Editorial

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6 pages, 247 KiB

Open AccessEditorial

Personalized Approaches for the Prevention and Treatment of Breast Cancer

by Hermann Nabi

J. Pers. Med. 2022, 12(8), 1201; https://doi.org/10.3390/jpm12081201 - 23 Jul 2022

Viewed by 1275

Abstract

Breast cancer (BC) remains a major public health issue worldwide [...] Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

Research

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13 pages, 844 KiB

Open AccessArticle

Canadian Healthcare Professionals’ Views and Attitudes toward Risk-Stratified Breast Cancer Screening

by Julie Lapointe, Jean-Martin Côté, Cynthia Mbuya-Bienge, Michel Dorval, Nora Pashayan, Jocelyne Chiquette, Laurence Eloy, Annie Turgeon, Laurence Lambert-Côté, Jennifer D. Brooks, Meghan J. Walker, Kristina Maria Blackmore, Yann Joly, Bartha Maria Knoppers, Anna Maria Chiarelli, Jacques Simard and Hermann Nabi

J. Pers. Med. 2023, 13(7), 1027; https://doi.org/10.3390/jpm13071027 - 21 Jun 2023

Viewed by 1172

Abstract

Given the controversy over the effectiveness of age-based breast cancer (BC) screening, offering risk-stratified screening to women may be a way to improve patient outcomes with detection of earlier-stage disease. While this approach seems promising, its integration requires the buy-in of many stakeholders. [...] Read more.

Given the controversy over the effectiveness of age-based breast cancer (BC) screening, offering risk-stratified screening to women may be a way to improve patient outcomes with detection of earlier-stage disease. While this approach seems promising, its integration requires the buy-in of many stakeholders. In this cross-sectional study, we surveyed Canadian healthcare professionals about their views and attitudes toward a risk-stratified BC screening approach. An anonymous online questionnaire was disseminated through Canadian healthcare professional associations between November 2020 and May 2021. Information collected included attitudes toward BC screening recommendations based on individual risk, comfort and perceived readiness related to the possible implementation of this approach. Close to 90% of the 593 respondents agreed with increased frequency and earlier initiation of BC screening for women at high risk. However, only 9% agreed with the idea of not offering BC screening to women at very low risk. Respondents indicated that primary care physicians and nurse practitioners should play a leading role in the risk-stratified BC screening approach. This survey identifies health services and policy enhancements that would be needed to support future implementation of a risk-stratified BC screening approach in healthcare systems in Canada and other countries. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

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16 pages, 1229 KiB

Open AccessArticle

Adjuvant Whole Breast Radiotherapy Improve Survival in Women with Heart Failure with Reduced Ejection Fraction Receiving Breast-Conserving Surgery

by Jiaqiang Zhang, Shao-Yin Sum, Jeng-Guan Hsu, Ming-Feng Chiang, Tian-Shyug Lee and Szu-Yuan Wu

J. Pers. Med. 2021, 11(12), 1358; https://doi.org/10.3390/jpm11121358 - 13 Dec 2021

Cited by 3 | Viewed by 1936

Abstract

Background: to date, no data on the effect of adjuvant whole breast radiotherapy (WBRT) on oncologic outcomes, such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM), are available in women with left-side breast invasive ductal carcinoma (IDC) and heart failure with [...] Read more.

