Oncofertility-related psycho-educational therapy for young adult patients with breast cancer and their partners: Randomized controlled trial.

BACKGROUND: A couples' psycho-educational program called Oncofertility! Psycho-Education and Couple Enrichment (O!PEACE) therapy was created and its effect when provided before cancer treatment was examined. METHODS: This multicenter randomized controlled trial with nonmasking, parallel two-group comparison enrolled women aged 20 to 39 years with early-stage breast cancer and their partners. They were randomly assigned to receive O!PEACE (37 couples) or usual care (37 couples). Primary end points were cancer-related posttraumatic stress symptoms, symptoms of depression, and anxiety. Secondary end points were stress-coping strategies, resilience, and marital relationship. RESULTS: Women receiving psycho-educational therapy had significantly reduced Impact of Event Scale-revised version for Japanese scores (p = .011, ηp 2  =  = .089). For patients with Impact of Event Scale-revised version for Japanese scores at baseline ≥18.27, O!PEACE therapy improved these scores when compared with usual care (U = 172.80, p = .027, r = 0.258). A >5-point reduction was present in 59.3% and 30% of women in the O!PEACE therapy and usual-care groups, respectively. For partners, O!PEACE therapy significantly improved stress-coping strategies (95% CI, -0.60 to -0.05; p = .018, ηp 2  =  = .074) and escape-avoidance marital communication (95% CI, -0.33 to -0.08; p = .001, ηp 2  = .136). O!PEACE therapy significantly improved the partners' support (95% CI, 0.10-0.50; p = .001, ηp 2  = .127), the rate of receiving fertility preservation consultations, and knowledge levels. CONCLUSIONS: O!PEACE therapy before cancer treatment can improve posttraumatic stress symptoms, stress-coping behavior, and marital relationships. Larger sample sizes and longer term follow-up are required. PLAIN LANGUAGE SUMMARY: A psycho-educational program, the Oncofertility! Psycho-Education and Couple Enrichment (O!PEACE) therapy program was developed and evaluated for women diagnosed with breast cancer and their partners. A multicenter randomized controlled trial showed that the O!PEACE psycho-educational therapy, with only two precancer treatment sessions, can reduce cancer-related posttraumatic stress symptoms and improve oncofertility knowledge and marital relationships in young adult patients with breast cancer. The therapy could also improve stress-coping strategies in marital communications with their partners. Couples may use O!PEACE psycho-educational therapy to consider fertility preservation and improve their psychosocial aspects.

Post-traumatic growth and cancer-related communication among adolescents having mothers with breast cancer.

PURPOSE: This study aimed to clarify the characteristics of post-traumatic growth (PTG) among adolescents having mothers diagnosed with breast cancer and the relationship between PTG and cancer-related communication with breast cancer survivors. METHODS: A cross-sectional study was conducted using anonymous self-report questionnaires with breast cancer survivors and adolescent children. PTG in adolescents was measured using the Japanese version of the revised PTG Inventory for Children (PTGI-C-R-J). Furthermore, hierarchical multiple regression analysis was implemented. To evaluate the impact of cancer-related communication on each subscale, the total score of cancer-related communication was switched with other subscales individually within the constructed model. RESULTS: A total of 97 breast cancer survivors and their adolescent children were included. The mean scores of the total PTGI-C-R-J and subscale scores for "personal strength," "new possibilities," "relating to others," "appreciation of life," and "spiritual change" were 9.0, 1.7, 1.8, 2.3, 2.4, and 0.9, respectively. The connection between PTG and cancer-related communication was partially clarified. The PTGI-C-R-J score was higher when adolescents shared more information regarding breast cancer with their mothers and lower when adolescents expressed more negative feelings toward their mothers. Communication regarding relationships with mothers was not correlated with PTG. CONCLUSIONS: Of all PTG domains, "relating to others" and "appreciation of life" were comparatively higher in adolescents. Health professionals should support breast cancer survivors to ensure that they convey appropriate information regarding their treatment plans and side effects to their adolescent children. Health professionals should help adolescent children express their negative feelings calmly and clearly.

