Diagnostic performance of digital breast tomosynthesis and full-field digital mammography with new reconstruction and new processing for dose reduction

Background

The main barrier to adoption of digital breast tomosynthesis (DBT) plus full-field digital mammography (FFDM) is radiation exposure dose. The purpose of this study was to evaluate the diagnostic performance of DBT plus FFDM, both with newly developed technology (nd), at a dose comparable to that of the conventional FFDM alone.

Methods

Nine hundred and thirteen participants were recruited from May 2014 to January 2016 consecutively. For each subject, the exposure setting for DBT(nd) + FFDM(nd) was also used for the conventional FFDM alone. Retrospective reader studies were performed: DBT(nd) + FFDM(nd) (142 cases, including 42 cancer cases) and conventional FFDM (258 cases, including 87 cancer cases). Eight radiologists provided Japanese categorizations and probability of malignancy independently. Diagnostic performance was assessed by comparing sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Two-sided P values were calculated.

Results

DBT(nd) + FFDM(nd) showed sensitivity and AUC significantly increased over the conventional FFDM (85.4 vs. 80.3%, P = 0.015 and 90.9 vs. 88.3%, P = 0.049) and specificity did not significantly increase (89.6 vs. 88.4%, P = 0.52). The mean glandular dose (MGD) difference of DBT(nd) + FFDM(nd) and conventional FFDM was not significant (difference ? 0.11 mGy, P = 0.08).

Conclusions

In this study population, DBT plus FFDM, both with newly developed technology, provided diagnostic performance improved over the conventional FFDM alone, even at comparable MGD.

     

Performance of breast cancer screening using digital breast tomosynthesis: results from the prospective population-based Oslo Tomosynthesis Screening Trial

Purpose

Digital breast tomosynthesis (DBT) has the potential to overcome limitations of conventional mammography. This study investigated the effects of addition of DBT on interval and detected cancers in population-based screening.

Methods

Oslo Tomosynthesis Screening Trial (OTST) was a prospective, independent double-reading trial inviting women 50–69 years biennially, comparing full-field digital mammography (FFDM) plus DBT with FFDM alone. Performance indicators and characteristics of screen-detected and interval cancers were compared with two previous FFDM rounds.

Results

24,301 consenting women underwent FFDM + DBT screening over a 2-year period. Results were compared with 59,877 FFDM examinations during prior rounds. Addition of DBT resulted in a non-significant increase in sensitivity (76.2%, 378/496, vs. 80.8%, 227/281, p = 0.151) and a significant increase in specificity (96.4%, 57229/59381 vs. 97.5%, 23427/24020, p < .001). Number of recalls per screen-detected cancer decreased from 6.7 (2530/378) to 3.6 (820/227) with DBT (p < .001). Cancer detection per 1000 women screened increased (6.3, 378/59877, vs. 9.3, 227/24301, p < .001). Interval cancer rate per 1000 screens for FFDM + DBT remained similar to previous FFDM rounds (2.1, 51/24301 vs. 2.0, 118/59877, p = 0.734). Interval cancers post-DBT were comparable to prior rounds but significantly different in size, grade, and node status from cancers detected only using DBT. 39.6% (19/48) of interval cancers had positive nodes compared with only 3.9% (2/51) of additional DBT-only-detected cancers.

Conclusions

DBT-supplemented screening resulted in significant increases in screen-detected cancers and specificity. However, no significant change was observed in the rate, size, node status, or grade of interval cancers.ClinicalTrials.gov: NCT01248546.

     

Clinical implementation of synthesized mammography with digital breast tomosynthesis in a routine clinical practice

Background

Most published studies evaluating digital breast tomosynthesis (DBT) included a separate 2-dimensional full-field digital mammogram (FFDM) for DBT screening protocols, increasing radiation from screening mammography. Synthesized mammography (SM) creates a 2-dimensional image from the DBT source data, and if used in place of FFDM, it reduces radiation of DBT screening. This study evaluated the implementation of SM + DBT in routine screening practice in terms of recall rates, cancer detection rates (CDR), % of minimal cancers, % of node-positive cancers, and positive predictive values (PPV).

