Pruthi, Sandhya

Background: A breast cancer diagnosis can entail numerous physical and psychosocial challenges. Yoga practice (YP) may contribute to improved well-being for these patients. Primary Study Objective: Investigate feasibility and impact of YP on quality of life (QoL), mood, fatigue, and perceived stress immediately after breast cancer diagnosis. Methods: Thirty women were randomly assigned to a yoga group (YG) or control group (CG) immediately after cancer diagnosis. Setting: Pilot study conducted at an academic medical center breast clinic. Participant(s): Females (N = 30) who received a biopsy-proven breast cancer diagnosis without metastatic disease. Intervention (YG): One individual YP session at baseline, then 2 individual and 8 weekly group sessions followed by weekly gentle yoga at home (DVD). Questionnaires and saliva samples (ie, cortisol) completed at baseline and 12 weeks postdiagnosis. Results: Both groups reported significant improvements in QoL postintervention but with no significant difference between groups. Emotional well-being, mood-related tension-anxiety, depression-dejection, and confusion-bewilderment scores improved for both groups, and cortisol and cortisone levels decreased. Lumpectomies were prevalent with YG (67%) and CG (47%). YP was rated as “very effective,” providing relaxation (85%), stress relief (69%), and reduced muscle tension/general feeling of wellness (each 62%). Conclusion: Feasibility of YP immediately after breast cancer diagnosis was good. Improvement in emotional well-being, anxiety, depression, and levels of confusion was found in both groups. To our knowledge, this is the first study examining the impact of YP immediately after breast cancer diagnosis. Further research in this area is warranted.

The development of pharmacologic agents for the prevention of breast cancer is a significant milestone in medical and laboratory research. Despite these advances, the endorsement of preventive options has become challenging and complex, as physicians are expected to counsel and tailor their recommendations using a personalized approach taking into account medical comorbidities, degree of risk and patient preferences. This article provides a comprehensive overview of the major breast cancer prevention trials, review of the pharmacologic options available for breast cancer prevention, and strategies for integrating chemoprevention of breast cancer in high-risk women into clinical practice.

Women who are at high risk of breast cancer can be offered chemoprevention. Chemoprevention strategies have expanded over the past decade and include selective receptor modulator inhibitors and aromatase inhibitors. Physicians are expected to provide individualized risk assessments to identify high risk women who may be eligible for chemoprevention. It is prudent that physicians utilize a shared decision approach when counseling high risk women about their preventive options. Barriers and misperceptions however exist with patient and physician acceptance of chemoprevention and continue to impede uptake of chemoprevention as a strategy to reduce breast cancer risk. Programs to increase awareness and elucidate the barriers are critical for women to engage in cancer prevention and promote chemoprevention adherence.

Background: The use of breast magnetic resonance imaging (MRI) for screening high-risk patients is well established. However, the role of MRI as a diagnostic problem-solving tool is less well studied. With the increasing availability of MRI, its use for problem solving has increased. This small retrospective study examines the use and utility of breast MRI in evaluating palpable breast masses with negative diagnostic mammogram and ultrasound studies. Methods: We reviewed our breast MRI database, selecting breast MRI studies performed to assess palpable abnormalities with negative mammogram and ultrasound findings. Evidence of cancer was determined by biopsy. Results: Seventy-seven studies were included, comprising 1.3% of all breast MRI studies performed at our institution during the study period (2005–2011). Twenty-two patients underwent biopsy, and 55 were followed clinically without biopsy. Approximately half (27 of 55) of the patients without biopsy were lost to follow-up after negative MRI, and the rest had no evidence of cancer on imaging or clinical examination at 1 year. Of the 22 patients who underwent biopsy, 2 were diagnosed with cancer, both with positive MRI studies. Sensitivity of MRI when compared to tissue diagnosis was 100%, and specificity was 70%. Positive and negative predictive values were 25% and 100%, respectively. Conclusions: When used for evaluation of a palpable breast mass with negative traditional imaging, breast MRI likely offers low yield of cancer diagnosis and low specificity. Negative MRI results may cause a low compliance rate for recommended follow-up. Because a biopsy is indicated for persistent palpable masses, the addition of diagnostic MRI only adds another step, with associated costs and burdens.

