Prevention, Diagnosis, and Treatment of Breast Cancer

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Women's Health Care".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 14758

Special Issue Editors

1. Banner MD Anderson Cancer Center, Banner University, Phoenix, AZ 85006, USA
2. University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
3. University of Arizona College of Medicine, Phoenix, Arizona 85004, USA
Interests: ductal carcinoma in situ; atypical hyperplasia; early and locally advanced invasive breast cancer, germline mutations predisposing patients to breast cancer
1. Breast Surgical Oncology, University of Kansas Cancer Center, Westwood, KS 66205, USA
2. Department of Surgery, University of Kansas School of Medicine, Kansas City, KS 66160, USA
Interests: breast cancer related lymphedema; high risk patient populations; oncoplastic techniques; clinical trials; mitigating the overtreatment of breast diseases; medical student and resident education

Special Issue Information

Dear Colleagues,

Breast cancer is the most common non-skin cancer in women today, affecting 1 in 8 women. This Special Issue will promote the publication of high-quality original research and review articles pertaining to the prevention, screening, diagnosis, and treatment of breast cancer.

The treatment of breast cancer is rapidly evolving, with treatment becoming more individualized. This issue aims to discuss the latest developments in the multidisciplinary management of breast cancer care, including radiology, medical oncology, radiation oncology, plastic surgery, and surgical oncology. We welcome basic science and clinical research pertaining to breast cancer.

Dr. Brittany Murphy
Dr. Lyndsey Kilgore
Guest Editors

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Keywords

  • breast cancer
  • lymphedema
  • imaging

Published Papers (10 papers)

