Breaking Research News from sources other than Breastcancer.org
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Leapfrog to begin evaluating surgical centers
The Leapfrog Group said it will begin evaluating and grading safety and quality at up to 5,600 surgery centers, focusing on staffing, surgical outcomes and patient experience. CEO Leah Binder said the evaluations will address gaps in information about same-day surgery.
https://khn.org/news/influential-leapfrog-group-ju...
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Study evaluates effects of patient access to physician's notes
A new study has found that patients who were given access to their physicians' notes via electronic medical records and completed a final survey post-treatment trusted their doctors more and gained a more enhanced understanding of their illnesses and the treatments they undergo, according to the online journal Practical Radiation Oncology. The respondents were cancer patients at the University of California, Los Angeles, Jonsson Cancer Center who were undergoing radiotherapy in 2017.
https://www.medscape.com/viewarticle/903548
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ESMO 2018: Shorter-Course of Trastuzumab Possible Option for Some HER2-Positive Early Breast Cancers
Treatment de-escalation may benefit patients at low and intermediate risk of relapse
A subgroup analysis of the Short-HER trial has found that a 9-week course of adjuvant trastuzumab, compared to the standard 1-year of treatment, can have a similar disease-free survival rate and carries a lower risk of cardiac toxicity for women who have HER2-positive early breast cancer with small tumors, according to a presentation at the European Society for Medical Oncology's 2018 Congress, October 19 to 23.
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Deep Learning Algorithm Can ID Mammographic Breast Density
{Researchers} conducted a retrospective study to develop a deep learning algorithm to assess mammographic breast density. A deep convolutional neural network was trained to assess Breast Imaging Reporting and Data System breast density based on an original interpretation by an experienced radiologist. The researchers found good agreement between the DL model and radiologists in the test set (κ = 0.67) and with radiologists in the reader set (κ = 0.78). In the clinical implementation set, there was very good agreement with radiologists (κ = 0.85); 94 percent of the 10,763 DL assessments for binary categorization of dense or non-dense breasts were accepted by the interpreting radiologist.
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Maternal Breast Cancer Risk in Relation to Birthweight and Gestation of Her Offspring
Published in: Breast Cancer Research
- In a cohort of 83,451 parous women, study investigators collected information on each pregnancy with the goal of investigating the associations of length of gestation and birthweight of offspring in a woman's pregnancies with her breast cancer risk, adjusting for a full range of non-reproductive as well as reproductive risk factors. High birthweight first pregnancies may increase breast cancer risk, possibly through the association of birthweight with estrogen and insulin-like growth factor 1 levels.
- This study adds to evidence that short gestation pregnancies may increase the risk of breast cancer, at least premenopausally, perhaps by hormonal stimulation and breast proliferation early in pregnancy without the opportunity for the differentiation that occurs in late pregnancy.
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Magnetic resonance imaging in breast cancer management in the context of neo-adjuvant chemotherapy
This review discusses the clinical applications of magnetic resonance imaging (MRI) for the assessment of neo-adjuvant chemotherapy (NAC) indication, axillary lymph node status, preNAC cancer prognosis, early and intermediate response to NAC, and post-NAC residual disease in patients with breast cancer. Contrast-enhanced MRI with analysis of the tumor morphological features and qualitative enhancement kinetics must be considered as the standard method for pre-NAC breast cancer staging and post-NAC residual disease assessment. Diffusion-weighted imaging (DWI) is easy to perform and may increase the specificity of breast MRI for tumor staging, and also for the assessment of tumor multifocality and multicentricity and lymph node status. It also provides an ancillary added value in the early and post-NAC response evaluation. Changes in the functional tumor volume are the main criterion for the early response analysis. Other MRI methods, such as quantitative perfusion analysis, MR spectroscopy and texture analysis, are still under study.
https://www.practiceupdate.com/C/74029/56?elsca1=e...
https://www.croh-online.com/article/S1040-8428(18)30035-0/abstract
DOI: https://doi.org/10.1016/j.critrevonc.2018.09.012
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Applying Deep Learning to Metastatic Breast Cancer Detection
Friday, October 12, 2018Discusses use of artificial intelligence to detect metastatic cancer...described our deep learning–based approach to improve diagnostic accuracy (LYmph Node Assistant, or LYNA) to the 2016 ISBI Camelyon Challenge, which provided gigapixel-sized pathology slides of lymph nodes from breast cancer patients for researchers to develop computer algorithms to detect metastatic cancer. While LYNA achieved significantly higher cancer detection rates (Liu et al. 2017) than had been previously reported, an accurate algorithm alone is insufficient to improve pathologists' workflow or improve outcomes for breast cancer patients. For patient safety, these algorithms must be tested in a variety of settings to understand their strengths and weaknesses. Furthermore, the actual benefits to pathologists using these algorithms had not been previously explored and must be assessed to determine whether or not an algorithm actually improves efficiency or diagnostic accuracy.
