Breast Cancer Screening: Early Detection Is Not Enough

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Promoting Team-Based Exercise Among African American Breast Cancer Survivors

Physical activity benefits the health and well-being of breast cancer survivors (BCS). Yet, many African American survivors do not routinely exercise and have increased risk of poor outcomes. The purpose of this mixed-method study was to identify motivational factors compelling African American BCS to participate in a 14-week team walking program and to intend to continue exercise after the intervention concluded. Focus groups were held with participants (n = 12) before and after training. Content analysis discovered themes before the intervention: Not wanting to go at it alone, exercise not a life or treatment priority, cancer treatment affected activity, advocates to exercise, and can exercise really help? Four themes postintervention themes included: In the same boat, changed mind-set, improved weight and activity, and overcoming barriers. Physical data verified improvements. Results suggest that a team-based exercise training program may assist in overcoming a sedentary behavior tendency and subsequently improve health among survivors

Survivors Speak: A Qualitative Analysis of Motivational Factors Influencing Breast Cancer Survivors’ Participation in a Sprint Distance Triathlon

Aims and Objectives To examine motivational factors influencing breast cancer survivors to participate in triathlon training, complete a triathlon and maintain an exercise thereafter. Background Routine exercise has been shown to improve quality of life and reduce recurrence for breast cancer survivors. Yet physical and psychological factors present barriers for initiating and maintaining an exercise routine. Research is limited in exploring factors of exercise motivation from the survivor\u27s perspective. Design Qualitative design using focus groups and individual follow-up phone interviews to explore motivation for exercise initiation and maintenance. Methods One to two weeks after completing a triathlon, 11 breast cancer survivors who trained together participated in one of three focus groups to discuss their experience. Five months post triathlon 6 of the 11 participants were successfully contacted and phone interviews were conducted to explore exercise maintenance. Focus groups and interviews were analysed using content and thematic analysis. Results Five themes emerged (1) Champion for Exercise, (2) Part of a Team, (3) Everyone Had a Story, (4) Not Really Exercise and (5) What Do We Do Now? Overall, survivors recognised their need for lifestyle change (e.g. moving from a sedentary lifestyle to a more active one). More importantly, they identified the team approach to exercise initiation was crucial in their success in sustaining a behavioural change. Conclusions Emphasis needed on developing team exercise training programmes for survivors. Nurses can play a critical role in discussing with survivors, the benefits of exercise initiation and maintenance. Relevance to clinical practice Breast cancer survivors are hesitant to initiate routine exercise. Training with women who share a common lived experience increases the likelihood of success. Nurses are in a position to encourage breast cancer survivors to participate in group exercise programmes as a way to improve quality of life

Standardized Definitions for Efficacy End Points in Neoadjuvant Breast Cancer Clinical Trials: NeoSTEEP.

PURPOSE: The Standardized Definitions for Efficacy End Points (STEEP) criteria, established in 2007 and updated in 2021 (STEEP 2.0), provide standardized definitions of adjuvant breast cancer (BC) end points. STEEP 2.0 identified a need to separately address end points for neoadjuvant clinical trials. The multidisciplinary NeoSTEEP working group of experts was convened to critically evaluate and align neoadjuvant BC trial end points. METHODS: The NeoSTEEP working group concentrated on neoadjuvant systemic therapy end points in clinical trials with efficacy outcomes-both pathologic and time-to-event survival end points-particularly for registrational intent. Special considerations for subtypes and therapeutic approaches, imaging, nodal staging at surgery, bilateral and multifocal diseases, correlative tissue collection, and US Food and Drug Administration regulatory considerations were contemplated. RESULTS: The working group recommends a preferred definition of pathologic complete response (pCR) as the absence of residual invasive cancer in the complete resected breast specimen and all sampled regional lymph nodes (ypT0/Tis ypN0 per AJCC staging). Residual cancer burden should be a secondary end point to facilitate future assessment of its utility. Alternative end points are needed for hormone receptor-positive disease. Time-to-event survival end point definitions should pay particular attention to the measurement starting point. Trials should include end points originating at random assignment (event-free survival and overall survival) to capture presurgery progression and deaths as events. Secondary end points adapted from STEEP 2.0, which are defined from starting at curative-intent surgery, may also be appropriate. Specification and standardization of biopsy protocols, imaging, and pathologic nodal evaluation are also crucial. CONCLUSION: End points in addition to pCR should be selected on the basis of clinical and biologic aspects of the tumor and the therapeutic agent investigated. Consistent prespecified definitions and interventions are paramount for clinically meaningful trial results and cross-trial comparison

Breast Cancer Screening: Early Detection Is Not Enough

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The role of surgical primary tumor extirpation in de novo stage IV breast cancer in the era of targeted treatment

