Text message intervention delivered from Australian general practices to improve breast cancer survivors' physical activity and cardiovascular risk factors: protocol for the EMPOWER-SMS-GP effectiveness implementation randomised controlled trial.

Introduction: Australian breast cancer survivors are at increased risk of cardiovascular disease and mortality, partly due to behavioural risk factors, including unhealthy diet and physical inactivity. Guidelines recommend health promotion delivered by general practitioners (GPs), but resources (ie, time and funding) are limited. Text message interventions sent from general practice to survivors may offer a low-resource solution but have not been evaluated.

DIBH reduces right coronary artery and lung radiation dose in right breast cancer loco-regional radiotherapy.

To determine whether deep inspiratory breath-hold (DIBH) reduces dose to organs-at-risk (OAR), in particular the right coronary artery (RCA), in women with breast cancer requiring right-sided post-mastectomy radiotherapy (PMRT) including internal mammary chain (+IMC) radiotherapy (RT). Fourteen consecutive women requiring right-sided PMRT + IMC were retrospectively identified. Nodal delineation was in accordance with European Society for Radiology and Oncology (ESTRO) guidelines and tangential chest wall fields marked.

The Development and Evaluation of an Educational Video for Breast Cancer Patients Requiring Adjuvant Radiation Therapy.

Patient education and informed consent are required prior to adjuvant radiation therapy (RT) for early breast cancer (EBC), and include the role, rationale, potential toxicities and practicalities of the treatment process. Current education of patients about RT is verbal, in the form of a consultation by a radiation oncologist, often supplemented with print or online materials. This approach is limited by its doctor-dependency and non-standardised nature.

Women's views about current and future management of Ductal Carcinoma in Situ (DCIS): A mixed-methods study.

Management of low-risk ductal carcinoma in situ (DCIS) is controversial, with clinical trials currently assessing the safety of active monitoring amidst concern about overtreatment. Little is known about general community views regarding DCIS and its management. We aimed to explore women's understanding and views about low-risk DCIS and current and potential future management options.

Quantification of breast lymphoedema following conservative breast cancer treatment: a systematic review.

Purpose: Breast lymphoedema is a possible side effect of breast conserving surgery, but it is poorly understood. This is due, in part, to difficulty assessing the breast. This systematic review described outcome measures that quantify breast lymphoedema signs and symptoms and evaluated the measurement properties for these outcome measures.

Reliability and Measurement Error of Breast Volume Calculation Using Three-Dimensional Surface Imaging.

Breast lymphedema after breast cancer is challenging to quantify. Three-dimensional (3D) surface imaging is one available technique to measure breast volume, however, the measurement properties of available software programs have not been fully determined. The aim of this study was to determine equivalency of measurements with two software programs as well as reliability, standard error of measurement (SEM), and smallest detectable change (SDC).

Diagnosis and management of phyllodes tumours for the surgeon: An algorithm.

A Phyllodes Tumour (PT) is an uncommon fibroepithelial lesion, with three histological grades - benign, borderline and malignant. PTs cause significant challenges in diagnosis, management and prognostication. Recent publications have clarified the definitions and prognostication of PTs.

Impact of the EndoPredict genomic assay on treatment decisions for oestrogen receptor-positive early breast cancer patients: benefits of physician selective testing.

Purpose: Genomic tests improve accuracy of risk prediction for early breast cancers but these are expensive. This study evaluated the clinical utility of EndoPredict®, in terms of impact on adjuvant therapy recommendations and identification of parameters to guide selective application.

Methods: Patients with ER-positive, HER2-negative, and early-stage invasive breast cancer were tested with EndoPredict®.

Feasibility of arm-draining lymph node-sparing radiotherapy of breast cancer: A pilot planning study.

Introduction: Lymphoedema following axillary radiotherapy for breast cancer causes significant morbidity. Our goal was to evaluate the feasibility of sparing the lymph node that drains the arm's lymphatics (ARM node) while achieving standard dose constraints for whole breast and comprehensive lymph node irradiation.

