828 results on '"Monica Morrow"'
Search Results
2. Axillary lymph node dissection: Dead or still alive?
- Author
-
Anna C. Beck and Monica Morrow
- Subjects
Limit 6): axillary lymph node dissection ,de-escalation ,axillary surgery ,sentinel lymph node biopsy ,systemic therapy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Although sentinel lymph node biopsy is now the primary method of axillary staging and is therapeutic for patients with limited nodal disease, axillary lymph node dissection (ALND) is still necessary for staging in groups where sentinel lymph node biopsy has not been proven to be accurate and to maintain local control in those with a heavy axillary tumor burden. Additionally, newer approaches to systemic therapy tailored to risk level sometimes necessitate knowledge of the number of involved axillary nodes which can only be obtained with ALND. Ongoing trials will address whether there are additional circumstances where radiotherapy can replace ALND.
- Published
- 2023
- Full Text
- View/download PDF
3. Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy
- Author
-
Walter Paul Weber, Jane Shaw, Andrea Pusic, Lynda Wyld, Monica Morrow, Tari King, Zoltán Mátrai, Jörg Heil, Florian Fitzal, Shelley Potter, Isabel T. Rubio, Maria-Joao Cardoso, Oreste Davide Gentilini, Viviana Galimberti, Virgilio Sacchini, Emiel J.T. Rutgers, John Benson, Tanir M. Allweis, Martin Haug, Regis R. Paulinelli, Tibor Kovacs, Yves Harder, Bahadir M. Gulluoglu, Eduardo Gonzalez, Andree Faridi, Elisabeth Elder, Peter Dubsky, Jens-Uwe Blohmer, Vesna Bjelic-Radisic, Mitchel Barry, Susanne Dieroff Hay, Kimberly Bowles, James French, Roland Reitsamer, Rupert Koller, Peter Schrenk, Daniela Kauer-Dorner, Jorge Biazus, Fabricio Brenelli, Jaime Letzkus, Ramon Saccilotto, Sarianna Joukainen, Susanna Kauhanen, Ulla Karhunen-Enckell, Juergen Hoffmann, Ulrich Kneser, Thorsten Kühn, Michalis Kontos, Ekaterini Christina Tampaki, Moshe Carmon, Tal Hadar, Giuseppe Catanuto, Carlos A. Garcia-Etienne, Linetta Koppert, Pedro F. Gouveia, Jakob Lagergren, Tor Svensjö, Nadia Maggi, Elisabeth A. Kappos, Fabienne D. Schwab, Liliana Castrezana, Daniel Steffens, Janna Krol, Christoph Tausch, Andreas Günthert, Michael Knauer, Maria C. Katapodi, Susanne Bucher, Nik Hauser, Christian Kurzeder, Rosine Mucklow, Pelagia G. Tsoutsou, Atakan Sezer, Güldeniz Karadeniz Çakmak, Hasan Karanlik, Patricia Fairbrother, Laszlo Romics, Giacomo Montagna, Cicero Urban, Melanie Walker, Silvia C. Formenti, Guenther Gruber, Frank Zimmermann, Daniel Rudolf Zwahlen, Sherko Kuemmel, Mahmoud El-Tamer, Marie Jeanne Vrancken Peeters, Orit Kaidar-Person, Michael Gnant, Philip Poortmans, and Jana de Boniface
- Subjects
Breast cancer ,Post-mastectomy radiotherapy ,Nipple-sparing mastectomy ,Implant-based breast reconstruction ,Autologous breast reconstruction ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Aim: Demand for nipple- and skin- sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario. Methods: A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology. Results: The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recommendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR. Conclusions: The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BR
- Published
- 2022
- Full Text
- View/download PDF
4. De-escalation in breast cancer surgery
- Author
-
Sarah P. Shubeck, Monica Morrow, and Lesly A. Dossett
- Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
In recent years, several trials of breast cancer treatment have failed to demonstrate a survival benefit for some previously routine surgical therapies in selected patient groups. As each of these therapeutic approaches has been deemed of low value deimplementation has varied significantly. This demonstrates that effective de-escalation in breast cancer surgery relies on more than the availability of data from randomized controlled trials and other high-quality evidence, but is also influenced by various stakeholders, social expectations, and environmental contexts.
- Published
- 2022
- Full Text
- View/download PDF
5. Increased trunk fat is associated with altered gene expression in breast tissue of normal weight women
- Author
-
Byuri Angela Cho, Neil M. Iyengar, Xi Kathy Zhou, Hillary Mendieta, Lisle Winston, Domenick J. Falcone, Jonathan Landa, Monica Morrow, and Andrew J. Dannenberg
- Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Increased trunk fat is associated with an elevated risk of breast cancer in normal-weight postmenopausal women. The main objective of this study was to determine whether levels of trunk fat are associated with changes in breast gene expression in normal-weight women. Non-tumorous breast tissue was collected from 32 normal BMI women who underwent mastectomy for breast cancer risk reduction or treatment. Body composition was measured by dual-energy x-ray absorptiometry. High levels of trunk fat were associated with a large number of differentially expressed genes and changes in multiple pathways and processes potentially linked to breast cancer pathogenesis. High levels of trunk fat were also associated with an elevated immune score and increased levels of leptin, CCL2, VEGF-C, IL6, and aromatase. Collectively, these results help to explain why high levels of trunk fat are associated with an increased risk of breast cancer in normal BMI women.
- Published
- 2022
- Full Text
- View/download PDF
6. The Effect of Surgeon Referral and a Radiation Oncologist Productivity-Based Metric on Radiation Therapy Receipt Among Elderly Women With Early Stage Breast Cancer: Analysis From a Tertiary Cancer Network
- Author
-
Elaine E. Cha, MD, Mira A. Patel, MD, Y. Helen Zhang, MD, Stephanie Lobaugh, MS, Zhigang Zhang, PhD, Beryl McCormick, MD, Lior Z. Braunstein, MD, Oren Cahlon, MD, Simon N. Powell, MD, PhD, Monica Morrow, MD, Atif Khan, MD, and Erin F. Gillespie, MD
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Purpose: : Guidelines for early-stage breast cancer allow for radiation therapy (RT) omission after breast conserving surgery among older women, though high utilization of RT persists. This study explored surgeon referral and the effect of a productivity-based bonus metric for radiation oncologists in an academic institution with centralized quality assurance review. Methods and materials: : We evaluated patients ≥70 years of age treated with breast conserving surgery for estrogen receptor (ER)+ pT1N0 breast cancer at a single tertiary cancer network between 2015 and 2018. The primary outcomes were radiation oncology referral and RT receipt. Covariables included patient and physician characteristics and treatment decisions before versus after productivity metric implementation. Univariable generalized linear effects models explored associations between these outcomes and covariables. Results: : Of 703 patients included, 483 (69%) were referred to radiation oncology and 273 (39%) received RT (among those referred, 57% received RT). No difference in RT receipt pre- versus post-productivity metric implementation was observed (P = .57). RT receipt was associated with younger patient age (70-74 years; odds ratio [OR], 2.66; 95% confidence interval [CI], 1.54-4.57) and higher grade (grade 3; OR, 7.75; 95% CI, 3.33-18.07). Initial referral was associated with younger age (70-74; OR, 5.64; 95% CI, 3.37-0.45) and higher performance status (Karnofsky performance status ≥90; OR, 5.34; 95% CI, 2.63-10.83). Conclusions: : Nonreferral to radiation oncology accounted for half of RT omission but was based on age and Karnofsky performance status, in accordance with guidelines. Lack of radiation oncologist practice change in response to misaligned financial incentives is reassuring, potentially reflecting incentive design and/or centralized quality assurance review. Multi-institutional studies are needed to confirm these findings.
- Published
- 2023
- Full Text
- View/download PDF
7. Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma
- Author
-
Willard Wong, Edi Brogi, Jorge S. Reis-Filho, George Plitas, Mark Robson, Larry Norton, Monica Morrow, and Hannah Y. Wen
- Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Metaplastic breast carcinoma (MpBC) is a rare special histologic subtype of breast carcinoma characterized by the presence of squamous and/or mesenchymal differentiation. Most MpBCs are of triple-negative phenotype and neoadjuvant chemotherapy (NAC) is frequently utilized in patients with MpBC. The aim of this study was to evaluate response to NAC in a retrospective cohort of MpBCs. We identified 44 patients with MpBC treated with NAC at our center between 2002 and 2018. Median age was 48 years, 86% were clinical stage II–III, and 36% were clinically node-positive. Most (80%) MpBCs were triple-negative or low (1–10%) hormonal receptor positive and HER2 negative on pre-NAC biopsy. While on NAC, 49% showed no clinical response or clinico-radiological progression. Matrix-producing subtype was associated with clinico-radiological response (p = 0.0036). Post NAC, two patients initially ineligible for breast-conserving surgery (BCS) were downstaged to be eligible for BCS, whereas three patients potentially eligible for BCS before treatment became ineligible due to disease progression. Only one (2%) patient had a pathologic complete response (pCR). Among the 16 patients presenting with biopsy-proven clinical node-positive disease, 3 (19%) had nodal pCR. Axillary lymph node dissection was avoided in 3 (19%) patients who had successful axillary downstaging. Residual cancer burden (RCB) was assessed in 22 patients and was significantly associated with disease-free survival and overall survival. We observed a poor response or even disease progression on NAC among patients with MpBC, suggesting that NAC should be reserved for patients with inoperable MpBC.
