Bone mineral density and FRAX as predictors of fracture risk in women with breast cancer.

121 Background: The number of cancer survivors is rising in the USA, the 2007 CDC analysis of the SEER database estimated 11 million cancer survivors, with 90% being over the age of 65 years. Of these, 70% are women, and the most common cancer in survivors is breast cancer. Cancer therapy induced bone loss (CTIBL) contributes to an increase in fracture risk in women with breast cancer. Fractures are responsible for considerable morbidity, disability, hopitalizations and mortality in older adults. Fractures are often the cause for nursing home placement in seniors. Our objective was to analyze the prevalence of fractures after breast cancer therapy and to assess the effect of cancer therapy, clinical risk factors, bone density and the World Health Oragnization (WHO) fracture risk assessment [FRAX] as predictors of fracture occurrence. Methods: The study population consisted of breast cancer patients with invasive breast cancer who participated in a genetic databank within a NCI-Comprehensive Cancer Center. Demographic and clinical characteristics were abstracted from the EMR. Participants were followed for 6-12 years. Results: A total of 439 women with breast cancer were assessed; 79 had sustained fractures during the observation period (116 fractures), fractures occurred at multiple skeletal sites in 27 cases. The prevalence of fractures was 18%. Baseline characteristics revealed that women who sustained fractures were mostly Caucasian (91%, p=0.08), and had a family history of osteoporosis (36.9%, p=0.03). The time to fracture was 4.0 years (range 0-12 years) from diagnosis. Fracture cases had lower BMD at the femoral neck 0.86 ± 0.13 gm/cm2 (T-score= -1.0, p=0.04) than non- fracture cases, although BMD was in the low normal range. Eight cases of hip fractures were identified with a median age of 55 years (32-67 years) Median T-score -0.75. Cox proportional hazard analysis failed to identify any specific risk factors for fractures. Conclusions: Fractures occur shortly after commencing cancer therapy. BMD and FRAX risk calculation were not able to identify women who fractured. Occurrence of fractures in breast cancer raises the possibility of cancer-induced impairment in bone quality.

Download Full-text

A culturally specific dietary plan to manage weight gain among African American breast cancer survivors

Nutrition and Health ◽

10.1177/0260106012459938 ◽

2012 ◽

Vol 21 (2) ◽

pp. 97-105 ◽

Cited By ~ 11

Author(s):

Kathleen A Griffith ◽

Renee Royak-Schaler ◽

Kim Nesbitt ◽

Min Zhan ◽

Adriane Kozlovsky ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Vegetable Intake ◽

Survival Rates ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Daily Consumption ◽

Culturally Specific ◽

Fat Consumption

Breast cancer survival rates are lower in African Americans (AAs) than in Caucasians, owing in part to a higher prevalence of obesity in the former, which increases the risk of recurrence and mortality. The Women’s Intervention Nutrition Study (WINS) found that Caucasian women who followed a low-fat eating plan experienced a lower rate of cancer recurrence than women who maintained their usual diets. The purpose of this study was to test the feasibility of a WINS plan tailored to the cultural needs of AA breast cancer survivors. This feasibility pilot study was conducted at a university National Cancer Institute-designated comprehensive cancer center outpatient clinic with AA breast cancer survivors. The culturally specific WINS (WINS-c) plan included eight individual counseling sessions, five educational group meetings, and follow-up telephone calls over a 1-year period. Outcome measures included dietary fat, triglyceride, insulin and glucose levels, and fruit and vegetable intake. Participants ( n = 8) had a mean age of 61.1 years (standard error of the mean (SEM) 3.1 years) and a mean BMI of 32 kg/m2 (SEM 4.25 kg/m)2. Baseline daily fat consumption decreased from 64.6 g (range 36.8–119.6g) to 44.0 g (21.6–73.4g) at 52 weeks ( p = 0.07). Mean daily consumption of fruits and vegetables increased by 36% and 15%, respectively. Mean triglyceride levels decreased at 12 months ( p < 0.05). Sustained hyperinsulinemia was noted in most participants, including those without diabetes. Mean calcium and vitamin D consumption decreased over the 1-year study period. In AA breast cancer survivors, the WINS-c program resulted in a trend toward reduced fat consumption and may represent a sustainable approach in this population for improvement of diet quality after breast cancer.

