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Background. During the last decades the diagnosis, treatment, and prognosis of breast cancer have changed and improved in Denmark. The first mammography screening programme started in 1991. However, for many years only about 20% of Danish women aged 50-69 were offered screening. The national roll-out of screening took place in 2008-2010. Material and methods. Based on published Danish data, this overview describes the status of diagnosis and treatment, and the screening programme. For further evaluating the potential overdiagnosis and overtreatment, additional Danish Breast Cancer Cooperative Group (DBCG) data are included. Results and conclusion. Using incidence-based mortality method, reduction in breast cancer mortality was estimated to be 25% in the target group of women after 10 years of screening in Copenhagen; an outcome comparable to that of randomised controlled trials. A recent Danish study has indicated overdiagnosis to be around 4%. Others have estimated overdiagnosis to be 33%. National DBCG data showed that the rude breast cancer incidence increased during the period 1990-2011 from 126 to 206 per 100 000. The incidence was almost constant for women younger than 50 years. In regions not offering screening, the incidence increased with 3% per year for women aged 50-69 years with similar trends for small and large tumours. After introduction of screening the increase in the age group 50-69 years was confined to small tumours ≤ 20 mm, and most pronounced for node negative patients. From the 1990s, the use of breast conserving surgery has increased from around 25% to 69% in 2010. Screening has not increased the number of mastectomies. Breast cancer treatment in Denmark is evidence based and in agreement with international recommendations. After the introduction of mammography screening the absolute number of patients with a more advanced stage at diagnosis and the absolute number of patients undergoing mastectomy have decreased. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate the quality of clinical practice guidelines (CPGs) for breast cancer related lymphoedema (BCRL) and compare the similarities and differences in recommendations. Background: Many CPGs of BCRL have been developed; however, their recommendations and quality are controversial. Methods: Relevant papers were retrieved from electronic databases, professional associations and guideline development organizations, from 1 January 2015 to 30 September 2021. The Appraisal of Guidelines Research and Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. Intraclass correlation coefficient (ICC) analysis was used to evaluate the overall consistency among evaluators. Results: Eight CPGs were included. The ICC values evaluation for CPGs ranged from 0.76 to 0.95, with good consensus among evaluators. The highest median score was 68.75% (61.46, 72.22%) for clarity, and the lowest was 37.50% (25.78, 51.30%) for applicability. The NICE, ACS/ACSO and APTA CPGs were rated well in most areas. Professional health education, individualized exercise programme and regular surveillance are the main methods to prevent lymphoedema. Conclusion: In the past 6 years, the quality of BCRL guidelines has varied greatly, especially in the domains of rigour and applicability. Interrater agreement was excellent, but recommendation showed some inconsistencies in the details. Summary statement: What is already known about this topic? Providing recommendations based on evidence‐based guidelines for care of cancer treatment‐related lymphoedema will help to improve outcomes for patients with this chronic condition. What this paper adds? The rigour of the guidelines needs to be improved.Guideline‐making organizations have the responsibility to promote the application of guidelines into practice using a variety of methods.Multifactorial reasons were responsible for the differences inguidelines' recommendations The implications of this paper Nurses need to be more aware of guideline recommendations.There are inconsistencies in the details, despite many similarities.The formulation of individual nursing care programmes should be tailored to the local clinical situation and working environment. [ABSTRACT FROM AUTHOR]

The medical literature has been growing exponentially, and its size has become a barrier for physicians to locate and extract clinically useful information. As a promising solution, natural language processing (NLP), especially machine learning (ML)‐based NLP is a technology that potentially provides a promising solution. ML‐based NLP is based on training a computational algorithm with a large number of annotated examples to allow the computer to "learn" and "predict" the meaning of human language. Although NLP has been widely applied in industry and business, most physicians still are not aware of the huge potential of this technology in medicine, and the implementation of NLP in breast cancer research and management is fairly limited. With a real‐world successful project of identifying penetrance papers for breast and other cancer susceptibility genes, this review illustrates how to train and evaluate an NLP‐based medical abstract classifier, incorporate it into a semiautomatic meta‐analysis procedure, and validate the effectiveness of this procedure. Other implementations of NLP technology in breast cancer research, such as parsing pathology reports and mining electronic healthcare records, are also discussed. We hope this review will help breast cancer physicians and researchers to recognize, understand, and apply this technology to meet their own clinical or research needs. [ABSTRACT FROM AUTHOR]

In the landscape of cancer treatment, particularly in the realm of breast cancer management, effective communication emerges as a pivotal factor influencing patient outcomes. This article delves into the nuanced intricacies of communication skills, specifically spotlighting the strategies embraced by breast radiologists. By examining the ramifications of communication on patient experience, interdisciplinary collaboration, and legal ramifications, this study underscores the paramount importance of empathetic and comprehensive communication approaches. A special emphasis is placed on the utilization of the SPIKES protocol, a structured method for conveying sensitive health information, and the deployment of strategies for navigating challenging conversations. Furthermore, the work encompasses the significance of communication with caregivers, the integration of artificial intelligence, and the acknowledgement of patients' psychological needs. By adopting empathetic communication methodologies and fostering multidisciplinary collaboration, healthcare practitioners have the potential to enhance patient satisfaction, promote treatment adherence, and augment the overall outcomes within breast cancer diagnosis. This paper advocates for the implementation of guidelines pertaining to psychological support and the allocation of sufficient resources to ensure the provision of holistic and patient-centered cancer care. The article stresses the need for a holistic approach that addresses patients' emotional and psychological well-being alongside medical treatment. Through thoughtful and empathetic communication practices, healthcare providers can profoundly impact patient experiences and breast cancer journeys in a positive manner. [ABSTRACT FROM AUTHOR]

Simple Summary: Metastatic breast cancer is an aggressive disease that early diagnostic attempts is of an utmost importance. A machine learning model that utilizes NCA and MRMR in this work is attempting to isolate pertinent dysregulated miRNA's for the different four cancer stages. This work compares the current clinical diagnostic approaches with the proposed ML model results. Determining the tumor origin in humans is vital in clinical applications of molecular diagnostics. Metastatic cancer is usually a very aggressive disease with limited diagnostic procedures, despite the fact that many protocols have been evaluated for their effectiveness in prognostication. Research has shown that dysregulation in miRNAs (a class of non-coding, regulatory RNAs) is remarkably involved in oncogenic conditions. This research paper aims to develop a machine learning model that processes an array of miRNAs in 1097 metastatic tissue samples from patients who suffered from various stages of breast cancer. The suggested machine learning model is fed with miRNA quantitative read count data taken from The Cancer Genome Atlas Data Repository. Two main feature-selection techniques have been used, mainly Neighborhood Component Analysis and Minimum Redundancy Maximum Relevance, to identify the most discriminant and relevant miRNAs for their up-regulated and down-regulated states. These miRNAs are then validated as biological identifiers for each of the four cancer stages in breast tumors. Both machine learning algorithms yield performance scores that are significantly higher than the traditional fold-change approach, particularly in earlier stages of cancer, with Neighborhood Component Analysis and Minimum Redundancy Maximum Relevance achieving accuracy scores of up to 0.983 and 0.931, respectively, compared to 0.920 for the FC method. This study underscores the potential of advanced feature-selection methods in enhancing the accuracy of cancer stage identification, paving the way for improved diagnostic and therapeutic strategies in oncology. [ABSTRACT FROM AUTHOR]

Background: We aim to establish the characteristics of published cardio‐oncology research of clinical trials by bibliometric analysis and to talk about the prospects and difficulties facing the development of cardio‐oncology. Methods: Search of data related to clinical trials in cardiac oncology from 1990 to 2022 from the Web of Science core collection. Using CiteSpace to perform co‐citation analysis of authors, countries (regions) and institutions, journals and cited journals, cited authors and cited literature, and keywords. Results: Of the 607 clinical trial studies, the number of papers published per year has increased over time. The regions with the greatest influence were North America (especially the United States) and Europe. Multicenter research has always been the focus of cardio‐oncology research, but cross‐regional cooperation was still lacking. Myocardial toxicity caused by anthracyclines has received the earliest attention and has been studied for the longest time. Meanwhile, the efficacy and cardiotoxicity of new anticancer drugs always came into focus, but at a slow pace. Few studies on myocardial toxicity were related to the treatment of tumors except breast cancer. Risk factors, heart disease, adverse outcomes, follow‐up, and intervention protection were the major hotspots revealed by co‐citation cluster. Conclusions: There is great potential for the development of clinical trials in cardio‐oncology, especially in multicenter cooperation across different regions. Expansion of tumor types, myocardial toxicity of different drugs, and effective interventions in the research direction and design of clinical trials are necessary. [ABSTRACT FROM AUTHOR]

