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Zhang Z, Wu H, Shen C, Zhou F. Comprehensive Characterization of Immune Cell Infiltration Characteristics and Drug Sensitivity Analysis in Inflammatory Breast Cancer Based on Bioinformatic Strategy. Biochem Genet 2024; 62:1021-1039. [PMID: 37517031 DOI: 10.1007/s10528-023-10460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
Inflammatory breast cancer (IBC) is a rare and highly invasive form of breast cancer, renowned for its aggressive behavior, malignant capacity, and unfavorable prognosis. Despite considerable advancements in comprehending the underlying biology of IBC, the immune cell infiltration (ICI) profile in IBC remains inadequately elucidated. The current work endeavors to investigate the ICI characteristics of IBC and ascertain the pivotal immune cell subtypes and genes that impact its prognosis. The present study employed microarray data from the GEO database to demonstrate that IBC exhibited a lower abundance of activated mast cells (AMC) in comparison to non-inflammatory breast cancer (nIBC) or normal breast tissue (NBT). Additionally, the mRNA expression level of the gene polo-like kinase 5 (PLK5), which was correlated with AMC, was found to be lower in IBC relative to nIBC or NBT. Furthermore, this investigation provided compelling evidence indicating a potential association between a decreased mRNA expression level of PLK5 and a shorter progression-free survival in patients with breast cancer. The gene set enrichment analysis performed on PLK5 revealed that the gene expression in IBC was closely associated with diverse immune functions and pathways. Besides, a negative correlation has been established between PLK5 mRNA expression level and a majority of immune checkpoint-related genes, thereby suggesting the potential suitability of immunotherapy treatment for IBC. In summary, this study offers valuable insights into the ICI profile of IBC and identifies potential target PLK5 for improving its clinical management.
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Affiliation(s)
- Zhengguang Zhang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Haitao Wu
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Cunsi Shen
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Fuqiong Zhou
- Central Laboratory, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, 210022, China.
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2
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Boussen H, Berrazaga Y, Sherif Kullab, Manai M, Berrada N, Mejri N, Siala I, Levine PH, Cristofanilli M. Inflammatory breast cancer: Epidemiologic data and therapeutic results. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2024; 384:1-23. [PMID: 38637094 DOI: 10.1016/bs.ircmb.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Since the early description more than a century ago, inflammatory breast cancer (IBC) remains an aggressive disease, with a different geographic repartition, with the highest ones incidence reported in the North of Africa (Tunisia, Algeria, Morocco, and Egypt), and the lowest incidence in Western countries (USA, Europe…). In this study, we reviewed the literature using the Surveillance, Epidemiology, and End Results (SEER) database compared to other published series. We observed that in the high incidence areas (North of Africa) when compared to "classical" breast cancer, IBC was associated to younger age (less than 50 years) with rapid evolution of signs and symptoms (in less than 3 up to 6 months), and more aggressive clinical and histopathological-molecular parameters, due to the predominance of triple-negative and HER2+ subtypes in around 60% of cases. An epidemiologic trend was observed in both high and low incidence areas since the eighties are towards reduction of IBC prevalence. Concerning Tunisia, in comparison with the historical series of the 1980s, the incidence decreased in part by applying more stringent diagnostic criteria but also probably due to a slight improvement of the socio-economic level (SEL). This trend was also observed in the US, due to the efforts of collaborative IBC groups from MD Anderson Cancer Center (MDACC), Duke and IBC patient advocacy groups. Therapeutic results are slightly better due to the standardization of a multidisciplinary approach and the use of combined primary chemotherapy and/or targeted therapies (especially in HER2 positive patients), followed by mastectomy plus radiotherapy. The 5-year overall and disease-free survival is at more than 60%, related to an IBC mortality decrease observed in the cohorts of patients treated in the last decade.
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Affiliation(s)
- Hamouda Boussen
- Department of Medical Oncology, University Hospital A Mami, Ariana, Tunis, Tunisia; Inflammatory breast cancer international consortium (IBC-IC), New York, NY, United States.
