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"Bridge" Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions

Feinberg, Joshua; Cen, Cindy; Schnabel, Freya; Adams, Sylvia; Plasilova, Magdalena; Yeh, Janet; Meyers, Marleen; Speyer, James; Belenkov, Elliot; Kwa, Maryann; Novik, Yelena; Katz, Elena; Guth, Amber Azniv
ORIGINAL:0015541
ISSN: 2578-9503
CID: 5192472

Clinical Characteristics in Patients with Triple Negative Breast Cancer

Yeh, Janet; Chun, Jennifer; Schwartz, Shira; Wang, Annie; Kern, Elizabeth; Guth, Amber A; Axelrod, Deborah; Shapiro, Richard; Schnabel, Freya
PURPOSE: The purpose of this study was to compare and contrast the clinical characteristics of the triple negative breast cancer (TNBC) and non-TNBC patients, with a particular focus on genetic susceptibility and risk factors prior to diagnosis. METHODS: Our institutional database was queried for all patients diagnosed with invasive breast cancer between January 2010 and May 2016. RESULTS: Out of a total of 1964 patients, 190 (10%) patients had TNBC. The median age for both TNBC and non-TNBC was 59 years. There was a significantly higher proportion of African American and Asian patients with TNBC (p = 0.0003) compared to patients with non-TNBC. BRCA1 and BRCA2 were significantly associated with TNBC (p < 0.0001, p = 0.0007). A prior history of breast cancer was significantly associated with TNBC (p = 0.0003). There was no relationship observed between TNBC and a history of chemoprevention or patients who had a history of AH or LCIS. CONCLUSIONS: We found that having Asian ancestry, a prior history of breast cancer, and a BRCA1 or BRCA2 mutation all appear to be positively associated with TNBC. In order to develop more effective treatments, better surveillance, and improved prevention strategies, it is necessary to improve our understanding of the population at risk for TNBC.
PMCID:5585655
PMID: 28912973
ISSN: 2090-3170
CID: 2701342

The changing face of axillary lymph node dissection [Meeting Abstract]

Hiotis, K; Yeh, J; Schnabel, F; Chun, J; Schwartz, S; Snyder, A; Guth, A; Axelrod, D
Objective Sentinel lymph node biopsy (SLNB) is a widely accepted and safe technique that increases the accuracy of axillary staging in breast cancer for patients with clinically node-negative disease. Results from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial found no benefit for completion axillary lymph node dissection (ALND) in patients with breast cancer involving 1 to 2 positive sentinel nodes. The purpose of our study was to characterize the population of patients who had ALND since the publication of the Z0011 results. Methods This was an IRB-approved retrospective review of women with newly diagnosed breast cancer between 1/2010 and 6/2013 who were clinically node-negative and had >1 positive sentinel lymph node (SLN). Variables of interest included age, method of presentation, body mass index (BMI), tumor characteristics, surgery type, and preop imaging. Patients who received neoadjuvant therapy were excluded. Descriptive statistics and Pearson's chisquare analyses were utilized. Results Out of a total of 1,513 patients, 191 (12%) patients had >1 positive SLN in their initial surgery. The mean age was 56 years. Of the patients with a positive SLN, 139 (73%) went on to have a completion ALND. The distribution of age and tumor type was similar in patients who had SLNB alone and who underwent completion ALND. However, a higher proportion of patients who underwent completion ALND had later stage disease (p < 0.0001), larger tumors (p = 0.012), and greater number of positive SLN (p = 0.004), and had a higher BMI (p = 0.05). Among the 139 patients who went on to have a complete ALND, 127 (91%) patients had frozen section analysis with > 1 positive lymph node. Of these patients, 72 (57%) had 1 lymph node positive for metastasis and 41 (32%) had 2 lymph nodes positive for metastasis on final pathology. Conclusion Our study showed that women who had a completion ALND presented with later stage disease, larger tumors, and greater number of positive SLN. Frozen section analysis at the time of SLNB led to ALND in 113 patients with 1 or 2 positive SLN on final pathology. These patients would not meet the criteria for axillary dissection based on the results of Z0011. This suggests that patients should either undergo completion axillary dissection if 3 or more lymph nodes are found to have metastatic disease on frozen section or that completion dissection should be deferred until final pathology confirms the presence of 3 or more positive lymph nodes
EMBASE:71949188
ISSN: 1068-9265
CID: 1702522

Clinical presentation of extramammary paget disease of the axilla in a male patient

