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Ohnstad HO, Blix ES, Akslen LA, Gilje B, Raj SX, Skjerven H, Borgen E, Janssen EAM, Mortensen E, Brekke MB, Falk RS, Schlichting E, Boge B, Songe-Møller S, Olsson P, Heie A, Mannsåker B, Vestlid MA, Kursetgjerde T, Gravdehaug B, Suhrke P, Sanchez E, Bublevic J, Røe OD, Geitvik GA, Halset EH, Rypdal MC, Langerød A, Lømo J, Garred Ø, Porojnicu A, Engebraaten O, Geisler J, Lyngra M, Hansen MH, Søiland H, Nakken T, Asphaug L, Kristensen V, Sørlie T, Nygård JF, Kiserud CE, Reinertsen KV, Russnes HG, Naume B. Impact of Prosigna test on adjuvant treatment decision in lymph node-negative early breast cancer-a prospective national multicentre study (EMIT-1). ESMO Open 2024; 9:103475. [PMID: 38838499 DOI: 10.1016/j.esmoop.2024.103475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/15/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND EMIT-1 is a national, observational, single-arm trial designed to assess the value of the Prosigna, Prediction Analysis of Microarray using the 50 gene classifier (PAM50)/Risk of Recurrence (ROR), test as a routine diagnostic tool, examining its impact on adjuvant treatment decisions, clinical outcomes, side-effects and cost-effectiveness. Here we present the impact on treatment decisions. PATIENTS AND METHODS Patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative pT1-pT2 lymph node-negative early breast cancer (EBC) were included. The Prosigna test and standard histopathology assessments were carried out. Clinicians' treatment decisions were recorded before (pre-Prosigna) and after (post-Prosigna) the Prosigna test results were disclosed. RESULTS Of 2217 patients included, 2178 had conclusive Prosigna results. The pre-Prosigna treatment decisions were: no systemic treatment (NT) in 27% of patients, endocrine treatment alone (ET) in 38% and chemotherapy (CT) followed by ET (CT + ET) in 35%. Post-Prosigna treatment decisions were 25% NT, 51% ET and 24% CT + ET, respectively. Adjuvant treatment changed in 28% of patients, including 21% change in CT use. Among patients assigned to CT + ET pre-Prosigna, 45% were de-escalated to ET post-Prosigna. Of patients assigned to ET, 12% were escalated to CT + ET and 8% were de-escalated to NT; of those assigned to NT, 18% were escalated to ET/CT + ET. CT was more frequently recommended for patients aged ≤50 years. In the subgroup with pT1c-pT2 G2 and intermediate Ki67 (0.5-1.5× local laboratory median Ki67 score), the pre-Prosigna CT treatment decision varied widely across hospitals (3%-51%). Post-Prosigna, the variability of CT use was markedly reduced (8%-24%). The correlation between Ki67 and ROR score within this subgroup was poor (r = 0.25-0.39). The median ROR score increased by increasing histological grade, but the ROR score ranges were wide (for G1 0-79, G2 0-90, G3 16-94). CONCLUSION The Prosigna test result changed adjuvant treatment decisions in all EBC clinical risk groups, markedly decreased the CT use for patients categorized as higher clinical risk pre-Prosigna and reduced treatment decision discrepancies between hospitals.
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Affiliation(s)
- H O Ohnstad
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo
| | - E S Blix
- Department of Oncology, University of North Norway, Tromsø; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø
| | - L A Akslen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen; Department of Pathology Haukeland University Hospital, Bergen
| | - B Gilje
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger
| | - S X Raj
- Department of Oncology, St Olavs Hospital, Trondheim
| | - H Skjerven
- Department of Breast Surgery, Vestre Viken Hospital Trust, Drammen
| | - E Borgen
- Department of Pathology, Division of Laboratory Medicine, Oslo University Hospital, Oslo
| | - E A M Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger; Department of Chemistry, Bioscience and Environmental Engineering, Stavanger University, Stavanger, Norway; Menzies Health Institute Queensland and Griffith University, Southport, Australia
| | - E Mortensen
- Department of Pathology, University of North Norway, Tromsø
| | - M B Brekke
- Department of Pathology, St Olavs Hospital, Trondheim
| | - R S Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo
| | - E Schlichting
- Department of Oncology, Breast and Endocrine Surgery Unit, Division of Cancer Medicine, Oslo University Hospital, Oslo
| | - B Boge
- Department of Oncology, Hospital of Southern Norway, Kristiansand
| | | | - P Olsson
- Department of Breast Surgery, Innlandet Hospital Trust, Hamar
| | - A Heie
- Department of Breast Surgery, Haukeland University Hospital, Bergen
| | - B Mannsåker
- Department of Oncology, Nordland Hospital, Bodø
| | - M A Vestlid
- Department of Breast Surgery, Telemark Hospital Trust, Skien
| | - T Kursetgjerde
- Department of Oncology, Møre og Romsdal Hospital Trust, Ålesund
| | - B Gravdehaug
- Department of Breast Surgery, Akershus University Hospital, Lørenskog
| | - P Suhrke
- Department of Pathology, Vestfold Hospital Trust, Tønsberg
| | - E Sanchez
- Department of Oncology, Haugesund Hospital, Haugesund
| | - J Bublevic
- Department of Oncology, Førde Central Hospital, Førde
| | - O D Røe
- Department of Oncology, Levanger Hospital, Levanger
| | - G A Geitvik
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo
| | - E H Halset
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo
| | - M C Rypdal
- Department of Pathology, Division of Laboratory Medicine, Oslo University Hospital, Oslo
| | - A Langerød
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo
| | - J Lømo
- Department of Pathology, Division of Laboratory Medicine, Oslo University Hospital, Oslo
| | - Ø Garred
- Department of Pathology, Division of Laboratory Medicine, Oslo University Hospital, Oslo
| | - A Porojnicu
- Department of Oncology, Vestre Viken Hospital Trust, Drammen
| | - O Engebraaten
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo; Institute of Clinical Medicine, University of Oslo, Oslo
| | - J Geisler
- Institute of Clinical Medicine, University of Oslo, Oslo; Department of Oncology, Akershus University Hospital, Lørenskog
| | - M Lyngra
- Department of Pathology, Akershus University Hospital, Lørenskog
| | - M H Hansen
- Department of Breast Surgery, University of North Norway, Tromsø
| | - H Søiland
- Department of Research, Stavanger University Hospital, Stavanger; Department of Clinical Science, University of Bergen, Bergen
| | - T Nakken
- User representative, Oslo University Hospital, Oslo
| | - L Asphaug
- Clinical Trials Unit, Oslo University Hospital, Oslo; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo
| | - V Kristensen
- Institute of Clinical Medicine, University of Oslo, Oslo
| | - T Sørlie
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo; Institute of Clinical Medicine, University of Oslo, Oslo
| | | | - C E Kiserud
- National Advisory Unit for Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - K V Reinertsen
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo; National Advisory Unit for Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - H G Russnes
- Department of Pathology, Division of Laboratory Medicine, Oslo University Hospital, Oslo; Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo; Institute of Clinical Medicine, University of Oslo, Oslo
| | - B Naume
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo; Institute of Clinical Medicine, University of Oslo, Oslo.
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2
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Toi M, Kinoshita T, Benson JR, Jatoi I, Kataoka M, Han W, Yamauchi C, Inamoto T, Takada M. Non-surgical ablation for breast cancer: an emerging therapeutic option. Lancet Oncol 2024; 25:e114-e125. [PMID: 38423057 DOI: 10.1016/s1470-2045(23)00615-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/18/2023] [Accepted: 11/21/2023] [Indexed: 03/02/2024]
Abstract
Non-surgical ablation is emerging as an alternative local therapy option for patients with early-stage breast cancer and encompasses two main types of percutaneous therapeutic procedures: radiofrequency ablation and cryoablation. Both techniques involve obliteration of a spherical lesion and feasibility studies have shown that complete tumour ablation is achievable with good or excellent cosmetic results. Although few clinical studies have directly compared non-surgical ablation with conventional surgical resection, observational studies indicate that clinical outcomes are favourable with acceptable rates of local control and no detriment to long-term survival. There remain outstanding issues with these percutaneous ablative techniques that require resolution before they could be incorporated into routine clinical practice. Hence, a consensus meeting was convened to discuss the challenges of non-surgical ablation and clarify indications for its use alongside clinical management pathways. In this Policy Review we will address some of the broader biological aspects of non-surgical ablation, including immune-modulatory effects and potential novel applications for the future.