Background: to date, no data on the effect of adjuvant whole breast radiotherapy (WBRT) on oncologic outcomes, such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM), are available in women with left-side breast invasive ductal carcinoma (IDC) and heart failure with reduced ejection fraction (HFrEF). Patients and Methods: we included 294 women with left-breast IDC at clinical stages IA–IIIC and HFrEF receiving breast-conserving surgery (BCS) followed by adjuvant WBRT or non-adjuvant WBRT. We categorized them into two groups based on their adjuvant WBRT status and compared their overall survival (OS), LRR, and DM outcomes. We calculated the propensity score and applied inverse probability of treatment weighting (IPTW) to create a pseudo-study cohort. Furthermore, we performed a multivariate analysis of the propensity score–weighted population to obtain hazard ratios (HRs). Results: in the IPTW-adjusted model, adjuvant WBRT (adjusted HR [aHR]: 0.60; 95% confidence interval [CI]: 0.44–0.94) was a significant independent prognostic factor for all-cause death (p = 0.0424), and the aHR (95% CI) of LRR and DM for adjuvant WBRT was 0.33 (0.24–0.71; p = 0.0017) and 0.37 (0.22–0.63; p = 0.0004), respectively, compared with the non-adjuvant WBRT group. Conclusion: Adjuvant WBRT was associated with a decrease in all-cause death, LRR, and DM in women with left IDC and HFrEF compared with non-adjuvant WBRT. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

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16 pages, 434 KiB

Open AccessArticle

A Focus Group Study of Perceptions of Genetic Risk Disclosure in Members of the Public in Sweden: “I’ll Phone the Five Closest Ones, but What Happens to the Other Ten?”

by Carolina Hawranek, Senada Hajdarevic and Anna Rosén

J. Pers. Med. 2021, 11(11), 1191; https://doi.org/10.3390/jpm11111191 - 12 Nov 2021

Cited by 4 | Viewed by 3600

Abstract

This study explores perceptions and preferences on receiving genetic risk information about hereditary cancer risk in members of the Swedish public. We conducted qualitative content analysis of five focus group discussions with participants (n = 18) aged between 24 and 71 years, [...] Read more.

This study explores perceptions and preferences on receiving genetic risk information about hereditary cancer risk in members of the Swedish public. We conducted qualitative content analysis of five focus group discussions with participants (n = 18) aged between 24 and 71 years, recruited from various social contexts. Two prominent phenomena surfaced around the interplay between the three stakeholders involved in risk disclosure: the individual, healthcare, and the relative at risk. First, there is a genuine will to share risk information that can benefit others, even if this is difficult and causes discomfort. Second, when the duty to inform becomes overwhelming, compromises are made, such as limiting one’s own responsibility of disclosure or projecting the main responsibility onto another party. In conclusion, our results reveal a discrepancy between public expectations and the actual services offered by clinical genetics. These expectations paired with desire for a more personalized process and shared decision-making highlight a missing link in today’s risk communication and suggest a need for developed clinical routines with stronger healthcare–patient collaboration. Future research needs to investigate the views of genetic professionals on how to address these expectations to co-create a transparent risk disclosure process which can realize the full potential of personalized prevention. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

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11 pages, 280 KiB

Open AccessArticle

Identifying Clinicopathological Factors Associated with Oncotype DX^® 21-Gene Recurrence Score: A Real-World Retrospective Cohort Study of Breast Cancer Patients in Quebec City, Canada

by Simon Gagnet, Caroline Diorio, Louise Provencher, Cynthia Mbuya-Bienge, Julie Lapointe, Claudya Morin, Julie Lemieux and Hermann Nabi

J. Pers. Med. 2021, 11(9), 858; https://doi.org/10.3390/jpm11090858 - 28 Aug 2021

Cited by 4 | Viewed by 2134

Abstract

Gene expression profiling tests such as the Oncotype DX (ODX) 21-gene recurrence score (RS) assay is increasingly used in clinical practice to predict the risk of recurrence and support treatment planning for early-stage breast cancer (BC). However, this test has some disadvantages such [...] Read more.