| | - Yosra Berrazaga
- Department of Medical Oncology, University Hospital A Mami, Ariana, Tunis, Tunisia
| | | | - Maroua Manai
- Inflammatory breast cancer international consortium (IBC-IC), New York, NY, United States; Laboratory of Transmission, Control and Immunobiology of Infections, LR11IPT02 (LTCII), Pasteur Institute of Tunis, 13, place Pasteur, BP74, 1002 Tunis-Belvédère, University of Tunis El Manar, Tunis, Tunisia; Department of Medicine, Hematology/Oncology division, Weill Cornell Medicine, New York, NY, United States
| | | | - Nesrine Mejri
- Department of Medical Oncology, University Hospital A Mami, Ariana, Tunis, Tunisia
| | | | - Paul H Levine
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Massimo Cristofanilli
- Inflammatory breast cancer international consortium (IBC-IC), New York, NY, United States; Department of Medicine, Hematology/Oncology division, Weill Cornell Medicine, New York, NY, United States
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3
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Johnson KC, Grimm M, Sukumar J, Schnell PM, Park KU, Stover DG, Jhawar SR, Gatti-Mays M, Wesolowski R, Williams N, Sardesai S, Pariser A, Sudheendra P, Tozbikian G, Ramaswamy B, Doto D, Cherian MA. Survival outcomes seen with neoadjuvant chemotherapy in the management of locally advanced inflammatory breast cancer (IBC) versus matched controls. Breast 2023; 72:103591. [PMID: 37871527 PMCID: PMC10598404 DOI: 10.1016/j.breast.2023.103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
Inflammatory breast cancer (IBC) poses an ongoing challenge as rates of disease recurrence and mortality remain high compared to stage-matched controls. However, frontline therapy has evolved through the years, including the widespread use of neoadjuvant chemotherapy (NAC) given the prognostic importance of pathologic complete response (pCR). Due to these sweeping changes, we need new data to assess current recurrence and survival outcomes for locally advanced IBC in the context of matched non-inflammatory controls. We conducted a retrospective analysis of institutional IBC data from 2010 to 2016 with the primary objective of comparing overall survival (OS), relapse-free survival (RFS), and distant relapse-free survival (DRFS). We matched IBC patients to non-inflammatory controls based on age, receptor status, tumor grade, clinical stage, and receipt of prior NAC. Secondary objectives included assessing pCR rates and identifying prognostic factors. Among NAC recipients, we observed similar pCR rates (47.6 % vs. 49.4 %, p = 0.88) between IBC (n = 84) and matched non-IBC (n = 81) cohorts. However, we noted a significant worsening of OS (p = 0.0001), RFS (p = 0.0001), and DRFS (p = 0.001) in the IBC group. Specifically, 5-year OS in the IBC cohort was 58.9 % vs. 86.7 % for matched controls (p = 0.0003). Older age was a weak negative predictor for OS (HR 1.03, p = 0.001) and RFS (HR 1.02, p = 0.01). For DRFS, older age was also a weak negative predictor (HR 1.02, p = 0.02), whereas the use of NAC was a positive predictor (HR 0.47, p = 0.02). Despite no clear difference in pCR, survival outcomes remain poor for IBC compared to matched non-inflammatory controls.
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Affiliation(s)
- Kai Cc Johnson
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Michael Grimm
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Jasmine Sukumar
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Patrick M Schnell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ko Un Park
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Daniel G Stover
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Sachin R Jhawar
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Margaret Gatti-Mays
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Robert Wesolowski
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Nicole Williams
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Sagar Sardesai
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ashley Pariser
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Preeti Sudheendra
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Gary Tozbikian
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Bhuvaneswari Ramaswamy
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Dureti Doto
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Mathew A Cherian
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
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Devi GR, Fish LJ, Bennion A, Sawin GE, Weaver SM, Reddy K, Saincher R, Tran AN. Identification of barriers at the primary care provider level to improve inflammatory breast cancer diagnosis and management. Prev Med Rep 2023; 36:102519. [PMID: 38116289 PMCID: PMC10728446 DOI: 10.1016/j.pmedr.2023.102519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
The purpose of this study, based in the United States, was to evaluate knowledge gaps and barriers related to diagnosis and care of inflammatory breast cancer (IBC), a rare but lethal breast cancer subtype, amongst Primary Care Providers (PCP) as they are often the first point of contact when patients notice initial symptoms. PCP participants in the Duke University Health System, federally qualified health center, corporate employee health and community practices, nearby academic medical center, Duke physician assistant and advanced practice nurse leadership program alumni were first selected in a convenience sample and for semi-structured interviews (n = 11). Based on these data, an online survey tool was developed and disseminated (n = 78) to assess salient measures of IBC diagnosis, health disparity factors, referral and care coordination practices, COVID-19 impact, and continuing medical education (CME). PCP reported access to care and knowledge gaps in symptom recognition (mean = 3.3, range 1-7) as major barriers. Only 31 % reported ever suspecting IBC in a patient. PCP (n = 49) responded being challenged with referral delays in diagnostic imaging. Additionally, since the COVID-19 pandemic started, 63 % reported breast cancer referral delays, and 33 % reported diagnosing less breast cancer. PCP stated interest in CME in their practice for improved diagnosis and patient care, which included online (53 %), lunch time or other in-service training (33 %), patient and provider-facing websites (32 %). Challenges communicating rare cancer information, gaps in confidence in diagnosing IBC, and timely follow-up with patients and specialists underscores the need for developing PCP educational modules to improve guideline-concordant care.
