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Aldo Lorenzetti M.D, Internal Medicine & Hepatology, Milano - SIMEDET Delegate
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Persistent #vasomotor symptoms and #breast cancer in the Women's Health Initiative

https://journals.lww.com/menopausejournal/Abstract/publishahead/Persistent_vasomotor_symptoms_and_breast_cancer_in.97437.aspx

Results: Through 17.9 years (median) follow-up, 1,399 incident breast cancers were seen. Women with persistent VMS (VMS median duration 10+ years) (n = 9,715), compared to women with never VMS (n = 15,784), had a higher breast cancer incidence (hazard ratio HR 1.13 95% confidence interval CI 1.02-1.27). While breast cancer-specific mortality was higher in women with persistent VMS (HR 1.33 95% CI 0.88-2.02), the difference was not statistically significant. Persistent VMS status had no influence on breast cancer overall survival (HR 1.02 95% CI 0.81-1.29).

Conclusion: Women with persistent VMS are more likely to be diagnosed with breast cancer than women who never experienced VMS, but not more likely to die from breast cancer.
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Performance of Screening Ultrasonography as an Adjunct to Screening #Mammography in Women Across the Spectrum of #Breast Cancer Risk

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2728448

Comparing mammography plus ultrasonography with mammography alone, the cancer detection rate was similar at 5.4 vs 5.5 per 1000 screens (adjusted relative risk RR, 1.14; 95% CI, 0.76-1.68), as were interval cancer rates at 1.5 vs 1.9 per 1000 screens (RR, 0.67; 95% CI, 0.33-1.37). The false-positive biopsy rates were significantly higher at 52.0 vs 22.2 per 1000 screens (RR, 2.23; 95% CI, 1.93-2.58), as was short-interval follow-up at 3.9% vs 1.1% (RR, 3.10; 95% CI, 2.60-3.70). The positive predictive value of biopsy recommendation was significantly lower at 9.5% vs 21.4% (RR, 0.50; 95% CI, 0.35-0.71).

Conclusions and Relevance In a relatively young population of women at low, intermediate, and high breast cancer risk, these results suggest that the benefits of supplemental ultrasonography screening may not outweigh associated harms.
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Use of Contrast-Enhanced #MRI in Management of Discordant Core #Biopsy Results

https://www.ajronline.org/doi/abs/10.2214/AJR.18.20157

Evaluating concordance between core biopsy results and imaging findings is an integral component of #breast intervention. Pathologic results deemed benign discordant reflect concern that a malignancy may have been incorrectly sampled. Standard of care currently is surgical excision, although a large percentage of these lesions will be benign at final pathologic analysis. The purpose of this study was to determine whether inclusion of contrast-enhanced MRI would optimize patient care.

Fourteen patients had suspicious MRI findings; 31 patients did not. Negative or benign MRI findings were validated by stability at imaging follow-up of at least 1 year in 27 patients (28 lesions) and at least 6 months in four patients. Eight of the total of 46 discordant lesions were ultimately malignant, a rate of 17.3%, an expected result for BI-RADS 4 lesions. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI calculated in the group of 41 patients (42 lesions) with documented stability for at least 1 year were 100%, 93.3%, 85.7%, and 100%. The false-negative rate of MRI was 0%; the false-positive rate was 2 of 30 (6.7%).

CONCLUSION. In the management of discordant benign core biopsy results, contrast-enhanced MRI facilitated successful triage of patients to surgery; 31 of the original 45 patients (68.9%) avoided su
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#Screening for #Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians

https://annals.org/aim/fullarticle/2730520/screening-breast-cancer-average-risk-women-guidance-statement-from-american

Guidance Statement 1:
In average-risk women aged 40 to 49 years, clinicians should discuss whether to screen for breast cancer with mammography before age 50 years. Discussion should include the potential benefits and harms and a woman's preferences. The potential harms outweigh the benefits in most women aged 40 to 49 years.

Guidance Statement 2:
In average-risk women aged 50 to 74 years, clinicians should offer screening for breast cancer with biennial mammography.

Guidance Statement 3:
In average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer.

Guidance Statement 4:
In average-risk women of all ages, clinicians should not use clinical breast examination to screen for breast cancer
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The acceptability of addressing #alcohol consumption as a modifiable risk factor for #breast cancer: a mixed method study within breast screening services and symptomatic breast clinics

https://bmjopen.bmj.com/content/9/6/e027371

Potentially modifiable risk factors account for approximately 23% of breast cancers, with obesity and alcohol being the two greatest. Breast screening and symptomatic clinical attendances provide opportunities (‘teachable moments’) to link health promotion and breast cancer-prevention advice within established clinical pathways. This study explored knowledge and attitudes towards alcohol as a risk factor for breast cancer, and potential challenges inherent in incorporating advice about alcohol health risks into breast clinics and screening appointments.

