scholarly journals Impact of Primary Care Delay on Progression of Breast Cancer in a Black African Population: A Multicentered Survey

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Olayide Agodirin ◽  
Samuel Olatoke ◽  
Ganiyu Rahman ◽  
Julius Olaogun ◽  
Oladapo Kolawole ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Progression ◽  
Clustering Analysis ◽  
Short Interval ◽  
Tumor Stage ◽  
Stage Migration ◽  
Patient Journey ◽  
Low Middle Income Countries ◽  
The Impact

Background. Reports are scanty on the impact of long primary care interval in breast cancer. Exploratory reports in Nigeria and other low-middle-income countries suggest detrimental impact. The primary aim was to describe the impact of long primary care interval on breast cancer progression, and the secondary aim was to describe the factors perceived by patients as the reason(s) for long intervals. Method. Questionnaire-based survey was used in 9 Nigerian tertiary institutions between May 2017 and July 2018. The study hypothesis was that the majority of patients stayed >30 days, and the majority experienced stage migration in primary care interval. Assessment of the impact of the length of interval on tumor stage was done by survival analysis technique, and clustering analysis was used to find subgroups of the patient journey. Results. A total of 237 patients presented to primary care personnel with tumor ≤5cm (mean 3.4±1.2cm). A total of 151 (69.3%, 95% CI 62.0-75.0) stayed >30 days in primary care interval. Risk of stage migration in primary care interval was 49.3% (95% CI 42.5%-56.3%). The most common reasons for long intervals were symptom misinformation and misdiagnosis. Clustering analysis showed 4 clusters of patients’ experience and journey: long interval due to distance, long interval due to misinformation, long interval due to deliberate delaying, and not short interval—prepared for treatment. Conclusion. The majority of patients stayed longer than 30 days in primary care interval. Long primary care interval was associated with a higher risk of stage migration, and more patients reported misinformation and misdiagnosis as reasons for a long interval.

Learning Health System for Breast Cancer: Pilot Project Experience

2019 ◽  
pp. 1-11 ◽  
Author(s):  
Mark N. Levine ◽  
Gordon Alexander ◽  
Arani Sathiyapalan ◽  
Anjali Agrawal ◽  
Greg Pond
Keyword(s):  
Breast Cancer ◽  
Language Processing ◽  
Gold Standard ◽  
Pilot Project ◽  
Tumor Stage ◽  
Stage Iii ◽  
Patient Journey ◽  
Clinical Text ◽  
Stage Iii Breast Cancer ◽  
The Impact

PURPOSE Clinicians need accurate and timely information on the impact of treatments on patient outcomes. The electronic health record (EHR) offers the potential for insight into real-world patient experiences and outcomes, but it is difficult to tap into. Our goal was to apply artificial intelligence technology to the EHR to characterize the clinical course of patients with stage III breast cancer. PATIENTS AND METHODS Data from patients with stage III breast cancer who presented between 2013 and 2015 were extracted from the EHR, de-identified, and imported into the IBM Cloud. Specialized natural language processing (NLP) annotators were developed to extract medical concepts from unstructured clinical text and transform them to structured attributes. In the validation phase, these annotators were applied to 19 additional patients with stage III breast cancer from the same period. The resulting data were compared with that in the medical chart (gold standard) for nine key indicators. RESULTS Information was extracted for 50 patients, including tumor stage (94% stage IIIA, 6% stage IIIB), age (28% 50 years or younger, 52% between 51 and 70 years, and 24% older than 70 years), receptor status (84% estrogen receptor positive, 74% progesterone receptor positive), and first treatment (72% surgery, 26% chemotherapy, 2% endocrine). Events in the patient’s journey were compiled to create a timeline. For 171 data elements, NLP and the chart disagreed for 41 (24%; 95% CI, 17.8% to 31.1%). With additional manipulation using simple logic, the disagreement was reduced to six elements (3.5%; 95% CI, 1.3% to 7.5%; F1 statistic, 0.9694). CONCLUSION It is possible to extract, read, and combine data from the EHR to view the patient journey. The agreement between NLP and the gold standard was high, which supports validity.