Gene expression profiling tests such as the Oncotype DX (ODX) 21-gene recurrence score (RS) assay is increasingly used in clinical practice to predict the risk of recurrence and support treatment planning for early-stage breast cancer (BC). However, this test has some disadvantages such as a high cost and a long turnaround time to get results, which may lead to disparities in access. We aim to identify clinicopathological factors associated with ODX RS in women with early-stage BC. We conducted a retrospective cohort study of women identified in the medical database of the Deschênes-Fabia Breast Disease Center of Quebec City University, Canada. Our sample consists of 425 women diagnosed with early-stage BC who have obtained an ODX RS between January 2011 and April 2015. The ODX RS has been categorized into three levels as originally defined: low (0–17), intermediate (18–30), and high (>30). The mean RS was 17.8 (SD = 9.2). Univariate analyses and multinomial logistic regressions were performed to identify factors associated with intermediate and high RS compared with low RS. A total of 237 (55.8%) patients had low RS, 148 (34.8%) had intermediate RS, and 40 (9.4%) had high RS. Women with progesterone receptor (PR)-negative (ORs ranging from 3.51 to 10.34) and histologic grade II (ORs ranging from 3.16 to 23.04) tumors were consistently more likely to have intermediate or high RS than low RS. Similar patterns of associations were observed when the RS was categorised using redefined thresholds from (i.e., from the TAILORx study or dichotomized). This study provides evidence suggesting that histologic grade and PR status are predictive factors for intermediate or high RS in women with early-stage BC. If these results are confirmed in future studies, considering these clinicopathological factors could spare women the need to get such a test before the beginning of a possible adjuvant therapy. This option could be considered in settings where the cost of testing is an issue. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

13 pages, 982 KiB

Open AccessArticle

Association of Breast Tumour Expression of Cannabinoid Receptors CBR1 and CBR2 with Prognostic Factors and Survival in Breast Cancer Patients

by Jessica Morin-Buote, Kaoutar Ennour-Idrissi, Éric Poirier, Julie Lemieux, Daniela Furrer, Anna Burguin, Francine Durocher and Caroline Diorio

J. Pers. Med. 2021, 11(9), 852; https://doi.org/10.3390/jpm11090852 - 28 Aug 2021

Cited by 4 | Viewed by 2102

Abstract

Cannabinoid receptors (CBR) are potential therapeutic targets for breast cancer. However, the role of CBR in breast cancer survival remains poorly understood. Data from a prospective cohort of 522 women diagnosed with invasive breast cancer between 2010 and 2012 were analysed. Clinical and [...] Read more.

Cannabinoid receptors (CBR) are potential therapeutic targets for breast cancer. However, the role of CBR in breast cancer survival remains poorly understood. Data from a prospective cohort of 522 women diagnosed with invasive breast cancer between 2010 and 2012 were analysed. Clinical and pathological features were retrieved from electronic medical records. CBR expression was measured by immunohistochemistry. Adjusted partial Spearman correlations and multivariate Cox models were used to estimate associations with breast cancer prognostic factors and survival, respectively. The median follow-up was 92.0 months (range 7.0–114.0). CBR expression was heterogenous in tumours. Cytoplasmic expression of CBR1 was positively correlated with lymph node invasion (r_s = 0.110; p = 0.0155) and positive status of the human epidermal growth factor receptor 2 (HER2) (r_s = 0.168; p = 0.0002), while nuclear CBR2 was negatively correlated with grade (r_s = −0.171; p = 0.0002) and positively correlated with oestrogen receptor and progesterone receptor-positive status (r_s = 0.173; p = 0.0002 and r_s = 0.121; p = 0.0084, respectively). High cytoplasmic expression of CBR2 was associated, with 13% higher locoregional and distant recurrences (HR = 1.13 [0.97–1.33]), though this association did not reach statistical significance. Although the few events occurring during follow-up may have limited the detection of significant associations, these results indicate that CBR expression in breast cancer deserves further investigation. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

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15 pages, 291 KiB

Open AccessArticle

Risk-Stratified Approach to Breast Cancer Screening in Canada: Women’s Knowledge of the Legislative Context and Concerns about Discrimination from Genetic and Other Predictive Health Data

by Samuel Alarie, Julie Hagan, Gratien Dalpé, Sina Faraji, Cynthia Mbuya-Bienge, Hermann Nabi, Nora Pashayan, Jennifer D. Brooks, Michel Dorval, Jocelyne Chiquette, Laurence Eloy, Annie Turgeon, Laurence Lambert-Côté, Jean-Sébastien Paquette, Meghan J. Walker, Julie Lapointe, Palmira Granados Moreno, Kristina Blackmore, Michael Wolfson, Mireille Broeders, The PERSPECTIVE I&I Study Group, Bartha M. Knoppers, Anna M. Chiarelli, Jacques Simard and Yann Joly Show full author list Hide full author list

