83 results on '"Suzanne B Coopey"'
Search Results
2. Supraclavicular and Contralateral Axillary Lymph Node Involvement in Breast Cancer Patients
- Author
-
Suzanne B. Coopey
- Subjects
Oncology ,Surgery - Published
- 2022
3. Imaging Evaluation of the Axilla—A National Survey of Clinical Practice Among Radiologists
- Author
-
Erica T. Warner, Shinn-Huey S. Chou, Suzanne B. Coopey, Constance D. Lehman, Anand K. Narayan, Mansi A. Saksena, and Leslie R Lamb
- Subjects
medicine.medical_specialty ,Radiological and Ultrasound Technology ,Breast imaging ,business.industry ,medicine.disease ,Clinical Practice ,Axilla ,medicine.anatomical_structure ,Breast cancer ,medicine ,Medical imaging ,Radiology, Nuclear Medicine and imaging ,Radiology ,business - Abstract
Objective To assess awareness and implementation of the American College of Surgeons Oncology Group Z0011 trial findings, approaches to axillary nodal imaging, and to identify differences in practice based on respondent characteristics. Methods An online survey was distributed to members of the Society of Breast Imaging. Questions regarded demographics, evaluation approaches, and impact of the Z0011 trial. Poisson regression with robust standard errors to regression was used to generate multivariable-adjusted relative risks and 95% confidence intervals (CIs) for associations. Results The response rate was 21.7% (430/2007). The majority (295/430, 68.6%) reported always performing axillary US in patients with a BI-RADS 4B, 4C, or 5 breast mass. Most respondents (299/430, 69.5%) were familiar with the findings of the Z0011 trial. Radiologists in academic practice were 0.67 (95% CI: 0.54–0.83) times less likely than private practice radiologists to perform axillary US in all masses and 1.31 (95% CI: 1.13–1.52) times more likely to be very familiar with the trial. Frequency of axillary US showed no association with time spent in breast imaging, years in practice, or presence of dedicated breast surgeons. Increased time in breast imaging and presence of dedicated breast surgeons was strongly associated with familiarity with the trial. No association was observed with years in practice. Most respondents (291/430, 67.7%) made little or no change to their practice based on trial findings. Conclusion There is wide variability in approaches to axillary nodal evaluation, demonstrating a need for improved education and guidelines for axillary imaging in breast cancer patients.
- Published
- 2021
4. The safety of performing breast reconstruction during the COVID-19 pandemic
- Author
-
Eric C. Liao, Barbara L. Smith, Michelle C. Specht, Heather R. Faulkner, Amy S. Colwell, and Suzanne B. Coopey
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Breast Implants ,Mammaplasty ,medicine.medical_treatment ,Breast Neoplasms ,Outcomes ,Patient safety ,Postoperative Complications ,Breast cancer ,Chart review ,Pandemic ,medicine ,Humans ,Breast reconstruction ,Pharmacology (medical) ,Radiology, Nuclear Medicine and imaging ,General hospital ,skin and connective tissue diseases ,Pandemics ,Mastectomy ,Retrospective Studies ,SARS-CoV-2 ,business.industry ,General surgery ,COVID-19 ,General Medicine ,medicine.disease ,Oncology ,Female ,Original Article ,business - Abstract
PURPOSE: Elective operations including surgeries for breast cancer were significantly reduced during the height of the surge of COVID-19 cases in Massachusetts. The safety of performing breast reconstruction during the pandemic was unknown. This study aims to review the safety of performing mastectomy with immediate breast reconstruction during the first COVID-19 surge in Massachusetts. METHODS: A retrospective chart review of patients who underwent mastectomy with immediate breast reconstruction by Massachusetts General Hospital breast and plastic surgeons immediately preceding and during the COVID-19 pandemic was performed. RESULTS: Thirty patients (34 breasts) underwent mastectomies with immediate breast reconstruction during the COVID-19 restriction period in Massachusetts. Most reconstructions were unilateral. All reconstructions were performed with implants or expanders, and no autologous reconstructions were performed. Two patients (2 breasts) had operative complications. The complication rate during the pandemic was similar to the complication rate pre-pandemic. No patients or surgeons experienced symptoms or positive COVID-19 tests. Over 90% of patients were discharged the same day. CONCLUSION: Prosthetic breast reconstruction was able to be performed safely during the height of the COVID-19 pandemic surge in Massachusetts. Strict screening protocols, proper use of personal protective equipment, and same-day discharge when possible are essential for patient and surgeon safety during the pandemic.
- Published
- 2021
5. Axillary Ultrasound Evaluation in Breast Cancer Patients: A Multidisciplinary Viewpoint and Middle Ground
- Author
-
Suzanne B. Coopey, Rachel B. Jimenez, Mansi A. Saksena, and Katherine A Harris
- Subjects
Axillary ultrasound ,medicine.medical_specialty ,Breast cancer ,Radiological and Ultrasound Technology ,Multidisciplinary approach ,business.industry ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,medicine.disease - Abstract
Over the past decade, there has been a trend toward de-escalation of axillary surgery. Certain patients may now forego axillary lymph node dissection even in the setting of a positive sentinel lymph node biopsy (SLNB), and some patients may not even undergo a SLNB. However, there is wide variability in the imaging approach to assessing axillary lymph nodes in patients with breast cancer. Approaches range from performing axillary US in all patients with newly diagnosed breast cancer to omitting axillary imaging evaluation in all patients. This article provides a multidisciplinary middle ground approach for axillary nodal evaluation. The clinical impact and rationale for appropriate axillary nodal imaging are discussed and an imaging algorithm is proposed.
- Published
- 2021
6. Nipple-Sparing Mastectomy versus Skin-Sparing Mastectomy: Does Saving the Nipple Impact Short- and Long-Term Patient Satisfaction?
- Author
-
Kevin S. Hughes, Michelle C. Specht, Barbara L. Smith, Michele A. Gadd, Heather R. Faulkner, Suzanne B. Coopey, Bridget N. Kelly, Carson Brown, Amy S. Colwell, Jenna E. Korotkin, T. Salewa Oseni, and Conor R. Lanahan
- Subjects
Nipple-Sparing Mastectomy ,medicine.medical_specialty ,Skin sparing mastectomy ,business.industry ,medicine.medical_treatment ,Surgery ,Patient satisfaction ,Oncology ,Surgical oncology ,Cohort ,medicine ,business ,Psychosocial ,Body mass index ,Mastectomy - Abstract
Nipple-sparing mastectomy (NSM) is an oncologically safe alternative to skin-sparing mastectomy (SSM). This study evaluated whether NSM patients were more satisfied than SSM patients in short- and long-term follow-up. Women who underwent NSM or SSM between 2009 and 2019 completed a postoperative BREAST-Q survey at least 1 year after surgery and patient characteristics were compared. Patient satisfaction at 1–5 years and 6–10 years after NSM and SSM were analyzed. Overall, 431 patients were included; 247 had NSM and 184 had SSM 1–10 years prior to BREAST-Q survey completion. SSM patients were older, had higher body mass index (BMI), larger breast weight, and more hypertension than NSM patients, but oncologic treatments were similar between groups. BREAST-Q Psychosocial Well-Being and Sexual Well-Being scores were significantly higher in NSM patients compared with SSM patients in the 1–5 years cohort; however, scores attenuated in the 6–10 years cohort. Satisfaction with breasts was nearly significantly higher in NSM patients compared with SSM patients in the 1–5 years cohort (p = 0.056), but no different in the 6–10 years cohort. Receipt of adjuvant chemotherapy, receipt of postmastectomy radiation therapy, and BMI ≥30 were independent risk factors for dissatisfaction with breasts. Women who are not candidates for NSM should be reassured that long-term qualify of life is not significantly different between SSM and NSM. Dissatisfaction with reconstructed breasts is linked with other factors (besides the nipple), which patients should be made aware of at the time of surgical decision making.
- Published
- 2021
7. Contralateral Prophylactic Mastectomy in Average Risk Women: Who Can Choose This Wisely?
- Author
-
Suzanne B, Coopey
- Subjects
Humans ,Female ,Breast Neoplasms ,Mastectomy - Published
- 2022
8. Oncologic Safety of Nipple-Sparing Mastectomy for Breast Cancer in BRCA Gene Mutation Carriers: Outcomes at 70 Months Median Follow-Up
- Author
-
Alexandra J, Webster, Julia N, Shanno, Heidi S, Santa Cruz, Bridget N, Kelly, Meghan, Garstka, Anthony, Henriquez, Michelle C, Specht, Michele A, Gadd, Francys C, Verdial, Anvy, Nguyen, Tawakalitu O, Oseni, Suzanne B, Coopey, and Barbara L, Smith
- Abstract
Retention of the nipple-areola complex with nipple-sparing mastectomy (NSM) techniques provides a more natural cosmetic result than procedures that sacrifice the nipple. While the oncologic safety of NSM is established by several studies, there is little long-term data on outcomes in BRCA mutation carriers with breast cancer.BRCA1/2 mutation carriers who underwent NSM and immediate reconstruction from 2008 to 2019 were reviewed and patients with breast cancer on biopsy or final pathology were included. Patient demographics and tumor characteristics, as well as treatment, recurrence, and survival data were collected.A total of 114 therapeutic NSM were performed in 105 BRCA mutation carriers (56 BRCA1, 47 BRCA2, and two women with both mutations). Median age was 45 years. Cancers were 18% stage 0, 52% stage I, 27% stage II, and 3% stage III. Mean invasive tumor size was 1.6 cm and 33 (35%) invasive tumors were triple negative. There were five (4.4%) positive nipple margins on final pathology; all underwent nipple excision. Most patients (80, 76%) received systemic therapy: 65 (62%) received chemotherapy and 48 (46%) received endocrine therapy. At 70 months median follow-up (range 15-150 months), no patient had developed a recurrence in the retained nipple-areola complex or at the site of a nipple excised for a positive margin. The rate of locoregional recurrence outside the nipple was 2.6%, and the rate of distant recurrence was 3.8%. Overall survival was 96%.NSM is a safe option for BRCA1 and BRCA2 mutation carriers who undergo mastectomy for breast cancer.