This scoping review provides an overview of cancer interventions implemented with Arab Americans across the cancer control continuum, including an examination of outcomes and implementation processes. The search strategy included database searching and reviewing reference lists and forward citations to identify articles describing interventions with Arab adults living in the US, with no restrictions on date of publication or research methodology. The review included 23 papers describing 12 unique cancer interventions. Most interventions focused on individual-level determinants of breast and cervical cancer screening; used non-quasi-experimental research designs to evaluate intervention effectiveness; and demonstrated improvements in short-term cancer screening knowledge. Implementation processes were less commonly described. Most interventions were culturally and linguistically tailored to communities of focus; were delivered in educational sessions in community settings; engaged with the community mostly for recruitment and implementation; and were funded by foundation grants. Suggestions for research and intervention development are discussed. [ABSTRACT FROM AUTHOR]

Aims: To explore predictors of lymphedema self‐management behaviours among Chinese breast cancer survivors based on the Integrated Theory of Health Behaviour Change, and to clarify the interrelationship among these variables. Design: Further analysis of a multicentre cross‐sectional and survey‐based study. Methods: A total of 586 participants with breast cancer were recruited from December 2021 to April 2022 in different cities in China. We used self‐reported questionnaires to collect data. Descriptive analysis, bivariate analysis and structural equation model were performed. Results: The Integrated Theory of Health Behaviour Change is suitable for predicting lymphedema self‐management behaviours. The final structural model showed good model fit. Social support, self‐efficacy and lymphedema knowledge positively affected lymphedema self‐management behaviours, directly and indirectly. Self‐regulation acted as a crucial mediator between these variables and self‐management. The direct path between social support and self‐regulation was not significant. Lymphedema knowledge and social support also influenced self‐management via illness perception, self‐efficacy and self‐regulation, sequentially. These variables explained 55.9% of the variance in lymphedema self‐management behaviours. Conclusions: The modified model based on the Integrated Theory of Health Behaviour Change fitted well in predicting lymphedema self‐management behaviours among breast cancer patients. Lymphedema knowledge, illness perception, self‐efficacy, social support and self‐regulation directly and indirectly influenced lymphedema self‐management behaviours. Impact: This study provides a theoretical basis for the assessment and interventions of lymphedema self‐management behaviours in breast cancer patients. Lymphedema self‐management behaviours should be assessed regularly and comprehensively, taking these predictors into consideration to identify potential barriers. Further research is needed to explore effective interventions integrating these significant predictors. Reporting Method: This study was reported following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross‐sectional studies. Patient or Public Contribution: No patient or public contributed to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript. What Does This Paper Contribute to the Wider Global Clinical Community?: This study focused on identifying and predicting mechanism of self‐management based on a theory of behaviour change. The results can be applied among patients with other chronic diseases or high‐risk populations, and inspire the assessment and interventions facilitating self‐management behaviours. Study Registration: This study was registered as an observational study at Chinese Clinical Trial Registry: http://www.chictr.org.cn (ChiCTR2200057084). Implications for the Profession and/or Patient Care: For breast cancer patients with poor lymphedema self‐management behaviour, attention should be raised among nurses and involved healthcare staffs that lymphedema self‐management is multi‐faced. Strategies targeted at improving social support, self‐regulation, knowledge, self‐efficacy and illness perception should be also addressed in lymphedema self‐management programs, to facilitate more effective improvement of lymphedema self‐management behaviours. [ABSTRACT FROM AUTHOR]

Background. Disparity between patient report and physician perception of pain from radiotracer injection for sentinel node biopsy is thought to center on the severity of the intervention, ethnic composition of population queried, and socioeconomic factors. Objective. The objectives of this study were, first, to explore agreement between physicians' and their breast cancer patients' pain assessment during subareolar radionucleotide injection; and second, to evaluate potential ethnic differences in ratings. Methods. A trial was conducted, from January 2006 to April 2009, where 140 breast cancer patients were randomly assigned to standard topical lidocaine-4% cream and 99mTc-sulfur colloid injection, or to one of three other groups: placebo cream and 99mTc-sulfur colloid injection containing NaHCO3, 1% lidocaine, or NaHCO3 + 1% lidocaine. Providers and patients completed numeric pain scales (0-10) immediately after injection. Results. Patients and providers rated pain similarly over the entire cohort (median, 3 vs 2, P = 0.15). Patients rated pain statistically significantly higher than physicians in the standard (6 vs 5, P = 0.045) and placebo + NaHCO3 (5 vs 4, P = 0.032) groups. No significant difference in scores existed between all African Americans and their physicians (3 vs 4, P = 0.27). Conclusion. Patient-physician pain assessment congruence over the less painful injections and their statistically similar scores with the more painful methods suggests the importance of utilizing the least painful method possible. Providers tended to underestimate patients with the highest pain ratings-those in the greatest analgesic need. Lack of statistical difference between African American and physician scores may reflect the equal-access-to-care over the entire patient cohort, supporting the conclusion that socioeconomic factors may lie at the heart of previously reported discrepancies. [ABSTRACT FROM AUTHOR]

Simple Summary: Risk stratification for early breast cancer (BC) is extremely relevant for tailoring clinical decisions but challenging due to the absence of comprehensive guidelines. Traditional criteria like tumor size, lymph node involvement, histological type, grade, lymphovascular invasion, and immune cell infiltration serve as significant prognostic indicators. Alongside hormone receptor, HER2, and BRCA1/2 testing, molecular subtyping through gene expression profiling offers valuable insights for personalized clinical decisions. "Omics" technologies, applicable to tissue and liquid biopsy samples, have expanded risk evaluation capabilities, with limitations due to the lack of prospective data in early BC. This research overview paper highlights the need for standardized methodologies and integrated pathological models across multiple analytical dimensions for earlu BC risk stratification. The aim is to provide a practical guide for histopathologists and molecular pathologists involved in early BC profiling. Early breast cancer (BC) is the definition applied to breast-confined tumors with or without limited involvement of locoregional lymph nodes. While risk stratification is essential for guiding clinical decisions, it can be a complex endeavor in these patients due to the absence of comprehensive guidelines. Histopathological analysis and biomarker assessment play a pivotal role in defining patient outcomes. Traditional histological criteria such as tumor size, lymph node involvement, histological type and grade, lymphovascular invasion, and immune cell infiltration are significant prognostic indicators. In addition to the hormone receptor, HER2, and—in specific scenarios—BRCA1/2 testing, molecular subtyping through gene expression profiling provides valuable insights to tailor clinical decision-making. The emergence of "omics" technologies, applicable to both tissue and liquid biopsy samples, has broadened our arsenal for evaluating the risk of early BC. However, a pressing need remains for standardized methodologies and integrated pathological models that encompass multiple analytical dimensions. In this study, we provide a detailed examination of the existing strategies for early BC risk stratification, intending to serve as a practical guide for histopathologists and molecular pathologists. [ABSTRACT FROM AUTHOR]

Simple Summary: The aim of our study is to provide a wide perspective on the available literature data on the immune landscape of breast cancers, focusing on TILs and PD-L1 expression across different breast cancer subtypes. Moreover, treatment options such as immunotherapy and chemotherapy in adjuvant and neoadjuvant settings are discussed, along with the most relevant cut-offs and scores for TILs and PD-L1 pathological assessment. With the rise of novel immunotherapies able to stimulate the antitumor immune response, increasing literature concerning the immunogenicity of breast cancer has been published in recent years. Numerous clinical studies have been conducted in order to identify novel biomarkers that could reflect the immunogenicity of BC and predict response to immunotherapy. In this regard, TILs have emerged as an important immunological biomarker related to the antitumor immune response in BC. TILs are more frequently observed in triple-negative breast cancer and HER2+ subtypes, where increased TIL levels have been linked to a better response to neoadjuvant chemotherapy and improved survival. PD-L1 is a type 1 transmembrane protein ligand expressed on T lymphocytes, B lymphocytes, and antigen-presenting cells and is considered a key inhibitory checkpoint involved in cancer immune regulation. PD-L1 immunohistochemical expression in breast cancer is observed in about 10–30% of cases and is extremely variable based on tumor stage and molecular subtypes. Briefly, TNBC shows the highest percentage of PD-L1 positivity, followed by HER2+ tumors. On the other hand, PD-L1 is rarely expressed (0–10% of cases) in hormone-receptor-positive BC. The prognostic role of PD-L1 expression in BC is still controversial since different immunohistochemistry (IHC) clones, cut-off points, and scoring systems have been utilized across published studies. In the present paper, an extensive review of the current knowledge of the immune landscape of BC is provided. TILS and PD-L1 expression across different BC subtypes are discussed, providing a guide for their pathological assessment and reporting. [ABSTRACT FROM AUTHOR]