Alcohol was identified as a breast cancer risk factor by 40/205 (19.5%) of attenders and 16/33 (48.5%) of staff. Overall 66.5% of attenders drank alcohol, and 56.6% could not estimate correctly the alcohol content of any of four commonly consumed alcoholic drinks. All women agreed that including a prevention-focussed intervention would not reduce the likelihood of their attendance at screening mammograms or breast clinics..
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Type and timing of #menopausal #hormone therapy and #breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext

..Every MHT type, except vaginal oestrogens, was associated with excess breast cancer risks, which increased steadily with duration of use and were greater for oestrogen-progestagen than oestrogen-only preparations

Interpretation
If these associations are largely causal, then for women of average weight in developed countries, 5 years of MHT, starting at age 50 years, would increase breast cancer incidence at ages 50–69 years by about one in every 50 users of oestrogen plus daily progestagen preparations; one in every 70 users of oestrogen plus intermittent progestagen preparations; and one in every 200 users of oestrogen-only preparations. The corresponding excesses from 10 years of MHT would be about twice as great.
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Use of #anastrozole for #breast cancer prevention (IBIS-II): long-term results of a randomised controlled trial

..3864 women were recruited between Feb 2, 2003, and Jan 31, 2012. 1920 women were randomly assigned to 5 years anastrozole and 1944 to placebo. After a median follow-up of 131 months (IQR 105–156), a 49% reduction in breast cancer was observed for anastrozole (85 vs 165 cases, hazard ratio [HR] 0·51, 95% CI 0·39–0·66, p<0·0001). The reduction was larger in the first 5 years (35 vs 89, 0·39, 0·27–0·58, p<0·0001), but still significant after 5 years (50 vs 76 new cases, 0·64, 0·45–0·91, p=0·014), and not significantly different from the first 5 years (p=0·087).

..No significant difference in deaths was observed overall (69 vs 70, HR 0·96, 95% CI 0·69–1·34, p=0·82) or for breast cancer (two anastrozole vs three placebo). A significant decrease in non-breast cancers was observed for anastrozole (147 vs 200, odds ratio 0·72, 95% CI 0·57–0·91, p=0·0042), owing primarily to non-melanoma skin cancer. No excess of fractures or cardiovascular disease was observed.
Interpretation
This analysis has identified a significant continuing reduction in breast cancer with anastrozole in the post-treatment follow-up period, with no evidence of new late side-effects. Further follow-up is needed to assess the effect on breast cancer mortality

https://bit.ly/38AiwHD
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Sustained #weight loss and risk of #breast cancer in women ≥50 years: a pooled analysis of prospective data

..Compared with women with stable weight (± 2kg), women with sustained weight loss had a lower risk of breast cancer. This risk reduction was linear and specific to women not using postmenopausal hormones (>2-4.5kg lost: Hazard Ratio (HR)= 0.82, 95% confidence interval (CI): 0.70-0.96; >4.5-<9kg lost: HR = 0.75, 95% CI: 0.63-0.90; ≥9kg lost: HR = 0.68, 95% CI: 0.50-0.93). Women who lost ≥9kg and gained some (but not all) of it back were also at a lower risk of breast cancer. Other patterns of weight loss and gain over the two intervals had a similar risk of breast cancer to women with stable weight.

CONCLUSIONS
These results suggest that sustained weight loss, even modest amounts, is associated with lower breast cancer risk for women aged ≥50 years. Breast cancer prevention may be a strong weight loss motivator for the two-thirds of American women who are overweight or obese.

https://bit.ly/2s6BJjN
Similar #Breast Cancer Risk in Women Older Than 65 Years Initiating Glargine, Detemir, and NPH Insulins
https://2medical.news/2020/03/05/similar-breast-cancer-risk-in-women-older-than-65-years-initiating-glargine-detemir-and-nph-insulins/

To assess whether initiation of insulin glargine (glargine), compared with initiation of neutral protamine Hagedorn (NPH) or insulin detemir (detemir), was associated with an increased risk of breast cancer in women with diabetes.. Ever use of glargine was not associated with an increased risk of breast cancer compared with NPH (HR 0.97; 95% CI 0.88–1.06) or detemir (HR, 0.98; 95% CI 0.92–1.05). No increased risk …
Serum #iodine and #breast cancer risk: A prospective nested case-control study stratified for selenium levels
https://2medical.news/2020/06/03/serum-iodine-and-breast-cancer-risk-a-prospective-nested-case-control-study-stratified-for-selenium-levels/

Iodine has been suggested to protect against breast cancer, but there are no epidemiological studies on individual risk. An interesting finding is that in areas where the exposure to both selenium and iodine are high (e.g. Japan), the risk of breast cancer is lower than in areas where selenium is high and iodine low (e.g. USA), or in areas where both are low (e.g. Northern …
#Aspirin use and risk of #breast cancer in African American women
https://2medical.news/2020/09/18/aspirin-use-and-risk-of-breast-cancer-in-african-american-women/

