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Breast Neoplasms: HELP
Articles by Ern-Yu Tan
Based on 21 articles published since 2010
(Why 21 articles?)
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Between 2010 and 2020, E. Y. Tan wrote the following 21 articles about Breast Neoplasms.
 
+ Citations + Abstracts
1 Review Predicting survival of de novo metastatic breast cancer in Asian women: systematic review and validation study. 2014

Miao, Hui / Hartman, Mikael / Bhoo-Pathy, Nirmala / Lee, Soo-Chin / Taib, Nur Aishah / Tan, Ern-Yu / Chan, Patrick / Moons, Karel G M / Wong, Hoong-Seam / Goh, Jeremy / Rahim, Siti Mastura / Yip, Cheng-Har / Verkooijen, Helena M. ·Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore. · Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. · National Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia; Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands. · Department of Hematology Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore. · Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. · Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore. · Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands. · National Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia. · Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore. · Ministry of Health Holdings, Singapore, Singapore. · Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands. ·PLoS One · Pubmed #24695692.

ABSTRACT: BACKGROUND: In Asia, up to 25% of breast cancer patients present with distant metastases at diagnosis. Given the heterogeneous survival probabilities of de novo metastatic breast cancer, individual outcome prediction is challenging. The aim of the study is to identify existing prognostic models for patients with de novo metastatic breast cancer and validate them in Asia. MATERIALS AND METHODS: We performed a systematic review to identify prediction models for metastatic breast cancer. Models were validated in 642 women with de novo metastatic breast cancer registered between 2000 and 2010 in the Singapore Malaysia Hospital Based Breast Cancer Registry. Survival curves for low, intermediate and high-risk groups according to each prognostic score were compared by log-rank test and discrimination of the models was assessed by concordance statistic (C-statistic). RESULTS: We identified 16 prediction models, seven of which were for patients with brain metastases only. Performance status, estrogen receptor status, metastatic site(s) and disease-free interval were the most common predictors. We were able to validate nine prediction models. The capacity of the models to discriminate between poor and good survivors varied from poor to fair with C-statistics ranging from 0.50 (95% CI, 0.48-0.53) to 0.63 (95% CI, 0.60-0.66). CONCLUSION: The discriminatory performance of existing prediction models for de novo metastatic breast cancer in Asia is modest. Development of an Asian-specific prediction model is needed to improve prognostication and guide decision making.

2 Clinical Trial RASAL2 activates RAC1 to promote triple-negative breast cancer progression. 2014

Feng, Min / Bao, Yi / Li, Zhimei / Li, Juntao / Gong, Min / Lam, Stella / Wang, Jinhua / Marzese, Diego M / Donovan, Nicholas / Tan, Ern Yu / Hoon, Dave S B / Yu, Qiang. · ·J Clin Invest · Pubmed #25384218.

ABSTRACT: Patients with triple-negative breast cancer (TNBC) have a high incidence of early relapse and metastasis; however, the molecular basis for recurrence in these individuals remains poorly understood. Here, we demonstrate that RASAL2, which encodes a RAS-GTPase-activating protein (RAS-GAP), is a functional target of anti-invasive microRNA-203 and is overexpressed in a subset of triple-negative or estrogen receptor-negative (ER-negative) breast tumors. As opposed to luminal B ER-positive breast cancers, in which RASAL2 has been shown to act as a RAS-GAP tumor suppressor, we found that RASAL2 is oncogenic in TNBC and drives mesenchymal invasion and metastasis. Moreover, high RASAL2 expression was predictive of poor disease outcomes in patients with TNBC. RASAL2 acted independently of its RAS-GAP catalytic activity in TNBC; however, RASAL2 promoted small GTPase RAC1 signaling, which promotes mesenchymal invasion, through binding and antagonizing the RAC1-GAP protein ARHGAP24. Together, these results indicate that activation of a RASAL2/ARHGAP24/RAC1 module contributes to TNBC tumorigenesis and identify a context-dependent role of RASAL2 in breast cancer.

3 Article A Circulating miRNA Signature for Stratification of Breast Lesions among Women with Abnormal Screening Mammograms. 2019

Loke, Sau Yeen / Munusamy, Prabhakaran / Koh, Geok Ling / Chan, Claire Hian Tzer / Madhukumar, Preetha / Thung, Jee Liang / Tan, Kiat Tee Benita / Ong, Kong Wee / Yong, Wei Sean / Sim, Yirong / Oey, Chung Lie / Lim, Sue Zann / Chan, Mun Yew Patrick / Ho, Teng Swan Juliana / Khoo, Boon Kheng James / Wong, Su Lin Jill / Thng, Choon Hua / Chong, Bee Kiang / Tan, Ern Yu / Tan, Veronique Kiak-Mien / Lee, Ann Siew Gek. ·Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore 169610, Singapore. · SingHealth Duke-NUS Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore. · Division of Surgical Oncology, National Cancer Centre, Singapore 169610, Singapore. · Department of General Surgery, Singapore General Hospital, Singapore 169608, Singapore. · SingHealth Duke-NUS Breast Centre, Singapore 169610, Singapore. · Department of General Surgery, Sengkang General Hospital, Singapore 544886, Singapore. · Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore. · Division of Oncologic Imaging, National Cancer Centre, Singapore 169610, Singapore. · Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore. · Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117593, Singapore. ·Cancers (Basel) · Pubmed #31769433.

