PURPOSE: This study investigated the risk factors for cellulitis infection, the median time to onset of low volume swelling (5 to 10% relative volume change (RVC) and breast cancer-related lymphedema (BCRL) (≥10% RVC) after an incidence of cellulitis, and the impact of common risk factors of both cellulitis and lymphedema on low volume swelling and BCRL. METHODS: We reviewed electronic medical records of 98 patients who underwent unilateral breast cancer (BC) surgery in the year 2011, who had a presurgical baseline perometry measurement and at least two postsurgical follow-up measurements. Clinicopathologic data, edema, and cellulitis incidence were obtained by medical record review. RESULTS: 18.37% of patients (18/98) experienced at least one incidence of cellulitis at a median of 1.03 years postoperatively. Of those 18 patients, 44.44% (eight out of 18) developed low volume swelling and 11.11% (two out of 18) developed BCRL at a median of 1.08 years and 2.33 years postoperatively, respectively. The median time to cellulitis incidence was 0.94 years and 2.91 years after the onset of low volume swelling and BCLR, respectively. Univariate logistic regression revealed that regional lymph node radiation (RLNR) (OR 4.4; p = 0.032) and low volume swelling (OR 6.56; p = 0.004) are significant risk factors for BCRL. RLNR remained a significant risk factor for the development of BCRL by multivariate logistic regression (OR 9.43; p = 0.031). CONCLUSION: Cellulitis may not incite or worsen pre-existing BCRL or affect the median time to BCRL development. However, lymphedema may put patients at risk of cellulitis infection. Sample size may have precluded statistical significance and further research is required to definitively identify the effect of cellulitis infection on lymphedema risk. / 2022-06-04T00:00:00Z

A culturally-based theoretical model about how cultural beliefs about cancer and breast cancer screening techniques influence the screening behaviors of women of Mexican descent was developed using grounded theory. Across levels of acculturation and socioeconomic status, 34 women (49 to 81 years old) were interviewed through focus groups. Women who hold more traditional health beliefs about causes, nature, and responsibility with regard to breast cancer are more likely to "feel healthy" and not engage in breast cancer screening. Women who hold more traditional beliefs about propriety of female and health care provider behavior are more likely to "feel indecent" and also not engage in screening. The cultural health belief model is integrated within a sociocultural and a socioeconomic context.

Indiana University-Purdue University Indianapolis (IUPUI) / Photographs invite women to construct their own meanings of the self and illness without boundaries of race, ethnicity, and culture differences. This study analyzed 15 intensive interviews with 15 Asian (Thai) women in Thailand. The results are divided into two parts. In part I, grounded theory analyses revealed four major themes of experiences of Asian (Thai) female breast cancer survivors, including: (1) experiencing uncertainty of signs and symptoms, (2) entering the medical establishment, (3) experiencing self-change after treatment, and, (4) desiring to return to normality. In part II, the 15 women were shown a postmodern artistic photo book of American women who have breast cancer. The goal was to assess how they related to American women faced with their own stories of breast cancer. The results of the postmodern artistic photo book showed that Asian (Thai) women narrated their illness experiences in both modern and postmodern ways. This study not only revealed the sociological perspectives of Asian (Thai) women who suffered from breast cancer as they experienced a four-stage process, but enhanced our understanding of how disease experiences are socially constructed. In addition, this study provides an opportunity for medical systems in both the East and the West to use postmodern artistic photo books of women with breast cancer for forging ties with others, including patients, patients’ families, hospitals, and caregivers.

