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Background: Improved understanding of factors affecting the accuracy of breast MRI after NST can lead to more tailored use of MRI in deciding surgical extent after NST. Purpose: To investigate whether the accuracy of magnetic resonance imaging (MRI) and caliper predicting residual tumor extent is affected by neoadjuvant treatment in estrogen receptor (ER) positive and HER2-negative, lymph node-positive, premenopausal breast cancer breast cancer. Materials and Methods: We analyzed the imaging and clinicopathologic data of 123 patients in phase 3, randomized clinical trial (NCT01622361), which compared neoadjuvant chemotherapy (NCT) with neoadjuvant endocrine therapy (NET) in estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-), lymph node (LN)-positive, premenopausal breast cancer patients. In this study, we compared the largest size of MRI and Caliper after neoadjuvant treatment with one of pathology. Results: In patient with discrepancy in predicting response to NST, the measurement (MRI or caliper) that predict as non-response (SD or PD) was more accurate in both of NCT and NET group (ICC, Intraclass correlation coefficient, MRI; 0.84, 95% CI 0.616-0.942, Caliper;0.75, 95% CI 0.303-0.931). The accuracy of MRI was better in NCT group than in NET group (ICC 0.86; 95% CI 0.626-0.956 for NCT, 0.47; 95%CI 0.133-0.708 for NET). The mean absolute discrepancies (largest size by MRI or caliper -largest size in pathology) for the MRI and Caliper were, respectively, -0.78cm and -1.04cm in NCT group and -0.44cm and -1.32cm in NET group (p > 0.05). The proportion of discrepancy >1cm or >0.5cm were not significantly difference between NCT and NET groups among MRI and Caliper. Conclusion: In ER-positive, HER2-negative, lymph node-positive breast cancer, both MRI and caliper tend to overestimate residual tumor size than pathology in NET group compare to NCT group. When MRI and caliper show discrepancy in predicting response to NST, the measurement (MRI or caliper) that predict as non-response (SD or PD) was more accurate in both of NCT and NET group. These factors should be considered for deciding the evaluation method of response and surgical decision after NST and surgical decision in this subgroup. REGISTRATION: ClinicalTrials.gov identifier: NCT01622361 Citation Format: Sungchan Gwark, Sei Hyun Ahn, Jong Won Lee, Byung Ho Son, Beom Seok Ko, Jisun Kim, Il-Yong Chung, Sae Byul Lee, Jin-Hee Ahn, Kyung Hae Jung, Sung-Bae Kim, Hee Jin Lee, Gyungyub Gong, Hee Jeong Kim. Impact of neoadjuvant treatment on the accuracy of breast MRI and calliper in premenopausal ER-positive, HER2-negative, and node-positive breast cancer patients: Prospective phase III clinical trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-10-02.

The purpose of this study is to examine the effect of Adansonia digitata seed oil on hair damaged by bleaching. Experimental materials were prepared by treating damaged hair that had been bleached 3 times in the following 4 ways. 1) Treatment base (T0), 2) 3% Adansonia digitata seed oil treatment (T3), 3) 7% Adansonia digitata seed oil treatment (T7), 4) 3% silicone oil treatment (S3). The effect analysis before and after treatment of bleached hair was carried out in the following way. First, to measure the damaged hair, that is, to measure the porosity, the hair to be damaged was placed in a methylene blue solution. Second, to test the dynamic properties of hair, tensile strength and yield strength were measured. Finally, to observe the changes in the morphological structure of the hair surface, electric field emission scanning electron microscopy (FE-SEM) images were employed. The absorbance measurement using methylene blue showed a decrease in the average in hairs dyed with 3% and 7% of Adansonia digitata seed oil, indicating that there was a hair improvement effect in hairs dyed with Adansonia digitata seed oil. As a result of studying whether the hair bleached containing Adansonia digitata seed oil has the effect of improving hair quality, the absorption strength decreased and the tensile strength increased. In addition, absorbance measurement, gloss measurement, and FE-SEM experiments were conducted. As a result, It was confirmed that there is an effect of improving hair quality in terms of the constant arrangement of cuticles on the hair surface and increasing the gloss of the hair. It was found that Adansonia digitata seed oil, a natural ingredient, has a high effect on improving hair quality of dyed hair in order to minimize damage to bleached hair. As a result of this research, it is expected that various products will be developed using Adansonia digitata seed oil.

