Explore the vast range of titles available.

Background: In Hong Kong, breast cancer is the commonest female cancer. In addition to intrinsic risk factors that cannot be modified, other factors may be potentially modifiable. The objective of this report was to determine modifiable risk factors in association with breast cancer among Chinese women in our locality. Methods: This is a case-control study that enrolled breast cancer patients from the Hong Kong Breast Cancer Registry and healthy matched controls from the local community between 2014 and 2017. Potential risk factors were analyzed using multiple logistic regression. Results: In total, 5186 breast cancer patients and 5571 controls were recruited. Several modifiable risk factors were identified. Self-perceived high stress level (adjusted odd ratios [AOR]= 3.44; 95% confidence intervals [CI] = 3.13-3.78), dairy-rich diet (AOR = 3.33; 95% CI = 2.01-5.52), delayed child-bearing (AOR = 2.23; 95% CI = 1.79-2.79), meat-rich diet (AOR = 1.77; 95% CI = 1.54-2.04), ever use of oral contraceptives (AOR = 1.34; 95% CI = 1.22-1.47), nulliparity (AOR = 1.21; 95% CI = 1.08-1.35), and being overweight/obese (AOR = 1.21; 95% CI = 1.10-1.32) were found to be associated with an increased risk of breast cancer. On the other hand, breastfeeding (AOR = 0.76; 95% CI = 0.69-0.83) and exercise (odds ratio = 0.62; 95% CI = 0.56-0.68) were associated with decreased risk. Conclusions: In our locality, high-stress level, meat- and dairy-rich diet, reproductive history, use of oral contraceptives, and being overweight/obese were identified to be modifiable risk factors for breast cancer. Lifestyle modification may help reduce breast cancer incidence in the coming decades.

PurposeIn the KATHERINE study (NCT01772472), patients with HER2-positive early breast cancer (EBC) and residual invasive disease after neoadjuvant chemotherapy plus HER2-targeted therapy who were treated with adjuvant trastuzumab emtansine (T-DM1) had a 50% reduction in the risk of an invasive disease-free survival (IDFS) event compared to patients treated with adjuvant trastuzumab. In metastatic disease, T-DM1 has resulted in higher rates of thrombocytopenia in Asian versus non-Asian patients. Here, we report safety and efficacy in Chinese patients from KATHERINE.MethodsPatients with HER2-positive EBC and residual invasive disease after taxane- and trastuzumab-containing neoadjuvant chemotherapy followed by surgery were randomized 1:1 to 14 cycles of adjuvant T-DM1 or trastuzumab. The primary endpoint was time to an IDFS event.ResultsAmong Chinese patients (T-DM1 n = 51, trastuzumab n = 50), T-DM1 treatment resulted in a 43% reduction in risk of an IDFS event compared to trastuzumab (HR = 0.57; 95% CI 0.25–1.31), with similar results for secondary endpoints. As in the global population, Chinese patients receiving T-DM1 versus trastuzumab had more grade ≥ 3 adverse events (AEs; 39.2% versus 4.1%) and AEs leading to treatment discontinuation (27.5% versus 0%). The most common grade ≥ 3 AE with T-DM1 was thrombocytopenia (21.6%), a frequency higher than the frequency in the global population (5.7%). Grade ≥ 3 hemorrhage was reported in 1 patient (T-DM1 arm).ConclusionsIn the KATHERINE study, T-DM1 demonstrated increased efficacy compared to trastuzumab in Chinese patients. Consistent with previous data in Asian patients, T-DM1 was associated with more grade ≥ 3 AEs, and AEs leading to discontinuation, which was driven by an increase in thrombocytopenia.