ABSTRACT: Although mammography is the gold standard for breast cancer screening, the high rates of false-positive mammograms remain a concern. Thus, there is an unmet clinical need for a non-invasive and reliable test to differentiate between malignant and benign breast lesions in order to avoid subjecting patients with abnormal mammograms to unnecessary follow-up diagnostic procedures. Serum samples from 116 malignant breast lesions and 64 benign breast lesions were comprehensively profiled for 2,083 microRNAs (miRNAs) using next-generation sequencing. Of the 180 samples profiled, three outliers were removed based on the principal component analysis (PCA), and the remaining samples were divided into training (

4 Article Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial. 2019

Sessler, Daniel I / Pei, Lijian / Huang, Yuguang / Fleischmann, Edith / Marhofer, Peter / Kurz, Andrea / Mayers, Douglas B / Meyer-Treschan, Tanja A / Grady, Martin / Tan, Ern Yu / Ayad, Sabry / Mascha, Edward J / Buggy, Donal J / Anonymous4221008. ·Department of Outcomes Research, Anesthesiology Institute and Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: ds@or.org. · Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China. · Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China. Electronic address: garybeijing@163.com. · Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria. · Department of Outcomes Research, Anesthesiology Institute and Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Anesthesiology Institute and Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA. · Department of Outcomes Research, Anesthesiology Institute and Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Regional Anesthesiology, Anesthesiology Institute and Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA. · Department of Anesthesiology, University of Düsseldorf, Düsseldorf, Germany. · Tan Tock Seng Hospital, Singapore, Singapore. · Department of Outcomes Research, Anesthesiology Institute and Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Anesthesiology Institute and Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA. · Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland. ·Lancet · Pubmed #31645288.

ABSTRACT: BACKGROUND: Three perioperative factors impair host defence against recurrence during cancer surgery: the surgical stress response, use of volatile anaesthetic, and opioids for analgesia. All factors are ameliorated by regional anaesthesia-analgesia. We tested the primary hypothesis that breast cancer recurrence after potentially curative surgery is lower with regional anaesthesia-analgesia using paravertebral blocks and the anaesthetic propofol than with general anaesthesia with the volatile anaesthetic sevoflurane and opioid analgesia. A second hypothesis was that regional anaesthesia-analgesia reduces persistent incisional pain. METHODS: We did a randomised controlled trial at 13 hospitals in Argentina, Austria, China, Germany, Ireland, New Zealand, Singapore, and the USA. Women (age <85 years) having potentially curative primary breast cancer resections were randomised by computer to either regional anaesthesia-analgesia (paravertebral blocks and propofol) or general anaesthesia (sevoflurane) and opioid analgesia. The primary outcome was local or metastatic breast cancer recurrence. The secondary outcome was incisional pain at 6 months and 12 months. Primary analyses were done under intention-to-treat principles. This trial is registered with ClinicalTrials.gov, NCT00418457. The study was stopped after a preplanned futility boundary was crossed. FINDINGS: Between Jan 30, 2007, and Jan 18, 2018, 2132 women were enrolled to the study, of whom 24 were excluded before surgery. 1043 were assigned to regional anaesthesia-analgesia and 1065 were allocated to general anaesthesia. Baseline characteristics were well balanced between study groups. Median follow-up was 36 (IQR 24-49) months. Among women assigned regional anaesthesia-analgesia, 102 (10%) recurrences were reported, compared with 111 (10%) recurrences among those allocated general anaesthesia (hazard ratio 0·97, 95% CI 0·74-1·28; p=0·84). Incisional pain was reported by 442 (52%) of 856 patients assigned to regional anaesthesia-analgesia and 456 (52%) of 872 patients allocated to general anaesthesia at 6 months, and by 239 (28%) of 854 patients and 232 (27%) of 852 patients, respectively, at 12 months (overall interim-adjusted odds ratio 1·00, 95% CI 0·85-1·17; p=0·99). Neuropathic breast pain did not differ by anaesthetic technique and was reported by 87 (10%) of 859 patients assigned to regional anaesthesia-analgesia and 89 (10%) of 870 patients allocated to general anaesthesia at 6 months, and by 57 (7%) of 857 patients and 57 (7%) of 854 patients, respectively, at 12 months. INTERPRETATION: In our study population, regional anaesthesia-analgesia (paravertebral block and propofol) did not reduce breast cancer recurrence after potentially curative surgery compared with volatile anaesthesia (sevoflurane) and opioids. The frequency and severity of persistent incisional breast pain was unaffected by anaesthetic technique. Clinicians can use regional or general anaesthesia with respect to breast cancer recurrence and persistent incisional pain. FUNDING: Sisk Healthcare Foundation (Ireland), Eccles Breast Cancer Research Fund, British Journal of Anaesthesia International, College of Anaesthetists of Ireland, Peking Union Medical College Hospital, Science Fund for Junior Faculty 2016, Central Bank of Austria, and National Healthcare Group.

5 Article Majority of flat epithelial atypia diagnosed on biopsy do not require surgical excision. 2018

Chan, Patrick Mun Yew / Chotai, Niketa / Lai, Eileen Shujuan / Sin, Pei Yi / Chen, Juliana / Lu, Sarah Qinghui / Goh, Mui Heng / Chong, Bee Kiang / Ho, Bernard Chi Shern / Tan, Ern Yu. ·Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore. · Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore. · Department of Pathology, Tan Tock Seng Hospital, Singapore 308433, Singapore. · Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore. Electronic address: Ern_Yu_Tan@ttsh.com.sg. ·Breast · Pubmed #29040892.