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Affiliation(s)
- Masakazu Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan; Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - John R Benson
- Cambridge Breast Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK; School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - Ismail Jatoi
- Division of Surgical Oncology and Endocrine Surgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Wonshik Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Chikako Yamauchi
- Department of Radiation Oncology, Shiga General Hospital, Moriyama, Japan
| | - Takashi Inamoto
- Breast Center, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Masahiro Takada
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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3
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Naoum GE, Taghian AG. Endocrine Treatment for 5 Years or Radiation for 5 Days for Patients With Early Breast Cancer Older Than 65 Years: Can We Do It Right? J Clin Oncol 2022; 41:2331-2336. [PMID: 36538740 DOI: 10.1200/jco.22.02171] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- George E. Naoum
- Department of Radiation Oncology, Northwestern University Memorial Hospital, Chicago, IL
| | - Alphonse G. Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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4
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Cold S, Cold F, Jensen MB, Cronin-Fenton D, Christiansen P, Ejlertsen B. Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study. J Natl Cancer Inst 2022; 114:1347-1354. [PMID: 35854422 PMCID: PMC9552278 DOI: 10.1093/jnci/djac112] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/21/2022] [Accepted: 05/16/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Women treated for breast cancer (BC) often suffer genitourinary syndrome of menopause. These symptoms may be alleviated by vaginal estrogen therapy (VET) or menopausal hormone therapy (MHT). However, there are concerns of risks of recurrence of BC and death following treatment. METHODS Our study included longitudinal data from a national cohort of postmenopausal women, diagnosed 1997-2004 with early-stage invasive estrogen receptor-positive nonmetastatic BC, who received no treatment or 5 years of adjuvant endocrine therapy. We ascertained prescription data on hormone therapy, VET or MHT, from a national prescription registry. We evaluated mortality and risk of recurrence associated with use of VET and MHT vs non-use using multivariable models adjusted for potential confounders. RESULTS Among 8461 women who had not received VET or MHT before BC diagnosis, 1957 and 133 used VET and MHT, respectively, after diagnosis. Median follow-up was 9.8 years for recurrence and 15.2 years for mortality. The adjusted relative risk of recurrence was 1.08 (95% confidence interval [CI] = 0.89 to 1.32) for VET (1.39 [95% CI = 1.04 to 1.85 in the subgroup receiving adjuvant aromatase inhibitors]) and 1.05 (95% CI = 0.62 to 1.78) for MHT. The adjusted hazard ratios for overall mortality were 0.78 (95% CI = 0.71 to 0.87) and 0.94 (95% CI = 0.70 to 1.26) for VET and MHT, respectively. CONCLUSIONS In postmenopausal women treated for early-stage estrogen receptor-positive BC, neither VET nor MHT was associated with increased risk of recurrence or mortality. A subgroup analysis revealed an increased risk of recurrence, but not mortality, in patients receiving VET with adjuvant aromatase inhibitors.
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Affiliation(s)
- Søren Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Frederik Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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5
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Lemij AA, de Glas NA, Derks MGM, Bastiaannet E, Merkus JWS, Lans TE, van der Pol CC, van Dalen T, Vulink AJE, van Gerven L, Guicherit OR, Linthorst-Niers EMH, van den Bos F, Kroep JR, Liefers GJ, Portielje JEA. Discontinuation of adjuvant endocrine therapy and impact on quality of life and functional status in older patients with breast cancer. Breast Cancer Res Treat 2022; 193:567-577. [PMID: 35441273 PMCID: PMC9114046 DOI: 10.1007/s10549-022-06583-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/27/2022] [Indexed: 11/25/2022]
Abstract
Purpose Side effects are the main reason for discontinuation of adjuvant endocrine therapy in older adults. The aim of this study was to examine geriatric predictors of treatment discontinuation of adjuvant endocrine therapy within the first 2 years after initiation, and to study the association between early discontinuation and functional status and quality of life (QoL). Methods Patients aged ≥ 70 years with stage I–III breast cancer who received adjuvant endocrine therapy were included. The primary endpoint was discontinuation of endocrine therapy within 2 years. Risk factors for discontinuation were assessed using univariate logistic regression models. Linear mixed models were used to assess QoL and functional status over time. Results Overall, 258 patients were included, of whom 36% discontinued therapy within 2 years after initiation. No geriatric predictive factors for treatment discontinuation were found. Tumour stage was inversely associated with early discontinuation. Patients who discontinued had a worse breast cancer-specific QoL (b = − 4.37; 95% CI − 7.96 to − 0.78; p = 0.017) over the first 2 years, in particular on the future perspective subscale (b = − 11.10; 95% CI − 18.80 to − 3.40; p = 0.005), which did not recover after discontinuation. Treatment discontinuation was not associated with functional improvement. Conclusion A large proportion of older patients discontinue adjuvant endocrine treatment within 2 years after initiation, but geriatric characteristics are not predictive of early discontinuation of treatment. Discontinuation of adjuvant endocrine therapy did not positively affect QoL and functional status, which implies that the observed poorer QoL in this group is probably not caused by adverse effects of endocrine therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06583-7.
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Affiliation(s)
- Annelieke A Lemij
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Nienke A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marloes G M Derks
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos W S Merkus
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | - Titia E Lans
- Department of Surgery, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | | | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Annelie J E Vulink
- Department of Medical Oncology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Leander van Gerven
- Department of Internal Medicine, LangeLand Hospital, Zoetermeer, The Netherlands
| | - Onno R Guicherit
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Frederiek van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerrit Jan Liefers
- Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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6
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Carleton N, Nasrazadani A, Gade K, Beriwal S, Barry PN, Brufsky AM, Bhargava R, Berg WA, Zuley ML, van Londen GJ, Marroquin OC, Thull DL, Mai PL, Diego EJ, Lotze MT, Oesterreich S, McAuliffe PF, Lee AV. Personalising therapy for early-stage oestrogen receptor-positive breast cancer in older women. THE LANCET. HEALTHY LONGEVITY 2022; 3:e54-e66. [PMID: 35047868 PMCID: PMC8765742 DOI: 10.1016/s2666-7568(21)00280-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Age is one of the most important risk factors for the development of breast cancer. Nearly a third of all breast cancer cases occur in older women (aged ≥70 years), with most cases being oestrogen receptor-positive (ER+). Such tumours are often indolent and unlikely to be the ultimate cause of death for older women, particularly when considering other comorbidities. This Review focuses on unique clinical considerations for screening, detection, and treatment regimens for older women who develop ER+ breast cancers-specifically, we focus on recent trends for de-implementation of screening, staging, surgery, and adjuvant therapies along the continuum of care. Additionally, we also review emerging basic and translational research that will further uncover the unique underlying biology of these tumours, which develop in the context of systemic age-related inflammation and changing hormone profiles. With prevailing trends of clinical de-implementation, new insights into mechanistic biology might provide an opportunity for precision medicine approaches to treat patients with well tolerated, low-toxicity agents to extend patients' lives with a higher quality of life, prevent tumour recurrences, and reduce cancer-related burdens.
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Affiliation(s)
- Neil Carleton
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Azadeh Nasrazadani
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Kristine Gade
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Sushil Beriwal
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Parul N Barry
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Adam M Brufsky
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Rohit Bhargava
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Wendie A Berg
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Margarita L Zuley
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - G J van Londen
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Oscar C Marroquin
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Darcy L Thull
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Phuong L Mai
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Emilia J Diego
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Michael T Lotze
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Steffi Oesterreich
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Priscilla F McAuliffe
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Adrian V Lee
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
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7
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Hjorth CF, Damkier P, Ejlertsen B, Lash T, Sørensen HT, Cronin-Fenton D. Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark. BMC Med 2021; 19:235. [PMID: 34587961 PMCID: PMC8482675 DOI: 10.1186/s12916-021-02108-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/26/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To investigate how socioeconomic position (SEP) influences the effectiveness of cancer-directed treatment in premenopausal breast cancer patients in terms of breast cancer recurrence and mortality. METHODS We conducted a cohort study nested in the ProBeCaRe (Predictors of Breast Cancer Recurrence) cohort (n = 5959). We identified all premenopausal women aged 18-55 years diagnosed with non-metastatic breast cancer and prescribed docetaxel-based chemotherapy in Denmark during 2007-2011. Population-based administrative registries provided data on SEP: marital status (married including registered partnership or single including divorced or widowed), cohabitation (cohabiting or living alone), education (low, intermediate, or high), income (low, medium, or high), and employment status (employed, unemployed, or health-related absenteeism). For each SEP measure, we computed incidence rates, cumulative incidence proportions (CIPs), and used Poisson regression to compute incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of recurrence and death. We stratified on estrogen receptor (ER) status/tamoxifen to evaluate interaction. RESULTS Our study cohort included 2616 women; 286 (CIP 13%) experienced recurrence and 223 (CIP 11%) died during follow-up (median 6.6 and 7.2 years, respectively). Single women had both increased 5-year risks of recurrence (IRR 1.45, 95% CI 1.11-1.89) and mortality (IRR 1.83, 95% CI 1.32-2.52). Furthermore, we observed increased 5-year mortality in women with low education (IRR 1.49, 95% CI 0.95-2.33), low income (IRR 1.37, 95% CI 0.83-2.28), unemployment (IRR 1.61, 95% CI 0.83-3.13), or health-related work absenteeism (IRR 1.80, 95% CI 1.14-2.82), but smaller or no increased risk of recurrence. These findings were especially evident among women with ER+ tumors prescribed tamoxifen. Overall analyses (follow-up max. 10 years) provided similar results. CONCLUSIONS Low SEP in premenopausal women with non-metastatic breast cancer was associated with increased mortality, but not always recurrence. This suggests underdetection of recurrences in certain groups. Poor prognosis in women with low SEP, especially single women, may partly be explained by tamoxifen adherence.
