Outcome of African-American compared to White-American patients with early-stage breast cancer, stratified by phenotype

BACKGROUND: Breast cancer mortality rates are 39% higher in the African-American (AA) women compared to White-American (WA) women despite the advances in overall breast cancer screening and treatments. Several studies have undertaken to identify the factors leading to this disparity in United States with possible effects of lower socioeconomic status and underlying aggressive biology. METHODS: A retrospective analysis was done using a prospectively maintained database of a metropolitan health system. Patients were selected based on diagnosis of early-stage breast cancer between 10/1998 and 02/2017, and included women over age of 18 with clinically node-negative disease. Patients were then stratified by phenotype confirmed by pathology and patient-identified race. RESULTS: A total of 2,298 women were identified in the cohort with 39% AA and 61% WA women. The overall mean age at the time of diagnosis for AA women was slightly younger at 60 years compared to 62 years for WA women (p = 0.003). Follow-up time was longer for the WA women at 95 months vs. 86 months in AA women. The overall 5-year survival was analyzed for the entire cohort, with the lowest survival occurring in patients with triple-negative breast cancer (TNBC). Phenotype distribution revealed a higher incidence of TNBC in AA women compared to WA women (AA 16% vs. WA 10%; p \u3c 0.0001). AA women also had higher incidence of HER2 positive cancers (AA 16.8% vs. WA 15.3%; p \u3c 0.0001). WA women had a significantly higher distribution of Non-TNBC/HER2-negative phenotype (AA 55% vs. WA 65%; p \u3c 0.0001). Furthermore, a subgroup analysis was done for a sentinel lymph node (SLN) negative cohort that showed higher rates of grade 3 tumors in AA (AA 35% vs. WA 23%; p \u3c 0.0001); and higher rates of grade 1 and grade 2 tumors in WA (30% vs. 21% and 44% vs. 40%). Despite higher grade tumors in AA women, five-year overall survival outcomes in SLN-negative cohort did not differ between AA and WA women when stratifying based on tumor subtype. CONCLUSION: Breast cancer survival disparities in AA and WA women with SLN-negative breast cancer are diminished when evaluated at early-stage cancers defined by SLN-negative tumors. Our evaluation suggests that when diagnosed early, phenotype does not contribute to racial survival outcomes. The lower survival rate in AA women with breast cancer may be attributed to later stage biology between the two races, or underlying socioeconomic disparities

A rare presentation of bilateral, synchronous male breast cancer

Rarity of male breast cancer limits available clinical research and data for management guidance and screening guidelines for patients at high risk. Here, we report on a patient with bilateral, synchronous male breast cancer with discussion of risk factors and need for possible screening

The Immediate Aesthetic and Functional Restoration of Maxillary Incisors Compromised by Periodontitis Using Short Implants with Single Crown Restorations: A Minimally Invasive Approach and Five-Year Follow-Up

The functional and aesthetic restoration of teeth compromised due to aggressive periodontitis presents numerous challenges for the clinician. Horizontal bone loss and soft tissue destruction resulting from periodontitis can impede implant placement and the regeneration of an aesthetically pleasing gingival smile line, often requiring bone augmentation and mucogingival surgery, respectively. Conservative approaches to the treatment of aggressive periodontitis (i.e., treatments that use minimally invasive tools and techniques) have been purported to yield positive outcomes. Here, we report on the treatment and five-year follow-up of patient suffering from aggressive periodontitis using a minimally invasive surgical technique and implant system. By using the methods described herein, we were able to achieve the immediate aesthetic and functional restoration of the maxillary incisors in a case that would otherwise require bone augmentation and extensive mucogingival surgery. This technique represents a conservative and efficacious alternative to the aesthetic and functional replacement of teeth compromised due to aggressive periodontitis

Aesthetic Surgical Approach for Bone Dehiscence Treatment by Means of Single Implant and Interdental Tissue Regeneration: A Case Report with Five Years of Follow-Up

The replacement of single anterior teeth by means of endosseous implants implies the achievement of success in restoring both aesthetic and function. However, the presence of wide endoperiodontal lesions can lead to horizontal hard and soft tissues defects after tooth extraction, making it impossible to correctly place an implant in the compromised alveolar socket. Vertical augmentation procedures have been proposed to solve these clinical situations, but the amount of new regenerated bone is still not predictable. Furthermore, bone augmentation can be complicated by the presence of adjacent teeth, especially if they bring with them periodontal defects. Therefore, it is used to restore periodontal health of adjacent teeth before making any augmentation procedures and to wait a certain healing period before placing an implant in vertically augmented sites, otherwise risking to obtain a nonsatisfactory aesthetic result. All of these procedures, however, lead to an expansion of treatment time which should affect patient compliance. For this reason, this case report suggests a surgical technique to perform vertical bone augmentation at a single gap left by a central upper incisor while placing an implant and simultaneously to regenerate the periodontal attachment of an adjacent lateral incisor, without compromising the aesthetic result

Sentinel Lymph Node Positivity in Clinically Node Negative Breast Cancer Patients After Neoadjuvant Chemotherapy: Opportunities to Defer Intraoperative Frozen Section Analysis

