Using the Internet for information about breast cancer: A questionnaire-based study

Objectives

To identify the proportion of breast cancer patients that used the Internet for breast cancer information; to classify patterns of use based on patient demographics; and to evaluate whether using the Internet for this purpose was beneficial or problematic. Also to recognize whether a specific demographic group was more likely to experience problems when using the Internet for breast cancer information.

Methods

A 10-item questionnaire was given to patients who attended the breast unit at the University Hospital of South Manchester between May and June 2011 following breast cancer treatment within the last 5 years.

Results

200 questionnaires were completed. 50.5% of patients had used the Internet for breast cancer information, with younger (p < 0.001) patients with a higher household income (p < 0.001) being most likely to do so. The majority (73%) found it beneficial; however 31% had experienced problems. Ethnicity affected the likelihood of experiencing problems with white patients encountering fewer problems (25%) than non-white patients (64%) (p = 0.008).

Conclusion

A significant proportion of breast cancer patients will encounter difficulties when using the Internet for breast cancer information, particularly those from ethnic minorities.

Practice implications

Health professionals need to include a discussion about Internet use in consultations with breast cancer patients.     

肉芽肿性小叶性乳腺炎伴发乳腺导管扩张症的临床病理学观察

目的 分析肉芽肿性小叶性乳腺炎伴发乳腺导管扩张症的临床病理特征.方法 收集2005年8月至2013年5月诊断的此类病例32例,对其临床和组织病理学资料进行回顾性分析.结果 患者年龄26～45岁,2例未生育,其余有生育史,其中14例患侧乳腺未哺乳或哺乳障碍.大体检查乳腺肿块直径3～12 cm,与周围组织界限不清,切面见小脓腔或小囊腔,直径0.1～0.5 cm,腔内有灰白或淡黄色分泌物.镜下观察32例均有肉芽肿性小叶性乳腺炎表现,在此基础上均可见乳腺导管扩张症.11例曾行抗生素治疗无效,12例因切开引流致皮肤窦道形成.术后随访5 ～ 90个月,3例患侧复发,1例对侧发生肉芽肿性小叶性乳腺炎伴发乳腺导管扩张症,2例对侧发生肉芽肿性小叶性乳腺炎,4例失访.结论 肉芽肿性小叶性乳腺炎可与乳腺导管扩张症伴发,准确诊断有助于针对性治疗和减少复发.     

When cure is no option: How explicit and hopeful can information be given? A qualitative study in breast cancer

Objective

To investigate how oncologists can balance explicit with general and realistic with hopeful information when discussing various topics at the transition from curative to palliative care in breast cancer.

Methods

Qualitative analysis of focus groups consisting of female breast cancer survivors and healthy women.

Results

Perceptions of survivors and healthy women largely overlapped. Participants thought that oncologists can help patients regain a future perspective during this consultation. To achieve this, four themes seemed important: honest medical information, availability of continued support, hope has many faces, and space to choose. Moreover, participants stressed they would need time to let the message sink in before any further information was provided.

Conclusion

Participants thought that when confronted with this type of consultation they would need – more or less explicit – medical information and information regarding support. In order to maintain hope, knowledge about (treatment) possibilities is important, but also the certainty not to be abandoned by the hospital at a later stage of the disease and the confidence to remain able to make one's own decisions.

Practice implications

A life-limiting diagnosis may shatter patients’ future perspective; however, this study provides suggestions for oncologists to create a new perspective.     

Is there shared decision making when the provider makes a recommendation?

Objective

To compare the amount of shared decision making in breast cancer surgery interactions when providers do and do not make a treatment recommendation.

Methods

We surveyed breast cancer survivors who were eligible for mastectomy and lumpectomy. Patients reported whether the provider made a recommendation and the recommendation given. They completed items about their interaction including discussion of options, pros, cons, and treatment preference. A total involvement score was calculated with higher scores indicating more shared decision making.

Results

Most patients (85%) reported that their provider made a recommendation. Patients who did not receive a recommendation had higher involvement scores compared to those who did (52% vs. 39.1%, p = 0.004). Type of recommendation was associated with involvement. Patients given different recommendations had the highest total involvement scores followed by those who received mastectomy and lumpectomy recommendations (65.5% vs. 42.5% vs. 33.2%, respectively, p < 0.001).

