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To better understand how to support UK breast surgeons in clinical trial participation and recruitment, the Association of Breast Surgery (ABS) Academic and Research (A&R) Committee surveyed the ABS membership on the challenges and barriers surrounding the recruitment of patients to breast cancer clinical trials. Improving patient outcomes depends on better engagement with clinical research. [ABSTRACT FROM AUTHOR]

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The article presents a study designed to examine the practice and short-term outcomes of therapeutic mammaplasty as a treatment method for breast cancer. The authors conclude that therapeutic mammaplasty is a safe and effective treatment method compared to mastectomy or breast-conserving surgery.

The article talks about implications of the 2013 general surgery curriculum of Intercollegiate Surgical Curriculum Programme (ISCP) and Greenaway review for breast surgery trainees focusing on how trainees balance the demands of broad-based surgical and subspecialty training.

INTRODUCTION: The most recent United Kingdom (NICE, 2009) guidelines recommend neoadjuvant chemotherapy as the most appropriate initial treatment for locally advanced breast cancer followed by mastectomy. Neoadjuvant chemotherapy should also be offered to patients with early breast cancer who are considering breast conserving surgery that is not advisable at presentation. However, the evidence base is still gathering. This study reviews the recent experience of neoadjuvant chemotherapy in a large United Kingdom breast unit according to breast cancer subtype. METHODS: Retrospective chart review of patients who received neoadjuvant chemotherapy for breast cancer at University Hospitals of Leicester between January 2008 and March 2011. Patients were identified from the unit database. Breast cancers were typed according to immunehistochemical marker profile: luminal A (ER or PR positive, HER2 negative), luminal B (ER or PR positive, HER2 positive), triple negative (ER and PR negative, HER2 negative), and HER2 positive (ER and PR negative, HER2 positive). RESULTS: Of 2,489 new patients with breast cancer seen during the study period, 153 patients received neoadjuvant chemotherapy. 20 patients had lobular-type cancers, and the remaining 133 patients had ductal- or mixed-type histology. 101 patients had locally advanced disease and 52 patients presented as early breast cancer. 24 of all patients (15 %) achieved complete pathological response. 18 patients (12 %) never proceeded to surgery, eight of whom died during the study period. In total to date, 23 patients (15 %) have died including one death due to complications from chemotherapy. Of 120 patients initially scheduled for mastectomy, the tumor was downsized in 26 patients (22 %) so that they were able to undergo breast conserving surgery (BCS), with margins involved in six patients. The outcome of neoadjuvant chemotherapy according to breast cancer subtype is presented (Tables 1 and 2). CONCLUSIONS: In our experience, patients receive neoadjuvant chemotherapy for breast cancer for a variety of indications. Compared to our standard population of breast cancer patients, early mortality remains relatively high, particlularly in the hormone receptor negative subtypes. BCS conversion rates were similar across breast cancer subtypes, but BCS was less likely to be successful in the Luminal A group. Luminal A cancers were also significantly less likely to achieve pCR after neoadjuvant chemotherapy. Breast cancer subtype should be taken into account when scheduling patients for neoadjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

The authors describe a young patient with a history of type IV vascular Ehlers-Danlos syndrome (EDS) who underwent successful treatment for a spontaneous haemorrhage from a splenic artery aneurysm, and the authors would like to remind clinicians of the mortality and morbidity associated with vascular-type EDS. [ABSTRACT FROM AUTHOR]

Objectives. To assess effectiveness, safety, and acceptability of follow-up regimens for oral dysplasia with regards to malignant transformation rate and duration to transformation. Method. Study design–Systematic literature review with criteria for identifying studies, assessing quality and data extraction. Selection criteria–Cohort studies, case-control studies, or randomised-controlled trials (RCTs). Interventions–Clinical follow-up and surveillance, surgical and non-surgical treatment, modification of aetiological factors. Outcome measures–Malignant transformation rate, predictive value of clinical prognostic indicators. Data collection and analysis–Using selection criteria, we identified published data by electronic searching. The validity of studies and extracted data was independently assessed by two authors. Quantitative data is compared and summarized in a table. Qualitative data is also discussed. Results. There are no RCTs assessing follow-up strategies. Nineteen cohort studies (level II and III evidence) reported follow-up, of which 12 were included in the meta-analysis. The malignant transformation rate varies widely between studies (6.6–36.0%). Surgical treatment appears to be more effective than non-surgical modalities, but recurrence is high. Tobacco and alcohol use, site and histological grade of the lesion are associated with progression to cancer. Conclusions. There is currently no evidence-based or consensus strategy for malignant risk quantification and follow-up of patients with oral dysplasia. We present a follow-up protocol based on best evidence. Large randomised-controlled trials are needed to assess these new strategies, including the use of molecular markers to quantify risk and follow-up these lesions. [ABSTRACT FROM AUTHOR]

Abstract Aims Radiotherapy is an important treatment for many types of cancer, but a minority of patients suffer long-term side-effects of treatment. Multiple lines of evidence suggest a role for circadian rhythm in the development of radiotherapy late side-effects. Materials and methods We carried out a study to examine the effect of radiotherapy timing in two breast cancer patient cohorts. The retrospective LeND cohort comprised 535 patients scored for late effects using the Late Effects of Normal Tissue-Subjective Objective Management Analytical (LENT-SOMA) scale. Acute effects were assessed prospectively in 343 patients from the REQUITE study using the CTCAE v4 scales. Genotyping was carried out for candidate circadian rhythm variants. Results In the LeND cohort, patients who had radiotherapy in the morning had a significantly increased incidence of late toxicity in univariate (P = 0.03) and multivariate analysis (P = 0.01). Acute effects in the REQUITE group were also significantly increased in univariate analysis after morning treatment (P = 0.03) but not on multivariate analysis. Increased late effects in the LeND group receiving morning radiotherapy were associated with carriage of the PER3 variable number tandem repeat 4/4 genotype (P = 6 × 10−3) and the NOCT rs131116075 AA genotype (P = 5 × 10−3). Conclusion Our results suggest that it may be possible to reduce toxicity associated with breast cancer radiotherapy by identifying gene variants that affect circadian rhythm and scheduling for appropriate morning or afternoon radiotherapy. Highlights • Radiotherapy for breast cancer in the morning causes worse acute and late toxicity. • Alleles of two circadian rhythm genes predict worse outcome in the morning. • The results will allow genetically determined chronoradiotherapy. [ABSTRACT FROM AUTHOR]