Download Full-text

Clinical findings and outcomes from MRI staging of breast cancers in women.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.1124 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 1124-1124

Author(s):

Akshara Raghavendra ◽

Charite Nicolette Ricker ◽

Lingyun Ji ◽

Terry Church ◽

Sujie Tang ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Underserved Populations ◽

Preoperative Staging ◽

Case Series ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Minority Population ◽

Breast Cancers ◽

Mri Staging

1124 Background: For patients diagnosed with breast cancer, case series have shown that staging MRI can detect occult breast cancers in 1-10% of cases. Prevalence and risk factors in underserved populations remain unclear. Methods: We performed a retrospective analysis of all patients, newly diagnosed, with breast cancer who had a preoperative staging MRI seen at Norris Comprehensive Cancer Center and LAC +USC, that cares for an underserved and minority population, from 2006 to 2011. Demographic, clinicopathologic and imaging data were obtained through a review of electronic records. Non index lesions were defined as those not known to be malignant, not presenting with clinical, mammographic or ultrasound findings, in a different quadrant and given an MRI BIRADS score of 4 or 5. Results: A total of 718 patients were analyzed and 148 patients (21%) had a total of 187 non index lesions; 63% were ipsilateral, 26% contralateral and 11% bilateral. As initial evaluation of non-index ipsilateral lesions, 71 (38%) had biopsy, 24 (13%) had excision and 34 (18%) had mastectomy. For contralateral non-index lesions, 41 (22%) had contralateral biopsy, 6 (3%) had excision and 11(6%) had mastectomy. Among all non index lesions, 111 (59%) were benign, 14 (7%) DCIS and 62 (33%) invasive cancer. Occult ipsilateral cancer was detected in 50 (6.9%) of patients and contralateral in 10 (1.4%) and bilateral in 6 (0.8%). Conclusions: The occult cancer detection rate with staging MRI was in this 9.2% of this diverse population. No clear risk factors were identified, with detailed factors, including BRCA status to be updated and reanalyzed. [Table: see text]

Download Full-text

Detecting bone loss in early breast cancer survivors: The Arm-DXA method.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e12066 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e12066-e12066

Author(s):

Yousuf Al-Farhat ◽

Auth Peter

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Hormone Therapy ◽

Cancer Patients ◽

Early Breast Cancer ◽

Bone Fracture ◽

Breast Cancer Survivors ◽

Mineral Density ◽

T Score ◽

Clinically Significant

e12066 Background: Breast cancer survivors who are on adjunct therapy with Aromatase Inhibitors (AIs) or premature menopause due to chemotherapy are known to have an increased risk of osteoporosis and bone fracture. Being at high risk for osteoporosis, these patients should be screened using with dual energy X-ray absorptiometry (DXA) to measure bone mineral density (BMD) according to national guidelines. This study screened the population of patients with early Breast cancer utilizing the Arm-DXA as a user friendly and efficient method. Methods: All Breast cancer patients at the Tolna County Cancer Center, Szekszárd who are diagnosis of early invasive breast cancer were scanned using Arm-DXA during their regular visit to the center. Cancer patients under hormone therapy were scanned annually. Patients who have metastatic disease or known to have osteoporosis were excluded from the study. A total of 431 patients were subject of an arm-DEXA scan for BMD during the period February 2015 to September 2016. Results: Out of the 431 patients, normal T score >-1,5 detected in 223 patients (51,7%), clinically significant osteopenia (CSO) T score -1,5- -2,5 detected in 129 patients (29,9%), and osteoporosis T score < -2,5 detected in 79 patients (18,3%). For the 224 Patients who were under hormone therapy or/and chemotherapy about 29,9% (n: 67) had a CSO, and 20,5% (n:46) had osteoporosis. Conclusions: This study highlights the fact that osteoporosis is under-detected in early breast cancer survivors who are on or after hormone and chemotherapy. About 48% of early breast cancer survivors found to have osteoporosis or clinically significant osteopenia in our study. Our BMD test results shows that half the 224 patients who were under hormone therapy need to take treatment (zoledronic -acid or denosumab ) to prevent bone fracture.