J. Pers. Med. 2021, 11(8), 726; https://doi.org/10.3390/jpm11080726 - 27 Jul 2021

Cited by 5 | Viewed by 2424

Abstract

The success of risk-stratified approaches in improving population-based breast cancer screening programs depends in no small part on women’s buy-in. Fear of genetic discrimination (GD) could be a potential barrier to genetic testing uptake as part of risk assessment. Thus, the objective of [...] Read more.

The success of risk-stratified approaches in improving population-based breast cancer screening programs depends in no small part on women’s buy-in. Fear of genetic discrimination (GD) could be a potential barrier to genetic testing uptake as part of risk assessment. Thus, the objective of this study was twofold. First, to evaluate Canadian women’s knowledge of the legislative context governing GD. Second, to assess their concerns about the possible use of breast cancer risk levels by insurance companies or employers. We use a cross-sectional survey of 4293 (age: 30–69) women, conducted in four Canadian provinces (Alberta, British Colombia, Ontario and Québec). Canadian women’s knowledge of the regulatory framework for GD is relatively limited, with some gaps and misconceptions noted. About a third (34.7%) of the participants had a lot of concerns about the use of their health information by employers or insurers; another third had some concerns (31.9%), while 20% had no concerns. There is a need to further educate and inform the Canadian public about GD and the legal protections that exist to prevent it. Enhanced knowledge could facilitate the implementation and uptake of risk prediction informed by genetic factors, such as the risk-stratified approach to breast cancer screening that includes risk levels. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

20 pages, 200391 KiB

Open AccessArticle

Quantitative Measurement of Breast Tumors Using Intravoxel Incoherent Motion (IVIM) MR Images

by Si-Wa Chan, Wei-Hsuan Hu, Yen-Chieh Ouyang, Hsien-Chi Su, Chin-Yao Lin, Yung-Chieh Chang, Chia-Chun Hsu, Kuan-Wen Chen, Chia-Chen Liu and Sou-Hsin Chien

J. Pers. Med. 2021, 11(7), 656; https://doi.org/10.3390/jpm11070656 - 13 Jul 2021

Cited by 4 | Viewed by 2177

Abstract

Breast magnetic resonance imaging (MRI) is currently a widely used clinical examination tool. Recently, MR diffusion-related technologies, such as intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI), have been extensively studied by breast cancer researchers and gradually adopted in clinical practice. In this study, [...] Read more.

Breast magnetic resonance imaging (MRI) is currently a widely used clinical examination tool. Recently, MR diffusion-related technologies, such as intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI), have been extensively studied by breast cancer researchers and gradually adopted in clinical practice. In this study, we explored automatic tumor detection by IVIM-DWI. We considered the acquired IVIM-DWI data as a hyperspectral image cube and used a well-known hyperspectral subpixel target detection technique: constrained energy minimization (CEM). Two extended CEM methods—kernel CEM (K-CEM) and iterative CEM (I-CEM)—were employed to detect breast tumors. The K-means and fuzzy C-means clustering algorithms were also evaluated. The quantitative measurement results were compared to dynamic contrast-enhanced T1-MR imaging as ground truth. All four methods were successful in detecting tumors for all the patients studied. The clustering methods were found to be faster, but the CEM methods demonstrated better performance according to both the Dice and Jaccard metrics. These unsupervised tumor detection methods have the advantage of potentially eliminating operator variability. The quantitative results can be measured by using ADC, signal attenuation slope, D*, D, and PF parameters to classify tumors of mass, non-mass, cyst, and fibroadenoma types. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

