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Calabrese A, von Arx C, Tafuti AA, Pensabene M, De Laurentiis M. Prevention, diagnosis and clinical management of hereditary breast cancer beyond BRCA1/2 genes. Cancer Treat Rev 2024; 129:102785. [PMID: 38870570 DOI: 10.1016/j.ctrv.2024.102785] [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: 02/06/2024] [Revised: 05/18/2024] [Accepted: 06/09/2024] [Indexed: 06/15/2024]
Abstract
The detection of germline pathogenic variants (gPVs) in BRCA1/2 and other breast cancer (BC) genes is rising exponentially thanks to the advent of multi-gene panel testing. This promising technology, coupled with the availability of specific therapies for BC BRCA-related, has increased the number of patients eligible for genetic testing. Implementing multi-gene panel testing for hereditary BC screening holds promise to maximise benefits for patients at hereditary risk of BC. These benefits range from prevention programs to antineoplastic-targeted therapies. However, the clinical management of these patients is complex and requires guidelines based on recent evidence. Furthermore, applying multi-gene panel testing into clinical practice increases the detection of variants of uncertain significance (VUSs). This augments the complexity of patients' clinical management, becoming an unmet need for medical oncologists. This review aims to collect updated evidence on the most common BC-related genes besides BRCA1/2, from their biological role in BC development to their potential impact in tailoring prevention and treatment strategies.
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Affiliation(s)
- A Calabrese
- Department Breast and Thoracic Oncology, Istituto Nazionale Tumori - IRCCS, 'Fondazione G. Pascale', Via Mariano Semmola, 53, 80131 Napoli, NA, Italy
| | - C von Arx
- Department Breast and Thoracic Oncology, Istituto Nazionale Tumori - IRCCS, 'Fondazione G. Pascale', Via Mariano Semmola, 53, 80131 Napoli, NA, Italy.
| | - A A Tafuti
- Department Breast and Thoracic Oncology, Istituto Nazionale Tumori - IRCCS, 'Fondazione G. Pascale', Via Mariano Semmola, 53, 80131 Napoli, NA, Italy
| | - M Pensabene
- Department Breast and Thoracic Oncology, Istituto Nazionale Tumori - IRCCS, 'Fondazione G. Pascale', Via Mariano Semmola, 53, 80131 Napoli, NA, Italy
| | - M De Laurentiis
- Department Breast and Thoracic Oncology, Istituto Nazionale Tumori - IRCCS, 'Fondazione G. Pascale', Via Mariano Semmola, 53, 80131 Napoli, NA, Italy
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Buijs SM, Koolen SLW, Mathijssen RHJ, Jager A. Tamoxifen Dose De-Escalation: An Effective Strategy for Reducing Adverse Effects? Drugs 2024; 84:385-401. [PMID: 38480629 PMCID: PMC11101371 DOI: 10.1007/s40265-024-02010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 05/19/2024]
Abstract
Tamoxifen, a cornerstone in the adjuvant treatment of estrogen receptor-positive breast cancer, significantly reduces breast cancer recurrence and breast cancer mortality; however, its standard adjuvant dose of 20 mg daily presents challenges due to a broad spectrum of adverse effects, contributing to high discontinuation rates. Dose reductions of tamoxifen might be an option to reduce treatment-related toxicity, but large randomized controlled trials investigating the tolerability and, more importantly, efficacy of low-dose tamoxifen in the adjuvant setting are lacking. We conducted an extensive literature search to explore evidence on the tolerability and clinical efficacy of reduced doses of tamoxifen. In this review, we discuss two important topics regarding low-dose tamoxifen: (1) the incidence of adverse effects and quality of life among women using low-dose tamoxifen; and (2) the clinical efficacy of low-dose tamoxifen examined in the preventive setting and evaluated through the measurement of several efficacy derivatives. Moreover, practical tools for tamoxifen dose reductions in the adjuvant setting are provided and further research to establish optimal dosing strategies for individual patients are discussed.
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Affiliation(s)
- Sanne M Buijs
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, PO Box 2040, 3015 CN, Rotterdam, The Netherlands.
| | - Stijn L W Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, PO Box 2040, 3015 CN, Rotterdam, The Netherlands
- Department of Clinical Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, PO Box 2040, 3015 CN, Rotterdam, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, PO Box 2040, 3015 CN, Rotterdam, The Netherlands
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3
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Ntowe KW, Lee MS, Plichta JK. Clinical genetics in breast cancer. J Surg Oncol 2024. [PMID: 38557982 DOI: 10.1002/jso.27630] [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: 01/29/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
As genetic testing becomes increasingly more accessible and more applicable with a broader range of clinical implications, it may also become more challenging for breast cancer providers to remain up-to-date. This review outlines some of the current clinical guidelines and recent literature surrounding germline genetic testing, as well as genomic testing, in the screening, prevention, diagnosis, and treatment of breast cancer, while identifying potential areas of further research.
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Affiliation(s)
- Koumani W Ntowe
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael S Lee
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Filip CI, Cătană A, Kutasi E, Roman SA, Militaru MS, Risteiu GA, Dindelengan GC. Breast Cancer Screening and Prophylactic Mastectomy for High-Risk Women in Romania. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:570. [PMID: 38674216 PMCID: PMC11052261 DOI: 10.3390/medicina60040570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/10/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Breast cancer remains a significant contributor to morbidity and mortality within oncology. Risk factors, encompassing genetic and environmental influences, significantly contribute to its prevalence. While germline mutations, notably within the BRCA genes, are commonly associated with heightened breast cancer risk, a spectrum of other variants exists among affected individuals. Diagnosis relies on imaging techniques, biopsies, biomarkers, and genetic testing, facilitating personalised risk assessment through specific scoring systems. Breast cancer screening programs employing mammography and other imaging modalities play a crucial role in early detection and management, leading to improved outcomes for affected individuals. Regular screening enables the identification of suspicious lesions or abnormalities at earlier stages, facilitating timely intervention and potentially reducing mortality rates associated with breast cancer. Genetic mutations guide screening protocols, prophylactic interventions, treatment modalities, and patient prognosis. Prophylactic measures encompass a range of interventions, including chemoprevention, hormonal inhibition, oophorectomy, and mastectomy. Despite their efficacy in mitigating breast cancer incidence, these interventions carry potential side effects and psychological implications, necessitating comprehensive counselling tailored to individual cases.
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Affiliation(s)
- Claudiu Ioan Filip
- Department of Plastic Surgery and Burn Unit, Emergency District Hospital, 400535 Cluj-Napoca, Romania; (C.I.F.); (G.C.D.)
- First Surgical Clinic, Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
| | - Andreea Cătană
- Department of Molecular Sciences, Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania; (A.C.); (E.K.); (S.A.R.); (G.A.R.)
- Department of Oncogeneticcs, Institute of Oncology, “Prof. Dr. I. Chiricuță”, 400015 Cluj-Napoca, Romania
- Regional Laboratory Cluj-Napoca, Department of Medical Genetics, Regina Maria Health Network, 400363 Cluj-Napoca, Romania
| | - Eniko Kutasi
- Department of Molecular Sciences, Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania; (A.C.); (E.K.); (S.A.R.); (G.A.R.)
| | - Sara Alexia Roman
- Department of Molecular Sciences, Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania; (A.C.); (E.K.); (S.A.R.); (G.A.R.)
| | - Mariela Sanda Militaru
- Department of Molecular Sciences, Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania; (A.C.); (E.K.); (S.A.R.); (G.A.R.)
- Regional Laboratory Cluj-Napoca, Department of Medical Genetics, Regina Maria Health Network, 400363 Cluj-Napoca, Romania
| | - Giulia Andreea Risteiu
- Department of Molecular Sciences, Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania; (A.C.); (E.K.); (S.A.R.); (G.A.R.)
| | - George Călin Dindelengan
- Department of Plastic Surgery and Burn Unit, Emergency District Hospital, 400535 Cluj-Napoca, Romania; (C.I.F.); (G.C.D.)
- First Surgical Clinic, Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
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Pruitt WR, Samuels B, Cunningham S. The Gail Model and Its Use in Preventive Screening: A Comparison of the Corbelli Study. Cureus 2024; 16:e56290. [PMID: 38501027 PMCID: PMC10945157 DOI: 10.7759/cureus.56290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 03/20/2024] Open
Abstract
Background This study aims to determine the usage of the Gail model in screening for breast cancer during physical examinations of women by sampling primary care physicians in two regions of Texas - Hidalgo County and Johnson County. A Gail score of 1.66% or higher indicates increased breast cancer risk. Three specialties are surveyed: internal medicine (IM), family medicine (FM), and gynecology (GYN). The null hypothesis for this study is that primary care physicians do not use the Gail model in screening for breast cancer during physical examinations of women. Methods A survey was distributed to 100 physicians with specialties in IM, FM, and GYN from May 2022 to July 2022. The survey assessed the physician's frequency of use of the Gail model and chemoprevention. Data were collected by distributing survey questionnaires to physicians in person. Descriptive statistics were used for response distributions. Fisher's exact probability test was used for comparisons across specialties. Results The response rate was 34% (34/100). Thirty-eight percent of the physicians surveyed reported using the Gail model in their practice (IM 46%, FM 23%, and GYN 31%). All 13 of the physicians using the Gail model were open to using chemoprevention. Conclusions Only 38% of the physicians surveyed responded that they use the Gail model in their practice. The study concluded that a minority of primary care physicians used the Gail model to decrease breast cancer risk. Further research would help to define better the Gail model and its use in preventing breast cancer in women. The Gail model appears to be beneficial to breast cancer risk reduction; however, risk reduction medication side effects need to be minimized.