- Published
- 2021
- Full Text
- View/download PDF
8. Effects of obesity on breast aromatase expression and systemic metabo-inflammation in women with BRCA1 or BRCA2 mutations
- Author
-
Neil M. Iyengar, Xi Kathy Zhou, Hillary Mendieta, Omar El-Hely, Dilip D. Giri, Lisle Winston, Domenick J. Falcone, Hanhan Wang, Lingsong Meng, Taehoon Ha, Michael Pollak, Monica Morrow, and Andrew J. Dannenberg
- Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Obesity is associated with an increased risk of breast cancer in post-menopausal women and decreased risk in pre-menopausal women. Conversely, in BRCA1/2 mutation carriers, pre-menopausal obesity is associated with early-onset breast cancer. Here we show that obese, pre-menopausal BRCA1/2 mutation carriers have increased levels of aromatase and inflammation in the breast, as occurs in post-menopausal women. In a prospective cohort study of 141 women with germline BRCA1 (n = 74) or BRCA2 (n = 67) mutations, leptin, and aromatase expression were higher in the breast tissue of obese versus lean individuals (P
- Published
- 2021
- Full Text
- View/download PDF
9. Surgery and prophylactic surgery in hereditary breast cancer
- Author
-
Monica Morrow
- Subjects
Hereditary ,Breast cancer ,Levels of risk ,Diagnosis ,Surgical approach ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Women with hereditary breast cancer are at increased risk of second primary cancers in the ipsilateral and contralateral breast. The level of risk varies with mutation and age at first breast cancer diagnosis. These factors as well as life expectancy should be considered when selecting the surgical approach.
- Published
- 2022
- Full Text
- View/download PDF
10. P47. REVERSAL OF TRENDS IN U.S. BREAST SURGERY RATES: AN ANALYSIS FROM 2005-2017 USING THREE NATIONWIDE DATASETS
- Author
-
Jonas A. Nelson, MD, MPH, Robyn N. Rubenstein, MD, Kathryn Haglich, BS, Jacqueline J. Chu, BA, Carrie S. Stern, MD, Monica Morrow, MD, Audree B. Tadros, MD, MPH, Mary L. Gemignani, MD, MPH, Babak J. Mehrara, MD, and Evan Matros, MD, MMSc, MPH
- Subjects
Surgery ,RD1-811 - Published
- 2022
- Full Text
- View/download PDF
11. 11. Reversal of Trends in U.S. Breast Surgery Rates: An Analysis From 2005-2017 Using Three Nationwide Datasets
- Author
-
Robyn Nicole Rubenstein, MD, Jonas A. Nelson, MD, MPH, Kathryn Haglich, BS, MS, Jacqueline J. Chu, BA, Shen Yin, PhD, Carrie S. Stern, MD, Monica Morrow, MD, Audree B. Tadros, MD, MPH, Mary L. Gemignani, MD, MPH, Babak J. Mehrara, MD, and Evan Matros, MD, MMSc, MPH
- Subjects
Surgery ,RD1-811 - Published
- 2022
- Full Text
- View/download PDF
12. MRI-based machine learning radiomics can predict HER2 expression level and pathologic response after neoadjuvant therapy in HER2 overexpressing breast cancer
- Author
-
Almir G.V. Bitencourt, Peter Gibbs, Carolina Rossi Saccarelli, Isaac Daimiel, Roberto Lo Gullo, Michael J. Fox, Sunitha Thakur, Katja Pinker, Elizabeth A. Morris, Monica Morrow, and Maxine S. Jochelson
- Subjects
Magnetic resonance imaging ,Breast invasive ductal carcinoma ,HER2 ,ErbB-2 receptor ,Neoadjuvant therapy ,Machine learning ,Medicine ,Medicine (General) ,R5-920 - Abstract
Background: To use clinical and MRI radiomic features coupled with machine learning to assess HER2 expression level and predict pathologic response (pCR) in HER2 overexpressing breast cancer patients receiving neoadjuvant chemotherapy (NAC). Methods: This retrospective study included 311 patients. pCR was defined as no residual invasive carcinoma in the breast or axillary lymph nodes (ypT0/isN0). Radiomics/statistical analysis was performed using MATLAB and CERR software. After ROC and correlation analysis, selected radiomics parameters were advanced to machine learning modelling alongside clinical MRI-based parameters (lesion type, multifocality, size, nodal status). For predicting pCR, the data was split into a training and test set (80:20). Findings: The overall pCR rate was 60.5% (188/311). The final model to predict HER2 heterogeneity utilised three MRI parameters (two clinical, one radiomic) for a sensitivity of 99.3% (277/279), specificity of 81.3% (26/32), and diagnostic accuracy of 97.4% (303/311). The final model to predict pCR included six MRI parameters (two clinical, four radiomic) for a sensitivity of 86.5% (32/37), specificity of 80.0% (20/25), and diagnostic accuracy of 83.9% (52/62) (test set); these results were independent of age and ER status, and outperformed the best model developed using clinical parameters only (p=0.029, comparison of proportion Chi-squared test). Interpretation: The machine learning models, including both clinical and radiomics MRI features, can be used to assess HER2 expression level and can predict pCR after NAC in HER2 overexpressing breast cancer patients. Funding: NIH/NCI (P30CA008748), Susan G. Komen Foundation, Breast Cancer Research Foundation, Spanish Foundation Alfonso Martin Escudero, European School of Radiology.
- Published
- 2020
- Full Text
- View/download PDF
13. Breast carcinoma with 21-gene recurrence score lower than 18: rate of locoregional recurrence in a large series with clinical follow-up
- Author
-
Gulisa Turashvili, Edi Brogi, Monica Morrow, Maura Dickler, Larry Norton, Clifford Hudis, and Hannah Y. Wen
- Subjects
Breast cancer ,Estrogen receptor positive ,Early stage ,21-gene recurrence score assay ,Low risk ,Locoregional recurrence ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background The 21-gene recurrence score (RS) assay determines the benefit of adding chemotherapy to endocrine therapy for patients with early stage, estrogen receptor (ER)-positive, HER2-negative breast cancer. The RS risk groups predict the likelihood of distant recurrence and have recently been associated with an increased risk of locoregional recurrence (LRR). This study analyzed clinicopathologic features of patients with low RS and LRR. Methods In our institutional database, we identified 1396 consecutive female patients with lymph node negative, ER+/HER2- invasive breast carcinoma and low RS (
- Published
- 2018
- Full Text
- View/download PDF
14. Hormone receptor status of a first primary breast cancer predicts contralateral breast cancer risk in the WECARE study population
- Author
-
Anne S. Reiner, Charles F. Lynch, Julia S. Sisti, Esther M. John, Jennifer D. Brooks, Leslie Bernstein, Julia A. Knight, Li Hsu, Patrick Concannon, Lene Mellemkjær, Marc Tischkowitz, Robert W. Haile, Ronglai Shen, Kathleen E. Malone, Meghan Woods, Xiaolin Liang, Monica Morrow, Jonine L. Bernstein, and on behalf of WECARE Study Collaborative Group
- Subjects
Contralateral breast cancer ,Hormone receptor ,Estrogen receptor ,Progesterone receptor ,Population-based ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Previous population-based studies have described first primary breast cancer tumor characteristics and their association with contralateral breast cancer (CBC) risk. However, information on influential covariates such as treatment, family history of breast cancer, and BRCA1/2 mutation carrier status was not available. In a large, population-based, case-control study, we evaluated whether tumor characteristics of the first primary breast cancer are associated with risk of developing second primary asynchronous CBC, overall and in subgroups of interest, including among BRCA1/2 mutation non-carriers, women who are not treated with tamoxifen, and women without a breast cancer family history. Methods The Women’s Environmental Cancer and Radiation Epidemiology Study is a population-based case-control study of 1521 CBC cases and 2212 individually-matched controls with unilateral breast cancer. Detailed information about breast cancer risk factors, treatment for and characteristics of first tumors, including estrogen receptor (ER) and progesterone receptor (PR) status, was obtained by telephone interview and medical record abstraction. Multivariable risk ratios (RRs) and 95% confidence intervals (CIs) were estimated in conditional logistic regression models, adjusting for demographics, treatment, and personal medical and family history. A subset of women was screened for BRCA1/2 mutations. Results Lobular histology of the first tumor was associated with a 30% increase in CBC risk (95% CI 1.0–1.6). Compared to women with ER+/PR+ first tumors, those with ER-/PR- tumors had increased risk of CBC (RR = 1.4, 95% CI 1.1–1.7). Notably, women with ER-/PR- first tumors were more likely to develop CBC with the ER-/PR- phenotype (RR = 5.4, 95% CI 3.0–9.5), and risk remained elevated in multiple subgroups: BRCA1/2 mutation non-carriers, women younger than 45 years of age, women without a breast cancer family history, and women who were not treated with tamoxifen. Conclusions Having a hormone receptor negative first primary breast cancer is associated with increased risk of CBC. Women with ER-/PR- primary tumors were more likely to develop ER-/PR- CBC, even after excluding BRCA1/2 mutation carriers. Hormone receptor status, which is routinely evaluated in breast tumors, may be used clinically to determine treatment protocols and identify patients who may benefit from increased surveillance for CBC.
