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We surveyed breast providers from a national oncology cooperative group to evaluate axillary management recommendations for patients with 1–2 positive sentinel lymph nodes (+SLNs) with scenarios not explicitly included in the Z0011 trial. These scenarios included patients underrepresented (premenopausal, HER2+/triple‐negative tumors, and invasive lobular carcinoma) or excluded (treated with mastectomy or neo‐adjuvant chemotherapy [NAC]) from the ACOSOG Z0011 trial. Survey response rate was 94/149 (64%). For patients in underrepresented groups, 45–63% of providers recommended no further axillary treatment. For mastectomy patients, 45–55% recommended multi‐disciplinary discussion. 83% felt more data are needed to change practice, but 41% believed there would be significant accrual challenges to a clinical trial. For patients treated with NAC, recommendations varied widely. 85% felt more data are needed to change practice, but 26% felt there would be significant accrual challenges. For all scenarios, 86–100% of radiation oncologists recommended axillary radiation, while surgeons more often recommended no further axillary treatment. Traditional randomized trials are likely not feasible to provide answers to these critical management questions, so more pragmatic or big data studies may be needed. [ABSTRACT FROM AUTHOR]

We sought to identify factors associated with disparities in tamoxifen utilization among young patients at high‐risk for developing breast cancer. We identified 67 premenopausal, high‐risk women age 35‐45, without surgical prophylaxis, who did not initiate tamoxifen. Factors associated with noninitiation were examined. About 37% of patients had no documented provider‐based discussion regarding initiation. Type of high‐risk diagnosis was the only factor associated with a provider‐based discussion (P =.03). For patients offered tamoxifen, primary reasons for noninitiation were perceived minimal benefit (66.7%), fertility concerns (16.7%), and concerns about side effects (7.1%). Implementation of comprehensive educational strategies regarding the benefits of tamoxifen should be facilitated to improve initiation among young high‐risk patients. [ABSTRACT FROM AUTHOR]

Surgical techniques for reconstructing the nipple‐areola complex (NAC) pose disadvantages such as areola necrosis, loss of nipple projection, depression or local necrosis, temporary leave from professional activities due to convalescence, and operational costs, all of which are factors that may discourage patients from undergoing them. In this context, dermopigmentation stands out as an emerging nonsurgical option. It is an inexpensive outpatient procedure that mimics the nipple‐areola complex by means of defining the areolar contour, Montgomery's tubercles, and a variety of colors that allow for individualization and contralateral symmetry. In this pioneering study, we propose to validate the 3D dermopigmentation technique as a preferential technique in the NAC reconstruction process. We selected 30 women with previous breast cancer who underwent conservative breast surgeries or mastectomy with NAC removal more than 6 months prior to their participating in our study. We employed the dermopigmentation technique, which we evaluated with the aid of questionnaires intended for patients, doctors, and tattooists. Among specialists, results were considered good and excellent with regard to overall esthetics (76.07%) and color (72.5%); whereas among patients, results were considered good and excellent with regard to overall satisfaction (95%) and color (100%); no adverse events were observed. Three‐dimensional dermopigmentation proved to be a promising nonsurgical technique for nipple‐areola complex reconstruction. [ABSTRACT FROM AUTHOR]

The purpose of this study was to report rates and severities of radiation‐related toxicities and analyze disease‐control outcomes in patients who have received hypofractionated whole breast radiation (HF) with concurrent trastuzumab with or without pertuzumab. We conducted a retrospective cohort study including women with stage I‐III HER2‐positive breast cancer who received HF at the University of Pennsylvania between 1/2005 and 5/2018 with concurrent trastuzumab with or without pertuzumab. Fractionation was 266 cGy daily to a total dose of 4256 cGy with or without a sequential tumor bed boost. Eighty patients were included in the cohort with a median follow‐up time of 21.44 months. There was one grade 3 acute toxicity (fatigue) and no grade 3 late toxicities. 91% and 25% of patients experienced grade 1‐2 acute and late skin reactions, respectively. An excellent‐good cosmetic outcome was reported by 74% and 95% of patients and physicians, respectively. No patients experienced tumor recurrences, and the only death was due to a secondary cause. These results suggest that hypofractionated whole breast radiation administered concurrently with anti‐HER‐2 therapies is efficacious and has acceptable toxicity in early‐stage breast cancer patients treated with lumpectomy. Continued follow‐up is warranted to evaluate long‐term outcomes. [ABSTRACT FROM AUTHOR]

The article discusses that Phyllodes tumors account for less than 1% of all breast tumors worldwide. Topics discussed include they are classified as benign, borderline, and malignant according to histological characteristics; and recurrence rates are high after surgery, ranging from 8% to 46% due to the rare nature and relatively low mortality of most phyllodes tumors, there have been no randomized trials or consensus management guidelines.