Materials and methods

A multivariate retrospective institutional analysis was performed on 31,979 women who obtained screening mammography (10/2013–12/2015) with cohorts divided by modality (SM + DBT, FFDM + DBT, and FFDM). We adjusted for comparison mammograms, age, breast density, and the interpreting radiologist. Recall type was analyzed for differences (focal asymmetry, asymmetry, masses, calcifications, architectural distortion).

Results

SM + DBT significantly decreased the recall rate compared to FFDM (5.52 vs. 7.83%, p < 0.001) with no differences in overall CDR (p = 0.66), invasive and/or in situ CDR, or percentages of minimal and node-negative cancers. PPV1 significantly increased with SM + DBT relative to FFDM (9.1 vs. 6.2%, p = 0.02). SM + DBT did not differ significantly in recall rate or overall CDR compared to FFDM + DBT. There were statistically significant differences in certain findings recalled by screening modality (e.g., focal asymmetries).

Conclusions

SM + DBT reduces false positives compared to FFDM, while maintaining the CDR and other desirable audit outcome data. SM + DBT is more accurate than FFDM alone, and is a desirable alternative to FFDM + DBT, given the added benefit of radiation reduction.

     

Comparison of synthetic mammography,reconstructed from digital breast tomosynthesis,and digital mammography: evaluation of lesion conspicuity and BI-RADS assessment categories

Purpose

To compare the interpretive performance of synthetic mammography (SM), reconstructed from digital breast tomosynthesis (DBT), and full-field digital mammography (FFDM) in a diagnostic setting, covering different conditions of breast density and mammographic signs.

Methods

A retrospective analysis was conducted on 231 patients, who underwent FFDM and DBT (from which SM images were reconstructed) between September 2014–September 2015. The study included 250 suspicious breast lesions, all biopsy proven: 148 (59.2%) malignant and 13 (5.2%) high-risk lesions were confirmed by surgery, 89 (35.6%) benign lesions had radiological follow-up. Two breast radiologists, blinded to histology, independently reviewed all cases. Readings were performed with SM alone, then with FFDM, collecting data on: probability of malignancy for each finding, lesion conspicuity, mammographic features and dimensions of detected lesions.

Results

Agreement between readers was good for BI-RADS classification (Cohen’s k-coefficient = 0.93 ± 0.02) and for lesion dimension (Wilcoxon’s p = 0.76). Visibility scores assigned to SM and FFDM for each lesion were similar for non-dense and dense breasts, however, there were significant differences (p = 0.0009) in distribution of mammographic features subgroups. SM and FFDM had similar sensitivities in non-dense (respectively 94 vs. 91%) and dense breasts (88 vs. 80%) and for all mammographic signs (93 vs. 87% for asymmetric densities, 96 vs. 75% for distortion, 92 vs. 85% for microcalcifications, and both 94% for masses). Based on all data, there was a significant difference in sensitivity for SM (92%) vs. FFDM (87%), p = 0.02, whereas the two modalities yielded similar results for specificity (SM: 60%, FFDM: 62%, p = 0.21).

Conclusions

SM alone showed similar interpretive performance to FFDM, confirming its potential role as an alternative to FFDM in women having tomosynthesis, with the added advantage of halving the patient’s dose exposure.

     

Detectability comparison of modes in dual-mode digital breast tomosynthesis

Background

The objectives of this study were: (1) to evaluate the detectability of full-field digital mammography (FFDM) plus dual-mode digital breast tomosynthesis (DBT) and compare it with that of FFDM alone and (2) to compare the detectability of high-resolution-mode (HR mode used with 40°-angle imaging, 100-µm pixel size, and higher dose) DBT with that of standard-mode (ST mode used with 15°-angle imaging, 150-µm pixel size, and lower dose) DBT for diagnostic evaluation.