- Published
- 2017
- Full Text
- View/download PDF
15. Abstract 179: Breast Implant-associated Anaplastic Large Cell Lymphoma Incidence: Determining An Accurate Risk
- Author
-
Jonas A. Nelson, MD, Stefan Dabic, MPH, Babak J. Mehrara, MD, Peter G. Cordeiro, MD, Joseph J. Disa, MD, Andrea L. Pusic, MD, MHS, Evan Matros, MD, MMSc, Joseph H. Dayan, MD, Robert J. Allen, MD, Michelle Coriddi, MD, Thais O. Polanco, MD, Meghana G. Shamsunder, MPH, Itay Wiser, MD, PhD, Monica Morrow, MD, Ahmet Dogan, MD, Michele R. Cavalli, BA, Elizabeth Encarnacion, BA, Meghan E. Lee, BS, and Collen M. McCarthy, MD
- Subjects
Surgery ,RD1-811 - Published
- 2020
- Full Text
- View/download PDF
16. Will surgery be a part of breast cancer treatment in the future?
- Author
-
Monica Morrow, MD
- Published
- 2019
- Full Text
- View/download PDF
17. Increasing rates of general anesthesia use in lumpectomy procedures: A 15‐year trends analysis
- Author
-
Robyn N. Rubenstein, Audree Tadros, Hanna L. Slutsky, Ethan L. Plotsker, Kathryn Haglich, Carrie S. Stern, Monica Morrow, Jonas A. Nelson, and Priscilla Nelson
- Subjects
Oncology ,Surgery ,General Medicine - Published
- 2023
- Full Text
- View/download PDF
18. Does a brief surgeon training in negotiation theory principles decrease rates of contralateral prophylactic mastectomy?
- Author
-
Anita Mamtani, Daniel D. Sjoberg, Alain Vincent, Behfar Ehdaie, Deepak Malhotra, Andrew Vickers, and Monica Morrow
- Subjects
Cancer Research ,Oncology - Published
- 2023
- Full Text
- View/download PDF
19. Outcomes of Breast Cancer Patients with High Volume of Residual Disease Following Neoadjuvant Chemotherapy
- Author
-
Y. Helen Zhang, Giacomo Montagna, Jessica Flynn, Erin F. Gillespie, Anita Mamtani, Zhigang Zhang, Lior Z. Braunstein, Simon N. Powell, Monica Morrow, Andrea Barrio, and Atif J. Khan
- Subjects
Cancer Research ,Radiation ,Oncology ,Radiology, Nuclear Medicine and imaging - Abstract
The use of neoadjuvant chemotherapy (NAC) in patients with operable breast cancer allows for assessment of treatment response and subsequent tailoring of adjuvant therapy. Data are limited with respect to outcomes among patients with a heavy residual tumor burden after NAC. We report outcomes in patients who had exceptionally poor responses to NAC: those with9 involved nodes after NAC or with 5 cm or more of residual disease in the breast.Between June 2014 and April 2020, 1511 patients with breast cancer received NAC followed by surgery at our institution. Poor responders, defined as those with positive nodes or residual tumor in the breast, were identified for analysis. Patients were further classified into 3 groups for comparison purposes: (1) 1 to 3 positive nodes; (2) 4 to 9 positive nodes; or (3)9 positive nodes and/or5 cm of residual tumor, which was defined as high-volume residual (HVR). Recurrence and survival outcomes were compared based on residual disease burden after NAC.Among 934 poor responders, 539 patients had 1 to 3 positive nodes (ypN1), 215 had 4 to 9 positive nodes (ypN2), and 180 had HVR disease. Specifically, 118 had9 positive nodes (HVR), and 62 patients had5 cm of residual tumor in the breast. With a median follow-up of 31 months (interquartile range, 18-46), the 5-year overall survival rate was 88% among ypN1, 76% among ypN2, and 72% among patients with HVR disease (P.001). The 5-year distant recurrence-free survival and locoregional recurrence incidences were 82% and 7.6% among ypN1 versus 67% and 8.4% among ypN2 versus 53% and 12% among HVR, respectively.Our work suggests that patients with HVR disease are at high risk for locoregional and distant recurrence as well as death, despite best available standard-of-care treatment. Intensification of locoregional therapies and/or alternative adjuvant systemic treatment may improve outcomes in these poor responders.
- Published
- 2023
- Full Text
- View/download PDF
20. Abstract P5-08-09: Does Breast Inflammation Contribute to Lymphedema Risk in Patients Treated with Axillary Lymph Node Dissection?
- Author
-
Andrea V. Barrio, Giacomo Montagna, Varadan Sevilimedu, Ethan Gomez, Dilip Giri, Babak Mehrara, and Monica Morrow
- Subjects
Cancer Research ,Oncology - Abstract
Background Chronic inflammatory responses initiated by lymphatic injury play a key role in the pathophysiology of secondary lymphedema. However, it is unclear if baseline inflammation or ethnic/racial variability in inflammatory responses increase lymphedema risk. Crown-like structures of the breast (CLS-B), consisting of macrophages engulfing necrotic adipocytes, are a marker of systemic inflammation and have been implicated in the pathogenesis of breast cancer, but their role in lymphedema development is unknown. Here we determine whether baseline differences in inflammation, characterized by the presence of CLS-B, contributed to lymphedema risk in a diverse cohort of patients treated with ALND. Methods Patients ≥ 18 years undergoing ALND were enrolled in a prospective lymphedema screening study. Body mass index (BMI) and volumetric arm measurements (perometer) were performed at baseline, postoperatively, and every 6 months. Breast tissue obtained at definitive surgery was assessed for CLS-B with CD-68 IHC stain in non-tumor breast tissue. Inflammation severity was determined by number of CLS-B/cm2, with the median used to differentiate between mild and severe inflammation. Lymphedema was defined as a relative arm volume change of ≥10%. Lymphedema incidence was assessed using competing risk analysis and compared between patients with and without CLS-B. Uni- and multivariable analysis was performed to identify factors associated with lymphedema development. Results Between 11/2016-03/2020, 304 ALND patients were enrolled; 281 had at least 6 months of follow-up and were included in the study. Eleven percent self-identified as Asian, 20% Black, 6% Hispanic, and 60% White. Median age was 48 years; median BMI was 26.3 kg/m2, with higher BMI observed in Black and Hispanic women compared to Asian and White women (p < 0.001). Overall, 54% had CLS-B, with severe inflammation (> 0.4 CLS-B/cm2) identified in 71 (25%) patients. CLS-B presence correlated with BMI (36% [BMI < 25], 63% [BMI 25-30], 70% [BMI > 30], p < 0.001) and varied across racial/ethnic groups, with a higher prevalence in Black and Hispanic women (68% [Black], 69% [Hispanic] vs 59% [Asian], 46% [White], p = 0.03) (Table). Inflammation severity did not differ by race/ethnicity (p = 0.11). At 2.1 years median follow-up (IQR 1.6-3.1), 66 women developed lymphedema, with a 2-year lymphedema rate of 21.3% (95% CI 16.4-26.8). Lymphedema incidence was higher among Black and Hispanic women, compared to Asian and White women (2-year rate: 33.8% [Black], 31% [Hispanic], 17.4% [Asian], 18.2% [White], p = 0.002), and was higher among women with CLS-B (2-year rate: 28.2% [CLS-B] vs 12.9% [no CLS-B], p = 0.02). On multivariable analysis, Black race (White [referent]: HR 2.85, 95% CI 1.4-5.8; p = 0.03), receipt of NAC (upfront surgery [referent]: HR 2.46, 95% CI 1.04-5.8, p = 0.04) and older age (HR 1.03, 95% CI 1.01-1.06 per 1-year increase; p = 0.009) were independently associated with lymphedema development, while CLS-B was not (HR 1.37, 95% CI 0.81-2.34, p = 0.2). Conclusions In a prospective cohort of patients treated with ALND, Black race, receipt of NAC, and increasing age, but not CLS-B, were independently associated with lymphedema risk. However, the higher CLS-B prevalence in Black women suggests that they may have a propensity for increased inflammation, which may in part be contributing to the higher lymphedema risk observed, but is likely not the only inflammatory mechanism that modulates risk. Table. Clinical characteristics of study cohort stratified by the presence of CLS-B Citation Format: Andrea V. Barrio, Giacomo Montagna, Varadan Sevilimedu, Ethan Gomez, Dilip Giri, Babak Mehrara, Monica Morrow. Does Breast Inflammation Contribute to Lymphedema Risk in Patients Treated with Axillary Lymph Node Dissection? [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-08-09.