ABSTRACT: BACKGROUND: Borderline risk lesions such as flat epithelial atypia (FEA) are increasingly being diagnosed on biopsy. The need for surgery is being debated. In this study, we determined the frequency of histological upgrade following a diagnosis of FEA on biopsy and evaluated potential predictive factors. METHODS: Retrospective review was done of 194 women who underwent biopsy of indeterminate lesions (total 195 lesions) that were diagnosed as FEA. The review covered a 10-year period. Cases where malignancy was also present together with FEA within the same biopsy cores were excluded. RESULTS: Lesions diagnosed as FEA on biopsy were mostly asymptomatic and presented as microcalcifications on mammogram. Flat epithelial atypia was the only abnormality detected in one-third of cases, was associated with a benign or another borderline lesion in another third and was associated with atypical ductal hyperplasia (ADH) in another third. Six patients (3.1%) were later found to have ductal carcinoma-in-situ (DCIS) at surgery. The presence of ADH in the biopsy was the only predictor of histological upgrade to malignancy (P = 0.04, OR 11.24, 95% CI 1.10 - 115.10), and was present in 5 of the 6 patients. Surgery was advised in the last patient because of radiology-pathology discordance. Thirty-six lesions (18.5%) were not excised and no interval progression or malignancy was found on follow up. CONCLUSION: Histological upgrade to malignancy was uncommon in lesions found on biopsy to be FEA. Non-operative management of biopsy-proven FEA can be considered in the absence of ADH and radiology-pathology discordance.

6 Article Chromosome 1q21.3 amplification is a trackable biomarker and actionable target for breast cancer recurrence. 2017

Goh, Jian Yuan / Feng, Min / Wang, Wenyu / Oguz, Gokce / Yatim, Siti Maryam J M / Lee, Puay Leng / Bao, Yi / Lim, Tse Hui / Wang, Panpan / Tam, Wai Leong / Kodahl, Annette R / Lyng, Maria B / Sarma, Suman / Lin, Selena Y / Lezhava, Alexander / Yap, Yoon Sim / Lim, Alvin S T / Hoon, Dave S B / Ditzel, Henrik J / Lee, Soo Chin / Tan, Ern Yu / Yu, Qiang. ·Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore. · Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · Cytogenetics Laboratory, Department of Pathology, Singapore General Hospital, Singapore. · Cancer Research Institute and School of Pharmacy, Jinan University, Guangzhou, China. · Cancer Science Institute of Singapore, National University of Singapore, Singapore. · Department of Oncology, Odense University Hospital, Odense, Denmark. · Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark. · Department of Translational Molecular Medicine, John Wayne Cancer Institute, Santa Monica, California, USA. · Division of Medical Oncology, National Cancer Centre Singapore, Singapore. · Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore. · Department of General Surgery, Tan Tock Seng Hospital, Singapore. · Institute of Molecular and Cellular Biology, A*STAR, Biopolis, Singapore. · Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore. ·Nat Med · Pubmed #28967919.

ABSTRACT: Tumor recurrence remains the main reason for breast cancer-associated mortality, and there are unmet clinical demands for the discovery of new biomarkers and development of treatment solutions to benefit patients with breast cancer at high risk of recurrence. Here we report the identification of chromosomal copy-number amplification at 1q21.3 that is enriched in subpopulations of breast cancer cells bearing characteristics of tumor-initiating cells (TICs) and that strongly associates with breast cancer recurrence. Amplification is present in ∼10-30% of primary tumors but in more than 70% of recurrent tumors, regardless of breast cancer subtype. Detection of amplification in cell-free DNA (cfDNA) from blood is strongly associated with early relapse in patients with breast cancer and could also be used to track the emergence of tumor resistance to chemotherapy. We further show that 1q21.3-encoded S100 calcium-binding protein (S100A) family members, mainly S100A7, S100A8, and S100A9 (S100A7/8/9), and IL-1 receptor-associated kinase 1 (IRAK1) establish a reciprocal feedback loop driving tumorsphere growth. Notably, this functional circuitry can be disrupted by the small-molecule kinase inhibitor pacritinib, leading to preferential impairment of the growth of 1q21.3-amplified breast tumors. Our study uncovers the 1q21.3-directed S100A7/8/9-IRAK1 feedback loop as a crucial component of breast cancer recurrence, serving as both a trackable biomarker and an actionable therapeutic target for breast cancer.

7 Article Outcome after neoadjuvant chemotherapy in Asian breast cancer patients. 2017

Lim, Li Yan / Miao, Hui / Lim, Joline S J / Lee, Soo Chin / Bhoo-Pathy, Nirmala / Yip, Cheng Har / Taib, Nur Aishah B M / Chan, Patrick / Tan, Ern Yu / Lim, Swee Ho / Lim, Geok Hoon / Woo, Evan / Tan, Yia Swam / Lee, Jung Ah / Wong, Mabel / Tan, Puay Hoon / Ong, Kong Wee / Wong, Fuh Yong / Yap, Yoon Sim / Hartman, Mikael. ·Department of Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. · Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549, Singapore. · Department of Hematology Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. · Julius Centre University Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia. · Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia. · Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. · Breast Department, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. · Department of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore. · Department of Pathology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore. · Division of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore. · Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore. · Department of Surgery, National University of Singapore and National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. ·Cancer Med · Pubmed #28000426.

