Surveillance Protocols for Survivors at Risk for Lymphedema
This article provides an overview of the prospective surveillance model (PSM), an optimal framework for early identification of BCRL in individuals at risk, shares implementation strategies across two different cultures, and suggests future direction for research and clinical practice to enhance implementation. (Source: Current Breast Cancer Reports)
Source: Current Breast Cancer Reports - January 7, 2021 Category: Cancer & Oncology Source Type: research

Advances in Breast Cancer Radiation Therapy
AbstractPurpose of ReviewRadiation therapy remains an integral component in the treatment of all stages of breast cancer which is the leading cause of cancer worldwide for women. We aimed to identify and characterize clinical trials in radiation therapy that have led to changes in practice essential for every physician who treats breast cancer.Recent FindingsHypofractionation, accelerated partial breast irradiation, and prone positioning have led to shorter treatment times and decreased toxicity for early-stage breast cancer patients. For patients with nodal metastasis, regional nodal radiation has improved disease-free su...
Source: Current Breast Cancer Reports - January 6, 2021 Category: Cancer & Oncology Source Type: research

Safety and Outcomes of Oncoplastic Breast Surgery
AbstractPurpose of ReviewTraditional breast-conserving surgery combined with whole breast radiation results in equivalent overall survival as total mastectomy, with the benefit of being less invasive with fewer surgical complications and faster recovery. However, the surgical defect in the breast parenchyma, when combined with whole breast radiation, can result in cosmetic deformities that many patients find distressing. Partial mastectomy performed using plastic/reconstructive surgical techniques with the goal of optimizing both oncologic and esthetic outcomes is referred to as oncoplastic (breast) surgery. Herein, the su...
Source: Current Breast Cancer Reports - January 5, 2021 Category: Cancer & Oncology Source Type: research

Breast Cancer Risk and Screening in Transgender Individuals
AbstractPurpose of ReviewThere are over 1.4 million individuals who identify as transgender in the USA, and these individuals are frequently treated with cross-sex hormonal therapy (CSH) to acquire their desired phenotype. Simultaneously, breast cancer is one of the most common cancers in the USA, and there are mixed data on how CSH may influence breast cancer development in transgender individuals. Here, we review the barriers that exist to health access in this population, the current evidence of breast cancer risk in transgender individuals, and breast cancer screening guidelines for both transgender women and men.Recen...
Source: Current Breast Cancer Reports - January 4, 2021 Category: Cancer & Oncology Source Type: research

Model-Based Patterns of Lymphedema Symptomatology: Phenotypic and Biomarker Characterization
This study aimed to identify lymphedema symptom patterns and the association of such patterns with phenotypic characteristics and biomarkers using latent class analysis (LCA). A prospective, descriptive, and repeated-measure design was used to enroll 140 women and collect data.Recent FindingsLCA identified three distinct lymphedema symptom classes at 8  weeks and 12 months post-surgery: low, moderate, and severe symptom classes and associated phenotypic characteristics. Participants were more likely to be in the severe symptom classes at 12 months post-surgery if they had lower education level, cording, an a...
Source: Current Breast Cancer Reports - November 24, 2020 Category: Cancer & Oncology Source Type: research

Locoregional Management of Inflammatory Breast Cancer
AbstractPurpose of ReviewInflammatory breast cancer (IBC) is a biologically aggressive subtype with a high risk for rapid local progression and early distant metastasis. We review the updated data for optimal locoregional management of IBC, including areas of active controversy.Recent FindingsAdvancements in tri-modality therapies have improved survival among IBC patients in recent years; however, the risk of locoregional and distant recurrence remains high, particularly in triple-negative IBC. Data to support de-escalation of surgery or radiotherapy is limited, and the recommended treatment approach for non-metastatic IBC...
Source: Current Breast Cancer Reports - November 18, 2020 Category: Cancer & Oncology Source Type: research

Addressing Fertility: an Essential Aspect of Comprehensive Care for Young Patients with Breast Cancer
AbstractPurpose of ReviewApproximately 12,000 women between 20 and 39  years of age are diagnosed with invasive breast cancer (BC) annually in the USA. We aim to summarize data regarding the impact of BC treatment on fertility and strategies for fertility preservation in young women with BC.Recent FindingsStandard curative therapies for breast cancer can lead to subfertility, infertility, and primary ovarian insufficiency by their direct gonadotoxic effects and/or by delaying the age at which a woman can attempt pregnancy. Oocyte and embryo cryopreservation are the preferred options for fertility preservation and, if ...
Source: Current Breast Cancer Reports - November 13, 2020 Category: Cancer & Oncology Source Type: research