Bakgrund: Bröstcancer är den vanligaste cancerformen bland kvinnor. Behandlingsalternativen är cytostatika, kirurgi och antihormonbehandling som resulterar i påfrestande biverkningar. Behandlingarna påverkar kvinnorna på flera olika sätt och det kan leda till ett lidande och minskat välbefinnande. Sjuksköterskan har flera ansvarsområden gällande omvårdnaden av patienten. Metod: En litteraturöversikt där vetenskapliga artiklar med kvalitativ ansats analyserades. Syfte: Syftet var att belysa kvinnors upplevelser av sin sexualitet under och efter behandling mot bröstcancer. Resultat: I analysen framkom fem teman 1) Förlorat bröst en känsla av vanställdhet, 2) självbilden och kroppsuppfattningen förändrades, 3) Förändrad sexuell hälsa, 4) Biverkningar och komplikationer påverkade den sexuella hälsan och 5) En önskan om öppenhet. Konklusion: Behandlingarna påverkade kvinnornas självbild, sexualitet och femininitet i olika grad vilket kan härledas till att alla upplevelser är individuella. En önskan om öppenhet kring samtal om den sexuella hälsan fanns. Med hjälp av information, stöd samt att inleda samtal om den sexuella hälsan och kvinnornas självbild kan det leda till att kvinnan upplever en god omvårdnad. / Background: Breast cancer is the most common form of cancer among women. The treatment options are chemotherapy, surgery and anti-hormone treatment that are carried out in stressful side effects. The treatment affects women in several different ways and can lead to suffering and reduced well-being. The nurse has several areas of responsibility regarding the care of the patient. Method: A literature review in which scientific articles with a qualitative approach were analyzed. Aim: The purpose was to describe women’s experiences of their sexuality during and after breast cancer treatment. Findings: The analysis revealed five themes 1) Lost breast a feeling of disfigurement, 2) self-image and body perception changed, 3) Changed sexual health, 4) Side effects and complications affected sexual health and 5) A desire for openness. Conclusion: The treatment affected the women’s self-image, sexuality, and femininity to varying degrees, which can be attributed to the fact that all experiences are individual. There was a desire for openness about conversations about sexual health. With the help of information, support and initiating conversations about sexual health and women’s self-image, it can lead to the women experiencing good care.

Women undergoing endocrine therapy for breast cancer often experience hot flashes. As part of a performance improvement project, 14 patients were surveyed to determine who is at risk for hot flashes during endocrine therapy. This information encourages the education of patients, increases compliance with therapy, and improves quality of life.

Indiana University-Purdue University Indianapolis (IUPUI) / Long-term survivors (LTSs) of breast cancer are defined as patients who have been in remission for a year or longer. Even after being declared breast-cancer-free, many LTSs have questions that were not answered by clinicians. Although online resources provide some content for LTSs, none, or very little, provide immediate answers to specific questions. Thus, the aim involves proposing specifications for a system, the Health Electronic Learning Platform (HELP), that can assist survivors by becoming an all-inclusive resource for LTSs of breast cancer. To achieve this, relevant information from the literature was used to assess the needs of LTSs. Also, data from a study involving the breast cancer survivor’s forum project that had been filtered to include posts with mentions of features to be added to the website and usability issues encountered. To complete the actual design of the system, a synthesis of the results obtained from these two sources was performed. HELP is simple in terms of its layout and consists of a main search-bar, where LTSs are able to ask questions using their own terms and language. This navigator should not be taken as definitive solution, but instead, should be used as a starting point toward better patient-centered care.