ABSTRACT: We aim to identify clinicopathologic predictors for response to neoadjuvant chemotherapy and to evaluate the prognostic value of pathologic complete response (pCR) on survival in Asia. This study included 915 breast cancer patients who underwent neoadjuvant chemotherapy at five public hospitals in Singapore and Malaysia. pCR following neoadjuvant chemotherapy was defined as 1) no residual invasive tumor cells in the breast (ypT0/is) and 2) no residual invasive tumor cells in the breast and axillary lymph nodes (ypT0/is ypN0). Association between pCR and clinicopathologic characteristics and treatment were evaluated using chi-square test and multivariable logistic regression. Kaplan-Meier analysis and log-rank test, stratified by other prognostic factors, were conducted to compare overall survival between patients who achieved pCR and patients who did not. Overall, 4.4% of nonmetastatic patients received neoadjuvant chemotherapy. The median age of preoperatively treated patients was 50 years. pCR rates were 18.1% (pCR ypT0/is) and 14.4% (pCR ypT0/is ypN0), respectively. pCR rate was the highest among women who had higher grade, smaller size, estrogen receptor negative, human epidermal growth factor receptor 2-positive disease or receiving taxane-based neoadjuvant chemotherapy. Patients who achieved pCR had better overall survival than those who did not. In subgroup analysis, the survival advantage was only significant among women with estrogen receptor-negative tumors. Patients with poor prognostic profile are more likely to achieve pCR and particularly when receiving taxane-containing chemotherapy. pCR is a significant prognostic factor for overall survival especially in estrogen receptor-negative breast cancers.

8 Article Significant Effect of Polymorphisms in 2017

Zembutsu, Hitoshi / Nakamura, Seigo / Akashi-Tanaka, Sadako / Kuwayama, Takashi / Watanabe, Chie / Takamaru, Tomoko / Takei, Hiroyuki / Ishikawa, Takashi / Miyahara, Kana / Matsumoto, Hiroshi / Hasegawa, Yoshie / Kutomi, Goro / Shima, Hiroaki / Satomi, Fukino / Okazaki, Minoru / Zaha, Hisamitsu / Onomura, Mai / Matsukata, Ayami / Sagara, Yasuaki / Baba, Shinichi / Yamada, Akimitsu / Shimada, Kazuhiro / Shimizu, Daisuke / Tsugawa, Koichiro / Shimo, Arata / Tan, Ern Yu / Hartman, Mikael / Chan, Ching-Wan / Lee, Soo Chin / Nakamura, Yusuke. ·Division of Genetics, National Cancer Center Research Institute, Tokyo, Japan. hzenbuts@ncc.go.jp. · Department of Breast Surgery, Showa University, Tokyo, Japan. · Department of Breast Surgery, Nippon Medical School, Tokyo, Japan. · Department of Breast Surgery, Tokyo Medical University, Tokyo, Japan. · Department of Breast Surgery, Saitama Cancer Center, Saitama, Japan. · Department of Breast Surgery, Hirosaki Municipal Hospital, Hirosaki, Japan. · 1st Department of Surgery, Sapporo Medical University, Sapporo, Japan. · Department of Breast Surgery, Sapporo Breast Surgical Clinic, Sapporo, Japan. · Department of Breast Surgery, Nakagami Hospital, Okinawa, Japan. · Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan. · Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Japan. · Department of Breast Surgery, Yokohama Minato Red Cross Hospital, Yokohama, Japan. · Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine Hospital, Kawasaki, Japan. · Department of General Surgery, Tan Tock Seng Hospital, Singapore. · Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore. · Department of Hematology Oncology, National University Cancer Institute, National University Health System, Singapore. · Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois. ·Clin Cancer Res · Pubmed #27797974.

ABSTRACT:

9 Article Validation of the CancerMath prognostic tool for breast cancer in Southeast Asia. 2016

Miao, Hui / Hartman, Mikael / Verkooijen, Helena M / Taib, Nur Aishah / Wong, Hoong-Seam / Subramaniam, Shridevi / Yip, Cheng-Har / Tan, Ern-Yu / Chan, Patrick / Lee, Soo-Chin / Bhoo-Pathy, Nirmala. ·Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549, Singapore. ephmh@nus.edu.sg. · Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549, Singapore. · Department of Surgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore. · Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77, Stockholm, Sweden. · Imaging Division, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands. · Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. · Clinical Epidemiology Unit, National Clinical Research Centre, Jalan Pahang, 50586, Kuala Lumpur, Malaysia. · Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. · Department of Hematology Oncology, National University Cancer Institute, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. · Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. · Julius Center for Health Sciences and Primary Care, University Medical Center, PO Box 85500, 3508, AB, Utrecht, The Netherlands. ·BMC Cancer · Pubmed #27769212.

ABSTRACT: BACKGROUND: CancerMath is a set of web-based prognostic tools which predict nodal status and survival up to 15 years after diagnosis of breast cancer. This study validated its performance in a Southeast Asian setting. METHODS: Using Singapore Malaysia Hospital-Based Breast Cancer Registry, clinical information was retrieved from 7064 stage I to III breast cancer patients who were diagnosed between 1990 and 2011 and underwent surgery. Predicted and observed probabilities of positive nodes and survival were compared for each subgroup. Calibration was assessed by plotting observed value against predicted value for each decile of the predicted value. Discrimination was evaluated by area under a receiver operating characteristic curve (AUC) with 95 % confidence interval (CI). RESULTS: The median predicted probability of positive lymph nodes is 40.6 % which was lower than the observed 43.6 % (95 % CI, 42.5 %-44.8 %). The calibration plot showed underestimation for most of the groups. The AUC was 0.71 (95 % CI, 0.70-0.72). Cancermath predicted and observed overall survival probabilities were 87.3 % vs 83.4 % at 5 years after diagnosis and 75.3 % vs 70.4 % at 10 years after diagnosis. The difference was smaller for patients from Singapore, patients diagnosed more recently and patients with favorable tumor characteristics. Calibration plot also illustrated overprediction of survival for patients with poor prognosis. The AUC for 5-year and 10-year overall survival was 0.77 (95 % CI: 0.75-0.79) and 0.74 (95 % CI: 0.71-0.76). CONCLUSIONS: The discrimination and calibration of CancerMath were modest. The results suggest that clinical application of CancerMath should be limited to patients with better prognostic profile.