Methods: Six patients underwent lymphoscintigraphy and SPECT CT to identify the breast sentinel node (SN) and ARM node.

Verification using in vivo optically stimulated luminescent dosimetry of the predicted skin surface dose in patients receiving postmastectomy radiotherapy.

The purpose of this study was to evaluate whether dose to the skin surface underneath bolus, was accurately predicted by a 3D treatment planning system (TPS) in patients receiving 50 Gy/25# postmastectomy radiotherapy (PMRT) using optically stimulated luminescent dosimetry (OSLD) for verification. In vivo dosimetry using OSLDs was performed in 20 consecutive patients receiving PMRT. An array of 9 OSLDs were applied to the chest wall or neobreast in a grid arrangement.

Patient-Specific Heart Constraint: A Tool for Optimization and Evaluation of Mean Heart Dose in Breast Cancer Patients.

Purpose: Our institution introduced a patient-specific heart constraint (PSHC) and a mean heart dose (MHD) constraint of 4 Gy for all patients receiving breast radiation therapy (RT) with a simultaneous boost (SIB). This was introduced as a method to calculate the predicted MHD before optimizing IMRT fields. We sought to determine whether the introduction of a PSHC reduced MHD, while maintaining optimally dosed treatment plans.

Views of healthcare professionals about the role of active monitoring in the management of ductal carcinoma in situ (DCIS): Qualitative interview study.

Background: Ductal carcinoma in situ (DCIS) is an in-situ (pre-cancerous) breast malignancy whereby malignant cells are contained within the basement membrane of the breast ducts. Increasing awareness that some low-risk forms of DCIS might remain indolent for many years has led to concern about overtreatment, with at least 3 clinical trials underway internationally assessing the safety of active monitoring for low-risk DCIS. This study aimed to understand healthcare professionals' (HCPs) views on the management options for patients with DCIS.

Radiation-induced oesophagitis in breast cancer: Factors influencing onset and severity for patients receiving supraclavicular nodal irradiation.

Aim: The aim of this study was to determine dosimetric factors, such as mean dose and oesophageal length, which may influence the incidence and severity of oesophagitis in breast cancer patients receiving radiotherapy to the supraclavicular nodes.

Methods: This was a single-arm prospective observational study. Toxicity grading was undertaken twice weekly to determine the onset of grade 2 oesophagitis in consecutive patients prescribed IMRT to the breast or chest wall and supraclavicular fossa (SCF) nodes.

Location of arm draining lymph node in relation to breast cancer radiotherapy field and target volume.

Background: Lymphoedema of the arm following axillary surgery or radiotherapy remains a significant side effect affecting some women after breast cancer treatment. Axillary reverse mapping (ARM) is a technique used to identify the lymph node draining the arm (ARM node). Our study aim was to examine the location of the ARM nodes in relation to target volumes and treatment fields for breast cancer radiotherapy.

Contouring consensus guidelines in breast cancer radiotherapy: Comparison and systematic review of patterns of failure.

Adequate coverage of sites harbouring potential microscopic disease is paramount, where the clinical decision has been made to include regional lymph node radiotherapy for patients with breast cancer. This must be achieved in balance with minimising dose to normal tissues. Several international consensus guidelines detailing clinical target volumes (CTVs) are available, but there is currently no agreement as to which is most appropriate for a given clinical situation.

Patient education using virtual reality increases knowledge and positive experience for breast cancer patients undergoing radiation therapy.

Purpose: Improved access to technology in the radiation therapy (RT) workforce education has resulted in opportunities for innovative patient education methods. This study investigated the impact of a newly developed education tool using the Virtual Environment for Radiotherapy Training (VERT) system on patients' RT knowledge and anxiety.

Method: Breast cancer patients were recruited into a control group (CG) (n = 18) who underwent the standard pre-RT education package at a targeted cancer therapy centre, followed by a VERT group (VG) (n = 19).

Breast Cancer Patients' Perceptions of a Virtual Learning Environment for Pretreatment Education.