Impact of Breast Cancer Systemic Therapies on Fertility
AbstractPurpose of ReviewMany young women diagnosed with breast cancer will be confronted with premature ovarian insufficiency and infertility as a consequence of systemic therapies used to treat their cancer. This is a concern for nearly half of young women diagnosed with breast cancer. We will review the impact of breast cancer chemotherapy, endocrine therapy, and immunotherapy on fertility and surrogate markers of fertility.Recent FindingsModern breast cancer treatments continue to have an impact on a woman ’s fertility potential. This risk is reduced as more patients are able to safely eliminate chemotherapy as p...
Source: Current Breast Cancer Reports - November 10, 2020 Category: Cancer & Oncology Source Type: research

De-Escalation of Local-Regional Therapy for Older Breast Cancer Patients
AbstractPurpose of ReviewOver the past decade, prospective clinical trials and retrospective data have changed clinical guidelines for the treatment of older patients, most notably those patients with early, hormone receptor-positive, clinically node-negative breast cancer. Here is a comprehensive review of the literature supporting de-escalation of local-regional therapy in older patients with breast cancer.Recent FindingsThe de-escalation of treatment in elderly patients includes minimizing surgical interventions and adjuvant radiation therapy. Current Choosing Wisely ® guidelines recommend considering the omission o...
Source: Current Breast Cancer Reports - November 9, 2020 Category: Cancer & Oncology Source Type: research

Regional Nodal Recurrence after Treatment for Breast Cancer
AbstractPurpose of ReviewRegional nodal recurrence (RNR) after breast cancer treatment is historically rare but associated with worse survival outcomes. The management of primary breast cancer has changed significantly, with less completion axillary dissection (ALND) and increased use of genomic testing, neoadjuvant therapy, and regional nodal irradiation. This review examines the incidence, risk factors, presentation, treatment, and prognosis of RNR in the context of modern breast cancer treatment.Recent FindingsThe rate of RNR recurrence is low (
Source: Current Breast Cancer Reports - November 6, 2020 Category: Cancer & Oncology Source Type: research

Impact and Timing of Breast Cancer Radiation Therapy and Fertility Preservation
In conclusion, the impact that breast radiation appears to have on fertility is low and, in our opinion, should not result in patients choosing mastectomy over breast conservation therapy due to fears of infertility. However, further studies specifying the patients receiving breast radiation and requiring fertility preservation methods are warranted to help reassure patients and their providers. (Source: Current Breast Cancer Reports)
Source: Current Breast Cancer Reports - November 5, 2020 Category: Cancer & Oncology Source Type: research

Ovarian Tissue Cryopreservation and Novel Bioengineering Approaches for Fertility Preservation
AbstractPurpose of ReviewBreast cancer patients who cannot delay treatment or for whom hormone stimulation and egg retrieval are contraindicated require alternative methods of fertility preservation prior to gonadotoxic treatment. Ovarian tissue cryopreservation is an alternative approach that may offer patients the opportunity to preserve fertility and carry biologically related children later in life. Various experimental approaches are being explored to obtain mature gametes from cryopreserved and thawed ovarian tissue for fertilization and implantation using biomimetic tissue culture in vitro. Here, we review the most ...
Source: Current Breast Cancer Reports - November 4, 2020 Category: Cancer & Oncology Source Type: research

Oocyte Donation, Gestational Carriers, and Adoption for Breast Cancer Survivors
AbstractPurpose of ReviewThe purpose of this review is to describe and compare the use of oocyte donation, gestational carriers, and adoption for family building specifically in women with a history of breast cancer.Recent FindingsOocyte donation is an effective and safe option for women whose exposure to gonadotoxic cancer therapy has resulted in primary ovarian insufficiency, or for women with a familial cancer syndrome who are concerned about genetic risk to their offspring. A gestational carrier may also be considered —with or without oocyte donation—depending on the patient’s acceptance of ovarian st...
Source: Current Breast Cancer Reports - November 3, 2020 Category: Cancer & Oncology Source Type: research

