of both genes between the patient and control groups, but trends that made significant overall differences in metabolic pathogenesis were observed in the controls of patients with breast cancer. The findings suggest that the effects of gene polymorphisms on metabolic pathogenesis may be a pioneer in detecting negative symptoms in breast cancer diagnosis. As we know, metabolic pathway gene variations have been shown to be important in the development process of metabolic diseases. Many studies have shown that BDNF and TaqI gene polymorphisms are important in breast cancer. Recently, genetically related studies with cancer-targeting SNPs have focused on determining susceptibility, survival, complications, or responses to pharmacological intervention. The aim of our study is to investigate the possible relationship between susceptibility to metabolic disease and psychopathological symptoms.

Does oncoplastic surgery increase immediate (30-day)postoperativecomplications? An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.

Although there has been a significant increase in the use of oncoplastic surgery(OPS), data on the postoperative safety of this approach are limited compared to traditionallumpectomy. This study aimed to compare the immediate (30-day) postoperative complications associated with OPS and traditional lumpectomy. An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was performed on women with breast cancer who underwent OPS or traditionallumpectomy. Logistic regression was used to explore the effect of type of surgery on the outcome of interest. A total of 109,487 women were analyzed of whom 8.3% underwent OPS. OPShad a longer median operative time than traditional lumpectomy. The unadjusted immediate (30-day) overall complication rate was significantly higher with OPS than traditional lumpectomy (3.8% versus 2.6%, p < 0.001). After adjusting for baseline differences, overall 30-day postoperative complications were significantly higher amongst women undergoing OPS compared with traditional lumpectomy (OR 1.41, 95%CI 1.24-1.59). Factors that were independent predictors of overall 30-day complications included higher age, higher BMI, race, smoking status, lymph node surgery, neoadjuvant chemotherapy, ASA class ≥ 3, in situ disease, and year of operation. The interaction term between type of surgery and operative time was not statistically significant, indicating that operative time did not modify the effect of type of surgery on immediatepostoperative complications. Although there were slightly higher overall complication rates with OPS, the absolute rates remained quite low for both groups. Therefore, OPS may be performed in women withbreast cancer who are suitable candidates.

Investigating the Effect of Cognitive-behavioral Stress Management on Occupational Performance among Women with Breast Cancer

Background: Treatment of breast cancer can be accompanied by long-term consequences affecting women’s participation in many tasks. Objective: This study aimed to assess the effect of cognitive behavioral stress management (CBSM) program on occupational performance of women with breast cancer. Methods: In this randomized clinical trial, conducted between Feb 3 and Oct 26, 2016, 104 women with breast cancer who had referred to Imam Khomeini clinic in Hamadan, and who fulfilled the inclusion criteria (20-60 years old, married, suffering from grade 1-3 breast cancer with a history of recent surgery) were enrolled. They were randomly divided into two groups of 52 using a permuted block size of four. The intervention group took part in four 60-minute sessions of CBSM over four weeks. The study data were collected using a demographic information form and the Canadian Occupational Performance Measure. The statistical analyst was masked to intervention allocation. The data were analyzed using descriptive statistics, paired t-test, and repeated measures ANOVA. Results: A significant difference was observed between the two groups regarding the mean scores of occupational performance (p=0.02) and satisfaction (p=0.005) after the intervention. Each variable was measured at three time points (before the intervention, immediately and 2 weeks after intervention). A significant difference was observed in the two groups’ mean scores of performance (p=0.026) and satisfaction (p=0.01), irrespective of the time of assessment. Conclusion: The CBSM program promoted the occupational performance immediately and two weeks after the intervention in women with breast cancer. This technique can be used as a complementary method alongside medical therapies in oncology centers.

