Breast Cancer Diagnosis and Treatment in Low- and Mid-Resource Settings: the Role of Resource-Stratified Clinical Practice Guidelines
AbstractPurpose of ReviewOne of the most important recent advances in the management of cancer patients have become the development of guidelines. Guidelines are usually evidence-based or international consensus guidelines. Those guidelines may not be applicable worldwide, especially where resources are limited. This prompted initiatives for the development of resource-stratified guidelines so that health care providers and authorities can do the best they can with the resources they have, while working on improving their resources. We will describe the process of development of those guidelines and briefly review recommen...
Source: Current Breast Cancer Reports - September 1, 2018 Category: Cancer & Oncology Source Type: research
Breast Reconstruction in the Setting of Surgical Prevention for Breast Cancer
AbstractPurpose of ReviewBreast reconstruction after prophylactic mastectomy is an important component of the surgical prevention of breast cancer. Women who undergo bilateral prophylactic mastectomy view reconstruction as part of their treatment and the choice to pursue a contralateral mastectomy is influenced by the availability of reconstruction.Recent FindingsThere has been increased data available on both medical outcomes and patient-reported outcomes in reconstruction after mastectomy. This review of recent literature includes trends and outcomes with contralateral and bilateral prophylactic mastectomy with reconstru...
Source: Current Breast Cancer Reports - September 1, 2018 Category: Cancer & Oncology Source Type: research
Breast Cancer Disparities Among Women in Underserved Communities in the USA
AbstractPurpose of ReviewBreast cancer disparities that exist between high-income countries (HIC) and low- and middle-income countries (LMICs) are also reflected within population subgroups throughout the United States (US). Here we examine three case studies of US populations “left behind” in breast cancer outcomes/equity.Recent FindingsAfrican Americans in Chicago, non-Latina White women in Appalachia, and Latinas in the Yakima Valley of Washington State all experience a myriad of factors that contribute to lower rates of breast cancer detection and appropriate treatment as well as poorer survival. These factors, rel...
Source: Current Breast Cancer Reports - August 29, 2018 Category: Cancer & Oncology Source Type: research
Access to Affordable Breast Cancer Care in Eastern Europe
AbstractPurpose of ReviewThe majority of Central and Eastern European (CEE) countries report inferior breast cancer survival rates compared with Western European countries. We review limitations in access to screening programs, surgery, radiotherapy, pathology, palliative care, and antineoplastic medicines as potential explanations for these disparities.Recent FindingsMost CEE countries do not have the quality and quantity of radiotherapy needed to adequately service the population. Surgical services are widely accessible, but sentinel node biopsy is not universally available. There are important limitations for CEE patien...
Source: Current Breast Cancer Reports - August 10, 2018 Category: Cancer & Oncology Source Type: research
Moderate-Penetrance Predisposition to Breast Cancer
AbstractPurpose of ReviewResearch over the past 25 years has revealed much about the architecture of predisposition to breast and ovarian cancer. There is now a general understanding that there are three broad categories of germline variation that may increase risk. First, there are the “high-penetrance” genes associated with a relative risk f or cancer of greater than 5 and demonstrating an autosomal dominant pattern of inheritance. At the other end of the spectrum are “low-penetrance” common variants. These variants are associated with minor increases in risk (commonly less than a relative risk of 1.5). The thi...
Source: Current Breast Cancer Reports - August 9, 2018 Category: Cancer & Oncology Source Type: research
Breast Cancer Disparities Among Women in Low- and Middle-Income Countries
AbstractPurpose of ReviewThe burden of breast cancer in low-income and middle-income countries transitioning to higher levels of human development is a public health crisis, set to increase dramatically in the coming decades. This paper provides an overview of the burden in human and economic terms, a summary of the costs, and cost-effective analyses for breast cancer interventions and suggests a way forward through research to better inform national, regional, and global policies for breast cancer control.Recent FindingsInequitable access to effective health services for breast cancer is striking between and within countr...
Source: Current Breast Cancer Reports - August 7, 2018 Category: Cancer & Oncology Source Type: research
Adjuvant HER2-Targeted Therapy Update in Breast Cancer: Escalation and De-escalation of Therapy in 2018
AbstractPurpose of ReviewThe introduction of trastuzumab for the adjuvant treatment of tumors with amplification of HER2/neu has been one of the most exciting advances in systemic treatment in the history of breast cancer and has transformed the natural history of HER2/neu-positive (HER2+) breast cancer (BC). There have been several recent advances in the adjuvant treatment of HER2+ BC and herein we review recently reported clinical trials focusing on the impact of expanding therapeutic options with attention to optimal sequence of the available treatment options and clinical aspects of escalating or de-escalating therapy ...
