1
|
Cortina CS, Purdy A, Brazauskas R, Stachowiak SM, Fodrocy J, Klement KA, Sasor SE, Krucoff KB, Robertson K, Buth J, Lakatos AEB, Petroll AE, Doren EL. The Impact of a Breast Cancer Risk Assessment on the Decision for Gender-Affirming Chest Masculinization Surgery in Transgender and Gender-Diverse Individuals: A Pilot Single-Arm Educational Intervention Trial. Ann Surg Oncol 2024; 31:7474-7482. [PMID: 38940898 PMCID: PMC11452287 DOI: 10.1245/s10434-024-15701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Persons assigned female or intersex at birth and identify as transgender and/or gender-diverse (TGD) may undergo gender-affirming chest masculinization surgery (GACMS); however, GACMS is not considered equivalent to risk-reducing mastectomies (RRM). This study aimed to estimate the prevalence of elevated breast cancer (BC) risk in TGD persons, compare self-perceived versus calculated risk, and determine how risk impacts the decision for GACMS versus RRM. METHODS A prospective single-arm pilot educational intervention trial was conducted in individuals assigned female or intersex at birth, age ≥ 18 years, considering GACMS, without a BC history or a known pathogenic variant. BC risk was calculated using the Tyrer-Cuzik (all) and Gail models (age ≥ 35 years). Elevated risk was defined as ≥ 17%. RESULTS Twenty-five (N = 25) participants were enrolled with a median age of 24.0 years (interquartile range, IQR 20.0-30.0 years). All were assigned female sex at birth, most (84%) were Non-Hispanic (NH)-White, 48% identified as transgender and 40% as nonbinary, and 52% had a first- and/or second-degree family member with BC. Thirteen (52%) had elevated risk (prevalence 95% confidence interval (CI) 31.3-72.2%). Median self-perceived risk was 12% versus 17.5% calculated risk (p = 0.60). Of the 13 with elevated risk, 5 (38.5%) underwent/are scheduled to undergo GACMS, 3 (23%) of whom underwent/are undergoing RRM. CONCLUSIONS Over half of the cohort had elevated risk, and most of those who moved forward with surgery chose to undergo RRM. A BC risk assessment should be performed for TGD persons considering GACMS. Future work is needed to examine BC incidence and collect patient-reported outcomes. Trial Registration Number ClinicalTrials.gov (No. NCT06239766).
Collapse
Affiliation(s)
- Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA.
| | - Anna Purdy
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ruta Brazauskas
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Samantha M Stachowiak
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jessica Fodrocy
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kristen A Klement
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah E Sasor
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kate B Krucoff
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin Robertson
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Froedtert and the Medical College of Wisconsin's Inclusion Health Clinic, Milwaukee, WI, USA
| | - Jamie Buth
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Froedtert and the Medical College of Wisconsin's Inclusion Health Clinic, Milwaukee, WI, USA
| | - Annie E B Lakatos
- Froedtert and the Medical College of Wisconsin's Inclusion Health Clinic, Milwaukee, WI, USA
| | - Andrew E Petroll
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Froedtert and the Medical College of Wisconsin's Inclusion Health Clinic, Milwaukee, WI, USA
| | - Erin L Doren
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
2
|
Cheng O, Fiser C, Paysour J, Aluwalia R, Hilliard A, Arciero C, Farley CR, Jones J, Conyers J, Postlewait LM. Defining the Need for Services for Patients at High Risk of Breast Cancer at a Safety-Net Hospital: An Approach to Narrowing the Disparities Gap. Ann Surg Oncol 2024; 31:7570-7581. [PMID: 39138769 DOI: 10.1245/s10434-024-15789-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/25/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND The National Accreditation Program for Breast Cancer (NAPBC) standards were recently revised to promote breast cancer (BC) risk assessment and subsequent referral for high-risk services. This project sought to estimate the proportion of patients at high risk for BC in the authors' safety-net hospital system, gauge patient interest in high-risk services, and define resources for program development. METHODS Women presenting for breast imaging during 2 weeks in 2023 were surveyed. Thirty-five patients with a history or diagnosis of BC were excluded. The Tyrer-Cuzick (TC) model version 8 was used to calculate BC risk. High/intermediate risk was defined as a 10-year risk of 5% or more, a lifetime risk of 15% or more, or both. The criteria for genetic counseling and testing referral were based on National Comprehensive Cancer Network guidelines. RESULTS A total of 257 patients had a TC risk assessment showing 14.8% (n = 38) with a 10-year BC risk of 5% or more (consideration of endocrine therapy), 6.2% (n = 16) with a lifetime BC risk of 20% or more (qualifying for annual screening MRI), and 10.5% (n = 27) with a lifetime BC risk of 15% or more (consideration of high-risk screening). The criteria for genetic counseling/testing were met by 61 (23.7%) of the 257 patients. Overall, 31.5% (n = 81) qualified for high/intermediate-risk screening, risk reduction, and/or genetic assessment/testing, 92.8% of whom were interested in referrals for additional information and care. CONCLUSIONS In the authors' community, almost one third of patients undergoing breast imaging qualify for BC high-risk assessment and services. The majority of the patients expressed interest in pursuing such services. These data will be used in financial planning and resource allocation to develop a high-risk program at the authors' institution in line with NAPBC guidelines. They are hopeful that these efforts will improve oncologic outcomes and survival from BC in their community.