OBJECTIVE: Previous reports evaluating primary tumor extirpation (hereafter, surgery) in patients presenting with de novo stage IV breast cancer describe mixed results regarding overall survival (OS). In this modern era of treatment, the impact of surgery was assessed, both controlling and adjusting for potential confounders, including comorbidities, tumor burden, vitality impact of distant metastatic site, hormonal therapy of ER/PR+ disease, and targeted therapy of HER-2+ disease. METHODS: Women presenting with de novo stage IV breast cancer during 2000–2015 were retrospectively studied using a single institution’s cancer registry data. Patients with severe competing comorbidities (heart failure, chronic kidney disease) were excluded, as well as those missing data for patient, tumor, or treatment variables used in matching or analysis. As primary tumor extirpation was of principal interest, patients who underwent surgery as a first course of treatment were 1:1 matched with those treated without surgery by patient age (within ± 20 years), number of cardiovascular risk factors (smoking, hypertension, dyslipidemia, diabetes mellitus, obesity; within ± 1 factor), coronary artery disease, HER-2/neu and ER/PR, tumor grade, number of metastatic sites (tumor burden within ± 1 site), vitality impact of metastatic sites (CNS, visceral, bone), and first-course systemic and site-specific radiation (breast/chest, metastatic site) therapies received. The adjusted effects of surgery and other patient, tumor, and treatment characteristics on OS were quantified using hazard ratios (HR) derived from marginal Cox proportional hazards models, all containing surgery. Through estimation of the survivor function, OS rates were computed per study group. RESULTS: Of 609 total patients identified, 280 entered the matching algorithm. Women who underwent surgery (n = 58) vs those who did not undergo surgery (n = 58) within the matched-pairs population did not differ by age (mean, 62 yr) or other matched characteristics, but did significantly differ by length of follow-up (3.03 vs 1.97 yr, respectively). Single-variable adjustment led to detection of a significant surgery effect (P \u3c 0.04) in 4 of 10 models of OS (table). Across models of nonsignificant surgery effects (P = 0.06-0.08), HRs were within the range of values produced by models revealing significance. All models suggested a 40% reduction in risk for patients receiving surgery, and 9 of the 10 models suggested 3-yr OS rates of approximately 60% for patients undergoing surgery vs. 45% for patients treated without surgery. Age, number of risk factors, ER/PR, and vitality impact of metastatic sites impacted OS. Hazard Ratios and Adjusted 3-Year Overall Survival Rates Derived From Cox Proportional Hazards Models of Overall Survival in Women Who Presented With Stage IV Breast Cancer During 2000– 2015 and Were Matched by Primary Tumor Extirpation (Surgery, N = 116) Model No. Model Variable 1 HR (95% CI) 3-year OS rate (95% CI) Model Variable 2 HR (95% CI) 1 Surgery Patient agea 1.50 (1.24–1.84)* Performed 0.65 (0.44–1.03) 0.60 (0.48–0.75) Not performed Reference 0.46 (0.32–0.67) 2 Surgery Number of risk factors Performed 0.61 (0.40–0.95)* 0.59 (0.46–0.74) b 1.33 (1.06–1.66)* Not performed Reference 0.43 (0.31–0.61) 3 Surgery Tumor sizec Performed 0.65 (0.41–1.02) 0.58 (0.460.74) 0.98 (0.91–1.06) Not performed Reference 0.43 (0.31–0.61) 4 Surgery HER2neu expression Performed 0.65 (0.41–1.02) 0.58 (0.45–0.74) Positive 0.89 (0.54–1.47) Not performed Reference 0.43 (0.30–0.62) Negative Reference 5 Surgery ER/PR expressiond Performed 0.59 (0.36–0.97)* 0.17 (0.05–0.58) Positive 0.23 (0.12–0.46)* Not performed Reference 0.05 (0.01–0.53) Negative Reference 6 Surgery Grade Performed 0.61 (0.39–0.97)* 0.63 (0.52–0.79) I or II Reference Not performed Reference 0.49 (0.34–0.70) III or IV 1.51 (0.89–2.56) 7 Surgery Tumor burdene Performed 0.66 (0.42–1.05) 0.58 (0.46–0.74) 1.30 (0.90–1.86) Not performed Reference 0.43 (0.31–0.61) 8 Surgery Metastatic site impact Performed 0.59 (0.38–0.91)* 0.58 (0.47–0.74) Visceral 1.93 (1.15–3.25)* Not performed Reference 0.42 (0.29–0.61) Bone Reference 9 Surgery Chemotherapy Performed 0.68 (0.43–1.08) 0.52 (0.37–0.73) Performed 0.70 (0.40–1.23) Not performed Reference 0.38 (0.25–0.59) Not performed Reference 10 Surgery Radiation therapy Performed 0.65 (0.41–1.03) 0.55 (0.42–0.72) Performed 0.66 (0.35–1.25) Not Performed Reference 0.40 (0.26–0.60) Not performed Reference HR indicates hazard ratio; OS, overall survival; CI, confidence interval; HER2neu, human epidermal growth factor receptor 2; ER, estrogen receptor; PR, progesterone receptor; CNS, central nervous system. *Hazard ratio significantly differs from 1. a Number of times the hazard increases per 10-year increase in age. b Number of times the hazard increases per 1-factor increase in cardiovascular risk. c Number of times the hazard increases per 10-mm increase in tumor size. d Classified as positive when either ER or PR or both are overexpressed and negative when neither ER or PR are overexpressed. e Number of times the hazard increases per 1-metastatic site increase in tumor burden. CONCLUSION: Even after accounting for hormonal therapy, targeted therapy, and radiation to local and distant metastatic sites, surgical extirpation of the primary tumor remains associated with an OS improvement in patients with de novo stage IV breast cancer