In "Artificial Intelligence Based Breast Cancer Nodal Metastasis Detection: Insights into the Black Box for Pathologists" (Liu et al. 2018), published in the Archives of Pathology and Laboratory Medicine and "Impact of Deep Learning Assistance on the Histopathologic Review of Lymph Nodes for Metastatic Breast Cancer" (Steiner, MacDonald, Liu et al. 2018) published in The American Journal of Surgical Pathology, we present a proof-of-concept pathologist assistance tool based on LYNA, and investigate these factors.https://ai.googleblog.com/2018/10/applying-deep-le... -
This is being shared all over Canada since yesterday
https://www.theprogress.com/news/b-c-oncologist-changing-the-face-of-breast-cancer-treatment/
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Wow Blugene, that’s amazing news. You should crosspost it at the Canadian topic. I wonder if they can use it anywhere in the body.
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Brachytherapy is used often here... but I don't think it's good for everyone. Mostly a wider spread of the radiation beam is necessary, not just to the tumor bed, but the adjacent tissue/nodes as well.
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Glad to read that about the organic food research. I switched to all organic the day after my dx; although I was choosing organic when I could, I wasn't so mindful about it. Now everything I eat, practically, is organic.
Claire
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Survey: Advanced breast cancer patients worried about medical costs
Almost 70% of the 1,054 US women diagnosed with advanced breast cancer who responded to a survey said they were anxious about their financial struggles, often declining or putting off getting treatment or failing to make payments on bills unrelated to medical care. A key finding from the survey by researchers from the University of North Carolina at Chapel Hill was that "financial toxicity" was worse among patients with health insurance than among uninsured patients, according to a presentation at the American Society of Clinical Oncology Quality Care Symposium.
https://consumer.healthday.com/public-health-infor...
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4th ESO–ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4) | ESMO
https://www.esmo.org/Guidelines/Breast-Cancer/4th-... -
Trump proposes to lower drug prices by basing them on other countries' costs
The New York Times
The announcement, part of a flurry of initiatives from the White House ahead of the midterms, came after a government study found that Medicare is paying 80 percent more than other nations for drugs. Read the full story
Shared from Apple News -
This brings to mind the Neulasta shot - at $15,000 per shot/arm pack. I had 4. I wonder what it costs outside of the US?
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Lanne, I'm almost afraid to write that, but the Neulasta shot here costs $ 954. No, I didn't forget a number, it's really nine hundred something. But I guess it's very different in each EU country
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Ack. If I hadn't already met my annual out-of-pocket max, mine would have cost me 10% or $1,500 each! (And that was pretty fantastic insurance).
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Neulasra shots in Australia are around $1000 if used outside the hospital system. Otherwise they cost nothing.
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When I had Neulasta in 2015, the cost in Alberta was $6,000 if you were paying without insurance, or if you had private drug insurance, but there is a non group plan through Alberta Health (premium about $50/month for individual coverage) and on that plan, the cost to the patient was $25, with total cost of just under $3,000. If you enrolled in the non group plan at diagnosis, as I did, the manufacturer “comped” any required shots during the 3 month waiting period before coverage kicked in. Total cost to me for Neulasta x 8 was $100.
avmom
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In New Zealand, neulasta is about $1300 US outside of the public system. Prescribed within it, it’s cost me $3.25 each.
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Weekly Oral Vinorelbine in Breast Cancer Patients Previously Treated With Anthracyclines or Taxanes
- Clinical & Translational Oncology: Official Publication of the Federation of Spanish Oncology Societies In this real-world study, 55 patients with metastatic breast cancer who were previously treated with anthracyclines or taxanes were given oral weekly vinorelbine, and safety and efficacy were evaluated. The median progression-free and overall survival were 3.7 months and 10 months, respectively. The overall response rate was 29.1%, and the clinical benefit rate was 49.1%. Overall, 86% of patients received treatment without delays or dose reduction. Patients with HER2-positive disease who received oral vinorelbine and trastuzumab exhibited better response and disease control compared with patients with HER2-negative disease.These findings demonstrate the efficacy and tolerability of oral weekly vinorelbine in patients with metastatic breast cancer and suggest benefit in patients with HER2-positive disease when given in combination with trastuzumab.https://www.practiceupdate.com/c/74860/67/13/?elsc...DOIhttps://doi.org/10.1007/s12094-018-1946-9https://link.springer.com/article/10.1007/s12094...
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Cutoff to Subdivide pT1 Tumors in HR-Negative and HER2-Positive Breast Cancer
- Cancer Medicine This study retrospectively analyzed the SEER-database to explore the clinicopathological characteristics and prognosis of T1a-T1c HER2+/HR− breast cancer. A total of 2648 HER2+/HR− and 56,387 HER2−/HR+ T1a-T1c breast cancer patients were enrolled. There was a clear trend that tumor size had a positive correlation with advanced AJCC stage (P<.001) and N stage (P<.001). T1a and T1b HER2+/HR− breast cancer had great homogeneity in that these two subgroups had comparable survival and both showed no significant survival difference with its counterpart of HER2−/H R+ subtype. Conversely, T1c HER2+/HR− breast cancers revealed worse prognosis than T1a/T1b HER2+/HR− and T1c HER2−/HR+ tumors (BCSS HR = 3.847, P<.001; OS HR = 2.055, P<.001).T1a and T1b HER2+/HR− breast cancer had favorable prognosis and great homogeneity, indicating 1.0 cm may be a suitable cutoff for subclassification of T1 cancer.