Download Full-text

Screening for absolute fracture risk using FRAX tool in men and women within 40-90 years in urban population of Puducherry, India

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173940 ◽

2017 ◽

Vol 3 (5) ◽

pp. 1051

Author(s):

Amena Firoz ◽

Shishir Suranigi Murugharaj ◽

Ravichandran Kandasamy ◽

Syed Najimudeen

Keyword(s):

Risk Factors ◽

Bone Mineral Density ◽

Fracture Risk ◽

Bone Mineral ◽

Urban Population ◽

Assessment Tool ◽

World Health ◽

Mineral Density ◽

Men And Women ◽

The Mean

Background: Osteoporosis is presently considered as one of the major non-communicable world health hazards. It predominantly affects post-menopausal women, elderly men and women. The aim of the study was to assess fracture risk among men and women within 40-90 years in urban population of Puducherry, India and detect the most prevalent risk factors for fractures.Methods: This is a cross-sectional study done over a period of two months (July - August 2015) involving a sample size of 500 participants, 250 in each gender. Using the FRAX (Fracture Risk Assessment) tool the major osteoporotic fracture risk percentage (MOFR) and hip fracture risk (HFR) were obtained without femoral neck bone mineral density. Chi-square test was applied to test association and p<0.05 considered statistically significant.Results: The mean age of males (57.2±12.7 years) was higher than females (52.5±2.6 years). Out of 500 participants, 18 and 95 participants were found to satisfy the criteria of ≥20% MOFR and ≥3% HFR respectively. The average MOFR was 4.5±6.7 and 4.0±4.6 for women and men respectively. The mean HFR was 1.8±4.0 and 1.8±3.3 for women and men respectively. The requirement of treatment did not differ significantly between gender (44 females versus 51 males). Eight male participants and 9 female participants were advised for further evaluation with a DEXA scan. Conclusions: The FRAX tool provides an aid to enhance patient assessment by the integration of clinical risk factors especially as an osteoporosis screening tool with/without the combination of bone mineral density. It is an effective tool, particularly in developing countries like India, where most of the patients cannot afford expensive investigations like DEXA. People with high risk can be subjected to further evaluation and management, thereby reducing the health resources.

Download Full-text

Mindfulness-Based Stress Reduction for Breast Cancer Survivors (MBSR (BC)): Evaluating Mediators of Psychological and Physical Outcomes in a Large Randomized Controlled Trial

10.1101/2020.05.05.20092171 ◽

2020 ◽

Author(s):

Cecile A. Lengacher ◽

L. Forest Gruss ◽

Kevin E. Kip ◽

Richard R. Reich ◽

Manolete S. Moscoso ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Perceived Stress ◽

National Cancer Institute ◽

Breast Cancer Survivors ◽

South Florida ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Cognitive Mechanisms ◽

Link Type

ABSTRACTMBSR(BC) is known to have a positive impact on psychological and physical symptoms among breast cancer survivors (BCS). However, the cognitive mechanisms of “how” MBSR(BC) works are unknown. The purpose of this study, as part of a larger R01 trial, was to test whether positive effects achieved from the MBSR(BC) program were mediated through changes in increased mindfulness, decreased fear of breast cancer recurrence, and perceived stress. Female BCS >21 years diagnosed with Stage 0-III breast cancer were randomly assigned to a 6-week MBSR(BC) or a Usual Care(UC) regimen. Potential outcome mediators were identified by use of an analysis of covariance (ANCOVA), comparing mean values of outcome variables and potential mediating variables followed by mediational and bootstrap analyses. Among 322 BCS (167 MBSR(BC) and 155 UC), fear of recurrence and perceived stress, but not mindfulness, mediated reductions in anxiety and fatigue at weeks 6 and 12, partially supporting our hypothesis of cognitive mechanisms of MBSR(BC).Support: This study was supported by the National Cancer Institute (Award Number 1R01 CA131080-01A2). This work also has been supported in part by the Biostatistics and Bioinformatics Shared Resource at the H. Lee Moffitt Cancer Center & Research Institute, an NCI designated Comprehensive Cancer Center (P30-CA076292). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. This study protocol was approved by the Institutional Review Board at the University of South Florida to ensure the ethical treatment of participants.Conflict of Interest: The authors have no conflicts to report.Trial Registration:www.ClinicalTrials.gov Registration Number: NCT01177124

Download Full-text

Weight change after (neo)adjuvant chemotherapy in a cohort of breast cancer survivors: Trends by race, hormone positivity, and chemotherapy regimen.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e12018 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e12018-e12018

Author(s):

Bradley S Colton ◽

Samuel Kareff ◽

Shaw Li ◽

Princess Alintah ◽

Chiranjeev Dash ◽

...

