Customized breast cancer risk assessment in an ambulatory clinic: a portal for identifying women at risk

Weiss, Anna; Grossmith, Samantha; Cutts, Danielle; Mikami, Sage; Suskin, Johanna A.; Graichen, Mary; Rojas, Negui Arilis; Pace, Lydia E.; Joyce, Eileen M.; Rhei, Esther; Scheib, Rochelle; Bychkovsky, Brittany; Garber, Judy E.; Morganstern, Daniel; King, Tari A.

doi:10.1007/s10549-018-05116-5

Cited by 9 publications

(8 citation statements)

References 36 publications

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“…The most commonly cited reason for not taking tamoxifen is fear of side effects, especially endometrial cancer, blood clots, and menopausal symptoms [ 8 , 13 , 14 ]. One approach to address low rates of initiation is to identify and support patients at higher risk of breast cancer in a specialized clinic [ 15 ]. In prior work, this approach has demonstrated improved rates of chemoprevention uptake (24–37%), although high discontinuation rates remain a challenge [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Initiation and tolerance of chemoprevention among women with high-risk breast lesions: the potential of low-dose tamoxifen

Bychkovsky

Laws

Katlin

et al. 2022

Breast Cancer Res Treat

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Purpose High-risk lesions (HRLs) of the breast are an indication for chemoprevention, yet uptake is low, largely due to concerns about side effects. In 2019, low-dose (5 mg) tamoxifen was demonstrated to reduce breast cancer risk with improved tolerance. We describe chemoprevention uptake in an academic clinic before and after the introduction of low-dose tamoxifen. Methods Females age ≥ 35 with HRLs who established care from April 2017 through January 2020 and eligible for chemoprevention were included. Rates of chemoprevention initiation before and after the introduction of low-dose tamoxifen (pre-2019 vs. post-2019) were compared with chi-squared tests. Logistic regression identified demographic and clinical factors associated with chemoprevention initiation. Kaplan–Meier methods determined the rates of discontinuation. Results Among 660 eligible females with HRLs, 22.7% initiated chemoprevention. Median time from first visit to chemoprevention initiation was 54 days (interquartile range (IQR): 0–209); 31.0% (46/150) started chemoprevention > 6 months after their initial visit. Chemoprevention uptake was not significantly different pre-2019 vs. post-2019 (21.2% vs. 26.3%, p = 0.16); however, post-2019, low-dose tamoxifen became the most popular option (41.5%, 34/82). On multivariable analyses, age and breast cancer family history were significantly associated with chemoprevention initiation. Discontinuation rates at 1 year were lowest for low-dose tamoxifen (6.7%) vs. tamoxifen 20 mg (15.0%), raloxifene (20.4%), or an aromatase inhibitor (20.0%). Conclusion In this modern cohort, 22.7% of females with HRLs initiated chemoprevention with 31.0% initiating chemoprevention > 6 months after their first visit. Low-dose tamoxifen is now the most popular choice for chemoprevention, with low discontinuation rates at 1 year. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06577-5.

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Section: Introductionmentioning

confidence: 99%

Initiation and tolerance of chemoprevention among women with high-risk breast lesions: the potential of low-dose tamoxifen

Bychkovsky

Laws

Katlin

et al. 2022

Breast Cancer Res Treat

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“…We wanted to ensure optimal performance of the panels and avoid cross-reactivity between different antibody-fluorophore conjugates. For these analyses, we used cryopreserved PBMCs obtained from women who were seen at the Brigham and Women's Hospital B-PREP clinic ( 22 ). We confirmed cell viability upon thawing using the trypan blue method as well as upon data analysis using the Cytek Aurora SpectroFlo software.…”

Section: Resultsmentioning

confidence: 99%

Spectral Flow Cytometry Methods and Pipelines for Comprehensive Immunoprofiling of Human Peripheral Blood and Bone Marrow