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Research

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31 pages, 1101 KiB  
Article
A Federated Learning Approach to Breast Cancer Prediction in a Collaborative Learning Framework
Healthcare 2023, 11(24), 3185; https://doi.org/10.3390/healthcare11243185 - 17 Dec 2023
Viewed by 725
Abstract
Breast cancer continues to pose a substantial worldwide public health concern, necessitating the use of sophisticated diagnostic methods to enable timely identification and management. The present research utilizes an iterative methodology for collaborative learning, using Deep Neural Networks (DNN) to construct a breast [...] Read more.
Breast cancer continues to pose a substantial worldwide public health concern, necessitating the use of sophisticated diagnostic methods to enable timely identification and management. The present research utilizes an iterative methodology for collaborative learning, using Deep Neural Networks (DNN) to construct a breast cancer detection model with a high level of accuracy. By leveraging Federated Learning (FL), this collaborative framework effectively utilizes the combined knowledge and data assets of several healthcare organizations while ensuring the protection of patient privacy and data security. The model described in this study showcases significant progress in the field of breast cancer diagnoses, with a maximum accuracy rate of 97.54%, precision of 96.5%, and recall of 98.0%, by using an optimum feature selection technique. Data augmentation approaches play a crucial role in decreasing loss and improving model performance. Significantly, the F1-Score, a comprehensive metric for evaluating performance, turns out to be 97%. This study signifies a notable advancement in the field of breast cancer screening, fostering hope for improved patient outcomes via increased accuracy and reliability. This study highlights the potential impact of collaborative learning, namely, in the field of FL, in transforming breast cancer detection. The incorporation of privacy considerations and the use of diverse data sources contribute to the advancement of early detection and the treatment of breast cancer, hence yielding significant benefits for patients on a global scale. Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Treatment of Breast Cancer)
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10 pages, 616 KiB  
Article
A Clinical Prediction Model for Breast Cancer in Women Having Their First Mammogram
Healthcare 2023, 11(6), 856; https://doi.org/10.3390/healthcare11060856 - 14 Mar 2023
Viewed by 1375
Abstract
Background: Digital mammography is the most efficient screening and diagnostic modality for breast cancer (BC). However, the technology is not widely available in rural areas. This study aimed to construct a prediction model for BC in women scheduled for their first mammography at [...] Read more.
Background: Digital mammography is the most efficient screening and diagnostic modality for breast cancer (BC). However, the technology is not widely available in rural areas. This study aimed to construct a prediction model for BC in women scheduled for their first mammography at a breast center to prioritize patients on waiting lists. Methods: This retrospective cohort study analyzed breast clinic data from January 2013 to December 2017. Clinical parameters that were significantly associated with a BC diagnosis were used to construct predictive models using stepwise multiple logistic regression. The models’ discriminative capabilities were compared using receiver operating characteristic curves (AUCs). Results: Data from 822 women were selected for analysis using an inverse probability weighting method. Significant risk factors were age, body mass index (BMI), family history of BC, and indicated symptoms (mass and/or nipple discharge). When these factors were used to construct a model, the model performance according to the Akaike criterion was 1387.9, and the AUC was 0.82 (95% confidence interval: 0.76–0.87). Conclusion: In a resource-limited setting, the priority for a first mammogram should be patients with mass and/or nipple discharge, asymptomatic patients who are older or have high BMI, and women with a family history of BC. Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Treatment of Breast Cancer)
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10 pages, 868 KiB  
Article
Improving Medical Student Anatomy Knowledge and Confidence for the Breast Surgical Oncology Rotation
Healthcare 2023, 11(5), 709; https://doi.org/10.3390/healthcare11050709 - 27 Feb 2023
Cited by 1 | Viewed by 1322
Abstract
Background: The anatomy curriculum has undergone considerable reductions in class time, resulting in decreased student anatomical knowledge retention and confidence during their surgical rotations. To counter this deficit in anatomy knowledge, a clinical anatomy mentorship program (CAMP) was developed by fourth-year medical student [...] Read more.