Collapse
Affiliation(s)
- Olivia Cheng
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Breast Cancer Program, Georgia Cancer Center for Excellence, Grady Health System, Atlanta, GA, USA
| | - Caroline Fiser
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Breast Cancer Program, Georgia Cancer Center for Excellence, Grady Health System, Atlanta, GA, USA
| | - Jamie Paysour
- Breast Cancer Program, Georgia Cancer Center for Excellence, Grady Health System, Atlanta, GA, USA
- Department of Human Genetics, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Ruchi Aluwalia
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - Aysia Hilliard
- Breast Cancer Program, Georgia Cancer Center for Excellence, Grady Health System, Atlanta, GA, USA
| | - Cletus Arciero
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Clara R Farley
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jade Jones
- Breast Cancer Program, Georgia Cancer Center for Excellence, Grady Health System, Atlanta, GA, USA
- Division of Medical Oncology, Department of Medicine, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jesse Conyers
- Breast Cancer Program, Georgia Cancer Center for Excellence, Grady Health System, Atlanta, GA, USA
- Division of Breast Imaging, Department of Radiology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Lauren M Postlewait
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
- Breast Cancer Program, Georgia Cancer Center for Excellence, Grady Health System, Atlanta, GA, USA.
| |
Collapse
|
3
|
Patil V, Ruterbusch JJ, Chen W, Boerner JL, Abdulfatah E, Alosh B, Pardeshi V, Shaik AN, Bandyopadhyay S, Ali-Fehmi R, Cote ML. Multiplicity of benign breast disease lesions and breast cancer risk in African American women. Front Oncol 2024; 14:1410819. [PMID: 38817898 PMCID: PMC11137188 DOI: 10.3389/fonc.2024.1410819] [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: 04/01/2024] [Accepted: 04/25/2024] [Indexed: 06/01/2024] Open
Abstract
The risk of developing subsequent breast cancer is higher in women diagnosed with benign breast disease (BBD) but these studies were primarily performed in non-Hispanic white populations. Still, these estimates have been used to inform breast cancer risk models that are being used clinically across all racial and ethnic groups. Given the high breast cancer mortality rates among African American (AA) women, it is critical to study BBD in this population, to ensure the risk models that include this information perform adequately. This study utilized data from AA women who underwent benign breast biopsies at a hospital served by the University Pathology Group in Detroit, Michigan, from 1998 to 2010. Patients were followed for subsequent breast cancers through the population-based Metropolitan Detroit Cancer Surveillance System (MDCSS). BBD lesion scores were assigned to represent the severity or extent of benign breast lesions, with higher scores indicating a greater number of distinct lesion types. Of 3,461 eligible AA women with BBD in the cohort, 6.88% (n=238) subsequently developed breast cancer. Examined individually, six of the eleven lesions (apocrine metaplasia, ductal hyperplasia, lobular hyperplasia, intraductal papilloma, sclerosing adenosis, columnar alterations and radial scars) were significantly associated with increased risk of breast cancer after adjustment for age and year of biopsy and were further considered in multiple lesion models. For every different type of benign breast lesion, subsequent risk of breast cancer increased by 25% (RR=1.25, 95% CI: 1.10, 1.42) after adjustment for age at biopsy and proliferative versus non-proliferative disease. In summary, this study affirms the increased breast cancer risk in AA women with BBD, particularly in those with multiple lesions. These findings have implications for the management of breast cancer risk in millions of women affected by BBD, a high risk group that could benefit from personalized surveillance and risk reduction strategies.
Collapse
Affiliation(s)
- Vidya Patil
- Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, United States
| | - Julie J. Ruterbusch
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Wei Chen
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Julie L. Boerner
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Eman Abdulfatah
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Baraa Alosh
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Visakha Pardeshi
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Asra N. Shaik
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Sudeshna Bandyopadhyay
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Rouba Ali-Fehmi
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Michele L. Cote
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States
| |
Collapse
|
4
|
Ahsan MD, Webster EM, Wolfe IA, McGonigle R, Brewer JT, Chandler IR, Weiss JM, Enriquez A, Cantillo E, Holcomb K, Chapman-Davis E, Blank SV, Sharaf RN, Frey MK. Personalized survivorship care: Routine breast cancer risk assessment in the gynecologic oncology clinic. Gynecol Oncol 2024; 183:47-52. [PMID: 38503141 DOI: 10.1016/j.ygyno.2024.03.004] [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: 01/29/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Gynecologic and breast cancers share several risk factors. Breast cancer risk assessment tools can identify those at elevated risk and allow for enhanced breast surveillance and chemoprevention, however such tools are underutilized. We aim to evaluate the use of routine breast cancer risk assessment in a gynecologic oncology clinic. METHODS A patient-facing web-based tool was used to collect personal and family history and run four validated breast cancer risk assessment models (Tyrer-Cuzick (TC), Gail, BRCAPRO, and Claus) in a gynecologic oncology clinic. We evaluated completion of the tools and identification of patients at elevated risk for breast cancer using the four validated models. RESULTS A total of 99 patients were included in this analysis. The BRCAPRO model had the highest completion rate (84.8%), followed by the TC model (74.7%), Gail model (74.7%), and the Claus model (52.1%). The TC model identified 21.6% of patients completing the model as having ≥20% lifetime risk of breast cancer, compared to 6.8% by the Gail model, and 0% for both the BRCAPRO and Claus models. The Gail model identified 52.5% of patients as having ≥1.67% 5-year risk of breast cancer. Among patients identified as high-risk for breast cancer and eligible for screening, 9/9 (100%) were referred to a high-risk breast clinic. CONCLUSION Among patients that completed the TC breast cancer risk assessment in a gynecologic oncology clinic, approximately 1 in 5 were identified to be at significantly elevated lifetime risk for breast cancer. The gynecologic oncologist's office might offer a convenient and feasible setting to incorporate this risk assessment into routine patient care, as gynecologic oncologists often have long-term patient relationships and participate in survivorship care.
