The Clinical Breast Care Project (CBCP) conducts coordinated clinical care and research across military and civilian medical centers, requiring secure and integrated management of participant records and biospecimens. To support enrollment, biospecimen processing, and translational research in this specialized environment, the Data Tracking System for the Clinical Breast Care Project (DTS-CBCP) was developed.

DTS-CBCP collects participant, clinical, consent, pathology, and biospecimen metadata through a web-based platform. It uses a patient-centric model to connect clinical events with biospecimen data. Development utilized a tiered web-application architecture and an Oracle database environment that meet Department of War (DOW) and Health Insurance Portability and Accountability Act standards. Audit trails, encryption, and role-based access ensure secure multi-site participation. DTS-CBCP also integrates with the Data Warehouse for Translational Research (DW4TR), Freezerworks, and digital pathology tools.

DTS-CBCP has supported participant enrollment (n = 11,452) and biospecimen tracking (n = 104,671 specimens, including 18,974 frozen tissue and 9866 Formalin-Fixed Paraffin-Embedded samples). Additionally, 219,280 blood aliquots and 19,937 slides have been tracked across three military and civilian sites. The system enables consent tracking, clinical annotation, specimen chain-of-custody, remote digital pathology, and automated reporting. DTS-CBCP has supported breast cancer research initiatives such as The Cancer Genome Atlas and the Applied Proteogenomic Organizational Learning and Outcomes projects.

DTS-CBCP addresses coordination of clinical and biospecimen data across military and civilian institutions. In addition to supporting breast cancer research, it creates an informatics framework for expanded translational research networks and future DOW-aligned programs.

Rare dermatologic disorders may complicate breast radiotherapy because treatment-related skin reactions can overlap with inflammatory flare, infection, or skin fragility. Evidence guiding radiotherapy delivery in Sweet’s-syndrome and inherited epidermolysis-bullosa (EB) remains limited.

Two patients receiving adjuvant breast radiotherapy were managed prospectively using a multidisciplinary protocol. A patient with Sweet’s syndrome received chest wall and regional nodal radiotherapy (50 Gy in 25 fractions) to minimise flare risk. A second patient with inherited EB received whole-breast radiotherapy (40 Gy in 15 fractions) to balance efficacy with skin fragility concerns. Both were treated using forward-planned Intensity-modulated-radiotherapy with daily cone beam computed-tomography verification. Structured toxicity review and skin-handling precautions were employed throughout treatment. Both completed treatment without interruption. The Sweet’s syndrome patient developed mild erythema only (grade 1) with no flare. The EB patient developed limited localised blistering (grade 1) without infection or extensive skin breakdown. Acute reactions resolved within six weeks, with no recurrent dermatologic flare at 6- and 12-month follow-up.

These cases suggest that rare inflammatory or fragility-related skin disorders do not preclude curative-intent breast radiotherapy when supported by multidisciplinary care.

Individualise fractionation, minimise skin trauma, and incorporate structured toxicity monitoring and escalation pathways into routine management.

Surface-guided radiotherapy (SGRT) allows patient prepositioning based on a 3D surface instead of conventional skin marks. The primary aim was to investigate the feasibility of SGRT using ExacTrac Dynamic (ETD) for prepositioning patients receiving breast radiotherapy in free breathing compared to conventional skin-marker setup, secondary to assess intrafraction motion using surface data.

Twenty-one patients receiving whole- or partial-breast radiotherapy in free breathing were included. Each patient was set up using both skin marks and SGRT for different fractions in a non-systematic order. The setup offset was evaluated using 3D couch shifts from subsequent image guidance. Intrafraction motion was analysed for all monitor units (MU) delivered, and systematic patient movement was assessed by analysing the average surface shift per main tangential field compared to baseline. The shift between main fields represented the intrafraction movement.

No significant difference was found in mean population setup offset between SGRT and skin-marker setup. SGRT demonstrated reduced random errors in vertical and longitudinal direction and reduced systematic errors in lateral direction. Intrafraction motion was limited with a vector displacement of 0·9 mm. A small but significant inter-field movement of −0·3 mm was, however, detected vertically.

Surface-guided setup using ETD is a viable alternative for prepositioning patients receiving breast radiotherapy in free breathing compared to conventional skin-marker setup. It is, however, advisable to use subsequent IGRT for final positioning. Patient motion can be tracked effectively using ETD surface monitoring.

This study examined longitudinal associations between spirituality and quality of life (QoL) in women newly diagnosed with breast cancer and undergoing chemotherapy at a large tertiary cancer center.