Sexual Health Outcomes of PLISSIT-based Counseling versus Grouped Sexuality Education among Iranian Women with Breast Cancer: A Randomized Clinical Trial

Background: In-person counseling using the Permission, Limited Information, Specific Suggestion, and Intensive Therapy (PLISSIT) model is a well-known approach to people with sexual problems. Evidence suggests that Grouped Sexuality Education (GSE) can be as effective as in-person Counseling at educating individuals about their sexuality. However, the efficacy of PLISSIT versus GSE has not previously been evaluated in women with Breast Cancer (BC). Methods: In this paper, we report on the primary outcomes, i.e. the influence of PLISSIT and GSE on the main elements of sexual behavior: sexual capacity, motivation and performance as well as sexual distress experienced by women throughout the post BC life (n=75). The women (married, age 20-50 years, sexual distress &gt; 11, at least three months post treatment, and mastectomy) were randomly allocated into three groups, with 25 women in each arm. The PLISSIT group received at least three private sessions over the 6 week study period, while the other intervention group received GSE, and the control group received routine care. Data were collected at baseline, six and 12 weeks post intervention. This study was part of a larger study focused on sexual behavior and quality of life. That main outcome of the current analysis was the sexual behavior of women with breast cancer, comparing two intervention groups and one control group across two follow-up periods of six and 12 weeks. Results: Data analysis of the intention-to-treat population (n=65) revealed a significant intervention impact for both GSE and PLISSIT on the elements of sexual behaviors (P&lt; 0.0001) with positive change in sexual capacity, motivation and performance after 6 and 12 weeks post intervention. We found a greater effect size (1.4) in GSE group compared with the PLISSIT group (68.1%). The mean sexual behavior assessment score was increased in both intervention groups; however, the GSE group was significantly higher than the control group (P&lt;0.0001). Conclusions: To the best of our knowledge, this is the first three-armed randomized trial of sexuality counseling and education for women with BC employing two interventions of PLISSIT and GSE. We found GSE to be more efficacious than PLISSIT. Our findings recommend the integration of sexuality counseling and education into health care delivery before BC treatment and during BC post life rehabilitation.

Exercise Training and Breast Cancer-Related Lymphedema: A Systematic Review

Abstract Context: Despite the improvements thathavebeenmade intreatment of breast cancer, upper-limblymphedema is still anunsolved problemin the treatment of womenwith breast cancer. Upper extremity lymphedemamay accompanywith decreased in shoulder range of motion and strength, and also pain. Nowadays, exercise training acts as a treatment method to control lymphedema in breast cancer survivors. Therefore, this study reviews the resultsof the appliedstudies inthisfieldtosurvey the influencesof exercise training on lymphedema and to determine its related symptoms in women with breast cancer. Data Sources: Literature investigation was conducted on August 1st, 2016 using PUBMED, MEDLINE, CINAHL, and Google Scholar databases. StudySelection: RandomizedandnonrandomizedcontrolledtrialspublishedinEnglishwere included. Twelve trailsmet inclusion criteria. Data Extraction: Datawere extractedina standardizedmanner into thepredefinedtable. Then, quality of the studieswas evaluated using the guide to community preventive services tool. Conclusions: It can be seen that a few studies have examined the effect of exercise training on lymphedema to conduct a review study. So, lymphedema continues to be a problem for breast cancer survivors. According to most studies, aerobic, resistance and stretching training programs had no influence on the volume and circumference of armin lymphedema cancer patients, but the training had a noticeable influence on quality of life

Proses Koping Religius pada Wanita Dengan Kanker Payudara

The study’s main purpose was to describe how process religious coping in women with breast cancer. Religious coping is effort of someone with the involve religious elements for cope internal or extrenal pressure. Women with the breast cancer is women with growth of cells or tissues that are not controlled so that the growth of abnormal cells, rapid, and immortal. This study uses a phenomenological qualitative approach is to understand the experiences realized by the respondent in the process of religious coping were carried along with the influence of religious coping and the factors that affect the process of religious coping. Collecting data using interview and observation techniques. Respondents in this study were three women diagnosed with breast cancer. Respondents were drawn based on the criteria in this study. The results showed that religious coping has an important role for respondents in the face of breast cancer or in everyday life. The process of religious coping in this study were divided into 4 phases which religious coping in phase symptoms, diagnosis phase, treatment phase and the phase of meaning to the illness. Religious coping performed by respondents that appear in every phase although there are also some religious coping that do not appear again in another phase. Religious coping that have appeared in the diagnosis phase to the treatment phase is the phase of prayer and ibadah (tahajud prayer and dhikr), while the phase of meaning to pain that pain is a trial / test from God. The influence is felt by religious coping is tranquility, relief, satisfaction, pleasure in ibadah, uncontrolled emotions and thoughts, and feel easy in many ways. Some of the factors that affect religious coping is the influence (education / learning) of those closest (parents, husbands, teachers of religion), appreciation of life experiences, appreciation and experience of religious activities and ibadah and culture.