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14 pages, 4380 KiB

Open AccessArticle

Toward a Population-Based Breast Cancer Risk Stratification Approach? The Needs and Concerns of Healthcare Providers

by Jolyane Blouin-Bougie, Nabil Amara and Jacques Simard

J. Pers. Med. 2021, 11(6), 540; https://doi.org/10.3390/jpm11060540 - 10 Jun 2021

Cited by 9 | Viewed by 2585

Abstract

Given the expanding knowledge base in cancer genomics, risk-based screening is among the promising avenues to improve breast cancer (BC) prevention and early detection at the population level. Semi-structured interviews were conducted to explore the perceptions of healthcare professionals (HPs) regarding the implementation [...] Read more.

Given the expanding knowledge base in cancer genomics, risk-based screening is among the promising avenues to improve breast cancer (BC) prevention and early detection at the population level. Semi-structured interviews were conducted to explore the perceptions of healthcare professionals (HPs) regarding the implementation of such an approach and identify tools that can support HPs. After undertaking an in-depth thematic content analysis of the responses, 11 themes were identified. These were embedded into a logical model to distinguish the potential eligible participants (who?), the main clinical activities (how?) and associated tools (what?), the key factors of acceptability (which?), and the expected effects of the strategy (why?). Overall, it was found that the respondents positively welcomed the implementation of this strategy and agreed on some of the benefits that could accrue to women from tailored risk-based screening. Some important elements, however, deserve clarification. The results also highlight three main conditions that should be met to foster the acceptability of BC risk stratification: respecting the principle of equity, paying special attention to knowledge management, and rethinking human resources to capitalize on the strengths of the current workforce. Because the functioning of BC risk-based screening is not yet well defined, important planning work is required before advancing this organizational innovation, and outstanding issues must be resolved to get HPs on board. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

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20 pages, 1206 KiB

Open AccessArticle

Women’s Views on Multifactorial Breast Cancer Risk Assessment and Risk-Stratified Screening: A Population-Based Survey from Four Provinces in Canada

by Cynthia Mbuya Bienge, Nora Pashayan, Jennifer D. Brooks, Michel Dorval, Jocelyne Chiquette, Laurence Eloy, Annie Turgeon, Laurence Lambert-Côté, Jean-Sébastien Paquette, Emmanuelle Lévesque, Julie Hagan, Meghan J. Walker, Julie Lapointe, Gratien Dalpé, Palmira Granados Granados Moreno, Kristina Blackmore, Michael Wolfson, Yann Joly, Mireille Broeders, Bartha M. Knoppers, Anna M. Chiarelli, Jacques Simard and Hermann Nabi Show full author list Hide full author list

J. Pers. Med. 2021, 11(2), 95; https://doi.org/10.3390/jpm11020095 - 02 Feb 2021

Cited by 29 | Viewed by 3488

Abstract

Risk-stratified screening for breast cancer (BC) is increasingly considered as a promising approach. However, its implementation is challenging and needs to be acceptable to women. We examined Canadian women’s attitudes towards, comfort level about, and willingness to take part in BC risk-stratified screening. [...] Read more.

Risk-stratified screening for breast cancer (BC) is increasingly considered as a promising approach. However, its implementation is challenging and needs to be acceptable to women. We examined Canadian women’s attitudes towards, comfort level about, and willingness to take part in BC risk-stratified screening. We conducted an online survey in women aged 30 to 69 years in four Canadian provinces. In total, 4293 women completed the questionnaire (response rate of 63%). The majority of women (63.5% to 72.8%) expressed favorable attitudes towards BC risk-stratified screening. Most women reported that they would be comfortable providing personal and genetic information for BC risk assessment (61.5% to 67.4%) and showed a willingness to have their BC risk assessed if offered (74.8%). Most women (85.9%) would also accept an increase in screening frequency if they were at higher risk, but fewer (49.3%) would accept a reduction in screening frequency if they were at lower risk. There were few differences by province; however, outcomes varied by age, education level, marital status, income, perceived risk, history of BC, prior mammography, and history of genetic test for BC (all p ≤ 0.01). Risk-based BC screening using multifactorial risk assessment appears to be acceptable to most women. This suggests that the implementation of this approach is likely to be well-supported by Canadian women. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