INTRODUCTION: Neoadjuvant chemotherapy (NACT) is frequently implemented in a breast cancer treatment plan. In clinically node negative (cN0) patients following NACT, it is routine to perform sentinel lymph node (SLN) biopsy with intraoperative frozen section analysis with subsequent axillary lymph node dissection (ALND) if metastatic disease were detected. We aim to define the rate of sentinel node positivity (ypN1 (sn)) at our institution in patients who presented as cN0 and received NACT. METHODS: Using our IRB approved breast cancer database a retrospective chart review was performed for all T1-T3, cN0 primary breast cancer cases who underwent NACT from 2016 to 2021 and have undergone a subsequent definitive operation at our institution. Demographics, clinical characteristics, tumor biology and staging were recorded. We stratified by hormone receptor (HR) and HER2 status defined as: HR negative (0%), HR weakly positive (1-10%), HR positive ( \u3e11%), HER2 negative (0, 1+, 2+ negative by FISH), HER2 positive (3+, 2+ positive by FISH). RESULTS: We identified 139 cN0 cases undergoing NACT from 2016 to 2021. Forty were excluded, leaving 99 for analysis. Of these, 8 (8 %) were found to be ypN1(sn). Of the 71 HER2 negative cases, we found 32 HR negative (triple negative) and 11 HR weakly positive, none of which (0%) were found to be ypN1(sn), and 28 HR positive of which 7 (25%) were found to be ypN1(sn). Of the 28 HER2 positive cases, we found 11 HR negative and 3 HR weakly positive cases, none of which (0%) were found to be ypN1, and 14 HR positive of which 1 (7%) was found to be a micrometastasis (ypN1mic(sn)). CONCLUSIONS: Our results show that for the more aggressive tumor subtypes, including HR negative and HR weakly positive, the rate of ypN1(sn) after NACT in cN0 patients was 0%. These results suggest that frozen section could be avoided at the time of surgery for these patients in lieu of permanent pathology, due to he negligible likelihood of finding ypN1(sn) and thus needing ALND

Frequency of sentinel lymph node (SLN) metastases in triple negative breast cancer (TNBC) versus non-TNBC

INTRODUCTION: Primary tumor size has historically had a direct correlation with risk of nodal metastatic disease, and adjuvant chemotherapy is recommended for the majority of node-positive breast cancers. The published literature to date however, has revealed inconsistent data regarding associations between nodal status and size of TNBC tumors. Studies revealing high rates of nodal metastases among cases of small TNBC therefore raise questions regarding the value of breast cancer screening to detect subclinical TNBC among populations at increased risk for this phenotype, such as African Americans (AAs). Our goal was to evaluate nodal status correlated with primary tumor size in a diverse population treated in metropolitan multi-hospital health care system. Methods: We utilized an IRB-approved, prospectively-maintained database of patients (pts) undergoing SLN biopsy for clinically node-negative breast cancer. Results: A total of 2,438 SLN pts 1998 to 2017 were evaluated (median age 61, range 24-94 years); 897 AA (36.8%; median age 60 years) and 1,541 WA (63.2%; median age 63 years). Frequency of TNBC was 17.3% (155/897) among the AAs compared to 11.4% (175/1541) among White Americans (WAs) (

Outcome of African American (AA) compared to white American (WA) patients with early-stage breast cancer, stratified by phenotype

INTRODUCTION: Population-based breast cancer mortality rates are approximately 40% higher for AA compared to WA women. The extent to which these outcome disparities are related to the two-fold higher incidence of triple negative breast cancer (TNBC) in AAs is unclear. Methods: We evaluated survival among AA and WA pts presenting with clinically early-stage/node negative breast cancer, stratified by having TNBC versus non-TNBC phenotype from a prospectively-maintained, IRB-approved database in an employee health plan-based hospital system serving a diverse community; Median follow-up was 60 months. Results: A total of 2,847 cases were analyzed; 1,061 (37%) AA and 1,786 (63%) WA. Frequency of TNBC was higher among the AA patients compared to WA patients (15% versus 10%;

Isolated unilateral adrenal gland hemorrhage following motor vehicle collision: a case report and review of the literature

BACKGROUND: Adrenal gland trauma is a rare condition that typically stems from blunt force trauma, and is associated with multiple organ injuries. Alternatively, isolated adrenal gland trauma is extremely rare, accounting for only 1.5 to 4% of all adrenal trauma cases. While isolated adrenal trauma is a mostly self-limiting condition, it is potentially life-threatening, representing a significant cause of bleeding, and/or hypotension due to adrenal insufficiency and adrenal crisis. Due to its rare occurrence, there are no reported guidelines for monitoring and observing isolated adrenal trauma. CASE PRESENTATION: Here we report on an isolated adrenal hemorrhage from a blunt trauma without associated injuries. A 53-year-old white man presented with abdominal pain after a high-speed motor vehicle accident. An initial evaluation revealed minimal abdominal pain and negative focused assessment with sonography for trauma examination; computed tomography imaging revealed a significant fluid collection consistent with adrenal hemorrhage. He was observed in our intensive care unit for 24 hours, and had stable hemoglobin and vital signs, after which he was discharged. At 1-month follow-up, he reported persistent intermittent abdominal pain, which was completely resolved by the 4-month follow-up. CONCLUSIONS: This case report demonstrates isolated adrenal gland injury resulting from significant blunt trauma to the abdomen. There are no current guidelines for monitoring isolated adrenal hemorrhage. Recognizing possible adrenal injury in blunt trauma cases is important due to potentially severe adrenal hemorrhage; therefore, we recommend follow-up with serial abdominal computed tomography until the resolution of hemorrhage and symptoms