10 Article High expression of MnSOD promotes survival of circulating breast cancer cells and increases their resistance to doxorubicin. 2016

Fu, Afu / Ma, Shijun / Wei, Na / Tan, Blanche Xiao Xuan / Tan, Ern Yu / Luo, Kathy Qian. ·School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore. · Department of General Surgery, Tan Tock Seng Hospital, Singapore. · Faculty of Health Sciences, University of Macau, Taipa, Macau, China. ·Oncotarget · Pubmed #27384484.

ABSTRACT: Understanding the survival mechanism of metastatic cancer cells in circulation will provide new perspectives on metastasis prevention and also shed new light on metastasis-derived drug resistance. In this study, we made it feasible to detect apoptosis of circulating tumor cells (CTCs) in real-time by integrating a fluorescence resonance energy transfer (FRET)-based caspase sensor into one in vitro microfluidic circulatory system, and two in vivo models: zebrafish circulation and mouse lung metastatic model. Our study demonstrated that fluid shear stresses triggered apoptosis of breast cancer cells in circulation by elevating the mitochondrial production of the primary free radical, superoxide anion. Cancer cells with high levels of manganese superoxide dismutase (MnSOD) exhibited stronger resistance to shear force-induced apoptosis and formed more lung metastases in mice. These metastasized cells further displayed higher resistance to chemotherapeutic agent doxorubicin, which also generates superoxide in mitochondria. Specific siRNA-mediated MnSOD knockdown reversed all three phenotypes. Our findings therefore suggest that MnSOD plays an important integrative role in supporting cancer cell survival in circulation, metastasis, and doxorubicin resistance. MnSOD can serve as a new biomarker for identifying metastatic CTCs and a novel therapeutic target for inhibiting metastasis and destroying doxorubicin-resistant breast cancer cells.

11 Article Trends in presentation, management and survival of patients with de novo metastatic breast cancer in a Southeast Asian setting. 2015

Bhoo-Pathy, Nirmala / Verkooijen, Helena Marieke / Tan, Ern-Yu / Miao, Hui / Taib, Nur Aishah Mohd / Brand, Judith S / Dent, Rebecca A / See, Mee-Hoong / Subramaniam, ShriDevi / Chan, Patrick / Lee, Soo-Chin / Hartman, Mikael / Yip, Cheng-Har. ·Julius Centre University of Malaya, Centre for Evidence Based Medicine and Clinical Epidemiology, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia. · Julius Center for Health Sciences and Primary Care, University Medical Center, PO Box 85500, 3508 GA Utrecht, The Netherlands. · Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597. · Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. · Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia. · Institution of Medical Epidemiology and Biostatistics, Karolinska Instituet, Nobels Väg 12A, 171 77 Stockholm, Sweden. · National Cancer Centre Singapore, 11 Hospital Dr, Singapore 169610. · Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857. · National Clinical Research Centre, Level 3, Dermatology Block, Kuala Lumpur Hospital, 50586 Jalan Pahang, Kuala Lumpur, Malaysia. · Department of Hematology Oncology, National University Cancer Institute, National University Health System, Singapore 119228. ·Sci Rep · Pubmed #26536962.

ABSTRACT: Up to 25% of breast cancer patients in Asia present with de novo metastatic disease. We examined the survival trends of Asian patients with metastatic breast cancer over fifteen years. The impact of changes in patient's demography, tumor characteristics, tumor burden, and treatment on survival trend were examined. Patients with de novo metastatic breast cancer from three hospitals in Malaysia and Singapore (N = 856) were grouped by year of diagnosis: 1996-2000, 2001-2005 and 2006-2010. Step-wise multivariable Poisson regression was used to estimate the contribution of above-mentioned factors on the survival trend. Proportions of patients presenting with metastatic breast cancer were 10% in 1996-2000, 7% in 2001-2005, and 9% in 2006-2010. Patients in 2006-2010 were significantly older, appeared to have higher disease burden, and received more chemotherapy, endocrine therapy, and surgery of primary tumor. The three-year relative survival in the above periods were 20·6% (95% CI: 13·9%-28·2%), 28·8% (95% CI: 23·4%-34·2%), and 33·6% (95% CI: 28·8%-38·5%), respectively. Adjustment for treatment considerably attenuated the relative excess risk of mortality in recent years, compared to other factors. Substantial improvements in survival were observed in patients with de novo metastatic breast cancer in this study.

12 Article IRAK1 is a therapeutic target that drives breast cancer metastasis and resistance to paclitaxel. 2015

Wee, Zhen Ning / Yatim, Siti Maryam J M / Kohlbauer, Vera K / Feng, Min / Goh, Jian Yuan / Bao, Yi / Lee, Puay Leng / Zhang, Songjing / Wang, Pan Pan / Lim, Elgene / Tam, Wai Leong / Cai, Yu / Ditzel, Henrik J / Hoon, Dave S B / Tan, Ern Yu / Yu, Qiang. ·Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, A*STAR (Agency for Science, Technology and Research), 60 Biopolis Street, 02-01, Biopolis 138672, Singapore. · First Affiliated Hospital, Jinan University, Guangzhou 510632, China. · Cancer Research Institute, Jinan University, Guangzhou 510632, China. · The Kinghorn Cancer Center, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia. · Cancer Science Institute, National University of Singapore, Singapore 117599, Singapore. · School of Pharmacy, Jinan University, Guangzhou 510632, China. · Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, Odense 5000, Denmark. · Department of Oncology, Odense University Hospital, Odense 5000, Denmark. · Department of Molecular Oncology, John Wayne Cancer Institute, Santa Monica, California 90404, USA. · Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore. · Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore. · Cancer and Stem Cell Biology, DUKE-NUS Graduate Medical School of Singapore, Singapore 169857, Singapore. ·Nat Commun · Pubmed #26503059.

