ORCID Profile
0000-0002-3281-7643
Current Organisations
The University of Notre Dame
,
University of Sydney
,
Westmead Breast Cancer Institute
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Publisher: Elsevier BV
Date: 2023
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.BREAST.2017.01.015
Abstract: This study evaluated the impact of breast MRI on surgical planning in selected cases of breast malignancy (invasive cancer or DCIS). MRI was used when there was ambiguity on clinical and/or conventional imaging assessment. Consecutive women with breast malignancy undergoing breast MRI were included. Clinical, mammogram and ultrasound findings and surgical plan before and after MRI were recorded. MRI findings and histopathology results were documented and the impact of MRI on treatment planning was evaluated. MRI was performed in 181/1416 (12.8%) cases (invasive cancer 155/1219 (12.7%), DCIS 26/197 (13.2%)). Indications for MRI were: clinically dense breast tissue difficult to assess (n = 66 36.5%), discordant clinical/conventional imaging assessment (n = 61 33.7%), invasive lobular carcinoma in clinically dense breast tissue (n = 22 12.2%), palpable/mass-forming DCIS (n = 11 6.1%) other (n = 19 10.5%). The recall rate for assessment of additional lesions was 35% (63/181). Additional biopsy-proven malignancy was found in 11/29 (37.9%) ipsilateral breast recalls and 8/34 (23.5%) contralateral breast recalls. MRI detected contralateral malignancy (unsuspected on conventional imaging) in 5/179 (2.8%). The additional information from MRI changed management in 69/181 (38.1%), with more unilateral surgery (wider excision or mastectomy) in 53/181 (29.3%), change to bilateral surgery in 12/181 (6.6%), less surgery in 4/181 (2.2%). Clinical examination estimated histological size within 20 mm in 57%, conventional imaging in 55% and MRI in 71%. MRI was most likely to show concordance with histopathology in the 'discordant assessment' and 'invasive lobular' groups and less likely for 'challenging clinically dense breast tissue.' MRI changed management in 69/181 (38.1%).
Publisher: Wiley
Date: 16-02-2016
DOI: 10.1002/PON.4087
Abstract: Women with locally advanced breast cancer face many conflicting issues affecting their choice of immediate versus delayed versus no breast reconstruction (BR). This single-centre pilot study assessed high-risk women's reasons and priorities in choosing the timing and type of BR in a setting where all clinically feasible options were discussed with all women. Fifty-one women from a metropolitan breast oncology practice, who were likely to require post-mastectomy radiotherapy (PMRT), were recruited after making their decision about BR. Participants completed a questionnaire (69% preoperatively), adapted from Reaby (1998), evaluating the factors affecting their decision. Responses were subsequently classified into eight issue-based domains (feeling normal, feeling good, being practical, influence of others, expectations, fear, timing and unnecessary). Demographic and clinical data were also collected. There were 32 immediate BR (IBR = 63%), seven delayed BR (DBR = 13%) and 12 no BR (NBR = 23%). Analysis using the chi square test showed women over 60 were more likely to choose NBR (p = 0.005), while women living with a partner were more likely to choose IBR (p = 0.032). The most relevant domains for both IBR and DBR were 'feeling good' and 'feeling normal' and for NBR were 'unnecessary' and 'being practical'. Although all women understood pre-operatively the potential aesthetic limitations of PMRT, 63% still chose IBR. These data will enable clinicians, researchers and women with breast cancer to gain a clearer understanding of the factors that impact on the choice and timing of BR in women requiring PMRT, a major breast cancer survivorship decision. Copyright © 2016 John Wiley & Sons, Ltd.
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.EJSO.2013.02.021
Abstract: There is enormous range in the reported rates of breast reconstruction. This study explored reasons for this variation by reviewing the published literature to examine rates of reconstruction, factors associated with uptake, and possible barriers. A systematic review of the literature was performed. Eligible studies reported rates of breast reconstruction and variables associated with uptake in women undergoing mastectomy for early invasive or in situ breast malignancy. Twenty-eight eligible studies were included, reporting 159,305 cases of breast reconstruction in 940,678 women. In these studies 16·9% of women underwent immediate or delayed reconstruction (range 4·9-81·2%, median 23·3%). Variables associated with reconstruction were: patient/tumour factors (early stage, no adjuvant therapy, young age, white race, private insurance, higher education/income), surgeon/hospital factors and psychological/other factors (including patient choice). Rates of breast reconstruction were highly variable. Reconstruction appeared to be offered to a minority of women around half took up the offer. The main reasons reported for no reconstruction included patient-related and adjuvant therapy-related factors. Clinicians' beliefs about reconstruction may be an important factor. Rates of reconstruction could be increased with early discussion of the options when mastectomy is chosen or required.
Publisher: Springer Science and Business Media LLC
Date: 28-03-2021
Publisher: Oxford University Press (OUP)
Date: 26-10-2017
DOI: 10.1002/BJS5.19
Publisher: Elsevier BV
Date: 2021
DOI: 10.2139/SSRN.3829713
Publisher: CSIRO Publishing
Date: 25-11-2021
DOI: 10.1071/PY21139
Abstract: This study assessed symptoms of anxiety, depression and fear of COVID-19 in members of the general community and healthcare workers (HCWs) attending for COVID testing. This cross-sectional study was conducted in a public hospital COVID-19 testing clinic (June–September 2020) using self-administered questionnaires (i.e. the Hospital Anxiety and Depression Scale (HADS) and the Fear of COVID-19 Scale). In all, 430 participants who met the criteria for COVID-19 testing with nasopharyngeal and throat swabs completed the questionnaires. The mean (±s.d.) age of participants was 37.6 ± 12.6 years. HCWs made up 35.1% of the s le. Overall, the mean (±s.d.) score for anxiety was 6.09 ± 4.41 and ‘case’ prevalence (any severity) was 151/430 (35.1%), higher than normative population scores. Higher anxiety was found in women (P = 0.001) and in clients who had previously been tested for coronavirus (P = 0.03). HCWs had lower anxiety scores than members of the general community (P = 0.001). For depression, the mean (±s.d.) score was 4.18 ± 3.60, with a ‘case’ prevalence (any severity) of 82/430 (19.1%), similar to normative population scores. Women reported a higher level of COVID-19 fear (P = 0.001), as did people with a lower education level (P = 0.001). A greater psychological impact of COVID-19 was observed in women, people undergoing repeat testing and participants reporting lower levels of educational attainment. HCWs had fewer symptoms of anxiety and depression than non-HCWs attending the same clinic for COVID-19 testing. This information can be used to plan mental health interventions in primary care and testing settings during this and future pandemics.
Publisher: S. Karger AG
Date: 26-09-2023
DOI: 10.1159/000526990
Abstract: b i Background: /i /b “Breast awareness” is a recommendation that women understand the symptoms of breast cancer and become familiar with the usual look and feel of their breasts. It is recommended for women of all ages in breast cancer screening guidelines around the world. The objective of this study was to assess the evidence for breast awareness by investigating its effect on breast cancer outcomes in women of pre-mammographic-screening age (under age 40), at average risk of breast cancer. b i Methods: /i /b A systematic review was performed using PRISMA methodology. Following the search, abstracts and full-text articles were assessed against eligibility criteria. Data were extracted into evidence tables, risk of bias was assessed, narrative synthesis was performed, and results were described. Eligible studies were original research studies assessing the impact of breast awareness on cancer outcomes (such as stage at diagnosis or survival) in women ≤40. Medline, PubMed, and Cochrane Library were searched. b i Results: /i /b After screening the 6,204 abstracts identified in the search, no studies meeting all eligibility criteria were found. Two partially eligible studies were identified. These met the intervention and outcomes criteria but included mixed-age cohorts that included but were not limited to women ≤40. These studies provided low-level (Level IV) evidence of moderate quality that there is some benefit (earlier stage at diagnosis and/or improved survival) of breast awareness in a mixed-age cohort that included some younger women. b i Conclusions: /i /b No studies evaluating the impact of breast awareness exclusively in young women were identified. Limited evidence of benefit of breast awareness was found. Guidelines that recommend breast awareness should be reviewed and qualified with an explanation that the evidence of benefit is weak. Women have limited screening options available to them for the early detection of breast cancer until they reach mammographic screening age. The study was registered on Prospero (ID: CRD42021279457).
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.BREAST.2016.08.008
Abstract: Immediate tissue expander/implant-based breast reconstruction (BR) is often avoided when post-mastectomy radiotherapy (PMRT) is planned due to concerns about high complication rates and poor aesthetic outcomes. This study evaluated surgical, aesthetic and quality of life (QoL) outcomes in women undergoing immediate implant-based BR (IIBR) followed by PMRT. Participants were recruited at least six months after completing the final stage of BR. They completed validated on-line questionnaires assessing satisfaction, QoL, distress, body image and regret. Aesthetic outcomes were rated by their operating surgeon through clinical examination and assessed by an independent surgeon using photographs. Forty-seven participants completed questionnaires and reported good outcomes for QoL (FACT-B = 115 TOI = 73), satisfaction (Breast-Q), distress (Impact of Events scale <4.8 all subscales) and body image (Body Image scale), with a low score on the Decisional Regret scale (mean 12.1). Aesthetic outcomes were rated fair-to-good (Kroll scale). The surgical complication rate was low (expander/implant loss rate 6.4%, wound infection 10.6%, seroma 4.1%). At follow-up, 33 (70.2%) participants retained their permanent implant and 12 (25.5%) converted to a TRAM or DIEP flap there were two LD flaps. This study demonstrated acceptable cosmetic results, high patient satisfaction and low complication rates. It provides evidence that women are willing to accept the potential risks of IIBR in exchange for its benefits including enhanced body image during chemotherapy and PMRT and the possible avoidance of more complicated and costly delayed autologous BR. The results support the importance of access to BR, even in women with high-risk disease.