- Published
- 2023
- Full Text
- View/download PDF
21. Timing of Chemotherapy and Patient-Reported Outcomes After Breast-Conserving Surgery and Mastectomy with Immediate Reconstruction
- Author
-
Kate R. Pawloski, Marissa K. Srour, Tracy-Ann Moo, Varadan Sevilimedu, Jonas A. Nelson, Paula Garcia, Laurie J. Kirstein, Monica Morrow, and Audree B. Tadros
- Subjects
Oncology ,Surgery - Published
- 2023
- Full Text
- View/download PDF
22. Focal Therapy for Prostate Cancer: Evolutionary Parallels to Breast Cancer Treatment
- Author
-
Craig V, Labbate, Laurence, Klotz, Monica, Morrow, Matthew, Cooperberg, Laura, Esserman, and Scott E, Eggener
- Subjects
Male ,Urology ,Humans ,Prostatic Neoplasms ,Breast Neoplasms ,Randomized Controlled Trials as Topic - Abstract
Our goal was to review the history of the adoption of focal therapy for breast and prostate cancer and review common barriers to implementation.A narrative review of the literature was performed of English-language MEDLINE indexed articles of breast-conservation therapy and prostate cancer focal therapy.The introduction of focal therapy in breast cancer began with pioneering case series, and multiple randomized trials were performed prior to widespread adoption. Focal therapy for prostate cancer has just started the process of clinical trials with a single published randomized controlled trial. Commonly cited barriers to the adoption of prostate focal therapy include historical views of Halstedian tumor biology, tumor multifocality, over-detection, limitations in prostate imaging, and trial design end points.The adoption of breast-conserving therapy evolved over decades and used data from multiple large, randomized, clinical trials. Barriers to the adoption of prostate cancer local therapy are similar to those faced by breast cancer clinical trials. Completion of well-designed trials in prostate cancer focal therapy is essential for its evidence-based adoption.
- Published
- 2023
- Full Text
- View/download PDF
23. Changes in the Diagnoses of Breast Core Needle Biopsies on Second Review at a Tertiary Care Center
- Author
-
Catarina Calle, Elaine Zhong, Matthew G. Hanna, Katia Ventura, Maria A. Friedlander, Monica Morrow, Hiram Cody, and Edi Brogi
- Subjects
Surgery ,Anatomy ,Pathology and Forensic Medicine - Published
- 2022
- Full Text
- View/download PDF
24. Use of a supervised machine learning model to predict Oncotype DX risk category in node-positive patients older than 50 years of age
- Author
-
Austin D. Williams, Kate R. Pawloski, Hannah Y. Wen, Varadan Sevilimedu, Donna Thompson, Monica Morrow, and Mahmoud El-Tamer
- Subjects
Cancer Research ,Oncology - Published
- 2022
- Full Text
- View/download PDF
25. Patient-Reported Outcome Measures for Patients Who Have Clinical T4 Breast Cancer Treated via Mastectomy with and Without Reconstruction
- Author
-
Emily Palmquist, Jessica Limberg, Jacqueline J. Chu, Charlie White, Raymond E. Baser, Varadan Sevilimedu, Kate R. Pawloski, Paula Garcia, Jonas A. Nelson, Tracy-Ann Moo, Monica Morrow, and Audree B. Tadros
- Subjects
Oncology ,Surgery - Published
- 2022
- Full Text
- View/download PDF
26. Nipple-Sparing Mastectomy and Immediate Reconstruction: A Propensity Score–Matched Analysis of Satisfaction and Quality of Life
- Author
-
George, Kokosis, Carrie S, Stern, Meghana G, Shamsunder, Thais O, Polanco, Vaidehi M, Patel, Hanna, Slutsky, Monica, Morrow, Tracy-Ann, Moo, Virgilio, Sacchini, Michelle R, Coriddi, Peter G, Cordeiro, Evan, Matros, Andrea L, Pusic, Joseph J, Disa, Babak J, Mehrara, and Jonas A, Nelson
- Subjects
Nipples ,Quality of Life ,Humans ,Female ,Breast Neoplasms ,Surgery ,Personal Satisfaction ,Propensity Score ,Mastectomy - Abstract
Although it is intuitive that nipple-sparing mastectomy in selected patients would result in excellent cosmetic outcomes and high patient satisfaction, studies of clinical outcomes and health-related quality of life are limited and show mixed results. This study aimed to use a propensity score-matching analysis to compare satisfaction and health-related quality-of-life outcomes in patients who underwent implant-based reconstruction following bilateral nipple-sparing mastectomy or skin-sparing mastectomy.A propensity score-matching analysis (1:1 matching, no replacement) was performed comparing patients undergoing nipple-sparing or skin-sparing mastectomy with immediate bilateral implant-based breast reconstruction. Patients with a history of any radiation therapy were excluded. Matched covariates included age, body mass index, race, smoking history, neoadjuvant chemotherapy, bra size, and history of psychiatric diagnosis. Outcomes of interest included BREAST-Q scores and complications.The authors examined 1371 patients for matching and included 460 patients (nipple-sparing mastectomy, n = 230; skin-sparing mastectomy, n = 230) in the final analyses. The authors found no significant differences in baseline, cancer, and surgical characteristics between matched nipple-sparing and skin-sparing mastectomy patients, who also had similar profiles for surgical complications. Interestingly, the authors found that postoperative Satisfaction with Breasts scores and all other health-related quality-of-life domains were stable over a 3-year period and did not differ significantly between the two groups.Compared with skin-sparing mastectomy, bilateral nipple-sparing mastectomy did not improve patient-reported or clinical outcomes when combined with immediate implant-based reconstruction. The impact that nipple-sparing mastectomy may have on breast aesthetics and the ability of the BREAST-Q to gauge an aesthetic result following nipple-sparing mastectomy warrant further investigation.Therapeutic, III.
- Published
- 2022
- Full Text
- View/download PDF
27. Omission of Intraoperative Frozen Section May Reduce Axillary Overtreatment Among Clinically Node-Negative Patients Having Upfront Mastectomy
- Author
-
Austin D. Williams, Atif J. Khan, Varadan Sevilimedu, Andrea V. Barrio, Monica Morrow, and Anita Mamtani
- Subjects
Oncology ,Surgery - Published
- 2022
- Full Text
- View/download PDF
28. Axillary Staging Is Not Justified in Postmenopausal Clinically Node-Negative Women Based on Nodal Disease Burden
- Author
-
Minna K, Lee, Giacomo, Montagna, Melissa L, Pilewskie, Varadan, Sevilimedu, and Monica, Morrow
- Subjects
Cost of Illness ,Oncology ,Humans ,Female ,Breast Neoplasms ,Surgery ,Middle Aged ,Aged - Abstract
RxPONDER showed no benefit of adjuvant chemotherapy in postmenopausal women with estrogen receptor (ER) positive/human epidermal growth factor receptor 2 (HER2) negative breast cancer and limited nodal burden (pN1) with a recurrence score ≤ 25, suggesting that axillary staging could be omitted in cN0 patients if significant numbers of such women do not have pN2-3 disease. Here we evaluate the pN2-3 disease rate in a large cohort of postmenopausal women presenting with cN0 breast cancer.Consecutive postmenopausal patients presenting with T1-2N0 breast cancer who underwent axillary surgery from February 2006 to December 2011 were identified. Clinicopathologic characteristics associated with pN2-3 disease were examined using chi-square or Fisher's exact tests.Of 3363 postmenopausal women with cT1-2N0 breast cancer (median age 58 years, IQR 48-67 years), median tumor size was 1.3 cm (IQR 0.90-1.90cm). Post-axillary staging, 2600 (77.3%) were pN0, 643 (19.1%) were pN1, and 120 (3.6%) were pN2-3. The pN2-3 disease rate did not differ across subtypes (4.4% HER2In postmenopausal women with cN0 disease, pN2-3 nodal burden is uncommon; omitting axillary staging would not miss a significant number of patients who might benefit from adjuvant chemotherapy. Information available preoperatively indicating a higher risk of nodal disease such as younger age and large, multifocal tumors should be considered in the multidisciplinary management of the axilla.