- Published
- 2022
9. How Protective are Nipple-Sparing Prophylactic Mastectomies in BRCA1 and BRCA2 Mutation Carriers?
- Author
-
Anvy Nguyen, Meghan Garstka, Tawakalitu O. Oseni, Barbara L. Smith, Bridget N. Kelly, Michelle C. Specht, Michele A. Gadd, Suzanne B. Coopey, Alexandra Webster, Kevin S. Hughes, Jasmine A. Khubchandani, and Anthony Henriquez
- Subjects
Oncology ,medicine.medical_specialty ,endocrine system diseases ,business.industry ,medicine.medical_treatment ,BRCA mutation ,Cancer ,Gene mutation ,medicine.disease ,medicine.anatomical_structure ,BRCA2 Mutation ,Surgical oncology ,Ipsilateral breast ,Internal medicine ,medicine ,Surgery ,skin and connective tissue diseases ,business ,Areola ,Mastectomy - Abstract
Nipple-sparing mastectomy (NSM) is now routinely offered to BRCA mutation carriers for risk reduction. We assessed the rates of ipsilateral cancer events after prophylactic and therapeutic NSM in BRCA1 and BRCA2 mutation carriers. BRCA1 and BRCA2 mutation carriers undergoing NSM from October 2007 to June 2019 were identified in a single-institution prospective database, with variants of unknown significance being excluded. Patient, tumor, and outcomes data were collected. Follow-up analysis was by cumulative breast-years (total years of follow-up of each breast) and woman-years (total years of follow-up of each woman). Overall, 307 BRCA1 and BRCA2 mutation carriers (160 BRCA1, mean age 41.4 years [range 21–65]; and 147 BRCA2, mean age 43.8 years [range 23–65]) underwent 607 NSMs, with a median follow-up of 42 months (range 1–143). 388 bilateral prophylactic NSMs had 744 cumulative woman-years of follow-up, with no new cancers seen (< 0.0013 new cancers per woman-years); 251 BRCA1 prophylactic NSMs had 1034 cumulative breast-years of follow-up, with no new ipsilateral cancers seen (< 0.0010 per breast-year); 66 BRCA1 therapeutic NSMs had 328 cumulative breast-years of follow-up, with one ipsilateral cancer recurrence not directly involving the nipple or areola (0.0030 per breast-year); 237 BRCA2 prophylactic NSMs had 926 cumulative breast-years of follow-up, with no new ipsilateral cancers seen (< 0.0011 per breast-year); and 53 BRCA2 therapeutic NSMs had 239 cumulative breast-years of follow-up, with two ipsilateral recurrent cancers, neither of which directly involved the nipple or areola (0.0084 per breast-year). The risk of new ipsilateral breast cancers is extremely low after NSM in BRCA1 and BRCA2 mutation carriers. NSM is an effective risk-reducing strategy for BRCA gene mutations.
- Published
- 2021
10. Comparison of Wireless Localization Alternatives with Wire Localization for Nonpalpable Breast Lesions
- Author
-
Alexandra J Webster, Bridget N Kelly, Caroline McGugin, Suzanne B Coopey, Barbara L Smith, Michele A Gadd, and Michelle C Specht
- Subjects
Biopsy ,Humans ,Surgery ,Breast Neoplasms ,Female ,Mastectomy, Segmental ,Retrospective Studies - Abstract
Radiofrequency identification tag localization (TL) and magnetic seed localization (MSL) are alternatives to wire localization (WL) for excision of nonpalpable breast lesions. We sought to compare localization methods with respect to operative time, specimen volume, and re-excision rate.A retrospective cohort analysis was performed on TL, MSL, and WL lumpectomies and excisional biopsies at a single institution. Association between localization method and operative time, specimen volume, and re-excision rate was assessed by multiple logistic regression using odds ratios (ORs) and 95% CIs.A total of 506 procedures were included: 147 TL (29.0%), 140 MSL (27.7%), and 219 WL (43.3%). On logistic regression analysis, MSL was associated with longer operative times than WL for excisional biopsies only (OR 4.24, 95% CI 1.92 to 9.34, p0.001). Mean excisional biopsy time was 39.1 minutes for MSL and 33.0 minutes for WL. Specimen volume did not vary significantly across surgery types between localization methods. In an analysis of all lumpectomies with an indication of carcinoma, marker choice was not associated with rate of re-excision (TL vs WL OR 0.64, 95% CI 0.26 to 1.60, p = 0.342; MSL vs WL OR 1.22, 95% CI 0.60 to 2.49, p = 0.587; TL vs MSL OR 0.65, 95% CI 0.26 to 1.64, p = 0.359).TL, MSL, and WL are comparable in performance for excision of nonpalpable breast lesions. Although increased operative time associated with MSL vs WL excisional biopsies is statistically significant, clinical significance warrants additional study. With similar outcomes, physicians may choose the marker most appropriate for the patient and setting.
- Published
- 2022
11. ASO Visual Abstract: Oncologic Safety of Nipple-Sparing Mastectomy for Breast Cancer in BRCA Gene Mutation Carriers-Outcomes at 70 Months Median Follow-up
- Author
-
Alexandra J. Webster, Julia N. Shanno, Heidi S. Santa Cruz, Bridget N. Kelly, Meghan Garstka, Anthony Henriquez, Michelle C. Specht, Michele A. Gadd, Francys C. Verdial, Anvy Nguyen, Tawakalitu O. Oseni, Suzanne B. Coopey, and Barbara L. Smith
- Subjects
Oncology ,Surgery - Published
- 2023
12. Similar rates of residual disease in patients with DCIS within 2 mm of lumpectomy margin regardless of the presence of invasive carcinoma
- Author
-
Barbara L. Smith, Michelle C. Specht, Suzanne B. Coopey, Rong Tang, Olga Kantor, Conor R. Lanahan, Jenna E. Korotkin, and Bridget N. Kelly
- Subjects
0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,Invasive carcinoma ,business.industry ,medicine.medical_treatment ,Lumpectomy ,Disease ,medicine.disease ,body regions ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Breast cancer ,Oncology ,Surgical oncology ,Margin (machine learning) ,030220 oncology & carcinogenesis ,Carcinoma ,medicine ,Breast-conserving surgery ,Radiology ,skin and connective tissue diseases ,business ,neoplasms - Abstract
The 2014 Society of Surgical Oncology/American Society for Radiation Oncology (SSO/ASTRO) breast-conserving surgery (BCS) margin guidelines for invasive cancer recommended “no ink on tumor” as an adequate margin width. However, 2016 SSO/ASTRO margin guidelines for pure DCIS recommended a 2 mm margin. Thus, management of a margin with DCIS > 0 mm but
- Published
- 2020
13. Contralateral Prophylactic Mastectomy in Average Risk Women: Who Can Choose This Wisely?
- Author
-
Suzanne B. Coopey
- Subjects
Oncology ,Surgery - Published
- 2022
14. Supraclavicular and Contralateral Axillary Lymph Node Involvement in Breast Cancer Patients
- Author
-
Suzanne B, Coopey
- Subjects
Lymphatic Metastasis ,Axilla ,Humans ,Lymph Node Excision ,Breast Neoplasms ,Female ,Lymph Nodes ,Combined Modality Therapy ,Neoplasm Staging - Abstract
Ipsilateral supraclavicular disease was reclassified from Stage IV, distant metastatic disease, to Stage IIIC, locally advanced breast cancer 20 years ago. Treatment with curative intent with multimodality therapy has led to improved outcomes over time. In contrast, metastatic disease to contralateral axillary lymph nodes remains as Stage IV distant disease. Despite this, in the absence of other distant metastases, many patients with contralateral axillary disease are treated more aggressively than other Stage IV patients. Outcomes of patients with contralateral axillary disease treated with curative intent are more like patients with ipsilateral supraclavicular disease and other locally advanced breast cancers than patients with de novo distant metastases elsewhere. Therefore, some favor reclassification of contralateral axillary metastases without distant metastasis from Stage IV to Stage III breast cancer similar to ipsilateral supraclavicular metastases.
- Published
- 2022
15. Baseline Screening MRI Uptake and Findings in Women with ≥ 20% Lifetime Risk of Breast Cancer
- Author
-
Katherine A Harris, Alison Laws, Therese M. Mulvey, Sarah Dalton, Elizabeth P Walsh, Suzanne B. Coopey, Karen Krag, Olga Kantor, and Nicole Jalbert
- Subjects
education.field_of_study ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Lobular carcinoma ,Population ,Cancer ,Retrospective cohort study ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Oncology ,030220 oncology & carcinogenesis ,Biopsy ,Atypia ,Medicine ,Mammography ,030211 gastroenterology & hepatology ,Surgery ,Radiology ,skin and connective tissue diseases ,business ,education - Abstract
The American Cancer Society recommends screening magnetic resonance imaging (MRI) for patients with a ≥ 20% lifetime breast cancer risk. This study assesses the outcomes of baseline MRI screens in women from a high-risk breast clinic (HRBC). We retrospectively reviewed patients from our institution’s HRBC, excluding those with prior breast cancer and predisposing genetic mutations. Screening MRI was recommended for a lifetime risk of ≥ 20% using the Tyrer–Cuzick model. We determined baseline MRI results, biopsy rates, and frequency of MRI-detected high-risk lesions (HRLs) and breast cancers. Overall, 319 women attended our HRBC; median age was 48 years and 4.7% had prior atypia/lobular carcinoma in situ. Screening MRI was recommended for 282 patients, of whom 196 (69.5%) completed a baseline screen. A Breast Imaging-Reporting and Data System (BIRADS) 3 or 4 finding occurred in 19.6% of patients; 23 (12.3%) required 6-month follow-up MRI, 16 (8.6%) underwent core biopsy, and 4 (2.1%) underwent excisional biopsy after initial core. An additional 7 (3.7%) patients had a non-breast incidental finding. An HRL was identified in 2 (1.1%) patients (atypical ductal and lobular hyperplasia, respectively), and 2 (1.1%) were diagnosed with T1N0 breast cancers. In the setting of an HRBC, 70% of women with a ≥ 20% lifetime risk of breast cancer pursued screening MRI when recommended. On baseline screen, the rate of MRI-detected breast cancer was low (1%); however, malignancies were mammographically occult and identified at an early stage. Despite a low cancer rate, nearly one in four women required additional diagnostic investigation. Prescreening counselling should include a discussion of this possibility, and longer-term follow-up of screening MRI is needed in this high-risk population.
- Published
- 2020
16. Long-Term Outcomes of Multiple-Wire Localizations for More Extensive Breast Cancer: Multiple-Wire Excision Does Not Increase Recurrence, Unplanned Imaging, or Biopsies
- Author
-
Barbara L. Smith, Michele A. Gadd, Bridget N. Kelly, Stephanie M. Wong, Maureen P. McEvoy, Michelle C. Specht, T. Salewa Oseni, Conor R. Lanahan, Suzanne B. Coopey, Carson Brown, Kevin S. Hughes, and Caroline McGugin
- Subjects
Adult ,0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,Biopsy ,medicine.medical_treatment ,Breast Neoplasms ,Mastectomy, Segmental ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,medicine ,Medical imaging ,Humans ,Breast ,Aged ,Retrospective Studies ,Aged, 80 and over ,Breast conservation ,medicine.diagnostic_test ,business.industry ,Carcinoma, Ductal, Breast ,Lumpectomy ,Chemoradiotherapy, Adjuvant ,Middle Aged ,medicine.disease ,Carcinoma, Intraductal, Noninfiltrating ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,Female ,Radiology ,Neoplasm Recurrence, Local ,business ,Mastectomy ,Follow-Up Studies ,Mammography - Abstract
Background We previously reported that breast conservation was feasible for women with large or irregularly shaped breast cancers when tumor resection was guided by multiple localizing wires. We now report long-term outcomes of multiple-wire versus single-wire localized lumpectomies for breast cancer. Patients and Methods We retrospectively reviewed wire-localized lumpectomies at our institution from May 2000 to November 2006. Rates of ipsilateral in-breast tumor recurrence, metastasis, and subsequent unplanned diagnostic imaging and biopsy were compared between multiple-wire and single-wire cohorts. Results We identified 112 multiple-wire and 160 single-wire breast cancer lumpectomies that achieved clear margins. Median age was 64 years in the multiple-wire cohort and 57 years in the single-wire cohort. Mean lumpectomy volume was 75 mL in multiple-wire patients and 49 mL in single-wire patients (P = .003). Invasive tumor size, axillary node status, and use of radiation and systemic therapy were similar, but the multiple-wire group had more patients with ductal carcinoma-in-situ only (38% vs. 28%). At 108 months’ median follow-up, there was no significant difference in local or distant recurrence rates between multiple-wire and single-wire cohorts. Six (5%) multiple-wire patients and 6 (4%) single-wire patients had local recurrences and 3 (3%) multiple-wire and 5 (3%) single-wire patients developed metastatic disease. Unplanned diagnostic imaging was required for 53 (47%) multiple-wire and 65 (41%) single-wire patients. Subsequent ipsilateral biopsy occurred in 15 (13%) multiple-wire and 19 (12%) single-wire patients. Conclusion Breast-conserving surgery with multiple localizing wires is a safe alternative to mastectomy for breast cancer patients with large mammographic lesions.