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Affiliation(s)
- Cathrine Fonnesbech Hjorth
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, J.B. Winsløvs vej 4, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, Winsløwparken 19, University of Southern Denmark, 5000, Odense, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Oncology, University of Copenhagen, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Timothy Lash
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
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8
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Inotai A, Ágh T, Maris R, Erdősi D, Kovács S, Kaló Z, Senkus E. Systematic review of real-world studies evaluating the impact of medication non-adherence to endocrine therapies on hard clinical endpoints in patients with non-metastatic breast cancer. Cancer Treat Rev 2021; 100:102264. [PMID: 34388473 DOI: 10.1016/j.ctrv.2021.102264] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
Breast cancer, one of the most common malignancies, is associated with significant economic and health burden both at the patient and societal level. Although medication non-adherence to endocrine breast cancer therapies is common, so far only limited systematic evidence has been available on its quantitative consequences, as previous systematic reviews focused mainly on factors contributing to medication non-adherence. The objective of this review was to explore the implications of medication non-adherence to endocrine therapies on hard clinical outcomes in breast cancer based on real-world studies. A systematic literature review was conducted on PubMed; empirical evidence on hard clinical endpoints (i.e., survival, disease-free survival, metastasis and recurrence) were extracted from uni- or multivariate statistical analyses from retrospective or prospective cohort studies. Of the 2,360 identified records, 12 studies met the inclusion criteria. Two studies identified significant positive association between medication non-adherence and the risk of distant metastasis, three articles between medication non-adherence and the recurrence of breast cancer, two studies between medication non-adherence- and non-persistence and of worse disease-free survival and eight articles between medication non-adherence and mortality. There was only one study where the positive association between medication adherence and survival did not apply to all subgroups. The strong evidence on the negative health consequences of non-adherence to breast cancer treatments indicates the need for the regular monitoring of medication adherence. Furthermore, explicit inclusion of adherence enhancing interventions into health policy agenda would be warranted to improve medication adherence also at a system level.
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Affiliation(s)
- András Inotai
- Semmelweis University, Center for Health Technology Assessment, Budapest, Hungary; Syreon Research Institute, Budapest, Hungary.
| | - Tamás Ágh
- Syreon Research Institute, Budapest, Hungary.
| | | | - Dalma Erdősi
- Semmelweis University, Center for Health Technology Assessment, Budapest, Hungary; University of Pécs, Faculty of Pharmacy, Department of Pharmacoeconomics, Pécs, Hungary.
| | - Sándor Kovács
- Syreon Research Institute, Budapest, Hungary; University of Pécs, Faculty of Pharmacy, Department of Pharmacoeconomics, Pécs, Hungary.
| | - Zoltán Kaló
- Semmelweis University, Center for Health Technology Assessment, Budapest, Hungary; Syreon Research Institute, Budapest, Hungary.
| | - Elżbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland.
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9
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Systemic therapy for early breast cancer in older adults: current status and prospects. Curr Opin Oncol 2021; 33:574-583. [PMID: 34183493 DOI: 10.1097/cco.0000000000000768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In this review, we describe the evidence on the efficacy and the safety of systemic treatments for the management of early breast cancer (EBC) in older individuals. RECENT FINDINGS Chemotherapy has a temporary impact on quality of life (QoL) for older EBC patients and improves survival outcomes for those with oestrogen receptor (ER)-negative disease. Benefits were seen also in the context of comorbidities, although these may be influenced by selection bias. The Cancer and Aging Research Group-Breast Cancer tool can predict the risk of severe toxicities on chemotherapy in older patients. Gene expression profiling is less frequently used in older adults although it holds promise to better inform patient selection also in this age group.Postneoadjuvant systemic therapy and novel agents remain poorly described in older patients with EBC. No disease-free survival benefits were seen in older patients receiving abemaciclib plus adjuvant endocrine therapy. SUMMARY Chemotherapy is beneficial for selected older patients with high-risk, ER-negative EBC. Although its impact on QoL is temporary, preferences, higher risk of toxicity and competing risks need to be carefully considered. Open questions remain on novel therapeutic approaches and gene expression profile in older EBC patients and more real-world evidence is warranted.
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10
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Updated recommendations regarding the management of older patients with breast cancer: a joint paper from the European Society of Breast Cancer Specialists (EUSOMA) and the International Society of Geriatric Oncology (SIOG). Lancet Oncol 2021; 22:e327-e340. [PMID: 34000244 DOI: 10.1016/s1470-2045(20)30741-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 01/01/2023]
Abstract
Breast cancer is increasingly prevalent in older adults and is a substantial part of routine oncology practice. However, management of breast cancer in this population is challenging because the disease is highly heterogeneous and there is insufficient evidence specific to older adults. Decision making should not be driven by age alone but should involve geriatric assessments plus careful consideration of life expectancy, competing risks of mortality, and patient preferences. A multidisciplinary taskforce, including members of the European Society of Breast Cancer Specialists and International Society of Geriatric Oncology, gathered to expand and update the previous 2012 evidence-based recommendations for the management of breast cancer in older individuals with the endorsement of the European Cancer Organisation. These guidelines were expanded to include chemotherapy toxicity prediction calculators, cultural and social considerations, surveillance imaging, genetic screening, gene expression profiles, neoadjuvant systemic treatment options, bone-modifying drugs, targeted therapies, and supportive care. Recommendations on geriatric assessment, ductal carcinoma in situ, screening, primary endocrine therapy, surgery, radiotherapy, adjuvant systemic therapy, and secondary breast cancer were updated.
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11
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Candio P, Meads D, Hill AJ, Bojke L. Cost-effectiveness of a proportionate universal offer of free exercise: Leeds Let’s Get Active. J Public Health (Oxf) 2020; 43:876-886. [DOI: 10.1093/pubmed/fdaa113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
The purpose of this paper is to assess the cost-effectiveness of a proportionate universal programme to reduce physical inactivity (Leeds Let us Get Active (LLGA)) in adults.
Methods
A continuous-time Markov chain model was developed to assess the cost implications and QALY gains associated with increases in physical activity levels across the adult population. A parametric survival analysis approach was applied to estimate the decay of intervention effect over time. Baseline model data were obtained from previous economic models, population-based surveys and other published literature. A cost-utility analysis was conducted from a health care sector perspective over the programme duration (39 months). Scenario and probabilistic sensitivity analyses were performed to test the robustness of cost-effectiveness results.
Results
In total, 51 874 adult residents registered to the programme and provided baseline data,19.5% of which were living in deprived areas. Under base case assumptions, LLGA was found to be likely to be cost-effective. However, variations in key structural assumptions showed sensitivity of the results.
Conclusions
Results from this study suggest a non-negligible level of uncertainty regarding the effectiveness, and therefore, cost-effectiveness of a universal offer of free leisure centre-based exercise that targets hard to reach groups. Further data collection and a shift towards prospective evaluations are needed.
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Affiliation(s)
- Paolo Candio
- Health Economics Research Centre, University of Oxford, Oxford OX3 7LF, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York YO10 5DD, UK
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12
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Vogsen M, Bille C, Jylling AMB, Jensen MB, Ewertz M. Adherence to treatment guidelines and survival in older women with early-stage breast cancer in Denmark 2008-2012. Acta Oncol 2020; 59:741-747. [PMID: 32364416 DOI: 10.1080/0284186x.2020.1757148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: The aims of this study were to compare patients 70 years or older with younger patients, to examine whether Danish patients with early-stage breast cancer aged 70 years or more received treatment according to guidelines, the reasons for deviating from the guidelines, and to analyze whether such deviations affected survival.Methods: From the Danish Breast Cancer Cooperative Group (DBCG) database we identified 23,247 women diagnosed with early-stage breast cancer in Denmark from 2008 to 2012. 17,391 were aged less than 70 years and 5856 were 70+ years. We reviewed medical charts of 441 patients aged 70+ years from Funen (a region of Denmark) to ascertain whether treatment was given according to the guidelines of DBCG and if not, the reason for deviating. Overall survival was analyzed by Cox proportional hazards models.Results: Up to age 80 years most women (94%) had surgery according to guidelines, decreasing to 41% in women aged 85+ years, the main reason for omitting surgery being patients' requests. Patients with breast cancer over the age of 80 years did not have an excess mortality compared with the general population in Funen. Compared with women who had surgery according to guidelines, women who did not have surgery had a significantly higher risk of dying with a hazard ratio (HR) of 8.38 (95% Confidence Intervals (CI) 4.46-15.8) if they were less than 80 years and HR = 2.56 (95% CI 1.63-4.01) if they were 80 years or more (p = .003 for interaction).Conclusions: Adherence to treatment according to guidelines decreases with increasing age, mainly for patients aged 80+ years. Our results suggest that surgery is important for the survival of patients aged less than 80 years.
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Affiliation(s)
- Marianne Vogsen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Bille
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Ewertz
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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13
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Biancari F, Dahlbacka S, Juvonen T, Virtanen MPO, Maaranen P, Jaakkola J, Laakso T, Niemelä M, Tauriainen T, Vento A, Husso A, Savontaus M, Laine M, Mäkikallio T, Raivio P, Eskola M, Rosato S, Anttila V, Airaksinen J, Valtola A. Favorable outcome of cancer patients undergoing transcatheter aortic valve replacement. Int J Cardiol 2020; 315:86-89. [PMID: 32216975 DOI: 10.1016/j.ijcard.2020.03.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/27/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
AIM The aim of this study was to assess the outcome of transcatheter aortic valve replacement (TAVR) in patients with cancer. METHODS This is a retrospective study from the nationwide FinnValve registry on 2130 consecutive patients who underwent TAVR for severe AS from January 2008 to October 2017. RESULTS In this cohort, 417 patients (19.6%) had history of cancer and 113 (5.3%) had an active malignancy at the time of TAVR. Patients with any malignancy had similar late mortality than patients without any malignancy (at 7 years, 65.1% vs. 59.3%, adjusted HR 1.105, 95%CI 0.892-1.369). At 7 years, cancer-related mortality was 22.5% among patients with preoperative cancer, and 11.0% in those without preoperative cancer (p < 0.0001). Among cancer patients, 18 died of the same disease (at 7 years, mortality 12.5%). Active malignancy was not associated with increased risk of all-cause mortality (adjusted HR 1.100, 95%CI 0.757-1.599). However, patients with blood malignancies had a significantly increased risk of mortality (at 4-year, 53.5% vs. 35.4%, adjusted HR 2.029, 95%CI 1.328-3.098). CONCLUSIONS This analysis showed that, when properly selected by the heart team and oncologists, most cancer patients undergoing TAVR can achieve a good survival and eventually die of other diseases. Blood malignancies seem to carry a poor prognosis in these patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03385915; https://clinicaltrials.gov/ct2/show/NCT03385915.