- Published
- 2022
- Full Text
- View/download PDF
29. Neoadjuvant Chemotherapy for Breast Cancer In the Elderly: Are We Accomplishing Our Treatment Goals?
- Author
-
Austin D. Williams, Chau T. Dang, Varadan Sevilimedu, Monica Morrow, and Andrea V. Barrio
- Subjects
Oncology ,Surgery - Published
- 2022
- Full Text
- View/download PDF
30. How Often Do Sentinel Lymph Node Biopsy Results Affect Adjuvant Therapy Decisions Among Postmenopausal Women with Early-Stage HR+/HER2− Breast Cancer in the Post-RxPONDER Era?
- Author
-
Melissa Pilewskie, Varadan Sevilimedu, Idil Eroglu, Tiana Le, Rui Wang, Monica Morrow, and Lior Z. Braunstein
- Subjects
Oncology ,Surgery - Published
- 2022
- Full Text
- View/download PDF
31. Risk Factors and Racial and Ethnic Disparities in Patients With Breast Cancer-Related Lymphedema
- Author
-
Giacomo Montagna, Jennifer Zhang, Varadan Sevilimedu, Jillian Charyn, Kelly Abbate, Ethan A. Gomez, Babak Mehrara, Monica Morrow, and Andrea V. Barrio
- Subjects
Adult ,Cancer Research ,Sentinel Lymph Node Biopsy ,Brief Report ,Breast Neoplasms ,Cohort Studies ,Oncology ,Risk Factors ,Axilla ,Ethnicity ,Humans ,Lymph Node Excision ,Female ,Lymphedema ,Prospective Studies - Abstract
IMPORTANCE: Risk factors for breast cancer–related lymphedema (BCRL) after axillary lymph node dissection (ALND) are poorly understood. OBJECTIVE: To evaluate rates of and risk factors associated with BCRL in a prospective cohort of women treated with ALND. DESIGN, SETTING, AND PARTICIPANTS: This prospective BCRL screening study performed at a tertiary cancer center enrolled women with breast cancer 18 years and older undergoing breast surgery and unilateral ALND in the primary setting or after sentinel lymph node biopsy. EXPOSURES: Risk of BCRL during the first 2 years after ALND and radiotherapy. MAIN OUTCOMES AND MEASURES: Patients were prospectively evaluated with arm volume (perometer) measurements, and BCRL was defined as a relative volume change of 10% or greater from baseline. Cumulative incidence of BCRL was assessed using competing risk analysis. Risk factors for BCRL were assessed on univariate and multivariable analyses. RESULTS: From November 2016 to March 2020, 304 patients were enrolled; 276 had at least 1 longitudinal measurement. Median (IQR) age was 48 (40-57) years; median (IQR) body mass index, calculated as weight in kilograms divided by height in meters squared, was 26.4 (22.5-31.2). Of the 276 patients included in the analysis, 29 (11%) self-identified as Asian, 55 (20%) as Black, 16 (6%) as Hispanic, 166 (60%) as White, and 10 (3%) as unknown race and ethnicity; 70% received neoadjuvant chemotherapy (NAC); 93% received nodal irradiation. The 24-month BCRL rate was 23.8% (95% CI, 17.9%-29.8%), with significant variation by race and ethnicity (24-month rate: 37.2% [Black], 27.7% [Hispanic], 22.5% [Asian], and 19.8% [White]; P = .004). The BCRL rates were also higher among patients receiving NAC vs up-front surgery (24-month rate: 29.3% vs 11.1%; P = .01). On multivariable analysis, Black race and Hispanic ethnicity (compared with White race) (odds ratio [OR], 3.88; 95% CI, 2.14-7.08 and OR, 3.01; 95% CI, 1.10-7.62, respectively; P
- Published
- 2023
32. Analysis of a Trend Reversal in US Lumpectomy Rates From 2005 Through 2017 Using 3 Nationwide Data Sets
- Author
-
Jonas A. Nelson, Robyn N. Rubenstein, Kathryn Haglich, Jacqueline J. Chu, Shen Yin, Carrie S. Stern, Monica Morrow, Babak J. Mehrara, Mary L. Gemignani, and Evan Matros
- Subjects
Postoperative Complications ,Prophylactic Mastectomy ,Humans ,Surgery ,Breast Neoplasms ,Female ,Mastectomy, Segmental ,Mastectomy ,United States ,SEER Program - Abstract
Rates of lumpectomy for breast cancer management in the United States previously declined in favor of more aggressive surgical options, such as mastectomy and contralateral prophylactic mastectomy (CPM).To evaluate longitudinal trends in the rates of lumpectomy and mastectomy, including unilateral mastectomy vs CPM rates, and to determine characteristics associated with current surgical practice using 3 national data sets.Data from the National Surgical Quality Improvement Program (NSQIP), Surveillance, Epidemiology, and End Results (SEER) program, and National Cancer Database (NCDB) were examined to evaluate trends in lumpectomy and mastectomy rates from 2005 through 2017. Mastectomy rates were also evaluated with a focus on CPM. Longitudinal trends were analyzed using the Cochran-Armitage test for trend. Multivariate logistic regression models were performed on the NCDB data set to identify predictors of lumpectomy and CPM.A study sample of 3 467 645 female surgical breast cancer patients was analyzed. Lumpectomy rates reached a nadir between 2010 and 2013, with a significant increase thereafter. Conversely, in comparison with lumpectomy rates, overall mastectomy rates declined significantly starting in 2013. Cochran-Armitage trend tests demonstrated an annual decrease in lumpectomy rates of 1.31% (95% CI, 1.30%-1.32%), 0.07% (95% CI, 0.01%-0.12%), and 0.15% (95% CI, 0.15%-0.16%) for NSQIP, SEER, and NCDB, respectively, from 2005 to 2013 (P .001, P = .01, and P .001, respectively). From 2013 to 2017, the annual increase in lumpectomy rates was 0.96% (95% CI, 0.95%-0.98%), 1.60% (95% CI, 1.59%-1.62%), and 1.66% (95% CI, 1.65%-1.67%) for NSQIP, SEER, and NCDB, respectively (all P .001). Comparisons of specific mastectomy types showed that unilateral mastectomy and CPM rates stabilized after 2013, with unilateral mastectomy rates remaining higher than CPM rates throughout the entire time period.This observational longitudinal analysis indicated a trend reversal with an increase in lumpectomy rates since 2013 and an associated decline in mastectomies. The steady increase in CPM rates from 2005 to 2013 has since stabilized. The reasons for the recent reversal in trends are likely multifactorial. Further qualitative and quantitative research is required to understand the factors driving these recent practice changes and their associations with patient-reported outcomes.
- Published
- 2023
33. Strategies to avoid mastectomy skin-flap necrosis during nipple-sparing mastectomy
- Author
-
Tracy-Ann Moo, Jonas A Nelson, Varadan Sevilimedu, Jillian Charyn, Tiana V Le, Robert J Allen, Babak J Mehrara, Andrea V Barrio, Deborah M Capko, Melissa Pilewskie, Alexandra S Heerdt, Audree B Tadros, Mary L Gemignani, Monica Morrow, and Virgilio Sacchini
- Subjects
Surgery - Abstract
Background Nipple-sparing mastectomy is associated with a higher risk of mastectomy skin-flap necrosis than conventional skin-sparing mastectomy. There are limited prospective data examining modifiable intraoperative factors that contribute to skin-flap necrosis after nipple-sparing mastectomy. Methods Data on consecutive patients undergoing nipple-sparing mastectomy between April 2018 and December 2020 were recorded prospectively. Relevant intraoperative variables were documented by both breast and plastic surgeons at the time of surgery. The presence and extent of nipple and/or skin-flap necrosis was documented at the first postoperative visit. Necrosis treatment and outcome was documented at 8–10 weeks after surgery. The association of clinical and intraoperative variables with nipple and skin-flap necrosis was analysed, and significant variables were included in a multivariable logistic regression analysis with backward selection. Results Some 299 patients underwent 515 nipple-sparing mastectomies (54.8 per cent (282 of 515) prophylactic, 45.2 per cent therapeutic). Overall, 23.3 per cent of breasts (120 of 515) developed nipple or skin-flap necrosis; 45.8 per cent of these (55 of 120) had nipple necrosis only. Among 120 breasts with necrosis, 22.5 per cent had superficial, 60.8 per cent had partial, and 16.7 per cent had full-thickness necrosis. On multivariable logistic regression analysis, significant modifiable intraoperative predictors of necrosis included sacrificing the second intercostal perforator (P = 0.006), greater tissue expander fill volume (P < 0.001), and non-lateral inframammary fold incision placement (P = 0.003). Conclusion Modifiable intraoperative factors that may decrease the likelihood of necrosis after nipple-sparing mastectomy include incision placement in the lateral inframammary fold, preserving the second intercostal perforating vessel, and minimizing tissue expander fill volume.