Background: Hot flushes and night sweats are life-altering symptoms experienced by many women after breast cancer treatment. A randomised controlled trial (RCT) was conducted to explore the effectiveness of breast care nurse (BCN)-led group cognitive behavioural therapy (CBT). This paper reported findings from a qualitative process evaluation to optimise the CBT intervention and explore the determinants of implementation into routine practice. Methods: Qualitative process evaluation occurred in parallel with the RCT to explore patient and healthcare staff experiences and perspectives using semi-structured interviews pre-and post-intervention. Normalisation Process Theory (NPT) informed data collection, analysis, and reporting of findings. The analysis involved inductive thematic analysis, NPT coding manual and subsequent mapping onto NPT constructs. Results: BCNs (n = 10), managers (n = 2), surgeons (n = 3) and trial participants (n = 8) across six recruiting sites took part. All stakeholders believed group CBT met a need for non-medical hot flushes/night sweats treatment, however, had little exposure or understanding of CBT before MENOS4. BCNs believed the work fitted with their identity and felt confident in delivering the sessions. Despite little understanding, patients enrolled onto group CBT because the BCNs were trusted to have the knowledge and understanding to support their needs and despite initial scepticism, reported great benefit from group-based participation. Both managers and surgeons were keen for BCNs to take responsibility for all aspects of CBT delivery, but there were some tensions with existing clinical commitments and organisational priorities. Conclusions: Both healthcare staff and patient participants believe BCN-led group CBT is a beneficial service but barriers to long-term implementation into routine care suggest there needs to be multi-level organisational support. Trial registration: NCT02623374 – Last updated 07/12/2015 on ClinicalTrials.gov PRS. [ABSTRACT FROM AUTHOR]

This paper describes a structured group approach for women vulnerable to psychological distress following treatment for breast and/or gynaecological cancer. Set in Hong Kong, the aim was to develop and pilot a brief art therapy intervention sensitive to local concerns and the specific needs of service-users. A mixed methods study was developed and piloted in two phases over six-years in collaboration with female service-users recovering from breast and/or gynaecological cancer treatment. Key therapeutic goals and core themes were identified in phase 1 leading to the piloting of a six-session structured intervention with six groups in phase 2. This was evaluated using qualitative and quantitative methods: through service-user feedback and reflections; informal feedback captured through the art therapy process; and pre and post assessment of emotional distress (Distress Thermometer) and mental wellness (C-SWEMWBS). A consistent six-session structure was developed addressing four therapeutic goals: stress release and relaxation; amelioration of psychological and emotional distress; exploration of self-image; promotion of self-acceptance and awareness. Six core themes relating to loss and readjustment were established through the art therapy process. Participants experienced statistically significant reductions in psychological distress and increased mental well-being. A new brief, structured, group art therapy approach was developed for women recovering from breast and/or gynaecological cancer treatment. The study contributes to the evidence base for the efficacy of art therapy in psycho-oncology and highlights the importance of service-user involvement in the design of a tailored, culturally sensitive, intervention responsive to local concerns. This paper describes a brief art therapy group approach for women in recovery from treatment for breast and/or gynaecological cancer who are finding it difficult to adjust to changes in their bodies and the way they see themselves in the world. The aim of the project was to explore the use of a participatory approach to develop and test a brief art therapy intervention designed to meet the specific needs of such women. The project took place in Hong Kong, in a community cancer service offering support with the emotional impact of a cancer diagnosis and treatment. The theme-based group model was developed in two phases over six years in collaboration with female participants, all of whom were over the age of eighteen and had received treatment for breast and/or gynaecological cancer in the previous two years. Four therapeutic goals were identified: relaxation, reduction of emotional distress; exploration of feelings about oneself in the world, and awareness and acceptance of various aspects of oneself and one's situation. Common issues relating to feelings of loss and difficulties adjusting to bodily changes led to the further identification of six core themes. These were creatively explored through the art therapy process leading to the development of a consistent six-session structure. The themed group approach was evaluated through service-user feedback and reflections, informal feedback during the art therapy process, and established measurement tools for assessing emotional distress and mental wellness. Results suggest an overall reduction in emotional distress with improvements in mental wellbeing. This contributes to the evidence base for the efficacy of art therapy in cancer care. Positive outcomes also reflect the participants' involvement in the design of a culturally sensitive intervention responsive to local needs. [ABSTRACT FROM AUTHOR]

Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer. Conventional treatment options for TNBC often have limited efficacy and significant side effects. In recent years, traditional Chinese medicine (TCM) has shown promising results in the treatment of TNBC. TCMs include herb combinations that have synergistic effects to regulate homeostasis in the body, reduce tumor resistance, and improve patient quality of life. At present, three main TCM methods are used to treat TNBC in the clinic: strengthening the body's resistance, dispelling phlegm, and removing cancer toxins. This paper reviews the theories and mechanisms of each in TNBC treatment. The method of strengthening the body's resistance emphasizes enhancing the body's original Qi to fight against pathogenic factors; the method of dispelling phlegm seeks to eliminate phlegm stagnation and alleviate the burden on affected organs; the method of removing cancer toxins focuses on detoxification and detumescence to remove the toxic elements associated with TNBC. Although these methods treat TNBC from different etiologies, they have achieved good therapeutic effects and represent an important academic approach: That is, to cure the disease with a comprehensive view of the body and restore the balance of Yin and Yang. This knowledge lays a foundation for the future development and reasonable application of TCM in the clinic. [ABSTRACT FROM AUTHOR]

The article announces the nominees to the UK Research Paper of the Year of the 2016 "British Medical Journal" Awards which include oxygen saturation targets in infants with bronchiolitis, spironolactone for drug resistant hypertension, and aromatase inhibitors use in early breast cancer.

Aim: The aim of this study is to explore the effects of exercise interventions by type, duration and intensity of exercise for fatigue in breast cancer survivors who had completed their treatment. Background: Most studies found that exercise has valuable outcomes for cancer survivors. This meta‐analysis comprehensively summarizes the benefits of exercise intervention for fatigue in breast cancer patients who had completed their adjuvant treatments. Methods: We conducted a meta‐analysis on randomized control trials published during 1 January 2000 through 31 December 2019, from PubMed, Cochrane Library databases, EMBASE, Medline (ProQuest), CINAHL, PsycINFO, Chinese Electronic Periodical Service and Wan Fan Data with prespecified searching criteria. Breast cancer patients earlier than stage IIIc and completing adjuvant treatments were included, and the effects of exercise on fatigue were investigated. Results: Nine randomized controlled trials (RCTs) were included (N = 581). Patients receiving exercise interventions showed reduced fatigue comparing with those without exercise. Exercise with low–moderate intensity, 20 min/day, three times per week and lasting up to 12 weeks had a significant effect on reducing fatigue for breast cancer survivors. Conclusion: Our study suggested that exercise interventions can reduce fatigue for this group of cancer survivors. The duration and intensity of exercise intervention could be prescribed for this specific group of cancer patients as a basic requirement to handle their reported fatigue. Summary statement: What is already known about this topic? Previous meta‐analysis has shown that exercise interventions can affect fatigue in breast cancer survivors during and after their adjuvant treatment. What this paper adds? Exercise at a low to moderate intensity, 20 min/day, three times per week, at 12‐week follow‐up reduced fatigue for breast cancer survivors who completed adjuvant treatment.The intensity of exercise interventions could be included in guidelines, to help patients in handling their reported fatigue. The implications of this paper: Findings support the positive effects of exercise interventions in reducing fatigue in women with breast cancer, suggesting that health‐care professionals and nurses may consider including exercise programmes into management plans for this population. [ABSTRACT FROM AUTHOR]

