Publications by authors named "Nina Tamirisa"
Importance: Active monitoring (AM) for low-risk ductal carcinoma in situ (DCIS) has been considered as a potential alternative to guideline-concordant care (GCC; inclusive of surgery with or without radiation). Reported data comparing patient-reported outcomes (PROs) between GCC and AM for DCIS are lacking.
Objective: To compare PROs at baseline and over time in patients with low-risk DCIS randomized to receive either AM or GCC.
Importance: Active monitoring for low-risk ductal carcinoma in situ (DCIS) of the breast has been proposed as an alternative to guideline-concordant care, but the safety of this approach is unknown.
Objective: To compare rates of invasive cancer in patients with low-risk DCIS receiving active monitoring vs guideline-concordant care.
Design, Setting, And Participants: Prospective, randomized noninferiority trial enrolling 995 women aged 40 years or older with a new diagnosis of hormone receptor-positive grade 1 or grade 2 DCIS without invasive cancer at 100 US Alliance Cancer Cooperative Group clinical trial sites from 2017 to 2023.
Survival outcomes after omission of surgery for ductal carcinoma in situ.
NPJ Breast Cancer
September 2024
Clinical trials of active surveillance (AS) for Ductal Carcinoma in Situ (DCIS) are underway. We sought to understand the historical management of biologically favorable DCIS and to determine the outcomes of patients who did not have immediate surgery. Using data from the NCDB from 2004 to 2017, the selected cohort included women >40 years of age, with low or intermediate grade and hormone receptor (HR) positive DCIS.
View Article and Find Full Text PDFBackground: HER2-positive breast cancer is traditionally treated with neoadjuvant systemic therapy (NST), but optimal treatment sequencing is less clear in patients with small tumors. We investigated clinicopathologic and oncologic outcomes in early stage HER2-positive breast cancer.
Patients And Methods: An institutional database was queried to identify patients with cT1-2 (≤ 3 cm) N0M0, HER2-positive breast cancer treated from 2015 to 2020 and compared upfront surgery and NST cohorts.
Importance: Premastectomy radiotherapy (PreMRT) is a new treatment sequence to avoid the adverse effects of radiotherapy on the final breast reconstruction while achieving the benefits of immediate breast reconstruction (IMBR).
Objective: To evaluate outcomes among patients who received PreMRT and regional nodal irradiation (RNI) followed by mastectomy and IMBR.
Design, Setting, And Participants: This was a phase 2 single-center randomized clinical trial conducted between August 3, 2018, and August 2, 2022, evaluating the feasibility and safety of PreMRT and RNI (including internal mammary lymph nodes).
Purpose: This study was designed to provide a comprehensive and up-to-date understanding of population-level reoperation rates and incremental healthcare costs associated with reoperation for patients who underwent breast-conserving surgery (BCS).
Methods: This is a retrospective cohort study using Merative™ MarketScan commercial insurance data and Medicare 5% fee-for-service claims data. The study included females aged 18-64 years in the commercial cohort and females aged 18 years and older in the Medicare cohort, who underwent initial BCS for breast cancer in 2017-2019.
Introduction: Elucent Medical has introduced a novel EnVisio™ Surgical Navigation system which uses SmartClips™ that generate a unique electromagnetic signal triangulated in 3 dimensions for real-time navigation. The purpose of this study was to evaluate the efficacy and feasibility of the EnVisio Surgical Navigation system in localizing and excising nonpalpable lesions in breast and axillary surgery.
Methods: This pilot study prospectively examined patients undergoing breast and nodal localization using the EnVisio Surgical Navigation system.
Article Synopsis
- The study aimed to evaluate surgical and clinical outcomes for patients diagnosed with lobular neoplasia (LN) via MRI biopsy, specifically looking at the rate of upgrades to malignancy and associated characteristics.
- A retrospective analysis was conducted on 94 patients from 2013 to 2022, with the findings showing a low upgrade rate of 7.4% for those treated with excision or surveillance.
- The results suggest that surgery may not be necessary for all patients with MRI-detected LN, highlighting the need for shared decision-making and further research to identify predictive factors for upgrade risk.
Objective: We evaluated the association between Medicaid expansion and time to surgery among patients with early-stage breast cancer (BC).
Background: Delays in surgery are associated with adverse outcomes. It is known that underrepresented minorities are more likely to experience treatment delays.
Vapocoolant Analgesia for Breast Lymphoscintigraphy: A Prospective Clinical Trial.
J Nucl Med Technol
June 2024
Breast lymphoscintigraphy is commonly performed before initial surgical intervention and surgical staging in the setting of breast cancer. Breast lymphoscintigraphy injections can often be quite painful and are routinely performed without any anesthesia or analgesia, thus representing a significant unmet need for the breast cancer population. Although vapocoolants have been previously available, they have typically been used on intact skin and not been recommended for sterile procedures.
View Article and Find Full Text PDFBackground: Advanced nodal disease is associated with poor prognosis. However, modern neoadjuvant systemic therapy (NST) regimens have resulted in higher pathologic complete response (pCR) rates, which are associated with improved survival. We sought to assess contemporary outcomes in patients with advanced nodal involvement and response to NST.
