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OBJECTIVE Breast cancer is the most diagnosed cancer in females. Cancer screening programs increase the detection of early-stage breast cancer. This study aimed to assess the long-term outcomes and the effect of adjuvant therapies for recurrence in stage I breast cancer patients. METHODS We recorded clinicopathological and treatment features of the stage I breast cancer patients and evaluated long-term outcomes retrospectively. Kaplan-Meier analysis and Cox regression analysis were used for recurrence and overall survival. RESULTS 308 patients with stage I breast cancer were involved in the study. The average age was 52 (range 21-81). The median follow-up was 99 (12-380) months. Forty-three (14%) patients were aged over 65, and 162 (52.7%) patients were postmenopausal. ER, PR, and HER2 receptor positivity were 78.9%, 60.8%, and 14.3%, respectively. Lumpectomy plus adjuvant radiotherapy was performed in 82.1% of the patients, and mastectomy in 10.7% of the patients for primary treatment. The patients received adjuvant chemotherapy (42.5%) and adjuvant hormonal therapy (79.9%). Recurrence (local-47.8%, metastatic-52.2%) occurred in 23 (7.5%) patients. In multivariate Cox regression analysis, we found that primary treatment (lumpectomy + adjuvant RT or mastectomy) (p=0.614), surgical margin status (p=0.495), adjuvant chemotherapy (p=0.259), and adjuvant hormonal therapy (p=0.289) were not statistically significant factors for recurrence. However, aged over 65 years (p=0.002) was statistically significant. CONCLUSION In this study, we showed long-term outcomes in stage I breast cancer patients. It was shown that the primary treatment type (lumpectomy + adjuvant RT or mastectomy) was not different in terms of recurrence. In addition, it was determined that adjuvant chemotherapy did not provide benefit for recurrence in stage I breast cancer patients in our results. For this reason, in patients with stage I cancer, more care should be taken in the decision of adjuvant therapy. [ABSTRACT FROM AUTHOR]

Objective: Differences in individual muscle/fat volumes may change the effectiveness of chemotherapy. In this study, the relationship between trunkal muscle and fat volume and body mass index (BMI) obtained before receiving neoadjuvant chemotherapy (NCT) in patients with breast cancer and complete pathological response (pCR) was investigated. Materials and Methods: The volumes of psoas, abdominal and paraspinal muscles, and trunkal subcutaneous and visceral fat were calculated using CoreSlicer AI 2.0 opensource program from the F-18 fluorodeoxyglucose positron emission tomography/computed tomography (CT) and CT images before NCT and postoperative pCR rates to NCT were recorded. Muscle/fat volumes and BMI prior to NCT were compared in terms of pathological pCR rates. Patients were followed up regularly for recurrence and survival. Results: Ninety-three patients were included with median (range) values for age, BMI, and body weights of 48 (28-72) years, 27 (16.8-51.6) kg/m2, and 71.94 (43-137) kg, respectively. The median follow-up time was 18.6 (6.7-59.6) months. No significant correlation was found between total muscle or fat volumes of patients with and without pCR. BMI [26.2 (16.8-51.6) kg/m2 vs. 24.6 (20.3-34.3) kg/m2, p = 0.03] and pCR rates in patients with low rightpsoas muscle volume [11.74 (7.03-18.51) vs. 10.2 (6.71-13.36), p = 0.025] were significantly greater. A significant relationship was found between right psoas muscle volume and disease-free survival (DFS) (11.74 cm3 (7.03-18.51) vs. 10.2 cm3 (6.71-13.36), p = 0.025). However, no significant relationship was detected between total muscle-fat volume, BMI and overall survival and DFS (p>0.05). Conclusion: This is the first published study investigating the relationship between the pCR ratio and body muscle and fat volume measured by CoreSlicer AI 2.0 in patients with breast cancer who received NCT. No correlation was found between the pCR ratio and total muscle plus fat volume. However, these results need to be validated with larger patient series. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the possible relationship between breast cancer-related lymphedema and central obesity, which is known to be effective in metabolic syndrome and chronic inflammation. Methods and Results: Thirty-six patients (18 lymphedemas, 18 control) enrolled in the study. There was no statistically significant difference in demographic data between the two groups except body mass index (BMI) distribution (p = 0.008). Although 50% of the patients in the study group were obese, this rate was 5.6% in the control group. Although there was a significant difference between the study and control groups in terms of abdominal circumference measurement, there was no significant difference between total and abdominal fat amount and ratios. When BMI and abdominal circumference measurements were evaluated together to predict lymphedema, the area under the curve in abdominal circumference measurement was higher than BMI (0.715 vs. 0.659). In receiver operating characteristic curve analysis, 107 cm of abdominal circumference measurement was determined as cutoff value for lymphedema, with 55% sensitivity and 89% specificity (Youden index: 0.44). Conclusion: Abdominal circumference measurement can be evaluated together with BMI in determining the risk of lymphedema. [ABSTRACT FROM AUTHOR]

Objective: In the phase of diagnosis and treatment of breast cancer cases, patients can usually experience sexual dysfunctions, sleep disorders and psychiatric disorders such as anxiety and depression. The main objective of our research is to study of the pre-treatment and post-treatment anxiety, depression, sleep and sexual function levels in the patients with breast cancer. Materials and Methods: Fifty-six patients with breast cancer and 52 healthy women have participated in our study. In order to determine the anxiety, depression, sleep and sexual function levels, Sociodemographic and Clinical Data Form, Hospital Anxiety Depression Scale (HADS), Pittsburgh Sleep Quality Scale (PSQI) and Arizona Sexual Experiences Scale (ASEX) scores are utilized at pre-treatment and post-treatment phases for patients with breast cancer and our control group. Results: According to scale scores applied to patients and control group, it has been determined that patients with breast cancer HADS sexual and sleep disorders, that their HADS and PSQI scores were higher and that ASEX scores decreased significantly (p<0.05). According to the scale scores calculated before and after treatment, there was a significant decrease in HADS and PSQI scores, whereas SEX scores have been increased significantly (p<0.05). Conclusion: According to the findings of our study, anxiety, depression, sexual dysfunction and sleep disorders in patients with breast cancer are far more explicit in the pre-treatment phase than post-treatment phase. Therefore, it is crucial to psycho-socially support patients with breast cancer in the early periods before starting the treatment after diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Premenopausal women with breast cancer are at risk of developing ovarian failure after chemotherapy. The aim of this study was to investigate the negative effects of systemic chemotherapy on ovarian function in premenoupausal women with breast cancer. Materials and Methods: Thirty-one premenopausal women with operable breast cancer aged between 26-48 years were enrolled in this prospective cohort study to investigate preliminary results. Additional 69 patients' data will be included after the completion of all five measurements. The change in serum Antimullerian Hormone (AMH) levels, mean ovarian volumes (MOV) and antral follicle counts (AFCs) at 3-month intervals were recorded to evaluate ovarian function. Women who had at least one pretreatment and four post-treatment measurements in one year follow-up period were included in the study. Decision of chemotherapy regimen was taken by the Tumor Board. Results: Thirty-one patients had all five AMH, MOV and AFCs results. There was a statistically significant negative correlation between 1st - 5th AMH levels (p=0.006) and 1st - 5th AFCs during the follow-up period (p<0.0001). However pre- and post-chemotherapy measurements of MOVs did not demonstrate any significant correlation (p=0.799). BMI, parity, lactation, histopathology and molecular subtypes of breast cancer, alcohol intake, smoking and type of chemotherapy regimen were not significantly correlated with AMH, AFC and MOV. Conclusion: Pretreatment AMH levels and AFC were shown to have a significant role in early prediction of ovarian-reserve after chemotherapy. [ABSTRACT FROM AUTHOR]