New Frontiers in Hypofractionation for Regional Nodal Irradiation in Breast Cancer
AbstractPurpose of ReviewIn recent years, there have been a number of small, yet notable practice changes in the delivery of postmastectomy radiation therapy (PMRT) in breast cancer patients. Herein, we describe the role of PMRT and its evolving delivery with hypofractionated regimens.Recent FindingsThe UK START trials and whole-breast hypofractionation studies established the safety and effectiveness of accelerated radiotherapy. This has inspired further investigations of similar principles in patients with reconstruction, acute and late toxicities associated with hypofractionated regimens, socioeconomic benefit, and evol...
Source: Current Breast Cancer Reports - October 27, 2020 Category: Cancer & Oncology Source Type: research

Leveraging Neoadjuvant Chemotherapy to Minimize the Burden of Axillary Surgery: a Review of Current Strategies and Surgical Techniques
AbstractPurpose of ReviewAxillary nodal disease is significantly less likely in both clinically node-negative (cN0) and node-positive (cN+) breast cancer patients after neoadjuvant chemotherapy (NAC). There have thus been significant efforts to “de-escalate” axillary surgery in this setting. This review discusses modern axillary surgical paradigms and techniques after NAC.Recent FindingsIn cN0 patients, the accuracy and feasibility of sentinel lymph node biopsy (SLNB) after NAC is well-established, with prospective evidence supporting its oncologic safety. SLNB is also acceptable in select cN+ patients when cer...
Source: Current Breast Cancer Reports - October 24, 2020 Category: Cancer & Oncology Source Type: research

Breast Cancer-Related Lymphedema: a Review of Risk Factors, Radiation Therapy Contribution, and Management Strategies
AbstractPurpose of ReviewIn recent years, breast cancer-related lymphedema (BCRL), which affects one in five patients treated for breast cancer (BC), has garnered increasing interest by clinicians and researchers as BC survival rates improve and survivorship issues become increasingly imperative. This review represents an overview of the literature for BCRL risk factors, such as radiation therapy (RT), screening, and treatment.Recent FindingsRisk factors with strong evidence include axillary surgery, regional lymph node radiation, elevated body mass index, cellulitis, and subclinical edema. Neoadjuvant and taxane-based che...
Source: Current Breast Cancer Reports - October 24, 2020 Category: Cancer & Oncology Source Type: research

Accelerated Partial Breast Irradiation (APBI): Where Are We Now?
AbstractPurpose of ReviewAccelerated partial breast irradiation (APBI) is an alternative approach to breast conserving therapy (BCT) where radiation (RT) is delivered over a shorter period of time compared with whole breast irradiation (WBI), resulting in improved patient convenience and cost savings. APBI can be delivered using brachytherapy, intraoperative RT, or conformal external beam radiation therapy (EBRT) techniques. In this review, the authors appraise the latest modern randomized controlled trials (RCTs) of APBI and discuss the application of the data to clinical practice.Recent FindingsThe OCOG-RAPID and NSABP B...
Source: Current Breast Cancer Reports - October 18, 2020 Category: Cancer & Oncology Source Type: research

Hypofractionated Whole Breast Radiotherapy and Boost in Early-Stage Breast Cancer
AbstractPurpose of ReviewTo review postlumpectomy whole breast irradiation (WBI) in early-stage breast cancer with regard to the use of hypofractionation and a tumor bed boost.Recent FindingsHypofractionation is currently standard practice for most cases of postlumpectomy WBI. A boost is recommended for women at increased risk for local recurrence due to clinical or pathologic risk factors. A sequential boost is currently standard practice for WBI with either conventional or hypofractionated radiation. Phase I –II trials of hypofractionation and concurrent boost have shown comparably low risks for local recurrence an...
Source: Current Breast Cancer Reports - October 16, 2020 Category: Cancer & Oncology Source Type: research

Radiation Therapy in the Management of Oligometastatic Breast Cancer: Current Evidence and Future Directions
AbstractPurpose of ReviewTo review the role of radiation therapy and specifically metastasis-directed stereotactic body radiation therapy (SBRT) in the management of patients with oligometastatic breast cancer with emphasis on potential toxicities and future directions.Recent FindingsRecent prospective studies have demonstrated encouraging initial results indicating the potential efficacy of metastasis-directed SBRT in the management of patients with oligometastatic disease. However, given potentially significant toxicities associated with metastasis-directed SBRT, additional data in the form of phase III randomized contro...
Source: Current Breast Cancer Reports - October 3, 2020 Category: Cancer & Oncology Source Type: research