The process and technicalities of radiation therapy (RT) for cancer treatment can be challenging for patients to understand as RT involves complex procedures, highly specialised equipment, and radiation itself has limited sensory characteristics. Hence, it is imperative that education programs are specifically planned and developed to suit the needs of patients, address radiation as an entity and include salient visual aids. In this context, the Virtual Environment for Radiotherapy Training (VERT) system, primarily created for RT practitioner simulation, may provide unique opportunities for patient education.

Left-sided breast cancer loco-regional radiotherapy with deep inspiration breath-hold: Does volumetric-modulated arc radiotherapy reduce heart dose further compared with tangential intensity-modulated radiotherapy?

Introduction: Left-sided breast cancer radiotherapy has been associated with an increase in cardiac mortality. This study investigated the potential heart-sparing effect of volumetric-modulated arc radiotherapy (VMAT). We compared VMAT to tangential intensity-modulated radiotherapy (t-IMRT) in the loco-regional treatment of left-sided breast cancer, including internal mammary nodal irradiation, based on deep inspiration breath-hold (DIBH) and free-breathing (FB).

Long-term outcomes of ductal carcinoma in situ of the breast: a systematic review, meta-analysis and meta-regression analysis.

Background: To summarize data on long-term ipsilateral local recurrence (LR) and breast cancer death rate (BCDR) for patients with ductal carcinoma in situ (DCIS) who received different treatments.

Methods: Systematic review and study-level meta-analysis of prospective (n = 5) and retrospective (n = 21) studies of patients with pure DCIS and with median or mean follow-up time of ≥10 years. Meta-regression was performed to assess and adjust for effects of potential confounders - the average age of women, period of initial treatment, and of bias - follow-up duration on recurrence- and death-rates in each treatment group.

Review of deep inspiration breath-hold techniques for the treatment of breast cancer.

Radiation treatment to the left breast is associated with increased cardiac morbidity and mortality. The deep inspiration breath-hold technique (DIBH) can decrease radiation dose delivered to the heart and this may facilitate the treatment of the internal mammary chain nodes. The aim of this review is to critically analyse the literature available in relation to breath-hold methods, implementation, utilisation, patient compliance, planning methods and treatment verification of the DIBH technique.

Left ventricular systolic function in HER2/neu negative breast cancer patients treated with anthracycline chemotherapy: a comparative analysis of left ventricular ejection fraction and myocardial strain imaging over 12 months.

Aim: Anthracycline agents are undermined by their cardiotoxicity. As life expectancy following treatment is greatly improved, techniques that ensure early detection and timely management of cardiotoxicity are essential. The aim of the present study was to evaluate left ventricular (LV) systolic function with LV ejection fraction (LVEF) and two-dimensional myocardial strain up to 12 months after anthracycline chemotherapy, specifically in HER2/neu negative breast cancer patients.

Analysis of 10-year cause-specific mortality of patients with breast cancer treated in New South Wales in 1995.

Objective: The objective of this study is to assess cause-specific mortality for patients with breast cancer and to determine if excess cardiac death was associated with radiation therapy (RT).

Methods: We obtained 10-year cause-specific mortality information from the New South Wales (NSW) Central Cancer Registry and National Death Index on 1242 patients with unilateral stage I-III invasive breast cancer in NSW, Australia, diagnosed over a 6-month period in 1995. We compared actuarial cause-specific mortality (breast cancer, cardiac, other cancers and other causes) for patients who received left-sided, right-sided or no RT.

Quality of breast imaging reports falls short of recommended standards.

Initial diagnosis and treatment of women with breast cancer is based on the imaging findings. Anecdotal experience suggests that the quality of breast imaging reports is variable; however, systematic evaluation of the content of reports has not been documented to date. We present an audit of the breast imaging reports of all new breast cancer cases referred to a multidisciplinary breast centre during 2004, based on 244 imaging reports from 253 cases.

Life after breast cancer.

This thirteenth article in our series on breast disease explores the many concerns that patients face after completion of their breast cancer treatment. The diagnosis and treatment of breast cancer is an ordeal for women on a number of levels. Similarly, there are often a multitude of issues and concerns raised after the completion of treatment.