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Affiliation(s)
| | - Beryl Samuels
- Neurosciences, Johns Hopkins University, Baltimore, USA
| | - Scott Cunningham
- Obstetrics and Gynecology, All American Institute of Medical Sciences, Black River, JAM
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Winham SJ, Sherman ME. Leveraging GWAS: Path to Prevention? Cancer Prev Res (Phila) 2024; 17:13-18. [PMID: 38173393 DOI: 10.1158/1940-6207.capr-23-0336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/10/2023] [Accepted: 11/14/2023] [Indexed: 01/05/2024]
Abstract
Developing novel cancer prevention medication strategies is important for reducing mortality. Identification of common genetic variants associated with cancer risk suggests the potential to leverage these discoveries to define causal targets for cancer interception. Although each risk variant confers small increases in risk, researchers propose that blocking those that produce causal carcinogenic effects might have large impacts on cancer prevention. While a promising concept, we describe potential hurdles that may need to be scaled to reach this goal, including: (i) understanding the complexity of risk; (ii) achieving statistical power in studies with binary outcomes (cancer development: yes or no); (iii) characterization of cancer precursors; (iv) heterogeneity of cancer subtypes and the populations in which these diseases occur; (v) impact of static genetic markers across complex events of the life course; (vi) defining gene-gene and gene-environment interactions and (vii) demonstrating functional effects of markers in human populations. We assess short-term prospects for this research against the backdrop of these challenges and the potential to prevent cancer through other means. See related commentary by Peters and Tomlinson, p. 7.
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Affiliation(s)
- Stacey J Winham
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Mark E Sherman
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
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Wang T, Che M, Huilgol YS, Keane H, Goodman D, Soonavala R, Ozanne E, Shieh Y, Belkora JK, Fiscalini AS, Esserman LJ. Validation Study on Risk-Reduction Activities after Exposure to a Personalized Breast Cancer Risk-Assessment Education Tool in High-Risk Women in the WISDOM Study. RESEARCH SQUARE 2023:rs.3.rs-2787493. [PMID: 37214889 PMCID: PMC10197747 DOI: 10.21203/rs.3.rs-2787493/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We performed a 318-participant validation study of an individualized risk assessment tool in women identified as having high- or highest-risk of breast cancer in the personalized arm of the Women Informed to Screen Depending on Measures of risk (WISDOM) trial. Per protocol, these women were educated about their risk and risk reducing options using the Breast Health Decisions (BHD) tool, which uses patient-friendly visuals and 8th grade reading level language to convey risk and prevention options. Prior to exposure to the educational tool, 4.7% of women were already taking endocrine risk reduction, 38.7% were reducing alcohol intake, and 62.6% were exercising. Three months after initial use of BHD, 8.4% of women who considered endocrine risk reduction, 33% of women who considered alcohol reduction, and 46% of women who considered exercise pursued the risk-reducing activities. Unlike lifestyle interventions which are under the control of the patient, additional barriers at the level of the healthcare provider may be impeding the targeted use of endocrine risk reduction medications in women with elevated breast cancer risk.
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Affiliation(s)
- Tianyi Wang
- UC San Francisco Department of Surgery, San Francisco, USA
- University of Michigan Medical School, Ann Arbor, USA
| | - Mandy Che
- UC San Francisco Department of Surgery, San Francisco, USA
- Rush University Medical College, Chicago, USA
| | | | - Holly Keane
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | - Elissa Ozanne
- University of Utah School of Medicine Department of Population Health Sciences, Salt Lake City, USA
| | - Yiwey Shieh
- Weill Cornell Medicine Department of Population Health Sciences, New York, NY, USA
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8
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Patel PJ, Shah JS. Metformin pretreatment potentiates the antiproliferative action of doxorubicin against breast cancer. ANNALES PHARMACEUTIQUES FRANÇAISES 2023:S0003-4509(23)00023-8. [PMID: 36907329 DOI: 10.1016/j.pharma.2023.03.001] [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: 03/31/2022] [Revised: 01/17/2023] [Accepted: 03/07/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES The present study aimed to evaluate the effect of metformin pretreatment on the potentiation of antiproliferative action of doxorubicin against breast cancer. MATERIAL AND METHODS Female Wistar rats were administered with 7,12-Dimethylbenz(a)anthracene (DMBA) (35mg) in 1mL olive oil subcutaneously beneath the mammary gland. Animals were pretreated with metformin (Met) 200mg/kg two weeks before DMBA administration. DMBA control groups received doxorubicin (Dox) (4mg/kg and 2mg/kg), Met (200mg/kg) alone and in combination with Dox (4mg/kg). Met pre-treated DMBA control groups received Dox 4mg/kg and 2mg/kg. RESULTS Met pre-treated groups treated with Dox exhibited a decrease in tumor incidence, tumor volume and increased survival rate than the DMBA group. Organ-to-body weight ratios and histopathology of heart, liver and lungs of Met pre-treated groups treated with Dox showed lesser toxicity than Dox treated DMBA control groups. There was a noteworthy decrease in malondialdehyde levels and a substantial increase in the levels of reduced glutathione together with a significant decrease in the levels of inflammatory markers like IL-6, IL-1β and NF-κB in Met pre-treated groups treated with Dox. Histopathology of breast tumors revealed better control of tumors in Met pre-treated groups treated with Dox than DMBA control group. Immunohistochemistry and real-time PCR data revealed a significant reduction in Ki67 expression in Met pre-treated groups treated with Dox as compared to the DMBA control group. CONCLUSION The present study suggests that metformin pretreatment potentiates the antiproliferative action of doxorubicin against breast cancer.
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Affiliation(s)
- P J Patel
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, 382481, India.
| | - J S Shah
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, 382481, India.
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Zunica ERM, Axelrod CL, Kirwan JP. Phytochemical Targeting of Mitochondria for Breast Cancer Chemoprevention, Therapy, and Sensitization. Int J Mol Sci 2022; 23:ijms232214152. [PMID: 36430632 PMCID: PMC9692881 DOI: 10.3390/ijms232214152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
Breast cancer is a common and deadly disease that causes tremendous physical, emotional, and financial burden on patients and society. Early-stage breast cancer and less aggressive subtypes have promising prognosis for patients, but in aggressive subtypes, and as cancers progress, treatment options and responses diminish, dramatically decreasing survival. Plants are nutritionally rich and biologically diverse organisms containing thousands of metabolites, some of which have chemopreventive, therapeutic, and sensitizing properties, providing a rich source for drug discovery. In this study we review the current landscape of breast cancer with a central focus on the potential role of phytochemicals for treatment, management, and disease prevention. We discuss the relevance of phytochemical targeting of mitochondria for improved anti-breast cancer efficacy. We highlight current applications of phytochemicals and derivative structures that display anti-cancer properties and modulate cancer mitochondria, while describing future applicability and identifying areas of promise.
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Urinary Comprehensive Genomic Profiling Correlates Urothelial Carcinoma Mutations with Clinical Risk and Efficacy of Intervention. J Clin Med 2022; 11:jcm11195827. [PMID: 36233691 PMCID: PMC9571552 DOI: 10.3390/jcm11195827] [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: 08/04/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 11/15/2022] Open
Abstract
The clinical standard of care for urothelial carcinoma (UC) relies on invasive procedures with suboptimal performance. To enhance UC treatment, we developed a urinary comprehensive genomic profiling (uCGP) test, UroAmplitude, that measures mutations from tumor DNA present in urine. In this study, we performed a blinded, prospective validation of technical sensitivity and positive predictive value (PPV) using reference standards, and found at 1% allele frequency, mutation detection performs at 97.4% sensitivity and 80.4% PPV. We then prospectively compared the mutation profiles of urine-extracted DNA to those of matched tumor tissue to validate clinical performance. Here, we found tumor single-nucleotide variants were observed in the urine with a median concordance of 91.7% and uCGP revealed distinct patterns of genomic lesions enriched in low- and high-grade disease. Finally, we retrospectively explored longitudinal case studies to quantify residual disease following bladder-sparing treatments, and found uCGP detected residual disease in patients receiving bladder-sparing treatment and predicted recurrence and disease progression. These findings demonstrate the potential of the UroAmplitude platform to reliably identify and track mutations associated with UC at each stage of disease: diagnosis, treatment, and surveillance. Multiple case studies demonstrate utility for patient risk classification to guide both surgical and therapeutic interventions.
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11
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Green VL. Breast Cancer Risk Assessment and Management of the High-Risk Patient. Obstet Gynecol Clin North Am 2022; 49:87-116. [DOI: 10.1016/j.ogc.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Crafts TD, Tonneson JE, Wolfe BM, Stroud AM. Obesity and breast cancer: Preventive and therapeutic possibilities for bariatric surgery. Obesity (Silver Spring) 2022; 30:587-598. [PMID: 35195366 DOI: 10.1002/oby.23369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 11/10/2021] [Accepted: 11/29/2021] [Indexed: 11/07/2022]
Abstract
Breast cancer is the most common and second deadliest malignancy in women. With rising obesity rates and building evidence for a strong association with obesity, the incidence of breast cancer can be expected to increase. Weight loss reduces breast cancer risk, the mechanisms of which are still poorly understood. As an effective therapy for obesity, bariatric surgery may be a powerful tool in breast cancer prevention and treatment. This review details the potential physiologic mechanisms that may underlie this association, as well as recently published studies that reinforce the link between bariatric surgery and a reduction in incident breast cancer. The use of bariatric surgery as an adjunct therapy in endometrial cancer also raises the potential for similar use in select breast cancer patients. Despite the expanding potential applications of bariatric surgery in this field, publications to date have been strictly observational, highlighting a need for future clinical trials.