Keyword(s):

Breast Cancer ◽

Weight Gain ◽

Adjuvant Chemotherapy ◽

Cancer Survivors ◽

Weight Change ◽

Breast Cancer Survivors ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Her2 Status ◽

Limited Information

e12018 Background: It is estimated that over 50% of breast cancer survivors gain weight during treatment; patients receiving chemotherapy are at higher risk for weight gain. Previous studies have reported limited information about weight gain with current chemotherapy regimens. Methods: Individual data were collected from a cohort of 98 breast cancer patients treated with neoadjuvant or adjuvant chemotherapy between 2015 and 2017 at Lombardi Comprehensive Cancer Center. Weight was recorded from baseline visits and ≥ 1 visit following completion of chemotherapy. Regimens were grouped into anthracycline- (AC) and non-anthracycline-based (NAC) chemotherapy. Results: Overall, 49% ( n = 48) of patients gained weight after chemotherapy, though African-American patients demonstrated higher baseline BMI. Patients with ER-positive cancers displayed greater weight gain than hormone-negative counterparts ( p = 0.04); PR- or HER2-status was not associated statistically significant changes in weight ( p = 0.12 and 0.82, respectively). Among patients who did gain weight, NAC was associated with greater weight gain (4.47kg) than AC-based regimens (2.54kg) ( p = 0.03). Conclusions: ER positivity and NAC may serve as independent predictors of weight gain during chemotherapy. Further studies might consider further analyzing these trends to demonstrate additional long-term patterns. Baseline and After Chemotherapy BMI (kg/m2) and Weight Change (kilograms and percentage change) (P* derived from ANOVA). [Table: see text]

Download Full-text

Early-stage breast cancer (BC) patients: Factors associated with aromatase inhibitor-induced musculoskeletal symptoms.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.525 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 525-525

Author(s):

Simran Arora Elder ◽

Yamin Sun ◽

Seungyoun Jung ◽

Candace Bavette Mainor ◽

Shruti Murali ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Aromatase Inhibitor ◽

Early Stage ◽

Musculoskeletal Symptoms ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Tumor Characteristics ◽

Factors Associated ◽

The Mean

525 Background: Hormone receptor positive (HR+) breast cancer comprises the largest subgroup of breast cancer. Aromatase Inhibitors (AI) are a key treatment for HR+ BC patients (pts) and reduce mortality. Aromatase Inhibitor-Associated Musculoskeletal Symptoms (AIMSS), defined as myalgias, arthralgias, or joint stiffness, occur in up to 50% of pts leading to low adherence to and often discontinuation of therapy. Little is known of the mechanism of AIMSS or its predisposing risk factors. This study aims to identify risk factors associated with AIMSS development in BC patients on AI therapy. Methods: We conducted a medical record review of pts with non-metastatic HR+ BC on adjuvant AI therapy between January 2009 and June 2017 at the University of Maryland Comprehensive Cancer Center. This study included 194 ptswho were free of arthralgia prior to AI therapy. We analyzed pts’ demographics, lifestyle factors, reproductive history, tumor characteristics, medications, cancer treatment, co-morbidities, AI type, onset and severity of AIMSS. Severe AIMSS was defined as requiring change in AI therapy or discontinuation. Multivariable-adjusted logistic regression was used to identify risk factors for severe AIMSS. Results: The mean age of participants was 61. The mean BMI at diagnosis was 30 kg/m2. 41% of pts were White, 40% were Black, 7% other and 12% unknown. Most (79%) did not have a history of tamoxifen and 16% were on GnRH agonists. Most (71%) used letrozole as initial AI therapy; 18% anastrozole; and 11% exemestane. 56% experienced AIMSS while on AI therapy and 20% required change or hold of AI therapy. 4% permanently discontinued AI due to AIMSS severity. BMI at diagnosis was significantly positively associated with risk of AIMSS. Multivariate odds ratio (95% confidence intervals) comparing the highest to lowest tertile of body mass index (BMI) at diagnosis was 4.01 (1.07-10.90; Ptrend: 0.05). There were no significant associations with race, smoking, reproductive factors, type of AI therapy, tamoxifen use prior to AI therapy, medication use, experience of other cancer treatments, and tumor characteristics. Conclusions: 56% of BC pts on adjuvant AI therapy experienced AIMSS. 24% of these changed, held or discontinued AI regimen due to severe AIMSS. Higher BMI at diagnosis was associated with a higher risk of AIMSS. Our results confirm clinical significance of AIMSS among BC pts on AI therapy and suggest BMI as a modifiable factor for AIMSS. A larger study is warranted to replicate our findings and seek other possible risk factors for AIMSS.