[Treatment Strategy for HER2 Positive and HER2 Low Breast Cancer].

Human epidermal growth factor receptor 2(HER2)positive breast cancer has been regarded as a poor prognosis breast cancer, but since the development of trastuzumab and various anti-HER2 drugs, the prognosis has significantly improved. Also, combining anti-HER2 drugs with chemotherapy as preoperative treatment, shows high ratings of pathological complete response(pCR). In terms of breast cancer, pCR is a prognosis predictive factor. As a result, in perioperative treatment for HER2 positive breast cancer, residual disease-guided approach which means to select postoperative treatment according to the response to preoperative chemotherapy has become the main stream. Furthermore, trastuzumab deruxtecan, which had been covered by insurance only for HER2 positive metastatic or recurrent breast cancer, was newly reimbursed for breast cancer with low HER2 expression at the end of March 2023, and the future movement is attracting attention.

Impact of childbirth history on dense breast in mammographic screening: a cross-sectional study.

BACKGROUND: The evaluation of breast density is important, because dense breast has been shown to be associated with increased risk of breast cancer and a greater risk of a false-negative diagnostic performance due to masking a tumor. Although the relationship between parity and dense breast is under investigation, conclusive evidence is lacking. We aimed to investigate whether parity affects breast density. METHODS: The study design is a cross-sectional study. The subjects are healthy Japanese women who underwent opportunistic mammographic screening at the center for preventive medicine at a single institution from January 2016 to December 2018. Clinical characteristics and lifestyle factors were obtained from questionnaires. Breast density was categorized into 4 groups, namely, almost entirely fatty dense, scattered fibroglandular dense, heterogeneously dense, and extremely dense, according to the Breast Imaging Reporting and Data System. Heterogeneously and extremely dense were considered collectively as dense breast. Multivariate logistic regression analysis was conducted to investigate the relationship between parity and dense breast among premenopausal and postmenopausal women separately. RESULTS: 7612 premenopausal and 9252 postmenopausal women were investigated. Dense breast was shown in 62.6% of nulliparity, 57.3% of single parity, 47.3% of two parity, 37.6% of more than two parity among premenopausal women, and in 41.6% of nulliparity, 31.1% of single parity, 19.3% of two parity, 10.1% of more than two parity among postmenopausal women. For premenopausal women, two parity, single parity and nulliparity showed a higher risk for dense breast with statistically significance (Odds Ratio (OR) adjusted for potential confounding factors: 1.458 (95% Confidence interval (CI); 1.123-1.894), 2.349 (95%CI; 1.801-3.064), 3.222 (95%CI; 2.500-4.151), respectively), compared with more than two parity. For postmenopausal women, two parity, single parity and nulliparity had a higher risk (OR: 1.849 (95%CI; 1.479-2.312), 3.023 (95%CI; 2.385-3.830), 4.954 (95%CI; 3.975-6.174), respectively) with statistically significance, compared with more than two parity. CONCLUSIONS: Parity showed an inverse trend of having dense breast among both premenopausal and postmenopausal women. In particular, nulliparous women need to recognize their higher risk of dense breast. In the future, the declining fertility rate may affect the prevalence of dense breast in the world.

Risk Factors for Ipsilateral Breast Tumor Recurrence in Triple-Negative or HER2-Positive Breast Cancer Patients Who Achieve a Pathologic Complete Response After Neoadjuvant Chemotherapy.

BACKGROUND: Attention has been focused on attempts to eliminate breast surgery for breast cancer patients who achieve a pathologic complete response after neoadjuvant chemotherapy (NAC). However, there are few data on ipsilateral breast tumor recurrence (IBTR) among patients with triple-negative or epidermal growth factor receptor 2-positive (HER2+) tumors who achieve a pathologic complete response after NAC and breast-conserving treatment. METHODS: Using a multi-institutional retrospective database, this study evaluated the risk factors for IBTR among patients with newly diagnosed stages 1 to 3 breast cancer involving triple-negative or HER2+ tumors who achieved ypT0 after NAC and breast-conserving treatment. RESULTS: During a median follow-up period of 4.8 years (range, 0.1-15.5 years), the 5-year IBTR-free survival rate was 95.5%. The breast cancer subtype was not associated with IBTR-free survival. Patients younger than 40 years at diagnosis had significantly worse IBTR-free survival than those who were 40 years of age or older (5-year IBTR-free survival, 87.7 vs 96.9%; p = 0.002). CONCLUSIONS: This retrospective study demonstrated that age at diagnosis was independently associated with IBTR-free survival. Special caution is needed when clinical trials analyzing omission of breast surgery after NAC are enrolling younger patients (UMIN-CTR No. UMIN000037067).

