Guidelines for Guidelines: An Assessment of the American Society of Breast Surgeons Contralateral Prophylactic Mastectomy Consensus Statement

Tuttle, Todd M.; Barrio, Andrea V.; Klimberg, V. Suzanne; Giuliano, Armando E.; Chávez-MacGregor, Mariana; Buum, Heather A. Thompson; McMasters, Kelly M.

doi:10.1245/s10434-016-5648-7

Cited by 18 publications

(9 citation statements)

References 10 publications

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“…Because autophagy both is upregulated in KRAS mutant PDAC 12 and is critical for tumorigenic growth 13 the autophagy inhibitor hydroxychloroquine is under clinical evaluation for PDAC treatment (clinical trials NCT01273805, NCT01506973 and NCT03344172). Hydroxychloroquine has shown limited activity as a monotherapy 14,15 ; but has shown promise in combination with preoperative gemcitabine plus nab-paclitaxel (NCT01978184) 16 . It has been assumed, albeit not demonstrated, that KRAS drives high basal levels of autophagy seen in KRAS -mutant PDAC.…”

mentioning

confidence: 99%

Combination of ERK and autophagy inhibition as a treatment approach for pancreatic cancer

Bryant

Stalnecker

Zeitouni

et al. 2019

Nat Med

535

443

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Competing interests C.J.D. is on the Scientific Advisory Board of Mirati Therapeutics. A.C.K. has financial interests in Vescor Therapeutics, LLC. A.C.K. is an inventor on patents pertaining to KRAS-regulated metabolic pathways, redox control pathways in pancreatic cancer, targeting GOT1 as a therapeutic approach, and the autophagic control of iron metabolism. A.C.K. is on the Scientific Advisory Board of Cornerstone/Rafael Pharmaceuticals.

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mentioning

confidence: 99%

Combination of ERK and autophagy inhibition as a treatment approach for pancreatic cancer

Bryant

Stalnecker

Zeitouni

et al. 2019

Nat Med

535

443

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“…15,43,44 Many women report pursuing CPM for symmetry, peace of mind, and the ability to forego continued surveillance. 45,46 Nevertheless, when compared with other options, BM has been associated with a greater risk of complications and delays in adjuvant treatment. 44,47,49 Reflecting this, recent guidelines from the American Society of Breast Surgeons and the Choosing Wisely campaign recommend that routine use of CPM be discouraged in average-risk women.…”

Section: Discussionmentioning

confidence: 99%

Financial Costs and Burden Related to Decisions for Breast Cancer Surgery

Greenup

Rushing

Fish

et al. 2019

JOP

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PURPOSE: Financial toxicity is a well-recognized adverse effect of cancer care, yet little is known about how women consider treatment costs when facing preference-sensitive decisions for breast cancer surgery or how surgical treatment choice affects financial harm. We sought to determine how financial costs and burden relate to decisions for breast cancer surgery. METHODS: Women (≥ 18 years old) with a history of breast cancer were recruited from the Army of Women and Sisters Network to complete an 88-item electronic survey. Descriptive statistics and regression analysis were used to evaluate the impact of costs on surgical decisions and financial harm after breast cancer surgery. RESULTS: A total of 607 women with stage 0 to III breast cancer were included. Most were white (90%), were insured privately (70%) or by Medicare (25%), were college educated (78%), and reported household incomes of more than $74,000 (56%). Forty-three percent underwent breast-conserving surgery, 25% underwent mastectomy, 32% underwent bilateral mastectomy, and 36% underwent breast reconstruction. Twenty-eight percent reported that costs of treatment influenced their surgical decisions, and at incomes of $45,000 per year, costs were prioritized over breast preservation or appearance. Overall, 35% reported financial burden as a result of their cancer treatment, and 78% never discussed costs with their cancer team. When compared with breast-conserving surgery, bilateral mastectomy with or without reconstruction was significantly associated with higher incurred debt, significant to catastrophic financial burden, treatment-related financial hardship, and altered employment. Among the highest incomes, 65% of women were fiscally unprepared, reporting higher-than-expected (26%) treatment costs. CONCLUSION: Cancer treatment costs influenced decisions for breast cancer surgery, and comparably effective surgical treatments differed significantly in their risk of patient-reported financial burden, debt, and impact on employment. Cost transparency may inform preference-sensitive surgical decisions and improve patient-centered care.

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“…In this context, tumor grade, lymph node metastasis, and the depth of invasion are well-established prognostic factors for CRC [27]. A previous study also showed that PNI was associated with lymph node metastasis and depth of invasion [28]. Given that tumor grade relates to malignant behavior, it would be reasonable to predict that PNI reflects the degree of tumor differentiation or grade.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Nomogram for Preoperative Prediction of Perineural Invasion in Colorectal Cancer

Huang

Liu

et al. 2019

Med Sci Monit

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BackgroundIn colorectal cancer (CRC), perineural invasion (PNI) is usually identified histologically in biopsy or resection specimens and is considered a high-risk feature for recurrence of CRC and is an indicator for adjuvant therapy. Preoperative identification of PNI could help determine the need for adjuvant therapy and the approach to surgical resection. This study aimed to develop and validate a nomogram for the preoperative prediction of PNI in patients with CRC.Material/MethodsA total of 664 patients with CRC from a single center were classified into a training dataset (n=468) and a validation dataset (n=196). The least absolute shrinkage and selection operator (LASSO) regression model was used to select potentially relevant features. Multivariate logistic regression analysis was used to develop the nomogram. The performance of the nomogram was assessed based on its calibration, discrimination, and clinical utility.ResultsThe nomogram consisted of five clinical features and provided good calibration and discrimination in the training dataset, with an area under the curve (AUC) of 0.704 (95% CI, 0.657–0.751). Application of the nomogram in the validation cohort showed acceptable discrimination, with the AUC of 0.692 (95% CI, 0.617–0.766) and good calibration. Decision curve analysis (DCA) showed that the nomogram was clinically useful.ConclusionsThe nomogram developed in this study might allow clinicians to predict the risk of PNI in patients with CRC preoperatively. The nomogram showed favorable discrimination and calibration values, which may help optimize preoperative treatment decision-making for patients with CRC.

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Guidelines for Guidelines: An Assessment of the American Society of Breast Surgeons Contralateral Prophylactic Mastectomy Consensus Statement

Cited by 18 publications

References 10 publications

Combination of ERK and autophagy inhibition as a treatment approach for pancreatic cancer

Combination of ERK and autophagy inhibition as a treatment approach for pancreatic cancer

Financial Costs and Burden Related to Decisions for Breast Cancer Surgery

Development and Validation of a Nomogram for Preoperative Prediction of Perineural Invasion in Colorectal Cancer

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