Mammographic density and breast cancer risk in breast screening assessment cases and women with a family history of breast cancer.

Mammographic density and breast cancer risk in breast screening assessment cases and women with a family history of breast cancer.

Author(s) Duffy, Stephen W; Morrish, Oliver W E; Allgood, Prue C; Black, Richard; Gillan, Maureen G C; Willsher, Paula; Cooke, Julie; Duncan, Karen A; Michell, Michael J; Dobson, Hilary M; Maroni, Roberta; Lim, Yit Y; Purushothaman, Hema N; Suaris, Tamara; Astley, Susan M; Young, Kenneth C; Tucker, Lorraine; Gilbert, Fiona J

Source European journal of cancer (Oxford, England : 1990); Jan 2018; vol. 88 ; p. 48-56

Publication Date Jan 2018

Place of Publication England

DOI 10.1016/j.ejca.2017.10.022

Accession Number 29190506

ISSN 1879-0852

PubMed ID 29190506

Publication Type(s) Journal Article

Database Medline

Abstract

BACKGROUNDMammographic density has been shown to be a strong independent predictor of breast cancer and a causative factor in reducing the sensitivity of mammography. There remain questions as to the use of mammographic density information in the context of screening and risk management, and of the association with cancer in populations known to be at increased risk of breast cancer.AIMTo assess the association of breast density with presence of cancer by measuring mammographic density visually as a percentage, and with two automated volumetric methods, Quantra™ and VolparaDensity™.METHODSThe TOMosynthesis with digital MammographY (TOMMY) study of digital breast tomosynthesis in the Breast Screening Programme of the National Health Service (NHS) of the United Kingdom (UK) included 6020 breast screening assessment cases (of whom 1158 had breast cancer) and 1040 screened women with a family history of breast cancer (of whom two had breast cancer). We assessed the association of each measure with breast cancer risk in these populations at enhanced risk, using logistic regression adjusted for age and total breast volume as a surrogate for body mass index (BMI).RESULTSAll density measures showed a positive association with presence of cancer and all declined with age. The strongest effect was seen with Volpara absolute density, with a significant 3% (95% CI 1-5%) increase in risk per 10 cm3 of dense tissue. The effect of Volpara volumetric density on risk was stronger for large and grade 3 tumours.CONCLUSIONSAutomated absolute breast density is a predictor of breast cancer risk in populations at enhanced risk due to either positive mammographic findings or family history. In the screening context, density could be a trigger for more intensive imaging.

Top ten concerns burdening people with cancer: Perceptions of patients with cancer and the nurses caring for them.

Top ten concerns burdening people with cancer: Perceptions of patients with cancer and the nurses caring for them.
Author(s) Mitchell, Keith S J; Delfont, Sarah; Bracey, Maria Lucinda; Endacott, Ruth

Source European journal of oncology nursing : the official journal of European Oncology Nursing Society; Apr 2018; vol. 33 ; p. 102-106

Publication Date Apr 2018
DOI 10.1016/j.ejon.2018.02.004
ISSN 1532-2122
Database Medline

PURPOSEWe examined the concerns that nurses perceive patients to have, whether these are congruent with patients' concerns and whether they vary according to cancer site. We also examined Distress Thermometer scores according to cancer site.METHODA cross-sectional survey design: (i) secondary analysis of an existing Holistic Needs Assessment (HNA) and Distress Thermometer (DT) dataset was used, (ii) a survey of specialist nurse teams to identify their perceptions of patient concerns. Data collected between January 2015 and June 2016 from the HNA database from one NHS Trust in England (n = 1233 patients). Specialist nurse teams for breast, colorectal, gynaecology, skin and urology cancers identified the concerns that they perceived their patients would report.RESULTSThe HNA showed high internal consistency (Cronbach's alpha 0.86). Across the five cancer sites, nurses identified between 3 and 6 of the top ten concerns (TTC) expressed by patients, with wide variation across cancer sites. Nine of the TTC were significantly associated (p < 0.05) with a specific cancer site. The breast and gynaecological cancer groups both recorded significantly higher median Distress Thermometer scores than the urology, skin and colorectal cancer groups (Kruskall-Wallis χ2 (4, n = 1228) 186.695, p=<.01).CONCLUSIONSOne of the aims of the eHNA is to enable service delivery appropriate to patient needs. Our findings suggest that this will only be achieved if eHNA is examined, and services developed, by individual cancer site. The misconception of patient needs by specialist nurses underscores the importance of review of information provided by patients during consultations.