Survivors of breast cancer are faced with a multitude of medical and psychological impairments during and after treatment and throughout their lifespan. Physical exercise has been shown to improve survival and recurrence in this population. Mind-body interventions combine a light-moderate intensity physical exercise with mindfulness, thus having the potential to improve both physical and psychological sequelae of breast cancer treatments. We conducted a review of mindfulness-based physical exercise interventions which included yoga, tai chi chuan, Pilates, and qigong, in breast cancer survivors. Among the mindfulness-based interventions, yoga was significantly more studied in this population as compared to tai chi chuan, Pilates, and qigong. The participants and the outcomes of the majority of the studies reviewed were heterogeneous, and the population included was generally not selected for symptoms. Yoga was shown to improve fatigue in a few methodologically strong studies, providing reasonable evidence for benefit in this population. Improvements were also seen in sleep, anxiety, depression, distress, quality of life, and postchemotherapy nausea and vomiting in the yoga studies. Tai chi chuan, Pilates, and qigong were not studied sufficiently in breast cancer survivors in order to be implemented in clinical practice.

Abstract INTRODUCTION: Mammographic breast density is a strong risk factor for breast cancer (BC). We established the Mayo Mammography Health Study (MMHS) cohort study at the Mayo Clinic in Rochester, Minnesota (MN) to examine the association of breast density with BC. We evaluated the influence of the image acquisition technique on the density and BC association. METHODS: From October 2003 to September 2006, all women scheduled for screening mammography at the Mayo Clinic were invited to participate. Eligible women were residents of MN, Iowa (IA) or Wisconsin (WI); age 35+; and had no personal history of BC. A risk factor questionnaire, consent form and permission to link to tumor registries were obtained. Incident BC was identified through 2009 by linkage to the Mayo and state cancer registries. A case-cohort of all incident BCs and 2300 randomly selected women (the subcohort) were used to examine the association of breast density and BC using digitized film mammograms at the time of enrollment while controlling for the influence of the acquisition parameters (peak kilovoltage, milliampere-second, and compressed breast thickness). Two density measures were considered: a quantitative percent density (PD) measure estimated using the computer-assisted thresholding program, Cumulus (University of Toronto), and the 4-category clinical BI-RADS measure. Proportional hazards regression was used to calculate hazards ratios (HR) and 95% confidence intervals (CI) for BC associated with quartiles of PD (0-6.2%,6.3-14.9%, 15.0-25.7% and 25.8%+) and BI-RADS categories 1-4 (almost entirely fatty to extremely dense). All models included age, postmenopausal hormone use (PMH), BMI, and menopausal status. The influence of acquisition parameters was evaluated by examining models with and without their inclusion. RESULTS: A total of 20,982 (50%) women participated in MMHS; 1058 (5%) with a prior history of BC were excluded, for a total cohort of 19,924. Compared to nonresponders, responders were younger (57.5 vs. 58.4 yrs), more likely to have ever used PMH (45% vs. 33%), and more likely to have a BC family history (19% vs 16%). The case-cohort consisted of 317 incident cases and 2300 women in the subcohort. Women were excluded from the current analysis if PD could not be estimated or if acquisition parameters were not available, leaving 249 cases and 1937 in the subcohort. As expected, PD was associated with BC [HR (95% CI): 1.0 (REF), 2.1 (1.4-3.1), 3.0 (2.0-4.5), and 4.6 (3.0-7.0) for quartiles; p-trend<0.001]. Controlling for acquisition parameters attenuated the association [HR (95% CI): 1.0 (REF), 2.3 (1.5-3.4), 2.4 (1.6-3.7), and 3.0 (1.8-5.0) for quartiles; p-trend<0.001]. Results for BI-RADS density were similar to those for PD. CONCLUSION: This study confirms that breast density is a significant risk factor for BC and demonstrates that the acquisition technique confounds the density and BC risk association. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3716. doi:10.1158/1538-7445.AM2011-3716

