Mussallem, Dawn M.

ABSTRACT Background Alcohol intake is a modifiable risk factor for breast cancer, yet patterns of alcohol intake in women with breast cancer remain underexplored. This study evaluates demographic and clinical predictors of alcohol intake in patients with breast cancer. Methods Patients at Mayo Clinic Rochester diagnosed with breast cancer (Stage 0–3) between July 2014 to March 2022 were surveyed about their average alcohol intake over the 10 years prior to their diagnosis. Alcohol intake was categorized as < 1, 1–4, 5–14, and ≥ 15 drinks per week. Demographic, behavioral, and clinical data were analyzed using univariate Fisher exact tests and multivariate multinomial logistic regression. Results Of 2030 participants (mean age at diagnosis: 59 years; 99.3% female; 95.9% White), 29% consumed < 1 drink/week, 48% reported 1–4 drinks/week, 20% consumed 5–14 drinks/week, and 3% reported ≥ 15 drinks/week. Older age at diagnosis (≥ 60 years), non‐White race, financial difficulty, and never smoking were associated with less alcohol intake. Patients who reported higher levels of mild–moderate intensity exercise reported more alcohol intake. Tumor stage, tumor receptors, and BRCA mutation status were not associated with alcohol intake. PROMIS‐10 physical health scores correlated with alcohol intake in univariate but not multivariate models. Conclusion Alcohol intake is more common prior to a breast cancer diagnosis for patients who are younger, White, financially secure, exercising, and smoking. These findings may inform alcohol intake‐related breast cancer prevention efforts and highlight patient subgroups who could benefit from targeted counseling at the time of diagnosis.

Abstract Backgroud. Breast cancer (BC) is the most common and deadly cancer in women worldwide. Emerging evidence highlights the role of gut microbiota in modulating breast cancer risk, treatment response, and recurrence through various mechanisms, including the production of biologically active compounds and metabolites. These non-viable microbial products and metabolic byproducts from probiotic fermentation, known as postbiotics, exert beneficial effects on the host without the need for live microorganisms. Postbiotics derived from Lacticaseibacillus species represent a novel class of therapeutics with potential anti-cancer properties. In this study, we investigated the therapeutic effects of an innovative postbiotic product (iPB), developed through sequential fermentation of L.paracasei NPB01 and L.rhamnosus GG, in BC experimental models. Methods. The following cell lines were used to represent main BC subtypes: MCF7 cells (ER+/HER2), MDA-MB-231 (triple negative breast cancer), SKBR3 (HER2+). MCF-10A (normal breast epithelial cells), Caco-2 (enterocytes), and peripheral mononuclear blood cells (PBMC) were used as control. Cell viability was assessed by colony formation assay. Apoptosis was evaluated using Annexin V/7-AAD staining, HLA class I surface expression by flow cytometry, and cancer cells migration by wound healing assay. Results. iPB exposure resulted in &gt;50% colony formation reduction in MCF7, &gt;30% in MDA-MB-231 and &gt;40% in SKBR3 cells starting from 0.5 mg/ml for 72 h (p&lt;0.01). iPB increased early and late apoptotic cell rate in all BC cell lines starting from 0.5 mg/ml for 72 h. On the contrary, iPB exposure up to 5 mg/ml for 120 h did not affect cell viability in control cells (MCF-10A, Caco-2, PBMC). 1.20 to 1.30 fold increase in HLA class I expression was observed in all BC cell lines after the exposure with iPB starting from the dose of 0.5 mg/ml for 72 h. A less intense HLA class I expression increase was observed in control cells after the iPB exposure. Cell migration process and inflammatory cytokines response were inhibited by the iPB exposure in all BC cell models. Conclusions. iPB reduces cell viability and cell migration in all main BC phenotypes. These effects parallel with HLA class I surface expression increase in all BC cell phenotypes, potentially enhancing immunogenicity. These findings suggest that iPB may represent a promising novel agent in BC treatment and prevention. Citation Format: Roberto Berni Canani, Chiara Luongo, Laura Pisapia, Franca Oglio, Roberta Di Santillo, Alessia Gaeta, Chiara Scocco, Marco Michelini, Vittoria Mauriello, Alessia Cadavere, Camilla Messuri, Saranya Chumsri, Dawn Mussallem. Postbiotic based on sequential fermentation of L.paracasei NPB01 and L.rhamnosus GG exerts antitumor activities against breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 312.