Genomic Predictors for Radiation Sensitivity and Toxicity in Breast Cancer —from Promise to Reality
AbstractPurpose of ReviewPrecision medicine and personalized treatment recommendations have become standard for systemic therapy decision-making in women with breast cancer. Until recently, however, such opportunities have been lacking for radiation related treatment decisions.Recent FindingsRecent studies have explored the utility of using genomic signatures developed to make systemic therapy recommendations (e.g. Oncotype DX ®, ProSigna®, IHC4-C) to guide recommendations for radiation as well. Emerging data suggests that these signatures, while prognostic, may not identify radiation benefit. Radiation-specific si...
Source: Current Breast Cancer Reports - October 3, 2020 Category: Cancer & Oncology Source Type: research

Community Outreach and Engagement Strategies to Address Breast Cancer Disparities
AbstractPurpose of ReviewBreast cancer disproportionately affects racial/ethnic minority women compared with their non-Hispanic white counterparts. Community-based researchers have long sought to reduce breast cancer-related health disparities using the core principles of community outreach and engagement. The primary goal of this paper is to discuss community outreach and engagement (COE) strategies in the context of breast cancer disparities and discuss evidence-based applications of COE.Recent FindingsEvidence-based COE to address breast cancer disparities include patient navigation, co-development of community-based in...
Source: Current Breast Cancer Reports - September 14, 2020 Category: Cancer & Oncology Source Type: research

Features, Predictors, and Treatment of Breast Cancer –Related Lymphedema
AbstractPurpose of ReviewBreast cancer –related lymphedema (BCRL) is a common sequelae among breast cancer survivors. This review provides updated information on recent studies to prevent, diagnose, and actively treat women with BCRL.Recent FindingsIn total, 63 articles were identified from 2015 and 2020 that assessed incidence, risk factors, surveillance, measurement and definition, treatment, and awareness of BCRL. Depending on the approach and timing of assessment, BCRL incidence rates ranged from 9.1 to 39%. Modified radical mastectomy, number of positive lymph nodes, and postoperative complications were linked t...
Source: Current Breast Cancer Reports - September 8, 2020 Category: Cancer & Oncology Source Type: research

Breast Cancer –Related Lymphedema: Personalized Plans of Care to Guide Survivorship
AbstractPurposeTo present and discuss care domains (oncologic, cardiometabolic, aging, behavioral, environmental) for clinicians when approaching care for a breast cancer survivor at risk for developing breast cancer –related lymphedema (BCRL), as well as survivors who have been diagnosed with BCRL. Assessment using each domain aids in decision-making, yet also identifies barriers to pursuing personalized care for survivors with BCRL.Recent FindingsBCRL occurs from damage to the lymphatics during breast cancer treatment and occurs in approximately 20 to 40% of survivors. Prospective surveillance and early treatment f...
Source: Current Breast Cancer Reports - September 3, 2020 Category: Cancer & Oncology Source Type: research

Pathophysiology of Breast Cancer-Related Lymphoedema
AbstractPurpose of ReviewTo review the literature regarding the pathophysiological changes found in BCRL and to link them to the cancer and the type and sequencing of treatments and raise attention to the fact that not all parts of the arm at risk or with lymphoedema may have underlying changes which are similar or are progressing at the same rate.Recent FindingsThere still remains a lack of awareness regarding BCRL-related pathophysiology and of the range of reasons for it. Linked to this is a lack of appropriate in-clinic assessment of these changes and of the use of this information to better target and sequence treatme...
Source: Current Breast Cancer Reports - August 31, 2020 Category: Cancer & Oncology Source Type: research

Psychosocial Issues Associated with Breast Cancer-Related Lymphedema: a Literature Review
AbstractPurpose of ReviewBreast cancer-related lymphedema (BCRL) is a chronic disease affecting breast cancer survivors. The purpose of this article is to update the scientific literature regarding psychosocial issues associated with BCRL.Recent FindingsReports describe economic burdens, social support, sexuality, BCRL patient-education needs, and interventions to reduce BCRL symptoms and improve QOL among women with breast cancer. The psychosocial impact of BCRL may differ between younger and older women which has implications for age-related interventions to reduce the adverse psychosocial experiences of women with BCRL....
Source: Current Breast Cancer Reports - August 24, 2020 Category: Cancer & Oncology Source Type: research

Drugs and Breast Cancer –Related Lymphoedema (BCRL): Incidence and Progression
AbstractPurpose of ReviewWhat is the current evidence for the role of drugs as risk factors for the development of breast cancer –related lymphoedema (BCRL) and in exacerbating existing BCRL? What are the mechanisms by which these effects occur?Recent FindingsThere is now evidence that taking calcium channel blockers (CCBs) during and after breast cancer treatment and receiving docetaxel chemotherapy are risk factors for the development of BCRL. CCBs cause oedema by increasing capillary filtration and docetaxel by inhibiting lymphatic vessel contractions.SummaryIdeally, CCBs should be avoided during and after treatme...
Source: Current Breast Cancer Reports - August 13, 2020 Category: Cancer & Oncology Source Type: research