Women (N = 114) completed measures of spirituality (3 subscales of the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale: Meaning, Peace, and Faith) and health-related QoL (36-Item Short Form Health Survey) at study entry and 3- and 15-months later. Bias-corrected bootstrap tests were used to examine whether baseline Faith was indirectly associated with mental and physical QoL 15 months later via Meaning and Peace at 3 months.

Baseline Faith was positively associated with Meaning (β = .31, p = .001) and Peace (β = .38, p < .001) at 3 months. Both Meaning [n = 94, effect = .07 (95% CI: .002, .17)] and Peace [n = 93, effect = .13 (95% CI: .02, .28)] mediated the association between Faith and mental QoL at 15 months. When baseline Meaning was controlled, the indirect effect of baseline Faith on mental QoL remained significant, [n = 94, effect = .07 (95% CI: .001, .18)], and increases in Meaning over the first 3 months became an even stronger predictor of later mental QoL (β = .36, p = .004), suggesting that change in meaning during active treatment is an especially important predictor of mental QoL.

Overall, findings demonstrate that Faith is indirectly associated with long-term QoL through early increases in Meaning and Peace. Because 90% of participants were within 6 weeks of diagnosis, the study provided a unique perspective on spirituality during the early treatment period. Clinically, results highlight the importance of early assessment of spiritual well-being and suggest that meaning-focused interventions may enhance long-term QoL for women undergoing chemotherapy.

Patients with recurrent breast cancer and liver metastases complicated by hepatic failure have limited treatment options and poor prognoses. Narrative-based medicine (NBM) and shared decision-making (SDM) may support patient-centered decisions even in critical clinical situations

To describe the role of NBM and SDM in guiding treatment decisions for a patient with recurrent breast cancer and diffuse hepatic metastases associated with severe liver dysfunction.

We present the case of a woman with recurrent breast cancer who developed hepatic failure caused by diffuse liver metastases. Repeated SDM discussions were conducted among the patient, her family, and a board-certified breast oncologist with certification in palliative care. Chemotherapy with eribulin was initiated together with intensive supportive care despite life-threatening organ failure.

Following the initial onset of adverse effects, the patient’s liver function improved, allowing continuation of outpatient chemotherapy and fulfillment of her goal of spending meaningful time with family. The patient survived for approximately 5 months after treatment initiation.

This case suggests that individualized care guided by NBM and SDM may support safe and goal-concordant treatment decisions, even near the end of life. Integration of oncologic and palliative expertise may help align medical interventions with patient values and preferences in complex clinical situations.

While breast cancer is rare in men, its incidence is rising, prompting more research into the mental health impacts of the disease in male patients. Anxiety, depression and sleep disorders are well-documented in women with breast cancer, but the effects on men are not as well understood, underscoring a need for gender-specific analysis.

This retrospective cohort study used data from the Health Insurance Review & Assessment Service from 2009 to 2017, examining patients diagnosed with ductal carcinoma in situ or invasive breast cancer. A propensity score matching at a 5:1 ratio resulted in a sample size of 280 men and 1,400 women for analysis. The study assessed the cumulative incidence of anxiety, depression and sleep disorders, along with potential risk factors for these conditions.

Out of 75,936 breast cancer patients, 0.4% (281) were men. Women exhibited a significantly higher incidence of mental health conditions compared to men (p = 0.017), particularly in terms of anxiety. However, there were no significant gender differences in the incidence of depression or sleep disorders. Women demonstrated a higher risk of developing anxiety disorders (hazard ratio: 1.498, 95% CI: 1.057–2.123, p = 0.023). After adjusting for confounders, gender differences in depression and sleep disorders were not statistically significant.

Women with breast cancer experience higher rates of anxiety disorders, while depression and sleep disorders show no gender disparity. These findings suggest that mental health care approaches should be adapted to better support men with breast cancer and address their unique mental health needs.

Radiotherapy (RT) is a highly effective breast cancer treatment. However, RT can deliver radiation dose to the healthy tissues of the shoulder, increasing the potential for long-term shoulder morbidity. This study compared the dose delivered to key shoulder muscles between common RT techniques and patient positioning.

The treatment plans of 54 patients were analysed, including those treated in the prone and supine positions. Eight shoulder muscles were contoured on each patient’s computer tomography scan. The following breast treatment techniques were analysed: hybrid-intensity-modulated RT (hybrid IMRT), wedged field, two partial arcs volumetric-modulated arc therapy (VMAT), hybrid VMAT, and 3-field supraclavicular technique. Moreover, the effect of patient positioning was also evaluated (supine versus prone). Muscle radiation exposure was compared for the mean dose and the percent muscle volume exposed to V15 Gy and V30 Gy.