Publisher: Elsevier BV
Date: 06-2007
DOI: 10.1016/J.BREAST.2006.11.006
Abstract: Initial diagnosis and treatment of women with breast cancer is based on the imaging findings. Anecdotal experience suggests that the quality of breast imaging reports is variable however, systematic evaluation of the content of reports has not been documented to date. We present an audit of the breast imaging reports of all new breast cancer cases referred to a multidisciplinary breast centre during 2004, based on 244 imaging reports from 253 cases. We focus on the quality of imaging reports from the perspective of completeness, concordance with standards, and provision of information considered relevant to clinical decision-making. The audit shows that many reports do not provide key information, and that there are substantial variations in the quality of reports between breast screening services (as part of a coordinated national programme) and community-based radiology services. About one-quarter of all reports do not provide an imaging diagnosis, and only half of all imaging reports are concordant with standards for structured reporting. The least reported variables were breast density category (reported in 24%), lesion depth (37%), lesion shape (55% for mammography, 39% for ultrasound), and location (59%). The most frequently provided information was mammography lesion type (99.6%), sonographic lesion size (90.4%), and recommendation for further investigation (89%). The vast majority of reports from screening services used structured reporting, and these were more likely to provide the information recommended in standards than were reports from community-based radiologists. This work indicates that the quality (content and completeness) of breast imaging reports, particularly community-based radiology reports, is not in line with standards. The clinical implications of these findings warrant further study.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-11-2009
Abstract: Preoperative magnetic resonance imaging (MRI) is increasingly used for staging women with breast cancer, including screening for occult contralateral cancer. This article is a review and meta-analysis of studies reporting contralateral MRI in women with newly diagnosed invasive breast cancer. We systematically reviewed the evidence on contralateral MRI, calculating pooled estimates for positive predictive value (PPV), true-positive:false-positive ratio (TP:FP), and incremental cancer detection rate (ICDR) over conventional imaging. Random effects logistic regression examined whether estimates were associated with study quality or clinical variables. Twenty-two studies reported contralateral malignancies detected only by MRI in 131 of 3,253 women. Summary estimates were as follows: MRI-detected suspicious findings (TP plus FP), 9.3% (95% CI, 5.8% to 14.7%) ICDR, 4.1% (95% CI, 2.7% to 6.0%), PPV, 47.9% (95% CI, 31.8% to 64.6%) TP:FP ratio, 0.92 (95% CI, 0.47 to 1.82). PPV was associated with the number of test positives and baseline imaging. Few studies included consecutive women, and few ascertained outcomes in all subjects. Where reported, 35.1% of MRI-detected cancers were ductal carcinoma in situ (mean size = 6.9 mm), 64.9% were invasive cancers (mean size = 9.3 mm), and the majority were stage pTis or pT1 and node negative. Effect on treatment was inconsistently reported, but many women underwent contralateral mastectomy. MRI detects contralateral lesions in a substantial proportion of women, but does not reliably distinguish benign from malignant findings. Relatively high ICDR may be due to selection bias and/or overdetection. Women must be informed of the uncertain benefit and potential harm, including additional investigations and surgery.
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2020-047513
Abstract: To understand general practitioners’ (GPs’) awareness and knowledge of mammographic breast density (BD) and their perspectives around information and potential notification of BD for women. Qualitative study using semistructured telephone interviews. Interviews were audiorecorded, transcribed and analysed using framework analysis. Australia. Australian GPs (n=30). GPs had limited knowledge of BD and little experience discussing BD with women. There were mixed views on notification of BD with some GPs believing this information would help informed decision making about breast health and that women have the right to know any information about their bodies. While others were concerned about causing unnecessary anxiety and were worried about the uncertainty about what to advise women to do with this information, particularly in relation to supplemental breast screening. The need for an equitable system where all women are either notified or not, and also provided with publicly funded supplemental screening was raised by GPs. Overall, there was high interest in education, training and support around the topic of BD. Australian GPs require education, support and evidence-based guidelines to have discussions with women with dense breasts and help manage their risk, especially if widespread notification is to be introduced in population-based screening programmes.
Publisher: Elsevier BV
Date: 08-2007
Publisher: The Royal Australian College of General Practitioners
Date: 07-2020
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.MATURITAS.2016.07.011
Abstract: As the debate about the potential benefits and harms of screening mammography continues, it is timely to consider the role of clinical breast examination in screening for women at average risk of breast cancer. This article reviews the results from clinical trials and discusses the varied recommendations around the world. It concludes that the evidence does not support routine clinical breast examination for women participating in screening mammography programs, but there may be a benefit for women not do not have mammographic screening, especially in developing nations where health literacy and 'breast awareness' levels may be lower. This review provides information for clinicians to support women who are making decisions about the increasingly complex issue of breast cancer screening.
Publisher: Oxford University Press (OUP)
Date: 07-01-2013
DOI: 10.1093/JNCI/DJS528
Abstract: It has been proposed that magnetic resonance imaging (MRI) be used to guide breast cancer surgery by differentiating residual tumor from pathologic complete response (pCR) after neoadjuvant chemotherapy. This meta-analysis examines MRI accuracy in detecting residual tumor, investigates variables potentially affecting MRI performance, and compares MRI with other tests. A systematic literature search was undertaken. Hierarchical summary receiver operating characteristic (HSROC) models were used to estimate (relative) diagnostic odds ratios ([R]DORs). Summary sensitivity (correct identification of residual tumor), specificity (correct identification of pCR), and areas under the SROC curves (AUCs) were derived. All statistical tests were two-sided. Forty-four studies (2050 patients) were included. The overall AUC of MRI was 0.88. Accuracy was lower for "standard" pCR definitions (referent category) than "less clearly described" (RDOR = 2.41, 95% confidence interval [CI] = 1.11 to 5.23) or "near-pCR" definitions (RDOR = 2.60, 95% CI = 0.73 to 9.24 P = .03.) Corresponding AUCs were 0.83, 0.90, and 0.91. Specificity was higher when negative MRI was defined as contrast enhancement less than or equal to normal tissue (0.83, 95% CI = 0.64 to 0.93) vs no enhancement (0.54, 95% CI = 0.39 to 0.69 P = .02), with comparable sensitivity (0.83, 95% CI = 0.69 to 0.91 vs 0.87, 95% CI = 0.80 to 0.92 P = .45). MRI had higher accuracy than mammography (P = .02) there was only weak evidence that MRI had higher accuracy than clinical examination (P = .10). No difference in MRI and ultrasound accuracy was found (P = .15). MRI accurately detects residual tumor after neoadjuvant chemotherapy. Accuracy was lower when pCR was more rigorously defined, and specificity was lower when test negativity thresholds were more stringent these definitions require standardization. MRI is more accurate than mammography however, studies comparing MRI and ultrasound are required.
Publisher: Wiley
Date: 22-09-2014
DOI: 10.1111/AJCO.12254
Abstract: Survivorship care plans (SCPs) have been proposed for universal use with the aim of addressing the many unmet needs of cancer survivors. Trials have failed to find a significant impact of SCPs on quality of life outcomes. This study evaluated quality of life, unmet needs, satisfaction with health care and perception of cancer care coordination at the end of treatment in a cohort of women at the end of treatment for early breast cancer. The aim was to identify specific needs to assist in the design of a tailored SCP. Women completed patient-reported measures of health-related quality of life (FACT-B [ES]), unmet needs (CaSUN), satisfaction with medical care and cancer care coordination. Total scores and subscale scores for the whole cohort and results of analysis comparing three age groups were reported. Sixty-eight women (mean age 56) participated. Mean score for FACT-B = 108 and FACT-B (ES) = 167.4. Younger women (<51 years) reported a significantly lower quality of life (P = 0.001 for FACT-B, TOI and FACT-B [ES]). Using CaSUN, 76.1% of participants reported at least one unmet need mean number of unmet needs = 6.2. Younger women reported more unmet needs than older women. The most frequently reported unmet need was fear of cancer recurrence. Overall, participants were very satisfied with medical care and cancer care coordination. Younger women reported poorer quality of life and more unmet needs. SCPs should specifically target younger women and must include strategies to address fear of cancer recurrence if they are to lead to a measureable difference in outcomes.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.BREAST.2016.08.013
Abstract: Differences in national health data collection systems preclude accurate assessments of how much breast reconstruction (BR) is performed in Australia. This paper aims to quantitatively document and visually map the national prevalence and distribution of BR, using the best available evidence. Quantitative analysis and spatial mapping of hospital-level data on BR prevalence in all six Australian states and two mainland territories. Data was extracted on 3786 women, under the care of members of Breast Surgeons of Australia and New Zealand Incorporated, who had mastectomy for breast malignancy with or without post-mastectomy BR in 2013. Analysis revealed a national BR rate of 18.3%. Statistically significant differences in BR uptake (p < .0001) were found between jurisdictions [χ Analysis of this substantial subset of Australian women requiring mastectomy for breast cancer has demonstrated significant variation in provision or uptake of BR across four important variables. As BR has been shown to provide long-term survivorship benefits for the growing number of women living longer following mastectomy for breast cancer, there is an urgent need to ensure BR is accessible and affordable for all women who choose this option.
Publisher: Elsevier BV
Date: 05-2017
Publisher: Springer Science and Business Media LLC
Date: 28-06-2007
DOI: 10.1038/NATURE05887
Publisher: Elsevier BV
Date: 10-2022
Publisher: Springer Science and Business Media LLC
Date: 26-01-2021
DOI: 10.1038/S41416-020-01185-W
Abstract: Epidemiological studies provide strong evidence for a role of endogenous sex hormones in the aetiology of breast cancer. The aim of this analysis was to identify genetic variants that are associated with urinary sex-hormone levels and breast cancer risk. We carried out a genome-wide association study of urinary oestrone-3-glucuronide and pregnanediol-3-glucuronide levels in 560 premenopausal women, with additional analysis of progesterone levels in 298 premenopausal women. To test for the association with breast cancer risk, we carried out follow-up genotyping in 90,916 cases and 89,893 controls from the Breast Cancer Association Consortium. All women were of European ancestry. For pregnanediol-3-glucuronide, there were no genome-wide significant associations for oestrone-3-glucuronide, we identified a single peak mapping to the CYP3A locus, annotated by rs45446698. The minor rs45446698-C allele was associated with lower oestrone-3-glucuronide (−49.2%, 95% CI −56.1% to −41.1%, P = 3.1 × 10 –18 ) in follow-up analyses, rs45446698-C was also associated with lower progesterone (−26.7%, 95% CI −39.4% to −11.6%, P = 0.001) and reduced risk of oestrogen and progesterone receptor-positive breast cancer (OR = 0.86, 95% CI 0.82–0.91, P = 6.9 × 10 –8 ). The CYP3A7*1C allele is associated with reduced risk of hormone receptor-positive breast cancer possibly mediated via an effect on the metabolism of endogenous sex hormones in premenopausal women.
Publisher: Royal College of General Practitioners
Date: 2013
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.BREAST.2011.11.001
Abstract: Efficient systems to triage increasing numbers of new referrals to breast clinics are needed, to optimise the management of patients with cancer and benign disease. A tool was developed to triage the urgency of referrals and allocate the most appropriate clinician consultation (surgeon or breast physician (BP)). 259 consecutive new referrals were triaged using the tool. 100% new cancers and 256 (98.8%) referrals overall were triaged to both appropriate category of urgency and the appropriate clinician. This triage tool provides a simple method for assessing new referrals to a breast clinic and can be easily delivered by trained administrative staff by telephone.