Source: Current Breast Cancer Reports - July 27, 2018 Category: Cancer & Oncology Source Type: research
Breast Cancer Diagnosis and Treatment in Low- and Mid-Resource Settings: the Role of Resource-Stratified Clinical Practice Guidelines
AbstractPurpose of ReviewOne of the most important recent advances in the management of cancer patients have become the development of guidelines. Guidelines are usually evidence-based or international consensus guidelines. Those guidelines may not be applicable worldwide, especially where resources are limited. This prompted initiatives for the development of resource-stratified guidelines so that health care providers and authorities can do the best they can with the resources they have, while working on improving their resources. We will describe the process of development of those guidelines and briefly review recommen...
Source: Current Breast Cancer Reports - July 24, 2018 Category: Cancer & Oncology Source Type: research
The Role of Quality Measures in Improving Breast Cancer Care in Low-Income Countries
AbstractPurpose of ReviewMeasurement of the quality of cancer care is foundational to quality improvement, and widely pursued in high-income countries. However, cancer care quality measurement has not yet been systematically attempted in low-income countries (LICs). We aimed to describe key considerations in developing quality measures for breast cancer care in LICs, and explore challenges and next steps.Recent FindingsThere are no published reports of systematically developed quality measures from LICs, and few reports of care quality. However, existing resource-stratified treatment guidelines can help facilitate measure ...
Source: Current Breast Cancer Reports - July 21, 2018 Category: Cancer & Oncology Source Type: research
Management of Lobular Neoplasia
AbstractPurpose of ReviewLobular neoplasia (LN) is a well-established risk factor and non-obligate precursor for breast cancer. The clinical breast cancer risk assessment and management for these patients can be challenging.Recent FindingsNumerous studies have confirmed that LN is a risk factor and non-obligate precursor for breast cancer. The molecular profile of LCIS is similar to invasive lobular carcinoma. Surgical excision is generally recommended after core biopsy, but there may be a subset of patients with LN who may be observed without surgery. The significant increase in breast cancer risk associated with this dis...
Source: Current Breast Cancer Reports - July 18, 2018 Category: Cancer & Oncology Source Type: research
Breast Reconstruction in the Setting of Surgical Prevention for Breast Cancer
AbstractPurpose of ReviewBreast reconstruction after prophylactic mastectomy is an important component of the surgical prevention of breast cancer. Women who undergo bilateral prophylactic mastectomy view reconstruction as part of their treatment and the choice to pursue a contralateral mastectomy is influenced by the availability of reconstruction.Recent FindingsThere has been increased data available on both medical outcomes and patient-reported outcomes in reconstruction after mastectomy. This review of recent literature includes trends and outcomes with contralateral and bilateral prophylactic mastectomy with reconstru...
Source: Current Breast Cancer Reports - July 12, 2018 Category: Cancer & Oncology Source Type: research
Risk and Prevention for Highly Penetrant Genes
AbstractPurpose of ReviewApproximately 10% of breast cancer cases are attributed to a hereditary predisposition. Here, we review the risks and management options for highly penetrant genes includingBRCA1/2,TP53,PTEN,CDH1,STK11, andPALB2 which confer a 5 to greater than 10-fold increased risk of breast cancer, and an increased risk of other cancers.Recent FindingsRisk-reducing salpingo-oophorectomy (RRSO) reduces mortality inBRCA1/2 carriers. Other management strategies are tailored to the hereditary cancer syndrome in question and include more intensive screening with imaging and serologic studies, risk-reducing surgeries ...
Source: Current Breast Cancer Reports - July 9, 2018 Category: Cancer & Oncology Source Type: research
Early Diagnosis of Breast Cancer in the Absence of Population-Based Mammographic Screening in Asia
AbstractPurpose of ReviewAsia is made up of mainly low- and middle-income countries, where the majority of breast cancer presents as late-stage disease where survival is poor even with treatment. We review methods of early diagnosis of breast cancer in countries where population-based mammographic screening is not feasible.Recent findingsWhile there is insufficient evidence that breast self-examination and clinical breast examination (CBE) lead to a reduction in breast cancer mortality, recent trials have shown that screening with CBE successfully reduces stage at diagnosis, which may translate to improved breast cancer su...
Source: Current Breast Cancer Reports - July 6, 2018 Category: Cancer & Oncology Source Type: research
Palliative Care in the Caribbean Through the Lens of Women with Breast Cancer: Challenges and Opportunities
AbstractBackgroundAcross the Caribbean, too many women are presenting with advanced breast cancer and dying with little or no access to palliative care. No comprehensive assessment of current capacity to deliver palliative care in the region exists, largely due to limited data. We assess the challenges in delivering palliative care for breast cancer patients in the Caribbean, highlighting the needs and experiences of low-income women through emblematic patient narratives.Recent FindingsThere is an urgent need to improve access to palliative care and pain relief throughout the region. Challenges include insufficient healthc...
Source: Current Breast Cancer Reports - July 5, 2018 Category: Cancer & Oncology Source Type: research