Enhanced Recovery After Surgery (ERAS): Protocols in Post-Mastectomy Breast Reconstruction
AbstractPurpose of ReviewEnhanced recovery after surgery (ERAS) protocols have become common for patients undergoing breast reconstruction, catalyzed by the recent opioid crisis. Here, we review standard ERAS protocol structure and the supporting evidence.Recent FindingsA perioperative multidisciplinary team and multimodal pain management appropriately are the two critical factors for ERAS success. Preoperative counseling, both antibiotic and venous thromboembolic prophylaxis, and multimodal antiemetics are crucial to optimize results. Regional nerve blocks provide an alternative to oral and intravenous opioids. Intraopera...
Source: Current Breast Cancer Reports - August 12, 2020 Category: Cancer & Oncology Source Type: research

Targeted Axillary Dissection for Patients Who Convert to Clinically Node Negative After Neoadjuvant Chemotherapy for Node-Positive Breast Cancer
AbstractPurpose of ReviewThe use of neoadjuvant chemotherapy (NAC) for breast cancer (BC) can eradicate axillary disease in>  40% of patients. The standard of care for node-positive BC has been axillary lymph node dissection. In this review, we examine the data for de-escalating axillary surgery after NAC.Recent FindingsStudies have shown that sentinel lymph node biopsy (SLNB) is accurate after NAC. False negative rates (FNR) of SLNB after NAC in node-positive patients have been reduced with a combination of dual tracers and localization of the clipped positive node. Clipped nodes may be localized with a variety ...
Source: Current Breast Cancer Reports - August 12, 2020 Category: Cancer & Oncology Source Type: research

Do Women with Breast Cancer –related Lymphoedema Need to Wear Compression While Exercising?: Results from a Systematic Review and Meta-analysis
AbstractPurpose of ReviewTo undertake a systematic review and meta-analysis to evaluate the effects of wearing compression versus no compression during a single bout of exercise, and during an exercise intervention, for those with breast cancer-related lymphoedema (BCRL). A multiple database search was undertaken to identify eligible randomised controlled trials (RCTs) and non-RCTs involving those with BCRL. The primary outcome variable was lymphoedema and pooled statistics were calculated using standardised mean differences (SMDs) within or between compression and no compression groups.Recent FindingsSix eligible studies ...
Source: Current Breast Cancer Reports - July 19, 2020 Category: Cancer & Oncology Source Type: research

Surgical Approaches to the Prevention and Management of Breast Cancer –Related Lymphedema
AbstractPurpose of ReviewUpper extremity lymphedema is a much-feared complication of breast cancer treatment leading to significant impairments in patients ’ quality of life. The mainstay of treatment for this debilitating chronic disease has been non-surgical modalities, namely complete decongestive therapies. Surgical treatment of lymphedema has emerged as an option for patients who have exhausted these conservative measures and consists of both ph ysiologic procedures (vascularized lymph node transplant and lymphovenous bypass) which aim to reduce the burden of lymphatic fluid and reductive procedures to remove ex...
Source: Current Breast Cancer Reports - July 17, 2020 Category: Cancer & Oncology Source Type: research

Return-to-Work and Breast Cancer Survivorship Care
AbstractPurpose of ReviewThis commentary addresses the current needs of breast cancer survivorship care focusing on return-to-work and management of chronic treatment effects, such as lymphedema.Recent FindingsCurrent literature reported a reduced work engagement and work ability among breast cancer survivors and those who developed treatment-related lymphedema. The return-to-work experience was highly individualized and built on the interactions among the survivor, the lymphedema disease processes, their work activities, and a broad array of contextual factors. Both lymphedema and its management negatively influenced wome...
Source: Current Breast Cancer Reports - June 21, 2020 Category: Cancer & Oncology Source Type: research

Breast Cancer Health Disparities in Hispanics/Latinas
AbstractPurpose of ReviewBreast cancer incidence and mortality rates are lower in some Hispanic/Latino subpopulations compared with non-Hispanic White women. However, studies suggest that the risk of breast cancer –specific mortality is higher in USA Hispanics/Latinas. In this review we summarized current knowledge on factors associated with breast cancer incidence and risk of mortality in women of Hispanic/Latino origin.Recent FindingsAssociative studies have proposed a multiplicity of factors likely contributing to differences in breast cancer incidence and survival between population groups, including socioeconomi...
Source: Current Breast Cancer Reports - May 27, 2020 Category: Cancer & Oncology Source Type: research