Abstract: Although annual breast magnetic resonance imaging (MRI) is recommended for women at high risk for breast cancer as an adjunct to screening mammography, breast MRI use remains low. We examined factors associated with breast MRI use in a cohort of women with a family history of breast cancer but no personal cancer history. Study participants came from the Sister Study cohort, a nationwide, prospective study of women with at least 1 sister who had been diagnosed with breast cancer but who themselves had not ever had breast cancer (n = 17 894). Participants were surveyed on breast cancer beliefs, cancer worry, breast MRI use, provider communication, and genetic counseling and testing. Logistic regression was used to assess factors associated with having a breast MRI overall and for those at high risk. Breast MRI was reported by 16.1% and was more common among younger women and those with higher incomes. After adjustment for demographics, ever use of breast MRI was associated with actual and perceived risk. Odds ratios (OR) were 12.29 (95% CI, 8.85‐17.06), 2.48 (95% CI, 2.27‐2.71), and 2.50 (95% CI, 2.09‐2.99) for positive BRCA1/2 test, lifetime breast cancer risk ≥ 20%, and being told by a health care provider of higher risk, respectively. Women who believed they had much higher risk than others or had higher level of worry were twice as likely to have had breast MRI; OR = 2.23 (95% CI, 1.82‐2.75) and OR = 1.76 (95% CI, 1.52‐2.04). Patterns were similar among women at high risk. Breast cancer risk, provider communication, and personal beliefs were determinants of breast MRI use. To support shared decisions about the use of breast MRI, women could benefit from improved understanding of the chances of getting breast cancer and increased quality of provider communications. [ABSTRACT FROM AUTHOR]

Abstract: Few studies have explored with standard measures patient satisfaction with care at the time of the diagnosis through rapid diagnostic pathways. This study aimed to assess satisfaction levels at the time of the diagnosis in a One‐Stop Breast Unit and to examine associations with psychological states. An anonymous cross‐sectional survey was conducted at a single center's One‐Stop Breast Unit, to assess patient satisfaction regarding several aspects of the Unit. Two days after the diagnosis, 113 participants completed self‐reported questionnaires evaluating satisfaction (Out‐Patsat35), anxiety (State Anxiety Inventory), and psychological distress (Distress Thermometer). Overall, patients were very satisfied (80.7±20.7) with the One‐Stop Breast Unit. The highest mean satisfaction scores concerned nurses' technical skills, interpersonal skills and availability. The lowest mean scores concerned physicians' availability, waiting time, and the provision of information. The results revealed a significant association between high state anxiety levels, lower levels of satisfaction with doctors' interpersonal skills (r=−.41, P<.001) and lower levels for information provided by nurses (r=−.38, P<.001). Moreover, greater psychological distress was associated with less satisfaction with the different aspects of care (doctors' interpersonal skills, doctors' availability and waiting‐time). The results of regression models showed that doctor‐related satisfaction scales explained 20% of the variance in anxiety (P<.01). Facing cancer diagnosis remains a stressful situation. However, our study suggested that a substantial part of this anxiety is sensitive to the quality of the patient‐doctor relationship. Consequently, further efforts should be expended on adapting patient‐doctor communication to improve patient reassurance. [ABSTRACT FROM AUTHOR]

As shared decision-making increasingly influences screening mammography, understanding similarities and differences between patients and physician perspectives becomes crucially important. This study compares women's and physicians' experiences of mammography shared decision-making. Results reflect the critical gaps which exist between women's expectations and physicians' confidence in shared decision-making regarding screening mammography. [ABSTRACT FROM AUTHOR]

Breast-cancer-specific tools that measure health-related quality of life ( HRQOL) were developed for use in research or clinical practice, and little is known about these tools' performance ability for quality improvement. Furthermore, existing tools may not fully reflect all issues that contribute to quality care as seen by patients. Work is needed to identify and validate patient-reported outcome measures for use in quality improvement in breast cancer surgical care. We conducted an exploratory qualitative study in order to better understand what HRQOL domains and processes of care define high quality surgical care for women undergoing mastectomy for breast cancer from both the patient and clinician perspective. We conducted focus groups and one-on-one interviews with 15 women and administered a prioritization questionnaire to participants. We also conducted a prioritization questionnaire among surgical oncologists, general surgeons, and reconstructive surgeons who are members of the Washington State Medical Association. Both the patient and surgeon prioritization questionnaire asked participants to prioritize HRQOL and treatment satisfaction-related aspects of their breast cancer surgical care at key time points before and after mastectomy. A Stakeholder Advisory Panel was convened to review focus group, interview, and prioritization questionnaire results and make recommendations as to patient-reported outcome domains to focus on and existing instruments to use for quality improvement. Patients and clinicians largely agreed on important HRQOL domains, including emotional well-being, education, communication, and process of care. The Stakeholder Advisory Panel, composed of 12 clinicians and five patients, reviewed study findings and existing patient-reported outcomes measurement tools. The panel recommended that the BREAST-Q, a flexible tool with independently validated modules designed for research and clinical care, is an ideal tool to begin developing novel quality improvement benchmarks focused on patient-reported outcomes. [ABSTRACT FROM AUTHOR]