Depression, Antidepressant Use, and Breast Cancer Risk in Pre- and Postmenopausal Women: A Prospective Cohort Study.

Depression, Antidepressant Use, and Breast Cancer Risk in Pre- and Postmenopausal Women: A Prospective Cohort Study.

Author(s) Reeves, Katherine W; Okereke, Olivia I; Qian, Jing; Tamimi, Rulla M; Eliassen, A Heather et al.

Source Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology; Mar 2018; vol. 27 (no. 3); p. 306-314

Publication Date Mar 2018

DOI 10.1158/1055-9965.EPI-17-0707

ISSN 1538-7755

Database Medline

Background: Depression and antidepressant use is highly prevalent among U.S. women and may be related to increased breast cancer risk. However, prior studies are not in agreement regarding an increase in risk.Methods: We conducted a prospective cohort study within the Nurses' Health Study (NHS) and NHSII among females age 25 and older. Over more than 10 years of follow-up in each cohort, 4,014 incident invasive breast cancers were diagnosed. We used Cox proportional hazards regressions with updating of exposures and covariates throughout follow-up to estimate HRs and 95% confidence intervals (CIs) for associations between clinical depression and antidepressant use with invasive breast cancer risk. Analyses were repeated separately for in situ disease, as well as stratified by estrogen receptor (ER) subtype and menopausal status at diagnosis.Results: No statistically significant associations were observed between clinical depression (HR for reporting ≥3 times vs. 0, 1.13; 95% CI, 0.85-1.49) or antidepressant use (HR for reporting ≥3 times vs. 0, 0.92; 95% CI, 0.80-1.05) and invasive breast cancer risk in multivariable analyses. Likewise, we observed no significant associations between clinical depression or antidepressant use and risk of in situ, ER+, ER-, premenopausal, or postmenopausal breast cancer.Conclusions: In the largest prospective study to date, we find no evidence that either depression or antidepressant use increase risk of breast cancer.Impact: The results of this study are reassuring in that neither depression nor antidepressant use appear to be related to subsequent breast cancer risk. Cancer Epidemiol Biomarkers Prev; 27(3); 306-14. ©2017 AACR.

Neoadjuvant chemotherapy for early breast cancer

Title: Neoadjuvant chemotherapy for early breast cancer

Author: Petros Charalampoudis and Andreas Karakatsanis

Publication: The Lancet (Oncology)  

Volume 19, No. 3, e128, March 2018

Abstract: 

The pivotal meta-analysis1 by the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) provides high-quality data on the concept of risk-adapted breast-conserving therapy. The investigators showed equivalent survival in patients treated with the same chemotherapy before or after surgery, with a significantly higher frequency of local recurrence in patients receiving neoadjuvant chemotherapy (NACT) compared with the adjuvant group. This difference in local recurrence was not accompanied by a decrease in survival.

(See also the associated correspondence on the right hand menu)

Where Do We Look? Assessing Gaze Patterns in Breast Reconstructive Surgery with Eye-Tracking Technology

Title: Where Do We Look? Assessing Gaze Patterns in Breast Reconstructive Surgery with Eye-Tracking Technology

Author: Cai, Lawrence Z. B.S.; Paro, John A. M. M.D.; Lee, Gordon K. M.D.; Nazerali, Rahim S. M.D.

Publication: Plastic and Reconstructive Surgery: March 2018 - Volume 141 - Issue 3 - p 331e–340e

Abstract: 

Background: Aesthetics plays a large role in determining a successful outcome in plastic and reconstructive surgery. As such, understanding perceptions of favorable aesthetics is crucial for optimizing patient satisfaction. Eye-tracking technology offers an unbiased way of measuring how viewers evaluate breast reconstructions.

Methods: Twenty-nine raters with varied plastic surgery experience were shown 20 images of breast reconstruction at various stages. Breasts were divided into those with nipples and no reconstruction scars, those with nipples and reconstruction scars, and those with reconstruction scars and no nipples. Raters viewed each image for 8 seconds to evaluate aesthetic outcomes. Eye-tracking equipment and software were used to track raters’ gaze and analyze the distribution of attention.