Materials

The local Institutional Review Board approved this retrospective study of two different sets of cases. All participants gave written informed consent. FFDM and DBT images of 471 women who were recalled were acquired between August 2013 and October 2014. HR mode and ST mode were applied to 155 breasts and 157 breasts, respectively. The cases of both modes were selected randomly. Eight radiologists interpreted the images. The detectability for recall cases and for follow cases, and area under the receiver operating characteristic curve (AUC) were calculated.

Results

Adding DBT to FFDM significantly increased the detectability for recall cases and AUC relative to those of FFDM alone (HR mode 8.9 %; 95 % confidence interval (CI) 5.7, 15.0 %; P = 0.013 and 4.9 %; 95 % CI 2.1, 7.7 %; P = 0.001; ST mode 8.3 %; 95 % CI 4.1, 12.1 %; P = 0.007 and 2.9 %; 95 % CI 0.5, 5.3 %; P = 0.02), whereas the detectability for follow cases did not significantly differ. The AUC increase was significantly higher in HR mode than in ST mode (1.5 %; 95 % CI 0.5, 3.7 %; P = 0.023).

Conclusion

Adding HR-mode or ST-mode DBT to FFDM significantly improved the detectability for diagnostic evaluation case.

     

Digital mammography versus digital breast tomosynthesis for detection of breast cancer in the intraoperative specimen during breast-conserving surgery

Purpose

To compare the diagnostic ability of specimen radiography using digital mammography (DM) and digital breast tomosynthesis (DBT) for detecting breast cancer and evaluating its extension in the intraoperative specimen.

Methods

Sixty-five specimens from 65 women (median 62 years; range 34–86) obtained during breast-conserving surgery were prospectively investigated. Specimens underwent DM (25–40 kVp, 12–322 mA s) and DBT (25–34 kVp, 13–137 mA) in two orthogonal planes, anteroposterior (AP) and latero-lateral (LL). Images were interpreted by a radiologist to detect invasive lesions and their extensive intraductal components (EIC) or ductal carcinomas in situ (DCIS); afterwards, they were compared with histopathological findings.

Results

In AP views, 96 % of the invasive lesions were detected by both the methods. Of the EICs, 55 and 65 % were detected by DM and DBT, respectively (P = 0.61). Of the DICSs, 31 and 38 % were detected by DM and DBT, respectively (P > 0.99). In LL views, 71 and 13 % of the invasive lesions were detected by DBT and DM, respectively (P < 0.0001). Of the EICs, 42 and 10 % were detected by DBT and DM, respectively (P = 0.0078). Of the 13 DCISs, 42 and 8 % were detected by DBT and DM, respectively (P = 0.32). The whole lesion and contour could be delineated in 45 % by DBT and in 6.2 % by DM (P < 0.0001).

Conclusions

DBT could detect breast cancer more accurately than DM in LL views, indicating its potential to more precisely diagnose vertical invasion.

     

Non-calcified ductal carcinoma in situ of the breast: comparison of diagnostic accuracy of digital breast tomosynthesis,digital mammography,and ultrasonography

Background

To retrospectively compare the diagnostic accuracy of digital breast tomosynthesis (DBT), digital mammography (DM), and ultrasonography (US) in non-calcified ductal carcinoma in situ (DCIS, include DCIS with micro-invasion).

Patients and methods

Ninety-eight patients with non-calcified DCIS (include DCIS with micro-invasion) were enrolled in our study. Breast carcinoma in situ was confirmed by surgical pathologic evaluation. Our Institutional Review Board granted approval and the participating women provided written informed consent. The imaging findings were evaluated according to the Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology (ACR) by comparing the differences in the detection rate and diagnostic accuracy among the three techniques in all cases, in dense breasts, and in non-dense breasts.