Abstract Backgroud. Breast cancer (BC) is the most common and deadly cancer affecting women globally. While traditional treatments are used, factors limit their effectiveness, such as tumor heterogeneity, drug resistance, and non-targeted actions on cancer cells. Emerging evidence highlights the role of gut microbiota in modulating breast cancer risk, treatment response, and recurrence through various mechanisms, including the production of biologically active compounds and metabolites. These non-viable microbial products and metabolic byproducts from probiotic fermentation, known as postbiotics, exert beneficial effects on the host without the need for live microorganisms. Postbiotics derived from Lacticaseibacillus species represent a novel class of therapeutics with potential anti-cancer properties. In this study, we investigated the therapeutic effects of an innovative postbiotic product (iPB), developed through sequential fermentation of L.paracasei NPB01 and L.rhamnosus GG, in BC experimental models. Methods. The following cell lines were used to represent main BC subtypes: MCF7 cells (HR+/HER2-), MDA-MB-231 (triple negative breast cancer), SKBR3 (HER2+). MCF-10A (normal breast epithelial cells) and Caco-2 (enterocytes) cell lines were used as control. Cell viability was assessed by colony formation assay. Apoptosis was evaluated using Annexin V and 7-AAD staining and HLA class I surface expression was quantified by flow cytometry. Wound healing assay was applied to investigate the inhibitory effect of iPB on cell migration. Results. The iPB exposure resulted in &gt;50% colony formation reduction in MCF7, MDA-MB-231 and SKBR3 cells starting from 0.5 mg/ml for 72 h. Furthermore, the iPB significantly increased early apoptotic cell rate in MCF7 cells starting at 0.5 mg/ml for 96 h. A similar trend was observed in MDA-MB231 and SKBR3 cells exposed to 5 mg/ml for 96 h iPB, as well as significant increase in late apoptotic cells detected by 7-AAD. On the contrary, control cells (MCF-10A, Caco-2) viability remained unaffected by the iPB exposure up to 5 mg/ml for 96 h. Evaluation of HLA class I surface expression revealed up to 30% increase in HLA class I expression in MCF7 cells induced by iPB starting at 0.5 mg/ml for 96 h, MDA-MB-231 cells at 1 mg/ml for 72 h, and SKBR3 cells at 5 mg/ml for 72 h, but there was no significant changes in MHC class I expression in control cells. Finally, the results of wound healing analysis revealed that iPB induced an up to 30% reduction in cell migration in all BC cell models, compared to the untreated cells where it induced a full wound closure. Conclusions. The iPB product reduces cell viability and cell migration in all main BC subtypes. These effects parallel with HLA class I surface expression increase in all BC cell phenotypes, potentially enhancing immunogenicity. These findings suggest that this iPB product may represent a promising novel agent in BC treatment and prevention. Citation Format: R. Berni Canani, C. Luongo, L. Pisapia, R. Di Santillo, A. Gaeta, C. Scocco, M. Michelini, V. Mauriello, A. Cadavere, C. Messuri, S. Chumsri, D. Mussallem. An Innovative Postbiotic Product Based on Sequential Fermentation of L.paracasei NPB01 and L.rhamnosus GG Demonstrates Antitumor Activity against Breast Cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-12-02.

Abstract Purpose To evaluate alcohol intake trends and identify demographic, clinical, lifestyle and socioeconomic factors associated with alcohol consumption in late survivorship among breast cancer survivors. Methods Individuals diagnosed with stage 0–3 breast cancer enrolled in the Mayo Clinic Breast Disease registry between 2014 to 2022 reported their average weekly alcohol intake at baseline (time of diagnosis) and at approximately four years post-diagnosis. Alcohol intake was divided into four categories and cross-sectional associations with demographic, clinical, and lifestyle factors were examined using Monte Carlo-based Fisher exact tests and multivariable multinomial logistic regression. Changes in alcohol consumption from baseline to Year 4 were evaluated using Bowker’s test of symmetry and multinomial models. Results Among 719 participants, alcohol intake 4 years post diagnosis closely resembled baseline patterns, with 30.2% of patients reporting no alcohol use and 48.8% of patients consuming 1–4 drinks per week. Younger age and current smoking status were strongly associated with higher intake at Year 4. Exercise and better physical health were associated with higher alcohol intake in univariable models, however not in adjusted models. From time of diagnosis to Year 4, 15.6% of patients decreased their alcohol intake, 10.2% increased alcohol intake, and 74.3% reported no change. Higher levels of mild intensity exercise were associated with an elevation in alcohol intake over time. Conclusion Alcohol consumption remained stable in late survivorship, in contrast to the initial decline in alcohol use during early survivorship seen in this cohort. Younger age and smoking were key associations with higher alcohol intake.