Metastatic primary cutaneous melanoma is a frequently fatal disease despite recent therapeutic advances. Biomarkers to stratify patients' prognosis are lacking. MicroRNAs (miRNAs) are small, non-coding RNAs. We aimed to determine the expression of miR-211-5p in primary tumors and metastases of malignant melanoma and its potential use as a prognostic biomarker. We performed in situ hybridization for miRNA-211-5p on 109 FFPE melanoma samples from 76 patients, including 31 paired primary tumor/metastasis samples. For validation, we performed in silico analyses of TCGA skin cutaneous melanoma (SKCM) cohort. High miR-211-5p expression was more frequent in primary tumors (70.8%) compared to metastases (39.3%). In metastases, it was associated with a significantly worse overall survival. Data from TCGA SKCM cohort confirmed that high miR-211-5p expression in melanoma metastases, but not primary tumors, is associated with worse overall survival. MiR-211-5p expression in metastases is associated with a shorter survival, emphasizing the potential of miR-211-5p as a risk predictor for a less favorable clinical outcome in metastatic disease. In situ hybridization could be implemented in a routine laboratory workflow and can be performed on diagnostic tissue.

Background and Purpose: Image-based data mining (IBDM) requires spatial normalisation to reference anatomy, which is challenging in breast radiotherapy due to variations in the treatment position, breast shape and volume. We aim to optimise spatial normalisation for breast IBDM., Materials and Methods: Data from 996 patients treated with radiotherapy for early-stage breast cancer, recruited in the REQUITE study, were included. Patients were treated supine (n = 811), with either bilateral or ipsilateral arm(s) raised (551/260, respectively) or in prone position (n = 185). Four deformable image registration (DIR) configurations for extrathoracic spatial normalisation were tested. We selected the best-performing DIR configuration and further investigated two pathways: i ) registering prone/supine cohorts independently and ii ) registering all patients to a supine reference. The impact of arm positioning in the supine cohort was quantified. DIR accuracy was estimated using Normalised Cross Correlation (NCC), Dice Similarity Coefficient (DSC), mean Distance to Agreement (MDA), 95 % Hausdorff Distance (95 %HD), and inter-patient landmark registration uncertainty (ILRU)., Results: DIR using B-spline and normalised mutual information (NMI) performed the best across all evaluation metrics. Supine-supine registrations yielded highest accuracy (0.98 ± 0.01, 0.91 ± 0.04, 0.23 ± 0.19 cm, 1.17 ± 1.18 cm, 0.51 ± 0.26 cm for NCC, DSC, MDA, 95 %HD, and ILRU), followed by prone-prone and supine-prone registrations. Arm positioning had no significant impact on registration performance. For the best DIR strategy, uncertainty of 0.44 and 0.81 cm in the breast and shoulder regions was found., Conclusions: B-spline algorithm using NMI and registered supine and prone cohorts independently provides the most optimal spatial normalisation strategy for breast IBDM., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier B.V. on behalf of European Society of Radiotherapy & Oncology.)

Background: Despite a UK 5-year breast cancer survival rate of 86.6%, patients may develop breast cancer recurrence within the same breast after breast conserving surgery, as well as in the remaining skin or chest wall after mastectomy or in the ipsilateral lymph glands. These recurrences, collectively termed locoregional recurrence (LRR), occur in around 8% of patients within 10 years of their original diagnosis. Currently, there is a lack of robust information on the presentation and prevalence of LRR with no UK-specific clinical guidelines available for the optimal management of this patient group. Additionally, there is a need to identify patterns of LRR presentation and their progression, which will enable prognostic factors to be determined. This will subsequently enable the tailoring of treatment and improve patient outcome., Methods: The MARECA study is a prospective, multicentre cohort study recruiting patients diagnosed with breast cancer LRR +/- associated distant metastases. Over 50 UK breast units are participating in the study with the aim of recruiting at least 500 patients over a recruitment period of 24 months. The data collected will detail the tumour pathology, imaging results, surgical treatment, radiotherapy and systemic therapy of the primary and recurrent breast cancer. Study follow-up will be for up to 5 years following LRR diagnosis to determine subsequent oncological outcomes and evaluate potential prognostic factors., Discussion: This study will address the current knowledge gap and identify subgroups of patients who have less successful treatment outcomes. The results will determine the current management of LRR and the prognosis of patients diagnosed with breast cancer LRR +/- distant metastases in the UK, with the aim of establishing best practice and informing future national guidelines. The results will direct future research and inform the design of additional interventional trials and translational studies., Competing Interests: SMcI reports honoraria from MSD, Roche, BD and Lilly, conference travel and support from Roche and Lilly, and institutional research funding from Novartis. RIC declares institutional research support from SECA and Astra Zeneca. EC reports honorarium from AstraZeneca, Eli Lilly, Novartis, Pfizer, Roche, Conference fees/travel/accommodation: Roche, Novartis, and Educational grant: Daiichi-Sankyo and Research support: SECA, AstraZeneca. All other authors declare that they have no competing interests., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)