Macrophages are immune cells with high plasticity that are widely distributed in all tissues and organs of the body. Under the influence of the immune microenvironment of breast tumors, macrophages differentiate into various germline lineages. They exert pro-tumor or tumor-suppressive effects by secreting various cytokines. Pyroptosis is mediated by Gasdermin family proteins, which form holes in cell membranes and cause a violent inflammatory response and cell death. This is an important way for the body to fight off infections. Tumor cell pyroptosis can activate anti-tumor immunity and inhibit tumor growth. At the same time, it releases inflammatory mediators and recruits tumor-associated macrophages (TAMs) for accumulation. Macrophages act as "mediators" of cytokine interactions and indirectly influence the pyroptosis pathway. This paper describes the mechanism of action on the part of TAM in affecting the pyroptosis process of breast tumor cells, as well as its key role in the tumor microenvironment. Additionally, it provides the basis for in-depth research on how to use immune cells to affect breast tumors and guide anti-tumor trends, with important implications for the prevention and treatment of breast tumors. Bdt29Nrj2-xDAhjkrKeCKy Video Abstract [ABSTRACT FROM AUTHOR]

Background: Each year the interdisciplinary Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), German Gynecological Oncology Group Breast Committee on Diagnosis and Treatment of Breast Cancer provides updated state-of-the-art recommendations for early and metastatic breast cancer. Summary: The updated evidence-based treatment recommendation for early and metastatic breast cancer has been released in March 2023. Key Messages: This paper concisely captures the updated recommendations for early breast cancer chapter by chapter. [ABSTRACT FROM AUTHOR]

A votive offering or ex-voto includes a variety of usually non-professional artworks offered to divinities and placed in religious sites to fulfill a vow or in gratitude for recovery from an illness or injury. Unfortunately, the ancient period lacks a scientifically verifiable understanding of the true nature of cancer and its natural history and, consequently, a lack of effective treatment. This paper discusses two ex-votos potentially related to breast cancer distant more than 2000 years, one from the other. The ex-votos convey the complex relationship of humans with illness through an art expression stemming from the heart and minds of ordinary people. [ABSTRACT FROM AUTHOR]

Worldwide, breast cancer constitutes the most common malignant neoplasm among females, impacting 2.1 million women annually. Interventional oncology techniques have been recently added as an additional therapeutic and palliative alternative in breast cancer metastatic disease, concerning mainly osseous, liver, and lung metastasis. In the current literature, there are reports of promising results and documented efficacy regarding the ablation of liver and lung metastasis from breast carcinoma, transarterial embolization or radioembolization, as well as the treatment of osseous metastatic disease. These literature studies are limited by the heterogeneity of breast cancer disease, the evaluation of variable different parameters, as well as the retrospective nature in most of the cases. Consequently, dedicated prospective series and randomized studies are required to identify the role of minimally invasive local therapies of interventional oncology armamentarium. The present review paper focuses upon the current role of interventional oncology techniques for the curative or palliative treatment of metastatic breast cancer disease. The purpose of this review paper is to present the current minimally invasive procedures in the treatment of metastatic breast disease, including local control rates and survival rates. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents my experience of breast cancer care in which I describe my care as positive and integrated. Design/methodology/approach: I have applied an autoethnographical approach to my patient story to analyse my care in order to reflect and share insights. I have applied my knowledge and experience in integrated care through my research, management and practice. Findings: In my patient story I describe being empowered and feeling like "one of the team." Vertical and horizontal integration was evident across staff services and agencies. This included integrated working across multi‐disciplinary teams, between primary and secondary care and also between the NHS and a voluntary agency. I identified features that were important to me in my care under the headings of: certainty, communication, contact, compassion, continuity, cohesive, care and collaboration. Practical implications: I consider the implications of sharing patient stories to inform quality improvement, influence education and training for staff and design support for patients. I consider how patients can be more involved in the evaluation of their care. Originality/value: This viewpoint has been written from my perspective as a patient and a professional, and was written in order to recognise good practice and share the learning for continual quality improvement. There is every sign that person-centred integrated care is starting to be embedded in some of our services and hopefully this will be recognised, celebrated and sustained. [ABSTRACT FROM AUTHOR]

Simple Summary: Lymphedema affecting the breast can develop after breast cancer treatment. Currently breast lymphedema isn't well recognised nor techniques to measure lymphedema affecting the breast as well studied. This paper explores the validity and reliability of measures which can be used to determine the presence of breast lymphedema. Women with and without breast lymphedema were included in this study to enable comparisons to be made. Improving the assessment of breast lymphedema will advance clinical practice and enable the outcome of treatment to be reported. Ultrasound and tissue dielectric constant were found to be able to reliably distinguish between edema and non edematous breast tissue. In addition certain patient characteristics and breast caner treatments were found to associated with the development of breast lymphedema. Lymphedema can develop after treatment for breast cancer (BCRL). Lymphedema of the breast is not well studied. Currently, the main techniques used to diagnose and monitor the effectiveness of treatment are subjective clinician assessment and patient reports. Eighty-nine women who had undergone breast cancer treatment were recruited with and without breast lymphedema. Blinded clinical assessment determined the presence or absence of breast lymphedema. Measurement of skin thickness by ultrasound scanning, local tissue water by tissue dielectric constant (TDC) and tissue indentation by tonometry was recorded. Breast cancer treatment and demographic details were documented. Descriptive statistics were undertaken to compare sample characteristics, including the Chi-squared test, Odds Ratio (OR) and Relative Risks (RR) calculated. Increased body mass index (BMI), larger bra size, increased number of positive lymph nodes, axillary surgery, chemotherapy and increased Nottingham Prognostic Index (NPI) were all associated with breast lymphedema (p < 0.05). Ultrasound and TDC measurements were significantly higher in the lymphedema group (p < 0.05). Receiver Operator Characteristic (ROC) curves demonstrated that ultrasound and TDC measurements could distinguish between edematous and non-edematous breasts. Threshold levels were produced, which demonstrated good levels of sensitivity and specificity. These findings have the potential to improve the diagnosis of breast lymphedema. [ABSTRACT FROM AUTHOR]

Background: Cancer cases diagnosed each year are increasing, mainly because the population is ageing and, in part, due to early detection. This implies that there are more and more persons that receive medical anticancer therapies and that are interested in maintaining their quality of life. Many oncological treatments, including chemotherapy, immunotherapy, surgery, and radiotherapy, and combined therapy are associated with cutaneous toxicity and long-term side effects to different tissues and organs. This is particularly relevant when new therapies are used since these may cause new and unexpected side effects that may be short-lived but, in some cases, may become chronic or permanent. Patients often seek advice with their oncologists on what can be done and what cannot be done. Notably, many of the cutaneous side effects can be prevented or reduced by adequate interventions. Summary: The aim of this review is to highlight how oncological patients may benefit from a closer collaboration between specialists in different branches. We will focus on women with breast cancer since we think that they may derive a special benefit from this collaboration, but we will analyse other cancers in future papers. Key Messages: The working group was created to help the medical doctor in the prevention and management of all the adverse effects of the oncological treatments, supporting patients in this phase of their life, including nutritional assessment and dietary support. [ABSTRACT FROM AUTHOR]

Background: Shared decision‐making has been shown to improve the quality of life in metastatic breast cancer patients in high‐literacy and high‐resource settings. However, limited studies have examined the cultural preferences of metastatic breast cancer patients with shared decision‐making implementation and the barriers encountered in an Asian setting where societal norms predominate and physician decision‐making is at the forefront. This paper aims to identify (1) barriers to practising shared decision‐making faced by healthcare professionals and patients and (2) strategies for implementing shared decision‐making in the context of metastatic breast cancer management in Malaysia. Methods: We conducted a qualitative study involving 12 patients diagnosed with metastatic breast cancer, 16 healthcare professionals and 5 policymakers from surgical and oncology departments at public healthcare centres in Malaysia. Semi‐structured in‐depth interviews and focus group discussions were conducted. The interviews were recorded, transcribed verbatim and analysed using the thematic approach. Nvivo software was used to manage and analyse the data. Results: Five main themes emerged from the study: healthcare provider–patient communication, workforce availability, cultural and belief systems, goals of care and paternalism versus autonomy. Other strategies proposed to overcome barriers to implementing shared decision‐making were training of healthcare professionals and empowering nurses to manage patients' psychosocial issues. Conclusion: This study found that practising shared decision‐making in the public health sector remains challenging when managing patients with metastatic breast cancer. The utilization of decision‐making tools, patient empowerment and healthcare provider training may help address the system and healthcare provider–patient barriers identified in this study. Patient or Public Contribution: Patients were involved in the study design, recruitment and analysis. [ABSTRACT FROM AUTHOR]