Objective To estimate the proportion of female patients from Mayo Clinic Family Medicine and Community Internal Medicine clinics who are aware of alcohol use as a breast cancer (BC) risk factor. Patients and Methods One thousand women aged 21 to 70 completed a survey collecting information on demographics, medical/family history, frequency and quantity of alcohol consumption, and other health behaviors. Participants were also asked to grade how likely certain factors were to increase lifetime BC risk. Results Most participants (844/990 [85.3%]) identified a family history of BC as a BC risk factor. In contrast, 48.4% (475/982) identified alcohol use as a BC risk factor. The remaining 51.6% (507/982) reported either they were not sure about alcohol consumption as a risk factor (341/982 [34.7%]), believed that there was no association (143/982 [14.6%]), or believed that alcohol consumption decreases the risk of BC (23/982 [2.3%]). In multivariable analyses, factors associated with awareness of alcohol consumption and BC risk included having never been pregnant ( P = 0.048), more education ( P < 0.001), and higher frequency of alcohol consumption in the past 12 months ( P = 0.005). Conclusion Further education of patients and the public is needed to promote awareness of alcohol as a risk factor for BC.

11114 Background: Advances in early detection and treatment of breast cancer (BC) have significantly improved survival outcomes. In this growing survivor population, addressing modifiable lifestyle factors such as alcohol intake (AI), a known risk factor for BC and BC recurrence, is critical to improving prognosis and health-related quality of life (HRQoL). This study examines AI patterns and their associations with mental and physical HRQoL in early BC survivorship. Methods: Adult patients newly diagnosed (≤1 year) with stage I–III BC at Mayo Clinic Rochester were invited to enroll in the Mayo Clinic Breast Disease Registry. Of the 3252 patients who consented, 1997 completed surveys approximately one-year post-diagnosis, capturing weekly AI, demographic factors, and PROMIS-10 scores. PROMIS-10 (a 10-item measure of health, well-being, and distress) physical and mental health T-scores (mean = 50, SD = 10) are standardized to the U.S. population. Weekly AI was categorized as minimal/none (<1 drink), mild (1–4 drinks), moderate (5–14 drinks), or high (≥15 drinks). Univariate analyses were performed with Monte Carlo-based Fisher exact tests. Multivariate multinomial logistic regression models using a glogit link function assessed AI as the outcome and PROMIS-10 scores as independent variables, adjusting for financial status, smoking, chemotherapy, and moderate exercise because those were associated with AI at year 1 in prior analyses. Results: Univariate analyses revealed statistically significant associations between AI and PROMIS-10 scores (Table 1). Adjusted multivariate analyses identified that patients with better physical health were more likely to drink 1–4 or 5–14 drinks/week and less likely to abstain (<1 drink/week) than those with poorer physical health (p=0.027). There was no statistically significant association between AI and mental health QoL after adjustment for covariates. Conclusions: Better physical HRQoL during early survivorship was associated with higher AI, suggesting that patients who are feeling physically unwell may be less likely to drink alcohol. Additional public health messaging about the relationship between AI and breast cancer risk and recurrence may be needed, especially for those who are feeling well enough to consume alcohol. Univariate analyses of year 1 PROMIS-10 scores with year 1 alcohol consumption using Monte Carlo-based Fisher exact test. Alcoholic drinks per week at year 1 < 1(N=1204) 1-4(N=600) 5-14(N=175) 15+(N=18) Total(N=1997) P-value PROMIS global mental health T score, Year 1, n (%) 0.008 < 50 466 (63.8%) 200 (27.4%) 54 (7.4%) 10 (1.4%) 730 (37.1%) 50+ 718 (57.9%) 394 (31.8%) 120 (9.7%) 7 (0.6%) 1239 (62.9%) Missing 20 6 1 1 28 PROMIS global physical health T score, Year 1, n (%) <0.001 < 50 440 (66.5%) 165 (24.9%) 50 (7.6%) 7 (1.1%) 662 (33.6%) 50+ 740 (56.7%) 432 (33.1%) 124 (9.5%) 10 (0.8%) 1306 (66.4%) Missing 24 3 1 1 29