Results

The detection rates of DBT, DM, and US for non-calcified DCIS in all cases were 83.7, 68.4, and 94.9%, respectively, and in patients with dense breasts were 81.2, 63.8, and 95.0%. The detection rate of US was higher than DBT, which, in turn, was higher than DM both in all cases and in dense breasts. Pairwise comparisons among the three techniques showed that the differences were statistically significant (P = 0.000 and P = 0.000, respectively). The experts identified a case as abnormal for all criteria (BI-RADS score of 4B-5) in 68.4% of ratings using DBT, 43.9% of ratings using DM, and 66.3% of ratings using US; for dense breasts, the positive identification rates were 62.5% of ratings using DBT, 41.2% of ratings using DM, and 61.2% of ratings using US. The diagnostic accuracy of DBT and US was significantly higher than that of DM in all cases (P = 0.001 and P = 0.006, respectively) and in dense breasts (P = 0.007 and P = 0.011, respectively). The diagnostic accuracy of DBT was slightly higher than US in all cases and in dense breasts, but the difference was not statistically significant (P = 0.761 and P = 0.871, respectively). By DBT, most non-calcified cases of DCIS presented as a mass lesion (54.9%) with an irregular shape (46.7%), indistinct margin (53.3%), and isodense composition (71.1%). Using US, 72 of 93 patients (77.4%) were shown to have a mass. Most mass lesions had an irregular shape (83.3%), indistinct margin (55.5%), and parallel the skin (82.8%).

Conclusion

DBT and US gave better detection rates and diagnostic accuracy for non-calcified DCIS compared with DM in all cases and in dense breasts. The detection rate of DBT was lower than that of US in all cases and in dense breasts. The diagnostic accuracy of DBT was slightly higher than that of US in all cases and in dense breasts, but the difference was not statistically significant. Imaging findings for non-calcified DCIS were relatively non-specific.

     

Breast cancer screening with digital breast tomosynthesis

Purpose

To give an overview of studies comparing full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) in breast cancer screening.

Materials and methods

The implementation of tomosynthesis in breast imaging is rapidly increasing world-wide. Experimental clinical studies of relevance for DBT screening have shown that tomosynthesis might have a great potential in breast cancer screening, although most of these retrospective reading studies are based on small populations, so that final conclusions are difficult to draw from individual reports. Several retrospective studies and three prospective trials on tomosynthesis in breast cancer screening have been published so far, confirming the great potential of DBT in mammography screening. The main results of these screening studies are presented.

Results

The retrospective screening studies from USA have all shown a significant decrease in the recall rate using DBT as adjunct to mammography. Most of these studies have also shown an increase in the cancer detection rate, and the non-significant results in some studies might be explained by a lack of statistical power. All the three prospective European trials have shown a significant increase in the cancer detection rate.

Conclusion

The retrospective and the prospective screening studies comparing FFDM and DBT have all demonstrated that tomosynthesis has a great potential for improving breast cancer screening. DBT should be regarded as a better mammogram that could improve or overcome limitations of the conventional mammography, and tomosynthesis might be considered as the new technique in the next future of breast cancer screening.

     

Interobserver variability of ultrasound elastography and the ultrasound BI-RADS lexicon of breast lesions

Background

Elastographpy is a newly developed noninvasive imaging technique that uses ultrasound (US) to evaluate tissue stiffness. The interpretation of the same elastographic images may be variable according to reviewers. Because breast lesions are usually reported according to American College of Radiology Breast Imaging and Data System (ACR BI-RADS) lexicons and final category, we tried to compare observer variability between lexicons and final categorization of US BI-RADS and the elasticity score of US elastography.

Methods

From April 2009 to February 2010, 1356 breast lesions in 1330 patients underwent ultrasound-guided core biopsy. Among them, 63 breast lesions in 55 patients (mean age, 45.7 years; range, 21–79 years) underwent both conventional ultrasound and elastography and were included in this study. Two radiologists independently performed conventional ultrasound and elastography, and another three observers reviewed conventional ultrasound images and elastography videos. Observers independently recorded the elasticity score for a 5-point scoring system proposed by Itoh et al., BI-RADS lexicons and final category using ultrasound BI-RADS. The histopathologic results were obtained and used as the reference standard. Interobserver variability was evaluated.

Results

Of the 63 lesions, 42 (66.7 %) were benign, and 21 (33.3 %) were malignant. The highest value of concordance among all variables was achieved for the elasticity score (k = 0.59), followed by shape (k = 0.54), final category (k = 0.48), posterior acoustic features (k = 0.44), echogenecity and orientation (k = 0.43). The least concordances were margin (k = 0.26), lesion boundary (k = 0.29) and calcification (k = 0.3).

