<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT02235051</url>
  </required_header>
  <id_info>
    <org_study_id>14135</org_study_id>
    <secondary_id>NCI-2014-01876</secondary_id>
    <secondary_id>14135</secondary_id>
    <nct_id>NCT02235051</nct_id>
  </id_info>
  <brief_title>Exercise Intervention in Preventing Breast Cancer Recurrence in Postmenopausal Breast Cancer Survivors</brief_title>
  <official_title>Deciphering the Breast Cancer Exercise Paradox: The Role of DNA Repair and Inflammation</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>City of Hope Medical Center</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>National Cancer Institute (NCI)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
  </sponsors>
  <source>City of Hope Medical Center</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      This randomized pilot trial studies how well an exercise intervention works in preventing&#xD;
      breast cancer from coming back in postmenopausal breast cancer survivors. Regular exercise&#xD;
      may be able to train the body to repair deoxyribonucleic acid (DNA) more efficiently and to&#xD;
      respond to inflammation more proficiently, helping to prevent primary and recurrent breast&#xD;
      cancer.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      PRIMARY OBJECTIVES:&#xD;
&#xD;
      I. To test the hypothesis that regular exercise increases DNA repair capacity.&#xD;
&#xD;
      II. To test the hypothesis that regular exercise reduces inflammatory response.&#xD;
&#xD;
      III. To test the hypothesis that regular exercise modulates telomerase activity.&#xD;
&#xD;
      SECONDARY OBJECTIVES:&#xD;
&#xD;
      I. To assess adherence to the study protocol.&#xD;
&#xD;
      II. To examine differences in body composition before and after the exercise intervention.&#xD;
&#xD;
      III. To examine differences in fitness before and after the exercise intervention.&#xD;
&#xD;
      IV. To test the hypothesis that regular exercise increases quality of life in breast cancer&#xD;
      survivors.&#xD;
&#xD;
      V. To examine the safety of the exercise intervention.&#xD;
&#xD;
      OUTLINE: Patients are randomized to 1 of 2 treatment arms.&#xD;
&#xD;
      ARM I: Patients participate in a supervised Curves exercise program three days a week for 16&#xD;
      weeks. The circuit-style workout consists of 14 exercises constructed with pneumatic or&#xD;
      hydraulic resistance that target opposing muscle groups in a concentric-only fashion. Each&#xD;
      session at a Curves facility will include two complete circuits which correspond to&#xD;
      exercising for approximately 30 minutes followed by a standardized stretching routine.&#xD;
&#xD;
      ARM II: Patients do not participate in a formal exercise program for 16 weeks. Patients are&#xD;
      then offered the Curves exercise intervention.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">September 7, 2014</start_date>
  <completion_date type="Actual">June 3, 2022</completion_date>
  <primary_completion_date type="Actual">December 19, 2016</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Prevention</primary_purpose>
    <masking>Single (Investigator)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Change in 60 minutes mean olive tail moments measured by the Comet assay</measure>
    <time_frame>Baseline to 16 weeks</time_frame>
    <description>Comet assay data will be analyzed according to methods by Wiklund et al. Log-transformed, mean Olive tail moments, assessing DNA damage, will be calculated and compared using a paired t-test. For the ex vivo analyses using a challenge assay, Log-transformed, mean Olive tail moments will be calculated before and after the introduction of the damaging agent at 0, 1 and 6 hours. Differences between the changes will be analyzed using the paired t-test. Multivariate analysis of variance (MANOVA) for repeated measure will be performed and linear regression models will be fitted.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in level of interleukin-6 (IL-6) cytokine measured by the 13 Plex-Immunology Multiplex Assay by EMD Millipore</measure>
    <time_frame>Baseline to 16 weeks</time_frame>
    <description>Paired t-tests will be used to compare pre-exercise cytokine concentrations in order to test whether the 16-week Curves exercise intervention decreased markers of inflammation. As secondary analysis linear regression models will be fitted.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in telomerase activity using the Trypan blue method and ImagedQuant</measure>
    <time_frame>Baseline to up to 16 weeks</time_frame>
    <description>Paired t-tests will be used to compare pre-exercise telomerase activity in order to test the 16-week Curves exercise intervention. As a second analysis regression models will be fitted. Potential confounding factors that may contribute to differences within the two groups of women (e.g. BMI, exercise intensity, etc.) will be investigated and included as appropriate. The impact of exercise intensity via CurvesSmart card will also be examined.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Change in the number of gamma-H2A histone, member X (H2AX) foci measured by the gamma-H2AX assay</measure>
    <time_frame>Baseline to 16 weeks</time_frame>