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Affiliation(s)
- Fausto Biancari
- Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland; Department of Surgery, Oulu University Hospital and Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland.
| | | | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Marko P O Virtanen
- Heart Hospital, Tampere University Hospital, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Pasi Maaranen
- Heart Hospital, Tampere University Hospital, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Jussi Jaakkola
- Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland
| | - Teemu Laakso
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Tuomas Tauriainen
- Department of Surgery, Oulu University Hospital and Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
| | - Antti Vento
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Annastiina Husso
- Heart Center, Kuopio University Hospital, Kuopio, Finland; University of Tampere, Tampere, Finland
| | - Mikko Savontaus
- Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland
| | - Mika Laine
- Heart Center, Kuopio University Hospital, Kuopio, Finland; University of Tampere, Tampere, Finland
| | - Timo Mäkikallio
- Heart Hospital, Tampere University Hospital, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Stefano Rosato
- National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Vesa Anttila
- Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland
| | - Antti Valtola
- Heart Center, Kuopio University Hospital, Kuopio, Finland
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14
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Hu Y, Zhang Y, Cheng J. Diagnostic value of molybdenum target combined with DCE-MRI in different types of breast cancer. Oncol Lett 2019; 18:4056-4063. [PMID: 31516606 PMCID: PMC6732951 DOI: 10.3892/ol.2019.10746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/26/2019] [Indexed: 12/13/2022] Open
Abstract
This study compared the diagnostic value of molybdenum target and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in different types of breast cancer. A retrospective analysis was performed on 120 female patients with breast cancer admitted to The First Affiliated Hospital of Zhengzhou University from February 2015 to October 2017. All of them underwent DCE-MRI and molybdenum target examination. Postoperatively, the pathological tissues were examined to determine their molecular typing. The sensitivity and diagnostic coincidence rates of Luminal-B breast cancer with different molecular types diagnosed by molybdenum target combined with DCE-MRI were significantly higher than those of molybdenum target or DCE-MRI alone. There were no statistical differences in sensitivity and diagnostic coincidence rates of breast cancer with different molecular types diagnosed by molybdenum target or DCE-MRI alone between the two groups (P>0.05). Molybdenum target combined with DCE-MRI in the diagnosis of different molecular types of breast cancer is better than the single imaging screening, which is of great clinical significance in the development of individualized comprehensive treatment for breast cancer patients and worthy of wide promotion in clinical practice.
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Affiliation(s)
- Ying Hu
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Yan Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
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15
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Wöckel A, Festl J, Stüber T, Brust K, Krockenberger M, Heuschmann PU, Jírů-Hillmann S, Albert US, Budach W, Follmann M, Janni W, Kopp I, Kreienberg R, Kühn T, Langer T, Nothacker M, Scharl A, Schreer I, Link H, Engel J, Fehm T, Weis J, Welt A, Steckelberg A, Feyer P, König K, Hahne A, Baumgartner T, Kreipe HH, Knoefel WT, Denkinger M, Brucker S, Lüftner D, Kubisch C, Gerlach C, Lebeau A, Siedentopf F, Petersen C, Bartsch HH, Schulz-Wendtland R, Hahn M, Hanf V, Müller-Schimpfle M, Henscher U, Roncarati R, Katalinic A, Heitmann C, Honegger C, Paradies K, Bjelic-Radisic V, Degenhardt F, Wenz F, Rick O, Hölzel D, Zaiss M, Kemper G, Budach V, Denkert C, Gerber B, Tesch H, Hirsmüller S, Sinn HP, Dunst J, Münstedt K, Bick U, Fallenberg E, Tholen R, Hung R, Baumann F, Beckmann MW, Blohmer J, Fasching P, Lux MP, Harbeck N, Hadji P, Hauner H, Heywang-Köbrunner S, Huober J, Hübner J, Jackisch C, Loibl S, Lück HJ, von Minckwitz G, Möbus V, Müller V, Nöthlings U, Schmidt M, Schmutzler R, Schneeweiss A, Schütz F, Stickeler E, Thomssen C, Untch M, Wesselmann S, Bücker A, Buck A, Stangl S. Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) - Part 2 with Recommendations for the Therapy of Primary, Recurrent and Advanced Breast Cancer. Geburtshilfe Frauenheilkd 2018; 78:1056-1088. [PMID: 30581198 PMCID: PMC6261741 DOI: 10.1055/a-0646-4630] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Method The process of updating the S3 guideline published in 2012 was based on the adaptation of identified source guidelines. They were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and with the results of a systematic search of literature databases followed by the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point and used them to develop suggestions for recommendations and statements, which were then modified and graded in a structured consensus process procedure. Recommendations Part 2 of this short version of the guideline presents recommendations for the therapy of primary, recurrent and metastatic breast cancer. Loco-regional therapies are de-escalated in the current guideline. In addition to reducing the safety margins for surgical procedures, the guideline also recommends reducing the radicality of axillary surgery. The choice and extent of systemic therapy depends on the respective tumor biology. New substances are becoming available, particularly to treat metastatic breast cancer.
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Affiliation(s)
- Achim Wöckel
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Jasmin Festl
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Tanja Stüber
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Katharina Brust
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | | | - Peter U. Heuschmann
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | - Steffi Jírů-Hillmann
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | | | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | - Ina Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | | | - Thorsten Kühn
- Frauenklinik, Klinikum Esslingen, Esslingen, Germany
| | - Thomas Langer
- Office des Leitlinienprogrammes Onkologie, Berlin, Germany
| | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Anton Scharl
- Frauenklinik, Klinikum St. Marien Amberg, Amberg, Germany
| | | | - Hartmut Link
- Praxis für Hämatologie und Onkologie, Kaiserslautern, Germany
| | - Jutta Engel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Tanja Fehm
- Universitätsfrauenklinik Düsseldorf, Düsseldorf, Germany
| | - Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Tumorzentrum/CCC Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Anja Welt
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Germany
| | | | - Petra Feyer
- Klinik für Strahlentherapie und Radioonkologie, Vivantes Klinikum, Neukölln Berlin, Germany
| | - Klaus König
- Berufsverband der Frauenärzte, Steinbach, Germany
| | | | | | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Wolfram Trudo Knoefel
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Denkinger
- AGAPLESION Bethesda Klinik, Geriatrie der Universität Ulm, Ulm, Germany
| | - Sara Brucker
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Benjamin Franklin, Universitätsklinikum Charité, Berlin, Germany
| | - Christian Kubisch
- Institut für Humangenetik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Gerlach
- III. Medizinische Klinik und Poliklinik, uct, Interdisziplinäre Abteilung für Palliativmedizin, Universitätsmedizin der Johannes Gutenberg Universität, Mainz, Germany
| | - Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Cordula Petersen
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Markus Hahn
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Volker Hanf
- Frauenklinik Nathanstift, Klinikum Fürth, Fürth, Germany
| | | | | | - Renza Roncarati
- Frauenselbsthilfe nach Krebs – Bundesverband e. V., Bonn, Germany
| | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Christoph Heitmann
- Ästhetisch plastische und rekonstruktive Chirurgie, Camparihaus München, München, Germany
| | | | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Hamburg, Germany
| | - Vesna Bjelic-Radisic
- Universitätsfrauenklinik, Abteilung für Gynäkologie, Medizinische Universität Graz, Graz, Austria
| | - Friedrich Degenhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Frederik Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Oliver Rick
- Klinik Reinhardshöhe Bad Wildungen, Bad Wildungen, Germany
| | - Dieter Hölzel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Matthias Zaiss
- Praxis für interdisziplinäre Onkologie & Hämatologie, Freiburg, Germany
| | | | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Denkert
- Institut für Pathologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | - Hans Tesch
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | | | - Hans-Peter Sinn
- Pathologisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Karsten Münstedt
- Frauenklinik Offenburg, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Ulrich Bick
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Eva Fallenberg
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Reina Tholen
- Deutscher Verband für Physiotherapie, Referat Bildung und Wissenschaft, Köln, Germany
| | - Roswita Hung
- Frauenselbsthilfe nach Krebs, Wolfsburg, Germany
| | - Freerk Baumann
- Centrum für Integrierte Onkologie Köln, Uniklinik Köln, Köln, Germany
| | - Matthias W. Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jens Blohmer
- Klinik für Gynäkologie incl. Brustzentrum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Fasching
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael P. Lux
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadia Harbeck
- Brustzentrum, Frauenklinik, Universität München (LMU), München, Germany
| | - Peyman Hadji
- Klinik für Gynäkologie und Geburtshilfe, Krankenhaus Nordwest, Frankfurt, Germany
| | - Hans Hauner
- Lehrstuhl für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | | | - Jutta Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | | | | | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ute Nöthlings
- Institut für Ernährungs- und Lebensmittelwissenschaften, Rheinische Friedrich-Wilhelms Universität Bonn, Bonn, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Universitätsmedizin der Johannes Gutenberg-Universität Mai, Germany nz, Mainz
| | - Rita Schmutzler
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen, Aachen, Germany
| | | | - Michael Untch
- Klinik für Geburtshilfe und Gynäkologie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | - Arno Bücker
- Klinik für Diagnostische und Interventionelle Radiologie am UKS, Universität des Saarlandes, Homburg, Germany
| | - Andreas Buck
- Nuklearmedizinische Klinik und Poliklinik des Universitätsklinikums Würzburg, Würzburg, Germany
| | - Stephanie Stangl
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
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16
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Derks MGM, Bastiaannet E, Kiderlen M, Hilling DE, Boelens PG, Walsh PM, van Eycken E, Siesling S, Broggio J, Wyld L, Trojanowski M, Kolacinska A, Chalubinska-Fendler J, Gonçalves AF, Nowikiewicz T, Zegarski W, Audisio RA, Liefers GJ, Portielje JEA, van de Velde CJH. Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group. Br J Cancer 2018; 119:121-129. [PMID: 29875471 PMCID: PMC6035184 DOI: 10.1038/s41416-018-0090-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/23/2018] [Accepted: 03/28/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Older patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival. METHODS Population-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. Proportions of local and systemic treatments, five-year relative survival and relative excess risks (RER) between countries were calculated. RESULTS In total, 236,015 patients were included. The proportion of stage I BC receiving endocrine therapy ranged from 19.6% (Netherlands) to 84.6% (Belgium). The proportion of stage III BC receiving no breast surgery varied between 22.0% (Belgium) and 50.8% (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95%CI 1.30-6.72, P < .001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium. CONCLUSIONS There is substantial variation in treatment strategies and survival outcomes in elderly with BC in Europe. For early-stage BC, we observed large variation in endocrine therapy but no variation in relative survival, suggesting potential overtreatment. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment.