- Published
- 2020
17. Does An ERAS Protocol Reduce Postoperative Opiate Prescribing in Plastic Surgery?
- Author
-
Lydia R. Maurer, Suzanne B. Coopey, Bridget N. Kelly, Rachel C. Sisodia, Dan B. Ellis, and Heather R. Faulkner
- Subjects
Protocol (science) ,medicine.medical_specialty ,Reconstructive surgery ,Controlled substance ,RD1-811 ,business.industry ,prescribing ,pain control ,Physician education ,Plastic surgery ,plastic surgery ,Emergency medicine ,opiate use ,Medicine ,Surgery ,Original Article ,ERAS ,Opiate ,Medical prescription ,business ,Prescription monitoring - Abstract
Summary Background Enhanced recovery after surgery (ERAS) protocols are effective at reducing inpatient opiate use. There is a paucity of studies on the effects of an ERAS protocol on outpatient opiate prescriptions. The aim of this study was to determine whether an ERAS protocol for plastic and reconstructive surgery would reduce opiate use in the outpatient postoperative setting. Methods A statewide (Massachusetts, USA) controlled substance prescription monitoring database was retrospectively reviewed to assess the prescribing patterns of a single academic plastic surgeon performing common plastic surgical outpatient operations. The time period prior to implementation of the ERAS protocol was then compared with the time period following protocol implementation. An additional three months of post-implementation data were then compared with those of each of the previous time periods to investigate whether the results were sustained. Results A comparison of opiate prescriptions in pre-ERAS, immediate post-ERAS procedures, and follow-up ERAS implementation procedures revealed a statistically significant decrease in opiate prescriptions after ERAS protocol implementation. This decrease in the quantity of opiates prescribed was sustained over time. Conclusions ERAS protocols are effective at reducing outpatient opiate prescriptions after a variety of plastic surgery operations. Appropriate patient and physician education is paramount for success.
- Published
- 2021
18. Axillary Downstaging in ER+/HER2− Breast Cancer: OncotypeDX As a Tool to Guide Neoadjuvant Approach
- Author
-
Olga Kantor and Suzanne B. Coopey
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,MEDLINE ,medicine.disease ,Axilla ,medicine.anatomical_structure ,Breast cancer ,Surgical oncology ,Internal medicine ,medicine ,Surgery ,business ,Neoadjuvant therapy - Published
- 2020
19. Nipple-Sparing Mastectomy versus Skin-Sparing Mastectomy: Does Saving the Nipple Impact Short- and Long-Term Patient Satisfaction?
- Author
-
Bridget N, Kelly, Heather R, Faulkner, Barbara L, Smith, Jenna E, Korotkin, Conor R, Lanahan, Carson, Brown, Michele A, Gadd, Michelle C, Specht, Kevin S, Hughes, T Salewa, Oseni, Amy S, Colwell, and Suzanne B, Coopey
- Subjects
Patient Satisfaction ,Mammaplasty ,Mastectomy, Subcutaneous ,Nipples ,Humans ,Breast Neoplasms ,Female ,Mastectomy ,Retrospective Studies - Abstract
Nipple-sparing mastectomy (NSM) is an oncologically safe alternative to skin-sparing mastectomy (SSM). This study evaluated whether NSM patients were more satisfied than SSM patients in short- and long-term follow-up.Women who underwent NSM or SSM between 2009 and 2019 completed a postoperative BREAST-Q survey at least 1 year after surgery and patient characteristics were compared. Patient satisfaction at 1-5 years and 6-10 years after NSM and SSM were analyzed.Overall, 431 patients were included; 247 had NSM and 184 had SSM 1-10 years prior to BREAST-Q survey completion. SSM patients were older, had higher body mass index (BMI), larger breast weight, and more hypertension than NSM patients, but oncologic treatments were similar between groups. BREAST-Q Psychosocial Well-Being and Sexual Well-Being scores were significantly higher in NSM patients compared with SSM patients in the 1-5 years cohort; however, scores attenuated in the 6-10 years cohort. Satisfaction with breasts was nearly significantly higher in NSM patients compared with SSM patients in the 1-5 years cohort (p = 0.056), but no different in the 6-10 years cohort. Receipt of adjuvant chemotherapy, receipt of postmastectomy radiation therapy, and BMI ≥30 were independent risk factors for dissatisfaction with breasts.Women who are not candidates for NSM should be reassured that long-term qualify of life is not significantly different between SSM and NSM. Dissatisfaction with reconstructed breasts is linked with other factors (besides the nipple), which patients should be made aware of at the time of surgical decision making.
- Published
- 2021
20. Performance of Breast Cancer Risk-Assessment Models in a Large Mammography Cohort
- Author
-
Zoe Guan, Giovanni Parmigiani, Suzanne B. Coopey, Ahmet Acar, Kevin S. Hughes, Molly Griffin, Anne Marie McCarthy, Alan Semine, Dorothy A. Sippo, Zhengyi Deng, Michaela Welch, and Danielle Braun
- Subjects
Adult ,Oncology ,Cancer Research ,medicine.medical_specialty ,Breast Cancer Surveillance Consortium ,Breast Neoplasms ,Risk Assessment ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Positive predicative value ,Internal medicine ,medicine ,Humans ,Mammography ,Registries ,030212 general & internal medicine ,Triple-negative breast cancer ,Aged ,Aged, 80 and over ,Models, Statistical ,medicine.diagnostic_test ,Receiver operating characteristic ,business.industry ,Editorials ,Middle Aged ,medicine.disease ,Confidence interval ,Massachusetts ,030220 oncology & carcinogenesis ,Female ,Risk assessment ,business - Abstract
Background Several breast cancer risk-assessment models exist. Few studies have evaluated predictive accuracy of multiple models in large screening populations. Methods We evaluated the performance of the BRCAPRO, Gail, Claus, Breast Cancer Surveillance Consortium (BCSC), and Tyrer-Cuzick models in predicting risk of breast cancer over 6 years among 35 921 women aged 40–84 years who underwent mammography screening at Newton-Wellesley Hospital from 2007 to 2009. We assessed model discrimination using the area under the receiver operating characteristic curve (AUC) and assessed calibration by comparing the ratio of observed-to-expected (O/E) cases. We calculated the square root of the Brier score and positive and negative predictive values of each model. Results Our results confirmed the good calibration and comparable moderate discrimination of the BRCAPRO, Gail, Tyrer-Cuzick, and BCSC models. The Gail model had slightly better O/E ratio and AUC (O/E = 0.98, 95% confidence interval [CI] = 0.91 to 1.06, AUC = 0.64, 95% CI = 0.61 to 0.65) compared with BRCAPRO (O/E = 0.94, 95% CI = 0.88 to 1.02, AUC = 0.61, 95% CI = 0.59 to 0.63) and Tyrer-Cuzick (version 8, O/E = 0.84, 95% CI = 0.79 to 0.91, AUC = 0.62, 95% 0.60 to 0.64) in the full study population, and the BCSC model had the highest AUC among women with available breast density information (O/E = 0.97, 95% CI = 0.89 to 1.05, AUC = 0.64, 95% CI = 0.62 to 0.66). All models had poorer predictive accuracy for human epidermal growth factor receptor 2 positive and triple-negative breast cancers than hormone receptor positive human epidermal growth factor receptor 2 negative breast cancers. Conclusions In a large cohort of patients undergoing mammography screening, existing risk prediction models had similar, moderate predictive accuracy and good calibration overall. Models that incorporate additional genetic and nongenetic risk factors and estimate risk of tumor subtypes may further improve breast cancer risk prediction.
- Published
- 2019
21. Trends in Unilateral and Contralateral Prophylactic Mastectomy Use in Ductal Carcinoma In Situ of the Breast: Patterns and Predictors
- Author
-
Kevin S. Hughes, Michele A. Gadd, Tawakalitu O. Oseni, David C. Chang, Suzanne B. Coopey, and Biqi Zhang
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Breast surgery ,Decision Making ,Breast Neoplasms ,Logistic regression ,03 medical and health sciences ,0302 clinical medicine ,Contralateral Prophylactic Mastectomy ,Epidemiology ,medicine ,Humans ,Practice Patterns, Physicians' ,Aged ,Retrospective Studies ,Obstetrics ,business.industry ,Carcinoma, Ductal, Breast ,Age Factors ,Retrospective cohort study ,Odds ratio ,Middle Aged ,Ductal carcinoma ,Prognosis ,Carcinoma, Intraductal, Noninfiltrating ,Prophylactic Mastectomy ,Oncology ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Surgery ,business ,Mastectomy ,Follow-Up Studies ,SEER Program - Abstract
Increased use of contralateral prophylactic mastectomy (CPM) as treatment for ductal carcinoma in situ (DCIS) in the US was first noted in the early 2000s. Optimization of treatment guidelines for DCIS requires an understanding of current surgical treatment trends, particularly as they may differ by patient sociodemographic and community resource factors. The aim of this study was to evaluate surgical treatment trends among US women with DCIS and to assess the impact of sociodemographic and community resource factors on surgical treatment choice. The Surveillance, Epidemiology, and End Results dataset was queried for women aged 40 years and older who were diagnosed with unilateral DCIS between 2000 and 2014. Annual mastectomy rates were compared over time by age and race/ethnicity. Multivariable logistic regressions were performed to identify predictors of mastectomy use, with patient sociodemographics, tumor characteristics, and community resource factors (i.e. plastic surgeon density) as covariates. A total of 130,731 women with DCIS met the inclusion criteria. Overall mastectomy rates remained relatively unchanged over the study period (25–30%). CPM use increased for all age and race/ethnic groups, with the greatest increase exhibited by women aged 40–49 years [relative to 2000; 2014 odds ratio (OR) 10.6]. With respect to community resource factors, CPM use, as opposed to unilateral mastectomy, was associated with counties of higher education level (OR 1.52), higher income level (OR 1.22), and lower plastic surgeon density (OR 1.26). While the popularity of mastectomy in the management of DCIS has remained relatively unchanged since the turn of the century, the use of CPM has risen substantially. Younger women with DCIS have seen the greatest increase in CPM use, a choice that remains influenced by race/ethnicity as well as income, education, and health resource availability. Until clinical risk stratifiers of DCIS are identified, the surgical decision-making paradigm must be improved so that treatment choice remains sensitive to cultural differences but becomes independent of income, education, and health resource availability.