The mean dose and exposed volume for the pectoralis major and pectoralis minor were similar between hybrid IMRT, wedged field, VMAT, and hybrid VMAT. VMAT and hybrid VMAT delivered a greater mean dose to most posterior shoulder muscles compared to hybrid IMRT, though overall exposure remained generally low for these muscles. The 3-field supraclavicular technique increased radiation exposure to all shoulder muscles, particularly to the pectoralis major, the pectoralis minor and the supraspinatus. Prone positioning significantly reduced V15 Gy and V30 Gy exposure for both anterior and posterior shoulder muscles.

Shoulder muscle exposure was similar between hybrid IMRT, wedged field, VMAT and hybrid VMAT. The anterior shoulder muscles were consistently exposed to radiation with all RT techniques investigated in this study. In comparison, the 3-field supraclavicular technique substantially increased the radiation exposure to the posterior shoulder muscles. Lastly, delivering radiation in the prone position spared the anterior and posterior shoulder muscles. These findings inform treatment planning decisions aimed at mitigating the risk of long-term shoulder dysfunction.

This study aimed to determine the optimal Biological Effective Dose (BED)-based compensation strategy for treatment interruptions in left-sided breast cancer radiotherapy, with a focus on evaluating cardiac substructures to address a previously unmet clinical need.

Twenty patients with left-sided breast cancer who had received radiotherapy were retrospectively enrolled.

Simulations assumed treatment interruptions (number of interruption days) occurred after the first week, ranging from 1 to 10 days. Three BED-based compensation strategies were evaluated: (A) maintaining total fractions and days while delivering twice-daily treatments; (B) maintaining total days while increasing the dose per fraction; and (C) keeping the dose per fraction constant while extending the overall treatment course. Original uninterrupted plans served as the baseline. BEDs for the planning target volume (PTV), simultaneous integrated boost (SIB), cardiac substructures and other organs at risk (OARs) were calculated. Physical and BED differences among the schemes were systematically compared.

Compared to the original scheme, physical doses to PTV and SIB were lower in Scheme B but higher in Scheme C. As interruptions increased from 1 to 10 days, PTV and SIB doses in Scheme B decreased to minimum values of 42.71 Gy and 50.58 Gy, respectively, while Scheme C resulted in maximum values of 58.60 Gy and 67.15 Gy. Analysis of BED changes (ΔBED) in OARs revealed that the left anterior descending artery (LAD) was the most affected cardiac substructure, with ΔBED values of 0.41, –1.20 and 0.60 for Schemes A, B and C, respectively, at 10 interruption days. Among other OARs, the left lung showed the highest ΔBED changes (0.39, –0.30 and 0.32, respectively). Most OAR comparisons reached statistical significance (ANOVA, p < 0.05).

Compensation strategies for radiotherapy interruptions significantly influence the BED of OARs, particularly in the LAD and left lung. Scheme B most effectively reduced the BED of OARs but requires replanning. Schemes A and C offer clinical convenience at the cost of a higher BED of OARs. The choice of compensation strategy should be individualised based on clinical priorities and patient-specific anatomy.

Susan G. Komen® (Komen) has invested nearly $1.1 billion in ground-breaking breast cancer research since 1982. As a patient-centered organization, Komen measures research funding impact beyond academic metrics in favor of economic value and societal effects. Here, we highlight an innovative approach to assessing the real-world impact of Komen-funded research by showing how Komen funding for pivotal studies and key personnel conducting research contributed to discovery and development of targeted therapy drugs approved to treat breast cancer by the United States Food and Drug Administration (FDA) between 2012 and 2023.

We utilized bibliometric analysis to work backwards through citations within pivotal Phase III clinical trial publications to identify earlier clinical trials, pre-clinical research, and basic research publications that supported development of each drug, evaluating each published study and contributing authors for Komen funding support.

All 19 targeted therapy drugs approved by the FDA between 2012 and 2023 were impacted at multiple phases along the drug development pipeline by Komen funding, including direct impacts in basic research (i.e., investments in projects) that supported target discovery, and impacts in support of key personnel who contributed to pivotal studies and clinical trials (i.e., investments in people) that led to approval.

Nonprofit and public sector research funding provide the foundation for the drug development pipeline. This paper highlights an innovative approach to assess the impact of research investments beyond traditional academic measures and underscores the significance of nonprofit, patient-centered organizations like Komen in driving drug development through supporting basic and applied research.

The study was conducted to determine the relationship between spirituality and the quality of life among women with breast cancer.

This study utilized descriptive correlational research and a purposive sampling technique that involved women with breast cancer. Patients with breast cancer from particular breast cancer societies and organizations in Manila made up the sample. A total of 123 participants were included in the study. The Spiritual Index of Well-Being (SIWB) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire were used to collect the needed data. Descriptive and inferential statistics were used to determine the relationship between spirituality and quality of life among women with breast cancer.