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Affiliation(s)
- Marloes G M Derks
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.,Department of Gerontology & Geriatrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Mandy Kiderlen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Denise E Hilling
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Petra G Boelens
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Paul M Walsh
- National Cancer Registry of Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, T12 CDF7, Ireland
| | | | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, Utrecht, 3511 DT, The Netherlands
| | - John Broggio
- Public Health England, 5 St Philip's Place, Birmingham, B3 2PW, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Western Bank, Sheffield, S10 2TN, UK
| | - Maciej Trojanowski
- Greater Poland Cancer Registry, Greater Poland Cancer Center, Garbary 15, Poznań, 60-101, Poland
| | - Agnieszka Kolacinska
- Department of Head and Neck Cancer Surgery, Department of Surgical Oncology, Medical University of Lodz, Kościuszki 4, Łódź, 90-419, Poland
| | | | - Ana Filipa Gonçalves
- Portuguese Oncology Institute of Porto, R. Dr. António Bernardino de Almeida 62, Porto, 4200-162, Portugal
| | - Tomasz Nowikiewicz
- Department of Surgical Oncology, Ludwik Rydygier's Collegium Medicum, Jagiellońska 13-15, Bydgoszcz, 85-067, Poland
| | - Wojciech Zegarski
- Department of Surgical Oncology, Ludwik Rydygier's Collegium Medicum, Jagiellońska 13-15, Bydgoszcz, 85-067, Poland
| | - Riccardo A Audisio
- Department of Surgery, St Helens Teaching Hospital, University of Liverpool, Marshalls Cross Rd, Saint Helens, St Helens, WA9 3DA, UK
| | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Johanneke E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Cornelis J H van de Velde
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
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17
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Freedman RA, Keating NL, Lin NU, Winer EP, Vaz-Luis I, Lii J, Exman P, Barry W. Breast cancer-specific survival by age: Worse outcomes for the oldest patients. Cancer 2018; 124:2184-2191. [PMID: 29499074 PMCID: PMC5935594 DOI: 10.1002/cncr.31308] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/27/2018] [Accepted: 02/01/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Although breast cancer often is perceived to be indolent in older women, breast cancer outcomes in the oldest patients are variable. In the current study, the authors examined breast cancer-specific death by age, stage, and disease subtype in a large, population-based cohort. METHODS Using Surveillance, Epidemiology, and End Results data, a total of 486,118 women diagnosed with American Joint Committee on Cancer stage I to IV breast cancer between 2000 and 2012 were identified. Using a series of Fine and Gray regression models to account for competing risk, the authors examined the risk of breast cancer-specific death by age and stage (I-IV) for subcohorts with hormone receptor (HR)-positive, HR-negative, human epidermal growth factor receptor 2-positive, and triple-negative disease, adjusting for demographic and clinical variables. RESULTS Overall, 18% of women were aged 65 to 74 years, 13% were aged 75 to 84 years, and 4% were aged ≥85 years. Regardless of stage of disease within the HR-positive and HR-negative cohorts, patients aged ≥75 years (vs those aged 55-64 years) experienced a higher adjusted hazard of breast cancer-specific death, which was particularly evident for those with early-stage, HR-positive disease (hazard ratio for those aged 75-84 years, 1.88 [95% confidence interval, 1.68-2.09] and hazard ratio for those aged ≥85 years, 3.59 [95% confidence interval, 3.12-4.13] [both for stage I disease]). In the cohorts with human epidermal growth factor receptor 2-positive and triple-negative disease, women aged ≥70 years had a consistently higher risk of breast cancer-specific death across disease stages (vs those aged 51-60 years), with the exception of stage IV triple-negative disease. CONCLUSIONS Older patients experience worse breast cancer outcomes, regardless of disease subtype and stage. With an increasing number of older patients anticipated to develop breast cancer in the future, addressing disparities for older patients must emerge as a clinical and research priority. Cancer 2018;124:2184-91. © 2018 American Cancer Society.
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Affiliation(s)
- Rachel A. Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston
| | - Nancy U. Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Eric P. Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ines Vaz-Luis
- Department of Medical Oncology, INSERM unit 981, Institute Gustave Roussy, Villejuif, France
| | - Joyce Lii
- Department of Pharmacoepidemiology, Brigham and Women’s Hospital, Boston
| | - Pedro Exman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - William Barry
- Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Boston
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18
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Block I, Burton M, Sørensen KP, Andersen L, Larsen MJ, Bak M, Cold S, Thomassen M, Tan Q, Kruse TA. Association of miR-548c-5p, miR-7-5p, miR-210-3p, miR-128-3p with recurrence in systemically untreated breast cancer. Oncotarget 2018; 9:9030-9042. [PMID: 29507672 PMCID: PMC5823652 DOI: 10.18632/oncotarget.24088] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/02/2018] [Indexed: 01/10/2023] Open
Abstract
Current prognostic markers allocate the majority of lymph node (LN) negative and estrogen receptor (ER) positive breast cancer patients into the high-risk group. Accordingly, most patients receive systemic treatments although approximately 40% of these patients may have been cured by surgery and radiotherapy alone. Two studies identified seven prognostic microRNAs in systemically untreated, LN negative and ER positive breast cancer patients which may allow more precise patient classification. However, six of the seven microRNAs were analyzed in both studies but only found to be prognostic in one study. To validate their prognostic potential, we analyzed microRNA expression in an independent cohort (n = 110) using a pair-matched study design minimizing dependence of classical markers. The expression of hsa-miR-548c-5p was significantly associated with abridged disease-free survival (hazard ratio [HR]:1.96, p = 0.027). Contradicting published results, high hsa-miR-516-3p expression was associated with favorable outcome (HR:0.29, p = 0.0068). The association is probably time-dependent indicating later relapse. Additionally, re-analysis of previously published expression data of two matching cohorts (n = 100, n = 255) supports an association of hsa-miR-128-3p with shortened disease-free survival (HR:2.48, p = 0.0033) and an upregulation of miR-7-5p (p = 0.0038; p = 0.039) and miR-210-3p (p = 0.031) in primary tumors of patients who experienced metastases. Further analysis may verify the prognostic potential of these microRNAs.