Results: In breasts with reconstruction scars and no nipples, viewers spent 53.9 percent of the view time examining scars, whereas viewers’ attention was divided evenly in breasts with both reconstruction scars and nipples, spending 27.5 percent and 27.7 percent of view time examining the nipples and reconstruction scars, respectively. When examining complete reconstructions, viewers spent more time scanning the entire image before fixating on scars and spent less time on single-site fixation.

Conclusions: Complete reconstructions, which notably include the final nipple-areola complex, appear to play an important role in restoring normal viewing parameters. In essence, completed breast reconstructions with nipple-areola complexes divert attention from extraneous surgical scars and lead viewers to assess the breasts more holistically. Eye-tracking technology provides a powerful link between objective gaze and viewer attention that may potentially be used to predict subjective aesthetic preferences.

Is the Right Research Being Conducted to Advance Knowledge about Breast Reconstruction? An Analysis of the Research Pipeline

Title: Is the Right Research Being Conducted to Advance Knowledge about Breast Reconstruction? An Analysis of the Research Pipeline

Author: Checketts, Jake X. B.S.; Gordon, Joshua D.O.; Crawford, Julia H. M.L.I.S., A.H.I.P.; Adams, Haley D.O.; Duckett, Laurie D.O.; Vassar, Matt Ph.D.

Publication: Plastic and Reconstructive Surgery: March 2018 - Volume 141 - Issue 3 - p 566–577

Abstract:

Background: Capsular contracture around breast implants is a severe and unpredictable complication experienced by up to 50 percent of patients after breast augmentation and reconstruction, and represents a major cause leading to reoperation. Several lines of evidence point to the involvement of subclinical infections and of bacterial biofilm formation.

Methods: To reduce the incidence of capsular contracture following mammaplasty, the authors studied the correlation between contamination by exogenous and endogenous bacterial flora and the capacity to develop bacterial biofilm in mammary implants. The authors performed a microbiological study assessing microbial growth of swabs from breast skin, nipple-areola complex, and mammary gland biopsy specimens. Furthermore, the authors compared the results with the data resulting from cultural experiments from biopsy specimens of periprosthetic capsule, contracted or not, and from the surfaces of the relative prosthesis.

Results: Between July of 2012 and July of 2013, a series of 65 female patients from the area of Naples, Italy, and its province, who underwent breast plastic surgery with the use of implants for aesthetic or reconstructive reasons, were included in the study. The authors noticed that there is a greater tendency for capsular contracture to form in oncologic patients who received radiotherapy, patients with precedent capsular contracture, and patients with cutaneous contamination by biofilm-producing microbes.

Conclusions: Although all of the new technical procedures tend to reduce the amount of bacterial charge that comes into contact with the prosthesis at the time of its introduction, a minimal amount must always be taken for granted. This is the rationale for a preventative personalized antibiotic therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

P2 Importance of breast tumour margins and how to measure them effectively

Author: 

C.M. Saunders

Correspondence information about the author C.M. Saunders, 

L. Watts

, 

W.M. Allen

, 

K.M. Kennedy

, 

Q. Fang

, 

L. Chin

, 

A. Curatolo

, 

R. Zilkens

, 

S.L. Chin

, 

B.F. Dessauvagie

, 

B. Latham

, 

B. Kennedy

Medical School, The University of Western Australia, Perth, WA, Australia

Publication: Australasian Society for Breast Disease 11th Scientific Meeting 5-7 October 2017

Abstract: : In Australia, around 70% of women with early breast cancer undergo breast-conserving surgery either as a primary procedure or after neoadjuvant systemic therapy. It is important to ensure that all tumour is removed during surgery, including all microscopic disease. Residual cancer can increase local recurrence risk (1). Therefore, women who have positive surgical margins are generally advised to undergo re-excision or mastectomy. Currently, 2030% of patients undergoing breast-conserving surgery require additional surgery for positive margins, increasing risk of wound infection, delay of adjuvant treatment, increased anxiety and poor cosmetic outcomes (1).