Abstract Introduction: Mammographic breast density is one of the strongest risk factors for breast cancer and appears to be modifiable. However, whether longitudinal changes in density are associated with breast cancer risk is unknown. We hypothesize that decreases in breast density are associated with reduced breast cancer risk. Methods: The Mayo Mammography Health Study cohort enrolled 19,924 women having a screening mammogram (mgm) at the Mayo Clinic, Rochester, between 2003 and 2006. Participants were 35 years and older, had no prior breast cancer and lived in the tri-state area (MN, IA and WI). Risk factor data were collected through self-administered questionnaire and clinic databases. Incident breast cancers were identified through tumor registries (Mayo Clinic, MN, IA, WI). The BI-RADS, 4-category clinical density measure (fatty, scattered density, heterogeneous density and extreme density) was available on all mgms performed after 1996. A case-cohort design consisting of incident cases (n=241) and a random selection of the cohort (n=2300, 28 developed cancer) was used to examine the association between change in BI-RADS density and breast cancer. BI-RADS densities measured from the earliest available, and enrollment mgms (average 6 years apart) were used to assess density change. Proportional hazards regression was performed to estimate the hazard ratio (HR) associated with a change in one or more BI-RADS density categories over time, relative to staying within the same category. Age was used as the time scale, and the subcohort was weighted by the inverse of the sampling proportion. Analyses were adjusted for age, years between mgms, BI-RADS density at earliest mgm, and changes in BMI, postmenopausal hormone use, and menopausal status. Results: Longitudinal analyses were conducted on the 219 cases and 1900 non-cases in the subcohort with at least one mgm available prior to enrollment mgm. Compared to the subcohort, cases were older (56.8 vs. 52.9 years), more likely postmenopausal (73.4% vs. 61.6%), had higher BMI (29.0 vs 28.1) and were more frequently screened (8.0 vs. 6.9 pre-enrollment mgms). As expected, cases were more likely to have extreme density (BI-RADS=4) at earliest mgm than non-cases (16.2% vs 14.3%). Cases were less likely than non-cases to experience a reduction of one density category or more (37.0% vs 38.6%) following earliest mgm. Adjusting for potential confounders, women who decreased one BI-RADS category or more over an average 6 years were at reduced risk of breast cancer (HR=0.72, 95%CI: 0.50-0.99) compared to those whose density was unchanged. However, women who increased one or more BI-RADS categories had suggestion of increased risk (HR=1.52, 95%CI: 0.97-2.4). Conclusion: Women with a decrease in BI-RADS density category over 6 years may have decreased breast cancer risk relative to women whose breast density category remains stable. Two measures of breast density may inform women's risk beyond a measure at one point in time. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4828.

Purpose Recent changes have occurred in the presurgical planning for breast cancer, including the introduction of preoperative breast magnetic resonance imaging (MRI). We sought to analyze the trends in mastectomy rates and the relationship to preoperative MRI and surgical year at Mayo Clinic, Rochester, MN. Patients and Methods We identified 5,405 patients who underwent surgery between 1997 and 2006. Patients undergoing MRI were identified from a prospective database. Trends in mastectomy rate and the association of MRI with surgery type were analyzed. Multiple logistic regression was used to assess the effect of surgery year and MRI on surgery type, while adjusting for potential confounding variables. Results Mastectomy rates differed significantly across time (P < .0001), and decreased from 45% in 1997% to 31% in 2003, followed by increasing rates for 2004 to 2006. The use of MRI increased from 10% in 2003% to 23% in 2006 (P < .0001). Patients with MRI were more likely to undergo mastectomy than those without MRI (54% v 36%; P < .0001). However, mastectomy rates increased from 2004 to 2006 predominantly among patients without MRI (29% in 2003% to 41% in 2006; P < .0001). In a multivariable model, both MRI (odds ratio [OR], 1.7; P < .0001) and surgical year (compared to 2003 OR: 1.4 for 2004, 1.8 for 2005, and 1.7 for 2006; P < .0001) were independent predictors of mastectomy. Conclusion After a steady decline, mastectomy rates have increased in recent years with both surgery year and MRI as significant predictors for type of surgery. Further studies are needed to evaluate the role of MRI and other factors influencing surgical planning.