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Affiliation(s)
- Ines Block
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Mark Burton
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristina P Sørensen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Lars Andersen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin J Larsen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Bak
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Søren Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Qihua Tan
- Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Epidemiology, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Torben A Kruse
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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19
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Ejlertsen B, Offersen BV, Overgaard J, Christiansen P, Jensen MB, Kroman N, Knoop AS, Mouridsen H. Forty years of landmark trials undertaken by the Danish Breast Cancer Cooperative Group (DBCG) nationwide or in international collaboration. Acta Oncol 2018; 57:3-12. [PMID: 29205077 DOI: 10.1080/0284186x.2017.1408962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Over the past 40 years the Danish Breast Cancer Cooperative Group (DBCG) has made significant contributions to improve outcome and to make treatment of patients with early breast cancer more tolerable through nationwide and international trials evaluating loco-regional and systemic treatments. These trials have been instrumental to establish standards for the treatment of early breast cancer. METHODS The DBCG 82 trials had a global impact by documenting that the significant gain in loco-regional recurrence from postmastectomy radiation added to systemic therapy was associated with a reduction in distant recurrence and mortality in high-risk pre- and postmenopausal patients. The DBCG trials comparing breast conserving surgery and radiotherapy with mastectomy and more recently the trial of internal mammary node irradiation also had a major impact of practice. The trials initiated by the DBCG 40 years ago on tamoxifen and cyclophosphamide based chemotherapy became instrumental for the development of adjuvant systemic therapy not only due to their positive results but by sharing these important data with other members of the Early Breast Cancer Trialist' Collaborative Group (EBCTCG). Trials from the DBCG have also been important for highlighting the relative importance of anthracyclines and taxanes in the adjuvant setting. Furthermore, DBCG has made a major contribution to the development of aromatase inhibitors and targeted adjuvant treatment for human epidermal growth factor receptor 2 positive breast cancers. RESULTS The substantial impact of these treatment improvements is illustrated by a 46.7% 10-year overall survival of early breast cancer patients treated in 1978-1987 compared to 71.5% for patients treated 2008-2012. CONCLUSIONS The trials conducted and implemented by the DBCG appear to have a major impact on the substantial survival improvements in breast cancer.
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Affiliation(s)
- Bent Ejlertsen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Vrou Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Department of Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Ann Søgaard Knoop
- Department of Oncology, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Henning Mouridsen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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20
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Rossing M, Østrup O, Majewski WW, Kinalis S, Jensen MB, Knoop A, Kroman N, Talman ML, Hansen TVO, Ejlertsen B, Nielsen FC. Molecular subtyping of breast cancer improves identification of both high and low risk patients. Acta Oncol 2018; 57:58-66. [PMID: 29164972 DOI: 10.1080/0284186x.2017.1398416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Transcriptome analysis enables classification of breast tumors into molecular subtypes that correlate with prognosis and effect of therapy. We evaluated the clinical benefits of molecular subtyping compared to our current diagnostic practice. MATERIALS AND METHODS Molecular subtyping was performed on a consecutive and unselected series of 524 tumors from women with primary breast cancer (n = 508). Tumors were classified by the 256 gene expression signature (CIT) and compared to conventional immunohistochemistry (IHC) procedures. RESULTS More than 99% of tumors were eligible for molecular classification and final reports were available prior to the multidisciplinary conference. Using a prognostic standard mortality rate index (PSMRi) developed by the Danish Breast Cancer Group (DBCG) 39 patients were assigned with an intermediate risk and among these 16 (41%) were furthermore diagnosed by the multi-gene signature assigned with a luminal A tumor and consequently spared adjuvant chemotherapy. There was overall agreement between mRNA derived and IHC hormone receptor status, whereas IHC Ki67 protein proliferative index proved inaccurate, compared to the mRNA derived index. Forty-one patients with basal-like (basL) subtypes were screened for predisposing mutations regardless of clinical predisposition. Of those 17% carried pathogenic mutations. CONCLUSION Transcriptome based subtyping of breast tumors evidently reduces the need for adjuvant chemotherapy and improves identification of women with predisposing mutations. The results imply that transcriptome profiling should become an integrated part of current breast cancer management.
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Affiliation(s)
- Maria Rossing
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Olga Østrup
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Wiktor W. Majewski
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Savvas Kinalis
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ann Knoop
- Department of Clinical Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maj-Lis Talman
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas V. O. Hansen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Finn C. Nielsen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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21
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Jensen MB, Laenkholm AV, Offersen BV, Christiansen P, Kroman N, Mouridsen HT, Ejlertsen B. The clinical database and implementation of treatment guidelines by the Danish Breast Cancer Cooperative Group in 2007-2016. Acta Oncol 2018; 57:13-18. [PMID: 29202621 DOI: 10.1080/0284186x.2017.1404638] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Since 40 years, Danish Breast Cancer Cooperative Group (DBCG) has provided comprehensive guidelines for diagnosis and treatment of breast cancer. This population-based analysis aimed to describe the plurality of modifications introduced over the past 10 years in the national Danish guidelines for the management of early breast cancer. By use of the clinical DBCG database we analyze the effectiveness of the implementation of guideline revisions in Denmark. METHODS From the DBCG guidelines we extracted modifications introduced in 2007-2016 and selected examples regarding surgery, radiotherapy (RT) and systemic treatment. We assessed introduction of modifications from release on the DBCG webpage to change in clinical practice using the DBCG clinical database. RESULTS Over a 10-year period data from 48,772 patients newly diagnosed with malignant breast tumors were entered into DBCG's clinical database and 42,197 of these patients were diagnosed with an invasive carcinoma following breast conserving surgery (BCS) or mastectomy. More than twenty modifications were introduced in the guidelines. Implementations, based on prospectively collected data, varied widely; exemplified with around one quarter of the patients not treated according to a specific guideline within one year from the introduction, to an almost immediate full implantation. CONCLUSIONS Modifications of the DBCG guidelines were generally well implemented, but the time to full implementation varied from less than one year up to around five years. Our data is registry based and does not allow a closer analysis of the causes for delay in implementation of guideline modifications.
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Affiliation(s)
- Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Peer Christiansen
- Breast Unit, Aarhus University Hospital/Randers Regional Hospital, Aarhus, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Henning T. Mouridsen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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22
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Xu W, Jia G, Cai N, Huang S, Davie JR, Pitz M, Banerji S, Murphy L. A 16 Yin Yang gene expression ratio signature for ER+/node- breast cancer. Int J Cancer 2017; 140:1413-1424. [PMID: 27925180 DOI: 10.1002/ijc.30556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 11/17/2016] [Indexed: 01/20/2023]
Abstract
Breast cancer is one of the leading causes of cancer death in women. It is a complex and heterogeneous disease with different clinical outcomes. Stratifying patients into subgroups with different outcomes could help guide clinical decision making. In this study, we used two opposing groups of genes, Yin and Yang, to develop a prognostic expression ratio signature. Using the METABRIC cohort we identified a16-gene signature capable of stratifying breast cancer patients into four risk levels with intention that low-risk patients would not undergo adjuvant systemic therapy, intermediate-low-risk patients will be treated with hormonal therapy only, and intermediate-high- and high-risk groups will be treated by chemotherapy in addition to the hormonal therapy. The 16-gene signature for four risk level stratifications of breast cancer patients has been validated using 14 independent datasets. Notably, the low-risk group (n = 51) of 205 estrogen receptor-positive and node negative (ER+/node-) patients from three different datasets who had not had any systemic adjuvant therapy had 100% 15-year disease-specific survival rate. The Concordance Index of YMR for ER+/node negative patients is close to the commercially available signatures. However, YMR showed more significance (HR = 3.7, p = 8.7e-12) in stratifying ER+/node- subgroup than OncotypeDx (HR = 2.7, p = 1.3e-7), MammaPrint (HR = 2.5, p = 5.8e-7), rorS (HR = 2.4, p = 1.4e-6), and NPI (HR = 2.6, p = 1.2e-6). YMR signature may be developed as a clinical tool to select a subgroup of low-risk ER+/node- patients who do not require any adjuvant hormonal therapy (AHT).
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Affiliation(s)
- Wayne Xu
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB.,Department of Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB.,College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Gaofeng Jia
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB
| | - Nianguang Cai
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB
| | - Shujun Huang
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB.,College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - James R Davie
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB.,Department of Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Marshall Pitz
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB.,Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Shantanu Banerji
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB.,Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Leigh Murphy
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB.,Department of Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
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23
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Abstract
AIM OF DATABASE Danish Breast Cancer Cooperative Group (DBCG), with an associated database, was introduced as a nationwide multidisciplinary group in 1977 with the ultimate aim to improve the prognosis in breast cancer. Since then, the database has registered women diagnosed with primary invasive nonmetastatic breast cancer. The data reported from the departments to the database included details of the characteristics of the primary tumor, of surgery, radiotherapy, and systemic therapies, and of follow-up reported on specific forms from the departments in question. DESCRIPTIVE DATA From 1977 through 2014, ~110,000 patients are registered in the nationwide, clinical database. The completeness has gradually improved to more than 95%. DBCG has continuously prepared evidence-based guidelines on diagnosis and treatment of breast cancer and conducted quality control studies to ascertain the degree of adherence to the guidelines in the different departments. CONCLUSION Utilizing data from the DBCG database, a long array of high-quality DBCG studies of various designs and scope, nationwide or in international collaboration, have contributed to the current updating of the guidelines, and have been an instrumental resource in the improvement of management and prognosis of breast cancer in Denmark. Thus, since the establishment of DBCG, the prognosis in breast cancer has continuously improved with a decrease in 5-year mortality from ~37% to 15%.