    <description>First, gamma-H2AX foci will be counted, and compared using the paired t-test. Second, for the ex vivo analyses gamma-H2AX foci will be counted before and after the introduction of a damaging agent at 0, 1 and 6 hours. For each time point, a foci change will be obtained. Differences in the foci changes at baseline and 16-weeks will be analyzed using the paired t-test. MANOVA for repeated measures will be performed to allow for the assessment of overall multivariate and univariate results, and linear regression models will be fitted.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in C-reactive protein (CRP) and levels of cytokines measured by the 13 Plex-Immunology Multiplex Assay by EMD Millipore</measure>
    <time_frame>Baseline to 16 weeks</time_frame>
    <description>Paired t-tests will be used to compare pre-exercise CRP and cytokines concentrations in order to test whether the 16-week Curves exercise intervention decreased markers of inflammation. As secondary analysis linear regression models will be fitted.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Adherence to the study protocol</measure>
    <time_frame>16 weeks</time_frame>
    <description>The CurvesSmart card will record both adherence of going to the sessions and completion of the circuit. Adherence will be analyzed as a continuous variable. During the 16-week testing session, women will be asked what barriers to adherence they may have experienced during the intervention.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Changes in weight</measure>
    <time_frame>Baseline to 16 weeks</time_frame>
    <description>A repeated measures analysis of variance (ANOVA) will be used.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Changes in BMI</measure>
    <time_frame>Baseline to 16 weeks</time_frame>
    <description>A repeated measures ANOVA will be used.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Changes in percent body fat</measure>
    <time_frame>Baseline to 16 weeks</time_frame>
    <description>A repeated measures ANOVA will be used.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Changes in cardiopulmonary function</measure>
    <time_frame>Baseline to 16 weeks</time_frame>
    <description>A repeated measures ANOVA will be used.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Changes in muscle strength</measure>
    <time_frame>Baseline to 16 weeks</time_frame>
    <description>A repeated measures ANOVA will be used.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Changes in functional capacity</measure>
    <time_frame>Baseline to 16 weeks</time_frame>
    <description>A repeated measures ANOVA will be used.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Changes in quality of life scores</measure>
    <time_frame>Baseline to 16 weeks</time_frame>
    <description>Changes in quality of life scores will be measured by Cohen's 10-item perceived stress scale, the Fatigue Symptom Inventory, Rosenberg Self-esteem Scale, the Centers for Epidemiology Depression (CESD) Scale, the state trait anxiety index (STAI), the Functional Assessment of Cancer Therapy-Breast scale (FACT-B+4), and Short Form-36 (SF-36) questionnaires. A repeated measures ANOVA will be used.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Incidence of exercise-attributed injury</measure>
    <time_frame>16 weeks</time_frame>
    <description>During the 16-week testing session, women will be asked details about any injuries or discomfort they may have experienced during the participation in the exercise intervention.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in telomere length as measured by quantitative polymerase chain reaction</measure>
    <time_frame>Baseline up to 16 weeks</time_frame>
    <description>Paired t-tests will be used to compare pre-exercise telomere length in order to test the 16-week Curves exercise intervention. As a second analysis regression models will be fitted. Potential confounding factors that may contribute to differences within the two groups of women (e.g. BMI, exercise intensity, etc.) will be investigated and included as appropriate. The impact of exercise intensity via CurvesSmart card will also be examined.</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">50</enrollment>
  <condition>Cancer Survivor</condition>
  <condition>Estrogen Receptor-positive Breast Cancer</condition>
  <condition>Stage IA Breast Cancer</condition>
  <condition>Stage IB Breast Cancer</condition>
  <condition>Stage IIA Breast Cancer</condition>
  <condition>Stage IIB Breast Cancer</condition>
  <condition>Stage IIIA Breast Cancer</condition>
  <condition>Postmenopausal</condition>
  <arm_group>
    <arm_group_label>Arm I (exercise intervention)</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Patients participate in a supervised Curves exercise program three days a week for 16 weeks. The circuit-style workout consists of 14 exercises constructed with pneumatic or hydraulic resistance that target opposing muscle groups in a concentric-only fashion. Each session at Curves will include two complete circuits which correspond to exercising for approximately 30 minutes followed by a standardized stretching routine.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Arm II (no formal exercise intervention)</arm_group_label>
    <arm_group_type>No Intervention</arm_group_type>
    <description>Patients do not participate in a formal exercise program for 16 weeks. Patients are then offered the Curves exercise intervention.</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>exercise intervention</intervention_name>
    <description>Undergo Curves exercise program</description>
    <arm_group_label>Arm I (exercise intervention)</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>laboratory biomarker analysis</intervention_name>