Motivated by the quest to curtail the high mortality rate of breast cancer, the manuscript proposes the sensitivity enhancement of monopole antenna for hyperthermia application by using electromagnetic time reversal (EMTR) technique with transformation structures for early treatment of multi-focal breast tumors. The EMTR technique is characterized with temporal and spatial focusing, hence enhancing the visibility of tumors embedded in the breast medium. In this study, we aim at the non-invasive power deposition on sub-wavelength-sized tumors at sub-wavelength separation incorporation with sub-wavelength scatterers. The paper is focused on enhancing the sensitivity of scattering reception in TR algorithm for hyperthermia application using sub-wavelength sized scatterers. The proposed applicator is an ultra-wideband (UWB) monopole antenna designed with sub-wavelength-sized split ring embedded square patch (SRESP) on a grounded substrate placed below it at some distance to serve as near field scatterer. Another plate of sub-wavelength scatterers but without the ground plate is placed in close proximity to the unhealthy breast in-conjunction with four ultra-wideband antenna time reversal mirrors (UWB-TRM). The proposed method shows promising potential for the selective power deposition for hyperthermia of sub-wavelength-sized tumors at sub-wavelength separations. This technique of enhancing front-end sensor sensitivity can also be extended to other optimization techniques for selective power deposition in hyperthermia of breast cancer. [ABSTRACT FROM AUTHOR]

Background: This review evaluates whether brachytherapy can be considered as an alternative to whole breast irradiation (WBI) using criteria such as local recurrence rates, overall survival rates and quality of life (QoL) factors. This is an important issue because of a decline in local recurrence rates, suggesting that some women at very low risk of recurrence may be incurring the negative long-term side effects of WBI without benefitting from a reduction in local recurrence and greater overall survival. As such, the purpose of this literature review is to evaluate whether brachytherapy is a credible alternative to external beam radiation with a particular focus on the impact it has on patient QoL. Methods: The search terms used were devised by using the Population Intervention Comparison Outcome framework, and a literature search was carried out using Boolean connectors and Medical Subject Headings in the PubMed database. The resultant articles were manually assessed for relevance and appraised using the Scottish Intercollegiate Guidelines Network tool. Additional papers were sourced from the citations of articles found using the search strategy. Government guidelines and regulations were also used following a manual search on the National Institute for Health and Care Excellence website. This process resulted in a total of 30 sources being included as part of the review. Results: Three types of brachytherapy were the foundation for the majority of the papers found: interstitial multi-catheter brachytherapy, intra-cavity brachytherapy and permanent seed implantation. The key themes that arose from the literature were that brachytherapy is equivalent to WBI both in terms of 5-year local recurrence rates and overall survival rates at 10–12 years. The findings showed that brachytherapy was superior to WBI for some QoL factors such as being less time-consuming and equal in terms of others such as breast cosmesis. The results did also show that brachytherapy does come with its own local toxicities that could impact upon QoL such as the poor breast cosmesis associated with some brachytherapy techniques. Conclusion: In conclusion, brachytherapy was deemed a safe or acceptable alternative to WBI, but there is a need for further research on the long-term local recurrence rates, survival rates and quality of life issues as the volume of evidence is still significantly smaller for brachytherapy than for WBI. Specifically, there needs to be further investigation as to which patients will benefit from being offered brachytherapy and the influence that factors such as co-morbidities, performance status and patient choice play in these decisions. [ABSTRACT FROM AUTHOR]

Personalising aftercare for curatively treated breast cancer patients is expected to improve patient satisfaction with care. A patient decision aid can support women in making decisions about their aftercare trajectory, but is currently not available. The aim of this study was to assess the needs of patients and health professionals with regard to an aftercare decision aid to systematically develop such a decision aid. Focus groups with patients and individual interviews with health professionals were digitally recorded and coded using the Framework analysis. Although most patients felt few aftercare options were available to them, health professionals reported to provide various options on the patients' request. Patients reported difficulty in expressing their need for options to their health professional. Although most patients were unfamiliar with decision aids, the majority preferred a paper‐based patient decision aid, while most health professionals preferred an online tool. The practical implications for the intended patient decision aid are: that a digital tool with paper‐based element should be developed, the patient decision aid should facilitate both rational and intuitive processes and should provide insight in patients' preferences concerning aftercare to discuss these explicitly. [ABSTRACT FROM AUTHOR]

Introduction: The AGO (Arbeitsgemeinschaft Gynäkologische Onkologie, German Gynecological Oncology Group) Task Force on Diagnosis and Treatment of Breast Cancer as an interdisciplinary team consists of specialists from gynecological oncology, pathology, diagnostic radiology, medical oncology, and radiation oncology with a special focus on breast cancer. Methods: The updated evidence-based treatment recommendation 2022 for early breast cancer (EBC) and metastatic breast cancer of the AGO Task Force has been released. Results and Conclusion: This paper captures the update of EBC. [ABSTRACT FROM AUTHOR]

Breast cancer treatment can affect estrogen levels leading to significant bone loss, osteoporosis, and risks for fracture. Although bone care guidelines are published, bone health interventions are often not routinely offered to at-risk individuals. This paper reports on the process of developing and implementing a nurse-led bilingual Breast and Bone Health Program (BBHP) in-person and online at a cancer centre in Montreal, Quebec (www.breastandbonehealth. ca, www.santeseinsetos.ca). The BBHP offers tailored bone health interventions (e.g., risk screening, information, rehabilitation, exercise prescriptions, nutritional counselling, and support for a health-promoting lifestyle). Over a two-year period, women treated for breast cancer (N = 430) took part in the program. Forty percent of surveyed participants (n = 97) initially reported being unaware that some breast cancer treatment could significantly affect bone health. Following the initial informational session with the BBHP nurse, self-reported bone health knowledge significantly increased, with 96% reporting sufficient information to manage their bone health. The BBHP offers both online and in-person risk assessment and bone health promotion activities and tools to both health care professionals and women with breast cancer. Herein, we review the background, BBHP development and implementation as well as preliminary program evaluation. [ABSTRACT FROM AUTHOR]

Background: Universal health coverage (UHC) indicators for monitoring the progress of effective service coverage for non-communicable diseases (NCDs) are still lacking. This paper aims to prove the possibility of adapting Quality Performance Indicators (QPIs) as indicators for effective service coverage of NCDs in the context of UHC. Materials and Methods: By reviewing major literatures on UHC framework and indicators between the years 2012 and 2015, service coverage indicators criteria and effective coverage indicator criteria were compiled. Two QPIs: one on breast cancer and one on acute myocardial infarction from renowned sources were selected as examples and their fulfilment of the indicator criteria was analysed. Result: The findings demonstrated that the selected QPIs were able to fulfil the criteria for indicators to measure effective service coverage component of Universal Health Coverage. Conclusion: It is proposed that suitable QPIs be considered to be adapted as indicators for UHC monitoring for non-communicable diseases. [ABSTRACT FROM AUTHOR]

Patients with breast cancer (BC) typically undergo multimodal treatment over an extended period and deal with a wide range of symptoms that severely impair their overall quality of life (QoL) and prognosis. Concern about the health-related QoL of persons diagnosed with cancer as well as the calibre of care they receive is increasing every day. This study aims to assess the impact of yoga on the QoL of patients with BC. PRISMA guidelines served as the foundation for the methodologies used to identify the studies. A total of 480 records were found using PubMed/Medline and Google Scholar databases. A final set of 22 studies was assessed for the work based on the exclusion and inclusion criteria and study eligibility. Yoga has a moderate effect on BC patients. Pranayama has been shown to have a positive effect on improving the QoL. The study observed that yoga was more useful during actual treatment for cancer than after completion. The various randomised controlled trials (RCT) and meta-analysis included in this study believe that yoga has a positive effect. However, the outcomes of various studies do not support this point completely. According to the safety information that is currently available, yoga is not associated with severe adverse outcomes. There is no concrete evidence that establishes the role of yoga as one of the alternative medicines in treating BC patients after chemotherapy. More clinical trials are needed to investigate the advantages of yoga in the overall improvement of QoL in BC patients. [ABSTRACT FROM AUTHOR]