Conclusion

Providers were less likely to present a balanced view of the options when they gave a recommendation for surgery. Patients who received a recommendation for lumpectomy had the lowest involvement score.

Practice implications

Providers need to discuss both mastectomy and lumpectomy and elicit patients’ goals and treatment preferences regardless of whether or not a recommendation is given.     

Results from a randomized trial of a web-based,tailored decision aid for women at high risk for breast cancer

Objective

To assess the impact of Guide to Decide (GtD), a web-based, personally-tailored decision aid designed to inform women's decisions about prophylactic tamoxifen and raloxifene use.

Methods

Postmenopausal women, age 46–74, with BCRAT 5-year risk ≥1.66% and no prior history of breast cancer were randomized to one of three study arms:intervention (n = 690), Time 1 control (n = 160), or 3-month control (n = 162). Intervention participants viewed GtD prior to completing a post-test and 3 month follow-up assessment. Controls did not. We assessed the impact of GtD on women's decisional conflict levels and treatment decision behavior at post-test and at 3 months, respectively.

Results

Intervention participants had significantly lower decisional conflict levels at post-test (p < 0.001) and significantly higher odds of making a decision about whether or not to take prophylactic tamoxifen or raloxifene at 3-month follow-up (p < 0.001) compared to control participants.

Conclusion

GtD lowered decisional conflict and helped women at high risk of breast cancer decide whether to take prophylactic tamoxifen or raloxifene to reduce their cancer risk.

Practice implications

Web-based, tailored decision aids should be used more routinely to facilitate informed medical decisions, reduce patients’ decisional conflict, and empower patients to choose the treatment strategy that best reflects their own values.     

Coexistence of arteriovenous malformation and meningioma in a single patient: Systematic review and illustrative case

BackgroundThe coexistence of intracranial arteriovenous malformation (AVM) and meningioma in a single patient is seldom reported, so the clinical profile, optimal management, and outcomes of these patients are mostly unknown.MethodsWe performed a systematic review of the SCOPUS and PubMed databases for case reports and case series on patients with both intracranial AVMs and meningiomas. Data on demographics, clinical characteristics, surgical management, and outcomes were collected.ResultsA total of 18 cases were reported in the literature, including the present case. The mean age at presentation was 54 years (range of 15–70 years), with no gender predilection. Most of the meningiomas and AVMs were frontal in location, and more than half of the lesions were contiguous. The most common presenting symptoms were seizures (67%), headache (44%), and weakness (33%). Majority of the patients underwent single stage meningioma and AVM excision (44%), followed by staged meningioma excision then AVM excision (17%) and meningioma excision only (17%). In all, 94% (17/18) of the meningiomas were excised compared to 72% (13/18) of the AVMs. Outcomes were reported in 15 patients; 80% were favorable, but there were 2 deaths and 1 tumor recurrence after 5 years.ConclusionThe coexistence of an intracranial AVM with a meningioma is recognized but rarely reported in the literature. Individualized treatment should be employed in managing patients with concurrent lesions, and outcomes are generally favorable due to the benign nature of both these entities.     

GTP酶激活蛋白(Src同源结构域3)结合蛋白1在乳腺癌细胞MDA-MB-231体外迁移中的作用

目的:研究GTP酶激活蛋白(Src同源结构域3)结合蛋白1[Ras-GTPase activating protein(Src homology domain 3)binding protein 1,G3BP1]在乳腺癌细胞MDA-MB-231体外迁移过程中的作用.方法:人乳腺癌细胞MDA-MB-231培养于RPMI1640培养基中;Western blot检测无表皮生长因子(Epidermal growth factor,EGF)刺激,以及10 ng/ml EGF分别刺激30秒、1分钟、2分钟和5分钟条件下乳腺癌细胞内G3BP1、蛋白激酶Cζ(Protein kinase Cζ,PKCζ)、Akt、pPKCζThin410/403及pAktSer473的表达水平;免疫共沉淀法检测乳腺癌细胞内G3BP1与PKCζ的相互作用;转染小干扰RNA抑制内源性G3BP1的表达;趋化实验和侵袭实验分别检测G3BP1抑制前后MDA-MB-231细胞穿过10 μm聚碳酸酯膜及人工基底膜的细胞数.结果:Western blot检测显示G3BP1在MDA-MB-231细胞内过表达;无EGF刺激时MDA-MB-231细胞内G3BP1,PKCζ与Akt均过表达,pPKCζThe410/403及pAktSer473不表达或低于Western blot检测下限;10 ng/ml EGF刺激后G3BP1、PKCζ与Akt表达水平不变,pPKCζThr410/403及pAktSer473的表达刺激时间增加而升高,至5分钟时达到峰值;在乳腺癌细胞内G3BP1与PKCζ具有相互作用;G3BP1表达抑制后乳腺癌细胞的趋化能力和侵袭能力均显著下降(P ＜0.05,P＜0.05).结论:G3 BP1通过与PKCζ相互作用,在乳腺癌细胞MDA-MB-231的体外迁移过程中发挥重要作用.     