    <description>Correlative studies</description>
    <arm_group_label>Arm I (exercise intervention)</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>questionnaire administration</intervention_name>
    <description>Ancillary studies</description>
    <arm_group_label>Arm I (exercise intervention)</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>quality-of-life assessment</intervention_name>
    <description>Ancillary studies</description>
    <arm_group_label>Arm I (exercise intervention)</arm_group_label>
    <other_name>quality of life assessment</other_name>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  The study will be conducted in women who have been diagnosed with a first primary&#xD;
             invasive estrogen receptor (ER) positive (+) breast cancer (stages I-IIIa) who are&#xD;
             within the first 3 years post-treatment&#xD;
&#xD;
          -  The study will be conducted in postmenopausal women&#xD;
&#xD;
          -  Women of child-bearing potential and men must agree to use adequate contraception&#xD;
             (hormonal or barrier method of birth control or abstinence) prior to study entry and&#xD;
             for six months following duration of study participation; should a woman become&#xD;
             pregnant or suspect that she is pregnant while participating on the trial, she should&#xD;
             inform her treating physician immediately&#xD;
&#xD;
          -  Postmenopausal, defined as meeting any of the following criteria:&#xD;
&#xD;
               -  Periods stopped more than 6 months ago&#xD;
&#xD;
               -  Bilateral oophorectomy&#xD;
&#xD;
               -  Not already classified as pre- or peri-menopausal&#xD;
&#xD;
               -  Started using hormone therapy for menopausal symptoms before periods stopped,&#xD;
                  and/or&#xD;
&#xD;
               -  Hysterectomy before age 56 years but aged 56 years or more at baseline&#xD;
&#xD;
          -  Any body mass index (BMI)&#xD;
&#xD;
          -  Sedentary (have not participated in a regular exercise program in the past 12 months)&#xD;
&#xD;
          -  Nonsmokers (not smoking during previous 12 months)&#xD;
&#xD;
          -  Willing and able to travel to the exercise facility&#xD;
&#xD;
          -  Diagnosed with a first primary invasive ER+ breast cancer (stages I-IIIa)&#xD;
&#xD;
          -  Have undergone a lumpectomy or mastectomy&#xD;
&#xD;
          -  Have completed adjuvant chemotherapy and/or radiation within the past 3 years prior to&#xD;
             study enrollment (when cytokine levels are predicted to be high) and able to initiate&#xD;
             an exercise program&#xD;
&#xD;
          -  May use adjuvant endocrine therapy if use will be continued for duration of study&#xD;
             period&#xD;
&#xD;
          -  All subjects must have the ability to understand and the willingness to sign a written&#xD;
             informed consent&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  History of chronic disease including diabetes, uncontrolled hypertension or thyroid&#xD;
             disease&#xD;
&#xD;
          -  Cardiovascular, respiratory or musculoskeletal disease or joint problems that preclude&#xD;
             moderate physical activity&#xD;
&#xD;
          -  Regular, necessary use of nonsteroidal anti-inflammatory drugs (NSAIDs) (will be asked&#xD;
             to stop use during study period)&#xD;
&#xD;
          -  Currently taking postmenopausal hormone replacement therapy&#xD;
&#xD;
          -  Stage IV or distant metastatic disease&#xD;
&#xD;
          -  Planned reconstructive surgery with flap repair during study period&#xD;
&#xD;
          -  Subjects, who in the opinion of the investigator, may not be able to comply with the&#xD;
             safety monitoring requirements of the study&#xD;
      </textblock>
    </criteria>
    <gender>Female</gender>
    <minimum_age>56 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Jessica Clague DeHart</last_name>
    <role>Principal Investigator</role>
    <affiliation>City of Hope Medical Center</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>City of Hope Medical Center</name>
      <address>
        <city>Duarte</city>
        <state>California</state>
        <zip>91010</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <verification_date>March 2023</verification_date>
  <study_first_submitted>September 5, 2014</study_first_submitted>
  <study_first_submitted_qc>September 5, 2014</study_first_submitted_qc>
  <study_first_posted type="Estimate">September 9, 2014</study_first_posted>
  <last_update_submitted>March 17, 2023</last_update_submitted>
  <last_update_submitted_qc>March 17, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">March 21, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Breast Neoplasms</mesh_term>
  </condition_browse>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT02235051
org study id: 14135
secondary id: NCI-2014-01876
secondary id: 14135
nct id: NCT02235051
lead sponsor: 
collaborator: 
has dmc: Yes
This randomized pilot trial studies how well an exercise intervention works in preventing
      breast cancer from coming back in postmenopausal breast cancer survivors. Regular exercise
      may be able to train the body to repair deoxyribonucleic acid (DNA) more efficiently and to
      respond to inflammation more proficiently, helping to prevent primary and recurrent breast
      cancer.
PRIMARY OBJECTIVES:

      I. To test the hypothesis that regular exercise increases DNA repair capacity.

      II. To test the hypothesis that regular exercise reduces inflammatory response.

      III. To test the hypothesis that regular exercise modulates telomerase activity.

      SECONDARY OBJECTIVES:

      I. To assess adherence to the study protocol.

      II. To examine differences in body composition before and after the exercise intervention.

      III. To examine differences in fitness before and after the exercise intervention.

      IV. To test the hypothesis that regular exercise increases quality of life in breast cancer
      survivors.

      V. To examine the safety of the exercise intervention.

      OUTLINE: Patients are randomized to 1 of 2 treatment arms.

      ARM I: Patients participate in a supervised Curves exercise program three days a week for 16
      weeks. The circuit-style workout consists of 14 exercises constructed with pneumatic or
      hydraulic resistance that target opposing muscle groups in a concentric-only fashion. Each
      session at a Curves facility will include two complete circuits which correspond to
      exercising for approximately 30 minutes followed by a standardized stretching routine.

      ARM II: Patients do not participate in a formal exercise program for 16 weeks. Patients are
      then offered the Curves exercise intervention.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Prevention
masking: Single (Investigator)
measure: Change in 60 minutes mean olive tail moments measured by the Comet assay
time frame: Baseline to 16 weeks
description: Comet assay data will be analyzed according to methods by Wiklund et al. Log-transformed, mean Olive tail moments, assessing DNA damage, will be calculated and compared using a paired t-test. For the ex vivo analyses using a challenge assay, Log-transformed, mean Olive tail moments will be calculated before and after the introduction of the damaging agent at 0, 1 and 6 hours. Differences between the changes will be analyzed using the paired t-test. Multivariate analysis of variance (MANOVA) for repeated measure will be performed and linear regression models will be fitted.
measure: Change in level of interleukin-6 (IL-6) cytokine measured by the 13 Plex-Immunology Multiplex Assay by EMD Millipore
time frame: Baseline to 16 weeks
description: Paired t-tests will be used to compare pre-exercise cytokine concentrations in order to test whether the 16-week Curves exercise intervention decreased markers of inflammation. As secondary analysis linear regression models will be fitted.
measure: Change in telomerase activity using the Trypan blue method and ImagedQuant
time frame: Baseline to up to 16 weeks
description: Paired t-tests will be used to compare pre-exercise telomerase activity in order to test the 16-week Curves exercise intervention. As a second analysis regression models will be fitted. Potential confounding factors that may contribute to differences within the two groups of women (e.g. BMI, exercise intensity, etc.) will be investigated and included as appropriate. The impact of exercise intensity via CurvesSmart card will also be examined.
measure: Change in the number of gamma-H2A histone, member X (H2AX) foci measured by the gamma-H2AX assay
time frame: Baseline to 16 weeks
description: First, gamma-H2AX foci will be counted, and compared using the paired t-test. Second, for the ex vivo analyses gamma-H2AX foci will be counted before and after the introduction of a damaging agent at 0, 1 and 6 hours. For each time point, a foci change will be obtained. Differences in the foci changes at baseline and 16-weeks will be analyzed using the paired t-test. MANOVA for repeated measures will be performed to allow for the assessment of overall multivariate and univariate results, and linear regression models will be fitted.
measure: Change in C-reactive protein (CRP) and levels of cytokines measured by the 13 Plex-Immunology Multiplex Assay by EMD Millipore
time frame: Baseline to 16 weeks
description: Paired t-tests will be used to compare pre-exercise CRP and cytokines concentrations in order to test whether the 16-week Curves exercise intervention decreased markers of inflammation. As secondary analysis linear regression models will be fitted.