With more patients with metastatic breast cancer ( MBC) living longer, patient-centered communication and shared decision making between patient and oncologist are vital to improve care and quality of life in patients with MBC. The Make Your Dialogue Count survey explored emotional needs of patients at initial diagnosis of MBC and treatment change to increase awareness about gaps and facilitate communication between patients and oncologists. The survey was conducted (June-August 2014) online, by telephone, or on paper among US women with MBC and US-licensed medical oncologists. Patient data were unweighted. Oncologist data were weighted by geographic region and years in practice by sex to match actual proportions in the population. Statistically significant differences between groups were determined by standard t-test of column proportions and means at the 95% confidence level. Between initial diagnosis of MBC and treatment change, some patients' attitudes and feelings adapted as their disease advanced. Fewer patients reported fear of the unknown (58% versus 44%) and distress over believing something could have been done to prevent disease progression (26% versus 12%), but more patients reported hope of keeping the disease stable (46% versus 59%) and confidence in treatment options (29% versus 37%). During their treatment journey, more women with children ≤17 years old were distressed because they believed something could have been done to prevent disease progression versus women with children 18+ years old or no children. There were instances of misalignment between patient expectations and what oncologists actually discussed with patients. Our findings suggest that patients exhibit an ability to adapt during their disease. Having a shared understanding of concerns and needs of patients serves to strengthen the patient-oncologist alliance and creates a framework for oncologists to tailor disease management and coping strategies to improve quality of life for patients of all ages with MBC. [ABSTRACT FROM AUTHOR]

The study aims to define how imaging findings, patient demographics, patient-provider interactions, and health care practices may affect a woman's decision to follow-up in the setting of a BI- RADS Category 3. A total of 398 women from the University of Arizona Breast Imaging Center with a BI- RADS Category 3 assessment for mammography and/or ultrasound findings were evaluated between February 2012 and June 2014. Demographic information was analyzed for all patients, regardless of follow-up. Women who returned for follow-up within the recommended time period were given one survey at the time of their follow-up appointment, and women who returned for follow-up, but later than recommended, were given a separate survey to complete. Age, palpability of a lesion, and menopause status were related to follow-up. Self-rated general health was the only factor found to be associated with the decision to follow-up on time. The majority of patients who followed up on time reported that mailed reminder cards were the primary practice that prompted follow-up. Of patients who followed up later than recommended, the major reason was 'no time.' The findings suggest that additional counseling regarding the benefits of short-interval imaging follow-up might be advantageous for patients. [ABSTRACT FROM AUTHOR]

The article focuses on patients with breast atypias, discussing the reports on the patient‐friendly pathology for the disease. It informs that Breast atypias includes lobular neoplasia (LN), atypical ductal hyperplasia (ADH) and flat epithelial atypia (FEA). The diagnosis reveals the role of the LN and ADH with the increased risk of cancer in breast. The patient may have the feeling of neglect and anxiety which can be controlled by giving comprehensible information to the patients.

The article discusses that in the U.S. approximately 1.6 million breast biopsies are performed annually. Minimally invasive breast biopsy is now the standard of care with between 86% and 89% of breast biopsies performed percutaneously. As the majority of minimally invasive breast biopsies are performed by radiologists, radiologists have taken an increasing role in disclosing biopsy results to patients.

The article offers information about the population of cancer survivors as on the rise owing to the recent advances in the diagnostic and treatment modalities. It mentions the genetics of the disease and moving toward finding more targetable receptors to increase the survival of the patients. It discusses that smoking as associated with an increased all-cause mortality and cancer-related death in breast cancer.

The article discusses Susan B. Anthony wrote "Sooner discover that the important moments in life have not the advertised ones, not the birthdays, the graduations, not the great goals achieved the real milestones have less prepossessing. Topics include era of precision oncology, has surprising that moment has not at all related to receiving word of an article accepted for publication; and moment has not related to an anticipated or unanticipated.

The article discusses the influence of several factors to the increase risk of developing breast cancer including obesity, low physical activity levels and alcohol consumption. It examines the influence of health behavioral change to reduce the threat of breast cancer risk. It also cites the efficacy of chemoprevention to the reduction of breast cancer risk.

The article discusses aspects of decision making in neo-adjuvant chemotherapy (NACT) for breast cancer. Topics include women's trust in clinicians to avoid the burden of decision-making in NACT for the treatment of breast cancer, women's access to a decision-support tool to help in their decision-making and the reasons behind breast cancer patients consideration of NACT.