- Published
- 2023
- Full Text
- View/download PDF
34. ASO Visual Abstract: Interpreting the BREAST-Q for Breast-Conserving Therapy—Minimal Important Differences and Clinical Reference Values
- Author
-
Jacqueline J. Chu, Audree B. Tadros, Lucas Gallo, Babak J. Mehrara, Monica Morrow, Andrea L. Pusic, Sophocles H. Voineskos, and Jonas A. Nelson
- Subjects
Oncology ,Surgery - Published
- 2023
- Full Text
- View/download PDF
35. ASO Visual Abstract: Is Surgical Excision of Focal Atypical Ductal Hyperplasia Warranted? Experience at a Tertiary Care Center
- Author
-
Anne Grabenstetter, Sandra B. Brennan, Varadan Sevilimedu, M. Gabriela Kuba, Dilip D. Giri, Hannah Yong Wen, Monica Morrow, and Edi Brogi
- Subjects
Oncology ,Surgery - Published
- 2023
- Full Text
- View/download PDF
36. Supplementary Figure 1 from Increased Levels of COX-2 and Prostaglandin E2 Contribute to Elevated Aromatase Expression in Inflamed Breast Tissue of Obese Women
- Author
-
Andrew J. Dannenberg, Clifford A. Hudis, Levy Kopelovich, Dilip Giri, Baoheng Du, Monica Morrow, Xi Kathy Zhou, Patrick G. Morris, and Kotha Subbaramaiah
- Abstract
PDF file - 41K
- Published
- 2023
- Full Text
- View/download PDF
37. Supplementary Tables from Effects of Adiposity and Exercise on Breast Tissue and Systemic Metabo-Inflammatory Factors in Women at High Risk or Diagnosed with Breast Cancer
- Author
-
Andrew J. Dannenberg, Monica Morrow, Laurie Kirstein, Michael Pollak, Jonathan Landa, Lingsong Meng, Hanhan Wang, Domenick J. Falcone, Lisle Winston, Omar El-Hely, Dilip D. Giri, Hillary Mendieta, Xi Kathy Zhou, and Neil M. Iyengar
- Abstract
Supplementary Tables S1, S2, and S3
- Published
- 2023
- Full Text
- View/download PDF
38. Figure S1 from Effects of Adiposity and Exercise on Breast Tissue and Systemic Metabo-Inflammatory Factors in Women at High Risk or Diagnosed with Breast Cancer
- Author
-
Andrew J. Dannenberg, Monica Morrow, Laurie Kirstein, Michael Pollak, Jonathan Landa, Lingsong Meng, Hanhan Wang, Domenick J. Falcone, Lisle Winston, Omar El-Hely, Dilip D. Giri, Hillary Mendieta, Xi Kathy Zhou, and Neil M. Iyengar
- Abstract
Figure S1. Breast SIRT1 levels correlate with adiposity. SIRT1 expression in the breast inversely correlated with (A) BMI, (B) adipocyte diameter, (C) total fat percentage, and (D) trunk fat percentage.
- Published
- 2023
- Full Text
- View/download PDF
39. Supplementary Table 1 from Deep Sequencing of T-cell Receptor DNA as a Biomarker of Clonally Expanded TILs in Breast Cancer after Immunotherapy
- Author
-
Heather L. McArthur, Larry Norton, Clifford Hudis, Jedd D. Wolchok, James P. Allison, Sujata Patil, Harlan Robins, Olivier Elemento, Virgilio Sacchini, Monica Morrow, Edi Brogi, Elizabeth Morris, Majid Maybody, Janice Sung, Adi Diab, Christopher Comstock, Phillip Wong, Zhiwan Dong, Stephen Solomon, Ryan Emerson, Jeremy C. Durack, Y Hanna Wen, David Redmond, Jianda Yuan, and David B. Page
- Abstract
Supplementary Table 1: TCRB sequencing sample IDs
- Published
- 2023
- Full Text
- View/download PDF
40. Supplementary Figure Legends 1-2 from Increased Levels of COX-2 and Prostaglandin E2 Contribute to Elevated Aromatase Expression in Inflamed Breast Tissue of Obese Women
- Author
-
Andrew J. Dannenberg, Clifford A. Hudis, Levy Kopelovich, Dilip Giri, Baoheng Du, Monica Morrow, Xi Kathy Zhou, Patrick G. Morris, and Kotha Subbaramaiah
- Abstract
PDF file - 73K
- Published
- 2023
- Full Text
- View/download PDF
41. Supplementary Figure 2 from Increased Levels of COX-2 and Prostaglandin E2 Contribute to Elevated Aromatase Expression in Inflamed Breast Tissue of Obese Women
- Author
-
Andrew J. Dannenberg, Clifford A. Hudis, Levy Kopelovich, Dilip Giri, Baoheng Du, Monica Morrow, Xi Kathy Zhou, Patrick G. Morris, and Kotha Subbaramaiah
- Abstract
PDF file - 98K
- Published
- 2023
- Full Text
- View/download PDF
42. How Much Pain Will I Have After Surgery? A Preoperative Nomogram to Predict Acute Pain Following Mastectomy
- Author
-
Linda M. Pak, Kate R. Pawloski, Varadan Sevilimedu, Hannah L. Kalvin, Tiana Le, Hanae K. Tokita, Audree Tadros, Monica Morrow, Kimberly J. Van Zee, Laurie J. Kirstein, and Tracy-Ann Moo
- Subjects
Oncology ,Surgery - Published
- 2022
- Full Text
- View/download PDF
43. Addressing the problem of overtreatment in breast cancer
- Author
-
Linda M. Pak and Monica Morrow
- Subjects
Carcinoma, Intraductal, Noninfiltrating ,Overtreatment ,Oncology ,Humans ,Breast Neoplasms ,Female ,Pharmacology (medical) ,Mastectomy, Segmental ,Article - Abstract
INTRODUCTION: As breast cancer treatment options have multiplied and biologic diversity within breast cancer has been recognized, the use of the same treatment strategies for patients with early-stage and favorable disease, and for those with biologically aggressive disease, has been questioned. In addition, as patient-reported outcome measures have called attention to the morbidity of many common treatments, and as the cost of breast cancer care has continued to increase, reduction in the overtreatment of breast cancer has assumed increasing importance. AREAS COVERED: Here we review selected aspects of surgery, radiation oncology, and medical oncology for which scientific evidence supports de-escalation for invasive carcinoma and ductal carcinoma in situ, and assess strategies to address overtreatment. EXPERT OPINION: The problems of breast cancer overtreatment we face today are based on improved understanding of the biology of breast cancer and abandonment of the “one-size-fits-all” approach. As breast cancer care becomes increasingly complex, and as our knowledge base continues to increase exponentially, these problems will only be magnified in the future. To continue progress, the move must be made from advocating the maximum-tolerated treatment to advocating the minimum-effective one.
- Published
- 2022
- Full Text
- View/download PDF
44. Association of Radiation Timing with Long-Term Satisfaction and Health-Related Quality of Life in Prosthetic Breast Reconstruction
- Author
-
Jonas A, Nelson, Peter G, Cordeiro, Thais, Polanco, Meghana G, Shamsunder, Aadit, Patel, Robert J, Allen, Evan, Matros, Joseph J, Disa, John J, Cuaron, Monica, Morrow, Babak J, Mehrara, Andrea L, Pusic, and Colleen M, McCarthy
- Subjects
Contracture ,Breast Implants ,Mammaplasty ,Tissue Expansion Devices ,Breast Neoplasms ,Personal Satisfaction ,Article ,Treatment Outcome ,Quality of Life ,Humans ,Female ,Surgery ,Breast Implantation ,Retrospective Studies - Abstract
Radiation therapy is increasingly used after breast cancer surgery, which may impact patients' postoperative quality of life. This study assessed differences in long-term patient satisfaction and health-related quality of life after radiation therapy administered at different stages of implant-based breast reconstruction or with no radiation after surgery.In this observational study, long-term outcomes were evaluated for four cohorts of women who completed breast reconstruction and received (1) no radiation, (2) radiation before tissue expander placement, (3) radiation after tissue expander placement, or (4) radiation after permanent implant between 2010 and 2017 at Memorial Sloan Kettering. Satisfaction and health-related quality of life were assessed using the prospectively collected Satisfaction with Breasts and Physical Well-Being of Chest BREAST-Q subscales. Score distributions were examined by radiation exposure status for 3 years after surgery using nonparametric analyses and regression models.Of 2932 patients who met the inclusion criteria, 25.8 percent received radiation during breast cancer treatment, including before tissue expander placement ( n = 239; 8.2 percent), after tissue expander placement ( n = 290; 9.9 percent), and after implant placement ( n = 228; 7.8 percent). Radiotherapy patients had average scores 7 to 9 points lower at all postoperative time points for Satisfaction with Breasts and Physical Well-Being of Chest subscales ( p0.001). Although patient-reported outcomes did not differ by radiation timing, there were higher rates of severe capsular contracture with postimplant radiotherapy ( p0.001).Radiation therapy significantly affected patient satisfaction and health-related quality of life following implant breast reconstruction through 3 years postoperatively. Patient perception of outcome was unaffected by radiotherapy timing; however, capsular contracture was higher after postimplant radiotherapy, suggesting there may be an advantage to performing radiotherapy before placement of the final reconstruction.Therapeutic, III.