- Published
- 2019
22. Incidental breast carcinoma: incidence, management, and outcomes in 4804 bilateral reduction mammoplasties
- Author
-
Michelle C. Specht, Kevin S. Hughes, Regina Barzilay, Judy Garber, Conor R. Lanahan, Anthony J. Guidi, Curtis L. Cetrulo, Adam Yala, Suzanne B. Coopey, Barbara L. Smith, Clara Li, Amy S. Colwell, Rong Tang, Michele A. Gadd, and Francisco Acevedo
- Subjects
Adult ,0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,Mammaplasty ,medicine.medical_treatment ,Breast Neoplasms ,Disease ,Reduction Mammoplasty ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Humans ,Medicine ,Public Health Surveillance ,Aged ,Retrospective Studies ,business.industry ,Incidence ,Incidence (epidemiology) ,Disease Management ,Cancer ,Middle Aged ,medicine.disease ,Tumor Burden ,Plastic surgery ,Treatment Outcome ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Female ,Radiology ,Neoplasm Grading ,business ,Breast carcinoma ,Mastectomy - Abstract
Bilateral reduction mammoplasty is one of the most common plastic surgery procedures performed in the U.S. This study examines the incidence, management, and prognosis of incidental breast cancer identified in reduction specimens from a large cohort of reduction mammoplasty patients. Breast pathology reports were retrospectively reviewed for evidence of incidental cancers in bilateral reduction mammoplasty specimens from five institutions between 1990 and 2017. A total of 4804 women met the inclusion criteria of this study; incidental cancer was identified in 45 breasts of 39 (0.8%) patients. Six patients (15%) had bilateral cancer. Overall, the maximum diagnosis by breast was 16 invasive cancers and 29 ductal carcinomas in situs. Thirty-three patients had unilateral cancer, 15 (45.5%) of which had high-risk lesions in the contralateral breast. Twenty-one patients underwent mastectomy (12 bilateral and nine unilateral), residual cancer was found in 10 in 25 (40%) therapeutic mastectomies. Seven patients did not undergo mastectomy received breast radiation. The median follow-up was 92 months. No local recurrences were observed in the patients undergoing mastectomy or radiation. Three of 11 (27%) patients who did not undergo mastectomy or radiation developed a local recurrence. The overall survival rate was 87.2% and disease-free survival was 82.1%. Patients undergoing reduction mammoplasty for macromastia have a small but definite risk of incidental breast cancer. The high rate of bilateral cancer, contralateral high-risk lesions, and residual disease at mastectomy mandates thorough pathologic evaluation and careful follow-up of these patients. Mastectomy or breast radiation is recommended for local control given the high likelihood of local recurrence without either.
- Published
- 2019
23. Radiofrequency identification tag localization is comparable to wire localization for non-palpable breast lesions
- Author
-
Michele A. Gadd, Michelle C. Specht, Barbara L. Smith, Tara Spivey, Bridget N. Kelly, Suzanne B. Coopey, Brian N. Dontchos, Kevin S. Hughes, and Caroline McGugin
- Subjects
Diagnostic Imaging ,0301 basic medicine ,Cancer Research ,Biopsy ,medicine.medical_treatment ,Wire localization ,Breast Neoplasms ,Mastectomy, Segmental ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,medicine ,Humans ,Aged ,Neoplasm Staging ,Retrospective Studies ,Invasive carcinoma ,medicine.diagnostic_test ,business.industry ,Lumpectomy ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Radio Frequency Identification Device ,Treatment Outcome ,030104 developmental biology ,Oncology ,Specimen volume ,030220 oncology & carcinogenesis ,Female ,Non palpable ,Nuclear medicine ,business ,Mammography - Abstract
Radiofrequency identification (RFID) tag localization (TL) is a technique of localizing non-palpable breast lesions that can be performed prior to surgery. We sought to evaluate whether TL is comparable to wire localization (WL) in regard to specimen size, operative time, and re-excision rate. A retrospective cohort analysis was performed on TL and WL excisional biopsies and lumpectomies performed by 5 surgeons at 2 institutions. Cases were stratified by surgery type and surgical indication. Associations between localization technique and specimen volume, operative time, and re-excision rate were assessed by univariate and multivariate analyses. A total of 503 procedures were included, 147 TL (29.2%) and 356 WL (70.8%). Nineteen (12.9%) RFID tags were placed before surgery, ranging 1–22 days. All intended targets were removed. TL and WL excisional biopsy and lumpectomy specimen volumes were similar (p = 0.560 and 0.494). TL and WL excisional biopsy and lumpectomy + SLNB operative times were similar (p = 0.152 and 0.158), but TL lumpectomies without SLNB took longer than WL (57 min vs 49 min; p = 0.027). Re-excision rates were similar by surgical procedure (p = 0.615), surgical indication (DCIS p = 0.145; invasive carcinoma p = 0.759), and confirmed by multivariable analysis (OR 0.754, 95% CI 0.392–1.450; p = 0.397). TL has similar surgical outcomes to WL with added benefit that TL can occur prior to the day of surgery. TL is an acceptable alternative to WL and should be considered for non-palpable breast lesions.
- Published
- 2019
24. Abstract P2-14-19: Surgical and long-term outcomes of patients receiving neoadjuvant pertuzumab-containing regimens for HER2-positive localized breast cancer
- Author
-
Beverly Moy, Laura Spring, Aditya Bardia, Barbara L. Smith, SJ Isakoff, Kevin S. Hughes, M.A. Gadd, Suzanne B. Coopey, Neelima Vidula, Ja Shin, Stephen A. Haddad, Michelle C. Specht, Amy Comander, Rachel B. Jimenez, and Alphonse G. Taghian
- Subjects
Cancer Research ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cancer ,medicine.disease ,Surgery ,Plastic surgery ,Regimen ,Breast cancer ,Oncology ,Trastuzumab ,medicine ,Pertuzumab ,Stage (cooking) ,business ,Mastectomy ,medicine.drug - Abstract
Background: The addition of pertuzumab to trastuzumab and chemotherapy significantly improves the pathologic complete response (pCR) rate in HER2+ localized breast cancer in the preoperative setting. Although many patients are converted to breast conserving therapy (BCT) candidates by neoadjuvant HER2-directed therapy, a significant proportion opt for a mastectomy for various reasons. Among mastectomy procedures, nipple sparing mastectomy (NSM) is frequently chosen instead of non-nipple sparing mastectomy (NNSM). In this study, we evaluated the surgical and long-term outcomes of HER2+ patients receiving neoadjuvant pertuzumab-containing regimens. Methods: We performed a retrospective review of localized breast cancer patients treated with neoadjuvant pertuzumab-containing regimens from 2011 to 2016, who underwent BCT or mastectomy at an academic institution and two community-based practices. Disease characteristics, treatment regimens, surgical outcomes, and recurrence data were extracted from the electronic medical records. Results: Among 90 patients with stage II-III HER2+ breast cancer, 45 received AC-THP (50.0%), 26 received THP (with adjuvant AC) (29.0%), and 19 received TCHP (21.0%). The majority of patients had grade 3 tumors (61.1%), clinical stage II disease (80.0%), invasive ductal carcinoma (86.7%), and ER+ disease (65.6%). Thirty-seven (41.0%) patients underwent BCT and 53 (59.0%) patients underwent mastectomy. Among the mastectomy patients, 38 (71.7%) patients underwent bilateral mastectomies, specifically 33 (62.0%) patients underwent a NSM and 20 (38.0%) patients underwent a NNSM. The type of surgery that patients underwent stratified by type of neoadjuvant regimen is outlined in the Table 1 below. Most patients who underwent BCT and mastectomy received radiation, including 36 (97.3%) BCT, 24 (72.7%) NSM, and 18 (95.0%) NNSM. Over a median follow-up period of 33 months, 6 patients (6.7%) had recurrences with 2 (2.2%) local recurrences and 4 (4.4%) distant recurrences. The 2 local recurrences occurred in one patient who underwent BCT and one patient who underwent NNSM followed by post-mastectomy radiation. Conclusions: Among mastectomy patients, NSM was more commonly pursued than NNSM. Rates of local recurrence following pertuzumab-containing regimens for HER2-positive localized breast cancer were low overall, regardless of the type of surgery. Data on plastic surgery approaches and complication rates will be presented at the meeting. Table 1.Type of surgery in patients receiving neoadjuvant HER2-directed therapy. AC-THP (N = 45)TCHP (N = 19)THP (N = 26)BCT46.7%47.4%26.9%NNSM26.7%10.5%23.1%NSM26.7%42.1%50.0% Citation Format: Haddad SA, Spring LM, Jimenez RB, Vidula N, Comander A, Shin JA, Coopey SB, Gadd MA, Hughes KS, Taghian A, Smith BL, Isakoff SJ, Moy B, Bardia A, Specht MC. Surgical and long-term outcomes of patients receiving neoadjuvant pertuzumab-containing regimens for HER2-positive localized breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-19.
- Published
- 2019
25. Impact of Race and Place of Origin on Contralateral Prophylactic Mastectomy Rates for Ductal Carcinoma in Situ (DCIS) in the United States 2000–2010
- Author
-
Suzanne B. Coopey, David C. Chang, Jasmine A. Khubchandani, Courtney M. Rentas, and Tawakalitu O. Oseni
- Subjects
medicine.medical_specialty ,Contralateral Prophylactic Mastectomy ,business.industry ,Ductal carcinoma in situ (DCIS) ,medicine ,Surgery ,Radiology ,business ,medicine.disease - Published
- 2021
26. Management and outcomes of men diagnosed with primary breast cancer
- Author
-
Jose Pablo Leone, Kevin S. Hughes, Nora Horick, Laura Spring, Rachel B. Jimenez, Nan Lin, Laura S. Dominici, Suzanne B. Coopey, and Andrew E. Johnson
- Subjects
0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,Chemotherapy ,Standard of care ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Cancer ,medicine.disease ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Breast cancer ,Oncology ,030220 oncology & carcinogenesis ,Internal medicine ,Male breast cancer ,Cohort ,Medicine ,business ,Mastectomy ,Genetic testing - Abstract
Fewer than 1% of all breast cancers occur in men. As a result, a distinct lack of data exists regarding the management and outcomes in this cohort. Any male patient with pathologically confirmed breast cancer diagnosed between August 2000 and October 2017 at either Massachusetts General Hospital or Brigham and Women’s Hospital/Dana-Farber Cancer Institute and their affiliate satellite locations were included. Primary chart review was used to assess clinical and pathologic characteristics. Patient and treatment variables were reported via descriptive statistics. Local–regional failure (LRF), overall survival (OS), breast cancer-specific survival (BCSS), and disease-free survival (DFS) were estimated using the Kaplan–Meier method. 100 patients were included in this study. Median follow-up was 112 months (range 1–220 months). Approximately 1/3 of patients experienced at least a 3-month delay to presentation. 83 patients ultimately underwent mastectomy as definitive surgical treatment. 46 patients received adjuvant radiation therapy, and 37 patients received chemotherapy. Of 82 hormone receptor-positive patients with invasive cancer, 94% (n = 77) received endocrine therapy. Of the fifty-eight patients who underwent genetic testing, 15 (26%) tested positive. The 5-year OS, BCSS, DFS, and LRF rates were 91.5%, 96.2%, 86%, and 4.8%, respectively. Delay to presentation was not associated with worse survival. Male breast cancer remains a rare diagnosis. Despite this, the majority of patients in this study received standard of care therapy and experienced excellent oncologic outcomes. Penetration for genetic testing improved over time.