Publisher: AMPCo
Date: 10-2019
DOI: 10.5694/MJA2.50359
Publisher: Springer Science and Business Media LLC
Date: 14-10-2014
DOI: 10.1038/BJC.2014.505
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.CLBC.2021.09.011
Abstract: Supplemental screening with MRI or ultrasound increases cancer detection rate (CDR) in women with standard screening mammography. Whether it also reduces interval cancer rate (ICR) is unclear. This study reviewed the evidence evaluating the effect of supplemental imaging on ICR in women undergoing screening mammography. This systematic review included studies that reported both CDR and ICR in women undergoing screening mammography alone compared to those undergoing screening mammography with supplemental imaging. Five studies (3 randomized trials) were eligible. These reported on 142,153 women undergoing mammography screening alone or mammography with supplemental imaging (3 ultrasound and 2 MRI studies). Two studies included a general screening population and 3 included special populations (young, high genetic risk and/or dense breasts). The incremental CDR for supplemental MRI was 14.2 to 16.5/1000 screens and for ultrasound was 0 to 4.4/1000 screens. Effect on ICR was variable but evidence of a reduced ICR was more consistent for studies using supplemental MRI (ICR 0.3 to 0.8 per 1000 screens) than those using ultrasound (ICR 0.49 to 1.9 per 1000 screens). The higher CDR and lower ICR with supplemental screening were associated with higher recall and biopsy rates particularly with supplemental MRI (9.5%-15.9%, up to 69/1000 screens). Cancers detected with supplemental imaging modalities were generally smaller and earlier stage. Mammography with supplemental MRI or ultrasound increases detection of cancers (versus mammography only) in some sub-groups but also increases recall and biopsy rates and may have a relatively modest effect in reducing ICR.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Springer Science and Business Media LLC
Date: 04-02-2017
DOI: 10.1007/S00520-017-3599-6
Abstract: This pilot study assessed the feasibility, acceptability and outcomes of referring breast cancer survivors to the 'Get Healthy Service' (GHS), a state health-funded 6-month telephone-delivered lifestyle program. Pre-post study with eligible and consenting women following treatment for stages I-III breast cancer referred by nurses in a cancer treatment centre to the GHS. Feasibility was assessed via GHS uptake and completion acceptability was assessed via patient satisfaction and nurse feedback. Changes in weight, physical activity, diet, quality of life (QoL) and fatigue from baseline to 6 months were examined. Fifty-three women (mean ± SD body mass index, 31.0 ± 5.5 kg/m GHS referral appeared feasible, acceptable and effective for a erse group of women following completion of treatment for breast cancer, yet more remains to be done to fully integrate GHS screening and referral into usual care.
Publisher: Wiley
Date: 2014
DOI: 10.1111/ANS.12471
Abstract: Breast reconstruction (BR) following mastectomy for breast cancer is safe and has high rates of patient satisfaction, yet only around 12% of Australian women undergo BR. This study presents BR rates and outcomes from a specialist practice that discusses reconstruction options with all women medically suitable for BR. Retrospective clinical study of all women that had undergone therapeutic mastectomy between 2009 and 2011. Patient, tumour and adjuvant therapy factors, and surgical complication rates, were compared between BR and no BR (NBR) patients. Of the 331 women who had mastectomy for cancer, 136 (41%) had BR, with the vast majority (132, 97%) opting for immediate BR (IBR). Factors significantly associated with BR were young age, pure ductal carcinoma in-situ (DCIS), menopausal status and private health insurance. The main reasons for NBR were patient choice (88/195, 45%) and surgeon's perception of high-risk tumours (63/195, 32%). At mean follow-up of 15.6 months, five patients had developed local or distant recurrence (2 BR, 3 NBR). IBR did not cause significant delays in commencement of adjuvant therapy, and the BR group had a lower rate of surgical complications. A BR rate of 41%, over three times the national average, was achieved when BR was discussed with all patients. This significant gain in BR rate was not accompanied by a commensurate increase in adverse outcomes, providing evidence that expanding the indications for BR to women who were previously not considered eligible is a valid option.
Publisher: Springer Science and Business Media LLC
Date: 04-05-2017
DOI: 10.1007/S00520-017-3712-X
Abstract: Breast reconstruction (BR) makes an important positive contribution to the quality of life of many women who have undergone mastectomy for breast cancer. The purpose of this article is to evaluate the evidence for possible relationships between women's expectations of BR and their satisfaction with outcomes to inform and facilitate improved communication about BR options prior to initial surgery. A systematic review of the literature reporting expectations of BR published between 1 January 1994 and 6 March 2017 identified 2107 initial search results. Twenty-one publications, reporting 20 studies (2288 participants), satisfied the selection criteria. Information on study aim and time frame, participation rate, design/methods, limitations/bias, results and conclusions, as well as participant clinical and demographic information, was reported. An overall quality score was generated for each study. Four of five studies that quantified expectations and satisfaction found a positive relationship between the two. This may indicate a possible trend, but as 16 of the 21 included publications did not provide quantifiable data, no firm conclusions are possible. Our findings have important implications for policy and practice which are applicable to medical decision-making more broadly. There is a clear need to utilise accurate and consistent measures of patient-reported expectations and to educate both patients and health practitioners about the importance of informed discussion about treatment options. This is particularly salient for women facing a choice about BR, a major breast cancer survivorship decision. Routine use of an expectations checklist in pre-operative consultations may be useful.
Publisher: Springer Science and Business Media LLC
Date: 12-2021
DOI: 10.1007/S10549-021-06456-5
Abstract: Genomic tests improve accuracy of risk prediction for early breast cancers but these are expensive. This study evaluated the clinical utility of EndoPredict®, in terms of impact on adjuvant therapy recommendations and identification of parameters to guide selective application. Patients with ER-positive, HER2-negative, and early-stage invasive breast cancer were tested with EndoPredict®. Two cohorts were recruited: one consecutively and another at clinical team discretion. Systemic treatment recommendations were recorded before and after EndoPredict® results were revealed to the multidisciplinary team. 233 patients were recruited across five sites: 123 consecutive and 110 at clinical team discretion. In the consecutive cohort 50.6% (62/123) cases were classified high risk of recurrence by EndoPredict®, compared with 62.7% (69/110) in the selective cohort. A change in treatment recommendation was significantly more likely (p < 0.0001) in the selective cohort (43/110, 39.1%) compared to the consecutive group (11/123, 8.9%). The strongest driver of selective recruitment was intermediate grade histology, whilst logistic regression modelling demonstrated that nodal status (p < 0.001), proliferative rate (p = 0.001), and progesterone receptor positivity (p < 0.001) were the strongest discriminators of risk. Whilst molecular risk can be predicted by traditional variables in a high proportion of cases, EndoPredict® had a greater impact on treatment decisions in those cases selected for testing at team discretion. This is indicative of the robust ability of the clinical team to identify cases most likely to benefit from testing, underscoring the value of genomic tests in the oncologists' tool kit.
Publisher: Springer Science and Business Media LLC
Date: 02-03-2010
Publisher: Archives of Breast Cancer
Date: 16-11-2020
DOI: 10.32768/ABC.202074145-148
Abstract: N/A
Publisher: Archives of Breast Cancer
Date: 16-11-2020
DOI: 10.32768/ABC.202073168-177
Abstract: Background: This study aimed to document referral-based barriers impeding Australian women's informed decision-making about breast reconstruction (BR) and to propose a designated BR referral pathway to help overcome these barriers.Methods: Semi-structured, in-depth interviews were conducted with ten women previously treated for breast cancer, 9 breast and reconstructive surgeons and 6 health professionals [n=25] who had identified problems with referrals for BR. Results: Referral-based barriers to BR discussion were identified at three different levels: from a public or private screening center to a General Practitioner (GP) or breast surgeon from a GP to a breast surgeon and from one breast surgeon (without BR skills) to another breast or plastic reconstructive surgeon (with BR skills). A lack of designated referral pathways has meant that clinically eligible women who are interested in considering immediate BR have been denied this opportunity.Conclusions: Streamlining referral processes, along with patient and clinician education, would help to ensure that women are at least seen by the most appropriate clinicians to discuss BR options and to maximise their opportunity for BR should they choose that option. Designated referral pathways could also be useful in ensuring that preference-sensitive treatment decisions are facilitated in settings with varying degrees of resources and in a range of clinical conditions.
Publisher: Wiley
Date: 06-2010
DOI: 10.1111/J.1743-7563.2010.01286.X
Abstract: The increasing number of breast cancer survivors and the complexity of follow-up care make the provision of high-quality survivorship care a challenge. This study explored the follow-up practices of health professionals and their attitudes to alternative models such as shared care and the use of a survivorship care plan. Specialist oncologists (surgeons, medical and radiation oncologists) breast physicians and breast-care nurses completed an online survey. A total of 217 practitioners completed the survey, which was estimated to include 42.8% of oncologists treating breast cancer in Australia. One-third of responding specialists reported spending more than 25% of their clinical time providing follow-up care. They reported many positive aspects to follow-up consultations and viewed follow-up care as an important part of their clinical role but expressed concern about the sustainability of follow-up care in their practices. The follow-up intervals and recommendations were in line with national guidelines. The specialists were supportive of sharing follow-up care with primary-care physicians, breast physicians and breast-care nurses. Most professionals felt that a survivorship care plan would improve care and said they would use a proforma. The oncologists felt that follow-up care was an important part of their role and they were supportive of the concepts of shared care programs and a survivorship care plan. Input from consumers is required to evaluate the acceptability of these alternative models and to assess ways of implementing these changes to work towards a more comprehensive and sustainable method of delivering survivorship care.