Background Prognoses of most adult Hodgkin lymphoma (HL) patients are excellent; most of them can achieve permanent remission that can be considered cured. However, many are under-treated or over-treated by standard modern therapies. An accurate determination of prognosis may allow clinicians to design personalised treatment according to individual risk of disease progression and survival. Lymphocyte monocyte ratio (LMR) at diagnosis has been investigated as a prognostic biomarker in patients with HL. Our objective with this meta-analysis was to explore the prognostic value of the LMR at diagnosis in adult HL, by investigating the association between LMR and survival outcomes. Methods PUBMED and EMBASE were searched for relevant articles. Survival outcomes that we investigated included overall survival (OS), progression-free survival (PFS), event-free survival (EFS), lymphoma-specific survival (LSS), and time to progression (TTP). No restriction to the language, date, study country, or sample size was applied. Final search of databases was performed on 2 April 2018. We performed random-effects meta-analysis to aggregate and summarise the results from included studies, where four or more studies on a particular outcome were available. Results A total of eight studies (all retrospective cohort studies) involving 3319 HL patients were selected for analysis. All studies except one reported the effect of LMR on OS; five reported on PFS, three reported on TTP and LSS, respectively, and one reported on EFS. The pooled estimates showed low LMR was associated with poor OS (hazard ratio [HR] 2.67, 95% CI 1.67, 4.26) and PFS (HR 2.19, 95% CI 1.46, 3.29). Subgroup analyses of OS stratified by LMR cut-off values and sample sizes both indicated that low baseline LMR was associated with poorer prognosis. Conclusions Low LMR at diagnosis was associated with poor OS and PFS in HL. LMR is easy and cheap to determine and has a potential role in daily clinical management. More studies are needed to validate this biomarker and explore its interaction with known prognostic factors.

Breast cancer is the most common cancer in reproductive age women. The aim of this study is to assess the knowledge, attitude and intention on fertility preservation among women diagnosed to have breast cancer. This is a multi-centre cross-sectional questionnaire study. Reproductive age women diagnosed with breast cancer attending Oncology, Breast Surgery and Gynaecology Clinics and support groups were invited to participate. Women filled in paper or electronic form of the questionnaire. 461 women were recruited and 421 women returned the questionnaire. Overall, 181/410 (44.1%) women had heard of fertility preservation. Younger age and higher education level were significantly associated with increased awareness of fertility preservation . Awareness and acceptance of the different fertility preservation methods in reproductive age women with breast cancer was suboptimal. However, 46.1% women felt that their fertility concerns affected their decision for cancer treatment in some way.

IntroductionBreast cancer poses substantial public health and economic burdens worldwide, particularly in Hong Kong, where incidence has risen fivefold in the last 30 years. While mammography (MMG) screening facilitates prognosis, early cancer detection has the potential to better use limited healthcare resources within a hospital system.MethodsA retrospective cohort study was conducted using data from the Hong Kong Breast Cancer Registry, which included 15 144 cases (13 502 self-detected and 1642 MMG-detected breast cancers) diagnosed between 2006 and 2018. A subgroup of 6359 cases (diagnosed 2006–2011) underwent Kaplan-Meier survival analysis to compare 10-year overall survival between detection methods. Population-based Markov models were developed to simulate 100 000 average-risk women aged 40 and to assess clinical outcomes, treatment costs and cost-minimisation analysis of MMG screening from the healthcare provider’s perspective.ResultsMMG-detected breast cancers presented significantly earlier at diagnosis, with higher proportions of stage 0 (33.2% vs 5.4%, p<0.001) and stage I (48.3% vs 31.5%, p<0.001) cancers, smaller tumour sizes (mean: 1.3 cm vs 2.3 cm, p<0.001) and less aggressive biological subtypes compared with self-detected cases. 10-year overall survival was notably higher in MMG-detected patients (95.7% vs 88.4%, log-rank p<0.001). Treatment costs per patient were 28.4% lower for MMG-detected vs self-detected cancers, driven primarily by stage downshifting. The Markov model demonstrated that MMG screening starting at age 40 in 100 000 women could prevent 27 932 life-years lost and save $98.8 million in treatment costs compared with self-detection. Benefits decreased if screening commenced at a later age.ConclusionsMMG screening in Hong Kong can significantly reduce mortality and healthcare expenditures due to earlier cancer detection. Policymakers and healthcare providers should consider expanding MMG screening programmes, particularly targeting women aged 40 and above, to optimise clinical outcomes and resource utilisation.