- Published
- 2021
27. ASO Visual Abstract: Nipple-Sparing Mastectomy Versus Skin-Sparing Mastectomy—Does Saving the Nipple Have an Impact on Short- and Long-Term Patient Satisfaction?
- Author
-
Amy S. Colwell, Barbara L. Smith, Jenna E. Korotkin, Carson Brown, Suzanne B. Coopey, T. Salewa Oseni, Conor R. Lanahan, Michele A. Gadd, Kevin S. Hughes, Bridget N. Kelly, Heather R. Faulkner, and Michelle C. Specht
- Subjects
Nipple-Sparing Mastectomy ,medicine.medical_specialty ,Patient satisfaction ,Oncology ,Skin sparing mastectomy ,Surgical oncology ,business.industry ,medicine ,Surgery ,business - Published
- 2021
28. ASO Visual Abstract: How Protective are Nipple-Sparing Prophylactic Mastectomies in BRCA1 and BRCA2 Mutation Carriers?
- Author
-
Barbara L. Smith, Tawakalitu O. Oseni, Jasmine A. Khubchandani, Meghan Garstka, Alexandra Webster, Kevin S. Hughes, Michele A. Gadd, Bridget N. Kelly, Anthony Henriquez, Michelle C. Specht, Anvy Nguyen, and Suzanne B. Coopey
- Subjects
medicine.medical_specialty ,BRCA2 Mutation ,Oncology ,business.industry ,Surgical oncology ,Medicine ,Surgery ,business - Published
- 2021
29. Management and outcomes of men diagnosed with primary breast cancer
- Author
-
Andrew E, Johnson, Suzanne B, Coopey, Laura M, Spring, Nora K, Horick, Jose Pablo, Leone, Nancy U, Lin, Laura S, Dominici, Kevin S, Hughes, and Rachel B, Jimenez
- Subjects
Male ,Massachusetts ,Chemotherapy, Adjuvant ,Humans ,Breast Neoplasms ,Female ,Breast ,Disease-Free Survival ,Mastectomy ,Breast Neoplasms, Male ,Retrospective Studies - Abstract
Fewer than 1% of all breast cancers occur in men. As a result, a distinct lack of data exists regarding the management and outcomes in this cohort.Any male patient with pathologically confirmed breast cancer diagnosed between August 2000 and October 2017 at either Massachusetts General Hospital or Brigham and Women's Hospital/Dana-Farber Cancer Institute and their affiliate satellite locations were included. Primary chart review was used to assess clinical and pathologic characteristics. Patient and treatment variables were reported via descriptive statistics. Local-regional failure (LRF), overall survival (OS), breast cancer-specific survival (BCSS), and disease-free survival (DFS) were estimated using the Kaplan-Meier method.100 patients were included in this study. Median follow-up was 112 months (range 1-220 months). Approximately 1/3 of patients experienced at least a 3-month delay to presentation. 83 patients ultimately underwent mastectomy as definitive surgical treatment. 46 patients received adjuvant radiation therapy, and 37 patients received chemotherapy. Of 82 hormone receptor-positive patients with invasive cancer, 94% (n = 77) received endocrine therapy. Of the fifty-eight patients who underwent genetic testing, 15 (26%) tested positive. The 5-year OS, BCSS, DFS, and LRF rates were 91.5%, 96.2%, 86%, and 4.8%, respectively. Delay to presentation was not associated with worse survival.Male breast cancer remains a rare diagnosis. Despite this, the majority of patients in this study received standard of care therapy and experienced excellent oncologic outcomes. Penetration for genetic testing improved over time.
- Published
- 2021
30. Axillary Downstaging in ER
- Author
-
Olga, Kantor and Suzanne B, Coopey
- Subjects
Axilla ,Humans ,Breast Neoplasms ,Neoadjuvant Therapy - Published
- 2020
31. Similar rates of residual disease in patients with DCIS within 2 mm of lumpectomy margin regardless of the presence of invasive carcinoma
- Author
-
Bridget N, Kelly, Olga, Kantor, Rong, Tang, Suzanne B, Coopey, Barbara L, Smith, Conor R, Lanahan, Jenna E, Korotkin, and Michelle C, Specht
- Subjects
Carcinoma, Intraductal, Noninfiltrating ,Neoplasm, Residual ,Carcinoma, Ductal, Breast ,Humans ,Margins of Excision ,Breast Neoplasms ,Female ,Mastectomy, Segmental - Abstract
The 2014 Society of Surgical Oncology/American Society for Radiation Oncology (SSO/ASTRO) breast-conserving surgery (BCS) margin guidelines for invasive cancer recommended "no ink on tumor" as an adequate margin width. However, 2016 SSO/ASTRO margin guidelines for pure DCIS recommended a 2 mm margin. Thus, management of a margin with DCIS 0 mm but 2 mm differs based on presence or absence of invasive carcinoma. We compared rates of residual disease in patients with pure DCIS to patients with invasive cancer with DCIS.BCS with complete shaved cavity margins (SCM) for invasive carcinoma or pure DCIS from 2004 to 2006 at our institution was reviewed. Margin width was measured on the main specimen and the presence of carcinoma in the SCM was used as a surrogate for residual disease in the cavity. Rates of residual disease were determined for varying margin widths of invasive carcinoma and DCIS.Of 329 BCS patients, 123 (37%) patients had pure DCIS and 206 (63%) had invasive cancer with DCIS. In the pure DCIS cohort, 61 patients had DCIS between 0 and 2 mm from the inked margin; 32 (52%) of which had residual disease in the SCM. In the invasive cancer plus DCIS cohort, 92 had DCIS between 0 and 2 mm from the inked margin; 39 (42%) of which had residual disease in the SCM (p = 0.221).Rates of residual disease are similar in patients treated with lumpectomy for pure DCIS and those with invasive carcinoma with DCIS when DCIS is found between 0 and 2 mm from the inked margin.
- Published
- 2020
32. ASO Author Reflections: Breast Cancer Detection of Baseline Screening MRI in High-Risk Women Who Are Not in the Highest Risk Groups
- Author
-
Suzanne B, Coopey
- Subjects
Risk Factors ,Humans ,Breast Neoplasms ,Female ,Magnetic Resonance Imaging ,Early Detection of Cancer - Published
- 2020
33. Baseline Screening MRI Uptake and Findings in Women with ≥ 20% Lifetime Risk of Breast Cancer
- Author
-
Alison, Laws, Therese M, Mulvey, Nicole, Jalbert, Sarah, Dalton, Olga, Kantor, Katherine A, Harris, Karen J, Krag, Elizabeth P, Walsh, and Suzanne B, Coopey
- Subjects
Humans ,Breast Neoplasms ,Female ,Middle Aged ,Magnetic Resonance Imaging ,Early Detection of Cancer ,Mammography ,Retrospective Studies - Abstract
The American Cancer Society recommends screening magnetic resonance imaging (MRI) for patients with a ≥ 20% lifetime breast cancer risk. This study assesses the outcomes of baseline MRI screens in women from a high-risk breast clinic (HRBC).We retrospectively reviewed patients from our institution's HRBC, excluding those with prior breast cancer and predisposing genetic mutations. Screening MRI was recommended for a lifetime risk of ≥ 20% using the Tyrer-Cuzick model. We determined baseline MRI results, biopsy rates, and frequency of MRI-detected high-risk lesions (HRLs) and breast cancers.Overall, 319 women attended our HRBC; median age was 48 years and 4.7% had prior atypia/lobular carcinoma in situ. Screening MRI was recommended for 282 patients, of whom 196 (69.5%) completed a baseline screen. A Breast Imaging-Reporting and Data System (BIRADS) 3 or 4 finding occurred in 19.6% of patients; 23 (12.3%) required 6-month follow-up MRI, 16 (8.6%) underwent core biopsy, and 4 (2.1%) underwent excisional biopsy after initial core. An additional 7 (3.7%) patients had a non-breast incidental finding. An HRL was identified in 2 (1.1%) patients (atypical ductal and lobular hyperplasia, respectively), and 2 (1.1%) were diagnosed with T1N0 breast cancers.In the setting of an HRBC, 70% of women with a ≥ 20% lifetime risk of breast cancer pursued screening MRI when recommended. On baseline screen, the rate of MRI-detected breast cancer was low (1%); however, malignancies were mammographically occult and identified at an early stage. Despite a low cancer rate, nearly one in four women required additional diagnostic investigation. Prescreening counselling should include a discussion of this possibility, and longer-term follow-up of screening MRI is needed in this high-risk population.
- Published
- 2020
34. Evaluating the Rate of Upgrade to Invasive Breast Cancer and/or Ductal Carcinoma In Situ Following a Core Biopsy Diagnosis of Non-classic Lobular Carcinoma In Situ
- Author
-
Faina Nakhlis, Kevin S. Hughes, Tari A. King, Susan C. Lester, Suzanne B. Coopey, Catherine S. Giess, and Beth T. Harrison
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Lobular carcinoma ,Breast Neoplasms ,Malignancy ,Cohort Studies ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Biopsy ,medicine ,Carcinoma ,Humans ,Neoplasm Invasiveness ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Carcinoma in situ ,Carcinoma, Ductal, Breast ,Middle Aged ,Ductal carcinoma ,Prognosis ,medicine.disease ,Carcinoma, Lobular ,Oncology ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Surgery ,Biopsy, Large-Core Needle ,Radiology ,Breast Carcinoma In Situ ,business ,Mastectomy ,Follow-Up Studies ,Mammography - Abstract
A diagnosis of non-classic lobular carcinoma in situ (NC-LCIS) encompasses a variety of lesions with poorly characterized natural history. We evaluated upgrade rates and factors associated with upgrade to malignancy following a core biopsy diagnosis of NC-LCIS, and its natural history. Upon Institutional Review Board approval, pathology databases were searched for NC-LCIS core biopsy diagnoses (carcinoma in situ [CIS], CIS with ductal and lobular features [CIS/DLF], pleomorphic LCIS [P-LCIS], variant LCIS [V-LCIS], LCIS with necrosis). Cases with available core and excision pathology were included, while cases with concurrent ipsilateral invasive carcinoma (IC), ductal carcinoma in situ (DCIS), and/or atypical ductal hyperplasia were excluded. Overall, 121 NC-LCIS cases were identified from 1998 to 2017. We excluded 46 cases with concurrent cancer; 75 patients with 76 NC-LCIS core biopsy diagnoses followed by excision formed our study cohort. Median age was 56 years (range 41–83), and all imaging findings were classified as Breast Imaging Reporting and Data System 4; calcifications were the most common biopsy indication (80%). Excision yielded malignancy in 27 (36%) patients (IC 17, 63%; DCIS alone 10, 37%). We were unable to identify radiologic or pathologic features predictive of upgrade. Of 49 pure NC-LCIS cases, 15 (31%) had mastectomy, 9 (18%) had excision and radiation, and 25 (51%) had excision alone. At a median follow-up of 58 months (range 1–224), 1/25 (4%) patients with excision alone developed ipsilateral DCIS 14 months later. In this series of NC-LCIS, 36% of cases were upgraded, supporting routine excision. We were unable to identify predictors of upgrade. Among 25 patients with pure NC-LCIS, only one patient developed a future ipsilateral cancer. Further study of the natural history of NC-LCIS is warranted.