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Review

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54 pages, 2048 KiB

Open AccessReview

Breast Cancer Treatments: Updates and New Challenges

by Anna Burguin, Caroline Diorio and Francine Durocher

J. Pers. Med. 2021, 11(8), 808; https://doi.org/10.3390/jpm11080808 - 19 Aug 2021

Cited by 100 | Viewed by 16477

Abstract

Breast cancer (BC) is the most frequent cancer diagnosed in women worldwide. This heterogeneous disease can be classified into four molecular subtypes (luminal A, luminal B, HER2 and triple-negative breast cancer (TNBC)) according to the expression of the estrogen receptor (ER) and the [...] Read more.

Breast cancer (BC) is the most frequent cancer diagnosed in women worldwide. This heterogeneous disease can be classified into four molecular subtypes (luminal A, luminal B, HER2 and triple-negative breast cancer (TNBC)) according to the expression of the estrogen receptor (ER) and the progesterone receptor (PR), and the overexpression of the human epidermal growth factor receptor 2 (HER2). Current BC treatments target these receptors (endocrine and anti-HER2 therapies) as a personalized treatment. Along with chemotherapy and radiotherapy, these therapies can have severe adverse effects and patients can develop resistance to these agents. Moreover, TNBC do not have standardized treatments. Hence, a deeper understanding of the development of new treatments that are more specific and effective in treating each BC subgroup is key. New approaches have recently emerged such as immunotherapy, conjugated antibodies, and targeting other metabolic pathways. This review summarizes current BC treatments and explores the new treatment strategies from a personalized therapy perspective and the resulting challenges. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

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15 pages, 316 KiB

Open AccessFeature PaperReview

Of Screening, Stratification, and Scores

by Bartha M. Knoppers, Alexander Bernier, Palmira Granados Moreno and Nora Pashayan

J. Pers. Med. 2021, 11(8), 736; https://doi.org/10.3390/jpm11080736 - 28 Jul 2021

Cited by 14 | Viewed by 3229

Abstract

Technological innovations including risk-stratification algorithms and large databases of longitudinal population health data and genetic data are allowing us to develop a deeper understanding how individual behaviors, characteristics, and genetics are related to health risk. The clinical implementation of risk-stratified screening programmes that [...] Read more.

Technological innovations including risk-stratification algorithms and large databases of longitudinal population health data and genetic data are allowing us to develop a deeper understanding how individual behaviors, characteristics, and genetics are related to health risk. The clinical implementation of risk-stratified screening programmes that utilise risk scores to allocate patients into tiers of health risk is foreseeable in the future. Legal and ethical challenges associated with risk-stratified cancer care must, however, be addressed. Obtaining access to the rich health data that are required to perform risk-stratification, ensuring equitable access to risk-stratified care, ensuring that algorithms that perform risk-scoring are representative of human genetic diversity, and determining the appropriate follow-up to be provided to stratification participants to alert them to changes in their risk score are among the principal ethical and legal challenges. Accounting for the great burden that regulatory requirements could impose on access to risk-scoring technologies is another critical consideration. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

Other

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18 pages, 1584 KiB

Open AccessFeature PaperPerspective

Personalized Risk Assessment for Prevention and Early Detection of Breast Cancer: Integration and Implementation (PERSPECTIVE I&I)

by Jennifer D. Brooks, Hermann Nabi, Irene L. Andrulis, Antonis C. Antoniou, Jocelyne Chiquette, Philippe Després, Peter Devilee, Michel Dorval, Arnaud Droit, Douglas F. Easton, Andrea Eisen, Laurence Eloy, Samantha Fienberg, David Goldgar, Eric Hahnen, Yann Joly, Bartha Maria Knoppers, Aisha Lofters, Jean-Yves Masson, Nicole Mittmann, Jean-Sébastien Paquette, Nora Pashayan, Rita Schmutzler, Tracy Stockley, Sean V. Tavtigian, Meghan J. Walker, Michael Wolfson, Anna Maria Chiarelli and Jacques Simard Show full author list Hide full author list