Publisher: The Royal Australian College of General Practitioners
Date: 09-2019
Publisher: American Association for Cancer Research (AACR)
Date: 12-2010
DOI: 10.1158/0008-5472.SABCS10-P6-02-01
Abstract: Background: A diagnosis of ductal carcinoma in situ (DCIS) on core needle biopsy (CNB) may represent an underestimate (or understaging) of invasive breast cancer (IBC). This is identified on excision histology in 4%-35% of CNB diagnoses of DCIS. It is of clinical significance as it may prevent informed discussion about management options for IBC and may mean that more than one surgical procedure is required. We systematically review the literature on CNB to report pooled estimates for underestimation of IBC following CNB diagnosis of DCIS and identify preoperative predictors of invasion. Methods: Studies were identified by searching MEDLINE and were evaluated against predetermined inclusion criteria: data were extracted independently by 2 authors. We calculated study-specific proportions for DCIS underestimates. Using meta-regression (random effects logistic models) we investigated the association between study-level preoperative variables and understaged IBC. Results: 47 studies met eligibility criteria reporting 6,213 cases of DCIS on CNB with excision histology as the reference standard. Table 1: Pooled underestimation rates for There were 1,482 underestimates (DCIS on CNB and IBC on excision) pooled estimate 25.9%(95% CI 22.2, 29.9). Preoperative variables associated with underestimation included ultrasound-guidance (vs stereotaxis), 14Gautomated (vs 11GVAB), high grade CNB lesion (vs nonhigh grade), size & mm, BIRADS 4/5 (vs BIRADS3), mammographic mass (vs calc only) and palpability. Conclusion: Using available evidence we estimate that around 26% of CNB DCIS diagnoses represent understaged IBC. We identified preoperative variables associated with higher risk of understaging. This information can be used for preoperative discussion of management options, including possible sentinel node biopsy at the time of excision. Citation Information: Cancer Res 2010 (24 Suppl):Abstract nr P6-02-01.
Publisher: Future Medicine Ltd
Date: 03-2013
DOI: 10.2217/BMT.13.4
Abstract: SUMMARY Thermography uses the pattern of heat measured on the skin surface to image the breast. This review examines the evidence regarding thermography for breast cancer screening, diagnosis and risk prediction. A systematic literature search was conducted and qualitative and quantitative data were extracted and summarized. Seventeen studies (nonrandomized trials) met the inclusion criteria. Four studies reported thermography accuracy for screening (60,802 women): median sensitivity was 47% (range 25–70%) and the median false-positive rate was 31% (range 21–38%). Twelve studies reported thermography accuracy (9887 women) in the context of a known clinical or mammographic abnormality: median sensitivity was 59% (range 25–97%). Two studies found no association between abnormal thermography and an increased 5-year risk of developing breast cancer. The sensitivity of thermography in breast cancer detection is low and the evidence does not support thermography as an alternative to screening mammography or for the investigation of symptoms.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.PEC.2021.06.026
Abstract: This study aimed to explore Australian women's current knowledge, perspectives and attitudes about breast density (BD) and information needs to inform effective evidence-based communication strategies. Fourteen online focus group sessions with a total of 78 women in New South Wales and Queensland, Australia aged 40-74 years without a personal diagnosis of breast cancer were conducted. Audio-recorded data was transcribed and analysed thematically. Women had a very limited knowledge of BD. Overall, women expressed a preference for more frequent mammograms and/or supplemental screening should they be told they had dense breasts, despite being presented with information on potential downsides of additional testing. The majority of women were supportive of the notion of BD notification, often suggesting they had a 'right to know' and they would prefer to be educated and informed about it. The potential of being informed and notified of BD is found to be of interest and importance to Australian women of breast screening age despite lacking current knowledge. This study highlights that policy makers and screening services need to consider how to weigh up these views and preferences of women with current evidence surrounding BD in deciding about implementing population-based BD notification.
Publisher: The Royal Australian College of General Practitioners
Date: 2020
Publisher: Archives of Breast Cancer
Date: 31-05-2020
Abstract: Background: While there is much information available about breast cancer in Australia overall, less is known about breast cancer in immigrant women and specifically Iranian-born women. Understanding this group is important to provide appropriate screening, treatment and support interventions. The aim of this study was to describe breast cancer presentation, tumour and treatment characteristics in Iranian-born women in Australia. Methods: Women were eligible for this retrospective audit if treated for breast malignancy with country of birth recorded. Demographic, tumour and surgical data were extracted and analysed. Data for Iranian-born women were compared to data for Australian-born (comparison group 1) and women born in countries other than Australia or Iran (comparison group 2, referred to as ‘other’). Results: 2086 women were eligible: Iranian-born n=27, Australian-born n=894 and Other n=1165. Iranian-born women were younger, mean age of 53.9 (five years younger in overall mean, SD 11.98, F=3.171, p=0.042). Iranian-born women were significantly less likely to present with a screen-detected cancer (X2= 11.481, p=0.003) and more likely to have a high-grade cancer (X2=14.383, p=0.006). There was no difference in mastectomy rate (X2=1.698, p=0.428).Conclusion: Iranian-born women treated for breast cancer in Australia were younger, had higher-grade tumours and were less likely to have a screen-detected cancer than Australian-born women or women born in other countries. Strategies to encourage screening participation in Iranian-born women are required. Support for these women is required as they are more likely to receive toxic treatments (chemotherapy and extended adjuvant endocrine therapy) due to younger age and higher grade tumours.
Publisher: Humana Press
Date: 20-12-2013
Publisher: Oxford University Press (OUP)
Date: 05-02-2021
DOI: 10.1093/JNCI/DJAB016
Abstract: Breast density (BD) is an independent risk factor for breast cancer and reduces the sensitivity of mammography. This systematic review aims to synthesize evidence from existing studies to understand the impact of BD information and/or notification on women’s cognitive, psychological, and behavioral outcomes. Studies were identified via relevant database searches up to March 2020. Two authors evaluated the eligibility of studies with verification from the study team, extracted and crosschecked data, and assessed the risk of bias. Of the 1134 titles identified, 29 studies were included. Twenty-three studies were quantitative, including only 1 randomized controlled trial of women receiving BD information, and 6 were qualitative. Twenty-seven studies were conducted in the United States, with 19 conducted post-BD legislation. The overall results in terms of BD awareness, knowledge, attitudes, perceptions, and intentions were heterogeneous across included studies, with the strongest consistency demonstrated regarding the importance of communication with and involvement of health-care professionals. Together, the studies did, however, highlight that there is still limited awareness of BD in the community, especially in more socioeconomic disadvantaged communities, and limited knowledge about what BD means and the implications for women. Importantly, BD information in the context of overall breast cancer risk has not yet been studied. There are important gaps in the understanding of the impact of BD information or notification on women and how best to communicate BD information to women. More high-quality evidence to inform both current and future practice related to BD is still needed.
Publisher: Wiley
Date: 10-10-2018
DOI: 10.1002/PON.4895
Abstract: Older age is associated with lower rates of breast reconstruction (BR) for women requiring mastectomy. This study compared patient-reported outcomes between women aged 60 years and older who had received mastectomy and BR with those who received no BR (NBR). About 135 women aged 60 or over treated between 2009 and 2016 with mastectomy only (N = 87) or mastectomy with BR (N = 48) for primary breast cancer completed patient-reported outcome measures using a set of validated questionnaires. Reasons for choosing or declining BR were also explored using a set of nonvalidated questionnaires. Patients who received BR were generally younger (P = <0.001) and reported greater satisfaction with their bodies (P = 0.048) than NBR patients. Patients with autologous reconstruction reported greater satisfaction with their breasts than implant-based reconstruction patients. Both BR and NBR patients reported good quality of life, low pain scores, good body image, and low levels of decisional regret. These data do not identify any quality of life-related reasons to not offer clinically fit, well-informed older women the option of BR.
Publisher: Springer Science and Business Media LLC
Date: 02-07-2015
Publisher: Springer Science and Business Media LLC
Date: 15-11-2020
DOI: 10.1007/S00520-019-05130-3
Abstract: The potential quality of life benefits of breast reconstruction (BR) for women who have undergone mastectomy for breast cancer have long been recognised. While many women will not want to have BR, international best-practice guidance mandates that all should be given the choice. The aim of this article is to highlight potential policies to support patients' informed discussion of BR options and to improve access to BR for women living in underserved locations. Ninety semi-structured interviews were conducted from May 2015 to May 2017 with a convenience s le of 31 breast reconstructive surgeons, 37 breast cancer health professionals and a purposive s le of 22 women who underwent mastectomy as part of their breast cancer treatment. Breast, plastic reconstructive surgeons and health professionals based in major cities also provided information about how they cared for patients from more remote areas. Analysis of interview data revealed a range of barriers that were grouped into four major categories describing issues for women living outside major cities: population characteristics associated with lower socioeconomic status locational barriers including limited health services resources and distance administrative barriers such as hospital policies and inadequate support for women who need to travel and surgical workforce recruitment barriers. Suggestions for potential solutions included the following: greater geographical centralisation of BR services within major cities the creation of designated breast centres with minimum caseload requirements similar to the UK's system and a buddy system, whereby smaller hospitals network with multidisciplinary teams based in larger hospitals.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.MATURITAS.2017.01.015
Abstract: Recent research from the United Kingdom (UK) has highlighted some of the differences in breast cancer presentations between women of different ethnic groups. Analysis of a large database showed that Black women of African or Caribbean heritage living in England and Wales are more likely to present with stage 3 or 4 cancer than White British women and less likely to have their cancer detected through screening. In many countries around the world, migrant and cultural minority groups experience social and economic disadvantage and this is reflected in their health outcomes. With world migration at record levels, it is timely to reflect on ethnic disparities and to consider how developed nations can care for their minority groups, which are increasing in number and ersity. These issues and challenges are discussed, using the UK's migrant population and Australia's Indigenous and migrant populations as case studies.