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Affiliation(s)
- Trevor D Crafts
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer E Tonneson
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Andrea M Stroud
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
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Etiopathogenesis of Breast Cancer and Prevention. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Castiel M, Morgan JC, Naaman S. The evolving role of the Women's Health Specialist in cancer prevention and survivorship. Menopause 2021; 29:104-113. [PMID: 34964725 DOI: 10.1097/gme.0000000000001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE AND OBJECTIVE This review provides a framework for primary care physicians, internists, family doctors, NP's, PA's, and oncologists caring for women-henceforth referred to as Women's Health Specialists-to identify and screen patients who may be at high risk for inherited cancer syndromes; an intervention referred to as previvorship care. For women who undergo risk-reducing oophorectomy, survivorship care is critical to optimizing quality of life thereafter. In this paper, we review management of the unique survivorship needs and management options for women at risk for or with a cancer diagnosis, highlighting the importance of interdisciplinary care. METHODS To review the available previvorship and survivorship management strategies, a Pub Med search was performed using keywords "survivorship," "genetics," "cancer," "menopause," "hormone therapy," "screening" in addition to review of guidelines, position statements and expert, and committee opinions from the American College of OBGYN, the American Society of Clinical Oncology, The North American Menopause Society, the National Comprehensive Cancer Network , and the American Society for Reproductive Medicine. DISCUSSION AND CONCLUSION Women's Health Specialists are in a unique position to identify and screen women who may be at risk for inherited cancer syndromes as well as provide necessary survivorship management following transition from their oncologists' care.
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Keane H, Huilgol YS, Shieh Y, Tice JA, Belkora J, Sepucha K, Shibley WP, Wang T, Che M, Goodman D, Ozanne E, Fiscalini AS, Esserman LJ. Development and pilot of an online, personalized risk assessment tool for a breast cancer precision medicine trial. NPJ Breast Cancer 2021; 7:78. [PMID: 34140528 PMCID: PMC8211836 DOI: 10.1038/s41523-021-00288-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/27/2021] [Indexed: 12/24/2022] Open
Abstract
Breast cancer risk reduction has been validated by large-scale clinical trials, but uptake remains low. A risk communication tool could provide personalized risk-reduction information for high-risk women. A low-literacy-friendly, visual, and personalized tool was designed as part of the Women Informed to Screen Depending On Measures of risk (WISDOM) study. The tool integrates genetic, polygenic, and lifestyle factors, and quantifies the risk-reduction from undertaking medication and lifestyle interventions. The development and design process utilized feedback from clinicians, decision-making scientists, software engineers, and patient advocates. We piloted the tool with 17 study participants, collecting quantitative and qualitative feedback. Overall, participants felt they better understood their personalized breast cancer risk, were motivated to reduce their risk, and considered lifestyle interventions. The tool will be used to evaluate whether risk-based screening leads to more informed decisions and higher uptake of risk-reduction interventions among those most likely to benefit.
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Affiliation(s)
- Holly Keane
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Yash S Huilgol
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Joint Medical Program, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Yiwey Shieh
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey A Tice
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jeff Belkora
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Boston, MA, USA
| | - W Patrick Shibley
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Tianyi Wang
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Mandy Che
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Deborah Goodman
- Department of Epidemiology, University of California, Irvine, Irvine, CA, USA
| | - Elissa Ozanne
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Laura J Esserman
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Jahan N, Jones C, Rahman RL. Endocrine prevention of breast cancer. Mol Cell Endocrinol 2021; 530:111284. [PMID: 33882282 DOI: 10.1016/j.mce.2021.111284] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/04/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023]
Abstract
Breast cancer (BC) is the most common non-cutaneous malignancy among women worldwide and is a significant cause of morbidity, mortality, and national health care expenditure. Unfortunately, with few exceptions like alcohol consumption, obesity, and physical activity, most BC risk factors are unmodifiable. Antiestrogen endocrine therapy, commonly known as BC chemoprevention, is an effective method of BC prevention. In multiple randomized trials, two selective estrogen receptor modulators - tamoxifen and raloxifene, and two aromatase inhibitors - exemestane and anastrozole have reduced BC incidence by 50%-65% in high-risk women. An estimated 15% of the US women between 35 and 79 years of age may qualify as high risk for BC, yet a small percentage of these women will ever have a formal BC risk assessment or a discussion of endocrine prevention options. The etiology of underutilization of endocrine prevention of BC is multifactorial - infrequent use of BC risk assessment tools in the primary care settings, insufficient knowledge of BC risk assessment tools and antiestrogen agents among primary care providers, concerns of side effects, inadequate time for counseling during primary care visit, and lack of predictive biomarkers may play significant roles. Many small studies incorporating risk assessment tools and decision-making aids showed minimal success in enhancing endocrine prevention. One critical factor for underutilization of endocrine prevention is low uptake of endocrine prevention by high-risk women even when appropriately recommended. Furthermore, adherence to BC endocrine prevention is unsatisfactorily low. Despite the current infrequent usage, endocrine prevention has the potential to reduce the public health burden of BC significantly. Innovative approaches like finding new agents, alternative dosing and schedule of currently available agents, transdermal medication delivery, increased public and professional awareness, and policymakers' commitments may bring the desired changes.
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Affiliation(s)
- Nusrat Jahan
- Division of Hematology-Oncology, Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th St, Lubbock, Tx, 79430, USA.
| | - Catherine Jones
- Division of Hematology-Oncology, Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th St, Lubbock, Tx, 79430, USA
| | - Rakhshanda Layeequr Rahman
- Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th St, Lubbock, Tx, 79430, USA
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Su M, Huynh V, Bronsert M, Su E, Goode J, Lock A, Banden S, Ahrendt G, Afghahi A, Arruda J, Tevis S. Longitudinal Risk Management for Patients with Increased Risk for Breast Cancer. J Surg Res 2021; 266:421-429. [PMID: 34102512 DOI: 10.1016/j.jss.2021.04.001] [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: 12/04/2020] [Revised: 03/05/2021] [Accepted: 04/01/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study aims to characterize longitudinal care management and evaluate the relationship between various patient factors and the likelihood of choosing risk-reducing behaviors in women with increased risk of developing breast cancer. METHODS A retrospective study was conducted to evaluate all adult female patients who had at least one clinic visit with a surgical provider for discussion of breast cancer risk assessment between January, 2017 to July, 2020 at an academic center. Patients with prior history of breast cancer were excluded. Patient details and strategies pursued at clinic visits were recorded. A time-to-event analysis was performed, and hazard ratios were determined to characterize associations between patient characteristics and time to pursuing risk-reducing care management. RESULTS There were 283 participants with at least one follow-up visit and 48 (17.0%) ultimately changed their initial strategy to either chemoprevention or prophylactic mastectomy. Patients with gene mutations were 6 times more likely to engage in risk-reducing management compared to those without (hazard ratio (HR) 5.99, P < 0.001). Those with histories of high-risk proliferative changes (HR 7.62, P < 0.001) and hysterectomy (HR 2.99, P = 0.019) were also more likely to engage in risk-reducing management. Age, race, and increased predicted risk of developing breast cancer (estimated by various calculators) were not associated with increased likelihood of engaging in risk-reducing strategies. CONCLUSION Known gene mutations, history of high-risk proliferative changes, and prior hysterectomy were factors associated with women who were more likely to engage in risk-reducing strategies. These findings, when paired with patient reported outcome measures, may help guide shared decision-making.
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Affiliation(s)
- Malcolm Su
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Victoria Huynh
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael Bronsert
- University of Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) and Surgical Outcomes and Applied Research (SOAR) Program, Aurora, CO, USA
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Jennifer Goode
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Allison Lock
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Serenity Banden
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anosheh Afghahi
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jaime Arruda
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sarah Tevis
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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18
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Park YHA, Keller A, Hsu TCM, Bidassie B, Venne V, Hawley D, Hoffman-Högg L, Heron B, Colonna S, Aggarwal A. Screening High-Risk Women Veterans for Breast Cancer. Fed Pract 2021; 38:S35-S41. [PMID: 34177240 PMCID: PMC8223736 DOI: 10.12788/fp.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Within the US Department of Veterans Affairs (VA), breast cancer prevalence has more than tripled from 1995 to 2012. Women veterans may be at an increased breast cancer risk based on service-related exposures and posttraumatic stress disorder (PTSD). METHODS Women veterans aged ≥ 35 years with no personal history of breast cancer were enrolled at 2 urban VA medical centers. We surveyed women veterans for 5-year and lifetime risks of invasive breast cancer using the Gail Breast Cancer Risk Assessment Tool (BCRAT). Data regarding demographics, PTSD status, eligibility for chemoprevention, and genetic counseling were also collected. Descriptive statistics were used to determine results. RESULTS A total of 99 women veterans participated, of which 60% were Black. In total, 35% were high risk with a 5-year BCRAT > 1.66%. Breast biopsies had been performed in 22% of our entire population; 57% had a family history positive for breast cancer. Comparatively, in our high-risk Black population, 33% had breast biopsies and 94% had a family history. High-risk patients were referred for chemoprevention; 5 accepted and 13 were referred for genetic counseling. PTSD was present in 31% of the high-risk subgroup. CONCLUSIONS A high percentage of Black patients participated in this pilot study, which also showed an above average rate of PTSD among women veterans who are at high risk for developing breast cancer. Historically, breast cancer rates among Black women are lower than those found in the general population. High participation among Black women veterans in this pilot study uncovered the potential for further study of this population, which is otherwise underrepresented in research. Limitations included a small sample size, exclusively urban population, and self-selection for screening. Future directions include the evaluation of genetic and molecular mutations in high risk Black women veterans, possibly even a role for PTSD epigenetic changes.