Breast-conserving surgery (BCS) plus radiotherapy (BCS + RT) has been shown to improve survival compared with mastectomy in patients with early breast cancer; however, whether this superiority is maintained in breast cancer patients receiving neoadjuvant chemotherapy (NCT) is unclear. We evaluated and compared the survival outcomes after BCS + RT and mastectomy in Korean women with breast cancer treated with NCT.We evaluated 1641 patients who received NCT before surgery (BCS or mastectomy). We performed propensity score matching to minimize potential bias due to factors other than the surgical method and compared the 5-year, disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates before and after exact matching.Among the 1641 patients, 839 (51.1%) underwent BCS + RT and 802 (48.9%) underwent mastectomy. Patients who underwent mastectomy had larger tumors and more frequently had positive nodes. For BCS+RT and mastectomy, the unadjusted 5-year DFS, 5-year DMFS, and 5-year OS rates were 87.0% and 73.1%, 89.5% and 77.0%, and 91.8% and 81.0%, respectively (all p0.05 = 0.000). After PSM, 5-year DFS, 5-year DMFS, and 5-year OS rates for BCS + RT and mastectomy were 87.6% and 69.1%, 89.7% and 76.0%, and 89.1% and 75.7%, respectively (all p0.05). In both unadjusted and adjusted analyses accounting for various confounding factors, BCS + RT was significantly associated with improved DFS (p0.05), DMFS (p0.05), and OS (p0.05) rates compared with mastectomy.BCS + RT does not impair DFS and OS in patients treated with NCT. Tumor biology and treatment response are significant prognostic indicators. Our results suggest that BCS + RT may be preferred in most breast cancer patients when both BCS and mastectomy are suitable.

Background Young breast cancer patients of childbearing age often had to give up their opportunity as women or mothers for cancer treatment. As the survival rate of young breast cancer patients increases with advances in early detection and treatment of breast cancer, interest in issues such as fertility preservation, which have not been satisfied so far, is increasing. This study aims to report the experience of improvement of the fertility preservation rate through a multidisciplinary team approach and systematic patient education for young breast cancer patients. Methods Patients treated with multidisciplinary team approach including surgical, medical oncologist and fertility specialist were included for analysis. Patient were divided into two periods: before and after intensive patient education. Patient education included in-person counseling, hand-out materials, and audiovisual education about ovarian dysfunctions related to cancer treatment and fertility preservation methods. We compared the rate of fertility counseling, preservation between two periods. Also, effect of hormonal receptor status on fertility outcome with pregnancy and birth were analyzed. Results The rates of fertility counseling (39.4% to 58.1%), ovarian function preservation with gonadotropin releasing hormone antagonists (37.8% to 49.7%), and either embryo (0.9% to 5.6%) or oocyte preservation (0 to 7.5%) were significantly increased (all, p< 0.001) after intensive patient education. Pregnancy (9.5% vs 14.2%, p=0.034) and birth rate (7.7% vs 12.2%, p=0.043) were significantly higher with women with negative hormone receptor status. In hormone receptor positive patients, similar pregnancy rates were observed (13.3 ~ 15.4%) in patients who complete 5yearsd of endocrine therapy, stopped endocrine therapy due to side effects, and received no endocrine therapy. Patients with any type of recurrence were not pregnant during follow up period. Patients who stopped endocrine therapy for child plan showed highest rate of pregnancy (56.0%). Multivariable analysis revealed intensive education were highly associated with improved fertility outcomes (OR 3.843 95% CI 2.781–5.311, p=< 0.001) after adjusted for different stage and treatment modality. Conclusion Multidisciplinary team approach with intensive patient education of fertility preservation in young women breast cancer significantly improved fertility preservation attempt. Hormonal receptor status and recurrence were associated with impaired fertility outcomes Citation Format: Young Joo Lee, Hayan Han, Hee Jeong Kim. Outcomes of multidisciplinary team approach and intensive patient education in young women with breast cancer to improve the rate of fertility preservation [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-01.