measure: Adherence to the study protocol
time frame: 16 weeks
description: The CurvesSmart card will record both adherence of going to the sessions and completion of the circuit. Adherence will be analyzed as a continuous variable. During the 16-week testing session, women will be asked what barriers to adherence they may have experienced during the intervention.
measure: Changes in weight
time frame: Baseline to 16 weeks
description: A repeated measures analysis of variance (ANOVA) will be used.
measure: Changes in BMI
time frame: Baseline to 16 weeks
description: A repeated measures ANOVA will be used.
measure: Changes in percent body fat
time frame: Baseline to 16 weeks
description: A repeated measures ANOVA will be used.
measure: Changes in cardiopulmonary function
time frame: Baseline to 16 weeks
description: A repeated measures ANOVA will be used.
measure: Changes in muscle strength
time frame: Baseline to 16 weeks
description: A repeated measures ANOVA will be used.
measure: Changes in functional capacity
time frame: Baseline to 16 weeks
description: A repeated measures ANOVA will be used.
measure: Changes in quality of life scores
time frame: Baseline to 16 weeks
description: Changes in quality of life scores will be measured by Cohen's 10-item perceived stress scale, the Fatigue Symptom Inventory, Rosenberg Self-esteem Scale, the Centers for Epidemiology Depression (CESD) Scale, the state trait anxiety index (STAI), the Functional Assessment of Cancer Therapy-Breast scale (FACT-B+4), and Short Form-36 (SF-36) questionnaires. A repeated measures ANOVA will be used.
measure: Incidence of exercise-attributed injury
time frame: 16 weeks
description: During the 16-week testing session, women will be asked details about any injuries or discomfort they may have experienced during the participation in the exercise intervention.
measure: Change in telomere length as measured by quantitative polymerase chain reaction
time frame: Baseline up to 16 weeks
description: Paired t-tests will be used to compare pre-exercise telomere length in order to test the 16-week Curves exercise intervention. As a second analysis regression models will be fitted. Potential confounding factors that may contribute to differences within the two groups of women (e.g. BMI, exercise intensity, etc.) will be investigated and included as appropriate. The impact of exercise intensity via CurvesSmart card will also be examined.
arm group label: Arm I (exercise intervention)
arm group type: Experimental
description: Patients participate in a supervised Curves exercise program three days a week for 16 weeks. The circuit-style workout consists of 14 exercises constructed with pneumatic or hydraulic resistance that target opposing muscle groups in a concentric-only fashion. Each session at Curves will include two complete circuits which correspond to exercising for approximately 30 minutes followed by a standardized stretching routine.
arm group label: Arm II (no formal exercise intervention)
arm group type: No Intervention
description: Patients do not participate in a formal exercise program for 16 weeks. Patients are then offered the Curves exercise intervention.
intervention type: Behavioral
intervention name: exercise intervention
description: Undergo Curves exercise program
arm group label: Arm I (exercise intervention)
intervention type: Other
intervention name: laboratory biomarker analysis
description: Correlative studies
arm group label: Arm I (exercise intervention)
intervention type: Other
intervention name: questionnaire administration
description: Ancillary studies
arm group label: Arm I (exercise intervention)
intervention type: Other
intervention name: quality-of-life assessment
description: Ancillary studies
arm group label: Arm I (exercise intervention)
other name: quality of life assessment
criteria: 
gender: Female
minimum age: 56 Years
maximum age: N/A
healthy volunteers: No
last name: Jessica Clague DeHart
role: Principal Investigator
affiliation: City of Hope Medical Center
facility: 
country: United States
responsible party type: Sponsor
mesh term: Breast Neoplasms