Publisher: American Association for Cancer Research (AACR)
Date: 12-2010
DOI: 10.1158/0008-5472.SABCS10-P1-01-03
Abstract: Introduction: Sentinel lymph node biopsy (SLNB) is well established for management of small unifocal breast cancers. As confidence in SLNB increases, use of SLN-based management has increased and it is now often used for axillary staging in cases of multifocal (MF) and multicentric (MC) breast cancer and larger tumors although its role in the management of these tumors is controversial. The aim of this study is to systematically review the evidence for SLNB in axillary staging for newly diagnosed invasive breast cancer that is MF/MC or greater than 30mm in diameter. Studies reporting accuracy of SLNB in these situations are reviewed and implications for patient management are discussed. Methods: Medline was searched, identifying 3,461 studies of SLNB in breast cancer. Of these, 57 abstracts met the eligibility criteria which were: (a) original studies that reported (b) outcomes of SLNB in invasive breast cancer and (c) outcomes separately for a population of women with tumors that were either MF/MC or diameter 30mm or greater. Following review of full text articles, 36 studies were excluded as they did not meet criteria two more studies were added after review of reference lists. Results: 23 studies met inclusion criteria and reported 20,687 cases of SLNB. This included data on accuracy for 1,541 MF, 369 MC, and 1,646 larger tumors. All included studies were case series no randomized controlled trials were identified. Injection for lymphatic mapping was variably performed in site and technique and was variably reported. For MF cancers (n=976 8 studies), success rate for identification of a SLN was 86-100%, SLN positivity rate 42-59%, false negative rate (FNR) 6-33%(with 4 of the 7 case series reporting false negative rates over 21%). The overall accuracy for MF tumors was 75-97%. For MC cancers (n=262 4 studies): success rate for identification of a SLN 92-96%, SLN positivity rate 50-61%, FNR 0-8% and accuracy 96-100%. For ‘multiple breast cancer’ (n=688 8 studies combining MF/MC cases): success rate for identification of a SLN 93-100%, SLN positivity rate 11-63%, FNR 6-13%, and accuracy 93-98%. For larger tumors (n=1646 9 studies): success rate for identification of a SLN 86-100%, SLN positivity rate 42-59%, FNR 3-16.2% and accuracy 88-97.7%. For MF/MC and larger cancers overall non-SLN positivity rates were up to 82% axillary recurrence rates were low but not often reported. Conclusion: Although the evidence suggests that success rate and FNR of SLNB in MF/MC and larger tumors are similar to small unifocal cancers, node positivity rates are higher in these breast cancers and this translates to higher rates of understaging in real terms. High rates of non-SLN positivity for these tumors compared to rates for lower risk tumors mean that omitting ALND in the case of a positive SLNB risks leaving disease in the axilla more often than previously accepted. Thus the evidence supports the use of ALND in the majority of cases when the SLNB is positive. Women must be made aware that the high likelihood of positive axillary lymph nodes in MF/MC and larger breast tumors. Relying on SLNB-based management means accepting a higher risk of understaging and/or under treatment than when using SLNB based management for lower risk tumors. Citation Information: Cancer Res 2010 (24 Suppl):Abstract nr P1-01-03.
Publisher: Elsevier BV
Date: 08-2014
Publisher: Wiley
Date: 26-08-2014
DOI: 10.1111/ANS.12696
Publisher: SAGE Publications
Date: 07-09-2001
DOI: 10.1177/09691413221125320
Abstract: Controversy surrounding recommendations for supplemental screening (ultrasound and magnetic resonance screening) in women with dense breasts exists, as the long-term benefits from these additional modalities may not outweigh the harms. This study aimed to examine factors associated with supplemental screening intentions following a hypothetical breast density notification in a population of women who have not been routinely notified. Australian women of breast screening age participated in an online randomised experimental study where they were presented with one of two breast density notifications (with or without health literacy-sensitive information) and asked their screening intentions. After adjusting for covariates in multivariable analyses, women in both groups (n = 940) who indicated higher levels of breast cancer worry, had private health insurance, had a family history of breast cancer, and had a greater number of times previously attending mammography screening had higher intentions for supplemental screening. Understanding women's supplemental screening intentions following notification of dense breasts has important implications for health systems with breast screening considering the impacts of widespread notification. Personal, clinical and psychological factors should be considered when discussing both the benefits and harms of supplemental screening with women with dense breasts.
Publisher: Radiological Society of North America (RSNA)
Date: 07-2011
Abstract: To perform a meta-analysis to report pooled estimates for underestimation of invasive breast cancer (where core-needle biopsy [CNB] shows ductal carcinoma in situ [DCIS] and excision histologic examination shows invasive breast cancer) and to identify preoperative variables that predict invasive breast cancer. Studies were identified by searching MEDLINE and were included if they provided data on DCIS underestimates (overall and according to preoperative variables). Study-specific and pooled percentages for DCIS underestimates were calculated. By using meta-regression (random effects logistic modeling) the association between each study-level preoperative variable and understaged invasive breast cancer was investigated. Fifty-two studies that included 7350 cases of DCIS with findings at excision histologic examination as the reference standard met the eligibility criteria and were included. There were 1736 underestimates (invasive breast cancer at excision) the random-effects pooled estimate was 25.9% (95% confidence interval: 22.5%, 29.5%). Preoperative variables that showed significant univariate association with higher underestimation included the use of a 14-gauge automated device (vs 11-gauge vacuum-assisted biopsy, P = .006), high-grade lesion at CNB (vs non-high grade lesion, P < .001), lesion size larger than 20 mm at imaging (vs lesions ≤ 20 mm, P < .001), Breast Imaging Reporting and Data System (BI-RADS) score of 4 or 5 (vs BI-RADS score of 3, P for trend = .005), mammographic mass (vs calcification only, P < .001), and palpability (P < .001). About one in four DCIS diagnoses at CNB represent understaged invasive breast cancer. Preoperative variables significantly associated with understaging include biopsy device and guidance method, size, grade, mammographic features, and palpability.
Publisher: Archives of Breast Cancer
Date: 30-07-2022
DOI: 10.32768/ABC.202294421-438
Abstract: Background: During the COVID-19 pandemic, health resources were stretched, access was impacted by lockdowns and there were concerns about exposure to the virus during visits to hospitals. The purpose of this study was to examine how breast cancer treatments (presentation, surgery, radiotherapy, chemotherapy and/or endocrine therapy) changed or were adapted during the early phase of the pandemic. Methods: A systematic review was conducted using PRISMA guidance. Eligible studies presented original data reporting changes to early breast cancer treatment by comparing ‘pandemic’ treatment to a ‘pre-pandemic’ cohort or to ‘ideal’ treatment of in idual cases. Data were extracted into evidence tables and narrative synthesis was used to analyse results. Results: Fifteen studies with paired design were eligible. These reported outcomes for 6,353 people treated for early breast cancer (January 2020–June 2021). All studies reported some change to treatment due to the pandemic. The nature of reported changes was inconsistent. Changes included: tumours more advanced at presentation compared to pre-pandemic, increase in breast conserving surgery increase in simple mastectomy (without breast reconstruction) trend towards increased wait times, delays to start of treatment, shorter post-operative hospital stay and hypofractionation or omission of radiotherapy. Centres used more or less neoadjuvant chemotherapy or endocrine therapy. Conclusion: In the early stage of the pandemic, fewer early-stage breast cancer cases were treated many centres. Treatment for breast cancer was impacted and various local solutions were developed. These included less complicated breast surgery, increased use of neoadjuvant therapy, and changes to radiotherapy regimens. Surgery was frequently delayed and breast reconstruction was often unavailable. These results have implications for breast cancer services during the pandemic recovery as a ‘catch-up’ increase in cancer diagnoses is expected. Women may wish to access breast reconstruction, unavailable due to COVID-19. The impact of changes to treatment on long-term quality of life should be evaluated.
Publisher: Springer Science and Business Media LLC
Date: 19-11-2019
DOI: 10.1038/S41598-019-52000-3
Abstract: Next generation sequencing has revolutionised genomic studies of cancer, having facilitated the development of precision oncology treatments based on a tumour’s molecular profile. We aimed to develop a targeted gene sequencing panel for application to disparate cancer types with particular focus on tumours of the head and neck, plus test for utility in liquid biopsy. The final panel designed through Roche/Nimblegen combined 451 cancer-associated genes (2.01 Mb target region). 136 patient DNA s les were collected for performance and application testing. Panel sensitivity and precision were measured using well-characterised DNA controls (n = 47), and specificity by Sanger sequencing of the Aryl Hydrocarbon Receptor Interacting Protein ( AIP ) gene in 89 patients. Assessment of liquid biopsy application employed a pool of synthetic circulating tumour DNA (ctDNA). Library preparation and sequencing were conducted on Illumina-based platforms prior to analysis with our accredited (ISO15189) bioinformatics pipeline. We achieved a mean coverage of 395x, with sensitivity and specificity of % and precision of %. Liquid biopsy revealed detection to 1.25% variant allele frequency. Application to head and neck tumours/cancers resulted in detection of mutations aligned to published databases. In conclusion, we have developed an analytically-validated panel for application to cancers of disparate types with utility in liquid biopsy.
Publisher: MDPI AG
Date: 16-01-2023
Abstract: Breast density (BD) is an independent risk factor for breast cancer and reduces mammographic sensitivity. This study explored women’s responses and intentions if notified that they had dense breasts. Methods: Content analysis was used to assess responses from a written questionnaire undertaken in conjunction with focus groups on BD involving 78 Australian women aged 40–74. Results: Half the women reported that they would feel a little anxious if notified they had dense breasts, while 29.5% would not feel anxious. The most common theme (29.5%) related to anxiety was the psychosocial impact of the possibility of developing cancer, and women believed that being better informed could help with anxiety (26.9%). When asked what they would do if notified of having dense breasts, the most common response was to consult their doctor for information/advice (38.5%), followed by considering supplemental screening (23%). Consequently, when asked directly, 65.4% were interested in undergoing supplemental screening, while others (10.3%) said they “wouldn’t worry about it too much”. Discussion: These findings have important implications for health systems with population-based breast screening programs that are currently considering widespread BD notification in terms of the impact on women, health services and primary care.
Publisher: MDPI AG
Date: 25-07-2022
Abstract: Background: There is a lack of evidence around Australian general practitioners’ (GPs) views of issues surrounding breast density. The current study aimed to quantitatively assess GPs’ current knowledge, understanding, and feelings around breast density information and notification. Methods: This study involved a cross-sectional survey using an online platform to collect quantitative data from Australian GPs. Survey data were analysed with descriptive statistics. Results: A total 60 responses from GPs were analysed. Most (n = 58 97%) had heard or read about breast density and nearly 90% (n = 52 87%) have had discussions about breast density with patients. Three-quarters (n = 45 75%) were supportive of making breast density notification mandatory for patients with dense tissue and a similar proportion (n = 45/58 78%) felt they need or want more education on breast density. Conclusions: There is strong support for notifying patients of breast density, and interest in further education and training among the surveyed GPs. As GPs play a central role in cancer prevention and control, their involvement in discussions related to breast density notification, evaluation and appraisal of evidence, development of communication strategies, and participation in ongoing research on the topic will be indispensable.