scholarly journals Boosting GWAS using biological networks: A study on susceptibility to familial breast cancer

2021 ◽  
Vol 17 (3) ◽  
pp. e1008819
Author(s):  
Héctor Climente-González ◽  
Christine Lonjou ◽  
Fabienne Lesueur ◽  
Dominique Stoppa-Lyonnet ◽  
Nadine Andrieu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Progression ◽  
Biological Networks ◽  
Familial Breast Cancer ◽  
Association Studies ◽  
P Value ◽  
Genome Wide Association Studies ◽  
Functional Relationships ◽  
Network Methods ◽  
The Impact

Genome-wide association studies (GWAS) explore the genetic causes of complex diseases. However, classical approaches ignore the biological context of the genetic variants and genes under study. To address this shortcoming, one can use biological networks, which model functional relationships, to search for functionally related susceptibility loci. Many such network methods exist, each arising from different mathematical frameworks, pre-processing steps, and assumptions about the network properties of the susceptibility mechanism. Unsurprisingly, this results in disparate solutions. To explore how to exploit these heterogeneous approaches, we selected six network methods and applied them to GENESIS, a nationwide French study on familial breast cancer. First, we verified that network methods recovered more interpretable results than a standard GWAS. We addressed the heterogeneity of their solutions by studying their overlap, computing what we called the consensus. The key gene in this consensus solution was COPS5, a gene related to multiple cancer hallmarks. Another issue we observed was that network methods were unstable, selecting very different genes on different subsamples of GENESIS. Therefore, we proposed a stable consensus solution formed by the 68 genes most consistently selected across multiple subsamples. This solution was also enriched in genes known to be associated with breast cancer susceptibility (BLM, CASP8, CASP10, DNAJC1, FGFR2, MRPS30, and SLC4A7, P-value = 3 × 10−4). The most connected gene was CUL3, a regulator of several genes linked to cancer progression. Lastly, we evaluated the biases of each method and the impact of their parameters on the outcome. In general, network methods preferred highly connected genes, even after random rewirings that stripped the connections of any biological meaning. In conclusion, we present the advantages of network-guided GWAS, characterize their shortcomings, and provide strategies to address them. To compute the consensus networks, implementations of all six methods are available at https://github.com/hclimente/gwas-tools.

scholarly journals The Extracellular Matrix and Vesicles Modulate the Breast Tumor Microenvironment

2020 ◽  
Vol 7 (4) ◽  
pp. 124 ◽  
Author(s):  
Jun Yang ◽  
Gokhan Bahcecioglu ◽  
Pinar Zorlutuna
Keyword(s):  
Breast Cancer ◽  
Extracellular Matrix ◽  
Tumor Microenvironment ◽  
Cancer Progression ◽  
Signaling Molecules ◽  
Clinical Applications ◽  
Breast Cancer Progression ◽  
Multiple Roles ◽  
Biophysical Properties ◽  
The Impact

Emerging evidence has shown multiple roles of the tumor microenvironment (TME) components, specifically the extracellular matrix (ECM), in breast cancer development, progression, and metastasis. Aside from the biophysical properties and biochemical composition of the breast ECM, the signaling molecules are extremely important in maintaining homeostasis, and in the breast TME, they serve as the key components that facilitate tumor progression and immune evasion. Extracellular vesicles (EVs), the mediators that convey messages between the cells and their microenvironment through signaling molecules, have just started to capture attention in breast cancer research. In this comprehensive review, we first provide an overview of the impact of ECM in breast cancer progression as well as the alterations occurring in the TME during this process. The critical importance of EVs and their biomolecular contents in breast cancer progression and metastasis are also discussed. Finally, we discuss the potential biomedical or clinical applications of these extracellular components, as well as how they impact treatment outcomes.

