Faculty Bibliography

BACKGROUND: Although black women develop invasive breast cancer at a lower incidence than white women, the cancers they develop tend to be of a higher grade and are more likely estrogen receptor negative. There is very little information with regard to black women and ductal carcinoma in situ (DCIS). In addition, although various reasons have been proposed for the delay to screening for black women, a delay after diagnosis has also been recognized. PURPOSE: The purpose of this study was to investigate disparities in time to treatment between black women and white women once DCIS has been diagnosed. METHODS: A retrospective analysis of 37 black women and 37 matched white women treated for DCIS was performed. Matches were made based on the date of birth, date of diagnosis, date and type of surgery, and age at diagnosis. The time from the date of diagnosis to the date of surgery was ascertained. RESULTS: Black women were 64% more likely to undergo a delay to surgery (>50 days) compared with white women (21% versus 13%, P < .05). CONCLUSION: Black women are more likely not to reach surgery within 50 days of diagnosis, which is concerning, and further studies to investigate the cause of these delays are warranted

The purpose of this study was to utilize a Bayesian risk prediction model to predict the incidence of breast cancer in a high risk population. 10-fold cross-validation was performed using a Naive Bayes classifier. The area under the ROC curve (AUC) was used to measure prediction accuracy. These results were then compared to the ROC curve (AUC) results of the Gail Model Risk Assessment Tool

BACKGROUND: Malignant phyllodes tumors are an extremely rare breast tumor. Prognostic features and overall survival data have not been consistent across studies. METHODS: Retrospectively, we examined the clinicopathologic features of 27 breast cancer patients treated for malignant phyllodes tumors from 1995 to 2004 and analyzed their recurrence and survival outcomes using contingency tables, a logistic regression model, or a proportional hazard model. RESULTS: The mortality rate was 12% (n = 3) of the cohort and 75% of the group with distant metastases. The median follow-up period was 51 months (range, 12-192 mo). A mitotic index greater than 10 per high-powered field, the presence of stromal overgrowth, mastectomy at initial surgery, and larger tumor size were associated with an increased incidence of distant metastases. Larger tumor size also was associated with an increased incidence of death. CONCLUSIONS: Most patients with malignant phyllodes tumors will enjoy significant long-term survival if treated appropriately with local excision with clear margins

BACKGROUND: The purpose of this study was to investigate the strongest predictors of breast cancer in a high-risk population and to increase our understanding of the possible interactions between risk factors. METHODS: The Women At Risk High-Risk Registry provided the study population. The variables of interest included age at enrollment, presence of lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, family history of breast cancer, body mass index, and Gail scores (5-year high-risk > or =1.7%). Univariate and multivariate analyses were conducted with the Cox proportional hazards regression model and years of follow-up evaluation as the time scale. RESULTS: Out of 1553 high-risk women, 79 (5%) developed breast cancer during a median follow-up period of 5 years. Results from the multivariate Cox model demonstrated that FHBC (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.05-2.97), ADH (HR = 1.90; 95% CI, 1.16-3.13), LCIS (HR = 1.71; 95% CI, .99-2.95), and a body mass index > or =30 (HR = 2.22; 95% CI, 1.14-4.35) were statistically significant predictors of breast cancer within this high-risk population. CONCLUSIONS: These results support current literature showing the synergistic increase in risk for patients with ADH, LCIS, and a positive family history of breast cancer. Obesity was also a strong predictor of breast cancer risk, which suggests that there may be a potentiating effect of obesity on other risk factors. Obesity may represent a modifiable risk factor, providing women with an opportunity to reduce their risk with lifestyle modification. Women with a strong family history of breast cancer or a diagnosis of ADH or LCIS may benefit most from risk-reduction strategies, chemoprevention, and surveillance

BACKGROUND: Sentinel lymph node (SLN) biopsy is often used in the assessment of lymph node status in melanoma and early stage breast cancer. With the rapidly increasing use of the technique, we can now better characterize and assess the rate of adverse reactions to the dye. METHODS: A retrospective review of all patients undergoing SLN mapping at the Columbia-Presbyterian Breast Center were identified from June 2000 to July 2002. All patients who experienced allergic reactions were documented and records examined. RESULTS: In total, three out of 351 patients had allergic complications from the procedure. All three patients developed 'blue hives' after injection with isosulfan blue. The incidence at our Breast Center was 0.9%. All were treated with intravenous corticosteroids and diphenhydramine and recovered within twenty-four hours. CONCLUSIONS: The increasing utilization of the sentinel lymph node technique will make these complications more common. A high index of suspicion and appropriate clinical management are recommended to minimize the potential morbidity of these reactions