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Affiliation(s)
- Peer Christiansen
- Department of Surgery P, Breast Surgery Unit, Aarhus University Hospital/Randers Regional Hospital, Aarhus C
| | - Bent Ejlertsen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital
- DBCG-secretariat, Department 2501, Rigshospitalet, Copenhagen Ø, Denmark
| | - Maj-Britt Jensen
- DBCG-secretariat, Department 2501, Rigshospitalet, Copenhagen Ø, Denmark
| | - Henning Mouridsen
- DBCG-secretariat, Department 2501, Rigshospitalet, Copenhagen Ø, Denmark
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24
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Dalenc F, Penault-Llorca F, Cohen M, Houvenaeghel G, Piat JM, Liegeois P, Puyuelo L, Suchaud JP, Zouai M, Lacroix-Triki M, Radosevic-Robin N, Benkanoun C, Attar-Rabia H, Chauvet MP, Gligorov J, Belkacemi Y. Daily Practice Management of pT1a-b pN0 Breast Carcinoma: A Prospective French ODISSEE Cohort Study. Clin Breast Cancer 2016; 17:107-116. [PMID: 27856201 DOI: 10.1016/j.clbc.2016.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/29/2016] [Accepted: 08/20/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most breast cancer (BC) tumors ≤10 mm have an excellent prognosis. The subgroups with a higher risk for distant recurrence requiring adjuvant systemic therapy are not precisely defined in current international guidelines. PATIENTS AND METHODS The OBSERVATOIRE DES PETITS CANCERS DU SEIN HER2 +/- (ODISSEE) study was a prospective, multicenter, cohort study that aimed to describe the daily adjuvant management and outcome of 616 patients with unifocal, invasive pT1a-b pN0 nonmetastatic BC who underwent surgery. RESULTS At the time of diagnosis, the median age of patients was 61 years. Tumor was detected on imaging or during a screening program in 397 patients (64.6%). Most patients (96%) underwent conservative surgery with sentinel node biopsy (89%), completed with axillary lymph node dissection in 15%. At inclusion, 82% of tumors were pT1b, 73% were pN0 (i-), 53% were Scarff-Bloom-Richardson Grade I, 91% were estrogen receptor (ER)-positive, 5% overexpressed/amplified HER2, and 5% were triple negative (TNBC). Adjuvant treatments were radiotherapy (95%), hormone therapy (82%), chemotherapy (7%), and trastuzumab (3.5%). In patients with TNBC and HER2-positive BC, chemotherapy and trastuzumab (if needed) were administered in 45% and 68%, respectively. After 5 years of follow-up, 7 patients had contralateral BC, 7 had locoregional recurrence, and 1 had distant metastasis. At 5 years, overall survival, disease-free survival, and recurrence-free survival were: 98.4% (96.9%-99.1%), 94.7% (92.4%-96.3%), and 97.1% (95.2%-98.2%), respectively. CONCLUSION This prospective cohort study showed that in France, the routine practice in pT1a-b pN0 breast cancers follows international standard guidelines for practice including conservative surgery followed by radiotherapy and endocrine therapy for ER-positive patients. Adjuvant chemotherapy with or without trastuzumab was used but their benefit in breast cancer of ≤10 mm remains controversial.
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Affiliation(s)
- Florence Dalenc
- Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse (UICT)-Oncopole, Department of Medical Oncology and Inserm UMR 1037, Team "Cholesterol Metabolism and Therapeutic Innovations", Cancer Research Center, Toulouse, France
| | | | - Monique Cohen
- Department of Surgery, Private Institute, Aubagne, France
| | | | | | | | - Laurent Puyuelo
- Department of Breast and Gynecologic Surgery, Union Clinic, Saint Jean, France
| | | | - Mohammed Zouai
- Department of Radiotherapy, Marie Curie Institute, Valence, France
| | - Magali Lacroix-Triki
- Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse (UICT)-Oncopole, Department of Medical Oncology and Inserm UMR 1037, Team "Cholesterol Metabolism and Therapeutic Innovations", Cancer Research Center, Toulouse, France
| | | | | | | | - Marie-Pierre Chauvet
- Department of Breast Surgery, Oscar Lambret Anti-Cancer Center-UNICANCER, Lille, France
| | - Joseph Gligorov
- Assistance Publique Hôpitaux de Paris (AP-HP), Department of Medical Oncology, Tenon Hospital, and University of Pierre et Marie Curie (UPMC), Paris
| | - Yazid Belkacemi
- Assistance Publique Hôpitaux de Paris (AP-HP), Department of Radiation Oncology and Henri Mondor Breast Center, INSERM U955 E07, and University of Paris-Est Créteil (UPEC), France.
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25
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Leone J, Leone BA, Leone JP. Adjuvant systemic therapy in older women with breast cancer. BREAST CANCER-TARGETS AND THERAPY 2016; 8:141-7. [PMID: 27524919 PMCID: PMC4966695 DOI: 10.2147/bctt.s110765] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Breast cancer in the elderly is an increasing clinical problem. In addition, ~60% of deaths from breast cancer occur in women aged 65 years and older. Despite this, older women with breast cancer have been underrepresented in clinical trials, and this has led to less than optimal evidence to guide their therapy. The management of elderly women with early breast cancer is a complex process that requires careful evaluation of life expectancy, comorbidities, patient values, and risks and benefits of available treatment options. This review will focus on current adjuvant systemic therapy options for older women with breast cancer, discuss the principles in the decision-making process, and define the role of endocrine therapy, chemotherapy, and targeted agents.
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Affiliation(s)
- Julieta Leone
- Department of Medical Oncology, Grupo Oncológico Cooperativo del Sur (GOCS), Neuquén, Argentina
| | - Bernardo Amadeo Leone
- Department of Medical Oncology, Grupo Oncológico Cooperativo del Sur (GOCS), Neuquén, Argentina
| | - José Pablo Leone
- Department of Internal Medicine, Division of Hematology-Oncology and Blood & Marrow Transplantation, University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
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26
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Jensen MB, Ejlertsen B, Mouridsen HT, Christiansen P. Improvements in breast cancer survival between 1995 and 2012 in Denmark: The importance of earlier diagnosis and adjuvant treatment. Acta Oncol 2016; 55 Suppl 2:24-35. [PMID: 26797010 DOI: 10.3109/0284186x.2015.1128119] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Breast cancer mortality has declined from 1995 through 2012 which may be attributed to earlier diagnosis, changes in lifestyle risk factors, and improved treatments. To a large extent the relative contribution of these modalities are unknown. Mammography screening was introduced late in Denmark; in 1995 around 20% of the Danish female population aged 50-69 was covered by population-based screening, and this was in 2008 extended to the entire population. Breast conserving surgery gradually replaced mastectomy, and sentinel node biopsy was introduced. In the same period adjuvant treatment was extended considerable. Methods A population-based study of 68 842 breast cancer patients registered in the clinical database of the Danish Breast Cancer Cooperative Group in 1995-2012. Comprehensive data on prognostic factors, comorbidity and treatment together with complete follow-up for survival were used to evaluate improvements in mortality and standardized mortality rate in successive time periods. Results The results from this study demonstrated a significant improvement in prognosis in successive time periods covering 1995-2012. Apart from patients with a high Charlson Comorbidity Index (CCI) improvements were seen in all subgroups of patients. Prognostic factors were more favorable in the latest time period accordingly to the introduction of nationwide screening. In the study period adjuvant treatment was extended considerable. Conclusion The impact of screening was by nature of limited magnitude. The modified treatment strategies implemented by the use of nationwide guidelines seemed to have a major impact on the substantial survival improvements.
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Affiliation(s)
- Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark
| | - Henning T. Mouridsen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark
| | - Peer Christiansen
- Department of Surgery, Breast Surgery Unit, Aarhus University Hospital/Randers Regional Hospital , Aarhus, Denmark
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27
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Prince RM, Amir E. Update in treatment of early breast cancer in post-menopausal women. Expert Rev Endocrinol Metab 2016; 11:243-252. [PMID: 30058935 DOI: 10.1080/17446651.2016.1175937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the last few years there have been significant advances in knowledge related to the treatment of post-menopausal women with early stage breast cancer. These include new information about the survival benefits with hormonal therapies and bone targeted treatments as well as identification of patient populations who may be able to avoid toxic treatments. In this paper we discuss these advances and provide suggested management algorithms.
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Affiliation(s)
- Rebecca M Prince
- a Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and the Department of Medicine , University of Toronto , Toronto , Canada
| | - Eitan Amir
- a Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and the Department of Medicine , University of Toronto , Toronto , Canada
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28
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Bodilsen A, Bjerre K, Offersen BV, Vahl P, Amby N, Dixon JM, Ejlertsen B, Overgaard J, Christiansen P. Importance of margin width in breast-conserving treatment of early breast cancer. J Surg Oncol 2016; 113:609-15. [DOI: 10.1002/jso.24224] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 02/28/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Anne Bodilsen
- Department of Breast and Endocrine Surgery; Aarhus University Hospital; Aarhus Denmark
| | - Karsten Bjerre
- Danish Breast Cancer Cooperative Group; Copenhagen Denmark
| | | | - Pernille Vahl
- Department of Pathology; Aarhus University Hospital; Aarhus Denmark
| | - Nikolaj Amby
- Department of Oncology; Aarhus University Hospital; Aarhus Denmark
| | - J. Michael Dixon
- Breakthrough Research Unit Edinburgh Breast Unit; Western General Hospital; Edinburgh United Kingdom
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group; Copenhagen Denmark
- Department of Oncology; Copenhagen University Hospital; Rigshospitalet Copenhagen Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology; Aarhus University Hospital; Aarhus Denmark
| | - Peer Christiansen
- Department of Surgery P, Breast Surgery Unit; Aarhus University Hospital/Randers Regional Hospital; Aarhus Denmark
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29
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Brenner DR, Brockton NT, Kotsopoulos J, Cotterchio M, Boucher BA, Courneya KS, Knight JA, Olivotto IA, Quan ML, Friedenreich CM. Breast cancer survival among young women: a review of the role of modifiable lifestyle factors. Cancer Causes Control 2016; 27:459-72. [PMID: 26970739 PMCID: PMC4796361 DOI: 10.1007/s10552-016-0726-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 02/06/2016] [Indexed: 02/06/2023]
Abstract
Almost 7 % of breast cancers are diagnosed among women age 40 years and younger in Western populations. Clinical outcomes among young women are worse. Early age-of-onset increases the risk of contralateral breast cancer, local and distant recurrence, and subsequent mortality. Breast cancers in young women (BCYW) are more likely to present with triple-negative (TNBC), TP53-positive, and HER-2 over-expressing tumors than among older women. However, despite these known differences in breast cancer outcomes and tumor subtypes, there is limited understanding of the basic biology, epidemiology, and optimal therapeutic strategies for BCYW. Several modifiable lifestyle factors associated with reduced risk of developing breast cancer have also been implicated in improved prognosis among breast cancer survivors of all ages. Given the treatment-related toxicities and the extended window for late effects, long-term lifestyle modifications potentially offer significant benefits to BCYW. In this review, we propose a model identifying three main areas of lifestyle factors (energy imbalance, inflammation, and dietary nutrient adequacy) that may influence survival in BCYW. In addition, we provide a summary of mechanisms of action and a synthesis of previous research on each of these topics.
