Jessica M. Bensenhaver

Postmastectomy Radiation Therapy and Two-stage Implant-based Breast Reconstruction: Is There a Better Time to Irradiate?

Background: The ideal timing of postmastectomy radiation therapy (PMRT) in the setting of two-stage implant-based breast reconstruction remains unclear. In this cohort study, the authors sought to determine whether complication rates differed between patients who received PMRT following tissue expander placement (TE-XRT) and those who received PMRT after exchange for permanent implants (Implant-XRT) utilizing using prospective, multicenter data. Methods: Eligible patients in the Mastectomy Reconstruction Outcomes Consortium study from 11 institutions across North America were included in the analysis. All patients had at least 6-month follow-up after their last intervention (i.e., implant exchange for TE-XRT patients, and radiation for Implant-XRT patients). Complications including seroma, hematoma, infection, wound dehiscence, capsular contracture, and implant loss were recorded. Results: The authors identified a total of 150 patients who underwent immediate, two-stage implant-based breast reconstruction and received PMRT. Of these, there were TE-XRT 104 patients (69.3 percent) and 46 (30.7 percent) Implant-XRT patients. There were no differences in the incidence of any complications or complications leading to reconstructive failure between the two cohorts. After adjusting for patient characteristics and site effect, the timing of PMRT (i.e., TE-XRT versus Implant-XRT) was not a significant predictor in the development of any complication, a major complication, or reconstructive failure. Conclusion: In the setting of PMRT and two-stage implant-based reconstruction, patients who received PMRT after expander placement (TE-XRT) did not have a higher incidence or increased odds of developing complications than those who received PMRT after exchange for a permanent implant (Implant-XRT). CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Surgical leadership and standardization of multidisciplinary breast cancer care: the evolution of the National Accreditation Program for Breast Centers.

Evidence has shown that multidisciplinary specialist team evaluation and management for cancer results in better patient outcomes. For breast cancer, breast centers are where this evaluation and management occurs. The National Accreditation Program for Breast Centers has helped standardize multidisciplinary breast cancer care by defining services and standards required of accredited breast centers.

Global surgical oncology disease burden: addressing disparities via global surgery initiatives: the University of Michigan International Breast Cancer Registry.

AbstractBackgroundDisparities in breast cancer incidence and outcome between African American and white American women are multifactorial in etiology. The increased frequency of triple-negative breast cancers (TNBC) in African American patients suggests the possible contribution of hereditary factors related to African ancestry.MethodsThe University of Michigan (UM)-Komfo Anoyke Teaching Hospital (KATH) Breast Cancer Research Collaborative and International Breast Registry was established in 2004. It features epidemiologic information, tumor tissue, and germline DNA specimens from African American, white American, and Ghanaian women.ResultsThis research collaborative has generated valuable findings regarding the pathogenesis and patterns of TNBC while concomitantly improving the standard of breast oncology care in Ghana. This partnership has also yielded important opportunities for academic and educational exchange. It has expanded to involve other sites in Africa and Haiti.ConclusionsThe UM-KATH collaborative is a model for demonstrating the research and academic exchange value of international partnerships.

Association Between Benign Breast Disease in African American and White American Women and Subsequent Triple-Negative Breast Cancer

Importance Compared with white American (WA) women, African American (AA) women have a 2-fold higher incidence of breast cancers that are negative for estrogen receptor, progesterone receptor, and ERBB2 (triple-negative breast cancer [TNBC]). Triple-negative breast cancer, compared with non-TNBC, likely arises from different pathogenetic pathways, and benign breast disease (BBD) predicts future non-TNBC. Objective To determine whether AA identity remains associated with TNBC for women with a prior diagnosis of BBD. Design, Setting, and Participants This study is a retrospective analysis of data of a cohort of 2588 AA and 3566 WA women aged between 40 and 70 years with a biopsy-proven BBD diagnosis. The data—obtained from the Pathology Information System of Henry Ford Health System (HFHS), an integrated multihospital and multispecialty health care system headquartered in Detroit, Michigan—include specimens of biopsies performed between January 1, 1994, and December 31, 2005. Data analysis was performed from November 1, 2015, to June 15, 2016. Main Outcomes and Measures Subsequent breast cancer was stratified on the basis of combinations of hormone receptor and ERBB2 expression. Results Case management, follow-up, and outcomes received or obtained by our cohort of 2588 AA and 3566 WA patients were similar, demonstrating that HFHS delivered care equitably. Subsequent breast cancers developed in 103 (4.1%) of AA patients (mean follow-up interval of 6.8 years) and 143 (4.0%) of WA patients (mean follow-up interval of 6.1 years). More than three-quarters of subsequent breast cancers in each subset were ductal carcinoma in situ or stage I. The 10-year probability estimate for developing TNBC was 0.56% (95% CI, 0.32%-1.0%) for AA patients and 0.25% (95% CI, 0.12%-0.53%) for WA patients. Among the 66 AA patients who developed subsequent invasive breast cancer, 16 (24.2%) developed TNBC compared with 7 (7.4%) of the 94 WA patients who developed subsequent invasive breast cancers and had complete biomarker data (P = .01). Conclusions and Relevance This study is the largest analysis to date of TNBC in the context of racial/ethnic identity and BBD as risk factors. The study found that AA identity persisted as a significant risk factor for TNBC. This finding suggests that AA identity is associated with inherent susceptibility for TNBC pathogenetic pathways.