Characteristics of taste alterations in people receiving taxane-based chemotherapy and their association with appetite, weight, and quality of life.

PURPOSE: There is limited evidence on the effect of chemotherapy-associated taste alteration. This study aimed to evaluate taste alteration characteristics in patients receiving taxane-based chemotherapy and investigate the association of taste alterations with appetite, weight, quality of life (QOL), and adverse events. METHODS: This cross-sectional study evaluated 100 patients receiving paclitaxel, docetaxel, or nab-paclitaxel as monotherapy or combination therapy. Taste alterations were evaluated using taste recognition thresholds and severity and symptom scales. Taste recognition thresholds, symptoms, appetite, weight, and adverse events were compared between patients with and without taste alterations, and logistic regression analysis was performed to identify risk factors. RESULTS: Of the 100 patients, 59% reported taste alterations. We found significantly elevated taste recognition thresholds (hypogeusia) for sweet, sour, and bitter tastes in the taste alteration group receiving nab-paclitaxel (p = 0.022, 0.020, and 0.039, respectively). The taste alteration group reported general taste alterations, decline in basic taste, and decreased appetite. Neither weight nor QOL was associated with taste alterations. Docetaxel therapy, previous chemotherapy, dry mouth, and peripheral neuropathy were significantly associated with taste alterations. CONCLUSIONS: Almost 60% of patients receiving taxane-based regimens, especially docetaxel, reported taste alterations. Taste alteration affected the patient's appetite but did not affect the weight or QOL. Docetaxel therapy, previous chemotherapy, dry mouth, and peripheral neuropathy were independent risk factors for taste alterations.

How pregnancy and childbirth affect the working conditions and careers of women surgeons in Japan: findings of a nationwide survey conducted by the Japan Surgical Society.

PURPOSE: To identify the conflicts between a career as a surgeon and pregnancy and childbirth for women in Japan. METHODS: The Japan Surgical Society conducted a nationwide survey on pregnancy and childbirth among its members who are women. The questionnaire included items regarding demography, working styles, and pregnancy and childbirth, including adverse events and harassment. RESULTS: The response rate was 29.9% (1068 responses, median age, 37 years). Among the responders, 61% were married and 47% had children (average number of children, 1.7). Half of the respondents reported having experienced sexual harassment and 62% reported having received unwelcome comments about pregnancy. About 20% had undergone fertility treatment. In total, 51% had pregnancies, with miscarriages in 33% of these. The top answer for the best timing for pregnancy and childbirth was after becoming board-certified. Nearly one-third of first-time mothers experienced adverse events during pregnancy and delivery, and 28% quit or changed their job because of their pregnancy and the birth of their first child. CONCLUSIONS: Japanese women who choose a career as a surgeon face obstacles during pregnancy and childbirth. It is vital to share the findings of this study and understand the issues associated with pregnancy and childbirth regardless of gender. Interventions are essential to ensure that every pregnant surgeon has a safe working environment to allow unobstructed development of her career.

Long-term survival analysis of addition of carboplatin to neoadjuvant chemotherapy in HER2-negative breast cancer.