The Effects of Breast Health Education in Women with Breast Cancer

Background/Objectives: In this study, we investigated effects of breast health education on knowledge, self-efficacy, resilience, and meaning and purpose in life of women with breast cancer (WWBC) in Korea. Methods/Statistical analysis: A total of 41 participants joined the study. A breast health education was provided for 24 hours over the course of two weeks to the treatment group in 2014. Data were collected using self-reported questionnaires and analyzed using SPSS 22. Gamma generalized linear model with log link was used to analyze between-group differences. Findings: The participants' mean (SD) age was 51.56(5.37), and 46.3% of them had stage II breast cancer. The baseline homogeneity was found in all variables except education, employment, and meaning and purpose in life before the education program. After breast health education, the levels of knowledge, self-efficacy, resilience, and meaning and purpose in life of the treatment group increased significantly compared with those of the control group (p<0.01).The scores of knowledge & self-efficacy about breast cancer and breast self-examination (BSE), resilience, and meaning and purpose of life in the treatment group were 33.2%, 49.4%, 30.8%, 10.7% higher than those in the control group respectively. The breast health education was helpful improving knowledge and self-efficacy regarding breast cancer and BSE, resilience, and meaning and purpose in life. This study highlights that narratives of WWBC in addition to self-efficacy theory can be integrated to develop effective nursing intervention for empowerment of WWBC. Improvements/Applications: We recommend oncology professionals utilize this education program for WWBC. Further studies need to be conducted to determine whether similar programs would be effective for people with other disease.

Abstract P5-01-11: PEM tests will have a high accuracy detecting breast cancer, if an individualized dosage of F-18-FDG is used

Abstract Introduction: The diagnostic performance of the first European PEM (PET mammography) is based on individualized dosage of FDG evaluated in 108 females with 166 suspected breast lesions. Methods: PEM imaging of the breast was performed in 108 consecutive females with 166 suspicious breast lesions or known breast cancer (BC) 90 min after i.v. application of 3.5 MBq/kg F-18-FDG per kg body weight. The maximum PEM uptake value (PUV) was derived from a ROI around the target lesion and was correlated with a corresponding non-target ROI in the contra lateral healthy breast to determine the target/non-target ratio (PUV-ratio). Images were analyzed by 2 experienced readers independently as compared to histopathology in all cases. The between group analyses for all malignant, benign and corresponding non-target lesions were calculated by paired Student t-Test. The mean target/non-target ratio in patients with BC compared to healthy patients was calculated by independent Student t-Test. Significance level was considered at p value &amp;lt;0.05. Receiver operating characteristic (ROC) analyses were employed to determine associations with PUV and PUV-ratio. Results: A total of 27 out of 166 (16.2%) lesions were malignant. Mean of PUV was estimated to be 3.9±2.5 in malignant lesions and 1.2±0.4 for the contra-lateral healthy breast (p&amp;lt;0.001). The mean PUV-ratio in patients with BC of 3.4±1.5 was significantly higher as compared to benign lesions 1.2±0.3 (p&amp;lt;0.001). The area under the ROC curve was 0.997 (0.000-1.000) for PUV and 0.986 (0.965-1.000) for PUV-ratio. PEM was true-positive in 27 cases of cancers and false positive in 3 cases (papilloma, mastopathia bds.) considering a PUVmax &amp;gt; 1,9, resulting in sensitivity of 100%, specificity of 97%, positive predictive value of 90%, and a negative predictive value of 100%. Conclusion: The different European approach in PEM using personalized FDG-dosage enables the comparability of FDG-metabolism in patients, resulting in a high diagnostic accuracy of PEM tests. Literature: 1. Hentschel M. et al. Can body volume be determined by PET? Eur J Nucl Med Mol Imaging 32:564–568 (2005) 2. Berg W., et al. Comparative Effectiveness of PEM and MRI for Presurgical Planning of the Ipsilateral Breast in Women with Breast Cancer. Radiology 1:258 (2011) 3. Narayanan D, Madsen KS, Kalinyak JE, Berg WA. Am J Roentgenol. 196:971-81(2011) 4. Kalinyak, JE et al, PET guided breast biopsy. Breast J. 17:143-151(2011) 5. Caldarella C. et al., Diagnostic Performance of Dedicated Positron Emission Mammography Using Fluorine-18- Fluorodeoxyglucose in Women With Suspicious Breast Lesions: A Meta-analysis. Clinical Breast Cancer: in Press. Citation Format: Frank HH Müller, Hentschel Michael, Anton G Müller, Jamshid Farahati. PEM tests will have a high accuracy detecting breast cancer, if an individualized dosage of F-18-FDG is used [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 P5-01-11.