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Affiliation(s)
- Yeun-Hee Anna Park
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Alison Keller
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Ta-Chueh Melody Hsu
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Balmatee Bidassie
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Vickie Venne
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Douglas Hawley
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Lori Hoffman-Högg
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Bernadette Heron
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Sarah Colonna
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Anita Aggarwal
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
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Schick J, Ritchie RP, Restini C. Breast Cancer Therapeutics and Biomarkers: Past, Present, and Future Approaches. Breast Cancer (Auckl) 2021; 15:1178223421995854. [PMID: 33994789 PMCID: PMC8100889 DOI: 10.1177/1178223421995854] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/26/2021] [Indexed: 12/11/2022] Open
Abstract
Breast cancer (BC) is the leading cause of cancer death in women and the second-most common cancer. An estimated 281 550 new cases of invasive BC will be diagnosed in women in the United States, and about 43 600 will die during 2021. Continual research has shed light on all disease areas, including tumor classification and biomarkers for diagnosis/prognosis. As research investigations evolve, new classes of drugs are emerging with potential benefits in BC treatment that are covered in this manuscript. The initial sections present updated classification and terminology used for diagnosis and prognosis, which leads to the following topics, discussing the past and present treatments available for BC. Our review will generate interest in exploring the complexity of the cell cycle and its association with cancer biology as part of the plethora of target factors toward developing newer drugs and effective therapeutic management of BC.
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Affiliation(s)
- Jason Schick
- College of Osteopathic Medicine, Michigan State University, Clinton Township, MI, USA
| | - Raquel P Ritchie
- College of Osteopathic Medicine, Michigan State University, Clinton Township, MI, USA
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, USA
| | - Carolina Restini
- College of Osteopathic Medicine, Michigan State University, Clinton Township, MI, USA
- Department of Pharmacology & Toxicology, Michigan State University, East Lansing, MI, USA
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20
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Fung SM, Wu RR, Myers RA, Goh J, Ginsburg GS, Matchar D, Orlando LA, Ngeow J. Clinical implementation of an oncology-specific family health history risk assessment tool. Hered Cancer Clin Pract 2021; 19:20. [PMID: 33743786 PMCID: PMC7981979 DOI: 10.1186/s13053-021-00177-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The presence of hereditary cancer syndromes in cancer patients can have an impact on current clinical care and post-treatment prevention and surveillance measures. Several barriers inhibit identification of hereditary cancer syndromes in routine practice. This paper describes the impact of using a patient-facing family health history risk assessment platform on the identification and referral of breast cancer patients to genetic counselling services. METHODS This was a hybrid implementation-effectiveness study completed in breast cancer clinics. English-literate patients not previously referred for genetic counselling and/or gone through genetic testing were offered enrollment. Consented participants were provided educational materials on family health history collection, entered their family health history into the platform and completed a satisfaction survey. Upon completion, participants and their clinicians were given personalized risk reports. Chart abstraction was done to identify actions taken by patients, providers and genetic counsellors. RESULTS Of 195 patients approached, 102 consented and completed the study (mean age 55.7, 100 % women). Sixty-six (65 %) met guideline criteria for genetic counseling of which 24 (36 %) were referred for genetic counseling. Of those referred, 13 (54 %) participants attended and eight (33 %) completed genetic testing. On multivariate logistic regression, referral was not associated with age, cancer stage, or race but was associated with clinical provider (p = 0.041). Most providers (71 %) had higher referral rates during the study compared to prior. The majority of participants found the experience useful (84 %), were more aware of their health risks (83 %), and were likely to recommend using a patient-facing platform to others (69 %). CONCLUSIONS 65 % of patients attending breast cancer clinics in this study are at-risk for hereditary conditions based on current guidelines. Using a patient-facing risk assessment platform enhances the ability to identify these patients systematically and with widespread acceptability and recognized value by patients. As only a third of at-risk participants received referrals for genetic counseling, further understanding barriers to referral is needed to optimize hereditary risk assessment in oncology practices. TRIAL REGISTRATION NIH Clinical Trials registry, NCT04639934 . Registered Nov 23, 2020 -- Retrospectively registered.
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Affiliation(s)
- Si Ming Fung
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - R Ryanne Wu
- Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA.
- Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA.
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
| | - Rachel A Myers
- Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
| | - Jasper Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Geoffrey S Ginsburg
- Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
- Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
| | - David Matchar
- Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Lori A Orlando
- Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
- Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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21
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Samimi G, Heckman-Stoddard BM, Holmberg C, Tennant B, Sheppard BB, Coa KI, Kay SS, Ford LG, Szabo E, Minasian LM. Assessment of and Interventions for Women at High Risk for Breast or Ovarian Cancer: A Survey of Primary Care Physicians. Cancer Prev Res (Phila) 2020; 14:205-214. [PMID: 33023915 DOI: 10.1158/1940-6207.capr-20-0407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/16/2020] [Accepted: 10/02/2020] [Indexed: 01/10/2023]
Abstract
As clinical guidelines for cancer prevention refer individuals to primary care physicians (PCP) for risk assessment and clinical management, PCPs may be expected to play an increasing role in cancer prevention. It is crucial that PCPs are adequately supported to assess an individual's cancer risk and make appropriate recommendations. The objective of this study is to assess use, familiarity, attitude, and behaviors of PCPs regarding breast and ovarian cancer risk and prevention, to better understand the factors that influence their prescribing behaviors. We conducted a cross-sectional, web-based survey of PCPs in the United States, recruited from an opt-in healthcare provider panel. Invitations were sent in batches until the target sample size of 750 respondents (250 each for obstetrics/gynecology, internal medicine, and family medicine) was met. Self-reported use of breast/ovarian cancer risk assessments was low (34.7%-59.2%) compared with discussion of cancer family history (96.9%), breast exams (87.1%), and mammograms (92.8%). Although most respondents (48.0%-66.8%) were familiar with cancer prevention interventions, respondents who reported to be less familiar were more likely to report cautious attitudes. When presented with hypothetical cases depicting patients at different breast/ovarian cancer risks, up to 34.0% of respondents did not select any of the clinically recommended course(s) of action. This survey suggests that PCP use of breast/ovarian cancer risk assessment tools and ability to translate the perceived risks to clinical actions is variable. Improving implementation of cancer risk assessment and clinical management guidelines within primary care may be necessary to improve the appropriate prescribing of cancer prevention interventions.Prevention Relevance: Primary care physicians are becoming more involved in cancer prevention management, so it is important that cancer risk assessment and medical society guideline recommendations for cancer prevention are better integrated into primary care to improve appropriate prescribing of cancer prevention interventions and help reduce cancer risk.
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Affiliation(s)
- Goli Samimi
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland.
| | | | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg, Havel, Germany
| | | | | | | | | | - Leslie G Ford
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
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Gu KJ, Li G. An Overview of Cancer Prevention: Chemoprevention and Immunoprevention. J Cancer Prev 2020; 25:127-135. [PMID: 33033707 PMCID: PMC7523034 DOI: 10.15430/jcp.2020.25.3.127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 12/21/2022] Open
Abstract
Cancer prevention encompasses a broad spectrum of strategies designed to lower the chance of developing cancer and reduce the morbidity of established cancer. There are three levels of cancer prevention. Eliminating or mitigating cancer risk factors by adopting healthy behaviors and lifestyles, such as avoiding tobacco and alcohol use, exercising, eating a healthy diet, and applying sunscreen to protect against UV exposure, belongs to primary prevention and is the easiest and most effective way of preventing cancer for the general public. Secondary prevention includes screening to identify precancerous lesions and taking intervention measures to prevent disease progression to malignancy. Tertiary prevention refers to reducing or controlling the symptoms and morbidity of established cancer or the morbidity caused by cancer therapy. For high-risk populations, chemopreventive agents, such as selective estrogen receptor modulators (including tamoxifan and raloxifene) in breast cancer prevention and non-steroidal anti-inflammatory drugs (aspirin) in colorectal cancer prevention, and immunoprevention using human papillomavirus and hepatitis B virus vaccines in infection-related cancers have shown clear clinical benefits of reducing cancer incidences. In this review, we will summarize the current status of cancer prevention, focusing on the major agents that are clinically used for chemoprevention and immunoprevention.