PURPOSE: Addition of carboplatin (CBDCA) to neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC) has improved pathological complete response (pCR) rates in previous studies. We present long-term survival outcomes (disease-free survival [DFS], pre-planned secondary endpoint; overall survival [OS], post hoc exploratory endpoint) of our randomized study of the addition of CBDCA to NAC for HER2-negative breast cancer. METHODS: Patients with stage II/III, HER2-negative breast cancer (N = 179) were randomly assigned to receive CP-CEF (four 3-week cycles of CBDCA [area under the curve, 5 mg/mL/min, day 1] and weekly paclitaxel [wPTX, 80 mg/m2, day 1, 8, 15] followed by four 3-week cycles of cyclophosphamide, epirubicin, and 5-fluorouracil [CEF, 500/100/500 mg/m2]) or P-CEF (four cycles of wPTX followed by four cycles of CEF) as NAC. DFS and OS were analyzed at each population of pCR status and assigned treatment arm. RESULTS: Of 179 patients, 154 were available for long-term follow-up. At a median follow-up of 6.6 years (range, 0.7-8.0 years), patients who achieved pCR [n = 42, 23.5% (CP-CEF: n = 28, P-CEF: n = 16)] had longer DFS and OS than non-pCR patients [DFS; HR 0.15 (0.04-0.61), P = 0.008, OS; log-rank P = 0.003]. Addition of carboplatin to NAC significantly improved DFS and OS in the subset of patients with TNBC [DFS: HR, 0.22 (0.06-0.82), P = 0.015; OS: HR, 0.12 (0.01-0.96), P = 0.046], but not in the subset of patients with hormone receptor-positive disease or among all patients. CONCLUSIONS: Addition of carboplatin to neoadjuvant chemotherapy significantly improved DFS and OS in patients with TNBC but not in those with hormone receptor-positive, HER2-negative breast cancer.

Validation of the Japanese version of the barriers questionnaire II in cancer pain management: a cross-sectional study.

BACKGROUND: The Barriers Questionnaire II (BQ-II) was developed to assess barriers to effective pain management. In this study, we aimed to assess the reliability and validity of the newly developed Japanese version of the BQ-II (JBQ-II). METHODS: This study used a cross-sectional design. The study was conducted an ambulatory infusion center for cancer in a general hospital in Tokyo, Japan. Participants were 120 Japanese patients with cancer and 21 Japanese health professionals with experience in pain management. Cronbach's alpha coefficient was used to calculate reliability. Test-retest reliability was assessed with Spearman's intra-class correlation coefficient (ICC). Construct, criterion-related, and discriminant validity were assessed using information about pain management, daily life, mental health, and subjective health. RESULTS: The Cronbach's alpha was 0.90 for the JBQ-II, and all ICCs exceeded 0.70 (P < 0.01). Factor analysis showed the JBQ-II had a virtually identical structure to the BQ-II, and path analysis supported the JBQ-II constructs. The JBQ-II was weakly correlated with poor mental state (r = 0.36, P < 0.01). Patients' JBQ-II scores were significantly higher than health professionals' scores. CONCLUSION: The JBQ-II is a valid and reliable measure of patient-related barriers to pain management among Japanese adult patients with cancer.

[Work Style Reform from Oncology Field].

The doctor's work style reform was enacted in April 2024, and it will enter oncology field without waiting. Oncology clinics already have the 3 powers to realize work style reforms.(1)Efficiency of tasks and task shifting/task sharing that can be advanced only because of the field where team medical care has been performed.(2)Patient understanding and good public skills how to apply medical care that can be obtained only because of the field where emphasis has been placed on collaboration with patients.(3)Improve practice efficiency by introducing ICT that can be realized only in the field where it is easy to introduce ICT, and introduce AI to medical care. I hope that we can make utilize maximally these 3 strengths and promote work style reform from oncology field.

[The Road to a Holistic Treatment-The Importance of Continuous Support for Breast Cancer Survivors].

The incidence of breast cancer peaks in women in their 40's and 50's. These women may play an important role in their careers, at home, and as a parent, and therefore need a multifaceted support while undergoing treatment. The concept of survivorship, which is focused on the cancer survivors' and their family's quality of life, is important in providing such support. There are many aspects for which support may be necessary, such as treatment decision-making, fertility preservation, child support, management of genetic conditions, and issues of employment. For providing home care services, the necessary care should be given without compromising their daily lives. For example, consideration should be given as to how to spend their last moments in the presence of their children. It is necessary to understand the patient's course of treatment from the beginning, which includes both hospital and home care services, in making the treatment plan together.