Social participation of women with breast cancer.

The general problems of persons with malignant diseases (stages of asthenia, chronic fatigue and exhaustion, followed by depression and anxiety) lead to a decrease in functional abilities and a declining quality of life. The aim of this study was to determine the level of difficulty, the type of required assistance and the level of satisfaction that derives from maintaining life habits. The study also examined the correlation between the level of accomplishment of life habits and the level of satisfaction with how they are maintained. The research was conducted at the Military Medical Academy in Belgrade and in the "Get Together" Association of Women with Breast Cancer from June to September 2012 on a sample of 30 women. A standardised questionnaire, Assessment of Life Habits-LIFE-H v.3.0, was administered. The lowest level of maintaining normal activities was related to education, housing and recreation. The greatest need for support to maintain normal activities was in the domains of housing, interpersonal relationships and employment The greatest satisfaction in the accomplishment of normal activities was observed in the domains of mobility, nutrition and housing, and the lowest level of satisfaction was in the domains of recreation, communication and interpersonal relationships. The correlation between the level of accomplishment of normal activities and the level of satisfaction was the highest in the domains of general physical activity, responsibility and life in a community; the lowest level was in the domains of personal hygiene, housing, mobility, employment and recreation (p < 0.001). The results indicate that research participants found it more difficult to maintain their social activities than their everyday activities. This clearly indicates the necessity to develop and implement special advisory and educational programs aimed at preventing social exclusion and to strengthen and support personal resources in the area of the social roles of women with breast cancer.

Relationship Between Sleep Quality and Spiritual Well-Being/Religious Activities in Muslim Women with Breast Cancer.

For determining relationship between quality of sleep and spiritual well-being/religious activities in Muslim women with breast cancer (WBC), we conducted a cross-sectional study on 80 WBC who presented at all chemotherapy clinics in Qom, Iran, in 2012. We used Pittsburgh Sleep Quality Index (PSQI), spiritual well-being scale (SWBS), and religious activities (RA) questionnaire. Global PSQI score and its seven components score were not significantly correlated with total score of SWBS and its two subscales. Global PSQI score was not significantly correlated with total score of RA questionnaire (P = 0.278), but its "sleep latency" (r = 0.235, P = 0.044) and "use of sleep medications" (r = 0.237, P = 0.040) components were significantly correlated with total score of RA. Global PSQI was significantly correlated with "I don't get much personal strength and support from my God," "I believe there is some real purpose for my life" questions in SWBS, and "Attendance in mosque or religious places" subscale of RA.