ABSTRACT: Metastatic tumour recurrence due to failed treatments remains a major challenge of breast cancer clinical management. Here we report that interleukin-1 receptor-associated kinase 1 (IRAK1) is overexpressed in a subset of breast cancers, in particular triple-negative breast cancer (TNBC), where it acts to drive aggressive growth, metastasis and acquired resistance to paclitaxel treatment. We show that IRAK1 overexpression confers TNBC growth advantage through NF-κB-related cytokine secretion and metastatic TNBC cells exhibit gain of IRAK1 dependency, resulting in high susceptibility to genetic and pharmacologic inhibition of IRAK1. Importantly, paclitaxel treatment induces strong IRAK1 phosphorylation, an increase in inflammatory cytokine expression, enrichment of cancer stem cells and acquired resistance to paclitaxel treatment. Pharmacologic inhibition of IRAK1 is able to reverse paclitaxel resistance by triggering massive apoptosis at least in part through inhibiting p38-MCL1 pro-survival pathway. Our study thus demonstrates IRAK1 as a promising therapeutic target for TNBC metastasis and paclitaxel resistance.

13 Article Prognostic role of adjuvant radiotherapy in triple-negative breast cancer: A historical cohort study. 2015

Bhoo-Pathy, Nirmala / Verkooijen, Helena M / Wong, Fuh-Yong / Pignol, Jean-Philippe / Kwong, Ava / Tan, Ern-Yu / Aishah Taib, Nur / Nei, Wen-Long / Ho, Gwo-Fuang / Tan, Benita / Chan, Patrick / Lee, Soo-Chin / Hartman, Mikael / Yip, Cheng-Har / Dent, Rebecca. ·Faculty of Medicine, Julius Centre University of Malaya, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia. · Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. · National Clinical Research Centre, Kuala Lumpur Hospital, Jalan Pahang, Kuala Lumpur, Malaysia. · Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. · Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore. · Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. · Breast Surgery Division, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong. · Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore. · Department of Surgery, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia. · Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia. · Department of General Surgery, Singapore General Hospital, Singapore, Singapore. · Department of Hematology Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore. · Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore. · Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore. · Department of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore, Singapore. ·Int J Cancer · Pubmed #26018878.

ABSTRACT: The value of adjuvant radiotherapy in triple-negative breast cancer (TNBC) is currently debated. We assessed the association between adjuvant radiotherapy and survival in a large cohort of Asian women with TNBC. Women diagnosed with TNBC from 2006 to 2011 in five Asian centers (N = 1,138) were included. Survival between patients receiving mastectomy only, breast-conserving therapy (BCT, lumpectomy and adjuvant radiotherapy) and mastectomy with radiotherapy were compared, and adjusted for demography, tumor characteristics and chemotherapy types. Median age at diagnosis was 53 years (range: 23-96 years). Median tumor size at diagnosis was 2.5 cm and most patients had lymph node-negative disease. The majority of patients received adjuvant chemotherapy (n = 861, 76%) comprising predominantly anthracycline-based regimes. In 775 women with T1-2, N0-1, M0 TNBCs, 5-year relative survival ratio (RSR) was highest in patients undergoing mastectomy only (94.7%, 95% CI: 88.8-98.8%), followed by BCT (90.8%, 95% CI: 85.0-94.7%), and mastectomy with radiotherapy (82.3%, 95% CI: 73.4-88.1%). The adjusted risks of mortality between the three groups were not significantly different. In 363 patients with T3-4, N2-3, M0 TNBCs, BCT was associated with highest 5-year RSR (94.1%, 95% CI: 81.3-99.4%), followed by mastectomy with radiotherapy (62.7%, 95% CI: 54.3-70.1%), and mastectomy only (58.6%, 95% CI: 43.5-71.6%). Following multivariable adjustment, BCT and mastectomy with radiotherapy remained significantly associated with lower mortality risk compared to mastectomy only. Overall, adjuvant radiotherapy was associated with higher survival in women aged <40 years, but not in older women. Adjuvant radiotherapy appears to be independently associated with a survival gain in locally advanced as well as in very young TNBC.

14 Article Extent of margin involvement, lymphovascular invasion, and extensive intraductal component predict for residual disease after wide local excision for breast cancer. 2015

Alrahbi, Salim / Chan, Patrick M Y / Ho, Bernard C S / Seah, Melanie D W / Chen, Juliana J C / Tan, Ern Yu. ·Department of General Surgery, Royal Hospital, Muscat, Oman. · Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore. · Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore. · Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore. Electronic address: Ern_Yu_Tan@ttsh.com.sg. ·Clin Breast Cancer · Pubmed #25576998.