Large Datasets for Disparities Research in Breast Cancer
AbstractPurpose of ReviewBreast cancer disparities affect how different populations are impacted by breast cancer incidence, mortality, and survival. We provide an overview of large datasets that scientists can use to study disparities in breast cancer outcomes.Recent FindingsMany large datasets are accessible to disparities researchers with a project plan and little or no cost. Yet only two datasets have been significantly used in breast cancer disparities publications. Other datasets combine administrative claim, molecular, electronic health record, patient reported, imaging, and clinical trial data in a way that could b...
Source: Current Breast Cancer Reports - May 25, 2020 Category: Cancer & Oncology Source Type: research

Panel Testing for Hereditary Breast Cancer: More or Less?
AbstractPurpose of ReviewPanel testing is increasingly being offered to patients. Currently, women may be offered a panel of up to 80 genes. Oncologists are tasked with understanding the indications for this testing as well as the potential implications. In this review, we outline which patients should undergo genetic testing for hereditary breast cancer, when this testing should be performed, and which genes should be tested for.Recent FindingsOur understanding of hereditary breast cancer has drastically changed with the advent of next generation sequencing (NGS), and many additional genes have been associated with increa...
Source: Current Breast Cancer Reports - May 19, 2020 Category: Cancer & Oncology Source Type: research

Disparities in Genetic Testing and Care Among Black Women with Hereditary Breast Cancer
AbstractPurpose of ReviewDespite a steady improvement in breast cancer survival rates over the past several decades, mortality disparities remain among Black women, who have a 42% higher death rate compared to non-Hispanic white (NHW) women. Hereditary breast cancer (HBC) accounts for 5 –10% of all breast cancer cases, the majority of which are due to theBRCA1 andBRCA2 (BRCA) genes. Despite the availability ofBRCA testing for over 25  years, there remain disproportionately lower rates of genetic testing among Blacks compared to NHW due to a multitude of factors. The intent of this review is to discuss racial dis...
Source: Current Breast Cancer Reports - May 18, 2020 Category: Cancer & Oncology Source Type: research

The Role of Artificial Intelligence in Understanding and Addressing Disparities in Breast Cancer Outcomes
AbstractPurpose of ReviewThe goal of our paper is to explore the role of AI in understanding health disparities in cancer care and its potential role in resolving them.Recent FindingsMultiple studies have shown that with the recent advances in AI, its integration in cancer care has the potential to impact earlier diagnosis and improve clinical decision making. While AI risks to further widen health disparities, some studies suggest that it represents an excellent opportunity for resolving them.SummaryWith active engagement, incorporating AI in breast cancer care represents an excellent opportunity for elucidating and resol...
Source: Current Breast Cancer Reports - May 17, 2020 Category: Cancer & Oncology Source Type: research

Breast Reconstruction Disparities in the United States and Internationally
AbstractPurpose of ReviewWomen electing to undergo breast reconstruction following mastectomy have increased in frequency. Classically studied healthcare disparities have an influence on whether women undergo reconstruction. This review evaluates these domains, globally, while exploring why they exist.Recent FindingsIn the USA, women who are young, white, with higher income and education level, private insurance, and those treated at private or academic hospitals are most likely to undergo reconstruction. Women of a minority race or ethnicity, lower socioeconomic group, early education status, and with public or no insuran...
Source: Current Breast Cancer Reports - May 14, 2020 Category: Cancer & Oncology Source Type: research

Integrating Biology and Access to Care in Addressing Breast Cancer Disparities: 25 Years ’ Research Experience in the Carolina Breast Cancer Study
AbstractPurpose of ReviewTo review research on breast cancer mortality disparities, emphasizing research conducted in the Carolina Breast Cancer Study, with a focus on challenges and opportunities for integration of tumor biology and access characteristics across the cancer care continuum.Recent FindingsBlack women experience higher mortality following breast cancer diagnosis, despite lower incidence compared to white women. Biological factors, such as stage at diagnosis and breast cancer subtypes, play a role in these disparities. Simultaneously, social, behavioral, environmental, and access to care factors are important....
Source: Current Breast Cancer Reports - May 13, 2020 Category: Cancer & Oncology Source Type: research