Background The current exploratory analysis was performed to evaluate the efficacy and safety of everolimus for treatment of human epidermal growth factor receptor 2-positive (HER2+) advanced breast cancer in the Asian subset of patients in the BOLERO-1 trial. Methods Postmenopausal women with HER2+ advanced breast cancer, who had not received systemic therapy for advanced disease, were randomized 2:1 to receive everolimus or placebo, plus trastuzumab and paclitaxel. The two primary end points were investigator-assessed progression-free survival (PFS) in the full population and in the hormone receptor-negative (HR–) subpopulation. Secondary end points included assessment of the objective response rate, the clinical benefit rate, and safety. Results In the Asian subset, median PFS was similar in the everolimus ( n  = 198) and placebo ( n  = 105) arms in the full analysis set (hazard ratio = 0.82 (95% CI 0.61–1.11)). In the HR– subpopulation, everolimus prolonged median PFS by 10.97 months vs placebo (25.46 vs 14.49 months; hazard ratio = 0.48 (95% CI 0.29–0.79)). In the everolimus arm of the Asian subset, the most common adverse events of any grade were stomatitis (62.2%), diarrhea (48.0%), rash (43.4%) and neutropenia (42.3%). Neutropenia (grade 3: 27.6%; grade 4: 4.6%) and decreased neutrophil count (grade 3: 11.2%; grade 4: 3.6%) were the most frequent grade 3/4 adverse events. Serious adverse events included pneumonia (5.1%), pneumonitis (3.1%), and interstitial lung disease (3.1%). There were three deaths (1.5%) during treatment in the everolimus arm vs none in the placebo arm. Conclusions The efficacy and safety of everolimus plus trastuzumab and paclitaxel as first-line treatment for HER2+ advanced breast cancer in the Asian subset was consistent with that reported previously in the overall population. Trial registration ClinicalTrials.gov, NCT00876395 . Registered on 2 April 2009.

Traditional carrier screening has been utilized for the detection of carriers of genetic disorders. Since a comprehensive assessment of the carrier frequencies of recessive conditions in the Southern Chinese population is not yet available, we performed a secondary analysis on the spectrum and carrier status for 315 genes causing autosomal recessive disorders in 1543 Southern Chinese individuals with next-generation sequencing data, 1116 with exome sequencing and 427 with genome sequencing data. Our data revealed that 1 in 2 people (47.8% of the population) was a carrier for one or more recessive conditions, and 1 in 12 individuals (8.30% of the population) was a carrier for treatable inherited conditions. In alignment with current American College of Obstetricians and Gynecologists (ACOG) pan-ethnic carrier recommendations, 1 in 26 individuals were identified as carriers of cystic fibrosis, thalassemia, and spinal muscular atrophy in the Southern Chinese population. When the >1% expanded carrier screening rate recommendation by ACOG was used, 11 diseases were found to meet the criteria in the Southern Chinese population. Approximately 1 in 3 individuals (35.5% of the population) were carriers of these 11 conditions. If the 1 in 200 carrier frequency threshold is used, and additional seven genes would meet the criteria, and 2 in 5 individuals (38.7% of the population) would be detected as a carrier. This study provides a comprehensive catalogue of the carrier spectrum and frequency in the Southern Chinese population and can serve as a reference for careful evaluation of the conditions to be included in expanded carrier screening for Southern Chinese people.

Pruritus and alcohol induced pain in involved lymph nodes are characteristic, albeit rare Frequent involvement of anterior mediastinum and contiguous spread to nodal regions on positron emission tomography-computed tomography Reed-Sternberg cells on biopsy Nodal non- Hodgkin's lymphoma B symptoms Multiple peripheral nodes and extranodal involvement common Non-contiguous spread to nodal regions on positron emission tomography-computed tomography Leukaemia Bruising or splenomegaly Abnormally high or low white cell counts Peripheral blood smear might show blasts Metastases Skin cancers typically spread to regional nodal basins Risk factors: smoking, drinking alcohol, occupational exposure Histological and immunohistochemical features on biopsy Infection Variable presentation: fever, chills, malaise, oropharyngeal exudate, dyspnoea Risk factors: high risk sexual behaviour, food, insect or animal contact, travel history Culture and disease specific serology to differentiate pathogens Autoimmune disorders Variable presentation: arthralgia and joint stiffness, muscle weakness, rash Auto-antibodies in serum such as antinuclear antibody Sarcoidosis Skin change, cough, dyspnoea, hilar lymphadenopathy Non-caseating granulomas on biopsy Radiograph shows bilateral hilar lymphadenopathy and interstitial infiltrates Increased serum angiotensin converting enzyme Medications Lymphadenopathy, otherwise well Improves after suspending the medication Superior vena cava obstruction Facial swelling and plethora, upper limb swelling, dilated chest wall veins Mediastinal and lung mass and lymphadenopathy on radiography/computed tomography.Lymphocyte depleted and mixed cellularity Hodgkin's lymphoma have poorer prognoses; however, treatment depends on stage and risk factors rather than histological subtypes. 7 Arrange blood tests to screen for hepatitis B, hepatitis C, and human immunodeficiency virus. 8 These infections are associated with increased risk of Hodgkin's lymphoma, and should also be treated if detected. 4 Positron emission-computed tomography imaging is the baseline investigation for staging and subsequent assessment of treatment response. 4 8 It can also detect bone marrow involvement with high sensitivity (bone marrow biopsy is only indicated if positron emission-computed tomography is not available).Advanced stage is stage IIB with extranodal disease and/or large mediastinal mass as risk factors, and stage III or IV. 4 8 Malignant cells in classical Hodgkin's lymphoma typically stain positive for CD15 and CD30 and negative for CD20 and CD45 (which is a leucocyte common antigen), while nodular lymphocyte predominant Hodgkin's lymphoma cells express CD20, CD45, and epithelial membrane antigen, and are negative for CD15 and CD30. 4 How would you manage this condition?In the first-line setting, the treatment protocol usually entails two to eight cycles of combination chemotherapy followed by radiotherapy in selected patients, depending on the risk group. 4 8 9 Patients in remission from Hodgkin's lymphoma are at risk of long term sequelae, including cardiovascular and pulmonary toxicities, and most notably secondary cancer induced by irradiating normal tissue. 4 8 Concerns regarding the risks of radiotherapy have led to a decline in the use of this treatment. 4 8 10 Up to 80% of patients with advanced stage disease and more than 90% with early disease achieve long term remission with standard first line treatment. 4 8 Even with relapse, a substantial number of patients achieve second remission.