Deutsch, Michael; Yeh, Janet; Grunes, Dianne; Horowitz, Elizabeth; Johnson, Elaheh; Joseph, Kathie-Ann
PMID: 25454739
ISSN: 1526-8209
CID: 1506702

Pregnancy-Associated Breast Cancer (PABC) in a Contemporary Cohort of Women With Newly Diagnosed Breast Cancer [Meeting Abstract]

Schnabel, Freya; Chun, Jennifer; Yeh, Janet; Schwartz, Shira; Rokosh, Sarah; Sure, Akhila; Novik, Yelena; Guth, Amber; Axelrod, Deborah; Hiotis, Karen
ISI:000360941400122
ISSN: 1534-4681
CID: 1788732

Imaging Characteristics in a Contemporary Cohort of Younger Women With Newly Diagnosed Breast Cancer [Meeting Abstract]

Schnabel, Freya; Chun, Jennifer; Yeh, Janet; Schwartz, Shira; Rokosh, Sarah; Sure, Akhila; Snyder, Aki; Guth, Amber; Axelrod, Deborah; Moy, Linda
ISI:000360941400123
ISSN: 1534-4681
CID: 1788742

Nicotine nasal spray as an adjuvant analgesic for third molar surgery

Yagoubian, Benjamin; Akkara, Joseph; Afzali, Payam; Alfi, David M; Olson, Luke; Conell-Price, Jessamyn; Yeh, Janet; Eisig, Sidney B; Flood, Pamela
PURPOSE: To determine the efficacy of preoperatively administered nicotine nasal spray (3 mg) for analgesia after third molar (TM) surgery. MATERIALS AND METHODS: A single-center, prospective, randomized, double-blind, crossover trial was conducted. The study population consisted of 20 nonsmoking patients referred to the Department of Oral and Maxillofacial Surgery of Columbia University College of Dental Medicine for extraction of all 4 TMs. Each patient received nicotine nasal spray or placebo spray before TM surgery. At a subsequent visit the contralateral TMs were removed with prior administration of the alternate treatment. For an hour postoperatively, subjects reported information on pain and nausea, and hemodynamic variables were recorded at 15-minute intervals. Telephone follow-up was recorded for 5 days postoperatively, where patients reported information on pain, nausea, and use of hydrocodone/acetaminophen as rescue analgesia. RESULTS: Nicotine treatment was associated with a highly significant decrease in pain reported during the 5 days after TM surgery. There was no difference in the amount of hydrocodone/acetaminophen used or amount of nausea reported. There was a small but significant increase in heart rate after nicotine treatment compared with placebo during the first hour after surgery. There was no difference in blood pressure between groups. CONCLUSION: Pain is well controlled by hydrocodone/acetaminophen in most patients after TM surgery. However, there is significant variability in pain reported. Nicotinic agonists represent a new class of analgesic that can be considered for patients who are expected to have significant opioid-resistant pain after TM surgery. Caution should be used with patients in whom a small increase in heart rate would be deleterious.
PMID: 21256649
ISSN: 0278-2391
CID: 1067282

Anesthesia matters: patients anesthetized with propofol have less postoperative pain than those anesthetized with isoflurane

Cheng, Sean S; Yeh, Janet; Flood, Pamela
BACKGROUND: Preclinical studies have suggested that some volatile anesthetics induce a hyperalgesic state that may be secondary to nicotinic inhibition. A previous trial of treatment with nicotine nasal spray demonstrated postoperative analgesia in women anesthetized with isoflurane. To determine whether the effect of nicotine was reversing hyperalgesia induced by isoflurane, or simply acting as an analgesic, we studied the effect of nicotine on postoperative pain in women anesthetized with isoflurane or propofol, with fentanyl. METHODS: In a randomized, prospective, double-blind trial, we assigned 80 women having open uterine surgery to be anesthetized with isoflurane or propofol. Within each anesthetic group, the subjects were further randomly assigned to receive nicotine 3 mg or placebo. Pain reported with a numerical analog scale was the primary outcome variable. RESULTS: The patient demographics were similar. Women who were anesthetized with propofol reported less pain and used less morphine during the first day after surgery than women who were anesthetized with isoflurane (P < 0.01, P < 0.01). Nicotine treatment did not change pain report or morphine use in either anesthetic group (P > 0.05). CONCLUSIONS: General anesthesia with propofol and is associated with less postoperative pain and morphine use than general anesthesia with isoflurane. Nicotine was not analgesic in this trial. If these results are repeated in other populations, reduced postoperative pain can be added to the previously described improvement in nausea and vomiting as a potential benefit of anesthesia with propofol.
PMID: 18165589
ISSN: 0003-2999
CID: 1067292