Little is known about the impact of financial toxicity in disease-free breast cancer survivors.We aim to validate the COST in Korean (COST-K) and evaluate financial toxicity among disease-free breast cancer survivors. Materials and MethodsWe conducted linguistic validation following a standardized methodology recommended by FACITtrans. For psychometric validation, we conducted a cross-sectional survey with 4,297 disease-free breast cancer survivors at a tertiary hospital in Seoul, Korea between November 2018 and April 2019. Survivors were asked to complete the COST-K and EORTC QLQ-C30 questionnaires. The test-retest reliability, internal consistency, and validity of the COST-K were assessed using standard scale construction techniques. ResultsThe COST-K demonstrated good internal consistency, with a Cronbach's α of 0.81. The testretest analysis revealed an intraclass correlation coefficient of 0.78. The COST-K had moderate correlation (r = -0.60) with the financial difficulty item of the EORTC QLQ-C30 and week correlation with the items on acute and chronic symptom burdens (nausea/vomiting = -0.18, constipation = -0.14, diarrhea = -0.14), showing good convergent and divergent validity. The median COST-K was 27 (range, 0-44; mean ± SD, 27.1 ± 7.5) and about 30% and 5% of cancer survivors experienced mild and severe financial toxicity, respectively. Younger age, lower education, lower household income was associated with higher financial toxicity.

Background: The aim of this study was to investigate the relationship between changes in breast density during menopause and breast cancer risk. Methods: This study was a retrospective, longitudinal cohort study for women over 30 years of age who had undergone breast mammography serially at baseline and postmenopause during regular health checkups at Samsung Medical Center. None of the participants had been diagnosed with breast cancer at baseline. Mammographic breast density was measured using the American College of Radiology Breast Imaging Reporting and Data System. Results: During 18,615 person-years of follow-up (median follow-up 4.8 years; interquartile range 2.8–7.5 years), 45 participants were diagnosed with breast cancer. The prevalence of dense breasts was higher in those who were younger, underweight, had low parity or using contraceptives. The cumulative incidence of breast cancer increased 4 years after menopause in participants, and the consistently extremely dense group had a significantly higher cumulative incidence (CI) of breast cancer compared with other groups [CI of extremely dense vs. others (incidence rate per 100,000 person-years): 375 vs. 203, P < 0.01]. Conclusion: Korean women whose breast density was extremely dense before menopause and who maintained this density after menopause were at two-fold greater risk of breast cancer. Prevention Relevance: Extremely dense breast density that is maintained persistently from premenopause to postmenopause increases risk of breast cancer two fold in Korean women. Therefore, women having risk factors should receive mammography frequently and if persistently extremely dense breast had been detected, additional modalities of BC screening could be considered.

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