Publications by authors named "Shelley Hwang"
Climate change is the greatest threat to human existence. Currently it impacts breast cancer care by disrupting treatment, by food poverty and economic hardship and through fossil fuel pollution which increases breast cancer incidence. These impacts are greatest in those already experiencing deprivation.
View Article and Find Full Text PDFImportance: 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.
Background: Since 2022, the Commission on Cancer (CoC) has developed three new breast cancer quality measures (QMs): time to surgery (BCSdx) and radiation (BCSRT) and the use of neoadjuvant therapy for triple negative and HER2/neu positive breast cancer (BneoCT). This study assesses CoC center historical performance for these measures and facility factors associated with low performance.
Methods: We examined the median number of days for time to surgery and radiation, and the proportion of facilities that achieved an estimated performance rate (EPR) of 70%, 80%, and 90% from 2004 to 2020 for all three measures.
Article Synopsis
- The age of newly diagnosed breast tumors provides important insights into their causes and potential outcomes, as it reflects the time from when the tumor starts growing until it is detected.
- Researchers estimate this age using a novel method based on epigenetic changes rather than traditional age-related markers, revealing that younger tumors tend to be more aggressive with higher growth rates and instability.
- These findings highlight the potential of this epigenetic approach for better risk assessment and early detection of breast cancer by distinguishing between aggressive young tumors and older, more stable ones.
Article Synopsis
- Breast cancer (BC) has distinct molecular subtypes influenced by different cell origins, yet the transcriptional networks for these subtypes are not well understood.
- This study utilized advanced techniques on 61 samples from 37 BC patients to reveal how gene expression and chromatin accessibility connect BC subtypes to their likely cells of origin.
- Key transcription factors BHLHE40 and KLF5 were found to play crucial roles in luminal and basal-like tumors, respectively, and exhausted CD8 T cells were linked to immune dysfunction in basal-like BC, showcasing the potential of single-cell level analysis in understanding cancer lineages.
Article Synopsis
- A study using single-cell RNA sequencing analyzed ductal carcinoma in situ (DCIS) to understand its growth mechanisms and how it may progress to invasive cancer.
- Researchers identified a mix of cancerous and normal epithelial cells, uncovering significant genetic diversity and different cell states driven by estrogen receptor expression.
- The findings suggest that changes in specific cell states and loss of basement membrane integrity are linked to the transition from DCIS to invasive breast cancer, highlighting the biological complexity of preinvasive breast diseases.
Background: Breast atypia increases overall breast cancer risk, potentially necessitating future interventions. This study examines the frequency and outcomes of additional percutaneous biopsies after an atypia diagnosis.
Methods: Adult patients with breast atypia (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ) at a single institution were reviewed for subsequent core needle biopsies (CNBs) and corresponding malignant outcomes.
Background: The heterogeneous biology of ductal carcinoma in situ (DCIS), as well as the variable outcomes, in the setting of numerous treatment options have led to prognostic uncertainty. Consequently, making treatment decisions is challenging and necessitates involved communication between patient and provider about the risks and benefits. We developed and investigated an interactive decision support tool (DST) designed to improve communication of treatment options and related long-term risks for individuals diagnosed with DCIS.
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- - The study aimed to investigate the prevalence of pathogenic (P) or likely pathogenic (LP) genetic mutations in women with phyllodes tumors (PT), highlighting the need for more research in this area.
- - Involving 274 women, the research found that 14.1% had P/LP variants, particularly in genes linked to autosomal dominant cancer conditions, like CHEK2, ATM, and RAD51D.
- - The findings suggest that genetic testing could be beneficial for women with PT to guide screening and treatment, even though current national guidelines do not address this necessity.
Background: Ductal carcinoma in situ (DCIS) is a non-obligate precursor to invasive breast cancer (IBC). Studies have indicated differences in DCIS outcome based on race or ethnicity, but molecular differences have not been investigated.
Methods: We examined the molecular profile of DCIS by self-reported race (SRR) and outcome groups in Black (n = 99) and White (n = 191) women in a large DCIS case-control cohort study with longitudinal follow up.
Article Synopsis
- The study compares survival outcomes for three treatment options for ductal carcinoma in situ: breast-conserving surgery alone, breast-conserving surgery with radiation, and mastectomy.
- Data was collected from a large sample of patients diagnosed between 2008 and 2014, with a median follow-up of about 68 months.
- Results showed extremely high disease-specific survival rates (99.6% or higher) across all treatment groups with no significant differences, although breast-conserving surgery without radiation had lower overall survival compared to surgery with radiation in patients under 65.
