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Item Position paper on screening for breast cancer by the European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland and Turkey(SPRINGER, 2017-01-01) Sardanelli, Francesco; Aase, Hildegunn S.; Alvarez, Marina; Azavedo, Edward; Baarslag, Henk J.; Balleyguier, Corinne; Baltzer, Pascal A.; Beslagic, Vanesa; Bick, Ulrich; Bogdanovic-Stojanovic, Dragana; Briediene, Ruta; Brkljacic, Boris; Herrero, Julia Camps; Colin, Catherine; Cornford, Eleanor; Danes, Jan; de Geer, Gerard; Esen, Gul; Evans, Andrew; Fuchsjaeger, Michael H.; Gilbert, Fiona J.; Graf, Oswald; Hargaden, Gormlaith; Helbich, Thomas H.; Heywang-Koebrunner, Sylvia H.; Ivanov, Valentin; Jonsson, Asbjorn; Kuhl, Christiane K.; Lisencu, Eugenia C.; Luczynska, Elzbieta; Mann, Ritse M.; Marques, Jose C.; Martincich, Laura; Mortier, Margarete; Mueller-Schimpfle, Markus; Ormandi, Katalin; Panizza, Pietro; Pediconi, Federica; Pijnappel, Ruud M.; Pinker, Katja; Rissanen, Tarja; Rotaru, Natalia; Saguatti, Gianni; Sella, Tamar; Slobodnikova, Jana; Talk, Maret; Taourel, Patrice; Trimboli, Rubina M.; Vejborg, Ilse; Vourtsis, Athina; Forrai, GaborEUSOBI and 30 national breast radiology bodies support mammography for population-based screening, demonstrated to reduce breast cancer (BC) mortality and treatment impact. According to the International Agency for Research on Cancer, the reduction in mortality is 40 \% for women aged 50-69 years taking up the invitation while the probability of false-positive needle biopsy is < 1 \% per round and overdiagnosis is only 1-10 \% for a 20-year screening. Mortality reduction was also observed for the age groups 40-49 years and 70-74 years, although with ``limited evidence{''}. Thus, we firstly recommend biennial screening mammography for average-risk women aged 50-69 yearsItem Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA)(SPRINGER, 2022-01-01) Sardanelli, Francesco; Trimboli, Rubina M.; Houssami, Nehmat; Gilbert, Fiona J.; Helbich, Thomas H.; Alvarez Benito, Marina; Balleyguier, Corinne; Bazzocchi, Massimo; Bult, Peter; Calabrese, Massimo; Camps Herrero, Julia; Cartia, Francesco; Cassano, Enrico; Clauser, Paola; Cozzi, Andrea; de Andrade, Danubia A.; de Lima Docema, Marcos F.; Depretto, Catherine; Dominelli, Valeria; Forrai, Gabor; Girometti, Rossano; Harms, Steven E.; Hilborne, Sarah; Ienzi, Raffaele; Lobbes I, Marc B.; Losio, Claudio; Mann, Ritse M.; Montemezzi, Stefania; Obdeijn, Inge-Marie; Ozcan, Umit A.; Pediconi, Federica; Pinker, Katja; Preibsch, Heike; Raya Povedano, Jose L.; Sacchetto, Daniela; Scaperrotta, Gianfranco P.; Schiaffino, Simone; Schlooz, Margrethe; Szabo, Botond K.; Taylor, Donna B.; Ulus, Ozden S.; Van Goethem, Mireille; Veltman, Jeroen; Weigel, Stefanie; Wenkel, Evelyn; Zuiani, Chiara; Di Leo, GiovanniObjectives Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue. Methods This observational study enrolled women aged 18-80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases. Results Of 5896 analyzed patients, 2763 (46.9\%) had conventional imaging only (noMRI group), and 3133 (53.1\%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1\%), with preoperative intent in 2441/3133 women (77.9\%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers >= 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4\% (MRI group) versus 14.4\% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3\%. The overall performed first- plus second-line mastectomy rate was 36.3\% (MRI group) versus 18.0\% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5\% versus 11.7\%, p < 0.001). Conclusions Clinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3\% more mastectomies, and with 3.2\% fewer reoperations in the breast conservation subgroup.Item Efficacy of Palbociclib and Endocrine Treatment in Heavily Pretreated Hormone Receptor-positive/HER2-negative Advanced Breast Cancer: Retrospective Multicenter Trial(GALENOS PUBL HOUSE, 2020-01-01) Demir, Atakan; Mandel, Nil Molinas; Paydas, Semra; Demir, Gokhan; Er, Ozlem; Turhal, Nazim