Collapse
Affiliation(s)
| | - Emily M Webster
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Isabel A Wolfe
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Rylee McGonigle
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Jesse T Brewer
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | | | - Jessica M Weiss
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Allan Enriquez
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Evelyn Cantillo
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Kevin Holcomb
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | | | - Stephanie V Blank
- Icahn School of Medicine at Mount Sinai - 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Ravi N Sharaf
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States
| | - Melissa K Frey
- Weill Cornell Medicine - 1300 York Ave, New York, NY 10065, United States.
| |
Collapse
|
5
|
Wilkerson AD, Gentle CK, Ortega C, Al-Hilli Z. Disparities in Breast Cancer Care-How Factors Related to Prevention, Diagnosis, and Treatment Drive Inequity. Healthcare (Basel) 2024; 12:462. [PMID: 38391837 PMCID: PMC10887556 DOI: 10.3390/healthcare12040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Breast cancer survival has increased significantly over the last few decades due to more effective strategies for prevention and risk modification, advancements in imaging detection, screening, and multimodal treatment algorithms. However, many have observed disparities in benefits derived from such improvements across populations and demographic groups. This review summarizes published works that contextualize modern disparities in breast cancer prevention, diagnosis, and treatment and presents potential strategies for reducing disparities. We conducted searches for studies that directly investigated and/or reported disparities in breast cancer prevention, detection, or treatment. Demographic factors, social determinants of health, and inequitable healthcare delivery may impede the ability of individuals and communities to employ risk-mitigating behaviors and prevention strategies. The disparate access to quality screening and timely diagnosis experienced by various groups poses significant hurdles to optimal care and survival. Finally, barriers to access and inequitable healthcare delivery patterns reinforce inequitable application of standards of care. Cumulatively, these disparities underlie notable differences in the incidence, severity, and survival of breast cancers. Efforts toward mitigation will require collaborative approaches and partnerships between communities, governments, and healthcare organizations, which must be considered equal stakeholders in the fight for equity in breast cancer care and outcomes.
Collapse
Affiliation(s)
- Avia D Wilkerson
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Corey K Gentle
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Camila Ortega
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Breast Center, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| |
Collapse
|
6
|
Greenwood HI, Dodelzon K. Screening in Women With BRCA Mutations Revisited. JOURNAL OF BREAST IMAGING 2024; 6:4-13. [PMID: 38166173 DOI: 10.1093/jbi/wbad093] [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: 07/27/2023] [Indexed: 01/04/2024]
Abstract
Patients with BRCA1 or BRCA2 gene mutations are at high risk for the development of breast cancer. This article reviews the current evidence for breast cancer screening of patients with BRCA1 or BRCA2 pathogenic gene mutations if they have not undergone prophylactic mastectomy. It will review the current evidence-based imaging recommendations for different modalities and ages of screening initiation in screening this patient population at high risk. Special considerations in transgender BRCA1 and BRCA2 mutation carriers are also discussed.
Collapse
Affiliation(s)
- Heather I Greenwood
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Katerina Dodelzon
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
7
|
Zaluzec EK, Sempere LF. Systemic and Local Strategies for Primary Prevention of Breast Cancer. Cancers (Basel) 2024; 16:248. [PMID: 38254741 PMCID: PMC10814018 DOI: 10.3390/cancers16020248] [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: 10/23/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/24/2024] Open
Abstract
One in eight women will develop breast cancer in the US. For women with moderate (15-20%) to average (12.5%) risk of breast cancer, there are few options available for risk reduction. For high-risk (>20%) women, such as BRCA mutation carriers, primary prevention strategies are limited to evidence-based surgical removal of breasts and/or ovaries and anti-estrogen treatment. Despite their effectiveness in risk reduction, not many high-risk individuals opt for surgical or hormonal interventions due to severe side effects and potentially life-changing outcomes as key deterrents. Thus, better communication about the benefits of existing strategies and the development of new strategies with minimal side effects are needed to offer women adequate risk-reducing interventions. We extensively review and discuss innovative investigational strategies for primary prevention. Most of these investigational strategies are at the pre-clinical stage, but some are already being evaluated in clinical trials and others are expected to lead to first-in-human clinical trials within 5 years. Likely, these strategies would be initially tested in high-risk individuals but may be applicable to lower-risk women, if shown to decrease risk at a similar rate to existing strategies, but with minimal side effects.
Collapse
Affiliation(s)
- Erin K. Zaluzec
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA;
- Department of Pharmacology & Toxicology, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Lorenzo F. Sempere
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA;
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
| |
Collapse
|
8
|
Zoghbi KK, Felipe VC, Graziano L, Guatelli CS, de Souza JA, Bitencourt AGV. Analysis of the indications for and results of breast cancer screening by magnetic resonance imaging at a cancer center in Brazil. Radiol Bras 2024; 57:e20230111en. [PMID: 38993971 PMCID: PMC11235068 DOI: 10.1590/0100-3984.2023.0111-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 07/13/2024] Open
Abstract
Objective To evaluate the indications for and results of magnetic resonance imaging (MRI) examinations for breast cancer screening at a cancer center in Brazil. Materials and Methods This was a retrospective observational study, based on electronic medical records, of patients undergoing MRI for breast cancer screening at a cancer center in Brazil. Results We included 597 patients between 19 and 82 years of age. The main indications for MRI screening were a personal history of breast cancer, in 354 patients (59.3%), a family history of breast cancer, in 102 (17.1%), and a confirmed genetic mutation, in 67 (11.2%). The MRI result was classified, in accordance with the categories defined in the Breast Imaging Reporting and Data System, as benign (category 1 or 2), in 425 patients (71.2%), probably benign (category 3), in 143 (24.0%), or suspicious (category 4 or 5), in 29 (4.9%). On MRI, 11 malignant tumors were identified, all of which were invasive carcinomas. Among those 11 carcinomas, six (54.5%) were categorized as minimal cancers (< 1 cm), and the axillary lymph nodes were negative in 10 (90.9%). The cancer detection rate was 18.4/1,000 examinations, and the positive predictive value for suspicious lesions submitted to biopsy was 37.9%. Conclusion In our sample, the main indication for breast MRI screening was a personal history of breast cancer. The results indicate that MRI is a highly accurate method for the early detection of breast neoplasms in this population.