- Published
- 2018
35. Abstract P5-22-01: Evaluating the risk of upgrade to invasive breast cancer and/or DCIS on excision following a diagnosis of non-classic lobular carcinoma in situ
- Author
-
Faina Nakhlis, Beth T. Harrison, Kevin S. Hughes, Ta King, Suzanne B. Coopey, and Susan C. Lester
- Subjects
Cancer Research ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Carcinoma in situ ,medicine.medical_treatment ,Lobular carcinoma ,Cancer ,030230 surgery ,Ductal carcinoma ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Oncology ,030220 oncology & carcinogenesis ,Biopsy ,Carcinoma ,medicine ,Radiology ,business ,Mastectomy - Abstract
Introduction: Non-classic lobular carcinoma in situ (NC-LCIS) is a rare pathologic entity which encompasses a variety of histologic diagnoses. As such its natural history, including upgrade rates to invasive cancer (IC) or ductal carcinoma in situ (DCIS) on excision, is poorly characterized. We sought to evaluate the risk of upgrade to IC or DCIS when NC-LCIS is diagnosed on core biopsy. Methods: After obtaining IRB approval, institutional pathology databases were searched for NC-LCIS core biopsy diagnoses (carcinoma in situ (CIS), carcinoma in situ with ductal and lobular features (CIS/DLF), pleomorphic LCIS (P-LCIS), variant LCIS (V-LCIS), LCIS with necrosis). Cases with a NC-LCIS core biopsy diagnosis and with available pathology results from subsequent surgery were included. Cases with known concurrent ipsilateral IC, DCIS and/or atypical ductal hyperplasia were excluded. Results: 107 cases with NC-LCIS in any pathology report were identified (1998-2016); 44 were excluded due to concurrent ipsilateral IC, the remaining 62 patients with 63 core biopsy diagnoses of NC-LCIS all underwent surgical excision and formed our study cohort. Median age was 56 years (range 43-83); 43 (68%) were postmenopausal. NC-LCIS was diagnosed on core biopsy for mammographic findings in 57 (90%) cases and for MRI findings in 6 (9%). All were BI-RADS 4 lesions; calcifications were the most common biopsy indication (50 (78%)). CIS/DLF was the most common term used for NC-LCIS (28 (44%)), followed by CIS (18 (29%)), V-LCIS (14 (22%)) and P-LCIS (3 (5%)). On core biopsy, 36/44 (82%) of NC-LCIS cases were E-cadherin negative, 38/41 (93%) were ER positive, and 6/34 (18%) were HER2 positive. IC and/or DCIS were diagnosed on subsequent surgery in 22 (33%) of patients, of which 14 (67%) were IC and 8 (18%) had DCIS only. LesionTotalE-cadherin negativeUpgraded, N (%)Invasive cancer, N (%)DCIS only, N (%)CIS188/10 (80%)3 (16%)2 (67%)1 (33%)CIS/DLF2819/23 (83%)12 (43%)7 (58%)5 (42%)P-LCIS31/1 (100%)3 (100%)2 (67%)1 (33%)V-LCIS148/10 (80%)4 (29%)3 (75%)1 (25%) Median IC size was 0.2 cm (0.06-1.1 cm). IC histology was ductal in n=4 (29%), lobular in n=7 (50%), and ductal and lobular in n=3 (21%). Among the 14 invasive lesions, 5 (36%) were grade I, 5 (36%) were grade II and 2(13%) were grade III, (grade was not reported for 2 remaining ICs); 12/14 (86%) were ER positive and 1/14 (7%) was HER2 positive; none had LVI or positive nodes. Among the 42 cases not upgraded, 13 (31%) had mastectomy, 9 (21%) had excision and radiation, 20 had excision only, all had negative margins. At median follow-up of 60 months (1-224 months), 1/20 patients treated with excision only was diagnosed with DCIS, 14 months after surgery for CIS/DLF on core biopsy. Conclusions: In this large series of NC-LCIS diagnosed on core biopsy, the upgrade rate to carcinoma was 33% supporting the recommendation for routine excision of these lesions. The cancers found at excision were all stage I and the majority were grade I or II. At a median follow-up of 60 months only 1/20 patients with pure NC-LCIS treated with excision alone developed a future ipsilateral cancer. Further study of the natural history of these rare lesions is warranted. Citation Format: Nakhlis F, Harrison BT, Lester SC, Hughes KS, Coopey SB, King TA. Evaluating the risk of upgrade to invasive breast cancer and/or DCIS on excision following a diagnosis of non-classic lobular carcinoma in situ [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-01.
- Published
- 2018
36. Pathologic Complete Response After Neoadjuvant Chemotherapy and Long-Term Outcomes Among Young Women With Breast Cancer
- Author
-
Beverly Moy, Barbara L. Smith, Steven J. Isakoff, Michelle C. Specht, Rachel B. Jimenez, Laura Spring, Leif W. Ellisen, Suzanne B. Coopey, Rachel A. Greenup, Andrzej Niemierko, Lidia Schapira, Alphonse G. Taghian, Kevin S. Hughes, Aditya Bardia, and Stephanie Haddad
- Subjects
Adult ,0301 basic medicine ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Breast Neoplasms ,Triple Negative Breast Neoplasms ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Recurrence ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Biomarkers, Tumor ,medicine ,Humans ,Registries ,Stage (cooking) ,Young adult ,Neoadjuvant therapy ,Survival analysis ,Neoplasm Staging ,Retrospective Studies ,Gynecology ,Chemotherapy ,Surrogate endpoint ,business.industry ,Age Factors ,Retrospective cohort study ,medicine.disease ,Survival Analysis ,Neoadjuvant Therapy ,Treatment Outcome ,030104 developmental biology ,030220 oncology & carcinogenesis ,Mutation ,Female ,Neoplasm Grading ,business ,Follow-Up Studies - Abstract
Purpose: Breast cancer in young women is associated with an aggressive tumor biology and higher risk of recurrence. Pathologic complete response (pCR) after neoadjuvant therapy has been shown to be a surrogate marker for disease-free survival (DFS) and overall survival (OS), but the association between pCR and survival outcomes in young women with breast cancer is not well described. Methods: This study included women aged ≤40 years at diagnosis who received neoadjuvant chemotherapy (NAC) for stage II-III invasive breast cancer between 1998 and 2014 at Massachusetts General Hospital. Outcomes were compared between patients who achieved pCR (ypT0/is, ypN0) and those with residual disease. Results: A total of 170 young women were included in the analytical data set, of which 53 (31.2%) achieved pCR after NAC. The 5-year DFS rate for patients with and without pCR was 91% versus 60%, respectively (P
- Published
- 2017
37. Oncologic Safety of Nipple-Sparing Mastectomy in Women with Breast Cancer
- Author
-
Barbara L. Smith, Upahvan Rai, Jennifer K. Plichta, Michelle C. Specht, Michele A. Gadd, Amy S. Colwell, William G. Austen, Suzanne B. Coopey, and Rong Tang
- Subjects
Adult ,medicine.medical_specialty ,Mastectomy, Subcutaneous ,Breast surgery ,medicine.medical_treatment ,Breast Neoplasms ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,medicine ,Carcinoma ,Humans ,Survival analysis ,Aged ,Retrospective Studies ,business.industry ,Carcinoma, Ductal, Breast ,Cancer ,Retrospective cohort study ,Middle Aged ,Ductal carcinoma ,medicine.disease ,Survival Analysis ,Surgery ,Carcinoma, Intraductal, Noninfiltrating ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Neoplasm Recurrence, Local ,business ,Mastectomy ,Follow-Up Studies - Abstract
Background Nipple-sparing mastectomy (NSM) has gained popularity for breast cancer treatment and prevention. There are limited data about long-term oncologic safety of this procedure. Study Design We reviewed oncologic outcomes of consecutive therapeutic NSM at a single institution. Nipple-sparing mastectomy was offered to patients with no radiologic or clinical evidence of nipple involvement. Results There were 2,182 NSM performed from 2007 to 2016. Long-term outcomes were assessed in the 311 NSM performed in 2007 to 2012 for Stages 0 to 3 breast cancer; 240 (77%) NSM were for invasive cancer and 71 (23%) were for ductal carcinoma in situ. At 51 months median follow-up, 17 patients developed a recurrence of their cancer. Estimated disease-free survival was 95.7% at 3 years and 92.3% at 5 years. There were 11 (3.7%) locoregional recurrences and 8 (2.7%) distant recurrences; 2 patients had simultaneous locoregional and distant recurrences. There were 2 breast cancer-related deaths in patients with isolated distant recurrences. No patient in the entire 2,182 NSM cohort has had a recurrence in the retained nipple-areola complex. Conclusions Rates of locoregional and distant recurrence are acceptably low after nipple-sparing mastectomy in patients with breast cancer. No patient in our series has had a recurrence involving the retained nipple areola complex.
- Published
- 2017
38. Reassessing risk models for atypical hyperplasia: age may not matter
- Author
-
Barbara L. Smith, Julliette M. Buckley, Kevin S. Hughes, Giovanni Parmigiani, Molly Griffin, Fernanda Polubriaginof, Suzanne B. Coopey, Judy Garber, Emanuele Mazzola, Michele A. Gadd, Anthony J. Guidi, and Michelle C. Specht
- Subjects
Adult ,Oncology ,Cancer Research ,medicine.medical_specialty ,Breast Neoplasms ,Kaplan-Meier Estimate ,Risk Assessment ,Article ,Atypical hyperplasia ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Internal medicine ,medicine ,Atypia ,Humans ,Breast ,030212 general & internal medicine ,skin and connective tissue diseases ,Aged ,Aged, 80 and over ,Hyperplasia ,business.industry ,Age Factors ,Cancer ,Middle Aged ,Ductal carcinoma ,Prognosis ,medicine.disease ,030220 oncology & carcinogenesis ,Cohort ,Female ,Neoplasm Grading ,business ,Risk assessment ,Precancerous Conditions ,Biomarkers - Abstract
The aim of this study was to investigate the influence of age at diagnosis of atypical hyperplasia (“atypia”, ductal [ADH], lobular [ALH], or severe ADH) on the risk of developing subsequent invasive breast cancer or ductal carcinoma in situ (DCIS). Using standard survival analysis methods, we retrospectively analyzed 1353 women not treated with chemoprevention among a cohort of 2370 women diagnosed with atypical hyperplasia to determine the risk relationship between age at diagnosis and subsequent breast cancer. For all atypia diagnoses combined, our cohort showed a 5-, 10-, and 15-year risk of invasive breast cancer or DCIS of 0.56, 1.25, and 1.30, respectively, with no significant difference in the (65,75] year age group. For women aged (35,75] years, we observed no significant difference in the 15-year risk of invasive breast cancer or DCIS after atypical hyperplasia, although the baseline risk for a 40-year-old woman is approximately 1/8 the risk of a 70-year-old woman. The risks associated with invasive breast cancer or DCIS for women in our cohort diagnosed with ADH, severe ADH, or ALH, regardless of age, were 7.6% (95% CI 5.9–9.3%) at 5 years, 25.1% (20.7–29.2%) at 10 years, and 40.1% (32.8–46.6%) at 15 years. In contrast to current risk prediction models (e.g., Gail, Tyrer-Cuzick) which assume that the risk of developing breast cancer increases in relation to age at diagnosis of atypia, we found the 15-year cancer risk in our cohort was not significantly different for women between the ages of 35 (excluded) and 75. This implies that the “hits” received by the breast tissue along the “high-risk pathway” to cancer might possibly supersede other factors such as age.