Serdal; Bavbek, Sevil; Eralp, Yesim; Saip, Pinar Mualla; Guler, Emine Nilufer; Aydiner, Adnan; Uluc, Basak Oyan; Kilickap, Sadettin; Uskent, Necdet; Karadurmus, Nuri; Kaplan, Mehmet Ali; Yanmaz, Mustafa Teoman; Demir, Hacer; Alan, Ozkan; Korkmaz, Taner; Olgun, Polat; Uysal, Ozlem Sonmez; Altundag, Kadri; Gunduz, Seyda; Gunaldi, Meral; Sari, Murat; Beypinar, Ismail; Basaran, GulBackground: The synthesis of CDK4/6 inhibitors with endocrine treatment in two series of treatment has been widely accepted as the standard for patients with estrogen receptor-positive metastatic breast cancer. In spite of this, the activity of CDK4/6 inhibitors in patients with metastatic breast cancer who have progressed despite receiving multiple lines of treatment is not well understood. Aims: To report the activity and safety of a CDK4/6 inhibitor (palbociclib) in patients in whom at least three lines of treatment for ER+ metastatic breast cancer had failed. Study Design: Multicenter retrospective observational cohort study. Methods: In this retrospective observational cohort study, we included 43 patients who received palbociclib after at least three lines of systemic treatment for ER+/HER2- metastatic breast cancer. Results: The median progression-free survival in our population was 7 months (25th-75th percentile, 4-10), and the median overall survival was 11 months (25th-75th percentile, 6-19). Although there were some adverse events, palbociclib was generally well tolerated, so dose reduction was needed for only six patients (14\%). Conclusion: The efficacy of palbociclib among heavily treated hormone receptor-positive/HER2- patients with advanced breast cancer was acceptable in terms of clinical benefit, and it was generally well tolerated among this population.Item Improvement of early detection of breast cancer through collaborative multi-country efforts: Medical physics component(ELSEVIER SCI LTD, 2018-01-01) Mora, Patricia; Faulkner, Keith; Mahmoud, Ahmed M.; Gershan, Vesna; Kausik, Aruna; Zdesar, Urban; Brandan, Maria-Ester; Kurth, Serap; Davidovic, Jasna; Salama, Dina H.; Aribal, Erkin; Odio, Clara; Chaturvedi, Arvind K.; Sabih, Zahida; Vujnovic, Sasa; Paez, Diana; Delis, HarryPurpose: The International Atomic Energy Agency (IAEA) through a Coordinated Research Project on ``Enhancing Capacity for Early Detection and Diagnosis of Breast Cancer through Imaging{''}, brought together a group of mammography radiologists, medical physicists and radiographersItem Does Lapatinib Increase Pulmonary Toxicity when Concurrently Used with Radiation Therapy? An Experimental Study with Wistar-Albino Rats(AKAD DOKTORLAR YAYINEVI, 2018-01-01) Yetmen Dogan, Ozlem; Guzel, Elif; Coban, Ilker; Suzer, Oner; Bese, NuranLapatinib is an oral receptor tyrosine kinase inhibitor which has shown activity in the treatment of metastatic breast cancer. There is no data regarding the side effects of combination of radiotherapy and Lapatinib. 40 female Wistar-albino rats (WAR) were divided into 4 groupsItem Is Season a Prognostic Factor in Breast Cancer?(ASIAN PACIFIC ORGANIZATION CANCER PREVENTION, 2013-01-01) Mutlu, Hasan; Akca, Zeki; Cihan, Yasemin Benderli; Kurnaz, Fatih; Aslan, Tuncay; Erden, Abdulsamet; Ugur, Hediye; Aksahin, Arzu; Buyukcelik, AbdullahBackground: Some studies have indicated an inverse relationship between cancer risk and sunlight exposure. Others have reported that the prognosis of some cancers such as prostate, colon, ovarian and non melanoma skin cancer, were affected by the season in which the cancer was diagnosed. In our study, we evaluated whether season is prognostic in Turkish patients with breast cancer. Materials and Methods: A total of 517 patients from Kayseri Training and Research Hospital were analysed retrospectively. Patients were divided into 4 groups according to season of cancer diagnosis: winter, spring, summer and autumn. The prognostic factors for disease free survival and overall survival were investigated. Results: No significant differences were found