Background Obesity is associated with poorer breast cancer-specific survival. The purpose of this study was to investigate the relationships between obesity and the presence of angiolymphatic invasion as well as other features of invasive breast cancer, including stage at presentation, estrogen receptor (ER) status, the triple-negative phenotype, and tumor grade. Methods Detailed clinical and pathologic data were abstracted from the medical records of all 1,312 patients with Stage I – III primary breast cancer who had breast surgery at the University of Michigan Comprehensive Cancer Center between January 1, 2000 and December 31, 2006. Bivariate and multivariate analyses were conducted to investigate the relationships between body mass index and tumor biologic features controlling for menopausal status, diabetes and hypertension, hormone replacement therapy before diagnosis, race, and ethnicity. Results In multivariate analyses, severe obesity was independently associated with the presence of angiolymphatic invasion (odds ratio, OR 1.80, 95% C.I. 1.08 to 2.99, joint test of significance, p = 0.03). Severe obesity was associated with a lower likelihood of triple-negative breast cancer (OR 0.39, 95% C.I. 0.16 to 0.96). Among premenopausal women with diabetes, ER-negative (OR 5.22, 95% C.I. 1.22 to 24.29) and triple-negative (OR 14.8, 95% C.I. 1.92 to 113.91) disease was significantly more common. Discussion In this large sample of invasive breast cancers, obesity was independently associated with the presence of angiolymphatic invasion. Higher rates of angiolymphatic invasion among obese women may account in part for the poorer outcomes among obese women with breast cancer.
Purpose To investigate factors associated with patients’ identification of themselves as survivors after a diagnosis of breast cancer. Methods A self-administered survey was deployed through the non-profit organization Breastcancer.org. As part of a larger study, we collected data on treatment, mental health, perceived prognosis, concerns about recurrence and the question, “Do you consider yourself a survivor of breast cancer?” Results Of the 629 survey respondents, 492 (78%) considered themselves survivors of breast cancer. Factors independently associated with an affirmative response were (1) believing that one’s prognosis was “very good” compared to others (p = < 0.001), (2) recalling being told that treatment was curative (p = 0.04), (3) having better mental health (p = 0.002), and (4) having received chemotherapy (p = 0.01). Conclusions and Implications for Cancer Survivors The disparate factors associated with the identification of oneself as a survivor—both the perception of having a very good prognosis and having received chemotherapy (reflecting high risk disease rather than a good prognosis)—are intriguing. Clinicians caring for women with breast cancer should be sensitive to the fact that not everyone considers herself a survivor. Addressing transitions at the end of treatment and during the follow up period may be challenging for clinicians and patients alike. Awareness of the complexities of the survivor identify may help clinicians in counseling their patients.
While it is recognized that cancer treatment can contribute to problems in sexual function, much less is currently known about the specific sexual health concerns and information needs of cancer survivors. This study tested a new instrument to measure cancer survivors' sexual health concerns and needs for sexual information after cancer treatment. The Information on Sexual Health: Your Needs after Cancer (InSYNC), developed by a multidisciplinary team of experts, is a novel 12-item questionnaire to measure sexual health concerns and information needs of cancer survivors. We tested the measure with a sample of breast and prostate cancer survivors. A convenience sample of 114 cancer survivors (58 breast, 56 prostate) was enrolled. Results of the InSYNC questionnaire showed high levels of sexual concern among cancer survivors. Areas of concern differed by cancer type. Prostate cancer survivors were most concerned about being able to satisfy their partners (57 %) while breast cancer survivors were most concerned with changes in how their bodies worked sexually (46 %). Approximately 35 % of all cancer survivors wanted more information about sexual health. Sexual health concerns and unmet information needs are common among breast and prostate cancer survivors, varying in some aspects by type of cancer. Routine screening for sexual health concerns should be included in comprehensive cancer survivorship care to appropriately address health care needs. The InSYNC questionnaire is one tool that may help clinicians identify concerns facing their patients.
BACKGROUND Substantial variation in adjuvant breast cancer chemotherapy dosing in obese women suggests that there is uncertainty about optimal practices. The purpose of this study was to investigate variations in dose determinations in clinical trial protocols and publications over the last 3 decades as potential sources of this uncertainty. METHODS The National Cancer Institute database was used to identify protocols of breast cancer adjuvant chemotherapy conducted by cooperative groups between 1970–2000, and these protocols were then obtained directly from the cooperative groups. Dose determinations were categorized in each protocol and in published reports from each clinical trial. Fisher exact tests were used to compare the proportions of protocols that used full weight‐based doses over time. RESULTS Protocol‐specified chemotherapy dosing was obtained for all of 44 eligible trials. A significant increase was identified in the use of full weight‐based doses in the later time period compared with the earlier (P = .004; 2‐sided Fisher exact test). A notable exception was 1 cooperative group that continues to require dose limitations for doxorubicin and cyclophosphamide in patients with a body surface area of more than 2.0 m2. Regardless of publication date, published reports of clinical trials rarely provide information on use of full or limited weight‐based doses. CONCLUSIONS Variations in dose determinations among clinical trial protocols and lack of information on use of full weight‐based doses in most publications are 2 likely sources of variation in chemotherapy dosing in obese women. Developing consensus and disseminating information on optimal chemotherapy dosing will likely reduce such variation and may improve survival among obese patients with breast cancer. Cancer 2008. © 2008 American Cancer Society.
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