Collapse
Affiliation(s)
- Karina Kuhl Zoghbi
- Graduate Program, A.C.Camargo Cancer Center, São Paulo, SP,
Brazil
- Hospital Saúde da Mulher, Belém, PA, Brazil
| | | | - Luciana Graziano
- Department of Imaging, A.C.Camargo Cancer Center, São Paulo,
SP, Brazil
| | | | | | | |
Collapse
|
9
|
Carroll EF, Rogers C, Summerside M, Cortina CS. Breast care considerations for transgender and gender-diverse patients. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241289706. [PMID: 39382481 PMCID: PMC11465296 DOI: 10.1177/17455057241289706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 09/16/2024] [Accepted: 09/19/2024] [Indexed: 10/10/2024]
Abstract
Transgender and gender-diverse (TGD) persons represent a small but growing population in the United States. Accessing inclusive, equitable, and evidence-based healthcare remains a challenge for this patient population. Many TGD persons seek gender-affirming care, including gender-affirming hormonal therapy (GAHT) and gender-affirming surgery (GAS), to help ameliorate the physical and mental aspects of their gender incongruence. Both GAHT and GAS induce clinically important histopathologic and anatomic changes in breast tissue. Consequently, breast care in TGD persons has become an increasingly recognized topic of importance in gender-affirming care. However, there remains a scarce but growing base of literature specifically addressing the unique healthcare needs of breast care in TGD patients. This article will review how to establish trusting patient-provider relationships for TGD patients, gender inclusivity in breast clinics and imaging centers, the influence of GAHT and GAS on breast tissue, breast cancer screening recommendations and barriers, and breast cancer risk and treatment considerations in TGD persons.
Collapse
Affiliation(s)
- Evelyn F Carroll
- Division of Breast Imaging and Intervention, Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Division of Emergency and Hospital Radiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| |
Collapse
|
10
|
Abstract
Multiple tools exist to assess a patient's breast cancer risk. The choice of risk model depends on the patient's risk factors and how the calculation will impact care. High-risk patients-those with a lifetime breast cancer risk of ≥20%-are, for instance, eligible for supplemental screening with breast magnetic resonance imaging. Those with an elevated short-term breast cancer risk (frequently defined as a 5-year risk ≥1.66%) should be offered endocrine prophylaxis. High-risk patients should also receive guidance on modification of lifestyle factors that affect breast cancer risk.
Collapse
Affiliation(s)
- Amy E Cyr
- Department of Medicine, Washington University, Box 8056, 660 South Euclid Avenue, Saint Louis, MO 63110, USA.
| | - Kaitlyn Kennard
- Department of Surgery, Washington University, Box 8051, 660 South Euclid Avenue, Saint louis, MO 63110, USA
| |
Collapse
|
11
|
Monticciolo DL, Newell MS, Moy L, Lee CS, Destounis SV. Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR. J Am Coll Radiol 2023; 20:902-914. [PMID: 37150275 DOI: 10.1016/j.jacr.2023.04.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023]
Abstract
Early detection decreases breast cancer death. The ACR recommends annual screening beginning at age 40 for women of average risk and earlier and/or more intensive screening for women at higher-than-average risk. For most women at higher-than-average risk, the supplemental screening method of choice is breast MRI. Women with genetics-based increased risk, those with a calculated lifetime risk of 20% or more, and those exposed to chest radiation at young ages are recommended to undergo MRI surveillance starting at ages 25 to 30 and annual mammography (with a variable starting age between 25 and 40, depending on the type of risk). Mutation carriers can delay mammographic screening until age 40 if annual screening breast MRI is performed as recommended. Women diagnosed with breast cancer before age 50 or with personal histories of breast cancer and dense breasts should undergo annual supplemental breast MRI. Others with personal histories, and those with atypia at biopsy, should strongly consider MRI screening, especially if other risk factors are present. For women with dense breasts who desire supplemental screening, breast MRI is recommended. For those who qualify for but cannot undergo breast MRI, contrast-enhanced mammography or ultrasound could be considered. All women should undergo risk assessment by age 25, especially Black women and women of Ashkenazi Jewish heritage, so that those at higher-than-average risk can be identified and appropriate screening initiated.