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Background: The first International Consensus Conference for Advanced Breast Cancer (ABC1) took place 10 years ago in November 2011. The rationale was – and still is – to standardize treatment of advanced breast cancer (ABC) based on the available evidence and to ensure that worldwide all breast cancer patients receive adequate treatment and access to new therapies. Rationale for the Manuscript: The 6th International Consensus Conference for ABC (ABC6) took place from November 4 to 6, 2021 and was the first in a purely online format, due to the COVID-19 pandemic. In the present manuscript, a working group of German breast cancer experts comments on the voting results of the ABC6 panelists regarding their applicability for routine clinical practice in Germany. Method: The ABC6 votes mainly include modified or new statements. With regard to all statements not modified for the ABC6 consensus, the German experts refer to the published paper of the ABC5 consensus. The German experts base their comments on the current recommendations of the Breast Committee of the Gynecological Oncology Working Group (Arbeitsgemeinschaft Gynäkologische Onkologie, AGO Mamma). Topics: ABC6 focused on new treatment options and their implications for clinical practice. Optimal therapy sequencing for example was one of the issues. To solve the challenge of a more individualized treatment, precision medicine is fundamental. Oligometastatic disease, brain metastases and adequate supportive and palliative care were also addressed. Of special interest was the treatment of inoperable locally advanced breast cancer, which was discussed as a separate topic. As in previous years, patient advocates from around the world were an integral part of the ABC6 conference and had a major input into the consensus. [ABSTRACT FROM AUTHOR]

Objectives: Quality of life, mental wellbeing, and physical function deteriorate among women with breast cancer. Tai Chi is a moderate form of exercise that may be effective in improving the mental and physical wellbeing, therefore, the quality of life of women with breast cancer. This protocol paper outlines a trial to determine the therapeutic effects of a Tai Chi programme on breast cancer management. Methods: The study will be an interventional, single-blind, double-armed, randomized, and controlled trial involving a 12-week Tai Chi programme for women with breast cancer. Forty participants aged 18 years and above who are diagnosed with breast cancer from the general community will be recruited. All participants will be randomized to either a Tai Chi programme or a waiting list control group. The Tai Chi programme will involve 12 weeks of group Tai Chi sessions, with 45 min per session, twice a week. The primary outcome will be potential improvements to the quality of life, and secondary outcomes will be potential improvements in mental wellbeing (anxiety and depression), and physical function (pain, flexibility, obesity, and vital signs). These outcomes will be assessed via self-administered online assessments and physical examinations pre-and post-intervention. Linear mixed modelling will be used to assess changes in outcomes. Discussion and dissemination: Tai Chi is a safe, easy to learn, inexpensive, and low-intensity exercise with increasing popularity worldwide. If the intervention improves the quality of life in women with breast cancer, this study will build research capacity and increase awareness of the potential for Tai Chi to empower patients and engage them in self-management of breast cancer symptoms. Research findings will be disseminated to the public, health professionals, researchers, and healthcare providers through conference presentations, lay summaries, and peer-reviewed publications. [ABSTRACT FROM AUTHOR]

In the past decades, the incidence rate of cancer has steadily risen. Although advances in early and accurate detection have increased cancer survival chances, these patients must cope with physical and psychological sequelae. The lack of personalized support and assistance after discharge may lead to a rapid diminution of their physical abilities, cognitive impairment, and reduced quality of life. This paper proposes a personalized support system for cancer survivors based on a cohort and trajectory analysis (CTA) module integrated within an agent-based personalized chatbot named EREBOTS. The CTA module relies on survival estimation models, machine learning, and deep learning techniques. It provides clinicians with supporting evidence for choosing a personalized treatment, while allowing patients to benefit from tailored suggestions adapted to their conditions and trajectories. The development of the CTA within the EREBOTS framework enables to effectively evaluate the significance of prognostic variables, detect patient's high-risk markers, and support treatment decisions. [ABSTRACT FROM AUTHOR]

The aim of this paper is to discuss and understand the interplay of surgical and radiotherapy (RT) techniques that potentially affect the aesthetic outcomes following breast conservation treatment. It reviews the reported cosmetic outcomes within the practice‐changing RT trials incorporating varied fractionation regimes as well as sequence (before, during, or after surgery) over the past two decades. The paper importantly highlights an overall improvement in breast surgical techniques particularly oncoplastic breast conservation techniques due to dedicated and streamlined training of late. Hence, erstwhile complications or sequel of breast surgery and associated post‐RT aesthetic concerns may not be of the same variety or magnitude that were noted in the past. Paper thus concludes by highlighting the paradigm shift in the breast surgical practice that will have a bearing on the accuracy of RT outcomes assessed (within or out with clinical trials) with implications as a potential research and outcomes assessment gap. [ABSTRACT FROM AUTHOR]

Aim. In this paper, we systematically review the evidence looking at the effect of dance/movement therapy (DMT) and mental health outcomes and quality of life in breast cancer patients. Method. The literature search was done with the databases PubMed (MEDLINE), EBSCO, and Cochrane Central by using the following search words: "dancing/dance/movement therapy," "breast cancer/neoplasms/carcinoma/tumour" or "mammary cancer," "mental health," and "quality of life." Ninety-four articles were found. Only empirical interventional studies (N = 6) were selected for the review: randomised controlled trials (RCT) (n = 5) and non-RCT (n = 1). PRISMA guidelines were used. Results. Data from 6 studies including 385 participants who had been diagnosed with breast cancer, were of an average age of 55.7 years, and had participated in DMT programmes for 3–24 weeks were analysed. In each study, the main outcomes that were measured were quality of life, physical activity, stress, and emotional and social well-being. Different questionnaires were used for the evaluation of outcomes. The mental health of the participants who received DMT intervention improved: they reported a better quality of life and decreased stress, symptoms, and fatigue. Conclusion. We found only six studies for review, and some had a small number of participants. However, our findings indicate that DMT could be successfully used as a complimentary therapy in addition to standard cancer treatment for improving the quality of life and mental health of women who have been diagnosed with breast cancer. More research is needed to evaluate the complexity of the impact of complimentary therapies. It is possible that DMT could be more effective if used with other therapies. [ABSTRACT FROM AUTHOR]

Simple Summary: Conducting a geriatric assessment represents the standard of care for the management of older adults with cancer. However, most studies of the geriatric assessment in oncology have included non-Hispanic white populations with high educational levels living in developed countries. In this study, we assessed the feasibility, reliability, and validity of two methods of administration (electronic touchscreen tablet and paper/pencil) of the Spanish language version of a self-administered geriatric assessment among older women with breast cancer in the United States. Our results show that implementing a self-administered geriatric assessment using either an electronic tablet or paper/pencil is feasible, reliable, and valid in Spanish-speaking older adults. However, in order to complete the geriatric assessment, participants with lower educational levels were more likely to need help and took significantly longer to do so. This study highlights the importance of tailoring assessments and questionnaires to the cultural, social, and educational level of older adults with cancer. We evaluated the feasibility, reliability, and validity of a Spanish-language self-administered geriatric assessment (GA) in older (age ≥ 65) Spanish-speaking women with breast cancer in the United States. Eligible participants (n = 181) were recruited and randomized. Feasibility was defined as the participant's unassisted GA completion rate, completion time, and perception on ease of completion. Reliability and validity were assessed using Spearman's correlation coefficients. Two-sided p < 0.05 was considered significant. Ninety-eight percent of participants (n = 177) completed the GA at least once. Median age was 70 years (range: 65–95) and 55% had ≤8th grade education. Forty-one percent (n = 73) were unable to complete the GA unassisted, median completion time was 28 min (range 8–90), and 77% (n = 136) rated the GA as "easy"/"very easy". Patients with ≤8th grade education took longer to complete the GA (30 vs. 25 min, p = 0.0036) and needed more assistance (59% vs. 19%, p < 0.001) than those with ≥9th grade education. Test–retest reliability was high (≥0.82) for all domains except social activity (0.73). Validity among similar scales was found. The self-administered GA is a feasible, reliable, and valid tool for Spanish-speaking older women with breast cancer. Tailoring GA tools to the patients' educational level is important when implementing tools in multicultural environments. [ABSTRACT FROM AUTHOR]