The purpose of this work was to develop novel optical imaging technology and algorithms as a nondestructive method for detection and diagnosis of cancer in breast specimens. There are many ways in which the diagnosis of disease can benefit from fast and intelligent optical imaging technology. Our existing ability to provide this diagnosis depends on time-consuming pathology analysis. Optical coherence tomography (OCT) is a non-invasive optical imaging modality that provides depth-resolved, high-resolution images of tissue microstructure in real-time. OCT could provide a rapid evaluation of specimens while patients are still in the office, and has strong potential to improve the efficiency in evaluation of breast pathology specimens (biopsy or surgical). In this work, we demonstrate an imaging system to address this unmet clinical need, artificial intelligence algorithms to interpret the images, and early work towards miniaturizing the technology. We present an OCT system that achieves a line scan rate of 250kHz, meaning we can image a pathology cassette in 41 seconds, which is more than double the fastest scan rate in the field. By utilizing a multiplexed superluminescent diode (SLD) light source, which has strong noise performance over imaging speed, we achieve high resolution imaging under 5 um in tissue (axially and laterally). The system features a 1.1 mm 6-dB sensitivity fall-off range when imaging at 250 kHz. The scanner features large-area scanning with the implementation of a 2-axis motorized stage, enabling visualization of areas up to 10 cm x 10 cm (prior work visualizes 3 mm x 3mm). We showcase the results of demonstrating the performance of this system on a 100-patient clinical imaging study of breast biopsies, as well as imaging of clinical pathology specimens from the breast, prostate, lung, and pancreas in an IRB-approved study. Further, we show our work towards developing artificial intelligence (AI) for cancer detection within OCT images. Using retrospective data, we developed a type of AI algorithm known as a convolutional neural network (CNN) to classify OCT images of breast tissue from 49 patients. The binary cancer classification achieved 94% accuracy, 96% sensitivity, and 92% specificity. This framework had higher accuracy than the 88% accuracy of 7 clinician readers combined in our lab’s earlier multi-reader study. Lastly, we demonstrate a supercontinuum light source based on a 1 mm2 Si3N4 photonic chip for OCT imaging that has better performance than the state-of-the-art laser. Existing broadband laser sources for OCT are large, bulky, and have high excess noise. Our Si3N4 chip fundamentally eliminates the excess noise common to lasers and achieves 105 dB sensitivity and 1.81 mm 6-dB sensitivity roll-off with only 300 µW power on the sample.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13218号 / 論医博第2165号 / 新制||医||1033(附属図書館) / 京都大学大学院医学研究科内科系専攻 / (主査)教授 溝脇 尚志, 教授 黒田 知宏, 教授 鈴木 実 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Breast cancer is a multifaceted disease that affects 1 in every 8 women. Triple negative breast cancer (TNBC) accounts for ~15-20% of all diagnosed breast cancers and is characterized by the absence of ER, PR, and HER2 on the tumor cell surface. As most cancer therapies to date target these cell surface receptors, TNBC is the only subtype of breast cancer without a targeted therapy and thus prognosis for it remains poor. The heterogeneity of TNBC also makes finding a targeted therapy particularly difficult. This work focuses on different methods of targeting distinct subpopulations of TNBC in order to identify potential novel therapeutic nodes to exploit as targeted therapies. The first chapter describes the use of a directed siRNA synthetic lethality screen to target vulnerabilities associated with basal TNBC, the most common TNBC subtype. The screen identified multiple dependency genes associated with RNA splicing, particularly those in the U4/U6.U5 tri-snRNP complex (PRPF8, PRPF38A). Depletion of these genes or the upstream splicing inhibitor E7107 in basal TNBC cell lines resulted in intronic retention and altered splicing of transcripts in pathways necessary for TNBC survival, including mitosis and apoptosis. In vivo, E7107 hindered the growth of both basal cell line and patient derived xenographs, a phenotype that was enhanced with the addition of the proteasome inhibitor bortezomib. This suggests that splicing and proteasome inhibition could be an effective basal TNBC treatment. The second chapter investigates the role of G-Protein Pathway Suppressor 2 (GPS2) as a tumor suppressor in the PI3K/AKT pathway in TNBC. Previous work has shown that GPS2 acts as a negative regulator of this pathway through inhibition of Ubc13-mediated activation of AKT in the insulin signaling pathway. In this study, MDA-MB231-GPS2KO cells were found to have increased proliferative, migratory, and invasive properties, which were rescued upon treatment with the allosteric AKT inhibitor MK2206. In vivo, GPS2 depleted cells conferred greater tumor burden in an orthotopic mouse model that was also responsive to AKT inhibition. Transcriptomic analysis showed significant overlap between MB231-GPS2KO and MB231 cells modified to have constitutively active AKT, indicating that the phenotypes observed in MB231-GPS2KO were at least in part due to loss of GPS2-mediated regulation of AKT activation. These studies point to GPS2 as a potential biomarker for a subclass of breast cancers that would be responsive to PI3K-class inhibitor drugs. In sum, these studies elucidate interactions and processes that seem to specifically adversely affect TNBC cells, which broaden our knowledge of TNBC biology and its potential weaknesses. / 2022-03-03T00:00:00Z