- Published
- 2022
- Full Text
- View/download PDF
45. The Effect of Age on Outcomes After Neoadjuvant Chemotherapy for Breast Cancer
- Author
-
Francys C. Verdial, Anita Mamtani, Kate R. Pawloski, Varadan Sevilimedu, Timothy M. D’Alfonso, Hong Zhang, Mary L. Gemignani, Andrea V. Barrio, Monica Morrow, and Audree B. Tadros
- Subjects
Oncology ,Surgery - Published
- 2022
- Full Text
- View/download PDF
46. Abstract P2-06-03: Obesity is associated with DNA damage in the breast epithelium of BRCA1 and BRCA2 mutation carriers: A role for estrogens & strategies for prevention
- Author
-
Priya Bhardwaj, Neil M. Iyengar, Sofya Oshchepkova, Phoebe Piloco, Rohan Bareja, Olivier Elemento, Dilip D. Giri, Michael Pollak, Monica Morrow, Jason A. Spector, and Kristy A. Brown
- Subjects
Cancer Research ,Oncology ,skin and connective tissue diseases - Abstract
Background: Elevated bodyweight is a risk factor for breast cancer development in women who carry a mutation in the DNA repair enzymes BRCA1 and BRCA2. However, the mechanistic basis for this association is unknown. Breast adipose tissue undergoes significant changes in the setting of weight gain and obesity, including elevation in aromatase expression which leads to the increased biosynthesis of estrogens. Given that estrogens and estrogen metabolites have known pro-proliferative and genotoxic effects, we hypothesized that in BRCA1/2 mutation carriers, obesity may be positively associated with breast epithelial cell DNA damage, thereby increasing the risk of tumorigenesis. Furthermore, we examined the impact of inhibiting estrogen signaling or production on breast epithelium DNA damage in BRCA1/2 mutation carriers. Methods: Tissue microarrays were generated from non-cancerous breast tissue derived from 72 women carrying a mutation in BRCA1 or BRCA2 with known body mass index (BMI, kg/m2). Breast epithelium DNA damage was quantified by immunofluorescence (IF) staining of the DNA damage marker γH2AX. RNA-Seq was performed on breast organoids to assess differences in gene expression in relation to BMI. Associations between DNA damage and biomarkers of estrogen biosynthesis and bioavailability, including aromatase expression in the breast and circulating steroid hormone binding globulin (SHBG), were also evaluated. To explore the effect of blocking estrogen signaling or production on DNA damage, non-tumorous breast tissue explants from BRCA1/2 mutation carriers were cultured with fulvestrant, an estrogen receptor degrader, or metformin, an anti-diabetic drug that also reduces aromatase expression in the breast. Breast epithelial cell DNA damage was measured in control vs treated explants by γH2AX IF staining after 24 hours of treatment. Results: BMI was positively correlated with DNA damage in the breast epithelium of BRCA1/2 mutation carriers. Upstream analysis of gene expression in organoids derived from women with a BMI ≥ 30 compared to Citation Format: Priya Bhardwaj, Neil M. Iyengar, Sofya Oshchepkova, Phoebe Piloco, Rohan Bareja, Olivier Elemento, Dilip D. Giri, Michael Pollak, Monica Morrow, Jason A. Spector, Kristy A. Brown. Obesity is associated with DNA damage in the breast epithelium of BRCA1 and BRCA2 mutation carriers: A role for estrogens & strategies for prevention [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-06-03.
- Published
- 2022
- Full Text
- View/download PDF
47. Abstract P3-17-03: Raising the level of cancer care around the world: The feasibility and perceived benefit of a virtual breast tumor board
- Author
-
Naomi Dempsey, Lauren Chiec, Mikala Lodder, Erin Shonkwiler, Kayla Haines, Reshma Mahtani, William Gradishar, Thomas Buchholz, Anne O'Dea, Norman Wolmark, Sara Hurvitz, Joyce O'Shaughnessy, Maxine Jochelson, Reni Butler, Eleftherios Mamounas, Frank Vicini, Mark Pegram, Chirag Shah, Tari King, Ruth O'Regan, Monica Morrow, and Mohammad Jahanzeb
- Subjects
Cancer Research ,Oncology - Abstract
Introduction: It is well established that multidisciplinary tumor boards improve the decision-making process for cancer patients. Tumor boards have been shown to improve the accuracy of diagnosis and staging, optimize patient outcomes, increase adherence to guidelines, and educate our peers and trainees. However, over 80% of patients in the United States receive their cancer care in the community setting, where access to multi-disciplinary tumor boards may not be readily available. This may particularly impact underserved populations who often lack the resources to travel to an academic center for second opinions or treatment. The problem is worse in low-resource countries. Virtual expert tumor boards could provide an effective solution. Methods: Preeminent breast oncology faculty from around the Unites States were assembled into virtual tumor board panels via an online platform to discuss challenging cases submitted by community providers and trainees. These tumor boards consisted of a moderator, a breast radiologist, a breast medical oncologist, a breast surgeon, and a breast radiation oncologist. The purpose of this ongoing endeavor is to educate community oncologists on how to best manage challenging cases. Following tumor board discussions, written recommendations were shared with submitting providers within 48 hours and recordings of the discussions were also later provided. After submitting providers watched the recording of their case discussion, we conducted a survey to determine their perceived benefit of the expert panel discussion. Results: From Sept 2020 to June 2021, ten breast cancer panels were virtually convened with 17 expert faculty panelists. During that time, 21 providers submitted 94 cases from the U.S. and around the world to be discussed by the expert panel. Thirty-three percent of the providers who submitted a case to be discussed have subsequently submitted an additional case to a later panel. Surveys were sent to all submitting providers and responses were recorded from 16/21 submitters (76.2%). Conclusion: With more than three out of four submitters responding, we learned that not only is it feasible to convene virtual expert breast tumor boards to discuss challenging cases, but the vast majority of respondents learned new information, changed management of their patients, and wanted to submit additional cases. This effort could raise the level of breast cancer care around the world. Ongoing assessment of educational and patient care impacts will be necessary. QuestionNumber answered (n)Number who answered yes (%)Number who answered no (%)Did you learn something new from the PrecisCa discussion of your case scenario?1614 (87.5)2 (12.5)Will anything you learned from the PrecisCa discussion of your case scenario change the management of this or future patients?1615 (93.8)1 (6.2)Are you likely to submit a future challenging case scenario to PrecisCa?1616 (100)0 (0) Citation Format: Naomi Dempsey, Lauren Chiec, Mikala Lodder, Erin Shonkwiler, Kayla Haines, Reshma Mahtani, William Gradishar, Thomas Buchholz, Anne O'Dea, Norman Wolmark, Sara Hurvitz, Joyce O'Shaughnessy, Maxine Jochelson, Reni Butler, Eleftherios Mamounas, Frank Vicini, Mark Pegram, Chirag Shah, Tari King, Ruth O'Regan, Monica Morrow, Mohammad Jahanzeb. Raising the level of cancer care around the world: The feasibility and perceived benefit of a virtual breast tumor board [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-17-03.