Objective: We aimed to compare visual and quantitative measurements of breast density and to reveal the density profile with compression characteristics. Materials and Methods: Screening mammograms of 1399 women between May 2014 and May 2015 were evaluated by using Volpara 4th and 5th version. First 379 mammograms were assessed according to ACR BI-RADS 4th edition and compared to Volpara. We categorized the breast density in two subgroups as dens or non-dens. Two radiologists reviewed the images in consensus. Agreement level between visual and volumetric methods and volumetric methods between themselves assessed using weighted kappa statistics. Volpara data such as fibroglandular volume (FGV), breast volume (BV), compression thickness (CT), compression force (CF), compression pressure (CP) were also analyzed with relation to the age. Results: 1399 mammograms were distributed as follows: 12.7% VDG1, 39.3% VDG2, 34.1% VDG3, 13.9% VDG4 according to the 4th edition of Volpara; 1.2% VDG1, 46% VDG2, 36.8% VDG3, 15.9% VDG4 according to the 5th edition of Volpara. The difference between two editions was 4.7% increase in dense category. 379 mammograms, according to ACR BI-RADS 4th edition, were distributed as follows: 25.9% category A, 50.9% category B, 19.8% category C, 3.4% category D. The strength of agreement between the Volpara 4th and 5th editions was found substantial (k=0.726). The agreements between visual assessment and both Volpara editions were poor (k=- 0.413, k=-0.399 respectively). There was a 142% increase in dense group with the VDG 4th edition and 162% with the VDG 5th edition when compared to visual assessment. Compression force decreased while compression pressure increased with increasing Volpara Density Grade (VDG) (p for trend <0.001 for both). Compression thickness and breast volume decreased with increasing VDG (p for trend <0.001 for both). The FGV decreases with age and the breast volume increases with increasing age (p<0.001). Conclusion: Visual assessment of breast density doesn't correlate well with volumetric assessments. Obtaining additional information about physical parameters and breast profile by the results of quantified methods is important for breast cancer risk assessments and prevention strategies. [ABSTRACT FROM AUTHOR]

Objective: Breast cancer is the most common type of cancer and the leading cause of cancer-related deaths in women in Turkey. This study presents the characteristics of patients registered in National Breast Cancer Registry Program of Turkish Federation of Breast Diseases Societies. Materials and Methods: The registry contains 242 variables under 10 categories and 699 questions. Patients were recorded (online and offline) from nationwide breast centers around Turkey. Results: Twenty-thousand patients were registered between May 2005 and April 2017 at 36 centers. After data cleaning, 19,503 women were included in the study. The median age at diagnosis was 51 [14-97]; 17.2% were younger than 40 and 37.2% were premenopausal; 13.6% were nulliparous. Breast conserving surgery rate was 39.3%. Histopathology was invasive ductal cancer in 77%. Majority of patients had stage II cancer (48.3%). Estrogen, progesterone and HER-2 receptor positivity rates in invasive breast cancer were 72.5%, 62.5% and 21.8%, respectively. The mean tumor diameter was 2.5±1.7 cm. During the mean 51.6 months of follow-up, the local/regional and systemic recurrence rates were 3.7% and 5.2%, respectively; five and 10-year overall survival rates were 86% and 76%. Conclusion: Despite increasing number of screening centers and free-of-charge mammography (ages 40 to 69) and mobile screening systems in recent years, a significant portion of patients were diagnosed at advanced stage due to lack of breast cancer awareness. In contrast with the study published 5 years ago, there was a decrease in the rate of pre-menopausal women and an increase in the breast conserving surgery. [ABSTRACT FROM AUTHOR]