Collapse
Affiliation(s)
- Debra L Monticciolo
- Division Chief, Breast Imaging, Massachusetts General Hospital, Boston, Massachusetts.
| | - Mary S Newell
- Interim Division Chief, Breast Imaging, Emory University, Atlanta, Georgia
| | - Linda Moy
- Associate Chair for Faculty Mentoring, New York University Grossman School of Medicine, New York, New York; Editor-in-Chief, Radiology
| | - Cindy S Lee
- New York University Grossman School of Medicine, New York, New York
| | - Stamatia V Destounis
- Elizabeth Wende Breast Care, Rochester, New York; Chair, ACR Commission on Breast Imaging
| |
Collapse
|
12
|
King CB, Bychkovsky BL, Warner ET, King TA, Freedman RA, Mittendorf EA, Katlin F, Revette A, Crookes DM, Maniar N, Pace LE. Inequities in referrals to a breast cancer risk assessment and prevention clinic: a mixed methods study. BMC PRIMARY CARE 2023; 24:165. [PMID: 37626335 PMCID: PMC10464083 DOI: 10.1186/s12875-023-02126-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Inequitable access to personalized breast cancer screening and prevention may compound racial and ethnic disparities in outcomes. The Breast Cancer Personalized Risk Assessment, Education and Prevention (B-PREP) program, located within the Brigham and Women's Hospital (BWH) Comprehensive Breast Health Center (BHC), provides care to patients at high risk for developing breast cancer. We sought to characterize the differences between BWH primary care patients referred specifically to B-PREP for risk evaluation and those referred to the BHC for benign breast conditions. Through interviews with primary care clinicians, we sought to explore contributors to potentially inequitable B-PREP referral patterns. METHODS We used electronic health record data and the B-PREP clinical database to identify patients referred by primary care clinicians to the BHC or B-PREP between 2017 and 2020. We examined associations with likelihood of referral to B-PREP for risk assessment. Semi-structured interviews were conducted with nine primary care clinicians from six clinics to explore referral patterns. RESULTS Of 1789 patients, 78.0% were referred for benign breast conditions, and 21.5% for risk assessment. In multivariable analyses, Black individuals were less likely to be referred for risk than for benign conditions (OR 0.38, 95% CI:0.23-0.63) as were those with Medicaid/Medicare (OR 0.72, 95% CI:0.53-0.98; OR 0.52, 95% CI:0.27-0.99) and those whose preferred language was not English (OR 0.26, 95% CI:0.12-0.57). Interviewed clinicians described inconsistent approaches to risk assessment and variable B-PREP awareness. CONCLUSIONS In this single-site evaluation, among individuals referred by primary care clinicians for specialized breast care, Black, publicly-insured patients, and those whose preferred language was not English were less likely to be referred for risk assessment. Larger studies are needed to confirm these findings. Interventions to standardize breast cancer risk assessment in primary care may improve equity.
Collapse
Affiliation(s)
- Claire B King
- Comprehensive Breast Health Center, Brigham and Women's Hospital, Boston, MA, USA
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Brittany L Bychkovsky
- Comprehensive Breast Health Center, Brigham and Women's Hospital, Boston, MA, USA
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Erica T Warner
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Tari A King
- Comprehensive Breast Health Center, Brigham and Women's Hospital, Boston, MA, USA
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Mittendorf
- Comprehensive Breast Health Center, Brigham and Women's Hospital, Boston, MA, USA
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Fisher Katlin
- Comprehensive Breast Health Center, Brigham and Women's Hospital, Boston, MA, USA
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Anna Revette
- Division of Population Science, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Danielle M Crookes
- Department of Health Sciences, Northeastern University, Boston, MA, USA
- Department of Sociology and Anthropology, Northeastern University, Boston, MA, USA
| | - Neil Maniar
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - Lydia E Pace
- Comprehensive Breast Health Center, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Division of Women's Health, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
13
|
Spaeth EL, Dite GS, Hopper JL, Allman R. Validation of an Abridged Breast Cancer Risk Prediction Model for the General Population. Cancer Prev Res (Phila) 2023; 16:281-291. [PMID: 36862830 PMCID: PMC10150247 DOI: 10.1158/1940-6207.capr-22-0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/30/2023] [Accepted: 02/28/2023] [Indexed: 03/04/2023]
Abstract
PREVENTION RELEVANCE In this prospective population-based cohort study, we show the improved performance of a new risk assessment model compared with a gold-standard model (BCRAT). The classification of at-risk women using this new model highlights the opportunity to improve risk stratification and implement existing clinical risk-reduction interventions.
Collapse
Affiliation(s)
| | | | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Richard Allman
- Genetic Technologies Limited, Fitzroy, Victoria, Australia
| |
Collapse
|
14
|
Seitzman RL, Pushkin J, Berg WA. Effect of an Educational Intervention on Women's Health Care Provider Knowledge Gaps About Breast Cancer Risk Model Use and High-risk Screening Recommendations. JOURNAL OF BREAST IMAGING 2023; 5:30-39. [PMID: 38416962 DOI: 10.1093/jbi/wbac072] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To assess effectiveness of a web-based educational intervention on women's health care provider knowledge of breast cancer risk models and high-risk screening recommendations. METHODS A web-based pre- and post-test study including 177 U.S.-based women's health care providers was conducted in 2019. Knowledge gaps were defined as fewer than 75% of respondents answering correctly. Pre- and post-test knowledge differences (McNemar test) and associations of baseline characteristics with pre-test knowledge gaps (logistic regression) were evaluated. RESULTS Respondents included 131/177 (74.0%) physicians; 127/177 (71.8%) practiced obstetrics/gynecology. Pre-test, 118/177 (66.7%) knew the Gail model predicts lifetime invasive breast cancer risk; this knowledge gap persisted post-test [(121/177, 68.4%); P = 0.77]. Just 39.0% (69/177) knew the Gail model identifies women eligible for risk-reducing medications; this knowledge gap resolved. Only 48.6% (86/177) knew the Gail model should not be used to identify women meeting high-risk MRI screening guidelines; this deficiency decreased to 66.1% (117/177) post-test (P = 0.001). Pre-test, 47.5% (84/177) knew the Tyrer-Cuzick model is used to identify women meeting high-risk screening MRI criteria, 42.9% (76/177) to predict BRCA1/2 pathogenic mutation risk, and 26.0% (46/177) to predict lifetime invasive breast cancer risk. These knowledge gaps persisted but improved. For a high-risk 30-year-old, 67.8% (120/177) and 54.2% (96/177) pre-test knew screening MRI and mammography/tomosynthesis are recommended, respectively; 19.2% (34/177) knew both are recommended; and 53% (94/177) knew US is not recommended. These knowledge gaps resolved or reduced. CONCLUSION Web-based education can reduce important provider knowledge gaps about breast cancer risk models and high-risk screening recommendations.