Use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) has been hypothesized to be associated with reduced risk of breast cancer; however, results of epidemiological studies have been mixed. Few studies have investigated these associations among African American women.. To assess the relation of aspirin use to risk of breast cancer in African American women, we conducted a prospective analysis within the Black Women’s Health …
Association of the Implant Surface Texture Used in Reconstruction With #Breast Cancer Recurrence
https://2medical.news/2020/10/10/association-of-the-implant-surface-texture-used-in-reconstruction-with-breast-cancer-recurrence/

The potential association between breast implant–related anaplastic large cell lymphoma (BIA-ALCL) and implant texture has raised concerns about the additional unexpected adverse effects of textured implants, including potentially adverse outcomes for other cancers. In addition to the risk of developing BIA-ALCL, breast cancer survivors may worry about whether the type of implant inserted is associated with recurrence of their original cancer—an issue for which little …
Individualizing Surveillance #Mammography for Older Patients After Treatment for Early-Stage #Breast Cancer Multidisciplinary Expert Panel and International Society of Geriatric Oncology Consensus Statement
https://2medical.news/2021/02/01/individualizing-surveillance-mammography-for-older-patients-after-treatment-for-early-stage-breast-cancer-multidisciplinary-expert-panel-and-international-society-of-geriatric-oncology-consensus-sta/

..After a literature review of the risk of ipsilateral and contralateral breast cancer events among breast cancer survivors and the harms and benefits associated with mammography, a multidisciplinary expert panel was convened to develop consensus guidelines on surveillance mammography for breast cancer survivors 75 years or older. Using an iterative consensus-based approach, input from clinician focus groups, and critical review by the International Society for …
Time-restricted #feeding normalizes hyperinsulinemia to inhibit #breast cancer in obese postmenopausal mouse models
https://2medical.news/2021/02/04/time-restricted-feeding-normalizes-hyperinsulinemia-to-inhibit-breast-cancer-in-obese-postmenopausal-mouse-models/

Accumulating evidence indicates that obesity with its associated metabolic dysregulation, including hyperinsulinemia and aberrant circadian rhythms, increases the risk for a variety of cancers including postmenopausal breast cancer. Caloric restriction can ameliorate the harmful metabolic effects of obesity and inhibit cancer progression but is difficult to implement and maintain outside of the clinic. In this study, we aim to test a time-restricted feeding (TRF) approach …
Incorporating Baseline Breast #Density When Screening Women at Average Risk for #Breast Cancer
https://2medical.news/2021/02/12/incorporating-baseline-breast-density-when-screening-women-at-average-risk-for-breast-cancer/

..Intervention: No screening; biennial or triennial mammography from age 50 to 75 years; annual mammography from age 50 to 75 years for women with dense breasts at age 50 years and biennial or triennial mammography from age 50 to 75 years for those without dense breasts at age 50 years; and annual mammography at age 40 to 75 years for women with dense breasts at …
Association of #PET-based #estradiol-challenge test for #breast cancer progesterone receptors with response to endocrine therapy
https://2medical.news/2021/02/23/association-of-pet-based-estradiol-challenge-test-for-breast-cancer-progesterone-receptors-with-response-to-endocrine-therapy/

Estrogen receptor (ER) testing of breast cancer imperfectly predicts response to endocrine therapy (ET). We hypothesize that a brief estradiol challenge will increase tumor progesterone receptor (PgR) levels only in tumors with functional ER. In this prospective, phase 2, single-center, single-arm trial (NCT02455453), we report the association of response to ET with change in tumor uptake of the progestin analog, 21-[18F]fluorofuranylnorprogesterone (FFNP), before and after …
Risk‐adapted starting age of #breast cancer screening in women with a family history of #ovarian or other cancers: A nationwide cohort study
https://2medical.news/2021/02/27/risk%E2%80%90adapted-starting-age-of-breast-cancer-screening-in-women-with-a-family-history-of-ovarian-or-other-cancers-a-nationwide-cohort-study/

There is a lack of evidence‐based recommendations for the age at which women with a family history of cancers other than breast cancer should start breast cancer screening. METHODS Using Swedish family cancer data sets, the authors conducted a nationwide cohort study including 5,099,172 Swedish women born after 1931 (follow‐up, 1958‐2015). Accounting for calendar time, they calculated the relative risk of breast cancer for women …
#Smoking, #Radiation Therapy, and Contralateral #Breast Cancer Risk in Young Women
https://2medical.news/2021/04/02/smoking-radiation-therapy-and-contralateral-breast-cancer-risk-in-young-women/

Evidence is mounting that cigarette smoking contributes to second primary contralateral breast cancer (CBC) risk. Whether radiation therapy (RT) interacts with smoking to modify this risk is unknown. In this multicenter, individually-matched case-control study, we examined the association between RT, smoking, and CBC risk. The study included 1,521 CBC cases and 2,212 controls with unilateral breast cancer, all diagnosed with first invasive breast cancer between …