Using a disease pathway management approach to improve the quality of breast cancer care in Ontario.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 109-109
Author(s):  
Andrea Eisen ◽  
Jasmin Soobrian ◽  
Ashley Tyrrell ◽  
Clement Li ◽  
Derek Muradali ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Quality Indicators ◽  
Cancer Care ◽  
Evidence Based ◽  
Breast Cancer Care ◽  
Patient Journey ◽  
The Impact

109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators. Objective: To evaluate the impact of DPM on quality assessment of breast cancer care in Ontario. Methods: DPM convened a multidisciplinary breast cancer working group (WG) of 40 experts from across Ontario. The WG held 12 meetings and used guidelines developed by CCO’s Program in Evidence Based Care (or other sources as needed) to generate pathways for the prevention, screening and diagnosis, treatment, and follow-up care for breast cancer. The pathways were used as a framework to review the existing inventory of provincial breast cancer quality indicators, and to identify areas where evidence based guidance is needed. The pathways were subjected to an extensive review process before publication. Results: The expert WG identified 28 priority areas, including opportunities to develop guidance in areas where it is lacking (e.g. role of perioperative breast MRI; indications for contralateral prophylactic mastectomy) and system barriers that may hinder optimal care (e.g. biomarker assessment). The WG also used the pathways as a framework for evaluating performance measurement indicators by mapping 48 existing quality indicators for breast cancer to the pathway. Conclusions: The CCO DPM Breast Cancer pathways facilitated a province-wide, multidisciplinary process to promote quality standards, to identify gaps and overlaps in performance and quality measurement, and to recommend additional indicators more relevant to the quality of breast cancer care in Ontario.

scholarly journals Influence of Social Determinants, Lifestyle, Emotional Well-Being and the Use of Unconventional Therapies in Breast Cancer Progression in a Cohort of Women in Barcelona: Protocol for the DAMA Cohort (Preprint)

2017 ◽  
Author(s):  
Rosa Puigpinos-Riera ◽  
Xavier Continente ◽  
Gemma Serral ◽  
Xavi Bargalló ◽  
Montserrat Doménech ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Progression ◽  
Social Determinants ◽  
Breast Cancer Survivors ◽  
Well Being ◽  
Lifestyle Changes ◽  
Convenience Sample ◽  
Informed Consent Form ◽  
Clinical Records ◽  
The Impact

BACKGROUND Breast cancer continues to be the most commonly diagnosed cancer in women. Breast cancer survivors face numerous problems, especially after completing the first year of intense treatment. We present the protocol for an ongoing study to analyze the impact of a series of factors on breast cancer survival related to lifestyle, emotional well-being, and use of complementary and alternative medicine (CAM). OBJECTIVE We aim to analyze the influence of social determinants, lifestyle changes, emotional well-being, and use of CAM in the progression of breast cancer in women diagnosed with breast cancer between 2003 and 2013 in Barcelona, Spain. METHODS We will perform a mixed cohort study (prospective and retrospective) of women diagnosed with breast cancer, created using a convenience sample in which we study the evolution of the disease (relapse, death, or remaining disease-free). Once identified, we sent the women information about the study and an informed consent form that they are required to sign in order to participate; a total of 2235 women were recruited. We obtained the following information from all participants: sociodemographic profile via a phone interview, and a self-administered survey of information about the study’s objectives (lifestyles, emotional well-being, health care services, and the use of CAM). Lastly, we examined clinical records to obtain data on the tumor at the time of diagnosis, the treatment received, the occurrence of relapses (if any), and the tumor typology. We present data on the women’s social profile based on descriptive data obtained from the telephone interview (welcome survey). RESULTS Based on the welcome survey, which was completed by 2712 women, 14.42% (391/2712) of respondents were <50 years of age, 45.50% (1234/2712) were between 50 and 65 years of age, and 40.08% (1087/2712) were >65 years of age. A total of 43.69% (1185/2712) belonged to the highest social classes (I and II), 31.27% (848/2712) to the middle class (III), and 23.49% (637/2712) to the working classes (IV and V). Approximately 22.71% (616/2712) lived alone, 38.31% (1039/2712) lived with one person, and 38.97% (1057/2712) lived with two or more people. CONCLUSIONS We obtained information from a large cohort of women, but this study has limitations related to the convenience sampling strategy, one of which is reduced representativeness. Conversely, being a self-administered survey, the study introduces biases, especially from respondents that answered on paper. However, the information that the study provides will serve as the basis for designing future interventions aimed at improving the knowledge gaps indicated for women with breast cancer.