Collapse
Affiliation(s)
| | | | - Wendie A Berg
- DenseBreast-info, Inc, Deer Park, NY, USA
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA, USA
| |
Collapse
|
15
|
Taylor G, McWilliams L, Woof VG, Evans DG, French DP. What are the views of three key stakeholder groups on extending the breast screening interval for low-risk women? A secondary qualitative analysis. Health Expect 2022; 25:3287-3296. [PMID: 36305519 PMCID: PMC9700144 DOI: 10.1111/hex.13637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION There is increasing interest in risk-stratified breast screening, whereby the prevention and early detection offers vary by a woman's estimated risk of breast cancer. To date, more focus has been directed towards high-risk screening pathways rather than considering women at lower risk, who may be eligible for extended screening intervals. This secondary data analysis aimed to compare the views of three key stakeholder groups on how extending screening intervals for low-risk women should be implemented and communicated as part of a national breast screening programme. METHODS Secondary data analysis of three qualitative studies exploring the views of distinct stakeholder groups was conducted. Interviews took place with 23 low-risk women (identified from the BC-Predict study) and 17 national screening figures, who were involved in policy-making and implementation. In addition, three focus groups and two interviews were conducted with 26 healthcare professionals. A multiperspective thematic analysis was conducted to identify similarities and differences between stakeholders. FINDINGS Three themes were produced: Questionable assumptions about negative consequences, highlighting how other stakeholders lack trust in how women are likely to understand extended screening intervals; Preserving the integrity of the programme, centring on decision-making and maintaining a positive reputation of breast screening and Negotiating a communication pathway highlighting communication expectations and public campaign importance. CONCLUSIONS A risk-stratified screening programme should consider how best to engage women assessed as having a low risk of breast cancer to ensure mutual trust, balance the practicality of change whilst ensuring acceptability, and carefully develop multilevel inclusive communication strategies. PATIENT AND PUBLIC CONTRIBUTION The research within this paper involved patient/public contributors throughout including study design and materials input.
Collapse
Affiliation(s)
- Grace Taylor
- School of Health Sciences, Manchester Centre of Health Psychology, Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK
| | - Lorna McWilliams
- School of Health Sciences, Manchester Centre of Health Psychology, Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Victoria G. Woof
- School of Health Sciences, Manchester Centre of Health Psychology, Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK
| | - D. Gareth Evans
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
- The Nightingale and Prevent Breast Cancer CentreManchester University NHS Foundation TrustManchesterUK
- Manchester Breast Centre, Manchester Cancer Research CentreUniversity of ManchesterManchesterUK
- Genomic Medicine, Division of Evolution and Genomic Sciences, St Mary's Hospital, Manchester University NHS Foundation TrustThe University of ManchesterManchesterUK
| | - David P. French
- School of Health Sciences, Manchester Centre of Health Psychology, Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
- Manchester Breast Centre, Manchester Cancer Research CentreUniversity of ManchesterManchesterUK
| |
Collapse
|
16
|
Beyond the AJR: Deep Learning Model for Risk-Based Breast Cancer Screening. AJR Am J Roentgenol 2022:1. [PMID: 36350116 DOI: 10.2214/ajr.22.28703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
17
|
Meadows RJ, Figueroa W, Shane‐Carson KP, Padamsee TJ. Predicting breast cancer risk in a racially diverse, community-based sample of potentially high-risk women. Cancer Med 2022; 11:4043-4052. [PMID: 35388639 PMCID: PMC9636513 DOI: 10.1002/cam4.4721] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Identifying women with high risk of breast cancer is necessary to study high-risk experiences and deliver risk-management care. Risk prediction models estimate individuals' lifetime risk but have rarely been applied in community-based settings among women not yet receiving specialized care. Therefore, we aimed: (1) to apply three breast cancer risk prediction models (i.e., Gail, Claus, and IBIS) to a racially diverse, community-based sample of women, and (2) to assess risk prediction estimates using survey data. METHODS An online survey was administered to women who were determined by a screening instrument to have potentially high risk for breast cancer. Risk prediction models were applied using their self-reported family and medical history information. Inclusion in the high-risk subsample required ≥20% lifetime risk per ≥1 model. Descriptive statistics were used to compare the proportions of women identified as high risk by each model. RESULTS N = 1053 women were initially eligible and completed the survey. All women, except one, self-reported the information necessary to run at least one model; 90% had sufficient information for >1 model. The high-risk subsample included 717 women, of which 75% were identified by one model only; 96% were identified by IBIS, 3% by Claus, <1% by Gail. In the high-risk subsample, 20% were identified by two models and 3% by all three models. CONCLUSIONS Assessing breast cancer risk using self-reported data in a community-based sample was feasible. Different models identify substantially different groups of women who may be at high risk for breast cancer; use of multiple models may be beneficial for research and clinical care.