Prognostic impact of multifocal and multicentric breast cancer versus unifocal breast cancer.

PURPOSES: The clinical behavior of multifocal and multicentric breast cancers (MMBCs) is not well characterized. We conducted this study to ascertain whether patients with MMBCs have a worse prognosis than patients with unifocal breast cancers (UBC). METHODS: The subjects of this retrospective study were 734 consecutive patients who underwent definitive surgery for invasive breast carcinoma at our hospital between January 2004 and December 2006. MMBC was defined as ≥ 2 separate invasive unilateral breast tumors and pathological T stage was redefined based on the sum of the maximum diameter of each tumor. We evaluated disease-free survival (DFS) using the Kaplan-Meier method and Cox proportional hazards models. RESULTS: Of the 734 patients, 136 (18.5%) had MMBC. The pathological T stage of 36 of the patients with MMBC was upstaged by adopting the sum of each focus. MMBC did not have any survival impact, but MMBC upstaged by the modified pathological T stage was associated with worse DFS than non-upstaging MMBC (P = 0.004). Multivariate analysis revealed that upstaging MMBC was an independent factor for poor prognosis and worse DFS (HR 2.757, P = 0.043). CONCLUSIONS: MMBC itself may not be predictive of a worse prognosis; however, the sum of the invasive diameters of MMBC might be an important prognostic factor. Further studies are needed to confirm the prognosis associated with MMBC, taking into consideration the biological characteristics of each invasive focus.

[Genetic Approach of Breast Cancer].

In July 2018, olaparib, an oral poly adenosine diphosphate-ribose polymerase(PARP)inhibitor, was approved for the first time in Japan as a companion diagnostic drug for the treatment of recurrent breast cancer in BRCA-positive patients. Genetic testing had been offered only to clients who met the eligibility criteria for the test, and the decision whether or not to receive the test was based on their medical and family history, tumor characteristics, and the client's preference. With the approval of olaparib as a companion diagnostic drug, genetic testing has become a part of the standard treatment protocol. Modern technology has made multiple genetic testing possible in one setting. It is therefore necessary for medical practitioners to have the knowledge and ability to take care for familiar tumors. It may be difficult to understand all the available information on genetics, but an individualized approach for each patient would be necessary in the future. Medical practitioners involved in the treatment of such patients would need adequate knowledge on genetics and genetic counseling, as well as the ability to educate and provide information to the patients and their families. If a more specialized approach is necessary, referral to an institution with a clinical genetics department is essential.

High rate of occult cancer found in prophylactic mastectomy specimens despite thorough presurgical assessment with MRI and ultrasound: findings from the Hereditary Breast and Ovarian Cancer Registration 2016 in Japan.

PURPOSE: Prophylactic surgery is a preemptive strategy for hereditary breast and ovarian cancer (HBOC). Prophylactic mastectomy (PM) reduces breast cancer risk by > 90%. The aim of our study is to analyze the information of the Japanese pedigrees and to utilize the results for clinical practice. METHODS: We statistically analyzed records of HBOC registrees who had undergone BRCA1/2 genetic testing at seven medical institutions up until 2016. In the cases of PM, we examined breasts with the use of mammography (MMG), ultrasound (US), and magnetic resonance imaging (MRI) before surgery. After PM, the specimens were divided about 1 cm serially and examined in their entirety. RESULTS: Of 1527 registrees who underwent BRCA testing, 1125 (73.7%) were negative for BRCA1/2 mutation, 297 (19.5%) were positive for BRCA1/2 mutation (BRCA1/2MUT+), and 105 (6.9%) had uncertain results. To decide whether to undergo total mastectomy vs. breast-conserving surgery (BCS), 370 registrees underwent presurgical genetic testing. During the follow-up period, four new-onset breast cancers were found among the 55 non-affected BRCA carriers. Among the 73 BRCA1/2MUT+ carriers who underwent BCS, 3 were found to have ipsilateral breast cancer. Of 189 BRCA1/2MUT+ carriers with unilateral breast cancer, 8 were found to have contralateral breast cancer. Of 53 PM specimens, 6 (11.3%) were found to have occult breast cancer despite using MMG, US, and MRI. CONCLUSIONS: Our report showed a relatively higher incidence rate of occult cancer at 11.3% in PM specimens despite thorough pre-operative radiological evaluations, which included a breast MRI. Considering the occult cancer rates and the various pathological methods of our study and published studies, we propose the necessity of a histopathological protocol.