J. Pers. Med. 2021, 11(6), 511; https://doi.org/10.3390/jpm11060511 - 04 Jun 2021

Cited by 52 | Viewed by 9215

Abstract

Early detection of breast cancer through screening reduces breast cancer mortality. The benefits of screening must also be considered within the context of potential harms (e.g., false positives, overdiagnosis). Furthermore, while breast cancer risk is highly variable within the population, most screening programs [...] Read more.

Early detection of breast cancer through screening reduces breast cancer mortality. The benefits of screening must also be considered within the context of potential harms (e.g., false positives, overdiagnosis). Furthermore, while breast cancer risk is highly variable within the population, most screening programs use age to determine eligibility. A risk-based approach is expected to improve the benefit-harm ratio of breast cancer screening programs. The PERSPECTIVE I&I (Personalized Risk Assessment for Prevention and Early Detection of Breast Cancer: Integration and Implementation) project seeks to improve personalized risk assessment to allow for a cost-effective, population-based approach to risk-based screening and determine best practices for implementation in Canada. This commentary describes the four inter-related activities that comprise the PERSPECTIVE I&I project. 1: Identification and validation of novel moderate to high-risk susceptibility genes. 2: Improvement, validation, and adaptation of a risk prediction web-tool for the Canadian context. 3: Development and piloting of a socio-ethical framework to support implementation of risk-based breast cancer screening. 4: Economic analysis to optimize the implementation of risk-based screening. Risk-based screening and prevention is expected to benefit all women, empowering them to work with their healthcare provider to make informed decisions about screening and prevention. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

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10 pages, 5520 KiB

Open AccessCase Report

Axillary Nodal Metastases from Carcinoma of Unknown Primary (CUPAx): Role of Contrast-Enhanced Spectral Mammography (CESM) in Detecting Occult Breast Cancer

by Melania Costantini, Rino Aldo Montella, Maria Paola Fadda, Giorgia Garganese, Alba Di Leone, Alejandro Martin Sanchez, Gianluca Franceschini and Pierluigi Maria Rinaldi

J. Pers. Med. 2021, 11(6), 465; https://doi.org/10.3390/jpm11060465 - 25 May 2021

Cited by 6 | Viewed by 2495

Abstract

Axillary lymph node metastases of occult breast cancer (CUPAx) is an unusual condition that represents both a diagnostic and therapeutic challenge. The first steps in the diagnostic work-up of patients with CUPAx are the histological analysis of the lymph node metastasis and the [...] Read more.

Axillary lymph node metastases of occult breast cancer (CUPAx) is an unusual condition that represents both a diagnostic and therapeutic challenge. The first steps in the diagnostic work-up of patients with CUPAx are the histological analysis of the lymph node metastasis and the execution of basic breast diagnostic imaging (mammography and ultrasound). In the case of occult breast cancer, breast Magnetic Resonance (MR) must be performed. Breast MR identifies a suspicious lesion in many patients and second-look ultrasound detects a corresponding ultrasound alteration in about half of cases, allowing the performance of a US-guided biopsy. In the case of an MR-only lesion, MR-guided biopsy is mandatory. We present a case of CUPAx in which contrast-enhanced spectral mammography (CESM) is used to help the detection of occult breast cancer and to guide stereotactic vacuum breast biopsy (VABB). CESM is a new breast imaging technique that is proving to have good performance in breast cancer detection and that is showing potential in the identification of occult breast cancer in a CUPAx setting. The use of an innovative and personalized breast imaging approach in breast cancer patients improves diagnostic possibilities and promises to become the focus in decision strategies. Full article

(This article belongs to the Special Issue Personalized Approaches for the Prevention and Treatment of Breast Cancer)

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