Conclusion

Elasticity score showed a higher level of interobserver agreement for the diagnosis of breast lesions than BI-RADS lexicons and final category.

     

Correlation of FANCM expression with clinical factors in luminal B breast cancer

Background

The genotype of Fanconi Anemia complementation group M (FANCM) was previously found to be associated with breast cancer risk in several populations. Here, we studied the expression of FANCM and its correlation with clinical characteristics in Chinese patients with breast cancer.

Methods

We performed an immunohistochemical study of FANCM protein in clinical breast cancer tissues from 310 patients along with 44 adjacent tissues.

Results

FANCM protein level is lower in triple-negative breast cancer tissues than in other subtypes (P = 0.008). In addition, high FANCM expression correlated with pathology type IDC (P = 0.040), estrogen receptor positive (P < 0.001), progesterone receptor positive (P = 0.001), and low Ki-67 status (P = 0.003). Multivariate analysis revealed that FANCM status was an independent prognostic factor for overall survival (P = 0.017) in luminal B breast cancer.

Conclusions

FANCM levels are significantly associated with different subtypes of human breast cancer. Specifically, FANCM could play a role in the progression of luminal B breast cancer.

     

Feasibility and potential limitations of abbreviated breast MRI: an observer study using an enriched cohort

Background

Breast cancer screening using magnetic resonance imaging (MRI) has been introduced in Western countries primarily for populations with an elevated risk of breast cancer. We conducted an observer study involving an experimental abbreviated MRI interpretation by Japanese radiologists, using an enriched cohort, to evaluate its feasibility in a screening setting.

Methods

Eighty-eight breast MRI examinations including 28 cases with breast cancer were enrolled as study subjects. Two radiologists independently reviewed the MR images, first with only two sequences (abbreviated series), and then with all of the images provided for clinical care (full diagnostic series). The difference in sensitivity and specificity was evaluated using McNemar’s test. Interobserver agreement was assessed by calculating κ values.

Results

A total of 176 breasts including 31 cancers (3 cases with bilateral disease) were included. No significant difference in sensitivity or specificity for either observer was observed between the abbreviated series and the full diagnostic series (observer 1: sensitivity 87.1 vs 87.1 %, p = 1.00, specificity 91.7 vs 90.3 %, p = 0.791; observer 2: sensitivity 93.5 vs 96.8 %, p = 1.00, specificity 83.4 vs 89.7 %, p = 0.064). Moderate interobserver agreement (κ = 0.56) was observed for the abbreviated series, whereas substantial agreement (κ = 0.69) was observed for the full diagnostic series.

Conclusions

The diagnostic accuracy of the abbreviated breast MRI was not inferior to that of the conventional full diagnostic interpretation, although a slight decline in interobserver agreement was observed.

     

Meta-analysis for psychological impact of breast reconstruction in patients with breast cancer

Aims

This meta-analysis aimed to evaluate the impact of breast reconstruction on the psychological aspects in patients with breast cancer.

Methods

A literature search on PubMed, Embase, ScienceDirect and Google scholar databases was conducted up to September 2017. The pooled risk radio (RR) or standard mean difference (SMD) and the corresponding 95% confidence intervals (CIs) were calculated using the RevMan 5.3 software.

Results

A total of 5 studies were included in this meta-analysis. There were 551 breast cancer patients receiving mastectomy plus breast reconstruction and 574 breast cancer patients receiving mastectomy alone. The results showed that breast reconstruction can significantly decrease the incidence of anxiety (RR = 0.62, 95% CI 0.47–0.82, P = 0.0006)/depression (RR = 0.54, 95% CI 0.32–0.93, P = 0.02) and scale score for evaluating anxiety (SMD = ? 0.20, 95% CI ? 0.37 to ? 0.03, P = 0.02)/depression (SMD = ? 0.22, 95% CI ? 0.39 to ? 0.66, P = 0.007) compared with mastectomy alone.