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Affiliation(s)
- Gayathri R. Devi
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
| | - Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA
| | - Alexandra Bennion
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
- Trinity School of Arts and Sciences, Duke University, 2606 DUMC, Durham, NC 27710, USA
| | - Gregory E. Sawin
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA
| | - Sarah M. Weaver
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
| | - Katherine Reddy
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
- Trinity School of Arts and Sciences, Duke University, 2606 DUMC, Durham, NC 27710, USA
| | - Rashmi Saincher
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA
| | - Anh N. Tran
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA
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Balema W, Morton J, Larson RA, Li L, Velasquez FC, Fowlkes NW, Krishnamurthy S, Debeb BG, Sevick-Muraca E, Woodward WA. High-fat diet, but not duration of lactation, increases mammary gland lymphatic vessel function and subsequent growth of inflammatory breast cancer cells. J Mammary Gland Biol Neoplasia 2023; 28:21. [PMID: 37801190 PMCID: PMC10558390 DOI: 10.1007/s10911-023-09548-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/09/2023] [Indexed: 10/07/2023] Open
Abstract
Inflammatory breast cancer (IBC) presents as rapid-onset swelling and breast skin changes caused by tumor emboli in the breast and breast skin lymphatics. IBC has been linked with obesity and duration of breastfeeding, but how these factors affect IBC tumor progression is not clear. We modeled the simultaneous effects of diet and weaning in mice on in vivo lymphatic function; on IBC tumor growth; and on aspects of the mammary gland microenvironment before and after IBC (SUM149) xenograft inoculation. We hypothesized that weaning status and diet would have synergistic effects on lymphatic function and the breast microenvironment to enhance IBC tumor growth. Changes in lymphatic structure and function were characterized with in vivo near-infrared fluorescence (NIRF) imaging. Mice were fed either a high-fat diet (HFD; 60 kcal%) or a normal/low-fat diet (LFD; 10 kcal%), bred twice, and subjected to either normal-duration nursing (NW) or forced weaning (FW). SUM149 IBC tumors were implanted at 14 months; images were obtained before and after implantation. Multiparous mice fed HFD showed increased pre-tumor lymphatic pulsing in both the FW and NW groups relative to mice fed LFD. HFD promoted tumor growth independent of weaning time (P = 0.04). Pre-tumor lymphatic pulsing was associated with tumor volume at 8 weeks (P = 0.02) and was significantly correlated with expression of the lymphatic tracking ligand CCL21 (P = 0.05, Table 1). HFD significantly increased the numbers of monocyte-derived IBA1+, CD163+, and CD11c+ cells (P < 0.0001, P < 0.0001, P = 0.0005) in the contralateral, non-tumor-bearing mammary gland. Numbers of lymphangiogenic podoplanin+/IBA1+ macrophages were increased in the ducts of HFD and FW mice (all P < 0.003). HFD in nulliparous mice had a similar increase in lymphatic pulsing at 14 weeks (P = 0.006), indicating that this functional change was independent of parity. We conclude that HFD induced increases in mammary gland lymphatic function, assessed as pulsing rate before tumor initiation, and correlated with inflammation in the mammary gland and increased SUM149 tumor growth. The relationship between diet, lymphatic pulsing, and tumor growth warrants further investigation.
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Affiliation(s)
- Wintana Balema
- MD Anderson UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The Morgan Welch IBC Clinic and Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janelle Morton
- The University of Texas Health Science Center, Institute of Molecular Imaging, Center for Molecular Imaging, Houston, TX, USA
| | - Richard A Larson
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The Morgan Welch IBC Clinic and Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Li Li
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The Morgan Welch IBC Clinic and Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fred Christian Velasquez
- The University of Texas Health Science Center, Institute of Molecular Imaging, Center for Molecular Imaging, Houston, TX, USA
| | - Natalie W Fowlkes
- Department of Veterinary Medicine and Surgery, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Savitri Krishnamurthy
- The Morgan Welch IBC Clinic and Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Pathology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Bisrat G Debeb
- The Morgan Welch IBC Clinic and Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eva Sevick-Muraca
- The University of Texas Health Science Center, Institute of Molecular Imaging, Center for Molecular Imaging, Houston, TX, USA
| | - Wendy A Woodward
- The Morgan Welch IBC Clinic and Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Breast Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX, USA.