- Published
- 2017
39. ASO Author Reflections: Breast Cancer Detection of Baseline Screening MRI in High-Risk Women Who Are Not in the Highest Risk Groups
- Author
-
Suzanne B. Coopey
- Subjects
medicine.medical_specialty ,Risk groups ,Breast cancer ,Oncology ,business.industry ,Surgical oncology ,Internal medicine ,medicine ,MEDLINE ,Surgery ,Baseline (configuration management) ,business ,medicine.disease - Published
- 2020
40. Enhanced Recovery Minimizes Opioid Use and Hospital Stay for Patients Undergoing Mastectomy with Reconstruction
- Author
-
Michelle C. Specht, Bridget N. Kelly, Carson Brown, Kevin S. Hughes, Michele A. Gadd, Barbara L. Smith, Suzanne B. Coopey, and Caroline McGugin
- Subjects
medicine.medical_specialty ,Gabapentin ,medicine.medical_treatment ,Breast Implants ,Mammaplasty ,Breast Neoplasms ,Preoperative care ,03 medical and health sciences ,0302 clinical medicine ,Surgical oncology ,Preoperative Care ,Carcinoma ,medicine ,Humans ,Pain Management ,Mastectomy ,Retrospective Studies ,Pain, Postoperative ,business.industry ,Tissue Expansion Devices ,Retrospective cohort study ,Length of Stay ,Middle Aged ,medicine.disease ,Prognosis ,Surgery ,Analgesics, Opioid ,Carcinoma, Intraductal, Noninfiltrating ,Oncology ,Opioid ,030220 oncology & carcinogenesis ,Cohort ,030211 gastroenterology & hepatology ,Female ,business ,medicine.drug ,Follow-Up Studies - Abstract
This study examined the effects of an enhanced recovery program on inpatient opioid requirements and hospital length of stay (LOS) for mastectomy patients undergoing immediate reconstruction. An enhanced recovery program for patients undergoing mastectomy with immediate tissue expander (TE) or implant reconstruction was evaluated by comparing a contemporary cohort of 611 patients in 2016–2018 with a historical cohort of 188 patients in 2010. Opioid use and LOS were compared over time and stratified by laterality, mastectomy type, axillary procedure, and reconstruction. Associations were assessed by uni- and multivariate analyses. In 2010, 95.2% of patients required intravenous (IV) opioids, with a last dose 15.5 h after completion of surgery, compared with 68.7% of patients in 2016–2018, with a last dose 1.8 h after surgery (p
- Published
- 2019
41. Nipple Discharge After Nipple-Sparing Mastectomy With and Without Associated Pregnancy
- Author
-
Michelle C. Specht, Michele A. Gadd, Caroline McGugin, Carson Brown, Kevin S. Hughes, Bridget N. Kelly, Tawakalitu O. Oseni, Rong Tang, Suzanne B. Coopey, Conor R. Lanahan, and Barbara L. Smith
- Subjects
0301 basic medicine ,Adult ,Cancer Research ,Galactorrhea ,medicine.medical_specialty ,Breast Neoplasms ,Malignancy ,Nipple discharge ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Breast cancer ,Pregnancy ,medicine ,Nipple Discharge ,Humans ,Mastectomy ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Prophylactic Mastectomy ,Middle Aged ,medicine.disease ,Prognosis ,Surgery ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Nipples ,Histopathology ,Female ,medicine.symptom ,Breast reconstruction ,business ,Organ Sparing Treatments ,Follow-Up Studies - Abstract
Background Nipple-sparing mastectomies (NSMs) preserve the intact nipple, including nipple duct orifices. Retained orifices might remain patent and communicate with the underlying reconstruction. We report the incidence and outcomes of nipple discharge after NSM in pregnant and nonpregnant women. Patients and Methods Retrospective review of all NSMs at our institution from June 2007 to June 2018 was performed. Subsequent pregnancies and nipple discharge were documented. Patient demographic, operative, histopathology, and cancer treatment data were collected. Descriptive analysis was performed for patients who developed nipple discharge. Results From June 2007 to June 2018, 2778 NSM procedures were performed in 1620 patients, with a mean age of 48 (range, 20-80) years. Fifteen hundred sixty-eight NSMs were therapeutic and 1210 were for risk reduction. Thirty-three subsequent pregnancies were observed in 27 patients, with a mean age of 33 (range, 26-42) years at NSM. Bilateral or unilateral discharge occurred in 6 of 27 (22%) postpartum patients and resolved spontaneously. At 54 months mean follow-up after NSM (range, 16-98 months) and 23 (range, 1-61) months after delivery, no local-regional recurrences were observed. In 1593 patients without subsequent pregnancy, there were 4 patients (0.25%) treated with bilateral NSM with subsequent unilateral watery nipple discharge. There was no evidence of associated malignancy on physical exam, imaging, or cytology, and with 55 to 110 months follow-up, no new or recurrent cancers have been observed. Conclusion Despite extensive removal of nipple and subareolar duct tissue during NSM, milky nipple discharge is possible postpartum. Watery, acellular discharge occurs rarely in nonpregnant patients. To date, no patient with discharge has developed a local recurrence or new breast cancer.
- Published
- 2019
42. Atypical ductal hyperplasia in men with gynecomastia: what is their breast cancer risk?
- Author
-
Anthony J. Guidi, Regina Barzilay, Kinyas Kartal, Adam Yala, Clara Li, Judy Garber, Suzanne B. Coopey, Tari A. King, Francisco Acevedo, Heather R. Faulkner, and Kevin S. Hughes
- Subjects
0301 basic medicine ,Adult ,Male ,Risk ,Cancer Research ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Urology ,Breast Neoplasms, Male ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Breast cancer ,Medicine ,Humans ,Ductal Hyperplasia ,Public Health Surveillance ,Family history ,skin and connective tissue diseases ,Mammary Glands, Human ,Mastectomy ,Aged ,Hyperplasia ,integumentary system ,business.industry ,urogenital system ,Carcinoma, Ductal, Breast ,Cancer ,Ductal carcinoma ,Middle Aged ,medicine.disease ,030104 developmental biology ,Oncology ,Gynecomastia ,030220 oncology & carcinogenesis ,business ,Tamoxifen ,hormones, hormone substitutes, and hormone antagonists ,medicine.drug ,Follow-Up Studies - Abstract
Purpose Atypical ductal hyperplasia (ADH) significantly increases the risk of breast cancer in women. However, little is known about the implications of ADH in men. Methods Review of 932 males with breast pathology was performed to identify cases of ADH. Patients were excluded if ADH was upgraded to cancer on excision, or if they had contralateral breast cancer. Cases were reviewed to determine whether any male with ADH developed breast cancer. Results Nineteen males were diagnosed with ADH from June 2003 to September 2018. All had gynecomastia. Surgical procedure was mastectomy in 8 patients and excision/reduction in 11. One patient had their nipple areola complex removed, and 1 required a free nipple graft. Median patient age at ADH diagnosis was 25 years (range 18–72 years). Of the 14 patients with bilateral gynecomastia, 10 had bilateral ADH and 4 had unilateral. Five cases of ADH were described as severe, bordering on ductal carcinoma in situ. No patient reported a family history of breast cancer. No patient took tamoxifen. At a mean follow-up of 75 months (range 4–185 months), no patient developed breast cancer. Conclusion Our study is the first to provide follow-up information for males with ADH. With 6 years of mean follow-up, no male in our series has developed breast cancer. This suggests that either ADH in men does not pose the same risk as ADH in women or that surgical excision of symptomatic gynecomastia in men effectively reduces the risk of breast cancer.
- Published
- 2018
43. Factors Associated with Recurrence Rates and Long-Term Survival in Women Diagnosed with Breast Cancer Ages 40 and Younger
- Author
-
Michelle C. Specht, Michele A. Gadd, Alphonse G. Taghian, Jennifer K. Plichta, Kevin S. Hughes, Upahvan Rai, Julliette M. Buckley, Rong Tang, Barbara L. Smith, and Suzanne B. Coopey
- Subjects
Adult ,Oncology ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Breast Neoplasms ,Mastectomy, Segmental ,Disease-Free Survival ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Risk Factors ,Surgical oncology ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Age of Onset ,Young adult ,Survival rate ,Neoplasm Staging ,business.industry ,Lumpectomy ,medicine.disease ,Tumor Burden ,Survival Rate ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Cohort ,Female ,Surgery ,Neoplasm Recurrence, Local ,Age of onset ,business ,Mastectomy ,Follow-Up Studies - Abstract
Young age at breast cancer diagnosis has been associated with increased risk of recurrence and mortality. We reevaluated this assumption in a large, modern cohort of women diagnosed with breast cancer at age ≤40 years. We identified women with breast cancer at age ≤40 years at a single institution from 1996–2008. We assessed locoregional recurrence (LRR), distant recurrence, disease-free survival (DFS), and overall survival (OS), and correlated patient and tumor characteristics with outcomes. We identified 584 women aged ≤40 years with breast cancer. Median age was 37 years, and median follow-up was 124 months; 61.5 % were stages 0–I and 38.5 % were stages II–III. Overall, 57.4 % had lumpectomies and 42.5 % mastectomies. DFS was 93 % at 5 years and 84.5 % at 10 years. OS was 93 % at 5 years and 86.5 % at 10 years. On multivariate analysis, worse DFS was associated with positive nodes (p = 0.002); worse OS was associated with larger tumor size (p = 0.042). When stratified by lumpectomy versus mastectomy, there were no significant differences in survival or recurrence. For lumpectomy patients, DFS was 96 % at 5 years and 88 % at 10 years; OS was 96 % at 5 years and 89 % at 10 years. For mastectomy patients, DFS was 89.5 % at 5 years and 79 % at 10 years; OS was 90 % at 5 years and 83 % at 10 years. Lumpectomy LRR rates were 1 % at 5 years and 4 % at 10 years. Mastectomy LRR rates were 3.5 % at 5 years and 8.7 % at 10 years. Outcomes for women with breast cancer at age ≤40 years have improved. Lumpectomy recurrence rates are low, suggesting that lumpectomy is oncologically safe for young breast cancer patients.