Conclusions

Breast reconstruction after mastectomy was benefit for improving the psychological damages in patients with breast cancer.

     

Improvement in diagnostic performance of breast cancer: comparison between conventional digital mammography alone and conventional mammography plus digital breast tomosynthesis

Background

The aim of this study was to determine if the diagnostic performance of breast lesion examinations could be improved using both digital breast tomosynthesis (DBT) and conventional digital mammography (CDM).

Methods

Our institutional review board approved the protocol, and patients were provided the opportunity to opt out of the study. A total of 628 patients aged 22–91 years with abnormal screening results or clinical symptoms were consecutively enrolled between June 2015 and March 2016. All patients underwent DBT and CDM, and 1164 breasts were retrospectively analyzed by three radiologists who interpreted the results based on the Breast Imaging Reporting and Data System. Categories 4 and 5 were considered positive, and pathological results were the gold standard. The diagnostic performance of CDM and CDM plus DBT was compared using the mean areas under the receiver operating characteristic (ROC) curves.

Results

A total of 100 breast cancer cases were identified. The areas under the ROC curves were 0.9160 (95% confidence interval 0.8779–0.9541) for CDM alone and 0.9376 (95% confidence interval 0.9019–0.9733) for CDM plus DBT. The cut-off values for both CDM alone and CDM plus DBT measurements were 4, with sensitivities of 61.0% (61/100) and 83.0% (83/100), respectively, and specificities of 99.1% (1054/1064) and 98.9% (1052/1064), respectively. CDM yielded 39 false-negative diagnoses, while CDM plus DBT identified breast cancer in 22 of those cases (56.4%).

Conclusion

The combination of DBT and CDM for the diagnosis of breast cancer in women with abnormal examination findings or clinical symptoms proved effective and should be used to improve the diagnostic performance of breast cancer examinations.

     

The prognostic value of the tumour-stroma ratio in primary operable invasive cancer of the breast: a validation study

Purpose

The primary aim of the current study is to validate the prognostic relevance of the relative amount of tumour-associated stroma, the tumour-stroma ratio, in a large cohort of primary operable breast cancer patients.

Methods

A retrospective cohort study was performed on women diagnosed and treated for primarily operable invasive breast cancer in the period from 1 January 1990 till 31 December 1999. Tumour-stroma ratio was estimated by microscopic evaluation of haematoxylin and eosin tumour slides. Two independent observers (k = 0.68) performed tumour-stroma ratio evaluation in a significant part of the cohort. The prognostic potential with respect to overall, recurrence-free and distant metastasis-free survival was evaluated.

Results

A total of n = 737 women were evaluated. Median follow-up time was 11.5 years. High stromal content was an independent prognosticator for worse overall (hazard ratio 1.56, p = 0.002, 95% confidence interval 1.18–2.05), distant metastasis-free (hazard ratio 1.52, p = 0.008, 95% confidence interval 1.12–2.06) and recurrence-free survival (hazard ratio 1.35, p = 0.046, 95% confidence interval 1.01–1.81). In subgroups of hormone receptor-positive and lymph node-negative cases, high stromal content was also an independent prognosticator for worse outcome.

Conclusion

Tumour-stroma ratio is an independent risk factor for worse overall, distant metastasis-free and recurrence-free survival in primarily operable breast cancer. However, detailed prospective studies with respect to tumour-stroma ratio are necessary to gain more insight in its prognostic potential in clinical practice.

     

A panel of autoantibodies as potential early diagnostic serum biomarkers in patients with breast cancer

Background

Specific circulating autoantibodies are produced by host immune systems to respond to antigens that arise during tumorigenesis. To achieve auxiliary diagnosis, the present study was designed to test whether circulating autoantibodies against tumor-associated antigens (TAAs) were altered in early breast cancer.

Methods

A total of 102 breast cancer patients and 146 age-matched healthy volunteers were recruited to participate in this study. Autoantibody expression was tested using in-house developed enzyme-linked immunosorbent assay (ELISA) with linear peptide envelope antigens derived from TAAs.

