Methodology: A search was done on PubMed, limited to reviews and the English language only. The search terms used were 'BRCA' or 'PALB2' or 'TP53' and 'surgery'. Fifteen articles were identified by searching and one article was obtained from other sources.

Results: Breast-conserving surgery has equivalent survival, but may have an increased risk of local recurrence, compared to mastectomy among BRCA mutation carriers. Contralateral prophylactic mastectomy may not improve overall survival, despite reducing the risk of developing contralateral breast cancer. The use of preoperative genetic testing allows patients to have combined curative and prophylactic surgery. However, preoperative genetic testing may influence patients to make rash decisions. In healthy BRCA mutation carriers, bilateral prophylactic mastectomy is done to prevent breast cancer from occurring. Bilateral prophylactic mastectomy is highly effective in reducing the risk of breast cancer in healthy BRCA mutation-positive women and may have a survival benefit. Prophylactic oophorectomy reduces the risk of ovarian cancer, but may not have an effect on the risk of breast cancer. There is a lack of studies on surgery for non-BRCA mutations. TP53 and PALB2 are potentially high-risk mutations for breast cancer, which may justify the use of prophylactic surgery. Advice should be given on a case-by-case basis.

METHODS: Breast cancer patients were recruited from three Malaysian hospitals between June and November 2017. We compared the proportion of patients who rated PROs as very important (scored 7-9 on a 9-point Likert scale) between Malaysian patients and data collected from patients in HICs via the ICHOM questionnaire development process, using logistic regression. A two-step cluster analysis explored differences in PROs among Malaysian patients.

METHODS: Data of 3,100 Malaysian women with nonmetastatic breast cancer diagnosed between 2010 and 2017 were analyzed. Adherence to the Malaysian Clinical Practice Guidelines for Management of Breast Cancer second Edition was measured. Outcomes comprised overall survival and event-free survival.

RESULTS: Guideline adherence for chemotherapy, radiotherapy, hormonal therapy, and targeted therapy were 61.7%, 79.2%, 85.1%, and 26.2%, respectively. Older age was generally associated with lower adherence to guidelines. Compared with patients who were treated according to treatment guidelines, overall survival and event-free survival were substantially lower in patients who were not treated accordingly; hazard ratios for all-cause mortality were 1.69 (95% CI, 1.29 to 2.22), 2.59 (95% CI, 1.76 to 3.81), 3.08 (95% CI, 1.94 to 4.88), and 4.48 (95% CI, 1.98 to 10.13) for chemotherapy, radiotherapy, hormone therapy, and targeted therapy, respectively. Study inferences remain unchanged following sensitivity analyses.

MATERIALS AND METHODS: A prospective cohort study of cancer patients and healthy individuals receiving vaccines was conducted in Malaysia. All participants were aged 18 or above at recruitment and received at least two doses of vaccine. We excluded patients who had missing serum antibody data post-first dose and post-second dose. Sociodemographic and clinical data were collected at baseline, prior to vaccination. Data on self-reported breakthrough infection was collected at six months. Multivariable linear mixed-effects regression models were used to investigate the association between the type of vaccine and serum IgG titer.

RESULTS: A total of 389 patients with solid (n=276, 71.0%) or hematologic cancers (n=113, 29.0%) were included, along with 246 healthy individuals. Most cancer patients received BNT162b2 (n=358, 92.0%), followed by AZ1222 (n=19, 4.9%) and Coronavac (n=12, 3.1%). Most healthy individuals received BNT162b2 (n=151, 61.4%), followed by Coronavac (n=95, 38.6%). Vaccination, after adjustment for confounders (pre-vaccine infection, age, ethnicity, comorbidity, timepoint, income, cancer type, and booster), with Coronavac was associated with lower log IgG titer (-3.09 U/ml, 95% confidence interval=-4.37 to -1.80, p<0.01) than that of BNT162b2 in patients with cancer and also lower log IgG titer (-2.64 U/ml, 95% confidence interval=-2.97 to -2.30, p<0.01) than that of BNT162b2 in healthy individuals. No effect modification by sex was observed. Among the cancer cohort, 76 patients (19.5%) reported breakthrough infections after vaccination, while 33 (13.4%) participants in the healthy cohort reported breakthrough infections after vaccination. Coronavac was associated with greater odds of breakthrough infection among healthy individuals (odds ratio=7.34 compared to BNT162b2, confidence interval=1.40 to 33.49, p=0.02).