View Article and Find Full Text PDFArticle Synopsis
- The study focuses on identifying factors that predict involvement of four or more positive axillary lymph nodes (ALNs) in postmenopausal women with early-stage breast cancer that initially shows no lymph node involvement (cN0).
- Researchers analyzed data from 2532 patients who underwent sentinel lymph node biopsy (SLNB) and completion axillary lymph node dissection (cALND) from 1993 to 2007, identifying key predictive factors like tumor size and lymphovascular invasion.
- The findings suggest that postmenopausal women with HR-positive, HER2-negative breast cancer and a single positive SLN have a low risk (5%) of having four or more positive nodes, indicating that aggressive treatments may not be necessary
Article Synopsis
- Researchers studied how axillary surgery practices have changed over time following neoadjuvant chemotherapy (NAC) in breast cancer patients enrolled in the I-SPY2 trial from 2011 to 2021.
- The findings showed a significant decrease in axillary lymph node dissection (ALND) procedures, particularly in patients who were clinically node-positive (cN+) at diagnosis, with a corresponding increase in the use of sentinel lymph node (SLN) surgery.
- These trends indicate a shift in surgical practices, with less extensive surgery being performed after NAC, particularly for patients showing node positivity before treatment, reflecting evolving clinical approaches prior to further research outcomes.
Neoadjuvant chemotherapy (NAC) increases rates of successful breast-conserving surgery (BCS) in patients with breast cancer. However, some studies suggest that BCS after NAC may confer an increased risk of locoregional recurrence (LRR). We assessed LRR rates and locoregional recurrence-free survival (LRFS) in patients enrolled on I-SPY2 (NCT01042379), a prospective NAC trial for patients with clinical stage II to III, molecularly high-risk breast cancer.
View Article and Find Full Text PDFUnlabelled: To determine whether Medicaid expansion under the 2010 Affordable Care Act affected rates of breast cancer surgery.
Background: Data regarding the impact of Medicaid expansion on access to surgical treatment of breast cancer are limited.
Methods: Patients in the National Cancer Database diagnosed with non-metastatic breast cancer between January 1, 2010 and December 31, 2017 and residing in a state that expanded Medicaid in January 2014 or in a state that opted out of expansion were included.
Background: Neighborhood-level factors have been shown to influence surgical outcomes through material deprivation, psychosocial mechanisms, health behaviors, and access to resources. To date, no study has examined the relationship between area-level deprivation (ADI) and post-mastectomy outcomes.
Methods: A cross-sectional survey of adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 to June 2019 was carried out.
Article Synopsis
- A study examined the impact of adjuvant endocrine therapy (ET) on survival in older women (70+) with ER-positive/HER2-negative breast cancer and multiple health issues.
- Women with higher comorbidity scores were analyzed, comparing those who received ET to those who did not, using advanced statistical methods for a fair comparison.
- Results showed that patients receiving ET had a significantly better overall survival (79.2 months vs. 67.7 months) and suggested that treatment plans for older patients should consider individual health conditions and life expectancy.
Article Synopsis
- The study investigated the impact of the SSO-ASTRO guideline on reexcision rates in older women (66+) with invasive breast cancer who underwent breast-conserving surgery (BCS).
- The research found that reexcision rates decreased significantly from 23.5% before the guideline to 19.3% after its publication.
- Factors influencing reexcision included histology type, with lobular tumors having a higher risk, and surgeon experience, where more skilled surgeons showed lower rates of reexcision.
Background: In 2002, breast cancer patients with supraclavicular nodal metastases (cN3c) were downstaged from AJCC stage IV to IIIc, prompting management with locoregional treatment. We sought to estimate the impact of multimodal therapy on overall survival (OS) in a contemporary cohort of cN3c patients.
Methods: Women ≥ 18 years with cT1-T4c/cN3c invasive breast cancer who underwent systemic therapy were identified from the 2004-2016 National Cancer Database.
Importance: Breast cancer risk and comorbidities increase with age. Data are lacking on the association of adjuvant chemotherapy with survival in elderly patients with multiple comorbidities and node-positive breast cancer.
Objective: To examine the association of chemotherapy with survival in elderly patients with multiple comorbidities and estrogen receptor-positive, node-positive breast cancer.
Purpose: Deintensification of adjuvant therapy is being considered for older women with early-stage, biologically favorable breast cancer. Although radiation therapy (RT) can be omitted in some cases, toxicity from hormone therapy (HT) is not trivial, and adherence rates vary. We hypothesized that adjuvant RT alone would produce survival outcomes comparable to those with adjuvant HT alone among elderly patients treated with lumpectomy.
View Article and Find Full Text PDFBackground: We aim to determine clinical and pathological stage discordance rates and to evaluate factors associated with discordance.
Methods: Adults with clinical stages I-III breast cancer were identified from the National Cancer Data Base. Concordance was defined as cTN = pTN (discordance: cTN≠pTN).