Management of hereditary breast and ovarian cancer.

Hereditary breast and ovarian cancer (HBOC) syndrome represents 5-10% of all breast cancers. In Japan, the HBOC syndrome is frequently diagnosed in patients with breast cancer. Therefore, a treatment strategy combining a plan for existing breast cancer and for reduction of future breast and ovarian cancer risk is necessary. Breast cancer risk-reducing management involves three options-surveillance, chemoprevention, and risk-reducing mastectomy (RRM). RRM can prevent >90% of new breast cancers. Ovarian cancer risk management options are more limited, and risk-reduction salpingo-oophorectomy is the only option since there is no proven effective early detection method available. The local recurrence rate following breast-conserving surgery in BRCA1/2 mutation-associated breast cancer is not significantly higher than that in sporadic breast cancer. Furthermore, there is no difference in prognosis between surgical methods. Clinicians should inform patients that there are no data on long-term monitoring and fully discuss risks of re-developing breast cancer with patients when choosing the surgical method. In HBOC, BRCA1/2 mutations lead to failure of double-strand DNA break repair, with poly ADP-ribose polymerase (PARP) playing an important role in single-strand DNA nick repair. Use of PARP inhibitors in HBOC prevents DNA repair (synthetic lethality) leading to cell death. This review summarizes management of the HBOC syndrome based on recent evidence.

Randomized phase II study of nab-paclitaxel as first-line chemotherapy in patients with HER2-negative metastatic breast cancer.

Weekly administration of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) has been shown to be a safe and effective treatment for metastatic breast cancer (MBC) in clinical studies. We conducted a multicenter, randomized, open-label phase II study to compare the efficacy and safety of weekly nab-paclitaxel and docetaxel in Japanese patients with human epidermal growth factor receptor 2-negative MBC. The primary endpoint was progression-free survival (PFS). Patients were randomized to receive nab-paclitaxel (150 mg/m2 nab-paclitaxel once per week for 3 of 4 weeks; n = 100) or docetaxel (75 mg/m2 docetaxel every 3 weeks; n = 100). The median PFS by independent radiologist assessment was 9.8 months (90% confidence interval [CI]: 8.5-11.2) for nab-paclitaxel and 11.2 months (90% CI: 8.4-13.8) for docetaxel (hazard ratio: 1.25, P = 0.363), and the median overall survival was 42.4 months and 34.0 months, respectively. The overall response rate was 56.1% for nab-paclitaxel and 52.5% for docetaxel. Adverse events in both treatment arms were similar to previous reports. Neutropenia was the most common adverse event in both arms, with 35.0% of patients in the nab-paclitaxel arm and 89.0% in the docetaxel arm experiencing grade 4 neutropenia. Grade 3 peripheral sensory neuropathy occurred in 22.0% of patients in the nab-paclitaxel and 5.0% in the docetaxel arm. In this study, although weekly nab-paclitaxel 150 mg/m2 did not show superiority in PFS compared with docetaxel, efficacy outcomes were similar in patients treated with weekly nab-paclitaxel and docetaxel.

BMI change and abdominal circumference are risk factors for breast cancer, even in Asian women.