Publisher: Elsevier BV
Date: 2013
Publisher: Elsevier BV
Date: 10-2006
DOI: 10.1016/J.BREAST.2005.12.002
Abstract: In Australia, and many health care provider systems, primary care physicians are the first to see women with breast symptoms and are responsible for making decisions on whether to investigate and when to refer to specialist teams. We present an audit of new patient referrals from primary care triaged to a 'low-risk' (low likelihood of cancer) clinic on the basis of benign findings. The most common reason for referral was 'breast lump' (38%) followed by 'image-detected' abnormality (26%.) We have identified that (outside of population screening services) many women are being referred from primary care to specialist clinics for management of screen-detected lesions considered benign on imaging. Further research is needed to identify the reasons for such referrals and to develop appropriate educational strategies and clinical policy, both for the primary care and the specialist breast practitioner.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2021
DOI: 10.1097/GOX.0000000000003456
Abstract: Severe infections of implant-based breast reconstruction are challenging to treat. Traditional management is removal of the implant with a further attempt at reconstruction months later once the infection has settled. This study evaluates an alternative management protocol using negative pressure wound therapy with instillation (NPWTi). Consecutive patients with severe peri-prosthetic infection following breast reconstruction were managed using the Implant Salvage Protocol: removal of the prosthesis with application of a NPWTi dressing, changed every 3 days until a negative culture was obtained. A new prosthesis was then placed in the pocket. Data were collected on patient demographics, microbiological, hospital/operative information, and overall success of salvage. Descriptive statistics were used for analysis. In total, 30 breast prostheses in 28 patients were treated for severe peri-prosthetic infection. Twenty-five (83%) implants were salvaged. Mean time from initial reconstruction surgery to presentation was 49.5 days (median 23, range 7–420). Mean hospital stay was 11.5 days (median 12.0, range 6–22), mean number of returns to the operating theater was 3.7 (median 3.0, range 2–7), and mean number of days to negative culture was 5.2 (median 4.0, range 1–14). The most common organisms were methicillin-sensitive Staphylococcus aureus (n = 9) and Serratia marcescens (n = 4). Most had a tissue expander (n = 24, 80%) or implant (n = 5, 16.7%) placed at the completion of therapy. There was no record of capsular contracture nor recurrent infection during follow-up (mean 39.4 months, range 6–74 months). An estimated 83% of prosthetic breast reconstructions with severe infection were successfully salvaged using NPWTi.
Publisher: Wiley
Date: 31-03-2020
DOI: 10.1002/PON.5379
Publisher: Wiley
Date: 08-09-2021
DOI: 10.1002/PON.5776
Abstract: To examine the impact of breast reconstruction on women's perceptions of body image over time and to assess the influence of sociodemographic variables on body image. A prospective, longitudinal cohort study, using validated breast cancer‐specific questionnaires, to compare patient‐reported outcomes in women choosing immediate ( n = 61), delayed ( n = 16) or no ( n = 23) breast reconstruction. One hundred women completed baseline questionnaires that included items on body image 30 women completed all four annual follow‐up sets, while 20 women completed baseline only. The three groups were well matched at baseline and similar trajectories in body image measures were identified over 48 months in all groups. At 12 months post‐mastectomy, significant changes were seen in eight of the 10 subscales this reduced to seven subscales at 24 months and four at 36 months. By 48 months, only three subscales remained significantly different to baseline scores: women remained less vulnerable and had fewer limitations (improved outcomes) the one worse outcome was persistently higher levels of arm concern. Three of the sociodemographic variables (health insurance, age and employment status) showed significant inter‐group differences at some time points. These findings suggest women recover from the negative impact of mastectomy on body image within four years of surgery, whether they have immediate, delayed or no reconstruction. Our results provide some indirect evidence that having a choice of BR options is important, regardless of the choice made. Four years appears to be a suitable follow‐up period for future studies in this area.
Publisher: BMJ
Date: 2022
DOI: 10.1136/BMJOPEN-2021-054005
Abstract: Artificial intelligence (AI) algorithms for interpreting mammograms have the potential to improve the effectiveness of population breast cancer screening programmes if they can detect cancers, including interval cancers, without contributing substantially to overdiagnosis. Studies suggesting that AI has comparable or greater accuracy than radiologists commonly employ ‘enriched’ datasets in which cancer prevalence is higher than in population screening. Routine screening outcome metrics (cancer detection and recall rates) cannot be estimated from these datasets, and accuracy estimates may be subject to spectrum bias which limits generalisabilty to real-world screening. We aim to address these limitations by comparing the accuracy of AI and radiologists in a cohort of consecutive of women attending a real-world population breast cancer screening programme. A retrospective, consecutive cohort of digital mammography screens from 109 000 distinct women was assembled from BreastScreen WA (BSWA), Western Australia’s biennial population screening programme, from November 2016 to December 2017. The cohort includes 761 screen-detected and 235 interval cancers. Descriptive characteristics and results of radiologist double-reading will be extracted from BSWA outcomes data collection. Mammograms will be reinterpreted by a commercial AI algorithm (DeepHealth). AI accuracy will be compared with that of radiologist single-reading based on the difference in the area under the receiver operating characteristic curve. Cancer detection and recall rates for combined AI–radiologist reading will be estimated by pairing the first radiologist read per screen with the AI algorithm, and compared with estimates for radiologist double-reading. This study has ethical approval from the Women and Newborn Health Service Ethics Committee (EC00350) and the Curtin University Human Research Ethics Committee (HRE2020-0316). Findings will be published in peer-reviewed journals and presented at national and international conferences. Results will also be disseminated to stakeholders in Australian breast cancer screening programmes and policy makers in population screening.
Publisher: Wiley
Date: 10-2019
DOI: 10.1111/ANS.15288
Publisher: EpiSmart Science Vector Ltd
Date: 02-2023
Publisher: Wiley
Date: 26-09-2023
DOI: 10.5694/MJA2.52117
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.EJCA.2010.07.043
Abstract: There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We review the evidence on surgical margins in BCT for early-stage invasive breast cancer. Meta-analysis of studies reporting local recurrence (LR) relative to quantified final microscopic margin status and the threshold distance for negative margins. The proportion of LR was modelled using random effects logistic meta-regression. Based on 21 studies (LR in 1,026 of 14,571 subjects) the odds of LR were associated with margin status [model 1: odds ratio (OR) = 2.02 for positive/close versus negative model 2: OR = 1.80 for close versus negative, 2.42 for positive versus negative (P 0.10 both models)], adjusting for median follow-up time. However, there was weak evidence in both models that the odds of LR decreased as the threshold distance for declaring negative margins increased. This bordered significance in model 2 [OR for 1mm, 2mm, 5mm: 1.0, 0.75, 0.51 (P = 0.097 for trend)], and was not significant in model 1 [OR for 1mm, 2mm, 5mm: 1.0, 0.85, 0.58 (P = 0.11 for trend)] but was evident when one study (of women ≤ 40 years) was excluded from this model [OR for 1mm, 2mm, 5mm: 1.0, 0.72, 0.52 (P = 0.058 for trend)]: this trend was rendered insignificant by adjustment for the proportion of subjects receiving a radiation boost or the proportion of subjects receiving endocrine therapy. Margin status has a prognostic effect in all women treated for invasive breast cancer increasing the threshold distance for declaring negative margins is weakly associated with reduced odds of LR, however adjustment for covariates (adjuvant therapy) removes the significance of this effect. Adoption of wider margins, relative to narrower widths, for declaring negative margins is unlikely to a have substantial additional benefit for long-term local control in BCT.
Publisher: Wiley
Date: 17-12-2019
DOI: 10.1111/ANS.15604
Abstract: Over the last decade, neoadjuvant systemic therapy (NAST) has gained considerable popularity and its use has been extended to include breast cancer patients with operable node-positive disease. It may no longer be necessary to commit patients who are node-positive at presentation to axillary dissection if they become clinically node-negative after completing NAST. Targeted axillary dissection (TAD) is a technique where the marked pre-NAST positive node is excised along with the sentinel nodes and its response to chemotherapy is assessed and thus helps guide further treatment to the axilla. The aim of this study was to determine the feasibility of marking positive axillary nodes with a clip and removing the clipped node after neoadjuvant treatment. We also assessed the concordance of the sentinel node with the clipped node. We prospectively evaluated 37 clinically and/or radiologically node-positive patients who underwent NAST. The overall identification rate of the clipped node was 78%. The identification rate was 100% if the clipped node was localized preoperatively and was much lower at 68% in patients who did not have the clipped node localized. The clipped node was not retrieved as the sentinel node in 14% of patients. We present the first Australian series on the feasibility of TAD. TAD is a feasible option in patients having NAST and with every new technique there is a learning curve. With the increasing experience globally and the refinement in marking and localization techniques, the accuracy of performing TAD will likely continue to improve.
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.EJSO.2011.01.011
Abstract: While sentinel lymph node biopsy (SLNB) is established in the management of small unifocal breast cancer its role in management of multifocal (MF), multicentric (MC) and larger tumors is still evolving. Medline was searched studies meeting pre-determined criteria were included. Data were extracted and entered into evidence tables. Twenty six studies met inclusion criteria and reported data on accuracy no randomized trials were identified. For MF cancers (n = 314 cases), success rate for identification of an SLN was 86-94%, SLN positivity rate 42-59%, false negative rate (FNR) 0-33% and overall accuracy 78-100%. For MC (n = 294 cases): success rate 92-100%, SLN positivity rate 25-61%, FNR 4-8% and accuracy 96-100%. For 'multiple breast cancer' (studies combining MF/MC cases n = 996 cases): success rate 92-100%, SLN positivity rate 12-63%, FNR 0-25%, and accuracy 82-100%. For larger tumors (n = 1912 cases): success rate 86-100%, SLN positivity rate 49-77%, FNR 3-18% and accuracy 85-98%. For MC/MF and larger cancers overall non-SLN positivity rates were up to 82% axillary recurrence rates were low but seldom reported. There are no randomized trials evaluating the safety of SLNB in MF/MC and larger breast cancers. Based on limited evidence, success rate and FNR appear to be similar to those for small unifocal cancers, however node positivity rates are higher and rates of non-SLN positivity are very high. Awareness of these issues is essential when recommending SLNB based axillary management for these higher-risk tumors.
Publisher: Elsevier BV
Date: 06-2015
Publisher: Wiley
Date: 10-2009
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.MATURITAS.2016.08.003
Abstract: Mammographic screening programs were established around the world following randomised clinical trials showing that women who were screened had a significant reduction in the risk of dying from breast cancer. Now, decades later, several harms of screening have become apparent and the degree of risk reduction is being debated. This article aims to provide clinicians with evidence-based information about the benefits and harms of screening mammography to enable them to confidently discuss the issues with their patients. The issues around screening for breast cancer in asymptomatic women at average risk are complex. Women need accurate, balanced information to make an informed decision about whether they wish to participate in screening. The decision will vary from one woman to another, depending on her level of anxiety about cancer and recall, her personal values and her philosophy about health care.