Background: The anatomy curriculum has undergone considerable reductions in class time, resulting in decreased student anatomical knowledge retention and confidence during their surgical rotations. To counter this deficit in anatomy knowledge, a clinical anatomy mentorship program (CAMP) was developed by fourth-year medical student leaders and staff mentors in a near-peer teaching fashion prior to the surgical clerkship. This study analyzed the impact this program had on third-year medical students (MS3s) self-assessed anatomical knowledge and confidence in the operating room on the Breast Surgical Oncology rotation after this near-peer program. Methods: A single-center prospective survey study was performed at an academic medical center. Pre- and post-program surveys were administered to all students who participated in the CAMP and rotated on the breast surgical oncology (BSO) service during the surgery clerkship rotation. A control group of individuals who did not rotate on the CAMP was established, and this group was administered a retrospective survey. A 5-point Likert scale was used to assess surgical anatomy knowledge, confidence in the operating room, and comfort in assisting in the operating room. Control group versus post-CAMP intervention group and pre- versus post-CAMP intervention groups survey results were compared using the Student’s t-test with a p-value of <0.05 statistically significant. Results: All CAMP students rated their surgical anatomy knowledge (p < 0.01), confidence in the operating room (p < 0.01), and comfort in assisting in the operating room (p < 0.01) as greater than those who did not participate in the program. Additionally, the program improved the ability of third-year medical students to prepare for operating room cases going into their third-year breast surgical oncology clerkship (p < 0.03). Conclusions: This near-peer surgical education model appears to be an effective way to prepare third-year medical students for the breast surgical oncology rotation during the surgery clerkship by improving anatomic knowledge and student confidence. The program can serve as a template for medical students, surgical clerkship directors, and other faculty interested in efficiently expanding surgical anatomy at their institution. Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Treatment of Breast Cancer)
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12 pages, 1409 KiB  
Article
Contrast-Enhanced Spectral Mammography in the Evaluation of Breast Microcalcifications: Controversies and Diagnostic Management
Healthcare 2023, 11(4), 511; https://doi.org/10.3390/healthcare11040511 - 09 Feb 2023
Cited by 3 | Viewed by 1647
Abstract
The aim of this study was to evaluate the diagnostic performance of contrast-enhanced spectral mammography (CESM) in predicting breast lesion malignancy due to microcalcifications compared to lesions that present with other radiological findings. Three hundred and twenty-one patients with 377 breast lesions that [...] Read more.
The aim of this study was to evaluate the diagnostic performance of contrast-enhanced spectral mammography (CESM) in predicting breast lesion malignancy due to microcalcifications compared to lesions that present with other radiological findings. Three hundred and twenty-one patients with 377 breast lesions that underwent CESM and histological assessment were included. All the lesions were scored using a 4-point qualitative scale according to the degree of contrast enhancement at the CESM examination. The histological results were considered the gold standard. In the first analysis, enhancement degree scores of 2 and 3 were considered predictive of malignity. The sensitivity (SE) and positive predictive value (PPV) were significative lower for patients with lesions with microcalcifications without other radiological findings (SE = 53.3% vs. 82.2%, p-value < 0.001 and PPV = 84.2% vs. 95.2%, p-value = 0.049, respectively). On the contrary, the specificity (SP) and negative predictive value (NPV) were significative higher among lesions with microcalcifications without other radiological findings (SP = 95.8% vs. 84.2%, p-value = 0.026 and NPV = 82.9% vs. 55.2%, p-value < 0.001, respectively). In a second analysis, degree scores of 1, 2, and 3 were considered predictive of malignity. The SE (80.0% vs. 96.8%, p-value < 0.001) and PPV (70.6% vs. 88.3%, p-value: 0.005) were significantly lower among lesions with microcalcifications without other radiological findings, while the SP (85.9% vs. 50.9%, p-value < 0.001) was higher. The enhancement of microcalcifications has low sensitivity in predicting malignancy. However, in certain controversial cases, the absence of CESM enhancement due to its high negative predictive value can help to reduce the number of biopsies for benign lesions Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Treatment of Breast Cancer)