Collapse
Affiliation(s)
- Rachel J. Meadows
- Center for Epidemiology & Healthcare Delivery ResearchJPS Health NetworkFort WorthTexasUSA
| | - Wilson Figueroa
- The Ohio State UniversityCenter for Health Outcomes and Policy Evaluation Studies, College of Public HealthColumbusOhioUSA
- Division of Health Services Management & PolicyCollege of Public Health, The Ohio State UniversityColumbusOhioUSA
| | - Kate P. Shane‐Carson
- Division of Human Genetics, Department of Internal MedicineOhio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Tasleem J. Padamsee
- Division of Health Services Management & PolicyCollege of Public Health, The Ohio State UniversityColumbusOhioUSA
| |
Collapse
|
18
|
Wetmore JB, Otarola L, Paulino LJ, Henry BR, Levine AF, Kone D, Ulloa J, Jandorf L, Margolies L, Vang S. Estimating lifetime risk for breast cancer as a screening tool for identifying those who would benefit from additional services among women utilizing mobile mammography. J Cancer Policy 2022; 34:100354. [PMID: 35995395 DOI: 10.1016/j.jcpo.2022.100354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND To estimate lifetime risk of breast cancer among women utilizing mobile mammography and to determine the proportion that might benefit from additional services, such as genetic counseling and educational programs. METHODS Retrospective analysis of electronic health records for 2214 women screened for breast cancer on a mobile mammography van was conducted. Participants answered questions about their demographic characteristics, breast health, and family history of cancer. Logistic regression analyses were used to assess the odds of being recommended for additional services by the Tyrer-Cuzick (TC) lifetime risk score. RESULTS The average TC ten-year risk score was 2.76 % ± 2.01 %, and the average TC lifetime risk score was 7.30 % ± 4.80 %. Using lifetime risk scores ≥ 10 %, it was determined that 444 patients (20.23 %) could be referred to additional services. Less than one percent of patients had been tested for the BRCA genes previously. The odds of being recommended for additional services by the TC model were significantly greater among those who were eligible for the New York Cancer Services Program (i.e., a proxy for lack of insurance) when compared to those who were ineligible (OR=1.31, 95 % CI: 1.03-1.66). After adjustment, screening borough and race/ethnicity were not significantly associated with being recommended for services. CONCLUSION Genetic counseling and education are some of the tools available to promote awareness and early detection of breast cancer; however, screening guidelines do not mandate genetic counseling or referrals for individuals at high-risk. POLICY SUMMARY Patients and providers should have discussions about predicted TC lifetime risk scores at follow-up breast cancer screening appointments, as this is a missed opportunity to improve care at both fixed sites and mobile clinics.
Collapse
Affiliation(s)
- John B Wetmore
- Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Lyshsae Otarola
- Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Lewis J Paulino
- Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Brittney R Henry
- Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alec F Levine
- NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Djeneba Kone
- Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jennifer Ulloa
- Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Lina Jandorf
- Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Laurie Margolies
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Suzanne Vang
- Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| |
Collapse
|
19
|
Porterhouse MD, Paul S, Lieberenz JL, Stempel LR, Levy MA, Alvarado R. Black Women Are Less Likely to Be Classified as High-Risk for Breast Cancer Using the Tyrer-Cuzick 8 Model. Ann Surg Oncol 2022; 29:6419-6425. [PMID: 35790586 DOI: 10.1245/s10434-022-12140-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/24/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Breast cancer risk assessment is a powerful tool that guides recommendations for supplemental breast cancer screening and genetic counseling. The Tyrer-Cuzick 8 (TC8) model is widely used for calculating breast cancer risk and thus helps determine if women qualify for supplemental screening or genetic counseling. However, the TC8 model may underestimate breast cancer risk in Black women. This study sought to assess this disparity. METHODS Data on race, breast density, body mass index (BMI), and TC8 scores were retrospectively extracted from the electronic medical record (EMR). Logistic regressions were run to evaluate racial differences in TC8 scores. Summary and correlation statistics determined relationships between BMI, breast density, and race. Rank biserial correlations were employed to explore the impact of breast density and BMI on TC8 scores. RESULTS Of 15,356 patients, 5796 were White and 5813 were Black. Black patients had higher rates of BMI ≥ 27 compared with White women (79.2% vs. 45.7%), lower rates of breast density (35.1% vs. 56.2%), and lower rates of high-risk TC8 scores (10.7% vs. 17.5%, OR = 1.6646). There was an inverse relationship between TC8 score and BMI (rrb = - 0.04) and a direct relationship between TC8 score and breast density (rrb = 0.37). DISCUSSION Black women are less likely to have high-risk TC8 scores despite having only marginally lower breast cancer incidence rates and higher breast cancer mortality rates than White women. This suggests that the TC8 model underestimates breast cancer risk in Black women, possibly due to lower rates of breast density and higher BMIs among Black women.
Collapse
Affiliation(s)
| | | | | | - Lisa R Stempel
- Rush University Cancer Center, Chicago, IL, USA.,Department of Radiology, Rush University Medical Center, Chicago, IL, USA
| | - Mia A Levy
- Rush University Cancer Center, Chicago, IL, USA.,Division of Hematology, Oncology, and Stem Cell Transplant, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Rosalinda Alvarado
- Rush University Cancer Center, Chicago, IL, USA. .,Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
20
|
Menopause Hormone Therapy in the Management of Postmenopausal Osteoporosis. Cancer J 2022; 28:204-207. [PMID: 35594468 DOI: 10.1097/ppo.0000000000000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This narrative review analyzes the customization of menopause hormone therapy (MHT) for osteoporosis prevention and treatment in the context of the patients' age and menopausal age. In short, MHT is indicated in most women suffering from menopause before the age of 45 years except for breast cancer survivors. These women should be treated with MHT until the age of 50 years. For women who have entered menopause at around the age of 50 years, risks associated with MHT are low, and MHT is a safe option, provided there is an indication for it. We suggest that pursuing MHT entails different risks than initiating it, after the age of 60 years. In both cases, advantages and risks should be evaluated. We suggest using risk calculators to assess the magnitude of these risks and choosing regimens that entail the lowest breast and thrombosis risks.