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ASTRO 2018: Once-Weekly and Conventional Breast Radiation Linked to Similarly Low Side Effects
Conventional and once-weekly radiation led to similar, low incidence of long-term side effects.
- PracticeUpdate Editorial Team
- https://www.practiceupdate.com/C/75129/56?elsca1=e...
- The study results suggest the possibility of a regimen delivered once a week over 5 weeks to treat early-stage breast cancer rather than daily treatment. ... these findings may help facilitate discussions regarding the risks and benefits of different courses of radiation therapy in a shared decision-making process between physicians and patients.
- FAST was designed to assess changes in healthy breast tissue following conventional radiation treatment vs two shorter regimens that delivered higher doses of radiation in fewer sessions. The trial enrolled 915 women with early-stage invasive breast cancer at 18 centers across the UK from 2004 to 2007.Initial trial results from 2011 indicated that once-weekly, hypofractionated therapy led to similarly low normal tissue effects as conventional therapy 2 years following treatment. The current results confirmed that these similarities persisted for an additional 8 years.
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Pictilisib + Paclitaxel, ± Bevacizumab or Trastuzumab, and + Letrozole in Advanced Breast Cancer
- Breast Cancer Research In this study, 69 patients with locally recurrent or metastatic breast cancer were enrolled in a three-part multi-schedule study. In parts 1 and 2, the 3+3 dose escalation and cohort expansion stages, patients received pictilisib (60–330 mg) plus paclitaxel (90 mg/m2) with and without bevacizumab or trastuzumab. In part 3, patients received pictilisib 260 mg plus letrozole. Grade 3 or higher adverse events were reported in 72.5% of patients, serious adverse events were reported in 30.4% of patients, and 2 patients experienced adverse events leading to death. Complete responses were achieved by 2 patients, whereas 17 patients achieved partial responses.These data demonstrate acceptable safety and promising antitumor activity of the combination, warranting further investigation.
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Incidence of Secondary MDS and AML in Patients With Ovarian or Breast Cancer
- Gynecologic Oncology The present study reports rates of knowledge regarding the probability of a BRCA1 and/or S pathogenic variant and genetic testing in 537 patients with breast cancer, collected as part of a randomized controlled trial of a tailored, comprehensive, and interactive decision tool (iCanDecide). The authors found that using an interactive decision tool did improve knowledge rates relative to a static website.Integrated tools in the treatment decision process is expected to improve decision-making over time as genetic testing becomes increasingly prominent.
DOI: 10.1002/cncr.31731 -
Autologous Fat Transfer Not Associated With Long-Term Cancer Relapse in Patients With Breast Cancer
- JAMA Surgery In this cohort study examining 287 patients (300 affected breasts) who underwent reconstruction with autologous fat transfer (AFT) and 300 matched control patients treated with conventional or no breast reconstruction, no significant difference in the rate of locoregional recurrence was observed after a 5-year follow-up.Exposure to AFT was not found to be associated with increased rates of cancer relapse, thereby confirming the short-term findings of previous studies, which found no association between AFT and increased risk for cancer recurrence.
doi:10.1001/jamasurg.2018.3744 -
Disseminated Tumor Cells Predict Efficacy of Regional Nodal Irradiation in Early-Stage Breast Cancer
- International Journal of Radiation Oncology*Biology*Physics
- This article reports the long-term (>10 years) results on the impact of DTC (disseminated tumor cells from a medullary iliac crest sample) status in early-stage breast cancer from 620 patients (95 DTC-positive). The study authors found high predictive impact of DTC status on the efficacy of regional radiotherapy on locoregional relapse in early breast cancer.
- Future work may reveal that DTC status could serve as a decision-making tool in customizing adjuvant radiation therapy for early-stage breast cancer patients.
https://www.redjournal.org/article/S0360-3016(18)33813-6/pdf -
Prolonged Metastatic Free Interval Is Associated With Improved MBC Survival
- Breast Cancer Research and Treatment In this study, patients with an initial stage I–III breast cancer diagnosis and a subsequent metastatic breast cancer diagnosis recorded from 1988 to 2014 were identified from the SEER database to investigate the association between metastatic-free interval (MFI) and subsequent survival. The 5-year recurrent metastatic breast cancer–specific survival rate was 23% for patients with an MFI <5 years, 26% for patients with an MFI of 5–10 years, and 35% for patients with an MFI >10 years. Compared with patients who had an MFI <5 years, patients with >10-year MFI were significantly less likely to die of breast cancer. Other factors associated with improved cancer-specific survival included white race, ER/PR-positive receptors, and lower tumor grade.These findings suggest that patients who have prolonged MFI >10 years between initial breast cancer diagnosis and subsequent metastatic diagnosis are more likely survive longer.
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Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts
- European Journal of Cancer
- https://www.practiceupdate.com/C/74684/56?elsca1=e...
https://www.ejcancer.com/article/S0959-8049(18)31370-4/pdf -
October 24, 2018
Who Determines What 'Value' Looks Like in Value-Based Cancer Care?
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