Purpose: High quality advanced cancer care includes goals of care (GOC) discussions and should be tailored according to clinical diagnosis, patient characteristics, and in concordance with patient's goals. Metastatic breast cancer (MBC) and treatment has heterogeneity according to subtype which makes the timing of initiating and continuing GOC discussions challenging. With an ever-increasing array of therapy, women with advanced stage disease are unique survivors in that they receive relatively aggressive cancer care to not only palliative symptoms but extend survival time. It is the purpose of this paper to explore the prevalence, pattern, and likelihood of having a GOC discussion according to key tumor, demographic, social, and clinical factors.Methods: A single-institution retrospective chart review of women deceased from MBC between November 2016 and November 2019 with double verification chart review was completed. Data were analyzed with descriptive, correlative, and comparative statistics.Results: Total sample was N=167 women, with 14.4% (n=24) Black and 85.6% (n=143) White. Mean age was 55.3 years (SD 11.73). Overall, MBC survival was 3.12 years (SD 3.31), White women 41.2 (3.4 years) months, and Black women 19 (1.6 years) months. A total of 87.4% (n=146) participated in one or more GOC discussions. GOC discussions were more likely among those who were referred to palliative care (p<0.001) and social work (p=0.035) services. Of the GOC discussions, only 29.3% were conducted by the primary oncologist. Black women were more likely to have GOC discussion near death.Conclusion and Implications: Advanced stage cancers are treated, at times relatively aggressively, to extend survival time instead of merely offering palliation. This new paradigm of survivorship requires thoughtful integration of GOC conversations. Describing the current status of GOC discussions among a cohort of women deceased from MBC highlights the patients most vulnerable to having a GOC discussion avoided or delayed. These identified vulnerabilities will indicate where targeted interventions can be implemented in the future. [ABSTRACT FROM AUTHOR]

Objective: To determine the extent of medical and non-medical out-of-pocket expenses (OOPE) among regional/rural and outer metropolitan Western Australian patients diagnosed with cancer, and the factors associated with higher costs. Methods: Cross-sectional data were collected from adult patients living in four regional/rural areas and two outer metropolitan regions in Western Australia who had been diagnosed with breast, prostate, colorectal or lung cancer. Consenting participants were mailed demographic and financial questionnaires, and requested to report all OOPE related to their cancer treatment. Results: The median total OOPE reported by 308 regional/rural participants and 119 outer metropolitan participants were A$1518 (interquartile range (IQR): A$581–A$3769) and A$2855 (IQR: A$958–A$7142) respectively. Participants most likely to experience higher total OOPE were younger than 65 years of age, male, resided in the outer metropolitan area, worked prior to diagnosis, had private health insurance, were in a relationship, and underwent surgery. Multivariate analysis of regional/rural participants revealed that receiving care at a rural cancer centre was associated with significantly lower non-medical OOPE (estimated mean A$805, 95% confidence interval (CI): A$735–A$875, P = 0.038; compared with other rural participants (A$1347, 95% CI: A$743–A$1951, P < 0.001)). Conclusion: The cancer patients who participated in this study experienced variation in OOPE, with outer metropolitan participants reporting higher OOPE compared with their regional/rural counterparts. There is a need for cost transparency and access to care close to home, so that patients can make informed choices about where to receive their care. What is known about the topic?: In recent years, OOPE for health care in general and cancer in particular have been widely debated by consumers and not-for-profit organisations; the topic has attracted much political attention because it affects both equity and access to care and has wider financial implications for the community. Research studies and reports from both consumer organisations and a Ministerial Advisory Committee found that cancer patients can face exorbitant out-of-pocket costs, and that individuals with private health insurance and those with prostate and breast cancer reported higher costs. In Western Australia, a cancer centre providing comprehensive cancer care was established in the second most populous region to ameliorate the high costs for travel and accommodation that regional cancer patients are known to experience. What does this paper add?: This study is unique because it collected detailed cost information from patients and reports on the OOPE of regional/rural and outer metropolitan Western Australian patients receiving care for one of the four most common cancers; it therefore offers novel insight into the experiences of these groups. This study demonstrates that outer metropolitan cancer patients are experiencing much higher OOPE compared with regional/rural cancer patients. Additionally, regional/rural study participants who accessed a Regional Cancer Centre experienced significantly lower non-medical OOPE, compared with regional/rural study participants receiving care elsewhere. What are the implications for practitioners?: First, there is a need for improved communication of OOPE to minimise costs to the patient, for example, by facilitating access to local cancer care. Health service providers and insurance companies can improve cost transparency for cancer patients by making this information more readily available, allowing patients to make informed financial choices about where to seek care. Second, the needs of working patients deserve specific attention. These patients face significant work uncertainty and additional distress following a cancer diagnosis. [ABSTRACT FROM AUTHOR]

Research identifies unique challenges for younger women diagnosed with breast cancer at or before 45 years of age. This paper explores the experiences of younger women from diverse cultural backgrounds with breast cancer to see if there are differing healthcare provision needs across cultures. Sandelowski and Barroso's framework for undertaking a meta-synthesis is used in this paper. Initial searches in academic databases returned 42 papers of interest. Re-reading the papers in the context of the research question identified 12 studies which met the inclusion criteria. Five key themes were identified in these 12 studies. The overarching finding is that, irrespective of cultural background, the confrontation with breast cancer transforms the younger woman's life. It seems that healthcare provision needs do not differ substantially across cultures. Health professionals should address the unique psychosocial effects of cancer in the context of the lifestage of the woman. [ABSTRACT FROM AUTHOR]

Objective.: To demonstrate proof of concept for a smart phone‐empowered community health worker (CHW) model of care for breast health promotion, clinical breast examination (CBE), and patient navigation in rural Bangladesh. Methods.: This study was a randomized controlled trial; July 1 to October 31, 2012, 30 CHWs conducted door‐to‐door interviews of women aged 25 and older in Khulna Division. Only women who disclosed a breast symptom were offered CBE. Arm A: smart phone with applications to guide interview, report data, show motivational video, and offer appointment for women with an abnormal CBE. Arm B: smart phone/applications identical to Arm A plus CHW had training in “patient navigation” to address potential barriers to seeking care. Arm C: control arm (no smart phone; same interview recorded on paper). Outcomes are presented as the “adherence” (to advice regarding a clinic appointment) for women with an abnormal CBE. This study was approved by Women's College Hospital Research Ethics Board (Toronto, Ontario, Canada) and district government officials (Khulna, Bangladesh). Funded by Grand Challenges Canada. Results.: In 4 months, 22,337 women were interviewed; <1% declined participation, and 556 women had an abnormal CBE. Control group CHWs completed fewer interviews, had inferior data quality, and identified significantly fewer women with abnormal breast exams compared with CHWs in arms A and B. Arm B had the highest adherence. Conclusion.: CHWs guided by our smart phone applications were more efficient and effective in breast health promotion compared with the control group. CHW “navigators” were most effective in encouraging women with an abnormal breast examination to adhere to advice regarding clinic attendance. Community health workers (CHWs) used smart phones with and without patient navigation to promote breast health in rural Bangladesh and were compared with CHWs using paper‐and‐pencil methods only. Findings showed that CHWs who did not use the smart phone applications completed fewer interviews, had inferior data quality, and identified significantly fewer women with abnormal breast exams, indicating that smart phones can be used to promote breast health in rural areas. CHWs with smart phones and 1‐day training in patient navigation were more effective in encouraging women with abnormal breast exams to attend for proper care. [ABSTRACT FROM AUTHOR]