Purpose There are many studies reporting survival after development of contralateral breast cancer(CBC) but with inconsistent results. Also, many studies were based on European or North American population and few on Asian population. However, Korean breast cancer patients have different characteristics such as age distribution. Therefore, purpose of this study is to investigate whether development of CBC has influence on survival in Korean breast cancer population. Methods In this retrospective study, we included patients who were diagnosed with a first primary unilateral non-metastatic breast cancer at Asan Medical Center, Korea, between 1999-2013 followed through 2018. In this population, patients who delveloped CBC during the follow-up period were divided into the CBC cohort, and who did not into the non-CBC cohort. Survival of CBC cohort and non-CBC cohort was compared in the whole study population and in subgroup analysis by interval of CBC development, and breast cancer subtype. Results Over median follow-up of 107 months, 418 patients developed CBC out of 16,251 patients. Development of CBC did not influence overall survival or breast cancer-specific survival. In subgroup analysis by interval of CBC development, patients who developed CBC within one year after diagnosis of the first breast cancer had higher risk for overall death in CBC cohort (hazard ratio 2.58; 95% CI 1.28-5.18), and patients who developed CBC after one year showed no significant difference in survival compared with non-CBC cohort. In subgroup analysis by the subtype, patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative subtype for the first breast cancer showed higher risk for overall death in CBC cohort (hazard ratio 1.88; 95% CI 1.14-3.10) whereas patients with triple negative subtype for the first breast cancer showed lower risk for overall survival in CBC cohort (hazard ratio 0.42; 95% CI 0.19-0.95). Conclusion Development of CBC in Korean breast cancer patients did not have significant impact on survival. However, development of CBC early after diagnosis of first breast or having certain subtype of breast cancer may have affect on survival. Such information can be important information when counseling patients who are considering contralateral prophylactic mastectomy. Citation Format: Hakyoung Kim, Hee Jeong Kim, Yoon Tae In, Seonok Kim, Sae Byul Lee, Jisun Kim, Il-Yong Chung, Beom Seok Ko, Jong Won Lee, Byung Ho Son, Sei Hyun Ahn. Survival after Development of Contralateral Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-30.

Purpose Literature is scarce regarding cancer care utilization during the massive outbreak of coronavirus disease 2019 (COVID-19) in the Republic of Korea. We investigated functional impairments in mental health and their relationships with depression, anxiety regarding the viral epidemic, and disruptions in healthcare service utilization among cancer patients in the COVID-19 pandemic era.Materials and Methods We used an online survey with questions related to the disturbances faced by patients with cancer in utilizing healthcare services in the pandemic era. Current mental health status was assessed using the Work and Social Adjustment Scale (WSAS), Stress and Anxiety to Viral Epidemics-6 (SAVE-6) scale, Patient Health Questionnaire-9 (PHQ-9), Insomnia Severity Index (ISI), Brief Resilience Scale (BRS), Cancer-Related Dysfunctional Beliefs about Sleep Scale (C-DBS), and Fear of COVID-19 over Cancer (FCC).Results Among the 221 responders, 95 (43.0%) reported disruptions in healthcare service utilization during the COVID-19 pandemic. Logistic regression analysis revealed that functional impairment in the mental health of these patients was expected due to disruptions in healthcare service utilization, high levels of depression, anxiety regarding the viral epidemic, fear of COVID over cancer, and low resilience. Mediation analysis showed that patient resilience and cancer-related dysfunctional beliefs about sleep partially mediated the effects of viral anxiety on functional impairment.Conclusion In this pandemic era, patients with cancer experience depression, anxiety regarding the viral epidemic, and disruptions in healthcare service utilization, which may influence their functional impairments in mental health.

