Improving staff engagement and development using pharmacy professional advancement career tract program.

BACKGROUND: To describe the benefits of an employee engagement and development program and provide an outline on how it may be adapted by other health system pharmacies. PRACTICE INNOVATION: The pharmacy Professional Advancement Career Tract (PACT) program has been active for over 10 years. A concept borrowed from nursing; it has become the primary employee engagement program within the pharmacy department. The program attracts self-motivated staff to participate in activities that benefit departmental operations and enhance the participant's project management and professional skills. This has provided an opportunity for staff to demonstrate their abilities and potential for future growth. The resources needed to initiate and maintain the program are program liaisons at the site level, mentorship time, and moderate bonus payments. A vast majority of the projects were completed (including cost savings initiatives) and the beneficial outcomes gained from those outweighed the minimal cost. CONCLUSION: Development and implementation of the pharmacy PACT program was a success for both staff and the pharmacy department. This program may benefit other pharmacy departments across the nation.

Perturbed myoepithelial cell differentiation in BRCA mutation carriers and in ductal carcinoma in situ.

Myoepithelial cells play key roles in normal mammary gland development and in limiting pre-invasive to invasive breast tumor progression, yet their differentiation and perturbation in ductal carcinoma in situ (DCIS) are poorly understood. Here, we investigated myoepithelial cells in normal breast tissues of BRCA1 and BRCA2 germline mutation carriers and in non-carrier controls, and in sporadic DCIS. We found that in the normal breast of non-carriers, myoepithelial cells frequently co-express the p63 and TCF7 transcription factors and that p63 and TCF7 show overlapping chromatin peaks associated with differentiated myoepithelium-specific genes. In contrast, in normal breast tissues of BRCA1 mutation carriers the frequency of p63+TCF7+ myoepithelial cells is significantly decreased and p63 and TCF7 chromatin peaks do not overlap. These myoepithelial perturbations in normal breast tissues of BRCA1 germline mutation carriers may play a role in their higher risk of breast cancer. The fraction of p63+TCF7+ myoepithelial cells is also significantly decreased in DCIS, which may be associated with invasive progression.

Breast implant-associated anaplastic large cell lymphoma.

Anaplastic large cell lymphoma is a rare disease associated with breast implants. We present the case of a woman who had had breast augmentation and multiple revisions over a period of 13 years and presented with recurrent fluid collections. The cause was determined to be anaplastic large cell lymphoma, which required removal of the implants, capsulectomy, and evaluation by a medical oncologist. The patient was not found to have metastatic disease on imaging studies. Breast implant-associated anaplastic large cell lymphoma is a poorly understood disease entity, and optimal treatment is unclear.

Two cancers in one: breast carcinoma with underlying melanoma.

A 61-year-old woman presented with a diagnosis of metastatic invasive lobular carcinoma of the right breast, and after treatment it had regressed or was stable except for a scalp nodule. When biopsied, the outer edges of the scalp lesion had findings consistent with breast carcinoma; however, the bulk of the tumor's pathology was consistent with melanoma. It appeared that most of the tumor was a highly vascularized melanoma with lobular breast carcinoma noted at its edges.

Basal cell adenoma of the breast.

Salivary gland-like neoplasms of the breast are a known entity. A single novel case of basal cell adenoma of the breast is presented, and the presentation, treatment, and morphologic features of this case are discussed.

Molecular profiling of human mammary gland links breast cancer risk to a p27(+) cell population with progenitor characteristics.

Early full-term pregnancy is one of the most effective natural protections against breast cancer. To investigate this effect, we have characterized the global gene expression and epigenetic profiles of multiple cell types from normal breast tissue of nulliparous and parous women and carriers of BRCA1 or BRCA2 mutations. We found significant differences in CD44(+) progenitor cells, where the levels of many stem cell-related genes and pathways, including the cell-cycle regulator p27, are lower in parous women without BRCA1/BRCA2 mutations. We also noted a significant reduction in the frequency of CD44(+)p27(+) cells in parous women and showed, using explant cultures, that parity-related signaling pathways play a role in regulating the number of p27(+) cells and their proliferation. Our results suggest that pathways controlling p27(+) mammary epithelial cells and the numbers of these cells relate to breast cancer risk and can be explored for cancer risk assessment and prevention.

Evolutionary pathways in BRCA1-associated breast tumors.

BRCA1-associated breast tumors display loss of BRCA1 and frequent somatic mutations of PTEN and TP53. Here we describe the analysis of BRCA1, PTEN, and p53 at the single cell level in 55 BRCA1-associated breast tumors and computational methods to predict the relative temporal order of somatic events, on the basis of the frequency of cells with single or combined alterations. Although there is no obligatory order of events, we found that loss of PTEN is the most common first event and is associated with basal-like subtype, whereas in the majority of luminal tumors, mutation of TP53 occurs first and mutant PIK3CA is rarely detected. We also observed intratumor heterogeneity for the loss of wild-type BRCA1 and increased cell proliferation and centrosome amplification in the normal breast epithelium of BRCA1 mutation carriers. Our results have important implications for the design of chemopreventive and therapeutic interventions in this high-risk patient population.