PURPOSE: We investigated the association between breast cancer incidence and obesity among Asian women. METHODS: We used data from 30,109 women who had undergone medical check-ups and opportunistic breast cancer screening at least twice at the St. Luke's International Hospital Affiliated Clinic, Center for Preventive Medicine, between April 1, 2005 and March 31, 2014. This study evaluated obesity through body mass index (BMI) at age 18-20 years (BMI18-20y), BMI at research entry (entry BMI), change of BMI from age 18-20 to research entry (ΔBMI), abdominal circumference at research entry (AC), and HbA1c [N] at research entry (HbA1c). We used a multivariate Cox proportional hazard model to evaluate hazard ratios (HRs) and 95% confidence intervals (95% CIs). RESULTS: Of the 30,109 women, 325 were initially diagnosed with breast cancer over 131,657 person-years. Postmenopausal women whose BMI increased ≥+5.0 were significantly more likely to develop breast cancer (HR 1.902, 95% CI 1.202-3.009) than were the stable BMI group (ΔBMI: -2.5 to +2.5). Postmenopausal women with AC ≥90 cm were significantly likelier to develop breast cancer than were those with AC <70 cm (HR 2.500, 95% CI 1.091-5.730). Among postmenopausal women whose BMI18-20y was ≥20, those with high (≥6.5) HbA1c were more likely to develop breast cancer than those with low (<5.5) HbA1c (HR 3.325, 95% CI 1.307-8.460). CONCLUSIONS: Breast cancer incidence and obesity are positively associated in postmenopausal Asian women.

Change in HER2 status after neoadjuvant chemotherapy and the prognostic impact in patients with primary breast cancer.

BACKGROUND: We aimed to assess change in HER2 status after neoadjuvant chemotherapy (NAC) in patients with primary breast cancer and the prognostic impact of such changes. PATIENTS AND METHODS: The study comprised 588 patients with a non-pathologic complete response who received anthracycline and/or taxane-based regimens in NAC setting. HER2 status was assessed before NAC and in residual invasive tumor of the surgical specimens. The associations between the change in HER2 status and clinicopathological factors were assessed. RESULTS: Before NAC, 489 (83%) of the 588 patients had HER2-negative tumors and 99 patients (17%) had HER2-positive tumors. Eleven (2.2%) of the HER2-negative tumors changed to HER2-positive, while 33 (33%) of the HER2-positive tumors changed to HER2-negative. ER and PR-positivity before NAC were associated with loss of HER2-positivity, whereas receiving trastuzumab was not. In terms of disease-free survival, there was no difference between patients with and those without change in HER2 status after NAC in either the patients with HER2-negative tumors (P = 0.26) or with HER2-positive tumors before NAC (P = 0.23). CONCLUSION: Our results showed that changes in HER2 status did not affect patients' prognosis. Further studies are needed to determine whether HER2-targeting agents can be omitted when loss of HER2-positivity is confirmed after NAC.

Inflammatory breast cancer: the disease, the biology, the treatment.

Inflammatory breast cancer (IBC) is a rare and aggressive form of invasive breast cancer accounting for 2.5% of all breast cancer cases. It is characterized by rapid progression, local and distant metastases, younger age of onset, and lower overall survival compared with other breast cancers. Historically, IBC is a lethal disease with less than a 5% survival rate beyond 5 years when treated with surgery or radiation therapy. Because of its rarity, IBC is often misdiagnosed as mastitis or generalized dermatitis. This review examines IBC's unique clinical presentation, pathology, epidemiology, imaging, and biology and details current multidisciplinary management of the disease, which comprises systemic therapy, surgery, and radiation therapy.

[Diagnosis and Treatment of HBOC Syndrome by a Breast Surgical Oncologist].

Of all breast cancer cases, 5-10% occur because of inherited germline mutation. For hereditary breast and ovarian cancer (HBOC)syndrome, congenital knowledge and strategies for breast cancer treatment and risk reduction are necessary. Regarding the surgical procedure for the cancer site, the ipsilateral breast tumor recurrence rate following breast-conserving surgery in breast cancers with BRCA1/2 mutation is not significantly higher than that in sporadic breast cancers. In addition, prognosis did not differ according to surgical methods. Therefore, breast-conserving surgery for HBOC is not an absolute contraindication, although the risk of developing new primary tumors in the long term should be carefully considered. For the contralateral breast, 3 choices are available, surveillance, chemo-prevention, and risk-reducing mastectomy. Risk-reducing mastectomy is known to decrease the risk of breast cancer by 90%. Genetic counseling is essential for decision making in HBOC treatment. In this review, we reevaluated the current evidence for surgical decision making and systemic therapies for HBOC syndrome.