- Published
- 2016
44. Positive Nipple Margins in Nipple-Sparing Mastectomies: Rates, Management, and Oncologic Safety
- Author
-
Amy S. Colwell, Upahvan Rai, Andrea L. Merrill, William G. Austen, Barbara L. Smith, Elena F. Brachtel, Rong Tang, Michelle C. Specht, Michele A. Gadd, and Suzanne B. Coopey
- Subjects
Adult ,medicine.medical_specialty ,Mastectomy, Subcutaneous ,medicine.medical_treatment ,Breast Neoplasms ,030230 surgery ,Malignancy ,03 medical and health sciences ,0302 clinical medicine ,Chart review ,medicine ,Humans ,Areola ,Aged ,Retrospective Studies ,business.industry ,Nipple areola complex ,Carcinoma, Ductal, Breast ,Margins of Excision ,Middle Aged ,Ductal carcinoma ,medicine.disease ,Surgery ,Carcinoma, Lobular ,Carcinoma, Intraductal, Noninfiltrating ,Treatment Outcome ,medicine.anatomical_structure ,Current practice ,Nipples ,030220 oncology & carcinogenesis ,Invasive lobular carcinoma ,Female ,business ,Mastectomy ,Follow-Up Studies - Abstract
When a nipple margin of a nipple-sparing mastectomy (NSM) contains malignancy, current practice includes removal of the nipple or nipple areola complex (NAC). We evaluated rates and trends of positive nipple margins, subsequent management, and oncologic outcomes.A retrospective chart review of all NSM at our institution from 2007 to 2014 was performed. A descriptive analysis was performed of patients with positive nipple/subareolar margins.Among 1,326 NSM, 43 of 642 (6.7%) therapeutic and 3 of 684 (0.4%) prophylactic NSM had positive nipple margins. Nipple or NAC excision was performed for 39 of 46 (85%) positive nipple margins: 20 of 39 (51%) had nipple only and 19 of 39 (49%) had the entire NAC excised. Practice evolved to remove only the nipple and retain the areola for positive nipple margins: in 2007 to 2011, 7 of 17 (41%) underwent nipple-only excision compared with 14 of 22 (64%) in 2012 to 2014. Among 39 excised nipples/NAC, 28 (72%) contained no residual malignancy, while 8 contained ductal carcinoma in situ (DCIS), 2 had invasive lobular carcinoma, and 1 had invasive ductal carcinoma. With experience, rates of positive nipple margins for therapeutic NSM decreased from 11% (17 of 160) in 2007 to 2011 to 5.4% (26 of 482) in 2012 to 2014 (p0.05). At 36 month median follow-up, there were no recurrences in the nipple/NAC.Early results suggest that excision of the nipple with retention of the areola is a safe approach for management of a positive nipple margin after NSM. With experience, low rates of positive nipple margins are possible in therapeutic NSM. Overall risk of nipple/NAC recurrence after NSM remains extremely low.
- Published
- 2016
45. Comparison of intra-operative specimen mammography to standard specimen mammography for excision of non-palpable breast lesions: a randomized trial
- Author
-
Michele A. Gadd, Barbara L. Smith, Michelle C. Specht, Cynthia L. Miller, Suzanne B. Coopey, and Elizabeth A. Rafferty
- Subjects
Adult ,Cancer Research ,medicine.medical_specialty ,Intra operative ,Concordance ,medicine.medical_treatment ,Breast Neoplasms ,Mastectomy, Segmental ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Randomized controlled trial ,law ,medicine ,Humans ,Mammography ,Breast ,Aged ,medicine.diagnostic_test ,business.industry ,Lumpectomy ,Middle Aged ,medicine.disease ,Surgery ,Oncology ,Specimen mammography ,030220 oncology & carcinogenesis ,Female ,Non palpable ,business ,Nuclear medicine - Abstract
Standard specimen mammography (SSM) is performed in the radiology department after wire-localized excision of non-palpable breast lesions to confirm the presence of the target and evaluate margins. Alternatively, intra-operative specimen mammography (ISM) allows surgeons to view images in the operating room (OR). We conducted a randomized study comparing ISM and SSM. Women undergoing wire-localized excision for breast malignancy or imaging abnormality were randomized to SSM or ISM. For SSM, the specimen was transported to the radiology department for imaging and interpretation. For ISM, the specimen was imaged in the OR for interpretation by the surgeon and sent for SSM. Interpretation time was from specimen leaving OR until radiologist interpretation for SSM and from placement in ISM device until surgeon interpretation for ISM. Procedure and interpretation times were compared. Concordance between ISM and SSM for target and margins was evaluated. 72 patients were randomized, 36 ISM and 36 SSM. Median procedure times were similar, 48.5 (17-138) min for ISM, and 54 (17-40) min for SSM (p = 0.72), likely since specimens in both groups traveled to radiology for SSM. Median interpretation time was significantly shorter with ISM, 1 (0.5-2.0) and 9 (4-16) min for ISM and SSM, respectively (p
- Published
- 2016
46. Twenty-Five Year Trends in the Incidence of Ductal Carcinoma in Situ in US Women
- Author
-
Kevin S. Hughes, Michele A. Gadd, Biqi Zhang, David C. Chang, Suzanne B. Coopey, and Tawakalitu O. Oseni
- Subjects
Adult ,medicine.medical_specialty ,Population ,Ethnic group ,Breast Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Epidemiology ,medicine ,Surveillance, Epidemiology, and End Results ,Breast screening ,Humans ,skin and connective tissue diseases ,education ,Aged ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Incidence ,Carcinoma, Ductal, Breast ,Ductal carcinoma ,Middle Aged ,medicine.disease ,United States ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,business ,Carcinoma in Situ ,Demography ,Mammography ,SEER Program - Abstract
The rising incidence of ductal carcinoma in situ (DCIS) since the widespread enactment of mammography screening has been well documented. Patterns in DCIS incidence among women of various ages and across different racial and ethnic groups have not been well described.The Surveillance, Epidemiology, and End Results public-use data set was queried for all women aged 40 years and older diagnosed with DCIS between 1990 and 2014. Annual age-adjusted incidence rates were compared among white, black, Hispanic, and Asian-Pacific Islander women. Additionally, using mammography screening data obtained from the CDC, patterns in mammography screening over time and as they relate to DCIS incidence rates by race and ethnicity were evaluated.We identified 200,400 women aged 40 years or older with DCIS. Between 1998 and 2014, a period that saw flux in national breast screening guidelines, DCIS incidence rates increased in blacks, Hispanics, and Asian-Pacific Islanders, but remained relatively unchanged in whites (increase in number of DCIS diagnoses per 100,000 individuals in the population per year among blacks +0.66/p0.01, Hispanics +3.0/p0.01, Asian-Pacific Islanders +0.53/p0.01, and whites +0.07/p = 0.21). After accounting for age, year of diagnosis, and mammography screening rates, DCIS incidence was found to be similar between white and black women (0.8 fewer diagnoses per 100,000 individuals compared with whites; p = 0.36) but lower for Hispanic women (9.7 fewer diagnoses per 100,000 individuals compared with whites; p0.01).The DCIS incidence rates are influenced substantially by breast cancer mammography screening patterns. However, differences exist by race and ethnicity and are not fully explained by screening mammography trends alone. Consideration should be given to including race and ethnicity in determining optimal breast screening guidelines.
- Published
- 2018
47. Nipple-Sparing Mastectomy
- Author
-
Barbara L. Smith and Suzanne B. Coopey
- Subjects
Nipple-Sparing Mastectomy ,medicine.medical_specialty ,Mastectomy, Subcutaneous ,Breast Neoplasms ,030230 surgery ,Risk Assessment ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,medicine ,Humans ,Neoplasm Invasiveness ,Neoplasm Staging ,business.industry ,Patient Selection ,medicine.disease ,Prognosis ,Survival Analysis ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Nipples ,Female ,Patient Safety ,Neoplasm Recurrence, Local ,business ,Organ Sparing Treatments - Published
- 2018
48. Breast Cancer Risk Prediction in Women with Atypical Breast Lesions
- Author
-
Kevin S. Hughes and Suzanne B. Coopey
- Subjects
Pathology ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Lobular carcinoma ,Population ,Atypical lobular hyperplasia ,Lobular hyperplasia ,medicine.disease ,Atypical hyperplasia ,Breast cancer ,Increased risk ,Medicine ,Cumulative incidence ,skin and connective tissue diseases ,business ,education - Abstract
Women with atypical breast lesions have a markedly increased risk of developing breast cancer. The risk of breast cancer in women with lobular carcinoma in situ is seven- to nine-fold that of the general population. The 35-year cumulative incidence of breast cancer with lobular carcinoma in situ is 35%, or approximately 1% per year, although more recent studies suggest the risk is higher. Women with atypical ductal and lobular hyperplasia are four times more likely to develop breast cancer than the general population. Atypical hyperplasia confers a cumulative incidence of breast cancer of nearly 30% at 25 years.
- Published
- 2018
49. Much Ado About Nipples
- Author
-
Suzanne B. Coopey
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,MEDLINE ,Breast Neoplasms ,Text mining ,Oncology ,Patient Satisfaction ,Surgical oncology ,Nipples ,Humans ,Medicine ,Female ,Surgery ,business ,Organ Sparing Treatments ,Mastectomy - Published
- 2019
50. Breast Cancer Risk and Follow-up Recommendations for Young Women Diagnosed with Atypical Hyperplasia and Lobular Carcinoma In Situ (LCIS)
- Author
-
Constance A. Roche, Michele A. Gadd, Keven S. Hughes, Ahmet Korkut Belli, Anthony J. Guidi, Rong Tang, Andrea L. Merrill, Emanuele Mazzola, Suzanne B. Coopey, Michelle C. Specht, Judy Garber, Maureen P. McEvoy, Barbara L. Smith, Julliette M. Buckley, and Fernanda Polubriaginof
- Subjects
Adult ,Oncology ,medicine.medical_specialty ,Population ,Breast Neoplasms ,Atypical hyperplasia ,Young Adult ,Breast cancer ,Risk Factors ,Internal medicine ,Lobular carcinoma in situ (LCIS) ,medicine ,Humans ,Neoplasm Invasiveness ,Breast ,Young adult ,skin and connective tissue diseases ,education ,Early Detection of Cancer ,Neoplasm Staging ,Retrospective Studies ,education.field_of_study ,Hyperplasia ,business.industry ,Carcinoma in situ ,Carcinoma, Ductal, Breast ,Cancer ,Retrospective cohort study ,Continuity of Patient Care ,Prognosis ,medicine.disease ,Carcinoma, Lobular ,Female ,Surgery ,business ,Precancerous Conditions ,Carcinoma in Situ ,Follow-Up Studies ,Mammography - Abstract
The risk of breast cancer in young women diagnosed with atypical hyperplasia and (LCIS) is not well defined. The objectives were to evaluate outcomes and to help determine guidelines for follow-up in this population. A retrospective review of women under age 35 diagnosed with ADH, ALH, LCIS, and severe ADH from 1987 to 2010 was performed. Patient characteristics, pathology and follow-up were determined from chart review. We identified 58 young women with atypical breast lesions. Median age at diagnosis was 31 years (range 19–34). 34 patients had ADH, 11 had ALH, 8 had LCIS, and 5 had severe ADH. 7 (12%) patients developed breast cancer. The median follow-up was 86 months (range 1–298). Median time to cancer diagnosis was 90 months (range 37–231). 4 cancers were on the same side, 3 were contralateral. 4 were IDC, 1 was ILC, and 2 were DCIS. Cancer was detected by screening mammogram in 4 patients, 2 by clinical exam, and 1 unknown. In the entire cohort, 26 (45%) patients had screening mammograms as part of their follow up, 12 patients had only clinical follow up, and 20 had no additional follow up. 13 patients required subsequent biopsies. Young women with atypical breast lesions are at a markedly increased risk for developing breast cancer and should be followed closely. Based on our findings, we recommend close clinical follow-up, MRI starting at age 25 through age 29, and screening mammograms for those over 30 in this high-risk group of patients.
- Published
- 2015
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.