scholarly journals Activation of epithelial-mesenchymal transition process during breast cancer progression – the impact of molecular subtype and stromal composition

2021 ◽  
Author(s):  
Aleksandra Markiewicz ◽  
Justyna Topa ◽  
Marta Popęda ◽  
Jolanta Szade ◽  
Jarosław Skokowski ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Cancer Progression ◽  
Epithelial Mesenchymal Transition ◽  
Molecular Subtypes ◽  
Molecular Subtype ◽  
Ki 67 ◽  
Mesenchymal Transition ◽  
Metastatic Colonization ◽  
The Impact

Breast cancer (BC) is a heterogeneous disease with different molecular subtypes, which can be defined by oestrogen (ER), progesterone (PR) and human epidermal growth factor (HER2) receptors’ status as luminal, HER2+ and triple negative (TNBC). Molecular subtypes also differ in their epithelial-mesenchymal phenotype, which might be related to their aggressiveness, as activation of the epithelial-mesenchymal transition (EMT) is linked with increased ability of cancer cells to survive and metastasize. Nevertheless, the reverse process of mesenchymal-epithelial transition was shown to be required to sustain metastatic colonization. In this study we aimed to analyse activation of the EMT process in primary tumours (PT), which have (N+) or have not (N–) colonized the lymph nodes, as well as the lymph nodes metastases (LNM) themselves in 88 BC patients. We showed that luminal N– PT have the lowest activation of the EMT process (27%), in comparison to N+ PT (48%, p=0.06). On the other hand, TNBC do not show statistically significant EMT activation at the stage before lymph colonization (N–, 83%) and after colonization of the lymph nodes (N+, 63%, p=0.58). TNBC are also the least plastic (unable to change the EMT phenotype) in terms of turning EMT on or off between matched PT and LNM (0% EMT plasticity in TNBC vs 36% plasticity in luminal tumours). Moreover, in TNBC activation of EMT was correlated with increased cell division rate of the PT– in mesenchymal TNBC PT median Ki-67 was 45% in comparison to 10% in epithelial TNBC PT (p=0.002), whereas in PT of luminal subtypes Ki-67 did not differ between epithelial and mesenchymal phenotypes. Profiling of immunotranscriptome of epithelial and mesenchymal luminal BC with Nanostring technology revealed that N– PT with epithelial phenotype were enriched in inflammatory response signatures, whereas N+ mesenchymal cancers showed elevated MHC class II antigen presentation. Overall, activation of EMT changes during cancer progression and metastatic colonization of the lymph nodes depending on the PT molecular subtype and is related to differences in stromal signatures. Activation of EMT is associated with colonizing phenotype in luminal PT and proliferative phenotype of TNBC.

Impact of mammographic screening in staging, treatment and prognosis of breast cancer: Early assessment

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10537-10537
Author(s):  
A. Lluch ◽  
I. Chirivella ◽  
A. Insa ◽  
F. Martinez-Ruiz ◽  
A. Santaballa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Carcinoma ◽  
Cancer Patients ◽  
Breast Conserving Surgery ◽  
Tumor Stage ◽  
Mammographic Screening ◽  
Invasive Breast Carcinoma ◽  
Breast Cancer Patients ◽  
Early Assessment ◽  
The Impact