Spasic,

Ogayo,

Parsons

et al. 2024

Cancer Research Communications

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Profiling hematopoietic and immune cells provides important information about disease risk, disease status, and therapeutic responses. Spectral flow cytometry enables high-dimensional single-cell evaluation of large cohorts in a high-throughput manner. Here, we designed, optimized, and implemented new methods for deep immunophenotyping of human peripheral blood and bone marrow by spectral flow cytometry. Two blood antibody panels capture 48 cell-surface markers to assess more than 58 cell phenotypes, including subsets of T cells, B cells, monocytes, NK cells, and dendritic cells, and their respective markers of exhaustion, activation, and differentiation in less than 2 ml of blood. A bone marrow antibody panel captures 32 markers for 35 cell phenotypes, including stem/progenitor populations, T cell subsets, dendritic cells, NK cells, and myeloid cells in a single tube. We adapted and developed innovative flow cytometric analysis algorithms, originally developed for single-cell genomics, to improve data integration and visualization. We also highlight technical considerations for users to ensure data fidelity. Our protocol and analysis pipeline accurately identifies rare cell types, discerns differences in cell abundance and phenotype across donors, and shows concordant immune landscape trends in patients with known hematologic malignancy.

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“…Still, the identification of almost 40% breast cancer patients as at above-average risk is a promising result, that is comparable to results of other studies. 10,[16][17][18][19] However it is still worrisome that as much as 60% of patients diagnosed with breast cancer in age group 40-49 would be diagnosed outside the screening program if women were invited to breast cancer screening based on S-IBIS risk calculation as it could be widely available at the present moment (that is, without data about mammographic density and PRS). Therefore our study showed that tailored mammographic screening in the age group 40-49 in Slovenian population cannot be organized based on this form of S-IBIS alone.…”

Section: Discussionmentioning

confidence: 99%

Breast cancer risk based on adapted IBIS prediction model in Slovenian women aged 40–49 years - could it be better?

Oblak

Zadnik

Krajc

et al. 2020

Radiology and Oncology

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AbstractBackgroundThe aim of the study was to assess the proportion of women that would be classified as at above-average risk of breast cancer based on the 10 year-risk prediction of the Slovenian breast cancer incidence rate (S-IBIS) program in two presumably above-average breast cancer risk populations in age group 40-49 years: (i) women referred for any reason to diagnostic breast centres and (ii) women who were diagnosed with breast cancer aged 40–49 years. Breast cancer is the commonest female cancer in Slovenia, with an incidence rate below European average. The Tyrer-Cuzick breast cancer risk assessment algorithm was recently adapted to S-IBIS. In Slovenia a tailored mammographic screening for women at above average risk in age group 40–49 years is considered in the future. S-IBIS is a possible tool to select population at above-average risk of breast cancer for tailored screening.Patients and methodsIn 357 healthy women aged 40–49 years referred for any reason to diagnostic breast centres and in 367 female breast cancer patients aged 40–49 years at time of diagnosis 10-years breast cancer risk was calculated using the S-IBIS software. The proportion of women classified as above-average risk of breast cancer was calculated for each subgroup of the study population.Results48.7% of women in the Breast centre group and 39.2% of patients in the breast cancer group had above-average 10-year breast cancer risk. Positive family history of breast cancer was more prevalent in the Breast centre group (p < 0.05).ConclusionsInclusion of additional risk factors into the S-IBIS is warranted in the populations with breast cancer incidence below European average to reliably stratify women into breast cancer risk groups.

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Customized breast cancer risk assessment in an ambulatory clinic: a portal for identifying women at risk

Cited by 9 publications

References 36 publications

Initiation and tolerance of chemoprevention among women with high-risk breast lesions: the potential of low-dose tamoxifen

Initiation and tolerance of chemoprevention among women with high-risk breast lesions: the potential of low-dose tamoxifen

Spectral Flow Cytometry Methods and Pipelines for Comprehensive Immunoprofiling of Human Peripheral Blood and Bone Marrow

Breast cancer risk based on adapted IBIS prediction model in Slovenian women aged 40–49 years - could it be better?

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