among groups regarding prognostic factors overall. Only estrogen receptor status and lymphovascular invasion were independent prognostic factors (p=0.001 and p=0.001 respectively). We found significantly differences for mean disease free survival among groups (p=0.019). Winter group had better mean DFS while summer group had worse DFS. Mean overall survival was similar in the four groups (p=0.637). Conclusions: The season is not an independent predictive factor. However, due to interaction with other factors, we think that the season of cancer diagnosis is important for cancer prognosis.Item An investigation of the effects of FGFR2 and B7-H4 polymorphisms in breast cancer(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2013-01-01) Ozgoz, Asuman; Samli, Hale; Ozturk, Kuyas Hekimler; Orhan, Bulent; Icduygu, Fadime Mutlu; Aktepe, Fatma; Imirzalioglu, NecatIntroduction: Polymorphisms in FGFR2 are important markers for breast cancer susceptibility in the general population. CHEK2 and FGFR2 polymorphisms with known susceptibility alleles of BRCA1, BRCA2, PTEN, and TP53, can be investigated as potential modifiers of high penetrant risk alleles. Although the B7-H4 gene is highly expressed in many different tumors, there is one published study showing the association of polymorphisms with breast cancer. We aimed to investigate FGFR2 and B7-H4 polymorphisms in breast cancer in the Turkish community. Materials and Methods: In a group of 31 cases diagnosed with breast cancer and 30 healthy women with matched ages, the single-nucleotide polymorphisms (SNPs) rs1219648, rs2981582 in FGFR2 gene were identified by sequence analysis and the SNPs rs10754339, rs10801935, and rs3738414 in the B7-H4 gene were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Statistical analysis was performed using SPSS. Results: Although statistically not significant, the frequency of FGFR2 heterozygous polymorphisms in the group with breast cancer was detected to be higher. In the B7-H4 SNP rs10801935, polymorphic AA, and AG genotype distributions were found in higher frequencies in the breast cancer patients. In contrast to the results of a published study, the present study shows that B7-H4 rs3738414 polymorphism GG genotype was found in higher frequency in the control group than the breast cancer group and the result was statistically significant (P=0.018). Conclusion: Larger scale studies are necessary to determine the prevalence of these polymorphisms and association with breast cancer in Turkish community, as this study is the first study performed.Item Is Sunlight a Predisposing Factor for Triple Negative Breast Cancer in Turkey?(ASIAN PACIFIC ORGANIZATION CANCER PREVENTION, 2013-01-01) Mutlu, Hasan; Buyukcelik, Abdullah; Colak, Taner; Ozdogan, Mustafa; Erden, Abdulsamet; Aslan, Tuncay; Akca, ZekiIntraduction: There is known to be a relationship between vitamin D level and more aggresive breast cancer subtypes, especially triple-negative breast cancer (TNBC). It was reported that sunlight exposure has an effect on the prognosis of patients with cancer, possibly related to the conversion of vitamin D to its active form with sunlight. We aimed to evaluate the effect of sunlight exposure on patients with TNBC. Materials-Methods: A total of 1,167 patients with breast cancer from two different regions of Turkey (Antalya and Kayseri, regions having different climate and sunlight exposure intensity over the year) were analysed retrospectively. The ratio of patients with TNBC was identified in those two regions. Results: The ratio of patients with TNBC was 8\% and 12\% for Kayseri and Antalya regions, respectively, and this difference between the two groups was statistically significant (p=0.021). Discussion: Sunlight exposure may be associated with more prevalent TNBC. This finding should be investigated with a prospective study.Item Investigation of effects of PALB2 genetic variations on breast cancer predisposition(CUKUROVA UNIV, FAC MEDICINE, 2020-01-01) Bilen, Muge Yuksel; Berkoz, Mehmet; Yalin, Ali