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10 pages, 1545 KiB  
Article
Use of Ultrasound and Ki–67 Proliferation Index to Predict Breast Cancer Tumor Response to Neoadjuvant Endocrine Therapy
Healthcare 2023, 11(3), 417; https://doi.org/10.3390/healthcare11030417 - 01 Feb 2023
Cited by 2 | Viewed by 1390
Abstract
Background: Prediction of tumor shrinkage and pattern of treatment response following neoadjuvant endocrine therapy (NET) for estrogen receptor positive (ER+), Her2 negative (Her2–) breast cancers have had limited assessment. We examined if ultrasound (US) and Ki–67 could predict the pathologic response to treatment [...] Read more.
Background: Prediction of tumor shrinkage and pattern of treatment response following neoadjuvant endocrine therapy (NET) for estrogen receptor positive (ER+), Her2 negative (Her2–) breast cancers have had limited assessment. We examined if ultrasound (US) and Ki–67 could predict the pathologic response to treatment with NET and how the pattern of response may impact surgical planning. Methods: A total of 103 postmenopausal women with ER+, HER2– breast cancer enrolled on the FELINE trial had Ki–67 obtained at baseline, day 14, and surgical pathology. A total of 70 patients had an US at baseline and at the end of treatment (EOT). A total of 48 patients had residual tumor bed cellularity (RTBC) assessed. The US response was defined as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). CR or PR on imaging and ≤70% residual tumor bed cellularity (RTBC) defined a contracted response pattern. Results: A decrease in Ki–67 at day 14 was not predictive of EOT US response or RTBC. A contracted response pattern was identified in one patient with CR and in sixteen patients (33%) with PR on US. Although 26 patients (54%) had SD on imaging, 22 (85%) had RTBC ≤70%, suggesting a non-contracted response pattern of the tumor bed. The remaining four (15%) with SD and five with PD had no response. Conclusion: Ki–67 does not predict a change in tumor size or RTBC. NET does not uniformly result in a contracted response pattern of the tumor bed. Caution should be taken when using NET for the purpose of downstaging tumor size or converting borderline mastectomy/lumpectomy patients. Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Treatment of Breast Cancer)
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9 pages, 307 KiB  
Article
The Effects of Prior Mammography Screening on the Performance of Breast Cancer Detection in Taiwan
Healthcare 2022, 10(6), 1037; https://doi.org/10.3390/healthcare10061037 - 02 Jun 2022
Cited by 2 | Viewed by 1574
Abstract
The aim of this study was to investigate the influence of previous mammography screening on the performance of breast cancer detection. The screened women were divided into first-visit and follow-up groups for breast cancer screening. The positive predictive value (PPV), cancer detection rate [...] Read more.
The aim of this study was to investigate the influence of previous mammography screening on the performance of breast cancer detection. The screened women were divided into first-visit and follow-up groups for breast cancer screening. The positive predictive value (PPV), cancer detection rate (CDR), and recall rate were used to evaluate and analyze the overall screening performance among the two groups. Among them, 10,040 screenings (67.2%) were first visits and 4895 screenings (32.8%) were follow-up visits. The proportion of positive screening results for first-visit participants was higher than that for their follow-up counterparts (9.3% vs. 4.0%). A total of 98 participants (74 first-visit and 24 follow-up visit) were confirmed to have breast cancer. The PPV for positive mammography for women who underwent biopsy confirmation was 28.7% overall, reaching 35.8% for the follow-up visit group and 27.0% for the first-visit group. The CDR was 6.6 per 1000 overall, reaching 7.4 per 1000 for first-visit group and 4.9 per 1000 for the follow-up group. The overall recall rate was 7.9%, reaching 9.7% for the first-visit group and 4.2% for the follow-up group. The PPV is improved and the recall rate is decreased if prior mammography images are available for comparison when conducting mammography screening for breast cancer. By this study, we concluded that prior mammography plays an important role for breast cancer screening, while follow-up mammography may increase the diagnostic rate when compared to the prior mammography. We suggest that the public health authority can encourage subjects to undergo screenings in the same health institute where they regularly visit. Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Treatment of Breast Cancer)
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Review