Trends in Female Breast Cancer Mortality in Urban Centers and Rural Regions of Brazil

BACKGROUND: Social and regional inequalities in Brazil such as delayed diagnosis and a healthcare system with technological limitations hamper the access of socioeconomically deprived women with breast cancer to treatment. Women living in urban centers are known to have a more favorable socioeconomic status and better access to medical and hospital care compared to those living in rural areas. In addition, the coverage of death registration is wider in urban areas. Nevertheless, few studies have been conducted to compare breast cancer mortality in urban centers and rural regions of Brazil. AIMS: To provide a comprehensive picture of mortality trends in female breast cancer in urban centers and rural regions of Brazil. METHODS: This was an ecological study of a temporal series, using mortality database (SIM/WHO) and demographic database (IBGE/WHO). An analysis of the mortality trends between 1980 and 2010 was performed using Poisson regression model. RESULTS: Breast cancer mortality was found to be 3 times lower in rural areas compared to urban areas throughout the entire evaluation period. A declining trend in mortality was found in some urban centers: Porto Alegre (-1.6%; 95%CI: -2.4 to -0.7; p<0.01); Rio de Janeiro (-0.9%; -1.4 to -0.4; p<0.01); Sao Paulo (-1.7%; -2.6 to -0.9; p<0.01); Belo Horizonte (-1.2%; -2.0 to -0.4; p=0.01) and Recife (-0.9%; -1.7 to -0.1; p=0.03). However, increases were found in other urban centers: Fortaleza (0.5%; 95%CI: 0.1–0.9; p=0.02), Belem (0.8%; 0.2–1.5; p=0.01), Joao Pessoa (1.6%; 0.7–2.6; p<0.01), Teresina (4.6%; 1.2–8.2; p=0.01) and Porto Velho (9.0%; 3.8–14.6; p<0.01). A reduction occurred in rural areas of the state of Sao Paulo (-2.8%; 95%CI: -4.4 to -1.3; p<0.01). However, increases were found in most other rural areas in all the different states of the country, the worst being in Maranhao (17.6%; 95%CI: 9.2–26.7; p<0.01), Paraiba (14.5%; 10.0–19.2; p<0.01), Piaui (10.0%; 8.1–13.7; p<0.01) and Alagoas (10.8%; 7.1–14.6; p<0.01). DISCUSSION: In the period between 1980 and 2010, considerable differences were found in mortality from breast cancer in the urban and rural regions of Brazil. These findings coincide with the socioeconomic inequalities that are prevalent in this country. Mortality rates are higher in the urban centers despite the fact that this is exactly where specialized healthcare is more readily available. No conclusions can be reached concerning the access of these women to diagnosis and treatment, since the coverage of death registration is heterogeneous in the different areas of the country. CONCLUSION: Reductions were found in female breast cancer mortality in five urban centers in Brazil, while increases incurred in most rural areas with the exception of some regions in the south of the country. One of the reasons for this disparity may be the lower access to treatment among patients living in rural areas.

The caregiver effect on treatment decisions for the elderly

The proper management of the axilla in all patients with breast cancer has been an area of active investigation. Although involvement of the axillary nodes remains an important prognostic factor, the approach to gathering this information has changed dramatically. Axillary lymph node dissection (ALND), long a standard component of the management of early stage breast cancer, remains the standard approach only for patients with clinically palpable axillary nodes or many positive axillary nodes confirmed by sampling techniques. For women with early stage breast cancer with a clinically negative axilla, ALND is no longer a routine part of the surgical treatment of breast cancer, having been replaced with the less invasive sentinel lymph node biopsy (SLNB). In patients with clinically node negative breast cancer, SLNB identifies patients without axillary node involvement, sparing them themorbidity of ALND. Several studies have shown that SLNB is associatedwith lower rates of armmorbidity, including lymphedema, sensory loss, and range of motion deficits when compared to a standard ALND. Older womenwith breast cancer should stand to particularly benefit from this therapeutic shift. Breast cancer is the most common cancer among older women, and nearly one half of new cases of female breast cancer in the United States are diagnosed in women age 65 or older. Some data suggest that older women may suffer from greater arm morbidity following ALND than younger women, particularly if they have preexisting arthritis, a common age-related condition. Older women tolerate SLNB well, and it is associated with lower rates of arm morbidity than ALND. SLNB may be particularly