Background. It is well known through several studies that listening to music can reduce the anxiety of patients. However, most of the previous studies focused only on the psychological effects of patients and some physiological effects such as blood pressure, pain. Moreover, previous studies played music that is not related to personal preferences. The purpose of this study is to investigate whether reducing the patient's anxiety through music selected by patients can improve the patient's surgical experience and the relationship between the patient and doctor. Methods. We randomly assigned 304 breast cancer patients who underwent surgery between September 2020 to April 2021 into a music therapy group(MG) and a control group(CG). Among them, 290 people completed the study. MG (n = 150) listened to the patient's chosen music after entering the operating room until induction of anesthesia, while CG (n = 140) wore earmuffs for noise block in the operating room instead of music. All patients measured anxiety scores over time by numeric rating scale. Treatment satisfaction and patient-doctor depth of relationship scale(PDDRS) were also assessed after surgery. In addition, surgical satisfaction and intimacy with patients were evaluated in the surgeon. Result. The anxiety scores immediately after entering the operating room were not significantly different between the two groups(MG: 4.62 ± 2.44, CG: 4.61 ± 2.45, p = .984). However, the anxiety levels before anesthesia induction of MG patients was 3.36 ± 2.32, which was significantly lower than that of CG patients (3.90 ± 2.26) (p = .047). There was no difference between the groups in PDDRS evaluated for patients after surgery (MG: 26.25 ± 5.529, CG: 25.56 ± 5.918, p = .338) while the degree of intimacy with the patient stated by the surgeon was significantly higher in MG (MG: 7.59 ± 0.89, CG: 7.30 ± 1.05, p = .013). Satisfaction with treatment experience of patients was 18.01 ± 1.78 in MG, which was significantly higher than 17.65 ± 1.59 in CG (p = .040). Especially among the detailed items, the experience in the operating room was evaluated more positively in MG as 4.21 ± 0.79 than 3.91 ± 0.78 in CG (p = .001). The difference in the anxiety-reducing effect of music therapy in the subgroup without surgery history was larger than with a history of surgery, but there was no statistical significance. Similarly, the difference in the anxiety reduction effect in the subgroup with low preoperative anxiety level was greater than that in the subgroup with high anxiety, but this was also not statistically significant (Table 1). People evaluated the experience of surgery more positively as the degree of anxiety reduction in the operating room was greater (Spearman's correlation coefficients = -0.124, p = .035). Conclusion. Personalized selected music in the operating room before anesthesia can effectively lower the patient's anxiety and has the potential to positively change the patient’s satisfaction with surgery. Patients with no surgical history, low pre-operative anxiety can more benefit from personalized music therapy. It is expected to create an opportunity for the patient with breast cancer who anticipate receiving surgery to improve their compliance to treatment by strengthening intimacy with the surgeon. Table 1.Subgroup analysis for anxiety-reducing effect of music in operating roomGroupNMean ± SDDifference between groupP value between groupP value for interactionOverallCG140-0.71±1.560.55.005MG150-1.26±1.68Surgical historyNoCG53-0.38 ± 1.690.75.012.428MG67-1.13 ± 1.49YesCG87-0.92 ± 1.450.44.076MG83-1.36 ± 1.83Pre-Op. GAD-7< 5 pointsCG85-0.55 ± 1.470.73.003.215MG91-1.28 ± 1.57≥5 pointsCG55-0.97 ± 1.670.25.416MG59-1.22 ± 1.86 Citation Format: Yohan Joo, Seockhoon Chung, Seonok Kim, Saebyeol Lee, Sei-Hyun Ahn, Jongwon Lee, BeomSeok Ko, Jisun Kim, Il Yong Chung, Byung Ho Son, Hee Jeong Kim. The effects of preoperative personalized music therapy associated with the patient-doctor relationship and surgical experience of patients with breast cancer (MARS) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-18.