Objective: Breast cancer is a heterogenous disease, and genetic profiling helps to individualize adjuvant treatment. The Oncotype DX is a validated test to predict benefit of adjuvant systemic treatment. The aims of this study are to determine the costs of chemotherapy in government hospitals in Turkey and evaluate the cost-effectiveness of the Oncotype DX from the national insurance perspective. Materials and Methods: A Markov model was developed to make long term projections of distant recurrence, survival, quality adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative or up to 3 node-positive early stage breast cancer. Turkish decision impact study patient data were captured for model reference. In that study, ten academic centers across Turkey participated in a prospective trial. Of 165 patients with pT1-3, pN0-N1mic, ER-positive, and HER-2 negative tumors, 57% had low recurrence score (RS), 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in chemotherapy treatment decisions following Oncotype DX was 33%. Results: The cost of adjuvant chemotherapy in public hospitals was estimated at $3.649, and Oncotype Dx test was $5.141. Based on the costeffectiveness analysis, Oncotype DX testing was estimated to improve life expectancy (+0.86 years) and quality-adjusted life expectancy (+0.68 QALYs) versus standard care. The incremental cost-effectiveness ratio (ICERs) of Oncotype DX was estimated to be $7207.9 per QALY gained and $5720.6 per LY gained versus current clinical practice. Conclusion: As Oncotype DX was found both cost-effective and life-saving from a national perspective, the test should be introduced to standard care in patients with ER+, HER-2 negative early-stage breast cancer in Turkey. [ABSTRACT FROM AUTHOR]

Objective: Hamartomas are rare, slowly-growing breast tumours. Clinical, radiological and histopathological examination together increase the diagnostic accuracy. To evaluate the clinicopathologic features of hamartomas and outline our clinical approach to hamartomas in our 20-year experience at our Breast Clinic. Materials and Methods: Between 1995 and 2015, 24 cases were retrospectively analyzed with a diagnosis of breast hamartoma at our Breast Clinic followed by excisional biopsy. Data was obtained on patient demographics, clinical examination, radiological findings and histopathological subtypes. Results: Of 1338 benign breast tumours excised from January 1995 to January 2015, 24 (1.8%) were identified as breast hamartoma. Median age of patients was 42 (range, 13-70), whereas the median tumour size was 5 cm (1-10 cm). On preoperative imaging, hamartoma was most commonly misdiagnosed as fibroadenoma. Pathological examination of the 24 biopsy specimens revealed 3 cases with pseudoangiomatous stromal hyperplasia, and another hamartoma associated with a radial scar within the centre of the lesion. Of those, one patient was diagnosed with malignant phylloides tumour in the same breast. At a median follow-up 58.4 months, none of the patients recurred or developed malignancy. Conclusion: Hamartomas can often be missed by clinicians, due to its benign nature which is poorly understood. Despite their slow growth, hamartomas can reach large sizes and can cause breast asymmetry. Although it is rare, hamartoma can be seen along with malignancy, as it is formed from similar components of breast tissue. Therefore, careful diagnosis and appropriate management including surgery are required. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the effect of mini latissimus dorsi flap (MLDF) reconstruction on ipsilateral shoulder functions. Materials and Methods: Those included in the study are the patients aged between 23 and 73, who were operated with the diagnosis of early breast cancer (cT1-3)N0). The first group includes the patients who had sentinel lymph node biopsy (SLNB) with partial mastectomy. The second group consists of the patients who had axillary lymph nodule dissection (ALND) with partial mastectomy. The third group includes the patients who had SLNB and MLDF with partial mastectomy. The fourth group includes the patients who had ALND and MLDF with partial mastectomy. Patients' Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score work model point were recorded. Results: 174 patients were included in this study. According to Q-DASH score, no functional change was detected in 69.5% of the patients, whereas slight functional loss was identified in 23.6%, moderate functional loss in 5.7%, severe functional loss 1.1%. In the comparison of Q-DASH scores in surgery groups, while these four groups were being analyzed, a significant difference was determined (p=0.007). When dual analyses were made, it was also established that the difference resulted from the group to which ALND and MLDF were applied together. Conclusion: We conclude that MLDF application for reconstruction purposes after breast surgery has a negative impact on shoulder functions of the patients who had both of partial mastectomy and ALND. [ABSTRACT FROM AUTHOR]