PurposeNeratinib, an irreversible pan-HER tyrosine kinase inhibitor, has demonstrated systemic efficacy and intracranial activity in various stages of HER2+breast cancer. NALA was a phase III randomized trial that assessed the efficacy and safety of neratinib+capecitabine (N+C) against lapatinib+capecitabine (L+C) in HER2+ metastatic breast cancer (mBC) patients who had received ≥ 2 HER2-directed regimens. Descriptive analysis results of the Asian subgroup in the NALA study are reported herein.Methods621 centrally assessed HER2+ mBC patients were enrolled, 202 of whom were Asian. Those with stable, asymptomatic brain metastases (BM) were eligible for study entry. Patients were randomized 1:1 to N (240 mg qd) + C (750 mg/m2 bid, day 1–14) with loperamide prophylaxis or to L (1250 mg qd) + C (1000 mg/m2 bid, day 1–14) in 21-day cycles. Co-primary endpoints were centrally assessed progression-free survival (PFS) and overall survival (OS). Secondary endpoints included time to intervention for central nervous system (CNS) disease, objective response rate, duration of response (DoR), clinical benefit rate, and safety.Results104 and 98 Asian patients were randomly assigned to receive N+C or L+C, respectively. Median PFS of N+C and L+C was 7.0 and 5.4 months (P = 0.0011), respectively. Overall cumulative incidence of intervention for CNS disease was lower with N+C (27.9 versus 33.8%; P = 0.039). Both median OS (23.8 versus 18.7 months; P = 0.185) and DoR (11.1 versus 4.2 months; P < 0.0001) were extended with N+C, compared to L+C. The incidences of grade 3/4 treatment emergent adverse events (TEAEs) and TEAEs leading to treatment discontinuation were mostly comparable between the two arms. Diarrhea and palmar-plantar erythrodysesthesia were the most frequent TEAEs in both arms, similar to the overall population in incidence and severity.ConclusionConsistent with the efficacy profile observed in the overall study population, Asian patients with HER2+ mBC, who had received ≥ 2 HER2-directed regimens, may also benefit from N+C. No new safety signals were noted.Clinical trial registrationNCT01808573

Neoadjuvant chemotherapy is a standard treatment for triple-negative breast cancer (TNBC) at an early stage. Given that pathological complete response is strongly associated with long-term clinical and survival benefits, the selection of appropriate treatment before and after surgery could further optimise treatment outcomes. With the emergence of immunotherapy in breast cancer, more combination treatment options are available, such as pembrolizumab, a programmed death receptor 1 inhibitor, which is approved for the perioperative treatment of stage II and III TNBC. However, the implementation of immunotherapy in perioperative settings for TNBC requires further discussion regarding patient selection and the use of different treatments in conjunction with immunotherapy. The Hong Kong Breast Cancer Foundation convened a multidisciplinary consensus panel consisting of surgeons, clinical oncologists, and medical oncologists to initiate this discussion. A modified Delphi panel was conducted, evaluating seven topics and 45 statements covering the workup and perioperative treatment of early-stage TNBC (eTNBC). The consensus statements provide guidance on determining whether a patient with eTNBC is a suitable candidate for neoadjuvant chemotherapy and immunotherapy.