Background: According to the statistics from 2013 to 2017 at the national cancer institute, more than 30% of breast cancer patients are under the age of 54, and their children are mostly minors. Diagnosis and treatment of breast cancer have a substantial impact on the patients themselves and as caregivers, resulting in both depression and parenting stress. Although there are previous studies investigating the parenting stress in patients with cancer, the factors affecting the parenting stress and depression in young women with breast cancer still remain inconclusive. Herein, we aimed to determine the parenting stress and depression of women diagnosed with breast cancer, and to identify the risk factors. Methods: A cross-sectional survey was conducted among ​​700 patients with breast cancer who visited the breast surgery outpatient clinic in a tertiary hospital from June 2020 to April2021. The study subjects were between 20 and 45 years old at the time of cancer diagnosis. Two-hundred patients without children were included for comparison regarding depression. The center for epidemiologic studies depression scale (CES-D) was used for evaluating depression in all subjects. Five-hundred patients with children also fill out the questionnaires including parenting stress index/short Form (PSI-SF), Child behavior checklist (CBCL), Junior temperament and character inventory (JTCI), and Children’s sleep habits questionnaire(CSHQ).Results: The risk of depression was significantly higher in patients having children (odds ratio [OR], 2.261; 95% confidential interval [CI],1.009-5.063; p=0.047) and who received gonadotropin-releasing hormone agonist (GnRH)treatment (OR 1.667; 95% CI, 1.142-2.433 p=0.008). Meanwhile, longer disease duration was associated with lower risk of depression (OR 0.852; 95% CI, 0.756-0.959 p=0.008). In regards to parenting stress, clinical factors related to breast cancer such as stage and type of treatment did not show significant association. However, children factors including the age (≥ 6 years old), specific behavioral patterns, temperature, and sleep habits reported significant impact on parenting stress. The significant correlation was noted between depression score and parenting stress score (β coefficient =0.557; p Citation Format: Yungil Shin, Harin Kim, Seonok Kim, Sae Byul Lee, Jisun Kim, Il Yong Chung, Beom Seok Ko, Jong Won Lee, Byung Ho Son, Sei Hyun Ahn, Hyo-won Kim, Hee Jeong Kim. Factors affecting the parentingstressand depressioninyoung women with breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-09-03.

Background: The poor prognostic value of young age at diagnosis appears to vary according to breast cancer (BC) subtype, although this has been studied mainly in hormone receptor-positive (HR+) disease, with limited data in HER2-positive BC and short follow-up. Limited evidence exists on the benefit of anti-HER2 therapy in young women with BC. Considering that age has historically been a rationale for overtreatment, further research efforts to better investigate the prognostic and predictive value of age are needed. This exploratory analysis conducted within the APHINITY trial aimed to investigate the prognostic and predictive value of young age in patients with HER2-positive early BC treated with modern chemotherapy and concurrent anti-HER2 targeted treatment. Methods: APHINITY (NCT01358877) is an international, placebo-controlled, double-blind randomized phase III trial in patients with HER2-positive early BC investigating the benefit of adding pertuzumab to adjuvant chemotherapy plus trastuzumab. For the purpose of the present analysis, 40 years of age at enrolment was used as the cut-off to distinguish between young (≤40 years) and older (>40 years) cohorts. Invasive disease-free survival (IDFS) was the primary endpoint. IDFS irrespective of treatment arm and the benefit of adding pertuzumab were evaluated in all patients by comparing the young and older cohorts and then according to centrally-assessed hormone receptor status. Univariate and multivariable Cox proportional hazard models were used to