Results

Student’s t tests showed that expression of autoantibodies against the panel (p16, c-myc, TP53, and ANXA-1) was significantly higher in the breast cancer group, stage I and II breast cancer group, and stage III and IV breast cancer group than in the healthy control group (p < 0.001, p < 0.001, p < 0.001). The sensitivities of detection of the panel (90% specificity) in these groups were 33.3%, 31.7%, and 33.3%, respectively, significantly higher than that of any single autoantibody.

Conclusion

The panel of autoantibodies is more sensitive than single TAA autoantibody detection and may be used as biomarkers for early diagnosis of breast cancer.

     

Survivorship care plans and adherence to lifestyle recommendations among breast cancer survivors

Purpose

The effectiveness of survivorship care plans has not been widely tested. We evaluated whether a one-time brief lifestyle consultation as part of a broader survivorship care plan was effective at changing diet and lifestyle patterns.

Methods

A diverse sample of women with stage 0-III breast cancer were randomized to control or intervention groups within 6 weeks of completing adjuvant treatment. Both groups received the National Cancer Institute publication, “Facing Forward: Life after Cancer Treatment.” The intervention group also met with a nurse (1 h) and a nutritionist (1 h) to receive personalized lifestyle recommendations based upon national guidelines. Diet, lifestyle, and perceived health were assessed at baseline, 3 and 6 months. Linear regression analyses evaluated the effects of the intervention adjusted for covariates.

Results

A total of 126 women completed the study (60 control/66 intervention, 61 Hispanic/65 non-Hispanic). At 3 months, the intervention group reported greater knowledge of a healthy diet (P?=?0.047), importance of physical activity (P?=?0.03), and appropriate use of dietary supplements (P?=?0.006) and reported lower frequency of alcohol drinking (P?=?0.03) than controls. At 6 months, only greater knowledge of a healthy diet (P?=?0.01) persisted. The intervention was more effective among non-Hispanics than Hispanics on improving attitude towards healthy eating (P?=?0.03) and frequency of physical activity (P?=?0.006).

Conclusions

The intervention changed lifestyle behaviors and knowledge in the short-term, but the benefits did not persist.

Implications for Cancer Survivors

Culturally competent long-term behavioral interventions should be tested beyond the survivorship care plan to facilitate long-term behavior change among breast cancer survivors.

     

KLF4 and NANOG are prognostic biomarkers for triple-negative breast cancer

Background

Prognosis of breast cancer patients has been reported to depend on the expression of induced pluripotent stem (iPS) cell-inducing factors: KLF4 and NANOG. However, the relationship between KLF4 or NANOG expression in each breast cancer subtype and the life prognosis has not been elucidated.

Method

KLF4 and NANOG expression levels were evaluated in 208 patients using a newly developed tissue microarray (TMA). In vitro, siRNA against klf4 (siKLF4) was transfected in TNBC cell line MDA-MB-231, and the expression of KLF4 was inhibited.

Results

Triple-negative breast cancer (TNBC) patients in KLF4 high-expression (upper) group had more favorable overall survival (OS) and disease-free survival (DFS) rates than KLF4 lower group (p = 0.0453 and p = 0.0427). In contrast, patients in the NANOG upper group had significantly poorer prognosis than lower group in TNBC breast cancer subtypes (p < 0.0001). Multivariate analysis showed that KLF4 (p = 0.0313), NANOG (p = 0.0002), and TNM stage (p = 0.0001) are mutually independent prognostic factors. It was also shown that the proliferation and invasion ability of siKLF4-induced TNBC cells were up-regulated significantly.

Conclusion

Our findings suggested that KLF4 and NANOG expression levels were favorable prognostic factors for TNBC patients. KLF4 also had an ability to inhibit the proliferation and invasion of TNBC.

     

Preventing weight gain in African American breast cancer survivors using smart scales and activity trackers: a randomized controlled pilot study

Purpose

This study evaluated the feasibility and preliminary efficacy of two 6-month, self-regulation interventions that focused on daily self-weighing (DSW) and used objective monitoring and tailored feedback about weight (±activity), to prevent weight gain among African American breast cancer survivors.