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.BREAST.2012.07.006
Abstract: Magnetic resonance imaging (MRI) has been proposed to have a role in predicting final pathologic response when undertaken early during neoadjuvant chemotherapy (NAC) in breast cancer. This paper examines the evidence for MRI's accuracy in early response prediction. A systematic literature search (to February 2011) was performed to identify studies reporting the accuracy of MRI during NAC in predicting pathologic response, including searches of MEDLINE, PREMEDLINE, EMBASE, and Cochrane databases. 13 studies were eligible (total 605 subjects, range 16-188). Dynamic contrast-enhanced (DCE) MRI was typically performed after 1-2 cycles of anthracycline-based or anthracycline/taxane-based NAC, and compared to a pre-NAC baseline scan. MRI parameters measured included changes in uni- or bidimensional tumour size, three-dimensional volume, quantitative dynamic contrast measurements (volume transfer constant [Ktrans], exchange rate constant [k(ep)], early contrast uptake [ECU]), and descriptive patterns of tumour reduction. Thresholds for identifying response varied across studies. Definitions of response included pathologic complete response (pCR), near-pCR, and residual tumour with evidence of NAC effect (range of response 0-58%). Heterogeneity across MRI parameters and the outcome definition precluded statistical meta-analysis. Based on descriptive presentation of the data, sensitivity/specificity pairs for prediction of pathologic response were highest in studies measuring reductions in Ktrans (near-pCR), ECU (pCR, but not near-pCR) and tumour volume (pCR or near-pCR), at high thresholds (typically >50%) lower sensitivity/specificity pairs were evident in studies measuring reductions in uni- or bidimensional tumour size. However, limitations in study methodology and data reporting preclude definitive conclusions. Methods proposed to address these limitations include: statistical comparison between MRI parameters, and MRI vs other tests (particularly ultrasound and clinical examination) standardising MRI thresholds and pCR definitions and reporting changes in NAC based on test results. Further studies adopting these methods are warranted.
Publisher: Elsevier BV
Date: 02-2023
Publisher: Mary Ann Liebert Inc
Date: 10-2021
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.BREAST.2011.10.005
Abstract: While guidelines recommend against routine use of staging imaging to detect asymptomatic distant metastases (DM) in newly diagnosed breast cancer (BC), modern imaging technologies may have improved detection capability and may have a role in some cases. We performed a systematic review of studies (1995-2011) evaluating the prevalence of DM and the accuracy of staging imaging for detection of asymptomatic DM. Twenty-two studies reporting on 14,824 BC subjects (median age 53 years) undergoing staging imaging were eligible. Median prevalence of DM was 7.0% (range 1.2-48.8%) prevalence increased with increasing BC stage. Conventional imaging studies had lower DM prevalence than studies of PET(PET/CT). Imaging median sensitivity/specificity respectively were: combined conventional imaging 78.0%/91.4% bone scintigraphy 98.0%/93.5% chest X-ray 100%/97.9% liver ultrasound 100%/96.7% CT chest/abdomen 100%/93.1% FDG-PET 100.0%/96.5% FDG-PET/CT 100%/98.1%. Low prevalence of DM was seen in Stage I-II BC with much higher prevalence in more advanced disease. Accuracy of PET modalities was very high however the high proportion of detected asymptomatic DM partly reflects selection bias.
Publisher: Informa UK Limited
Date: 24-07-2020
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.MATURITAS.2011.03.010
Abstract: Breast cancer, the most common cancer in women in developed countries, has a generally excellent prognosis, therefore long-term survivors living with the consequences of breast cancer ('survivors') and its treatment are an increasing group in clinical practice. This review discusses the complex issues relevant to survivorship care, including current recommendations for ongoing adjuvant hormonal therapy (tamoxifen and aromatase inhibitors), and the management of side effects of cancer treatment (such as menopause, arthralgia, and lymphoedema). Annual mammography screening is advised for detection of second breast cancers, and symptom-directed assessment is warranted where there is suspicion of distant recurrence or (in women using tamoxifen) of endometrial cancer. Management of menopausal symptoms, including treatment-induced premature menopause, is a key issue for many survivors, and can be challenging to manage as conventional hormone replacement therapy is contraindicated in most of these women. Specific therapeutic options for hot flushes and vaginal symptoms are discussed. The review also emphasises the need for survivorship care to include optimisation of general health, including psychosocial and sexual health, bone health and the evaluation of lifestyle-related risk factors and genetic factors. The review provides guidance on the management of many of these issues, and highlights areas requiring further evidence and research.
Publisher: Springer Science and Business Media LLC
Date: 20-08-2013
DOI: 10.1038/BJC.2013.473
Publisher: Springer Science and Business Media LLC
Date: 07-06-2014
Publisher: Wiley
Date: 29-04-2019
DOI: 10.1111/ANS.15145
Abstract: Older age is associated with lower rates of breast reconstruction (BR) following mastectomy. This study compared a range of factors in women aged 60 years and older who had received mastectomy and BR with those who received no BR (NBR). An audit of 338 women aged 60 or over treated with mastectomy with (n = 86) or without (n = 252) BR for primary breast cancer from 2009 to 2016 was conducted. Demographic, tumour, treatment, comorbidity and surgical complication data were obtained from patient medical records. NBR patients were associated with older age (P ≤ 0.001), more comorbidities (P = 0.038) and more extensive disease (P = 0.001) than BR patients. Total number of complications was not significantly different between BR and NBR patients (P = 0.286), or the different types of BR (P = 0.697). BR patients had higher rates of unplanned returns to the operating theatre, particularly in the late post-operative period (P = 0.025). Implant-based reconstruction was associated with more unplanned operating theatre returns than autologous reconstruction in the late post-operative period (P = 0.013). Post-mastectomy BR in elderly patients has a clinical complication profile similar to NBR patients. This audit found no clinical-based reasons to not offer oncologically suitable and clinically fit elderly women the option of BR.
Publisher: Springer Science and Business Media LLC
Date: 10-04-2017
DOI: 10.1007/S11136-017-1555-Z
Abstract: Many studies have explored women's reasons for choosing or declining a particular type of breast reconstruction (BR) following mastectomy for breast cancer. This systematic review synthesises women's reasons for choosing a range of BR options, including no BR, in different settings and across time. Thirteen databases were systematically searched, with 30 studies (4269 participants), meeting the selection criteria. Information on study aim and time frame, participation rate, design/methods, limitations/bias, reasons and conclusions, as well as participant clinical and demographic information, was reported. An overall quality score was generated for each study. Reasons were grouped into eight domains. While study methodology and results were heterogeneous, all reported reasons were covered by the eight domains: Feeling/looking normal Feeling/looking good Being practical Influence of others Relationship expectations Fear Timing and Unnecessary. We found a strong consistency in reasons across studies, ranging from 52% of relevant publications citing relationship expectations as a reason for choosing BR, up to 91% citing fear as a reason for delaying or declining BR. Major thematic findings were a lack of adequate information about BR, lack of genuine choice for women and additional access limitations due to health system barriers. Understanding women's reasons for wanting or not wanting BR can assist clinicians to help women make choices most aligned with their in idual values and needs. Our thematic findings have equity implications and illustrate the need for surgeons to discuss all clinically appropriate BR options with mastectomy patients, even if some options are not available locally.
Publisher: Wiley
Date: 17-12-2020
DOI: 10.1111/ANS.15580
Abstract: The emergence of breast oncoplastic surgery provides women with more surgical options for improved aesthetics following breast-conserving surgery and for breast reconstruction (BR) following mastectomy. For some established breast and plastic surgeons, this development may be perceived as increasing competition for patients and raises the potential for demarcation issues between and within surgical sub-specialties. The objectives of the study were to document surgeons' views on demarcation between general/breast, oncoplastic/breast and plastic reconstructive breast surgeons in Australia, to examine the potential impact demarcation issues may have on informed patient choice and to recommend ways of reducing them. In-depth qualitative interviews were conducted with a convenience s le of 31 (22 oncoplastic and nine plastic reconstructive) surgeons who performed BR. Descriptive analysis of the interviews revealed a range in the perceptions of the extent of demarcation. Six common themes were identified: oncoplastic techniques are unnecessary and potentially unsafe reconstructive surgery should be left to 'the experts' non-referral of patients for discussion of surgical options they do not offer professional jealousy workload capacity and the old versus the new guard. Potential solutions suggested by the participants focused on improving relations between oncoplastic and plastic reconstructive surgeons and changes to breast surgical training. While most surgeons were optimistic about the current ide diminishing with time, a more pro-active stance is required if patient-centred care is to be improved. Roundtable discussions with a broad range of stakeholders are planned to begin this process.
Publisher: Elsevier BV
Date: 04-2009
DOI: 10.1016/J.EJSO.2008.07.009
Abstract: Minimal access breast surgery (MABS) is a procedure that completes breast conservation surgery (BCS) and sentinel node biopsy (SNB) through a single incision. It allows access to axillary sentinel nodes via the breast incision and also provides access to the internal mammary nodes (IMN) as well as other nodal sites when needed. The aims of this study are to describe the MABS approach and to evaluate its safety and efficacy in cases undergoing BCS and SNB (axillary or IMN) for treatment of breast cancer. The surgical technique for MABS is described. One hundred and three consecutive clinically lymph node negative patients undergoing BCS and SNB (axillary or IMN) were considered for MABS. Cases were classified according to the location of sentinel nodes dissected (axillary, internal mammary or other), the location of the tumour and whether MABS was used. The success of MABS was calculated based on the number of cases where BCS and SNB were completed through a single breast incision. Number of lymph nodes (LN) retrieved, rate of LN positivity, aesthetics and complications were documented. Eighty-six percent of cases of BCS with axillary-only SNB were completed with MABS. For cases of BCS with axillary and IMN SNB, MABS was successful for BCS and IMN SNB in 97% of cases and for BCS and SNB from both nodal regions in 63%. There was only one case, a woman with breast prostheses, who required three separate incisions. When axillary-only SNB cases were completed with MABS, an average of 2.9 axillary LN per case with a 29% axillary LN positivity rate was seen. When axillary and IMN SNB were completed with MABS for both regions, an average of 3.0 axillary LN per case were retrieved with an axillary LN positivity rate of 65%. When separate axillary and breast incisions were made, 2.7 LN per case were removed with an axillary LN positivity rate of 30%. Aesthetics were excellent and there were no complications associated with reaching the nodes through the breast incision. MABS is a feasible option for the majority of women undergoing BCS and SNB and it does not compromise the success of SNB.