ABSTRACT: BACKGROUND: Positive margins after wide local excision (WLE) increase the probability of residual disease, and additional surgery is often recommended. However, residual tumor will be found in only two thirds of cases, suggesting that additional surgery can be avoided in many instances. In the present study, we sought to establish the frequency of residual tumor when the surgical margins are inadequate and to identify factors that predict for residual tumor. MATERIALS AND METHODS: A retrospective review was performed of 720 consecutive patients who had undergone WLE for ductal carcinoma in situ and nonmetastatic breast cancer at a single unit from January 1, 2004 to December 31, 2010. RESULTS: At least a single radial margin was affected (either involved or close, defined as tumor < 1 mm from the margin) in 244 patients who had undergone WLE, and either the anterior or posterior margin was affected in another 103 patients. Reoperation was performed in 215 patients with affected radial margins and 9 others with affected anterior or posterior margins. Residual disease was found in 98 of 224 patients (43.8%) and was more likely when tumor was present at the inked margin, when > 1 radial margin was affected, and when lymphovascular invasion (LVI) or an extensive intraductal component (EIC) was present. The association with tumor size was of borderline significance. No association was found with tumor histologic type or patient age. CONCLUSION: Additional evaluation is needed to determine whether additional surgery can be safely omitted in women with tumors without LVI or EIC when a single radial margin has been deemed to be close.

15 Article Limiting the use of primary endocrine therapy in elderly women with breast cancer. 2014

Chan, Shaun W Y / Chan, Patrick M Y / Seah, Melanie D W / Chen, Juliana J C / Tan, Ern Yu. ·Department of General Surgery, Tan Tock Seng Hospital, Singapore. ·Ann Acad Med Singapore · Pubmed #25341632.

ABSTRACT: Primary endocrine therapy (PET) is often included as a treatment option in elderly women with operable breast cancer. Elderly women tend to have pre-existing comorbidities and are often reluctant to undergo surgery. The benefit of surgery needs to be weighed against a relatively higher potential for operative morbidity and mortality, and a limited life expectancy. But while PET can provide relatively good locoregional control, it is not curative in nature and the possibility of local complications and metastasis remains. We retrospectively reviewed the outcome of PET in a series of 19 elderly women, older than 70 years of age, who had presented with operable non-metastatic breast cancer. Only about a third of these women were deemed medically unfit for surgery; the rest had declined surgery. Compliance was an issue, with almost half of these patients defaulting treatment and follow-up. Local control was achieved in most patients, but disease progression did occur in 5 patients. Three of these patients received additional treatment; which included surgery in 1 patient. PET should therefore not be considered an equivalent alternative to surgery in elderly women who were fi t to undergo surgery. However, having observed that only 1 of the 6 deaths in our study was related to breast cancer, PET does have a role in women whose life expectancy is more likely to be limited by coexisting morbidities than the breast cancer itself.

16 Article The use of traditional Chinese medicine among breast cancer patients: implications for the clinician. 2014

Wong, Kar Yong / Tan, Ern Yu / Chen, Juliana J C / Teo, Christine / Chan, Patrick M Y. ·Department of General Surgery, Tan Tock Seng Hospital, Singapore. ·Ann Acad Med Singapore · Pubmed #24652426.

ABSTRACT: INTRODUCTION: Traditional Chinese Medicine or Traditional Complementary Medicine (TCM) is commonly used in our culture. There are several concerns regarding its use in patients undergoing conventional treatments for breast cancer. In this study, we aimed to evaluate the prevalence and pattern of TCM use among our breast cancer patients, and to identify patients who were most likely to choose TCM. MATERIALS AND METHODS: A total of 300 patients on active follow-up with Breast Service at Tan Tock Seng Hospital were interviewed using a structured questionnaire. RESULTS: A total of 35% (104 of 296) of patients reported using TCM. The majority of the patients were introduced to TCM by family and friends following the diagnosis of breast cancer. All except 3 patients continued with recommended conventional therapy although most did not inform their clinicians of TCM use. None of the patients reported any serious adverse events and 75% of them perceived a benefit from TCM use. Younger patients and those of Chinese ethnicity were more likely to use TCM (P <0.01 and P = 0.03 respectively). There was no significant difference in the dialect group, religious beliefs and educational level between the 2 groups (P >0.05). CONCLUSION: TCM use is common among our breast cancer patients, particularly the younger women. However, most patients do not inform their clinicians of TCM use while on recommended conventional therapies. It is therefore important for clinicians to initiate discussions regarding TCM use in order to be aware of potential unwanted drug interactions.

17 Article Blue dye is sufficient for sentinel lymph node biopsy in breast cancer. 2014

Ang, C H / Tan, M Y / Teo, C / Seah, D W / Chen, J C / Chan, M Y P / Tan, E Y. ·Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. ·Br J Surg · Pubmed #24492989.

ABSTRACT: BACKGROUND: Most previous studies have reported superior results when blue dye and radiocolloids were used together for sentinel lymph node (SLN) biopsy in early breast cancer. Blue dye was reported to perform poorly when used alone, although more recent studies have found otherwise. This study reviewed the authors' practice of performing SLN biopsy with blue dye alone. METHODS: This was a retrospective review of patients who underwent SLN biopsy using blue dye alone from 2001 to 2005, when SLN biopsy was performed selectively and always followed by axillary lymph node dissection (ALND), and from 2006 to 2010, when SLN biopsy was offered to all suitable patients and ALND done only when the SLN was not identified or positive for metastasis. RESULTS: Between 2001 and 2005, 170 patients underwent SLN biopsy with blue dye alone. The overall SLN non-identification rate was 8·4 per cent. The overall false-negative rate was 34 per cent, but decreased with each subsequent year to 13 per cent in 2005. From 2006 to 2010, 610 patients underwent SLN biopsy with blue dye alone. The SLN was not identified in 12 patients (2·0 per cent) and no significant contributing factor was identified. A median of 2 (range 1-11) SLNs were identified. A non-SLN was found to be positive for metastasis in two patients with negative SLNs. Axillary nodal recurrence developed in one patient; none developed internal mammary nodal recurrence. Anaphylaxis occurred in one patient. CONCLUSION: Blue dye performed well as a single modality for SLN biopsy. Non-identification, axillary nodal recurrence and serious allergic reactions were uncommon.