Erdinc; Calikusu, Zuleyha; Eroglu, Pelin; Comelekoglu, Ulku; Yalin, SerapPurpose: In this study, the effects of three different single nucleotide polymorphisms (rs249954, rs249935, and rs16940342) of partner and localizer of breast cancer gene 2 (PALB2) on breast cancer predisposition have been investigated. Materials and Methods: For this purpose, 150 patients diagnosed to have breast cancer and 150 healthy individuals have been included. By using real time polymerase chain reaction (PCR) method isolated deoxyribonucleic acid (DNA) from each case has been investigated for the PALB2 genetic variations. Results: The distribution of homozygote wild type (AA) and heterozygote (AG) genotypes at rs16940342 polymorphism has been observed to be 44.7\% and 55.3\% in breast cancer group and 32.7\% and 67.3\% in control group. The homozygote polymorphic (GG) genotype was not observed in both groups. The discrepancy between the groups in terms of genotype distribution regarding rs16940342 polymorphism has been found statistically significant. However, there was no significant difference in the frequencies of rs249954 and rs249935 polymorphisms comparing both groups. Conclusion: These results show that rs16940342 polymorphism may be an important determinant in terms of breast cancer predisposition in the Turkish population.Item MITNET: a novel dataset and a two-stage deep learning approach for mitosis recognition in whole slide images of breast cancer tissue(SPRINGER LONDON LTD, 2022-01-01) Cayir, Sercan; Solmaz, Gizem; Kusetogullari, Huseyin; Tokat, Fatma; Bozaba, Engin; Karakaya, Sencer; Iheme, Leonardo Obinna; Tekin, Eren; Yazici, Cisem; Ozsoy, Gulsah; Ayalti, Samet; Kayhan, Cavit Kerem; Ince, Umit; Uzel, Burak; Kilic, OnurMitosis assessment of breast cancer has a strong prognostic importance and is visually evaluated by pathologists. The inter, and intra-observer variability of this assessment is high. In this paper, a two-stage deep learning approach, named MITNET, has been applied to automatically detect nucleus and classify mitoses in whole slide images (WSI) of breast cancer. Moreover, this paper introduces two new datasets. The first dataset is used to detect the nucleus in the WSIs, which contains 139,124 annotated nuclei in 1749 patches extracted from 115 WSIs of breast cancer tissue, and the second dataset consists of 4908 mitotic cells and 4908 non-mitotic cells image samples extracted from 214 WSIs which is used for mitosis classification. The created datasets are used to train the MITNET network, which consists of two deep learning architectures, called MITNET-det and MITNET-rec, respectively, to isolate nuclei cells and identify the mitoses in WSIs. In MITNET-det architecture, to extract features from nucleus images and fuse them, CSPDarknet and Path Aggregation Network (PANet) are used, respectively, and then, a detection strategy using You Look Only Once (scaled-YOLOv4) is employed to detect nucleus at three different scales. In the classification part, the detected isolated nucleus images are passed through proposed MITNET-rec deep learning architecture, to identify the mitosis in the WSIs. Various deep learning classifiers and the proposed classifier are trained with a publicly available mitosis datasets (MIDOG and ATYPIA) and then, validated over our created dataset. The results verify that deep learning-based classifiers trained on MIDOG and ATYPIA have difficulties to recognize mitosis on our dataset which shows that the created mitosis dataset has unique features and characteristics. Besides this, the proposed classifier outperforms the state-of-the-art classifiers significantly and achieves a 68.7\% F1-score and 49.0\% F1-score on the MIDOG and the created mitosis datasets, respectively. Moreover, the experimental results reveal that the overall proposed MITNET framework detects the nucleus in WSIs with high detection rates and recognizes the mitotic cells in WSI with high F1-score which leads to the improvement of the accuracy of pathologists' decision.