A high level of spirituality and quality of life were found among the participants. Overall, the mean score of the SIWB among the participants was 4.48 (±0.670), while the quality of life score was 62.6 (±10.9). A significant negative correlation was found between spirituality and quality of life (r = -0.127, p = 0.031), while significant positive correlations were noted between quality of life and self-efficacy (r = 0.683, p < 0.001) and life schemes or meaning in life (r = 0.704, p < 0.001).

Although spirituality and quality of life had a negative correlation, the subscales of self-efficacy and life scheme had high positive correlations, indicating the complex dimensions of spirituality. In addition to providing coping strategies, spirituality offers patients the emotional, social, and existential support they need to deal with the unknowns of illness.

Recruiting and retaining racial/ethnic minorities in research remains a significant challenge, often due to mistrust in clinical research and cultural misconceptions related to specific conditions. Despite the anonymity provided by technology-based intervention studies, difficulties in participant recruitment and retention in these studies remain. This paper addresses practical issues in recruiting and retaining Asian American breast cancer survivors with pain and depressive symptoms in a technology-based intervention study.

To identify practical issues in participant recruitment and retention, a content analysis was conducted on all recorded materials, including research diaries of individual research team members, weekly team meeting minutes, and research team members’ posts on Microsoft Teams.

Analysis identified six practical issues: (a) strict inclusion/exclusion criteria; (b) multiple stigmas associated with cancer, depressive symptoms, and pain; (c) lack of interest in research participation; (d) closed Asian American communities/groups; (e) frequent technological issues; and (f) potential unauthentic cases.

Addressing these recruitment and retention issues can inform the design of future culturally tailored, technology-based intervention studies for racial and ethnic minority populations.

Current breast cancer (BC) diagnostics include detailed pathological and genetic analysis for biological subtype identification; however, throughout the course of the disease, new alterations determining the progression of the disease or resistance to treatment appear. The tests based on liquid biopsy allow minimally invasive real-time monitoring of tumour-specific alteration during the entire disease treatment. Tumour-specific genetic material fragments occur in bodily fluids, and cell-free nucleic acids are a convenient tool for analysing genetic and epigenetic changes in tumours. Evidence for the diagnostic and prognostic value of epigenetic biomarkers is gradually increasing. Although, up to date, there is limited access to in vitro diagnostic (IVD) epigenetic liquid biopsy-based tests for BC management, the data on the clinical potential of such tests and biomarkers are accumulating rapidly.

In this review, we focused on research involving cell-free DNA methylation biomarkers in blood serum or plasma samples from BC patients.

Our review systematises data from genome-wide and targeted studies of DNA methylation changes in liquid biopsies from BC patients, aiming to highlight the most critical biomarkers suitable for early BC diagnosis, treatment personalisation and prognosis.

In summary, cell-free DNA methylation biomarkers show strong potential to enhance breast cancer diagnosis, prognosis, and personalised treatment through integrated clinical profiling.

Given the increased risk of cardiac toxicity with higher doses, cardiac sparing is crucial for left-sided breast cancer patients. Deep inspiration breath hold (DIBH) is one approach, but its reproducibility is questioned. This study evaluates the reproducibility of DIBH with an active breathing coordinator (ABC) device, focusing on its dosimetric impact in maintaining consistent cardiac sparing for patients undergoing partial breast irradiation (PBI).

Thirty-three patients undergoing PBI with a prescription dose of 30 Gy in five fractions were randomly selected. Each patient was treated with 6 MV photons using volumetric modulated arc therapy (VMAT) with DIBH using an ABC device. Prior to each fraction, kilo-voltage cone beam computed tomography (kV-CBCT) images were acquired to assess inter-fractional heart motion. Contours of the whole heart and left anterior descending artery (LAD) were transferred from the planning CT to CBCTs and back, using rigid alignment and isocentre shifts to represent treatment positions. Agreement between delivered and planned doses assessed DIBH reproducibility.

Throughout the entire treatment course, changes in mean and maximum cardiac doses were less than 16·4 cGy and 264·8 cGy, respectively. Changes in mean and maximum LAD doses were less than 54·0 cGy and 160·2 cGy, respectively. Overall, the mean cardiac dose increased by 2·4 ± 6·6 cGy, and the maximum by 23·3 ± 58·0 cGy. The mean LAD dose increased by 4·8 ± 18·5 cGy, and the maximum by 17·0 ± 51·0 cGy.

DIBH can be effectively reproduced with the ABC device, limiting inter-fractional cardiac dose changes.