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 disparities...
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 platinum chemot...
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 breast c...
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