18 Article ALDH1 expression is enriched in breast cancers arising in young women but does not predict outcome. 2013

Tan, E Y / Thike, A A / Anonymous6040761 / Tan, P H. ·Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. Ern_Yu_Tan@ttsh.com.sg ·Br J Cancer · Pubmed #23787917.

ABSTRACT: BACKGROUND: Tumours arising in younger women appear to be biologically more aggressive and tend to have a poorer outcome. Being relatively resistant to conventional treatments, breast cancer stem cells (CSCs) have been postulated as a possible cause of disease recurrence after treatment. In this study, we used ALDH1 as a CSC marker and determined whether ALDH1 expression correlated with clinical outcome in young women with breast cancer. METHODS: The expression of ALDH1 was evaluated through immunohistochemistry on microarrayed cores obtained from 141 consecutive patients up to 35 years of age. RESULTS: The expression of ALDH1 was observed in 25% (35 of 141) of tumours, in a median of 5% of cells. Younger women were 14 times more likely to have ALDH1-positive tumours (P<0.01, OR 14.4, 95% CI 4.34-48.09). The ALDH1 correlated independently with ER negativity (P=0.01, OR 0.33, 95% CI 0.15-0.77). There was no correlation with disease recurrence or breast cancer-related deaths. CONCLUSION: In younger women, ALDH1 was more highly expressed, and it correlated with ER negativity. It, however, did not predict survival in this study.

19 Article Protein tyrosine phosphatase UBASH3B is overexpressed in triple-negative breast cancer and promotes invasion and metastasis. 2013

Lee, Shuet Theng / Feng, Min / Wei, Yong / Li, Zhimei / Qiao, Yuanyuan / Guan, Peiyong / Jiang, Xia / Wong, Chew Hooi / Huynh, Kelly / Wang, Jinhua / Li, Juntao / Karuturi, K Murthy / Tan, Ern Yu / Hoon, Dave S B / Kang, Yibin / Yu, Qiang. ·Cancer Biology and Pharmacology, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore 138672. ·Proc Natl Acad Sci U S A · Pubmed #23784775.

ABSTRACT: Efforts to improve the clinical outcome of highly aggressive triple-negative breast cancer (TNBC) have been hindered by the lack of effective targeted therapies. Thus, it is important to identify the specific gene targets/pathways driving the invasive phenotype to develop more effective therapeutics. Here we show that ubiquitin-associated and SH3 domain-containing B (UBASH3B), a protein tyrosine phosphatase, is overexpressed in TNBC, where it supports malignant growth, invasion, and metastasis largely through modulating epidermal growth factor receptor (EGFR). We also show that UBASH3B is a functional target of anti-invasive microRNA200a (miR200a) that is down-regulated in TNBC. Importantly, the oncogenic potential of UBASH3B is dependent on its tyrosine phosphatase activity, which targets CBL ubiquitin ligase for dephosphorylation and inactivation, leading to EGFR up-regulation. Thus, UBASH3B may function as a crucial node in bridging multiple invasion-promoting pathways, thereby providing a potential therapeutic target for TNBC.

20 Article Achieving breast cancer surgery in a single setting with intraoperative frozen section analysis of the sentinel lymph node. 2013

Lu, Qinghui / Tan, Ern-Yu / Ho, Bernard / Teo, Christine / Seah, Melanie D W / Chen, Juliana J C / Chan, Patrick M Y. ·Department of General Surgery, Tan Tock Seng Hospital, Singapore. qinghui_sarah_lu@ttsh.com.sg ·Clin Breast Cancer · Pubmed #23218472.

ABSTRACT: BACKGROUND: Current guidelines recommend full axillary lymph node dissection (ALND) whenever the SLN is positive for metastases. In our institute, we aim to complete surgery in a single setting and base the decision for ALND on the intraoperative FS analysis of the SLN. In this study, we evaluate the efficacy this practice in terms of the accuracy of FS analysis, patient recall rate, and additional time required for FS analysis. MATERIALS AND METHODS: Retrospective review was performed of 586 patients who underwent SLN biopsy at our institution from January 1, 2006 to December 31, 2010. Intraoperative FS analysis was routinely performed in all cases with a preoperative diagnosis of invasive breast cancer and in selected cases of ductal carcinoma in situ according to surgeon preference. RESULTS: The SLN was positive for metastases in 123 (22.7%) patients; this was identified on FS analysis in 107 patients. FS analysis had a sensitivity of 87.0% and specificity of 100% and resulted in a patient recall rate of 3%. Micrometastasis accounted for most of the false negative FS results. These deposits were mostly detected only on deeper sectioning of the permanent sections of the SLN. An invasive lobular histology and lymphovascular invasion were found to be independent predictors of a false negative FS on multivariate analysis (P < .01). Intraoperative FS did not significantly prolong operating times. CONCLUSION: Intraoperative FS analysis is an accurate and efficient means of rapid SLN assessment and allows ALND to be completed in a single setting.

21 Minor Advanced breast cancer-are we doing enough? 2012

Pek, Chong Han / Tan, Ern Yu / Chen, Juliana J C / Ho, Pey Woei / Teo, Christine / Earnest, Arul / Chan, Patrick M Y. · ·Breast J · Pubmed #23009636.

ABSTRACT: -- No abstract --