Breast Cancer and African Ancestry: Lessons Learned at the 10-Year Anniversary of the Ghana-Michigan Research Partnership and International Breast Registry

Women with African ancestry in western, sub-Saharan Africa and in the United States represent a population subset facing an increased risk of being diagnosed with biologically aggressive phenotypes of breast cancer that are negative for the estrogen receptor, the progesterone receptor, and the HER2/neu marker. These tumors are commonly referred to as triple-negative breast cancer. Disparities in breast cancer incidence and outcome related to racial or ethnic identity motivated the establishment of the International Breast Registry, on the basis of partnerships between the Komfo Anokye Teaching Hospital in Kumasi, Ghana, the University of Michigan Comprehensive Cancer Center in Ann Arbor, Michigan, and the Henry Ford Health System in Detroit, Michigan. This research collaborative has featured educational training programs as well as scientific investigations related to the comparative biology of breast cancer in Ghanaian African, African American, and white/European American patients. Currently, the International Breast Registry has expanded to include African American patients throughout the United States by partnering with the Sisters Network (a national African American breast cancer survivors’ organization) and additional sites in Ghana (representing West Africa) as well as Ethiopia (representing East Africa). Its activities are now coordinated through the Henry Ford Health System International Center for the Study of Breast Cancer Subtypes. Herein, we review the history and results of this international program at its 10-year anniversary.

Differences between Breast Conservation-Eligible Patients and Unilateral Mastectomy Patients in Choosing Contralateral Prophylactic Mastectomies

There has been an increasing use of bilateral mastectomy (BM) for breast cancer. We sought to examine our trends among breast conservation (BCT) candidates and women recommended for unilateral mastectomy (UM). Our prospective breast cancer database was queried for women with a first‐time, unilateral breast cancer. Patient and histologic factors and surgical treatment, including reconstruction, were evaluated. A detailed chart review was performed among patients from two representative time periods as to the reasons the patient underwent mastectomy. We identified 3,892 women between 2000 and 2012 of whom 60% underwent BCT, 1092 (28%) had UM and 12% underwent BM. BM rose from 4% in 2000 to a high of 19% in 2011, increasing around 2002 for women <40. BCT was less likely with decreasing age (p < 0.0001), lobular histology (p < 0.0001), higher stage (p < 0.0001) and decreasing BMI (p < 0.0001). Among mastectomy patients, contralateral mastectomy was associated with decreasing age (p < 0.0001), Caucasian race (p < 0.0001), and lower stage (p = 0.005). Over time, indications for mastectomy decreased while patients deemed BCT‐eligible opting for UM or BM increased dramatically. Increases in the use of BM are in large part among women who were otherwise BCT‐eligible. Factors associated with BM use are different for BCT‐eligible patients and those recommended for UM. A better understanding of the factors driving individual patient choices is needed.

Ductal carcinoma in situ and microinvasive/borderline breast cancer

Ductal carcinoma in situ and microinvasive/borderline breast cancer / , Ductal carcinoma in situ and microinvasive/borderline breast cancer / , کتابخانه دیجیتال جندی شاپور اهواز

Abstract 3371: Aldh expressing stem cells mediate tumor initiation and metastasis in triple negative breast cancers across different ethnicities

TNBC is the only subtype of breast cancer for which there are no approved targeted therapies. In the US, its incidence is highest in women with African ancestry (AA); in western sub-Saharan Africa, single-institution studies show that TNBC constitutes 40- 80% of all breast cancers. Given the Caucasian/AA survival disparity in breast cancer, there is an urgent need to find actionable targets in TNBC of all ethnicities, but especially in TNBC in AA, which are suspected to be more aggressive. Breast cancer stem cells, the small population of cells that have been shown to mediate breast tumor initiation, metastasis, and resistance to conventional therapy have also been reported to mediate the heterogeneity of TNBC and are especially abundant in TNBC in AA women. Here, we sought to better understand the biology of TNBC by finding genes and pathways that are differentially expressed in the stem cell population of patient derived xenografts (PDX) from TNBC from Ghanaian (G), AA and Caucasian (C) women and the effect of these differentially expressed genes on the stem cell phenotype in these primary tumors. We isolated the ALDH+ and the CD44+/CD24- stem cell populations from the bulk cells from 15 PDXs using flow cytometry. We performed RNA sequencing (Illumina HiSeq platform) on the isolated populations and bulk cells (45). Comprehensive bioinformatics analyses led to the identificationof highly significantly differentially expressed genes and pathways between the cell populations. By principal component analysis, the tumors were very heterogeneous. However, the ALDH+ cells separated out from the CD44+/CD24- and the bulk cells. We identified 14 genes that were simultaneously differentially expressed between the ALDH+ vs the CD44+/CD24- as well as ALDH+ VS bulk (p-value Citation Format: Evelyn M. Jiagge, Shukmei Wong, Rabia Gilani, Sean Mcdermott, Lisa Newman, Jessica Bensenhaver, Max Wicha, John Carpten, Sofia Merajver. Aldh expressing stem cells mediate tumor initiation and metastasis in triple negative breast cancers across different ethnicities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3371. doi:10.1158/1538-7445.AM2017-3371