Impact of Genetic Ancestry on Treatment Toxicity and Racial Disparities in Breast Cancer
AbstractPurpose of ReviewRacial disparities in breast cancer are multifactorial and include inferior outcomes and increased rates of serious toxicity in African Americans. The purpose of this review is to evaluate the contribution of race, genetic ancestry, and genomic biomarkers to treatment toxicity and to demonstrate the impact of toxicity on racial disparities.Recent FindingsTaxane-induced peripheral neuropathy (TIPN) and congestive heart failure (CHF) are potentially irreversible and life-altering toxicities of curative chemotherapy for breast cancer. Analysis of genetic ancestry, rather than self-reported race, in a ...
Source: Current Breast Cancer Reports - May 11, 2020 Category: Cancer & Oncology Source Type: research

Ductal Carcinoma In Situ (DCIS): the Importance of Patient-Reported Outcomes (PRO)
AbstractPurpose of ReviewPatient reported outcomes (PROs) are an optimal method for assessing quality of life (QOL), including physical and psychosocial health. This review summarizes PROs frequently assessed in the setting of a DCIS diagnosis.Recent FindingsHealth-related QOL has generally been found to be modestly affected in women with DCIS and similar to women with invasive breast cancer. Several studies reported a substantial negative impact on sexual health and body image, including some differences based on surgery type. Some patients experience pain after treatment, although many physical symptoms resolve. The prev...
Source: Current Breast Cancer Reports - April 19, 2020 Category: Cancer & Oncology Source Type: research

Implications of BRCA Germline Mutations on Breast Cancer Medical Treatment
AbstractPurpose of ReviewDetection of BRCA germline mutations (gBRCAm) impacts breast cancer medical treatment —according to differential sensitivity to cytotoxic chemotherapy and the activity of PARP inhibitors—and not only familial prevention. Guidelines for genetic testing—initially mainly based on familial history, age, and triple negative breast cancer (TNBC) subtype—currently are expanding in o rder to offer new therapeutic options.Recent FindingsIn the early setting, gBRCAm patients present a similar outcome as the non-carrier population with standard neoadjuvant chemotherapy, and the role of...
Source: Current Breast Cancer Reports - April 5, 2020 Category: Cancer & Oncology Source Type: research

Breast Self-Examination: the Case for a Second Look
AbstractPurpose of ReviewBreast Self-Examination (BSE) remains controversial despite the 2009 United States Preventive Service Task Force (USPSTF) recommendation against teaching of BSE. The USPSTF recommendations were based on results from the Shanghai Study, a high-quality randomized trial of BSE in 266,064 Chinese factory workers from 1989 to 1991; women instructed in BSE did not have a significant difference in mortality versus uninstructed controls. Regardless of the outcome of the Shanghai Study, the practice of BSE in the US over the past 25  years has been associated with a marked reduction in the size of brea...
Source: Current Breast Cancer Reports - February 25, 2020 Category: Cancer & Oncology Source Type: research

Treatment of Ductal Carcinoma In Situ: Considerations for Tailoring Therapy in the Contemporary Era
AbstractPurpose of ReviewStandard options for the treatment of ductal carcinoma in situ (DCIS) include breast-conserving surgery (BCS) alone; BCS with radiotherapy or endocrine therapy, or both; and mastectomy. Survival is excellent with all options, but rates of local recurrence (LR) vary, as do quality-of-life measures. Here, we discuss treatment outcomes, risk factors for LR, and tools for risk estimation.Recent FindingsAfter BCS, radiotherapy reduces the risk of LR by half, and endocrine therapy reduces the risk by a third. Young age, inadequate margins, and greater volume of disease are associated with higher risk of ...
Source: Current Breast Cancer Reports - February 23, 2020 Category: Cancer & Oncology Source Type: research

Ductal Carcinoma In Situ —Pathological Considerations
AbstractPurpose of ReviewMammographic screening and radiological surveillance for local management has led to an exponential increase in diagnosis of ductal carcinoma in situ (DCIS) with limited impact on breast cancer specific mortality. Since definitive diagnosis of DCIS requires histopathological examination increase in radiological surveillance has resulted in significant increase in breast biopsies. Pathological characteristics of DCIS include grade, necrosis, size, anatomy, margins of excision, estrogen, and progesterone receptor status, and these features are useful for both prognostication and prediction.Recent Fin...
Source: Current Breast Cancer Reports - February 19, 2020 Category: Cancer & Oncology Source Type: research