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Affiliation(s)
- Kyle J Gu
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,College of Natural Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Guojun Li
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Epidemiology, The University of Texas School of Public Health, Houston, TX, USA
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Samimi G, Heckman-Stoddard BM, Holmberg C, Tennant B, Sheppard BB, Coa KI, Kay SS, Ford LG, Szabo E, Minasian LM. Cancer Prevention in Primary Care: Perception of Importance, Recognition of Risk Factors and Prescribing Behaviors. Am J Med 2020; 133:723-732. [PMID: 31862335 PMCID: PMC7293933 DOI: 10.1016/j.amjmed.2019.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Acceptability and uptake of cancer preventive interventions is associated with physician recommendation, which is dependent on physician familiarity with available preventive options. The goal of this study is to evaluate cancer prevention perceptions, understanding of breast and ovarian cancer risk factors, and prescribing behaviors of primary care physicians. METHODS We conducted cross-sectional. Web-based survey of 750 primary care physicians (250 each for obstetrics/gynecology, internal medicine, and family medicine) in the United States. Survey respondents were recruited from an opt-in health care provider panel. RESULTS Perception of importance and the practice of recommending general and cancer-specific preventive screenings and interventions significantly differed by provider type. These perceptions and behaviors reflected the demographics of the population that the primary care physicians see within their respective practices. The majority of respondents recognized genetic/hereditary risk factors for breast or ovarian cancer, while epidemiologic or clinical risk factors were less frequently recognized. Prescribing behaviors were related to familiarity with the interventions, with physicians indicating that they more frequently reinforced a specialist's recommendation rather than prescribed a preventive intervention. CONCLUSIONS Cancer prevention perceptions, recognition of cancer risk factors, and prescribing behaviors differ among practice types and were related to familiarity with preventive options. Cancer prevention education and risk assessment resources should be more widely available to primary care physicians.
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Affiliation(s)
- Goli Samimi
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD.
| | | | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg, Havel, Germany
| | | | | | | | | | - Leslie G Ford
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
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Tuohy VK, Johnson JM, Mazumder S. Primary immunoprevention of adult onset cancers by vaccinating against retired tissue-specific self-proteins. Semin Immunol 2020; 47:101392. [PMID: 31926646 DOI: 10.1016/j.smim.2020.101392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/01/2020] [Indexed: 11/25/2022]
Abstract
Despite the enormous success of childhood prophylactic vaccination against diseases caused by pathogens, there is currently no similar preventive vaccine program against diseases confronted with age like breast cancer and ovarian cancer. With the exception of the annual influenza vaccine, current recommendations for adult vaccination are for either primary vaccines not received during childhood or for booster vaccinations to maintain the immunity against pathogens already induced during childhood. Here we describe a strategy to provide prophylactic pre-emptive immunity against the development of adult onset cancers not associated with any definitive etiopathogenic agent. We propose that safe and effective pre-emptive immunity may be induced in cancer-free subjects by vaccination against immunodominant tissue-specific self-proteins that are 'retired' from expression in normal tissues as part of the normal aging process but are expressed in tumors that emerge with age. Primary immunoprevention of adult onset cancers like breast cancer and ovarian cancer represents a great challenge and an even greater unmet need for our current healthcare.
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Affiliation(s)
- Vincent K Tuohy
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Department of Biological, Geological and Environmental Sciences, Cleveland State University, Cleveland, OH, USA.
| | - Justin M Johnson
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Biological, Geological and Environmental Sciences, Cleveland State University, Cleveland, OH, USA
| | - Suparna Mazumder
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
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25
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Bajpai J, Singh G, Chougule A, Chandrani P. Rare mutations in breast cancer and implications in the clinic: Oscillation between sharp horns of dilemmas! CANCER RESEARCH, STATISTICS, AND TREATMENT 2020. [DOI: 10.4103/crst.crst_136_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Visvanathan K, Fabian CJ, Bantug E, Brewster AM, Davidson NE, DeCensi A, Floyd JD, Garber JE, Hofstatter EW, Khan SA, Katapodi MC, Pruthi S, Raab R, Runowicz CD, Somerfield MR. Use of Endocrine Therapy for Breast Cancer Risk Reduction: ASCO Clinical Practice Guideline Update. J Clin Oncol 2019; 37:3152-3165. [DOI: 10.1200/jco.19.01472] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To update the ASCO guideline on pharmacologic interventions for breast cancer risk reduction and provide guidance on clinical issues that arise when deciding to use endocrine therapy for breast cancer risk reduction. METHODS An Expert Panel conducted targeted systematic literature reviews to identify new studies. RESULTS A randomized clinical trial that evaluated the use of anastrozole for reduction of estrogen receptor–positive breast cancers in postmenopausal women at increased risk of developing breast cancer provided the predominant basis for the update. UPDATED RECOMMENDATIONS In postmenopausal women at increased risk, the choice of endocrine therapy now includes anastrozole (1 mg/day) in addition to exemestane (25 mg/day), raloxifene (60 mg/day), or tamoxifen (20 mg/day). The decision regarding choice of endocrine therapy should take into consideration age, baseline comorbidities, and adverse effect profiles. Clinicians should not prescribe anastrozole, exemestane, or raloxifene for breast cancer risk reduction to premenopausal women. Tamoxifen 20 mg/day for 5 years is still considered standard of care for risk reduction in premenopausal women who are at least 35 years old and have completed childbearing. Data on low-dose tamoxifen as an alternative to the standard dose for both pre- and postmenopausal women with intraepithelial neoplasia are discussed in the Clinical Considerations section of this article. Additional information is available at www.asco.org/breast-cancer-guidelines .
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Affiliation(s)
- Kala Visvanathan
- Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | | | - Andrea DeCensi
- National Hospital E.O. Ospedali Galliera S.C. Oncologia Medica, Genoa, Italy; and Queen Mary University of London, United Kingdom
| | | | | | | | - Seema A. Khan
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Rachal Raab
- Cancer Care of Western North Carolina, Asheville, NC
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27
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Shin JJ, Choi YM, Jun JK, Lee KH, Kim TY, Han W, Im SA. Amenorrhea and Menopause in Patients with Breast Cancer after Chemotherapy. J Breast Cancer 2019; 22:624-634. [PMID: 31897335 PMCID: PMC6933038 DOI: 10.4048/jbc.2019.22.e53] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 11/03/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose The probability of ovarian failure after cytotoxic chemotherapy in patients with breast cancer has not been well established in Korea. This study aimed to assess the rate of ovarian failure in a large cohort of Korean premenopausal patients with breast cancer 12 months after chemotherapy. Methods This retrospective cohort study included premenopausal women (aged 20−44 years) with breast cancer who underwent chemotherapy after surgery. The rates of treatment-related amenorrhea (TRA) and chemotherapy-induced menopause (CIM) at 12 months after chemotherapy were analyzed. Results A total of 237 patients met the inclusion criteria. The rate of TRA was 61.6% and that of CIM was 13.1% at 12 months after chemotherapy. The rates of TRA and CIM were 28.0% and 4.0%, respectively, in women aged 25−34 years, and they gradually increased up to 75.9% (TRA) and 15.8% (CIM), respectively, in women aged 40−44 years. The frequency of CIM was significantly lower than that of TRA in both age groups. In multivariate analyses, only tamoxifen use was significantly associated with a decreased risk of CIM (p < 0.001). Age of 40 years or higher and the regimens of doxorubicin plus cyclophosphamide followed by docetaxel or paclitaxel were associated with increased risk of TRA (p = 0.001 and p = 0.002, respectively). Conclusion Marked discrepancy in the rates of CIM and TRA was observed in this study. Further, the age-specific frequency of CIM and TRA observed in this study is a reliable and practical estimate of the risks of CIM and TRA in the absence of gonadal protection.
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Affiliation(s)
- Jae Jun Shin
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Fertility Center, Heryoojae Women's Hospital, Goyang, Korea
| | - Young Min Choi
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Medical Research Center, the Institute of Reproductive Medicine and Population, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Grady MC, Kolla KA, Peshkin BN. Multigene Cancer Panels: Implications for Pre- and Post-test Genetic Counseling. CURRENT GENETIC MEDICINE REPORTS 2019. [DOI: 10.1007/s40142-019-00173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Spinello A, Ritacco I, Magistrato A. Recent advances in computational design of potent aromatase inhibitors: open-eye on endocrine-resistant breast cancers. Expert Opin Drug Discov 2019; 14:1065-1076. [DOI: 10.1080/17460441.2019.1646245] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Angelo Spinello
- National Research Council - Istituto Officina dei Materiali c/o International School for Advanced Studies (SISSA), Trieste, Italy
| | - Ida Ritacco
- National Research Council - Istituto Officina dei Materiali c/o International School for Advanced Studies (SISSA), Trieste, Italy
| | - Alessandra Magistrato
- National Research Council - Istituto Officina dei Materiali c/o International School for Advanced Studies (SISSA), Trieste, Italy
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30
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Pederson HJ. Clinical care of women with intermediate breast cancer risk. Menopause 2019; 26:797-799. [PMID: 31259797 DOI: 10.1097/gme.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Ha R, Chang P, Karcich J, Mutasa S, Pascual Van Sant E, Liu MZ, Jambawalikar S. Convolutional Neural Network Based Breast Cancer Risk Stratification Using a Mammographic Dataset. Acad Radiol 2019; 26:544-549. [PMID: 30072292 PMCID: PMC8114104 DOI: 10.1016/j.acra.2018.06.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES We propose a novel convolutional neural network derived pixel-wise breast cancer risk model using mammographic dataset. MATERIALS AND METHODS An institutional review board approved retrospective case-control study of 1474 mammographic images was performed in average risk women. First, 210 patients with new incidence of breast cancer were identified. Mammograms from these patients prior to developing breast cancer were identified and made up the case group [420 bilateral craniocaudal mammograms]. The control group consisted of 527 patients without breast cancer from the same time period. Prior mammograms from these patients made up the control group [1054 bilateral craniocaudal mammograms]. A convolutional neural network (CNN) architecture was designed for pixel-wise breast cancer risk prediction. Briefly, each mammogram was normalized as a map of z-scores and resized to an input image size of 256 × 256. Then a contracting and expanding fully convolutional CNN architecture was composed entirely of 3 × 3 convolutions, a total of four strided convolutions instead of pooling layers, and symmetric residual connections. L2 regularization and augmentation methods were implemented to prevent overfitting. Cases were separated into training (80%) and test sets (20%). A 5-fold cross validation was performed. Software code was written in Python using the TensorFlow module on a Linux workstation with NVIDIA GTX 1070 Pascal GPU. RESULTS The average age of patients between the case and the control groups was not statistically different [case: 57.4years (SD, 10.4) and control: 58.2years (SD, 10.9), p = 0.33]. Breast Density (BD) was significantly higher in the case group [2.39 (SD, 0.7)] than the control group [1.98 (SD, 0.75), p < 0.0001]. On multivariate logistic regression analysis, both CNN pixel-wise mammographic risk model and BD were significant independent predictors of breast cancer risk (p < 0.0001). The CNN risk model showed greater predictive potential [OR = 4.42 (95% CI, 3.4-5.7] compared to BD [OR = 1.67 (95% CI, 1.4-1.9). The CNN risk model achieved an overall accuracy of 72% (95%CI, 69.8-74.4) in predicting patients in the case group. CONCLUSION Novel pixel-wise mammographic breast evaluation using a CNN architecture can stratify breast cancer risk, independent of the BD. Larger dataset will likely improve our model.