Publisher: Wiley
Date: 07-12-2017
DOI: 10.1002/PON.4585
Abstract: Women facing mastectomy for breast cancer should have the option of considering whether they would like breast reconstruction (BR), and if so, what type and when. Previous research has demonstrated that some women will come to regret their decision about BR. We aim to summarise the evidence about the prevalence of decisional regret (DR) associated with BR choices and identify factors influencing vulnerability to DR. A systematic review of the literature reporting BR-related DR published between January 1994 and February 2017 identified 254 initial search results. Thirteen publications from 12 studies (5672 participants) met the selection criteria and were included in the final review. Each article was allocated a quality score out of 24. Overall, DR levels were reported as low and stable, although direct comparison across studies was limited by inconsistencies in measurement and reporting methods. Estimates of DR scores ranged from 9.3/100 to 5.4/20. All studies identified a relationship between higher levels of DR and an insufficient amount, inadequate quality, or unclear nature of information provided to women prior to undergoing mastectomy. A major determinant of DR was new or recurrent cancer, while psychosocial characteristics including depression, distress, and negative body image increased the likelihood of DR. The available research is yet to provide a clear understanding of the many interrelated issues involved in DR. Given the consensus that presurgical information was inadequate, making standardised educational material more widely available and increasing use of breast care nurses in preoperative patient education roles may be useful.
Publisher: Elsevier BV
Date: 04-2008
Publisher: Elsevier BV
Date: 04-2008
Publisher: Public Library of Science (PLoS)
Date: 05-05-2016
Publisher: Elsevier BV
Date: 04-2008
Publisher: Springer Science and Business Media LLC
Date: 27-01-2023
DOI: 10.1038/S41431-022-01257-W
Abstract: Evidence from literature, including the BRIDGES study, indicates that germline protein truncating variants (PTVs) in FANCM confer moderately increased risk of ER-negative and triple-negative breast cancer (TNBC), especially for women with a family history of the disease. Association between FANCM missense variants (MVs) and breast cancer risk has been postulated. In this study, we further used the BRIDGES study to test 689 FANCM MVs for association with breast cancer risk, overall and in ER-negative and TNBC subtypes, in 39,885 cases (7566 selected for family history) and 35,271 controls of European ancestry. Sixteen common MVs were tested in idually the remaining rare 673 MVs were tested by burden analyses considering their position and pathogenicity score. We also conducted a meta-analysis of our results and those from published studies. We did not find evidence for association for any of the 16 variants in idually tested. The rare MVs were significantly associated with increased risk of ER-negative breast cancer by burden analysis comparing familial cases to controls (OR = 1.48 95% CI 1.07–2.04 P = 0.017). Higher ORs were found for the subgroup of MVs located in functional domains or predicted to be pathogenic. The meta-analysis indicated that FANCM MVs overall are associated with breast cancer risk (OR = 1.22 95% CI 1.08–1.38 P = 0.002). Our results support the definition from previous analyses of FANCM as a moderate-risk breast cancer gene and provide evidence that FANCM MVs could be low/moderate risk factors for ER-negative and TNBC subtypes. Further genetic and functional analyses are necessary to clarify better the increased risks due to FANCM MVs.
Publisher: BMJ
Date: 14-07-2020
Publisher: Springer Science and Business Media LLC
Date: 02-08-2020
DOI: 10.1007/S00520-019-04978-9
Abstract: "Patient-centred care" is widely promoted as an ideal goal of health care systems, but is often difficult to achieve in practice. This article has three aims: to develop an original set of generalisable patient-centred care principles (PCCPs) to identify barriers to the implementation of these principles in a real-world setting, using breast reconstruction (BR) services in Australia as a case study and to document ex les of successful patient-centred care in relation to BR. Semi-structured interviews (n = 90) were conducted with 31 breast and plastic reconstructive surgeons, 37 breast cancer health professionals and 22 women who underwent mastectomy as part of their breast cancer treatment and were dissatisfied with their BR experiences. Ten broad PCCPs were derived from our participant interviews. These principles comprised the following: maximising patient choice, access to services, patient and family support and appropriateness of information minimising patient costs and physical and psychosocial morbidity and facilitating informed decision-making, interdisciplinary patient management and evidence-informed practice. While the major barriers to the implementation of these PCCPs in relation to BR were resource driven, surgeon-related factors were also identified. These PCCPs highlight areas of need but also provide ex les of high quality patient-centred care. They may help to guide a national discussion about minimum standards of BR practice, while allowing for some necessary regional and cultural variation. They also have the potential to be applied more widely to the provision of a range of health services within Australia or internationally.
Publisher: Elsevier BV
Date: 2020
Publisher: Elsevier BV
Date: 12-2023
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.BREAST.2010.12.006
Abstract: Follow-up care after breast cancer treatment is becoming more complex as it attempts to address the long-term needs of an increasing number of survivors. Workforce issues in oncology challenge the sustainability of current specialist-based care. This study explores survivors' experiences with follow-up care and attitudes to alternative models including a tailored survivorship care plan and involvement of primary care physicians and breast care nurses. Twenty women across Australia participated in semi-structured telephone interviews. All continued to attend follow-up visits with a specialist oncologist and reported a high level of satisfaction with care. Participants described a strong reliance on their specialist but were open to an increased role for their primary care physician in a shared model of care. Communication between multidisciplinary team members was perceived as an ongoing problem and there was enthusiasm for a patient-held written survivorship care plan to address this, and to meet information needs.
Publisher: Wiley
Date: 21-01-2019
DOI: 10.1002/PON.4974
Abstract: Many studies have demonstrated the positive impact of breast reconstruction (BR) on women following mastectomy for breast cancer. However, women's preferences for BR are not always considered by surgeons prior to mastectomy. The aim of this research is threefold: to document the negative impact lack of choice has had on some Australian women to explore potential reasons for the absence of informed discussion and to develop a prompt list of discussion topics to aid informed decision making. This research is part of a larger study using semistructured telephone or face-to-face interviews with women with breast cancer, surgeons, and health professionals to explore ways of improving access to BR. This article focuses on responses from all 22 women who reported negative BR experiences and seven of 31 surgeons who had made comments relevant to limiting BR discussion and choice. The impact of a lack of information or choice at the time of mastectomy was often extreme and long-term. Breast surgeons are the gate keepers to accessing BR but too often appeared to limit women's choices. Interviews revealed cases where BR was not offered prior to mastectomy, even though it was available locally where BR was not available locally, but patients were not informed about BR options available in other locations where only delayed BR options were discussed and where the type of BR being offered did not match patient preferences. We have suggested essential BR discussion points to be raised with all clinically eligible women interested in considering BR.
Publisher: American Medical Association (AMA)
Date: 16-06-2022
Publisher: Wiley
Date: 07-2016
DOI: 10.1111/ANS.13590
Publisher: Future Medicine Ltd
Date: 06-2015
DOI: 10.2217/BMT.15.5
Publisher: Wiley
Date: 16-12-2019
DOI: 10.1111/ANS.15596
Abstract: Australia has a large population of immigrant women from Arabic-speaking countries. The aim of this study was to examine breast cancer tumour and surgical treatment features for women born in Arabic-speaking countries and compare them to women born in Australia and other countries. Another aim was to consider how this information can inform clinical care for this multicultural population. This is a retrospective audit of an institutional breast cancer database. Demographic, tumour and surgical treatment data were extracted for the Arab women and compared to Australian-born women (comparison 1) and to women born in all other countries (comparison 2) chi-squared analysis was performed to test for differences between groups. A total of 2086 cases with country of birth information were identified, of whom 139 women (6.7%) were born in Arabic-speaking countries, 894 (42.8%) were born in Australia and 1053 (50.4%) were born in other countries (71 nations). Arab women tended to be younger (P = 0.013), more disadvantaged (P < 0.001), were more likely to have symptomatic rather than screen-detected breast cancer (P < 0.001), had a higher rate of high grade (P = 0.021), HER2-positive (P = 0.025) breast cancer compared to Australian-born women or others. There was no difference in tumour (pT) stage, rate of breast conservation versus mastectomy, re-excision and contralateral prophylactic mastectomy between groups. Australian-born women were more likely to undergo breast reconstruction after mastectomy (P 29% in all groups. Women born in Arabic-speaking countries were younger, more disadvantaged and showed more aggressive tumour features. This has implications for supportive care during treatment and survivorship.
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.EJSO.2016.02.010
Abstract: Older age is associated with lower rates of breast reconstruction (BR) for women requiring mastectomy. The purpose was to assess the available evidence on uptake, outcome and quality of life (QoL) after BR in older women. A systematic literature review was performed via Medline, Embase and Cochrane databases using the search terms breast reconstruction, breast cancer, and mastectomy. Eligible studies reported rates of BR, rates of different reconstructive techniques, complication rates, and/or patient reported outcome measures (PROMs) of BR in women aged 60 years or older undergoing mastectomy for ductal carcinoma in situ or invasive carcinoma. A total of 42 eligible studies were included, with 32 of these reporting BR rates, 10 reporting rates of different reconstructive techniques, 10 reporting rates of complications, and four reporting PROMs. The studies reported 24,746 cases of BR in 407,570 mastectomy patients aged 60 years or older from 1987 to 2012. Implant based BR was more common than autologous techniques. Mostly, complication rates were not higher in older women, and QoL outcomes were similar to younger women. This review confirms that BR rates are lower in older women despite recent studies demonstrating its efficacy. The perception among some surgeons and women requiring mastectomy that the potential risks of BR in older women outweigh the benefits needs to be revisited. Education of consumers and surgeons along with public advocacy for offering BR to all clinically eligible women are the most promising means of changing practice.
Publisher: The Royal Australian College of General Practitioners
Date: 09-2022
Publisher: Wiley
Date: 30-08-2007
DOI: 10.1111/J.1445-2197.2007.04255.X
Abstract: Breast physicians are medical practitioners trained in the diagnosis and management of breast disease. This relatively small group of specialized clinicians has a unique and expanding role in multidisciplinary breast teams in Australia and New Zealand. With minimal available published works, this article studies the varied roles that breast physicians carry out and the way they participate in the multidisciplinary team. Investigation of their current roles in breast medicine identified breast physicians providing a broad range of clinical care in public and private breast clinics and breast screening programmes as well as holding academic and administrative positions in clinical and non-clinical organizations. Numerous benefits for patients and for specialist breast clinicians working in partnership with breast physicians were identified. Breast surgeons are often the most advantaged by the contributions made by the breast physician to the multidisciplinary breast-care team with breast physicians particularly adding value to the service provided by breast surgeons. Breast physicians are well-trained, highly valuable members of the multidisciplinary breast team with a skill set that may enhance patient care at all stages from diagnosis to treatment to follow up.
Publisher: Wiley
Date: 17-05-2020
DOI: 10.1111/ANS.15919
Publisher: Australian Society of Plastic Surgeons
Date: 31-03-2022
Abstract: Recommendations from the inaugural roundtable on breast reconstruction held on 9 October 2019 in Queensland, Australia, for improved decision-making and increased funding to support wider, timely access to breast reconstruction.
No related grants have been discovered for Meagan Brennan.