Collapse
|
21
|
Nocera Zachariah N, Lee MC, Chang MD, Moore C, Wang X. GeneHome - a Novel Model to Deliver Care to Individuals with Genetic Predisposition to Cancer. Cancer Control 2022; 29:10732748221109951. [PMID: 35976772 PMCID: PMC9393671 DOI: 10.1177/10732748221109951] [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] [Indexed: 11/17/2022] Open
Abstract
Genetic testing for hereditary cancer predisposition is more widely available, resulting in more patients being identified as carriers of pathogenic variants (PV) of cancer susceptibility genes. PV carriers may be at high risk for multiple cancers of different organ systems. Traditional high-risk cancer screening is often organ specific and conducted separately by specialists. However, with many genes associated with 3 or more types of cancer risks, coordination of such cancer screening can be overwhelming for patients and providers. At Moffitt Cancer Center (MCC), GeneHome clinic functions as a "home" to conduct and coordinate prevention, screening, counseling, and education for individuals carrying germline genetic PVs across the entire spectrum of cancer genes. The screening includes, but is not limited to, history review, physical examination, image studies, blood tests, urine tests, and endoscopy. GeneHome is a novel model for genetic high-risk cancer surveillance and has grown in 4 years since establishment. We sought to study various characteristics of the patient population it serves, common themes in referral patterns and evolution of the clinic since its inception. A total of 821 patients were seen over 42 months, encompassing PV carriers of 46 genes. Patients were 84.9% female and 13.3% male. Most PVs were of BRCA1 and BRCA2. Most patients had private insurance, and most were from Florida. Annual increase in patient visits was over 74.7% over the last year. Overall, GeneHome has been well accepted by providers and patients and is a valuable service for patients with a genetic predisposition to cancer.
Collapse
Affiliation(s)
- Nadia Nocera Zachariah
- Department of Breast Surgery, 25301H. Lee Moffitt Cancer Center and Research Institution, Tampa, FL, USA
| | - Marie C Lee
- Department of Breast Surgery, 25301H. Lee Moffitt Cancer Center and Research Institution, Tampa, FL, USA
| | - Maxine D Chang
- Department of Breast Surgery, 25301H. Lee Moffitt Cancer Center and Research Institution, Tampa, FL, USA
| | - Colin Moore
- Department of Breast Surgery, 25301H. Lee Moffitt Cancer Center and Research Institution, Tampa, FL, USA
| | - Xia Wang
- Department of Breast Surgery, 25301H. Lee Moffitt Cancer Center and Research Institution, Tampa, FL, USA
| |
Collapse
|
22
|
Palmer JR, Zirpoli G, Bertrand KA, Battaglia T, Bernstein L, Ambrosone CB, Bandera EV, Troester MA, Rosenberg L, Pfeiffer RM, Trinquart L. A Validated Risk Prediction Model for Breast Cancer in US Black Women. J Clin Oncol 2021; 39:3866-3877. [PMID: 34623926 PMCID: PMC8608262 DOI: 10.1200/jco.21.01236] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Breast cancer risk prediction models are used to identify high-risk women for early detection, targeted interventions, and enrollment into prevention trials. We sought to develop and evaluate a risk prediction model for breast cancer in US Black women, suitable for use in primary care settings. METHODS Breast cancer relative risks and attributable risks were estimated using data from Black women in three US population-based case-control studies (3,468 breast cancer cases; 3,578 controls age 30-69 years) and combined with SEER age- and race-specific incidence rates, with incorporation of competing mortality, to develop an absolute risk model. The model was validated in prospective data among 51,798 participants of the Black Women's Health Study, including 1,515 who developed invasive breast cancer. A second risk prediction model was developed on the basis of estrogen receptor (ER)-specific relative risks and attributable risks. Model performance was assessed by calibration (expected/observed cases) and discriminatory accuracy (C-statistic). RESULTS The expected/observed ratio was 1.01 (95% CI, 0.95 to 1.07). Age-adjusted C-statistics were 0.58 (95% CI, 0.56 to 0.59) overall and 0.63 (95% CI, 0.58 to 0.68) among women younger than 40 years. These measures were almost identical in the model based on estrogen receptor-specific relative risks and attributable risks. CONCLUSION Discriminatory accuracy of the new model was similar to that of the most frequently used questionnaire-based breast cancer risk prediction models in White women, suggesting that effective risk stratification for Black women is now possible. This model may be especially valuable for risk stratification of young Black women, who are below the ages at which breast cancer screening is typically begun.
Collapse
Affiliation(s)
- Julie R. Palmer
- Slone Epidemiology Center at Boston University, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Gary Zirpoli
- Slone Epidemiology Center at Boston University, Boston, MA
| | - Kimberly A. Bertrand
- Slone Epidemiology Center at Boston University, Boston, MA
- Boston University School of Medicine, Boston, MA
| | | | | | | | | | - Melissa A. Troester
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA
| | - Ruth M. Pfeiffer
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD
| | | |
Collapse
|