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Affiliation(s)
- Richard Ha
- Research and Education, Breast Imaging Section, Department of Radiology, Columbia University Medical Center, 622 West 168th Street, PB-1-301, New York, NY 10032.
| | - Peter Chang
- UC San Francisco Medical Center, Department of Radiology, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Jenika Karcich
- Department of Radiology, Columbia University Medical Center, New York, New York 10032
| | - Simukayi Mutasa
- Department of Radiology, Columbia University Medical Center, New York, New York 10032
| | | | - Michael Z Liu
- Department of Medical Physics, Columbia University Medical Center, New York, New York 10032-3784
| | - Sachin Jambawalikar
- Department of Medical Physics, Columbia University Medical Center, New York, New York 10032-3784
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Sin M, McGuinness JE, Trivedi MS, Vanegas A, Silverman TB, Crew KD, Kukafka R. Automatic Genetic Risk Assessment Calculation Using Breast Cancer Family History Data from the EHR compared to Self-Report. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:970-978. [PMID: 30815140 PMCID: PMC6371348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Genetic testing is a method to assess hereditary cancer risk. However, it is under-utilized and various methods of family history intake have been evaluated in previous studies. The six-point-scale (SPS) is a validated family history screener that is used to determine eligibility for BRCA genetic counseling. We automated the calculation of the SPS score using structured family history data along with free text from the electronic health record (EHR) to detect detailed family history information of breast cancer. We extracted data for all women aged 35 to 74 who had screening mammography at Columbia University Medical Center (CUMC) from January 2015 to May 2017 (N=37,596). After we calculated SPS scores using structured and free-text EHR data, we compared the results with SPS score calculated from a baseline survey conducted for a prospective study called Know Your Risks: Assessment at Screening (KYRAS). Among 1,202 patients with EHR structured family history data, we found 1.43% had an SPS score of 6 higher which meets criteria for genetic counseling referral, while 12.05% of the survey respondents had SPS score of 6 or higher. Results show there is a need for more efficient methods to identify patients eligible for genetic counseling through EHR analysis.
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Affiliation(s)
- Margaret Sin
- Columbia University Medical Center, New York, NY
| | | | | | | | | | | | - Rita Kukafka
- Columbia University Medical Center, New York, NY
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Moran O, Zaman T, Eisen A, Demsky R, Blackmore K, Knight JA, Elser C, Ginsburg O, Zbuk K, Yaffe M, Narod SA, Salmena L, Kotsopoulos J. Serum osteoprotegerin levels and mammographic density among high-risk women. Cancer Causes Control 2018; 29:507-517. [PMID: 29679262 DOI: 10.1007/s10552-018-1035-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/18/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE Mammographic density is a risk factor for breast cancer but the mechanism behind this association is unclear. The receptor activator of nuclear factor κB (RANK)/RANK ligand (RANKL) pathway has been implicated in the development of breast cancer. Given the role of RANK signaling in mammary epithelial cell proliferation, we hypothesized this pathway may also be associated with mammographic density. Osteoprotegerin (OPG), a decoy receptor for RANKL, is known to inhibit RANK signaling. Thus, it is of interest to evaluate whether OPG levels modify breast cancer risk through mammographic density. METHODS We quantified serum OPG levels in 57 premenopausal and 43 postmenopausal women using an enzyme-linked immunosorbent assay (ELISA). Cumulus was used to measure percent density, dense area, and non-dense area for each mammographic image. Subjects were classified into high versus low OPG levels based on the median serum OPG level in the entire cohort (115.1 pg/mL). Multivariate models were used to assess the relationship between serum OPG levels and the measures of mammographic density. RESULTS Serum OPG levels were not associated with mammographic density among premenopausal women (P ≥ 0.42). Among postmenopausal women, those with low serum OPG levels had higher mean percent mammographic density (20.9% vs. 13.7%; P = 0.04) and mean dense area (23.4 cm2 vs. 15.2 cm2; P = 0.02) compared to those with high serum OPG levels after covariate adjustment. CONCLUSIONS These findings suggest that low OPG levels may be associated with high mammographic density, particularly in postmenopausal women. Targeting RANK signaling may represent a plausible, non-surgical prevention option for high-risk women with high mammographic density, especially those with low circulating OPG levels.
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Affiliation(s)
- Olivia Moran
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., 6th Floor, Toronto, ON, M5S 1B2, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Tasnim Zaman
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., 6th Floor, Toronto, ON, M5S 1B2, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Andrea Eisen
- Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada
| | - Rochelle Demsky
- Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | | | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Christine Elser
- Division of Medical Oncology and Hematology, Department of Medicine, Mount Sinai Hospital and The Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Ophira Ginsburg
- Laura and Isaac Perlmutter Cancer Centre, NYU Langone Medical Center, NYU School of Medicine, New York, NY, USA
| | - Kevin Zbuk
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Martin Yaffe
- Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., 6th Floor, Toronto, ON, M5S 1B2, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Leonardo Salmena
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., 6th Floor, Toronto, ON, M5S 1B2, Canada. .,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Brewster AM, Thomas P, Brown P, Coyne R, Yan Y, Checka C, Middleton L, Do KA, Bevers T. A System-Level Approach to Improve the Uptake of Antiestrogen Preventive Therapy among Women with Atypical Hyperplasia and Lobular Cancer In Situ. Cancer Prev Res (Phila) 2018; 11:295-302. [DOI: 10.1158/1940-6207.capr-17-0314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/20/2017] [Accepted: 02/21/2018] [Indexed: 11/16/2022]
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Clinical Characteristics in Patients with Triple Negative Breast Cancer. Int J Breast Cancer 2017; 2017:1796145. [PMID: 28912973 PMCID: PMC5585655 DOI: 10.1155/2017/1796145] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/16/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose The purpose of this study was to compare and contrast the clinical characteristics of the triple negative breast cancer (TNBC) and non-TNBC patients, with a particular focus on genetic susceptibility and risk factors prior to diagnosis. Methods Our institutional database was queried for all patients diagnosed with invasive breast cancer between January 2010 and May 2016. Results Out of a total of 1964 patients, 190 (10%) patients had TNBC. The median age for both TNBC and non-TNBC was 59 years. There was a significantly higher proportion of African American and Asian patients with TNBC (p = 0.0003) compared to patients with non-TNBC. BRCA1 and BRCA2 were significantly associated with TNBC (p < 0.0001, p = 0.0007). A prior history of breast cancer was significantly associated with TNBC (p = 0.0003). There was no relationship observed between TNBC and a history of chemoprevention or patients who had a history of AH or LCIS. Conclusions We found that having Asian ancestry, a prior history of breast cancer, and a BRCA1 or BRCA2 mutation all appear to be positively associated with TNBC. In order to develop more effective treatments, better surveillance, and improved prevention strategies, it is necessary to improve our understanding of the population at risk for TNBC.
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Tschernichovsky R, Goodman A. Risk-Reducing Strategies for Ovarian Cancer in BRCA Mutation Carriers: A Balancing Act. Oncologist 2017; 22:450-459. [PMID: 28314837 PMCID: PMC5388383 DOI: 10.1634/theoncologist.2016-0444] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/22/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to review the role of bilateral salpingo-oophorectomy in BRCA mutation (mBRCA) carriers and alternative interventions in risk reduction of ovarian cancer (OC). MATERIALS AND METHODS A systematic review using PubMed, MEDLINE, EMBASE, and the Cochrane library was conducted to identify studies of different strategies to prevent OC in mBRCA carriers, including bilateral salpingo-oophorectomy, prophylactic salpingectomy with delayed oophorectomy, intensive surveillance, and chemoprevention. RESULTS Risk-reducing bilateral salpingo-oophorectomy is an effective intervention, but its associated morbidity is substantial and seems to curtail uptake rates among the target population. Although there is much interest and a strong theoretical basis for salpingectomy with delayed oophorectomy, data on its clinical application are scarce with regard to screening, the use of an algorithmic protocol has recently shown favorable albeit indefinite results in average-risk postmenopausal women. Its incorporation into studies focused on high-risk women might help solidify a future role for screening as a bridge to surgery. The use of oral contraceptives for chemoprevention is well supported by epidemiologic studies. However, there is a lack of evidence for advocating any of the other agents proposed for this purpose, including nonsteroidal anti-inflammatory drugs, vitamin D, and retinoids. CONCLUSION Further studies are needed before salpingectomy with delayed oophorectomy or intensive surveillance can be offered as acceptable, less morbid alternatives to upfront oophorectomy for mBRCA carriers. The Oncologist 2017;22:450-459 IMPLICATIONS FOR PRACTICE: Risk-reducing bilateral salpingo-oophorectomy is currently the most effective method for reducing the risk of ovarian cancer in BRCA mutation (mBRCA) carriers. Unfortunately, it is associated with significant short- and long-term morbidity, stemming from reduced circulating estrogen. In recent years, much research has been devoted to evaluating less morbid alternatives, especially multimodal cancer screening and prophylactic salpingectomy with delayed oophorectomy. This review describes the present state of the art, with the aim of informing the counseling provided to mBRCA carriers on this complicated issue and encouraging additional research to facilitate the incorporation of such alternatives into routine practice.