Breast cancer is the most common cancer in women. The life expectancy after a breast cancer diagnosis is improving steadily, leaving many more persons with the long-term consequences of treatment. Sexual problems are a common concern for breast cancer survivors yet remain overlooked in both the clinical setting and the research literature. Factors that contribute to sexual health concerns in breast cancer survivors are biopsychosocial, as are the barriers to addressing and treating these health concerns. Sexual health needs and treatment may vary by anatomy and gender. Multidisciplinary management may comprise lifestyle modifications, medications, sexual health aids such as vibrators, counseling, and referrals to pelvic health physical therapy and specialty care. In this article, we review the contributing factors, screening, and management of sexual difficulties in cisgender female breast cancer survivors. More information is needed to better address the sexual health of breast cancer survivors whose sexual/gender identity differs from that of cisgender women.

Abstract Background: Multiple studies have identified an association between diagnosis of breast cancer and post-diagnosis psychological distress. Some have taken a step further, identifying predictive markers of distress in diagnosed patients and interventions to minimize post-diagnosis distress. Data regarding pre-diagnosis psychological distress and its impact on surgical decision making and clinical outcomes in the breast cancer population are limited. Here, we assessed pre-diagnosis major life stressors and breast cancer outcomes in a single-center population. Methods: Patients with newly diagnosed stage 0-3 breast cancer seen at Mayo Clinic Florida between June 11, 2018, and October 7, 2019, were included. Prior to their initial visit, patients were administered a voluntary telephone survey regarding the incidence of major life events and stressors during the 18 months preceding their diagnosis. Demographic data including age and ethnicity were also included. Subsequent clinical outcomes were obtained through retrospective chart review. Clinical outcomes were assessed with descriptive statistics. Chi-square tests were used to compare subgroups, with p &lt; 0.05 considered statistically significant. Results: Of 469 patients seen for a new breast cancer diagnosis, 222 patients completed the intake survey and met inclusion criteria. Median age was 60 (27-84) years. 80.6% of patients were white, 7.7% were black, 5.4% were Asian/Pacific Islander, and 2.3% were Latino. Over 95% endorsed having some form of social support. 51.3% reported experiencing a major life event prior to breast cancer diagnosis. Of these patients (n = 114), 43.9% denoted this stressor as family-related, as compared to 20.2% citing non-breast cancer illness, 14.9% claiming relationship stress, and 14% describing employment-related stress. Only 1.8% endorsed stress caused by financial concerns. Multiple major life events were reported by 10.8% of all included patients. Subgroup analysis of the patients with pre-diagnosis stress revealed a similar demographic distribution to the overall sample. Compared to the subgroup without pre-diagnosis stress (n = 108), there were more patients with carcinoma in situ and stage T3/T4 disease (21.1% versus 13.0%, p = 0.11) and 11.4% versus 10.2%, p = 0.77), respectively) in the subgroup with pre-diagnosis stress, although these differences were not statistically significant. More patients with pre-diagnosis stress elected to undergo mastectomy (34.2% versus 22.2%, p = 0.048) as compared to the group without stress. Conclusions: With over half of sample patients reporting pre-diagnosis major life stressors, psychological distress is prevalent prior to breast cancer diagnosis and should be considered as a factor for early intervention, such as psychological and financial counseling, during breast cancer evaluation. The sample population was predominantly white and resource-rich in terms of financial and social support, highlighting a need for characterization of pre-diagnosis psychological distress in more ethnically diverse and/or resource-limited settings. Although additional study is recommended, current data suggest possible associations between pre-diagnosis psychological distress and treatment decision making, particularly the decision to pursue mastectomy. Citation Format: Tanmayi Pai, Laura Vallow, Danushka Seneviratne, Dawn Mussallem, Lauren Cornell. Pre-diagnosis major life stressors and breast cancer outcomes [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-46.