Methods

Participants (n = 35) were randomized to an intervention + activity monitoring (INT+), intervention (INT), or control (CON) group. Interventions included a wireless scale (±activity tracker) that transmitted objective data to a mobile app/website, emailed lessons, and tailored feedback based on objective weight (±activity data). Participants completed in-person and online assessments at baseline, 3 months, and 6 months.

Results

Ninety-four percent of participants completed assessments at 3 months, and 97 % at 6 months. Median (IQR) weight change after 6 months was ?0.9 % (?4.4–0.1) in the INT+ (p = 0.075; p = 0.067 vs. CON) and ?0.2 % (?4.2–1.3) in the INT groups (p = 0.463; p = 0.357 vs. CON), versus a 0.2 % (?0.7–1.7) gain in the CON group. The proportion of INT+, INT, and CON participants that were at or below baseline weight was 72.7, 53.8, and 45.5 %, respectively (effect sizes d = 0.64, d = 0.18). Most INT+ participants weighed and wore trackers ≥5 days/week (INT+, 81.9 % vs. INT, 38.5 % vs. CON, 0 %; p < 0.0005; INT+, 72.7 %). Both intervention groups perceived DSW as positive, and 100 % would recommend the program to other breast cancer survivors.

Conclusion

An intervention focused on DSW as a self-monitoring strategy shows promise for preventing weight gain in breast cancer survivors.

Implications for cancer survivors

Daily self-monitoring of weight and activity may be a feasible and accessible approach to promote weight gain prevention in breast cancer survivors.

Clinical trial registration

ClinicalTrials.gov, NCT02030353

     

Body mass index (BMI), postoperative appearance satisfaction,and sexual function in breast cancer survivorship

Purpose

We sought to explore the correlation between BMI and postoperative sexual function, body image, and breast-specific sensuality before and after breast cancer surgery.

Methods

A cross-sectional survey of patients at least 1 year from surgery employed the Female Sexual Function Index (FSFI) and investigator-generated questions. Patients who underwent lumpectomy (L), mastectomy (M), and mastectomy with reconstruction (MR) were compared across three BMI groups: normal weight, overweight, and obese.

Results

Two hundred fifty-five patients underwent lumpectomy (L, n = 174), mastectomy (M, n = 22), or mastectomy with reconstruction (MR, n = 59). Median age was 57 (range 30–93) and median BMI was 28 (range 19–45). Obese and overweight women reported more appearance dissatisfaction (18.1 and 13.0%) than normal weight women (4.1%) (p = 0.01). Lower satisfaction was associated with increasing BMI within the MR group (p = 0.05). The obese group’s median FSFI score met criteria for sexual dysfunction (25.90, range 11.30–33.10). More overweight women reported their chest played an important role in intimacy before and after surgery, but a postoperative decline in the importance of this role was observed in all groups.

Conclusions

Greater post-treatment BMI is inversely related to postoperative appearance satisfaction, particularly in those undergoing mastectomy with reconstruction. The role of the breast in intimacy is greatest in overweight women, but decreases postoperatively in all BMI groups.

Implications for cancer survivors

Postoperative appearance satisfaction and sexual function seems to be correlated to post-treatment BMI, which highlights the need to encourage perioperative weight management for improved survivorship outcomes.

     

Short stature in retinoblastoma survivors: a cross-sectional study of 138 patients

Purpose

Short stature has been reported in pediatric cancer survivors. Data on retinoblastoma survivors are limited. We conducted a cross-sectional study to assess the height in retinoblastoma survivors.

Method

The recorded height was compared with median height for age and sex as per the Indian Academy of Pediatrics. Z-score less than ?2 was considered short statured.

Result

Thirty percent of the survivors were short statured. The mean height was shorter than the mean 50th percentile height (119.7 ± 14.8 vs 128.7 ± 15 cm, p < 0.001). Previous chemotherapy showed a trend toward association (p = 0.09).

Conclusion

Short stature affects a significant number of retinoblastoma survivors.