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Affiliation(s)
| | - Annekathryn Goodman
- Division of Gynecologic Oncology
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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37
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Padamsee TJ, Wills CE, Yee LD, Paskett ED. Decision making for breast cancer prevention among women at elevated risk. Breast Cancer Res 2017; 19:34. [PMID: 28340626 PMCID: PMC5366153 DOI: 10.1186/s13058-017-0826-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Several medical management approaches have been shown to be effective in preventing breast cancer and detecting it early among women at elevated risk: 1) prophylactic mastectomy; 2) prophylactic oophorectomy; 3) chemoprevention; and 4) enhanced screening routines. To varying extents, however, these approaches are substantially underused relative to clinical practice recommendations. This article reviews the existing research on the uptake of these prevention approaches, the characteristics of women who are likely to use various methods, and the decision-making processes that underlie the differing choices of women. It also highlights important areas for future research, detailing the types of studies that are particularly needed in four key areas: documenting women's perspectives on their own perceptions of risk and prevention decisions; explicit comparisons of available prevention pathways and their likely health effects; the psychological, interpersonal, and social processes of prevention decision making; and the dynamics of subgroup variation. Ultimately, this research could support the development of interventions that more fully empower women to make informed and values-consistent decisions, and to move towards favorable health outcomes.
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Affiliation(s)
- Tasleem J. Padamsee
- Division of Health Services Management & Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH 43220 USA
| | - Celia E. Wills
- College of Nursing, The Ohio State University, Columbus, OH USA
| | - Lisa D. Yee
- College of Medicine, The Ohio State University, Columbus, OH USA
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Breast Cancer Profile among Patients with a History of Chemoprevention. Int J Breast Cancer 2017; 2016:9216375. [PMID: 28078143 PMCID: PMC5203899 DOI: 10.1155/2016/9216375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/27/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose. This study identifies women with breast cancer who utilized chemoprevention agents prior to diagnosis and describes their patterns of disease. Methods. Our database was queried retrospectively for patients with breast cancer who reported prior use of chemoprevention. Patients were divided into primary (no history of breast cancer) and secondary (previous history of breast cancer) groups and compared to patients who never took chemoprevention. Results. 135 (6%) of 2430 women used chemoprevention. In the primary chemoprevention group (n = 18, 1%), 39% had completed >5 years of treatment, and fully 50% were on treatment at time of diagnosis. These patients were overwhelmingly diagnosed with ER/PR positive cancers (88%/65%) and were diagnosed with equal percentages (44%) of IDC and DCIS. 117 (87%) used secondary chemoprevention. Patients in this group were diagnosed with earlier stage disease and had lower rates of ER/PR-positivity (73%/65%) than the nonchemoprevention group (84%/72%). In the secondary group, 24% were on chemoprevention at time of diagnosis; 73% had completed >5 years of treatment. Conclusions. The majority of patients who used primary chemoprevention had not completed treatment prior to diagnosis, suggesting that the timing of initiation and compliance to prevention strategies are important in defining the pattern of disease in these patients.
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Abstract
The risk for developing breast cancer can be influenced by a number of critical factors. An individual's age, gender, personal and family health history, nutritional status, level of physical activity, environmental exposures, and substance use can significantly shift the recommended screening guidelines format from the general risk population to a high-risk population. It is essential for health-care providers to become proficient in obtaining a complete cancer genetic risk assessment to accurately identify those who may be at high risk. There are a number of evidence-based risk models that can be utilized by providers to determine if an individual is indeed at a higher risk to develop breast cancer. In addition, there are evidence-based guidelines for breast cancer screening and possible recommendations for medical management/risk reduction that are appropriate to discuss for those high-risk individuals.
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Affiliation(s)
- Mary M Vecchio
- Hunterdon Regional Cancer Center, Family Risk Assessment Program, Flemington, NJ, USA
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Hunt KK, Euhus DM, Boughey JC, Chagpar AB, Feldman SM, Hansen NM, Kulkarni SA, McCready DR, Mamounas EP, Wilke LG, Van Zee KJ, Morrow M. Society of Surgical Oncology Breast Disease Working Group Statement on Prophylactic (Risk-Reducing) Mastectomy. Ann Surg Oncol 2016; 24:375-397. [PMID: 27933411 DOI: 10.1245/s10434-016-5688-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Indexed: 12/15/2022]
Abstract
Over the past several years, there has been an increasing rate of bilateral prophylactic mastectomy (BPM) and contralateral prophylactic mastectomy (CPM) surgeries. Since publication of the 2007 SSO position statement on the use of risk-reducing mastectomy, there have been significant advances in the understanding of breast cancer biology and treatment. The purpose of this manuscript is to review the current literature as a resource to facilitate a shared and informed decision-making process regarding the use of risk-reducing mastectomy.
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Affiliation(s)
- Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | | | | | | | | | | | | | | | | | | | - Monica Morrow
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Heisey R, Carroll JC. Identification et prise en charge des femmes ayant des antécédents familiaux de cancer du sein. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e572-e577. [PMID: 27737991 PMCID: PMC5063782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objectif Résumer les meilleures données portant sur les stratégies d’identification et de prise en charge des femmes qui présentent des antécédents familiaux de cancer du sein. Sources d’information Une recherche a été effectuée sur PubMed à l’aide des mots-clés anglais suivants : breast cancer, guidelines, risk, family history, management et magnetic resonance imaging screening, entre 2000 et 2016. La plupart des données sont de niveau II. Message principal Une bonne anamnèse familiale est essentielle lors de l’évaluation du risque de cancer du sein afin d’identifier les femmes qui sont candidates à une recommandation en counseling génétique pour un éventuel test génétique. On peut sauver des vies en offrant aux femmes porteuses d’une mutation au gène BRCA des interventions chirurgicales de réduction des risques (mastectomie bilatérale prophylactique, salpingo-ovariectomie bilatérale). Il faut encourager toutes les femmes qui présentent des antécédents familiaux de cancer du sein à demeurer actives et à limiter leur consommation d’alcool à moins de 1 verre par jour; certaines femmes sont admissibles à la chimioprévention. Il faut offrir aux femmes dont le risque à vie de cancer du sein est de 20 à 25 % ou plus un dépistage poussé par imagerie par résonance magnétique en plus d’une mammographie. Conclusion Une vie saine et la chimioprévention (chez les candidates) pourraient réduire l’incidence du cancer du sein; le dépistage poussé pourrait entraîner une détection plus précoce. Le fait d’aiguiller des femmes porteuses d’une mutation au BRCA vers la chirurgie de réduction des risques sauve des vies.
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Affiliation(s)
- Ruth Heisey
- Chef du Service de médecine familiale et communautaire à l'Hôpital Women's College à Toronto, en Ontario, généraliste-oncologue à l'Hôpital Princess Margaret à Toronto, et investigatrice clinicienne et professeure agrégée au Département de médecine familiale et communautaire de l'Université de Toronto.
| | - June C Carroll
- Médecin de famille au centre Granovsky Gluskin Family Medicine Centre de l'Hôpital Mount Sinai à Toronto, et scientifique clinicienne et professeure agrégée au Département de médecine familiale et communautaire de l'Université de Toronto
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Visser K, Zierau O, Macejová D, Goerl F, Muders M, Baretton GB, Vollmer G, Louw A. The phytoestrogenic Cyclopia extract, SM6Met, increases median tumor free survival and reduces tumor mass and volume in chemically induced rat mammary gland carcinogenesis. J Steroid Biochem Mol Biol 2016; 163:129-35. [PMID: 27142456 DOI: 10.1016/j.jsbmb.2016.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 02/07/2023]
Abstract
SM6Met, a phytoestrogenic extract of Cyclopia subternata indigenous to the Western Cape province of South Africa, displays estrogenic attributes with potential for breast cancer chemoprevention. In this study, we report that SM6Met, in the presence of estradiol, induces a significant cell cycle G0/G1 phase arrest similar to the selective estrogen receptor modulator, tamoxifen. Furthermore, as a proof of concept, in the N-Methyl-N-nitrosourea induced rat mammary gland carcinogenesis model, SM6Met increases tumor latency by 7days and median tumor free survival by 42 days, while decreasing palpable tumor frequency by 32%, tumor mass by 40%, and tumor volume by 53%. Therefore, the current study provides proof of concept that SM6Met has definite potential as a chemopreventative agent against the development and progression of breast cancer.