Background: Older breast cancer patients represent a heterogeneous population. Studies demonstrate that sentinel lymph node biopsy (SLNB) omission may be appropriate in some clinical scenarios, yet patients with triple-negative breast cancer (TNBC) are often excluded from these studies. This study evaluated differences in treatment and survival for older patients with TNBC based on SLNB receipt and result.
View Article and Find Full Text PDFProgression from pre-cancers like ductal carcinoma (DCIS) to invasive disease (cancer) is driven by somatic evolution and is altered by clinical interventions. We hypothesized that genetic and/or phenotypic intra-tumor heterogeneity would predict clinical outcomes for DCIS since it serves as the substrate for natural selection among cells. We profiled two samples from two geographically distinct foci from each DCIS in both cross-sectional (N = 119) and longitudinal cohorts (N = 224), with whole exome sequencing, low-pass whole genome sequencing, and a panel of immunohistochemical markers.
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- Patients with inflammatory breast cancer (IBC) experience worse overall survival compared to non-IBC patients, despite similar treatment approaches.
- The study analyzed data from 38,390 women with stage III breast cancer, showing that IBC patients had lower pathologic complete response (pCR) rates (20.7% vs. 23.3% for non-IBC), and higher 5-year mortality for those achieving pCR (16.4% vs. 9.1%).
- The findings suggest that even when IBC patients achieve pCR, their survival outcomes remain poorer than those of non-IBC patients, indicating the need for more effective treatment strategies for IBC.
Background: This study compared incident breast cancer cases in the National Cancer Database (NCDB) and Surveillance, Epidemiology, End Results Program (SEER) to a national population cancer registry.
Methods: Patients with malignant or in situ breast cancer (BC) 2010-2019 in the NCDB and SEER were compared to the US Cancer Statistics (USCS). Case coverage was estimated as the number of patients in the NCDB/SEER as a proportion of USCS cases.
Article Synopsis
- Proliferative breast atypical lesions, like atypical ductal hyperplasia (ADH) and lobular intraepithelial neoplasms (LIN), increase the risk for developing ductal carcinoma in situ (DCIS) and invasive breast cancer (IBC), though the timing for progression varies widely.
- A study of 418 patients diagnosed with these lesions revealed that 17% developed either IBC or DCIS, with almost half of these cases occurring within 5 years after the initial diagnosis.
- Neither patient demographics nor clinical features were linked to the timing or likelihood of developing subsequent cancer events, indicating that atypia is a significant marker for overall malignancy risk.
Background: The utility of sentinel lymph node biopsy (SLNB) in older patients remains controversial. Advancements in human epidermal growth factor receptor 2 (HER2)-directed therapy have revolutionized disease response rates and prognosis, supporting efforts to re-evaluate the utility of SLNB. We aimed to assess the differences in treatment and overall survival (OS) in older patients with HER2-positive breast cancer based on SLNB.
View Article and Find Full Text PDFDuctal carcinoma in situ (DCIS) is a heterogeneous breast disease that remains challenging to treat due to its unpredictable progression to invasive breast cancer (IBC). Contemporary literature has become increasingly focused on extracellular matrix (ECM) alterations with breast cancer progression. However, the spatial regulation of the ECM proteome in DCIS has yet to be investigated in relation to IBC.
View Article and Find Full Text PDFImportance: Data on oncological outcomes after omission of axillary lymph node dissection (ALND) in patients with breast cancer that downstages from node positive to negative with neoadjuvant chemotherapy are sparse. Additionally, the best axillary surgical staging technique in this scenario is unknown.
Objective: To investigate oncological outcomes after sentinel lymph node biopsy (SLNB) with dual-tracer mapping or targeted axillary dissection (TAD), which combines SLNB with localization and retrieval of the clipped lymph node.
Breast cancer is a significant global health concern affecting millions of women each year. Digital health platforms are an easily accessible intervention that can improve patient care, though their efficacy in breast cancer care is unknown. This scoping review aims to provide an overview of existing research on the utilization of digital health platforms for breast cancer care and identify key trends and gaps in the literature.
View Article and Find Full Text PDFBackground: Ductal Carcinoma In Situ (DCIS) can progress to invasive breast cancer, but most DCIS lesions never will. Therefore, four clinical trials (COMET, LORIS, LORETTA, AND LORD) test whether active surveillance for women with low-risk Ductal carcinoma In Situ is safe (E. S.
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