assess the prognostic and predictive value of age on IDFS as a continuous and dichotomous variable (≤40 years and >40 years). A STEPP analysis was also conducted to illustrate possible treatment-effect heterogeneity based on age as a continuous factor. Results: Out of 4,804 patients in the ITT population, 768 (16.0%) were ≤40 years at enrollment. Patients in the young cohort were less overweight/obese (29.3% vs. 50.4%), underwent mastectomy more frequently (63.2% vs. 52.6%), had higher rates of node positive (66.4% vs. 61.8%) and HR+ (71.7% vs. 64.9%) BC as compared to those in the older cohort (all p Citation Format: Matteo Lambertini, Shona Fielding, Sibylle Loibl, Wolfgang Janni, Emma Clark, Maria Alice Franzoi, Debora Fumagalli, Carmela Caballero, Luca Arecco, Sharon Salomoni, Noam F Ponde, Francesca Poggio, Hee Jeong Kim, Cynthia Villarreal-Garza, Olivia Pagani, Shani Paluch-Shimon, Alberto Ballestrero, Lucia Del Mastro, Martine Piccart, Jose Bines, Ann H. Partridge, Evandro de Azambuja. Effect of young age at diagnosis on clinical outcomes and efficacy of anti-HER2 targeted therapy in patients with HER2-positive early breast cancer: Results from the APHINITY trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-13-42.

Purpose Women under 40 years old are at increased risk for developing human epidermal growth factor receptor 2 (HER2) positive or triple negative subtype and more advanced breast cancer, yet young age itself has also historically been an independent prognostic factor. Methods Using the Surveillance, Epidemiology, and End Results (SEER) Program, we examined data for 271,173 women with stage I-III breast cancer between 2010 and 2015. Using Fine and Gray regression models to account for competing risks, we examined the risk of breast cancer-specific death by age and clinical subtypes, considering grade, hormone receptor (HR) and HER2 status, adjusting for demographic, clinical and treatment variables. Results Of 271,173 women eligible for analysis, 14,109 were 75 had increased breast cancer mortality in all subtypes. Conclusion With modern clinical subtyping, age under 40 remains independently associated with worse outcomes in 30 months follow-up only in HR-positive, lower grade disease., Highlights • Young women present with more advanced and aggressive types of breast cancer. • Young age is not an independent prognostic factor in HER2+ breast cancer or TNBC. • Young age is independently associated with poor outcomes in HR+/lower grade disease.

Our aim was to develop a tool to accurately predict the possibility of non-sentinel lymph node metastasis (NSLNM) during surgery so that a surgeon might decide the extent of further axillary lymph node dissection intraoperatively for patients with 1–3 positive sentinel lymph node(s) (SLN) after neoadjuvant chemotherapy. After retrospective analysis of Asan Medical Center (AMC) database, we included 558 patients’ records who were treated between 2005 and 2019. 13 factors were assessed for their utility to predict NSLNM with chi-square and logistic regression with a bootstrapped, backward elimination method. Based on the result of the univariate analysis for statistical significance, number of positive SLN(s), number of frozen nodes, Progesterone Receptor (PR) positivity, clinical N stage were selected for the multivariate analysis and were utilized to generate a nomogram for prediction of residual nodal disease. The resulting nomogram was tested for validation by using a patient group of more recent, different time window at AMC. We designed a nomogram to be predictive of the NSLNM which consisted of 4 components: number of SLN(s), number of frozen nodes, PR positivity, and clinical N stage before neoadjuvant chemotherapy. The Area under the receiver operating characteristics curve (AUC) value of this formula was 0.709 (95% CI, 0.658–0.761) for development set and 0.715 (95% CI, 0.634–0.796) for validation set, respectively. This newly created AMC nomogram may provide a useful information to a surgeon for intraoperative guidance to decide the extent of further axillary surgery.