Computer-Aided Diagnosis Scheme for Distinguishing Between Benign and Malignant Masses on Breast DCE-MRI Images Using Deep Convolutional Neural Network with Bayesian Optimization

Although magnetic resonance imaging (MRI) has a higher sensitivity of early breast cancer than mammography, the specificity is lower. The purpose of this study was to develop a computer-aided diagnosis (CAD) scheme for distinguishing between benign and malignant breast masses on dynamic contrast material-enhanced MRI (DCE-MRI) by using a deep convolutional neural network (DCNN) with Bayesian optimization. Our database consisted of 56 DCE-MRI examinations for 56 patients, each of which contained five sequential phase images. It included 26 benign and 30 malignant masses. In this study, we first determined a baseline DCNN model from well-known DCNN models in terms of classification performance. The optimum architecture of the DCNN model was determined by changing the hyperparameters of the baseline DCNN model such as the number of layers, the filter size, and the number of filters using Bayesian optimization. As the input of the proposed DCNN model, rectangular regions of interest which include an entire mass were selected from each of DCE-MRI images by an experienced radiologist. Three-fold cross validation method was used for training and testing of the proposed DCNN model. The classification accuracy, the sensitivity, the specificity, the positive predictive value, and the negative predictive value were 92.9% (52/56), 93.3% (28/30), 92.3% (24/26), 93.3% (28/30), and 92.3% (24/26), respectively. These results were substantially greater than those with the conventional method based on handcrafted features and a classifier. The proposed DCNN model achieved high classification performance and would be useful in differential diagnoses of masses in breast DCE-MRI images as a diagnostic aid.     

Anti-cancer effect of metformin on the metastasis and invasion of primary breast cancer cells through mediating NF-kB activity

Current evidence strongly suggests that aberrant activation of the nuclear factor kappa B (NF-kB) signaling cascade is connected to carcinogenesis. The matrix metalloproteinases (MMP) which are also the key agents for tumor metastasis may be potent candidates for tumor diagnosis in clinics. In this in vitro study, we hypothesized that metformin with an effective dose can inhibit tumor cell proliferation and metastasis by modulating the expressions of MMP-2 and -9 and interfering with NF-kB signaling in primary breast cancer cells (PBCCs). 300 000 cells per ml were obtained from biopsies of breast tumors from five human donors. The cell viability and proliferation were tested. Immunocytochemistry was performed for MMP-2, MMP-9, and NF-kB, and enzyme-linked immunosorbent assay for NF-kB activity, quantitative real-time PCR for RELA/p65, IkBα, MMP-2, and MMP-9. Three different doses of metformin (5, 10, and 25 mM) (Met) reduced the viability and proliferation of PBCCs in a dose-dependent manner, maximum inhibition was observed at 25 mM Met. The expression of RELA/p65 was not affected by 25 mM Met. Nuclear immunoreactivity and activity of NF-kB reduced while cytoplasmic NF-kB (p65) elevated by 25 mM Met compared to non-treatment (P < 0.05). The expression and immunoreactivity of MMP-9 but not MMP-2 were decreased by 25 mM Met treatment, compared with the non-treatment (P < 0.05). Metformin may have an essential antitumor role in the invasion and metastasis pathways of PBCCs by downregulating the MMP-9 expression blocking both the activity and nuclear translocation of NF-kB.