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MESH Headings
- Animals
- Antineoplastic Agents, Phytogenic/isolation & purification
- Antineoplastic Agents, Phytogenic/pharmacology
- Cell Line, Tumor
- Cyclopia Plant/chemistry
- Estrogen Antagonists/pharmacology
- Female
- G1 Phase Cell Cycle Checkpoints/drug effects
- G1 Phase Cell Cycle Checkpoints/genetics
- Humans
- Mammary Glands, Animal/drug effects
- Mammary Glands, Animal/metabolism
- Mammary Glands, Animal/pathology
- Mammary Neoplasms, Experimental/chemically induced
- Mammary Neoplasms, Experimental/drug therapy
- Mammary Neoplasms, Experimental/mortality
- Mammary Neoplasms, Experimental/pathology
- Methylnitrosourea
- Phytoestrogens/isolation & purification
- Phytoestrogens/pharmacology
- Rats
- Receptors, Estrogen/antagonists & inhibitors
- Receptors, Estrogen/genetics
- Receptors, Estrogen/metabolism
- Survival Analysis
- Tamoxifen/pharmacology
- Tumor Burden/drug effects
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Affiliation(s)
- Koch Visser
- Biochemistry Department, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Oliver Zierau
- Molecular Cell Physiology and Endocrinology, Institute for Zoology, Technische Universität Dresden, Dresden, Germany
| | - Dana Macejová
- Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Florian Goerl
- Institute for Pathology, Radeberg, Germany; Institute for Pathology, University Clinic Carl-Gustav-Carus, Dresden, Germany
| | - Michael Muders
- Institute for Pathology, University Clinic Carl-Gustav-Carus, Dresden, Germany
| | - Gustavo B Baretton
- Institute for Pathology, University Clinic Carl-Gustav-Carus, Dresden, Germany
| | - Günter Vollmer
- Molecular Cell Physiology and Endocrinology, Institute for Zoology, Technische Universität Dresden, Dresden, Germany
| | - Ann Louw
- Biochemistry Department, Stellenbosch University, Stellenbosch, Western Cape, South Africa.
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Heisey R, Carroll JC. Identification and management of women with a family history of breast cancer: Practical guide for clinicians. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:799-803. [PMID: 27737975 PMCID: PMC5063766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To summarize the best evidence on strategies to identify and manage women with a family history of breast cancer. SOURCES OF INFORMATION A PubMed search was conducted using the search terms breast cancer, guidelines, risk, family history, management, and magnetic resonance imaging screening from 2000 to 2016. Most evidence is level II. MAIN MESSAGE Taking a good family history is essential when assessing breast cancer risk in order to identify women suitable for referral to a genetic counselor for possible genetic testing. Offering risk-reducing surgery (bilateral prophylactic mastectomy, bilateral salpingo-oophorectomy) to women with BRCA genetic mutations can save lives. All women with a family history of breast cancer should be encouraged to stay active and limit alcohol intake to less than 1 drink per day; some will qualify for chemoprevention. Women with a 20% to 25% or greater lifetime risk of breast cancer should be offered enhanced screening with annual magnetic resonance imaging in addition to mammography. CONCLUSION Healthy living and chemoprevention (for suitable women) could reduce breast cancer incidence; enhanced screening could result in earlier detection. Referring women who carry BRCA mutations for risk-reducing surgery will save lives.
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Affiliation(s)
- Ruth Heisey
- Chief of Family and Community Medicine at Women's College Hospital in Toronto, Ont, a GP-oncologist at Princess Margaret Hospital in Toronto, and Clinician Investigator and Associate Professor in the Department of Family and Community Medicine at the University of Toronto.
| | - June C Carroll
- Family physician in the Granovsky Gluskin Family Medicine Centre at Mount Sinai Hospital in Toronto and Clinician Scientist and Associate Professor in the Department of Family and Community Medicine at the University of Toronto
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Hum S, Wu M, Pruthi S, Heisey R. Physician and Patient Barriers to Breast Cancer Preventive Therapy. CURRENT BREAST CANCER REPORTS 2016; 8:158-164. [PMID: 27617055 PMCID: PMC4995234 DOI: 10.1007/s12609-016-0216-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The uptake of selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) for the primary prevention of breast cancer is low, despite their proven efficacy in several randomized clinical trials. This review summarizes the latest data on physicians' and women's barriers to breast cancer preventive therapy. Physicians' challenges include: identifying suitable candidates for preventive therapy, inadequate training and confidence in risk assessment and counselling, insufficient knowledge of risk-reducing medications, and lack of time. High-risk women fear medication side effects, and they often weigh experiences of others more heavily than statistical probabilities to guide their decision-making. Despite decision aid interventions to help women make an informed decision, acceptance of preventive therapy will remain low until: risk/benefit profiles are more favorable, physicians are better educated and skilled in having these discussions, and suitable biomarkers to monitor drug efficacy and better clinical risk prediction models to assess true individual risk are available.
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Affiliation(s)
- Susan Hum
- Department of Family & Community Medicine, Women’s College Hospital, 76 Grenville St, Toronto, ON M5S 1B2 Canada
| | - Melinda Wu
- Department of Family & Community Medicine, University of Toronto, Women’s College Hospital, Princess Margaret Hospital, 76 Grenville St, Toronto, ON M5S 1B2 Canada
| | - Sandhya Pruthi
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Ruth Heisey
- Department of Family & Community Medicine, University of Toronto, Women’s College Hospital, Princess Margaret Hospital, 76 Grenville St, Toronto, ON M5S 1B2 Canada
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Madorsky-Feldman D, Sklair-Levy M, Perri T, Laitman Y, Paluch-Shimon S, Schmutzler R, Rhiem K, Lester J, Karlan BY, Singer CF, Van Maerken T, Claes K, Brunet J, Izquierdo A, Teulé A, Lee JW, Kim SW, Arun B, Jakubowska A, Lubinski J, Tucker K, Poplawski NK, Varesco L, Bonelli LA, Buys SS, Mitchell G, Tischkowitz M, Gerdes AM, Seynaeve C, Robson M, Kwong A, Tung N, Tessa N, Domchek SM, Godwin AK, Rantala J, Arver B, Friedman E. An international survey of surveillance schemes for unaffected BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Treat 2016; 157:319-327. [PMID: 27117159 PMCID: PMC5508745 DOI: 10.1007/s10549-016-3805-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/19/2016] [Indexed: 12/18/2022]
Abstract
Female BRCA1/BRCA2 mutation carriers are at substantially increased risk for developing breast and/or ovarian cancer, and are offered enhanced surveillance including screening from a young age and risk-reducing surgery (RRS)-mastectomy (RRM) and/or salpingo-oophorectomy (RRSO). While there are established guidelines for early detection of breast cancer in high-risk women who have not undergone RRM, there are less developed guidelines after RRM. We evaluated the schemes offered before and after RRS in internationally diverse high-risk clinics. An e-mailed survey was distributed to high-risk clinics affiliated with CIMBA. Overall, 22 centers from 16 countries responded. Pre RRS surveillance schemes overwhelmingly included breast imaging (primarily MRI) from 18 to 30 years and clinical breast exam (CBE) at 6-12 month intervals. For ovarian cancer, all but 6 centers offered semiannual/annual gynecological exam, transvaginal ultrasound, and CA 125 measurements. Post RRM, most centers offered only annual CBE while 4 centers offered annual MRI, primarily for substantial residual breast tissue. After RRSO only 4 centers offered specific gynecological surveillance. Existing guidelines for breast/ovarian cancer detection in BRCA carriers are being applied pre RRS but are not globally harmonized, and most centers offer no specific surveillance post RRS. From this comprehensive multinational study it is clear that evidence-based, long-term prospective data on the most effective scheme for BRCA carriers post RRS is needed.
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Affiliation(s)
| | - Miri Sklair-Levy
- The High Risk Clinic, Meirav Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Tamar Perri
- The High Risk Clinic, Meirav Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Yael Laitman
- The High Risk Clinic, Meirav Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
| | - Jenny Lester
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Beth Y Karlan
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Tom Van Maerken
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Kathleen Claes
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Joan Brunet
- Hereditary Cancer Program, Catalan Institute of Oncology Cancer Network, Barcelona, Spain
| | - Angel Izquierdo
- Hereditary Cancer Program, Catalan Institute of Oncology Cancer Network, Barcelona, Spain
| | - Alex Teulé
- Hereditary Cancer Program, Catalan Institute of Oncology Cancer Network, Barcelona, Spain
| | - Jong Won Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Won Kim
- Department of Surgery, Daerim Saint Mary's Hospital, Seoul, South Korea
| | - Banu Arun
- Breast Medical Oncology and Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Jan Lubinski
- Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Katherine Tucker
- Hereditary Cancer Service Prince of Wales Hospital, Sydney, Australia
| | - Nicola K Poplawski
- Adult Genetics Unit, South Australian Clinical Genetics Service SA Pathology at the Women's and Children's Hospital Site, North Adelaide, Australia
- University Department of Pediatrics, University of Adelaide, Adelaide, Australia
| | | | | | - Saundra S Buys
- Department of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Gillian Mitchell
- Hereditary Cancer Program at the BC Cancer Agency, Vancouver, BC, Canada
| | - Marc Tischkowitz
- Department of Medical Genetics, University of Cambridge Addenbrooke's Hospital, Cambridge, UK
| | - Anne-Marie Gerdes
- Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mark Robson
- Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Ava Kwong
- Hong Kong Hereditary Breast Cancer Family Registry, and Department of Breast Surgery, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | | | - Susan M Domchek
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Johanna Rantala
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Brita Arver
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Eitan Friedman
- The High Risk Clinic, Meirav Center, Sheba Medical Center, Tel Hashomer, Israel.
- The Susanne Levy Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
- The Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
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