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21 pages, 336 KiB  
Review
Disparities in Breast Cancer Care—How Factors Related to Prevention, Diagnosis, and Treatment Drive Inequity
Healthcare 2024, 12(4), 462; https://doi.org/10.3390/healthcare12040462 - 12 Feb 2024
Viewed by 477
Abstract
Breast cancer survival has increased significantly over the last few decades due to more effective strategies for prevention and risk modification, advancements in imaging detection, screening, and multimodal treatment algorithms. However, many have observed disparities in benefits derived from such improvements across populations [...] Read more.
Breast cancer survival has increased significantly over the last few decades due to more effective strategies for prevention and risk modification, advancements in imaging detection, screening, and multimodal treatment algorithms. However, many have observed disparities in benefits derived from such improvements across populations and demographic groups. This review summarizes published works that contextualize modern disparities in breast cancer prevention, diagnosis, and treatment and presents potential strategies for reducing disparities. We conducted searches for studies that directly investigated and/or reported disparities in breast cancer prevention, detection, or treatment. Demographic factors, social determinants of health, and inequitable healthcare delivery may impede the ability of individuals and communities to employ risk-mitigating behaviors and prevention strategies. The disparate access to quality screening and timely diagnosis experienced by various groups poses significant hurdles to optimal care and survival. Finally, barriers to access and inequitable healthcare delivery patterns reinforce inequitable application of standards of care. Cumulatively, these disparities underlie notable differences in the incidence, severity, and survival of breast cancers. Efforts toward mitigation will require collaborative approaches and partnerships between communities, governments, and healthcare organizations, which must be considered equal stakeholders in the fight for equity in breast cancer care and outcomes. Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Treatment of Breast Cancer)
20 pages, 384 KiB  
Review
Invasive Lobular Carcinoma: A Review of Imaging Modalities with Special Focus on Pathology Concordance
Healthcare 2023, 11(5), 746; https://doi.org/10.3390/healthcare11050746 - 03 Mar 2023
Cited by 4 | Viewed by 2222
Abstract
Invasive lobular cancer (ILC) is the second most common type of breast cancer. It is characterized by a unique growth pattern making it difficult to detect on conventional breast imaging. ILC can be multicentric, multifocal, and bilateral, with a high likelihood of incomplete [...] Read more.
Invasive lobular cancer (ILC) is the second most common type of breast cancer. It is characterized by a unique growth pattern making it difficult to detect on conventional breast imaging. ILC can be multicentric, multifocal, and bilateral, with a high likelihood of incomplete excision after breast-conserving surgery. We reviewed the conventional as well as newly emerging imaging modalities for detecting and determining the extent of ILC- and compared the main advantages of MRI vs. contrast-enhanced mammogram (CEM). Our review of the literature finds that MRI and CEM clearly surpass conventional breast imaging in terms of sensitivity, specificity, ipsilateral and contralateral cancer detection, concordance, and estimation of tumor size for ILC. Both MRI and CEM have each been shown to enhance surgical outcomes in patients with newly diagnosed ILC that had one of these imaging modalities added to their preoperative workup. Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Treatment of Breast Cancer)
11 pages, 470 KiB  
Review
Current Considerations in Surgical Treatment for Adolescents and Young Women with Breast Cancer
Healthcare 2022, 10(12), 2542; https://doi.org/10.3390/healthcare10122542 - 15 Dec 2022
Cited by 1 | Viewed by 1380
Abstract
Adolescents and young women (AYA) with breast cancer represent a unique patient population, compared to the general population with breast cancer. We performed a literature review to evaluate the factors that influenced the surgical outcomes in this patient population. Fifty-two studies were identified, [...] Read more.
Adolescents and young women (AYA) with breast cancer represent a unique patient population, compared to the general population with breast cancer. We performed a literature review to evaluate the factors that influenced the surgical outcomes in this patient population. Fifty-two studies were identified, which evaluated breast surgery type, axillary surgery, contralateral prophylactic mastectomy (CPM), surgical timing, psychological factors, disparities, and imaging use. AYA patients had equivalent oncologic outcomes with breast conserving surgery (BCS) or mastectomy. CPM did not improve survival. There are limited data on axillary management in the AYA population, and while more data would be beneficial, this is currently extrapolated from the general breast cancer population. A shorter time to initiate treatment correlated to better outcomes, and disparities need to be overcome for optimal outcomes. AYA patients appreciated involvement in clinical decisions, and shared decision making should be considered whenever possible. Providers must keep these factors in mind when counseling AYA patients, regarding the surgical management of breast cancer. Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Treatment of Breast Cancer)
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12 pages, 817 KiB  
Review
Breast Cancer—How Can Imaging Help?
Healthcare 2022, 10(7), 1159; https://doi.org/10.3390/healthcare10071159 - 22 Jun 2022
Cited by 2 | Viewed by 1609
Abstract
Breast cancer is the most common malignant disease among women, causing death and suffering worldwide. It is known that, for the improvement of the survival rate and the psychological impact it has on patients, early detection is crucial. For this to happen, the [...] Read more.
Breast cancer is the most common malignant disease among women, causing death and suffering worldwide. It is known that, for the improvement of the survival rate and the psychological impact it has on patients, early detection is crucial. For this to happen, the imaging techniques should be used at their full potential. We selected and examined 44 articles that had as subject the use of a specific imaging method in breast cancer management (mammography, ultrasound, MRI, ultrasound-guided biopsy, PET-CT). After analyzing their data, we summarized and concluded which are the best ways to use each one of the mentioned techniques for a good outcome. We created a simplified algorithm with easy steps that can be followed by radiologists when facing this type of neoplasia. Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Treatment of Breast Cancer)
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