10537 Background: The use of breast cancer mammographic screening (MS) leads to early detection and has been shown to reduce the mortality rate and to increase the proportion of breast-conserving surgery. The aim of this study is to analyze the impact of mammography in the staging, treatment and prognosis of breast carcinoma. Methods: In 1993, a population-based mammographic screening among women aged from 45 to 70 years was introduced in the community of Valencia. We examined the effects of this MS program by the comparison of two populations. The first one included all the women with screen-detected invasive breast carcinoma between 1993 and 2002 in the community of Valencia. The second one was comprised of all the women with invasive breast carcinoma, diagnosed in the same period, aged 45–70, not attending the MS and treated at H. Clinico of Valencia. Results: Between January, 1993 and December, 2002, 2313 new invasive breast cancer patients were detected by the MS program in the community of Valencia, and 1349 women aged 45–70, not attending de MS were diagnosed with invasive breast carcinoma in H.Clinico of Valencia. The median follow-up period was 45.5 months for the screen-detected breast cancer and 51.9 months for not screen-detected patients. The screen-detected tumors had smaller pathological size (pT1 tumors 70.2% vs 40.5%, p < 0.0001), were more likely to have pathologically confirmed negative nodal status (66.4% vs 52.2%, p < 0.0001) and stage I disease (55.3% vs 26.1%, p < 0.0001). Breast-conserving surgery was performed in 50.4% of patients with screen-detected tumors and in 31.9% of women who had not undergone MS (p < 0.0001). The 5-year estimated survival was 95.5% (SE 0.57) for women with screen-detected breast cancer and 85.5% (SE 1.17) for those with not screen-detected tumors (p < 0.0001). Conclusions: Our data demonstrate a better prognosis in terms of 5-year survival in screen-detected breast cancer patients that may explain why breast carcinoma mortality rates have decreased in recent decades. These patients have also been found to have smaller tumors, a more favorable tumor stage and a higher proportion of breast-conserving surgery. No significant financial relationships to disclose.

Impact of primary care providers on patient screening mammography and initial presentation in an underserved clinical setting.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 8-8
Author(s):  
Ajaratu Keshinro ◽  
Ioannis Hatzaras ◽  
Shubhada Dhage ◽  
Kenneth Rifkind ◽  
Kathie-Ann P. Joseph
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Primary Care Providers ◽  
Screening Mammography ◽  
Stage I ◽  
Cancer Stage ◽  
Care Providers ◽  
Palpable Mass ◽  
Stage Iv Breast Cancer ◽  
The Impact

8 Background: Screening mammography (SM) is a routinely used modality for earlier detection of breast cancer and is effective in reducing breast cancer-related morbidity and mortality. A better understanding of the impact of access to primary care physician (PCP), on the screening protocols and stage presentation, is needed to address the issue of breast cancer stage disparity amongst underserved women. Methods: A retrospective chart review of the electronic medical record, for breast cancer patients newly diagnosed from 2012-2013, was performed using the tumor registry at Bellevue Hospital Center, the largest public hospital in New York City. Patients with recurrent breast cancer, stage IV breast cancer, and those that weren’t managed surgically at our institution, were excluded from the study. Data including patient demographics, established relationship with PCP, and screening mammogram and palpable mass at presentation, were obtained and analyzed using SPSS Statistics Software. Results: 173 patients were included in the study of which 5 presented with bilateral breast cancer (n = 178). The majority of the patients seen at our institution were from minority groups, primarily Hispanic (34%) and Chinese (23%). 129 patients (72%) had a PCP at the time of diagnosis versus 49 patients (28%) without a PCP. Patients without a PCP were more likely to have a palpable breast mass at presentation, compared to patients with a PCP (73% vs. 42% respectively, p < 0.05). Furthermore, only 32 % of patients without a PCP had a SM at time of presentation, compared to 61% of patients with a PCP (p = 0.003). Overall, in the group of patients with a PCP, the majority presented with stage I breast cancer (43%), followed by 29% with stage 0. In comparison, the majority of patient without a PCP presented with stage II (41%), followed by 29% with stage I (p = 0.019). Conclusions: There is a benefit for patients with access to a PCP, as it leads to a higher likelihood of breast cancer detection via SM, as opposed to a symptomatic presentation, such as a palpable mass. Therefore, these patients are more likely to be diagnosed with an earlier stage of breast cancer, which improves their mortality.