Background: In order to offer optimal treatment approaches based on available evidence, the Commission Breast of the Working Group Gynecologic Oncology (AGO) of the German Cancer Society developed therapy algorithms for eight complex treatment situations in primary and advanced breast cancer. Summary: Therapy algorithms for the following complex treatment situations are outlined in this paper: (neo)adjuvant therapy of human epidermal growth factor receptor 2 (HER2)-positive breast cancer; axillary surgery and neoadjuvant chemotherapy; adjuvant endocrine therapy in premenopausal patients; adjuvant endocrine therapy in postmenopausal patients; hormone receptor (HR)-positive/HER2-negative metastatic breast cancer: strategies; HR-positive/HER2-negative metastatic breast cancer: endocrine-based first-line treatment; HER2-positive metastatic breast cancer: first to third-line; metastatic triple-negative breast cancer. Key Messages: The therapy options shown in these algorithms are based on the current AGO recommendations updated in January 2020 but cannot represent all evidence-based treatment options. Prior therapies, performance status, comorbidities, patient preference, etc. must be taken into account for the actual treatment choice. Therefore, in individual cases, other evidence-based treatment options not listed here may also be appropriate and justified. [ABSTRACT FROM AUTHOR]

Emerging evidence supports the efficacy of transdiagnostic approaches in the treatment of comorbid conditions. Given that both depression and anxiety disorders have been consistently noted as the most common psychological presentation across site and stage of illness in patients with cancer, psycho-oncology as a specialty may benefit from approaches that implement transdiagnostic approaches to treatment. This paper presents an adaptation of emotion-focused therapy for comorbid anxiety and depression in women with breast cancer. The described approach outlines how the chronic problematic emotion schemes are triggered by the experience of cancer and its medical treatment as well as transformation of those schemes through a sequence of steps. A process of change occurs through overcoming emotional avoidance and demoralization, increasing distress tolerance, differentiation of core painful feelings, articulation of unmet needs; and generation of adaptive emotions such as boundary setting anger and self-compassion. Implications for practice in a cancer context are discussed in terms of case conceptualisation and therapeutic strategy. Further investment in the clinical development and research of emotion-focused therapy in psycho-oncology may prove informative and supportive in efforts to widen the evidence base and the choice of clinical treatment available to patients with cancer and comorbid anxiety and depressive disorders. [ABSTRACT FROM AUTHOR]

Sentinel lymph node biopsy (SLNB) is a standard in diagnostic and therapeutic management of patients with nonadvanced invasive breast cancer. The aim of this paper was to evaluate the clinical importance of the failure of sentinel lymph node (SLN) identification during SLNB performed to spare axillary lymph nodes. A total of 5396 patients with invasive breast cancer qualified for SLNB, treated in a period from Jan 2004 to June 2018. All cases of the failure of SLN identification and reasons underlying this situation were analyzed retrospectively. In 196 (3.6%) patients, SLN was not identified (group I), and this resulted in a simultaneous axillary lymph node dissection. 48.5% patients from this group were diagnosed with cancer metastases to lymph nodes (vs 23.6% patients with SLN removed—group II, P <.00001)—stage pN1 in 44.2% of the cases, stage pN2 in 22.1% of the cases, and pN3 in 33.7% (in group II—73.4%, 19.5% and 7.1%, respectively), with a presence of extracapsular infiltration in 68.4% patients (vs 41.7% in group II) and with a significantly higher percentage of micrometastatic nature in group II (17.0%, vs 3.2% in group I). The failure of intraoperative sentinel lymph node mapping indicates a significantly increased risk of breast cancer metastases to the axillary lymph system. At the same time, it can also indicate higher cancer stage and its increased aggressiveness. For this reason, in such situation performance of axillary lymph node dissection still appears to be the approach most advantageous for patients. [ABSTRACT FROM AUTHOR]

Background: Value of information (VOI) analysis often requires modeling to characterize and propagate uncertainty. In collaboration with a cancer clinical trial group, we integrated a VOI approach to assessing trial proposals.Objective: This paper aims to explore the impact of modeling choices on VOI results and to share lessons learned from the experience.Methods: After selecting two proposals (A: phase III, breast cancer; B: phase II, pancreatic cancer) for in-depth evaluations, we categorized key modeling choices relevant to trial decision makers (characterizing uncertainty of efficacy, evidence thresholds to change clinical practice, and sample size) and modelers (cycle length, survival distribution, simulation runs, and other choices). Using a $150,000 per quality-adjusted life-year (QALY) threshold, we calculated the patient-level expected value of sample information (EVSI) for each proposal and examined whether each modeling choice led to relative change of more than 10% from the averaged base-case estimate. We separately analyzed the impact of the effective time horizon.Results: The base-case EVSI was $118,300 for Proposal A and $22,200 for Proposal B per patient. Characterizing uncertainty of efficacy was the most important choice in both proposals (e.g. Proposal A: $118,300 using historical data vs. $348,300 using expert survey), followed by the sample size and the choice of survival distribution. The assumed effective time horizon also had a substantial impact on the population-level EVSI.Conclusions: Modeling choices can have a substantial impact on VOI. Therefore, it is important for groups working to incorporate VOI into research prioritization to adhere to best practices, be clear in their reporting and justification for modeling choices, and to work closely with the relevant decision makers, with particular attention to modeling choices. [ABSTRACT FROM AUTHOR]

The 5th International Consensus Conference for Advanced Breast Cancer (ABC5) took place on November 14–16, 2019, in Lisbon, Portugal. Its aim is to standardize the treatment of advanced breast cancer based on the available evidence and to ensure that all breast cancer patients worldwide receive adequate treatment and access to new therapies. This year, the conference focused on developments and study results in the treatment of patients with hormone receptor-positive/HER2-negative breast cancer as well as precision medicine. As in previous years, patient advocates from around the world were integrated into the ABC conference and had seats on the ABC consensus panel. In the present paper, a working group of German breast cancer experts comments on the results of the on-site ABC5 consensus votes by ABC panelists regarding their applicability for routine treatment in Germany. These comments take the recommendations of the Breast Committee of the Gynecological Oncology Working Group (Arbeitsgemeinschaft Gynäkologische Onkologie; AGO) into account. The report and assessment presented here pertain to the preliminary results of the ABC5 consensus. The final version of the statements will be published in Annals of Oncology and The Breast. [ABSTRACT FROM AUTHOR]

This paper describes a series of steps taken to elevate the Hoag Breast Program to the next level. The hope is that some of our ideas will be useful to you and your breast program. [ABSTRACT FROM AUTHOR]

Introduction: The relevance of the research is on the one hand associated with improvement of medical technologies for oncological diseases treatment contributing to increasing the patients' life expectancy, which leads to an increase of the actual quantity of oncological patients. On the other hand, it is due to worsening of the quality of life of patients having malignant tumors depending both on treatment methods and the patients' mental and emotional condition. Objective: This paper is aimed at finding psychological personal determinants that create scientific bases to allow using subjective psychological factors alongside with medical practice in working with cancer patients for improving their quality of life. Methods: The leading approach to studying this problem is the systemic and subject-based approach that allows taking an integral view of subject and personal characteristics of oncological patients. Various questionnaires focused on the coping behavior, viability and control were used as psychodiagnostic techniques for assessing the subject and personal characteristics. Results: In the paper, a review of studies is presented that deal with psychological particularities of women having breast cancer, and psychological features women with breast cancer distinguishing them from healthy women are described. As a result of the research conducted, it has been found there are personal and subjective particularities of self-control, subjective control and viability in women having breast cancer distinguishing them from healthy women. Conclusion: The materials of the paper are of practical importance for practicing psychologists who monitor and adjust the treatment process both in terms of oncologists and of psychological support, which gives the opportunity to adjust treatment methods up to the patient's mental and emotional condition. [ABSTRACT FROM AUTHOR]

This paper is an overview of the current policies in the management of early breast cancer in Latin America, based on relevant papers published over the last ten years in the literature. We examine the recommendations for breast cancer diagnosis and staging, and treatment for Stage 0 through Stage IIB (T1-2, N0-1) disease. Early stage breast cancer management by the radiation oncologist may be as simple as considering breast conservative surgery followed by irradiation of the whole breast as the standard of care. However, in daily practice, different scenarios of the same disease may represent a challenge, mostly regarding regional lymph node irradiation in the presence of risk factors versus avoiding adjuvant irradiation. Each department should develop guidelines that are based on a multidisciplinary approach and it should tailor radio-therapy not only in the indication, but also in the definition of the radiation targets and respective doses. [ABSTRACT FROM AUTHOR]