Unwarranted variation in time to initiation of adjuvant chemotherapy in a statewide collaborative.

264 Background: The purpose of this study was to investigate clinical and non-clinical factors associated with time to initiation of breast cancer adjuvant chemotherapy following the final definitive surgery in a state-wide collaborative. METHODS We collected prospective data from all patients who received adjuvant chemotherapy for Stages I - III breast cancer in 25 health systems in the Michigan Breast Oncology Quality Initiative (MiBOQI) between 2006 - 2014. MiBOQI is a Blue Cross Blue Shield of Michigan/Blue Care Network-sponsored quality collaborative. The dependent variable was time to initiation of adjuvant chemotherapy. Time to chemotherapy was examined according to clinical and non-clinical patient and treatment factors and by health system, both with and without adjustment for patient and treatment variables. RESULTS Complete data were available for 7,513 of 8,236 eligible (91%) patients. The mean time to chemotherapy was 43 days (range 5-390). In multivariate analyses, clinical factors independently associated with longer time to chemotherapy included increasing age, greater comorbidity, and obesity (p value < 0.0001 for all). Higher stage disease was associated with shorter time to chemotherapy (p < 0.0001); there was no association with hormone receptor or HER2 status. Treatment factors associated with longer time to chemotherapy were breast reconstruction, receipt of genomic assays, and receipt of advanced imaging (p value < 0.0001 for all). Non-clinical factors-minority status, higher area-level poverty, and non-private insurance-were also independently associated with longer time to chemotherapy (p value < 0.0001 for all). In addition, time to chemotherapy varied significantly between health system (p < 0.0001); this difference persisted after adjustment for all patient and treatment factors. CONCLUSIONS Clinical and non-clinical factors, including site of care, are associated with variation in time to initiation of chemotherapy. Identifying patient-level factors and processes of care that facilitate or impede timely initiation of chemotherapy may decrease unwarranted variation in care delivery across a collaborative network.

Abstract P6-12-14: Comparative analysis of breast cancer phenotypes in African American, White American, and African patients- Correlation between African ancestry and triple negative breast cancer

Introduction: Population-based incidence rates of triple negative breast cancer (TNBC) are higher for African American (AA) compared to White American (WA) women, but it is unclear whether TNBC risk is genetically associated with African ancestry because AA women represent an ancestrally admixed population. Higher frequencies of TNBC have also been observed in sub-Saharan African breast cancer (BC) patients, but comparative analyses of biomarker expression among datasets that include AA, WA, and African women are sparse. We report findings from an international registry that features specimens from a diverse patient population in Detroit, Michigan as well as a hospital in Kumasi, Ghana. Methods: The study dataset included formalin-fixed, paraffin-embedded invasive BC tumors diagnosed between 1998 and 2014 at the Komfo Anokye Teaching Hospital in Ghana and the prospectively-maintained/annotated Henry Ford Health System cohort in Michigan. All Ghanaian tumors underwent pathology confirmation and immunohistochemistry for estrogen receptor (ER), progesterone receptor (PR) and HER2/neu expression at the University of Michigan. Women were classified into five BC phenotypes and dichotomized into two age groups, Results: A total of 234 Ghanaian cases with mean age 49 years (range 24-92); 271 AA with mean age 60 (range 27-87); and 321 WA with mean age 62 (range 31-91) (P=0.001) contributed to this study. Prevalence of histologic grade 3 was lowest in WA (n=107, 33.7%) which was statistically significant from the observed prevalence in AA (n=135, 50.4%) and Ghanaians (n=84, 53.8%) (P Conclusions: This study confirms an association between the TNBC phenotype and African ancestry; furthermore, extent of African ancestry appears to be associated with an increased likelihood of having a TNBC tumor, since frequency of TNBC among AA patients was intermediate between WA and Ghanaian patients. Citation Format: Newman LA, Jiagge E, Bensenhaver JM, Chitale D, Kleer C, Merajver S, Kyei I, Aitpillah F, Oppong J, Amankwaa-Frempong E, Adjei E, Wicha M, Awuah B, Stark A. Comparative analysis of breast cancer phenotypes in African American, White American, and African patients- Correlation between African ancestry and triple negative breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-14.