Download Full-text

Treatment of Osteoporosis in Postmenopausal Women Who Are At Risk of Fracture

US Endocrinology ◽

10.17925/use.2006.00.02.1w ◽

2006 ◽

Vol 00 (02) ◽

Author(s):

Adriana Ioachimescu ◽

Angelo Licata

Keyword(s):

Risk Factors ◽

At Risk ◽

Postmenopausal Women ◽

Bone Fractures ◽

World Health ◽

Bone Mass Density ◽

Premature Menopause ◽

Mineral Density ◽

T Score ◽

Increased Risk

Osteoporosis consists of decreased bone strength and increased risk of fractures due to decreased mass and abnormal bone microarchitecure. Almost 20% of postmenopausal women have osteoporosis as defined by World Health Organization (WHO) criteria (T-score <- 2.5). Besides the bone mineral density (BMD) expressed by T-score, advancing age, premature menopause, low body weight (≤120lbs), maternal history of hip fracture, previous fracture, loss of height (≥3 inches) and the use of glucocorticosteroids are risk factors for bone fractures. Identifying the postmenopausal women at risk include both an evaluation for risk factors (including secondary causes of osteoporosis) and measurement of bone mass density (BMD) by dual X-ray absorbtiometry (DXA).

Download Full-text

Sleep problems in breast cancer survivors 1–10 years posttreatment

Palliative & Supportive Care ◽

10.1017/s1478951517000311 ◽

2017 ◽

Vol 16 (3) ◽

pp. 325-334 ◽

Cited By ~ 17

Author(s):

Amy E. Lowery-Allison ◽

Steven D. Passik ◽

Matthew R. Cribbet ◽

Ruth A. Reinsel ◽

Barbara O'Sullivan ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Sleep Problems ◽

Physical Symptoms ◽

Stage I ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Vasomotor Symptoms ◽

Poor Sleep

ABSTRACTObjective:Sleep can affect quality of life (QoL) during cancer survivorship, and symptoms related to poor sleep can be exacerbated. We examined the prevalence, severity, and nature of subjective sleep complaints in women surviving stage I–III breast cancer who were 1–10 years posttreatment. We also examined the demographic, medical, physical, and psychosocial correlates of poor sleep in these women in order to identify the subgroups that may be most in need of intervention.Method:A total of 200 patients at a comprehensive cancer center who were 1–10 years posttreatment for primary stage I–III breast cancer with no evidence of disease at the time of enrollment completed a battery of questionnaires on demographics, sleep, physical symptoms, mood, cancer-specific fears, and QoL.Results:The women had a mean age of 57 years (SD = 10.0), with a mean of 63.3 months (SD = 28.8) of post-cancer treatment. Some 38% of these patients were identified as having poor-quality sleep. Women with poor sleep took longer to fall asleep, had more awakenings, and acquired 2 hours less sleep per night than those with good sleep. They also had a lower QoL, greater severity of pain, more concerns about health and recurrence, and increased vasomotor symptoms (p < 0.05). Daytime sleepiness and depression were found to be not significantly correlated with sleep quality.Significance of results:Many breast cancer survivors had severe subjective insomnia, and several breast cancer survivor subgroups were identified as having members who might be most in need of sleep-improvement interventions. Addressing physical symptoms (e.g., vasomotor symptoms and pain) and providing education about the behavioral, social, environmental, and medical factors that affect sleep could result in substantial improvement in the life course of breast cancer survivors.

Download Full-text