- Published
- 2022
- Full Text
- View/download PDF
48. Abstract P3-18-06: Satisfaction and physical wellbeing after breast conserving therapy: Clinical predictors and reference values using the BREAST-Q
- Author
-
Jacqueline J Chu, Jonas A Nelson, Paula Garcia, Babak J Mehrara, Andrea L Pusic, Monica Morrow, Mary L Gemignani, and Audree B Tadros
- Subjects
Cancer Research ,Oncology - Abstract
Background: BREAST-Q is a widely accepted patient reported outcome measure (PROM) for breast surgery patients. BREAST-Q has been challenging to implement for clinical practice, due to insufficient understanding of clinical factors influencing BREAST-Q scores and lack of reference values for score interpretation. As a result, the clinical applicability of the BREAST-Q is limited, and benefits of routine PROM implementation on care quality have not been realized for breast surgery patients. This study finds predictors impacting long-term scores for the BREAST-Q Breast Conserving Therapy (BCT) module and determines reference values to guide score interpretation in clinical practice. Methods: A retrospective review of BCT patients at Memorial Sloan Kettering Cancer Center was conducted. All patients completed at least one BREAST-Q in 2018-2020. Patient characteristics were collected, including age, BMI, race, smoking status, chemotherapy, radiation therapy (RT), and axillary surgery (sentinel lymph node biopsy, axillary lymph node dissection). BREAST-Q was collected routinely during clinical visits as part of standard of care. Linear regression measured the impact of patient characteristics on 1 year and 2 year BREAST-Q scores. Median scores at baseline and 2 weeks, 6 months, 1 year, and 2 years after surgery were determined for RT and No RT patients. Pearson’s Chi-square and Student t-tests were used for categorical and continuous variables, respectively. Based on prior literature, a minimal clinically important difference of 4 points was used (scale 0-100). Results: 1866 BCT patients were included. Average age was 58.9(11.4) with BMI of 27.9(6.4). Patients were primarily white (76.8%) and non-smokers (89.7%); 36.8% had chemotherapy, 74.7% had axillary surgery, and 73.3% had RT. Regression analysis showed age and race as significant predictors of Satisfaction with Breast and Physical Wellbeing scores (Table 1). RT was a clinically significant predictor for Physical Wellbeing, reducing scores by 4.5 points at 1 year and 4.6 points at 2 years. Reference values were then created for RT and No RT patients. (Table 2). Conclusions: This study found factors impacting satisfaction and physical wellbeing after BCT using BREAST-Q scores of a longitudinal cohort of women and presented references values for score interpretation. Separate reference values were created based on RT as it is a significant predictor of BREAST-Q scores and omission of RT is increasingly offered to older women with low-risk breast cancer, given no survival benefit. These reference values can be incorporated into a user-friendly application or integrated into electronic medical records to help patients and physicians interpret BREAST-Q scores in a clinically meaningful way. Future research should assess the impact of early interventions targeting BCT patients below the 25th percentile (e.g. referrals to plastic surgeons or physical therapy) on BREAST-Q scores. Table 1.Multivariate analysis of BREAST-Q score predictors at 1 year and 2 years after surgerySatisfaction with BreastPhysical Wellbeing1 year2 year1 year2 yearScore changeSEp-valueScore changeSEp-valueScore changeSEp-valueScore changeSEp-valueAge0.1533.907p=0.0020.1280.068p=0.0610.2800.041p < 0.0010.2930.054p < 0.001BMI0.0190.0483p=0.821-0.2200.119p=0.065-0.0120.073p=0.867-0.1380.093p=0.141RaceWhiteReference--Reference--Reference--Reference--Black-7.3462.018p < 0.001-11.4652.876p < 0.001-7.4821.748p < 0.001-6.6512.259p=0.003Asian-1.4631.936p=0.450-1.5842.842p=0.578-2.2221.677p=0.185-0.3472.248p=0.878Other-3.7162.998p=0.2150.7904.451p=0.859-7.4672.575p=0.004-4.1963.495p=0.230Unknown1.4962.804p=0.5946.2213.914p=0.1120.2342.410p=0.923-1.9253.074p=0.531Smoking StatusNeverReference--Reference--Reference--Reference--Previous-1.2161.174p=0.300-1.4221.603p=0.375-1.5821.013p=0.119-1.0301.259p=0.414Current-1.7752.584p=0.492-3.3293.946p=0.399-3.8962.238p=0.082-8.0853.099p=0.009Unknown6.7652.384p=0.0059.4784.054p=0.1120.7612.064p=0.7136.1623.183p=0.531ChemotherapyNoReference--Reference--Reference--Reference--Yes-0.7401.148p=0.5190.3961.603p=0.805-3.3750.993p < 0.001-1.8101.262p=0.152Radiation TherapyNoReference--Reference--Reference--Reference--Yes-0.8961.293p=0.488-2.8961.830p=0.114-4.4951.118p < 0.001-4.6431.435p=0.001Axillary SurgeryNoReference--Reference--Reference--Reference--Yes-0.3581.319p=0.786-1.8711.948p=0.337-3.9091.140p < 0.001-3.6461.526p=0.017 Table 2.BREAST-Q reference values at 2 weeks, 6 months, 1 year, and 2 years after surgeryBaseline2 Weeks6 Months1 Year2 YearsRTSatisfaction with Breastsn=445-n=485n=1223n=65325th percentile53-63615950th percentile64-78757275th percentile82-100100100Physical Wellbeingn=483n=843n=486n=1228n=65125th percentile726060606650th percentile857176717675th percentile10082898989Psychosocial Wellbeingn=445-n=487n=1221n=65125th percentile62-66646650th percentile71-83838375th percentile87-100100100Sexual Wellbeingn=417-n=430n=1108n=58025th percentile46-48484850th percentile62-66666675th percentile70-798484No RTSatisfaction with Breastsn=172-n=186n=439n=22925th percentile48-67.5636350th percentile64-88827875th percentile82-100100100Physical Wellbeingn=184n=323n=188n=442n=23025th percentile726066717650th percentile897176828975th percentile1008289100100Psychosocial Wellbeingn=174-n=187n=437n=23025th percentile64-71666950th percentile74-87878775th percentile93-100100100Sexual Wellbeingn=161-n=158n=387n=19925th percentile43-535354.550th percentile62-66666675th percentile74-919191 Citation Format: Jacqueline J Chu, Jonas A Nelson, Paula Garcia, Babak J Mehrara, Andrea L Pusic, Monica Morrow, Mary L Gemignani, Audree B Tadros. Satisfaction and physical wellbeing after breast conserving therapy: Clinical predictors and reference values using the BREAST-Q [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-18-06.
- Published
- 2022
- Full Text
- View/download PDF
49. Supplementary Figure S1 from Systemic Correlates of White Adipose Tissue Inflammation in Early-Stage Breast Cancer
- Author
-
Andrew J. Dannenberg, Clifford A. Hudis, Lee W. Jones, Michael Pollak, Hanhan Wang, Monica Morrow, Dilip D. Giri, Louise R. Howe, Patrick G. Morris, Ayca Gucalp, Xi Kathy Zhou, and Neil M. Iyengar
- Abstract
Supplementary Figure S1. White adipose tissue inflammation. A. CLS-B positive breast WAT. H&E (upper panel) and anti-CD68 immunostaining (lower panel); 40x (left panel) and 400x (right panel). Arrow indicates CLS-B. B. CLS-B negative breast WAT. H&E (upper panel) and anti-CD68 immunostaining (lower panel); 40x (left panel) and 400x (right panel). WAT, white adipose tissue; CLS-B, crown-like structures of the breast.
- Published
- 2023
- Full Text
- View/download PDF
50. Data from Frequent Mutational Activation of the PI3K-AKT Pathway in Trastuzumab-Resistant Breast Cancer
- Author
-
Tari A. King, Clifford Hudis, Neal Rosen, Larry Norton, Shanu Modi, Monica Morrow, Adriana Heguy, Sujata Patil, Dilip Giri, Rita A. Sakr, and Sarat Chandarlapaty
- Abstract
Purpose: HER2-amplified breast cancer is sometimes clinically insensitive to HER2-targeted treatment with trastuzumab. Laboratory models of resistance have causally implicated changes in HER2 expression and activation of the phosphoinositide 3-kinase (PI3K)–AKT pathway. We conducted a prospective tissue acquisition study to determine if there is evidence for these lesions in metastatic tumors that have progressed on trastuzumab-containing therapy.Experimental Design: From 2/2007 to 11/2011, 63 patients with HER2-amplified breast cancer with recurrence of disease after adjuvant trastuzumab therapy or World Health Organization–defined progression of metastatic disease on a trastuzumab-containing regimen were prospectively enrolled and underwent tumor biopsy. Specimens were analyzed for activating mutations in PIK3CA and HER2 by Sequenom and analyzed for HER2 and PTEN status by immunohistochemistry.Results: In 53/60 cases (88%, 3 cases not evaluable for HER2), HER2 overexpression persisted in the metastatic tumor following trastuzumab exposure. Among the 7 cases lacking HER2 overexpression, repeat analysis of the pretreatment tumor failed to confirm HER2 overexpression in five cases. Among cases evaluable for PTEN (56) or PI3K mutation (45), absent or significantly diminished PTEN expression was noted in 33 (59%) and activating mutations in PIK3CA in 13 (29%). The combined rate of PTEN loss and PIK3CA mutation in the trastuzumab-refractory tumors was 71% compared with 44% (P = 0.007) in an unexposed cohort of 73 HER2-amplified tumors.Conclusions: In this series of prospectively collected trastuzumab-refractory human breast cancers, loss of HER2 overexpression was rare, whereas activation of the PI3K-AKT pathway through loss of PTEN or PIK3CA mutation was frequently observed. Clin Cancer Res; 18(24); 6784–91. ©2012 AACR.
- Published
- 2023
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.