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Rickard AG, Sannareddy DS, Bennion A, Patel P, Sauer SJ, Rouse DC, Bouchal S, Liu H, Dewhirst MW, Palmer GM, Devi GR. A Novel Preclinical Murine Model to Monitor Inflammatory Breast Cancer Tumor Growth and Lymphovascular Invasion. Cancers (Basel) 2023; 15:cancers15082261. [PMID: 37190189 DOI: 10.3390/cancers15082261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Abstract
Inflammatory breast cancer (IBC), an understudied and lethal breast cancer, is often misdiagnosed due to its unique presentation of diffuse tumor cell clusters in the skin and dermal lymphatics. Here, we describe a window chamber technique in combination with a novel transgenic mouse model that has red fluorescent lymphatics (ProxTom RFP Nu/Nu) to simulate IBC clinicopathological hallmarks. Various breast cancer cells stably transfected to express green or red fluorescent reporters were transplanted into mice bearing dorsal skinfold window chambers. Intravital fluorescence microscopy and the in vivo imaging system (IVIS) were used to serially quantify local tumor growth, motility, length density of lymph and blood vessels, and degree of tumor cell lymphatic invasion over 0-140 h. This short-term, longitudinal imaging time frame in studying transient or dynamic events of diffuse and collectively migrating tumor cells in the local environment and quantitative analysis of the tumor area, motility, and vessel characteristics can be expanded to investigate other cancer cell types exhibiting lymphovascular invasion, a key step in metastatic dissemination. It was found that these models were able to effectively track tumor cluster migration and dissemination, which is a hallmark of IBC clinically, and was recapitulated in these mouse models.
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Affiliation(s)
- Ashlyn G Rickard
- Program of Medical Physics, Duke University, Durham, NC 27705, USA
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Dorababu S Sannareddy
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Alexandra Bennion
- Trinity College of Arts and Sciences, Duke University, Durham, NC 27705, USA
| | - Pranalee Patel
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
- Trinity College of Arts and Sciences, Duke University, Durham, NC 27705, USA
| | - Scott J Sauer
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Douglas C Rouse
- Division of Laboratory Animal Resources, Duke University School of Medicine, Durham, NC 27710, USA
| | - Samantha Bouchal
- Trinity College of Arts and Sciences, Duke University, Durham, NC 27705, USA
| | - Harrison Liu
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Mark W Dewhirst
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Inflammatory Breast Cancer Consortium, Duke Cancer Institute, Durham, NC 27710, USA
| | - Gregory M Palmer
- Program of Medical Physics, Duke University, Durham, NC 27705, USA
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Inflammatory Breast Cancer Consortium, Duke Cancer Institute, Durham, NC 27710, USA
| | - Gayathri R Devi
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Inflammatory Breast Cancer Consortium, Duke Cancer Institute, Durham, NC 27710, USA
- Program in Cancer Risk, Detection, and Interception, Duke Cancer Institute, Durham, NC 27710, USA
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7
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Devi G, Fish L, Bennion A, Sawin G, Weaver S, Tran A. Assessing Knowledge and Barriers at the Primary Care Provider Level that Contribute to Disparities in Inflammatory Breast Cancer Diagnosis and Treatment. RESEARCH SQUARE 2022:rs.3.rs-2302308. [PMID: 36523410 PMCID: PMC9753779 DOI: 10.21203/rs.3.rs-2302308/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Purpose The purpose of this study was to evaluate knowledge gaps and barriers related to diagnosis and care of inflammatory breast cancer (IBC), a rare but most lethal breast cancer subtype, amongst Primary Care Providers (PCP) as they are often the first point of contact when patients notice initial symptoms. Methods PCP participants within Duke University Health System, federally qualified health center, corporate employee health and community practices, nearby academic medical center, Duke physician assistant, and nurse leadership program alumni were first selected in a convenience sample (n=11) for semi-structured interviews (n=11). Based on these data, an online survey tool was developed and disseminated (n=78) to assess salient measures of IBC diagnosis, health disparity factors, referral and care coordination practices, COVID impact, and continued medical education (CME). Results PCP reported access to care and knowledge gaps in symptom recognition (mean = 3.3, range 1-7) as major barriers. Only 31% reported ever suspecting IBC in a patient. PCP (n=49) responded being challenged with referral delays in diagnostic imaging. Additionally, since the COVID-19 pandemic started, 63% reported breast cancer referral delays, and 33% reported diagnosing less breast cancer. PCP stated interest in CME in their practice for improved diagnosis and patient care, which included online (53%), lunch time or other in-service training (33%), patient and provider-facing websites (32%). Conclusions Challenges communicating rare cancer information, gaps in confidence in diagnosing IBC, and timely follow-up with patients and specialists underscores the need for developing PCP educational modules to improve guideline-concordant care.
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Affiliation(s)
| | | | | | | | | | - Anh Tran
- Duke University School of Medicine
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