Evaluation of the antioxidant impact of ginger-based kombucha on the murine breast cancer model

2017 ◽  
Vol 15 (1) ◽  
Author(s):  
Samaneh Salafzoon ◽  
Hamideh Mahmoodzadeh Hosseini ◽  
Raheleh Halabian
Keyword(s):  
Breast Cancer ◽  
Cancer Progression ◽  
Sod Activity ◽  
Antioxidant Agents ◽  
Kombucha Tea ◽  
Before And After ◽  
Abnormal Metabolism ◽  
Liver And Kidney ◽  
Tumor Homogenate ◽  
The Impact

AbstractBackgroundAbnormal metabolism is a common event in cancerous cells. For example, the increase of reactive oxygen species (ROS) production, particularly due to aerobic respiration during invasive stage, results in cancer progression. Herein, the impact of kombucha tea prepared from ginger on the alteration of antioxidant agents was assessed in the breast cancer animal model.MethodsTwo types of kombucha tea with or without ginger were administered to BALB/c mice before and after tumor challenge. Superoxide dismutase (SOD), catalase, glutathione (GSH) and malondialdehyde (MDA) were evaluated in tumor, liver and kidney.ResultsAdministration of kombucha ginger tea significantly decreased catalase activity as well as GSH and MDA level in tumor homogenate (p<0.001). A significant decrease in SOD activity and increase in MDA quantity was determined in the kidney which had received kombucha ginger tea (pConclusionsThe consumption of kombucha prepared from ginger could exert minor antioxidant impacts by balancing multi antioxidant factors in different tissues in the breast cancer models.

scholarly journals Impact of the COVID-19 pandemic on diagnosis, stage, and initial treatment of breast cancer in the Netherlands: a population-based study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Anouk H. Eijkelboom ◽  
◽  
Linda de Munck ◽  
Marie-Jeanne T. F. D. Vrancken Peeters ◽  
Mireille J. M. Broeders ◽  
...  
Keyword(s):  
Breast Cancer ◽  
The Netherlands ◽  
Initial Treatment ◽  
Cox Regression ◽  
Ductal Carcinoma ◽  
Screening Program ◽  
Stage Migration ◽  
Netherlands Cancer Registry ◽  
Tumor Stages ◽  
The Impact

Abstract Background The onset of the COVID-19 pandemic forced the Dutch national screening program to a halt and increased the burden on health care services, necessitating the introduction of specific breast cancer treatment recommendations from week 12 of 2020. We aimed to investigate the impact of COVID-19 on the diagnosis, stage and initial treatment of breast cancer. Methods Women included in the Netherlands Cancer Registry and diagnosed during four periods in weeks 2–17 of 2020 were compared with reference data from 2018/2019 (averaged). Weekly incidence was calculated by age group and tumor stage. The number of women receiving initial treatment within 3 months of diagnosis was calculated by period, initial treatment, age, and stage. Initial treatment, stratified by tumor behavior (ductal carcinoma in situ [DCIS] or invasive), was analyzed by logistic regression and adjusted for age, socioeconomic status, stage, subtype, and region. Factors influencing time to treatment were analyzed by Cox regression. Results Incidence declined across all age groups and tumor stages (except stage IV) from 2018/2019 to 2020, particularly for DCIS and stage I disease (p < 0.05). DCIS was less likely to be treated within 3 months (odds ratio [OR]wks2–8: 2.04, ORwks9–11: 2.18). Invasive tumors were less likely to be treated initially by mastectomy with immediate reconstruction (ORwks12–13: 0.52) or by breast conserving surgery (ORwks14–17: 0.75). Chemotherapy was less likely for tumors diagnosed in the beginning of the study period (ORwks9–11: 0.59, ORwks12–13: 0.66), but more likely for those diagnosed at the end (ORwks14–17: 1.31). Primary hormonal treatment was more common (ORwks2–8: 1.23, ORwks9–11: 1.92, ORwks12–13: 3.01). Only women diagnosed in weeks 2–8 of 2020 experienced treatment delays. Conclusion The incidence of breast cancer fell in early 2020, and treatment approaches adapted rapidly. Clarification is needed on how this has affected stage migration and outcomes.

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