DCIS: Radiation Considerations
AbstractPurpose of ReviewDuctal carcinoma in situ (DCIS) is commonly treated with radiotherapy as a part of breast-conserving therapy, though increasingly the use of routine radiation treatment is being questioned. The intent of this review is to summarize studies on the role of radiotherapy for DCIS, with an emphasis on more recent trials.Recent FindingsWhile older randomized clinical trials have established a local control benefit for adjuvant radiotherapy following breast-conserving surgery in all patients including those with low-risk DCIS, these and subsequent studies have failed to demonstrate any survival benefit. G...
Source: Current Breast Cancer Reports - February 17, 2020 Category: Cancer & Oncology Source Type: research

Treatment from within: Ductal Carcinoma as an Opportunity to Harness the Immune System
AbstractPurpose of ReviewBreast Ductal Carcinoma in Situ (DCIS) is an increasingly common diagnosis and already accounts for ~20% of screen-detected breast cancers. A subset of patients with DCIS will experience disease recurrence and some will die from breast cancer. Tailored strategies for treatment are lacking at this time. Human Epidermal Growth Factor Receptor 2 (HER2) is a tumor associated antigen that is shown to correlate with poorer outcomes among patients with early breast cancer, including DCIS. Significant interactions between the humoral and cellular branches of the immune system were observed in tumorigenesis...
Source: Current Breast Cancer Reports - February 16, 2020 Category: Cancer & Oncology Source Type: research

Risk Management for BRCA1/BRCA2 Mutation Carriers Without and With Breast Cancer
AbstractPurpose of ReviewWe review the management for unaffectedBRCA1/2 mutation carriers and the local management of early-stage breast cancer.Recent FindingsFor unaffectedBRCA1/2 mutation carriers, surveillance includes annual magnetic resonance imaging (MRI) and mammogram (MG). Novel imaging modalities, including abbreviated protocol MRI, ultrafast/accelerated MRI, and contrast-enhanced digital mammography are being investigated. Risk-reducing mastectomy (RRM) should be considered, and nipple-areolar sparing mastectomy (NSM) is now an option. Additionally, risk-reducing salpingo-oophorectomy (RRSO) is strongly recommend...
Source: Current Breast Cancer Reports - February 16, 2020 Category: Cancer & Oncology Source Type: research

Health Disparities in Germline Genetic Testing for Cancer Susceptibility
AbstractPurpose of ReviewDespite advances in testing for heritable cancer susceptibility gene mutations, health disparities persist. We review racial/ethnic and socioeconomic factors that affect access to genetic counseling and testing, which may influence the validity of results among diverse populations and the clinical utility of genetic testing.Recent FindingsDifferential access to genetic testing among racial/ethnic minorities including Hispanics and blacks compared with whites drives disparities in the clinical validity of results: specifically, variants of unknown significance (VUS) are notably more prevalent in min...
Source: Current Breast Cancer Reports - February 11, 2020 Category: Cancer & Oncology Source Type: research

Prophylactic Mastectomy and Breast Reconstruction in Patients at High Risk for Breast Cancer
AbstractPurpose of ReviewThis paper summarizes key issues pertinent to oncologic and surgical outcomes of risk-reducing mastectomy and reconstruction.Recent FindingsAmong BRCA 1/2 mutation carriers who present with initial breast cancer, risk-reducing mastectomy in patients who are young at time of initial breast cancer diagnosis have the greatest absolute reduction in contralateral breast cancer risk associated with contralateral risk-reducing mastectomy. Although retrospective studies are suggestive of a survival advantage conferred by risk-reducing mastectomy in BRCA ½ carriers, additional research in the contemp...
Source: Current Breast Cancer Reports - February 5, 2020 Category: Cancer & Oncology Source Type: research

Lobular Neoplasia
AbstractPurpose of ReviewToday, the term lobular neoplasia (LN) incorporates atypical lobular hyperplasia (ALH), classical lobular carcinoma in situ (C-LCIS) and nonclassical lobular carcinoma in situ (NC-LCIS). These neoplastic lesions are thought of as risk indicators and non-obligate precursors of invasive breast cancer. This review highlights the current literature and up-to-date treatment recommendations for ALH, C-LCIS, and NC-LCIS.Recent FindingsCurrently, NC-LCIS requires surgical excision to rule out a concurrent carcinoma; but a core biopsy diagnosis of ALH or C-LCIS can be safely managed with close clinical and ...
Source: Current Breast Cancer Reports - January 16, 2020 Category: Cancer & Oncology Source Type: research