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Affiliation(s)
- Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 513, Holy Cross Centre, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada. .,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Nigel T Brockton
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 513, Holy Cross Centre, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Michelle Cotterchio
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Beatrice A Boucher
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Kerry S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Julia A Knight
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ivo A Olivotto
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - May Lynn Quan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 513, Holy Cross Centre, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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30
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Spielmann M, Dalenc F, Pointreau Y, Azria D, Classe JM, Dromain C, Facchini T, Gonçalves A, Liegeois P, Namer M, Pivot X, Vincent-Salomon A. [Perception of pT1a,b pN0 breast tumor prognosis by the French oncology community: Results of the EURISTIC national survey]. Bull Cancer 2015; 103:154-63. [PMID: 26652718 DOI: 10.1016/j.bulcan.2015.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 10/05/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
The prognosis of infracentimetric breast cancers (BC) is heterogeneous. The EURISTIC survey describes how French oncology specialists perceive the prognosis of pT1a,b pN0 BCs. A self-administered questionnaire has been sent to over 2000 French BC specialists. Six hundred and sixty-three physicians responded. Fifty-eight percent do not consider tumor size as a key prognostic criterion. They consider that the cutoff for poor prognosis is 22mm, 10mm and 7mm for hormone receptors (HRs)+, HER2+ and triple-negative (TN) tumors respectively. Eighty-three percent of respondents consider that a HR+ pT1a,b tumor has a good prognosis (21% and 8% for HER2+ and TN respectively). Factors perceived as most detrimental are: HER2 overexpression (29% of respondents); HR- (20%); high grade (20%); TN status (14%); high KI67 (5%); presence of lymphovascular invasion (3%); young age (2%) and high mitotic index (1%). For French specialists, immunohistochemical characteristics, in particular hormone and HER2 status, are strong prognostic factors in BCs below 1cm.
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Affiliation(s)
- Marc Spielmann
- Institut Gustave-Roussy, department of medical oncology, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
| | - Florence Dalenc
- Institut Claudius-Regaud, department of medical oncology, 20-24, rue du Pont-Saint-Pierre, 31052 Toulouse, France
| | - Yoann Pointreau
- Centre Jean-Bernard, clinique Victor-Hugo, department of radiation oncology, 18, rue Victor-Hugo, 72000 Le Mans, France; Centre hospitalier régional universitaire, department of radiation oncology, 37044 Tours cedex 9, France
| | - David Azria
- ICM centre Val-d'Aurelle, department of radiation oncology, 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - Jean-Marc Classe
- Site hospitalier Nord, centre René-Gauducheau, department of surgery, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France
| | - Clarisse Dromain
- Institut Gustave-Roussy, department of medical oncology, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - Thomas Facchini
- Clinique Courlancy, department of medical oncology, 38, rue de Courlancy, 51100 Reims, France
| | - Anthony Gonçalves
- Institut Paoli-Calmettes, department of medical oncology, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Philippe Liegeois
- Institut du sein de l'Orangerie, department of surgery, 11, rue Silbermann, 67000 Strasbourg, France
| | - Moïse Namer
- Clinique Saint-Georges, department of medical oncology, 2, avenue de Rimiez, 06100 Nice cedex 2, France
| | - Xavier Pivot
- Centre hospitalier universitaire, department of medical oncology, 2, place Saint-Jacques, 25000 Besançon, France
| | - Anne Vincent-Salomon
- Institut Curie, department of pathology, 26, rue d'Ulm, 75248 Paris cedex 05, France
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31
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Dimitrakopoulos FID, Kottorou A, Antonacopoulou AG, Makatsoris T, Kalofonos HP. Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem. J Breast Cancer 2015; 18:207-17. [PMID: 26472970 PMCID: PMC4600684 DOI: 10.4048/jbc.2015.18.3.207] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/20/2015] [Indexed: 01/06/2023] Open
Abstract
Breast cancer generally develops in older women and its incidence is continuing to increase with increasing age of the population. The pathology and biology of breast cancer seem to be different in the elderly, often resulting in the undertreatment of elderly patients and thus in higher rates of recurrence and mortal-ity. The aim of this review is to describe the differences in the biology and treatment of early breast cancer in the elderly as well as the use of geriatric assessment methods that aid decision-making. Provided there are no contraindications, the cornerstone of treatment should be surgery, as the safety and efficacy of surgical resection in elderly women have been well documented. Because most breast cancers in the elderly are hormone responsive, hormonal therapy remains the mainstay of systemic treatment in the adjuvant setting. The role of chemotherapy is limited to patients who test negative for hormone receptors and demonstrate an aggressive tumor profile. Although the prognosis of breast cancer patients has generally improved during the last few decades, there is still a demand for evidence-based optimization of therapeutic interventions in older patients.
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Affiliation(s)
| | - Anastasia Kottorou
- Division of Oncology, Department of Medicine, University of Patras Medical School, Patras, Greece
| | - Anna G Antonacopoulou
- Division of Oncology, Department of Medicine, University of Patras Medical School, Patras, Greece
| | - Thomas Makatsoris
- Division of Oncology, Department of Medicine, University of Patras Medical School, Patras, Greece
| | - Haralabos P Kalofonos
- Division of Oncology, Department of Medicine, University of Patras Medical School, Patras, Greece
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32
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Bodilsen A, Bjerre K, Offersen BV, Vahl P, Ejlertsen B, Overgaard J, Christiansen P. The Influence of Repeat Surgery and Residual Disease on Recurrence After Breast-Conserving Surgery: A Danish Breast Cancer Cooperative Group Study. Ann Surg Oncol 2015; 22 Suppl 3:S476-85. [DOI: 10.1245/s10434-015-4707-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Indexed: 12/21/2022]
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33
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Mislang AR, Biganzoli L. Adjuvant Systemic Therapy in Older Breast Cancer Women: Can We Optimize the Level of Care? Cancers (Basel) 2015; 7:1191-214. [PMID: 26151681 PMCID: PMC4586766 DOI: 10.3390/cancers7030833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/17/2015] [Accepted: 06/26/2015] [Indexed: 01/03/2023] Open
Abstract
Defining optimal adjuvant treatment for older women with breast cancer is challenged by the lack of level-1 clinical evidence and the heterogeneity of the older population. Nevertheless, recommendations based on reviews of available evidence mainly from retrospective subgroup analyses and extrapolation of study results from younger patients, and expert opinions, may be useful to guide treatment decisions in fit patients. But how can we properly define a "fit" older patient? In clinical practice, age by itself and clinical impression generally drive treatment decision, although the appropriateness of this judgment is under-documented. Such an approach risks overtreatment or, more frequently, undertreatment. A geriatric assessment can be valuable in oncology practice to address this issue. In this review article, we will focus only on systemic treatment and will discuss "standard" adjuvant systemic treatment strategies for fit older breast cancer patients and the role of "personalized" systemic therapy in unfit patients. The concepts conveyed in this review cannot be extrapolated to locoregional therapy.
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Affiliation(s)
- Anna Rachelle Mislang
- Sandro Pitigliani Medical Oncology Unit, Nuovo Ospedale Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy
| | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Nuovo Ospedale Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy.
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Le Saux O, Ripamonti B, Bruyas A, Bonin O, Freyer G, Bonnefoy M, Falandry C. Optimal management of breast cancer in the elderly patient: current perspectives. Clin Interv Aging 2015; 10:157-74. [PMID: 25609933 PMCID: PMC4293298 DOI: 10.2147/cia.s50670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Breast cancer (BC) is the most common female malignancy in the world and almost one third of cases occur after 70 years of age. Optimal management of BC in the elderly is a real challenge and requires a multidisciplinary approach, mainly because the elderly population is heterogeneous. In this review, we describe the various possibilities of treatment for localized or metastatic BC in an aging population. We provide an overview of the comprehensive geriatric assessment, surgery, radiotherapy, and adjuvant therapy for early localized BC and of chemotherapy and targeted therapies for metastatic BC. Finally, we attempt to put into perspective the necessary balance between the expected benefits and risks, especially in the adjuvant setting.
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Affiliation(s)
- Olivia Le Saux
- Medical Oncology Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Bertrand Ripamonti
- Gynaecology-Obstetrics Department, University Hospital, Saint-Etienne, France
| | - Amandine Bruyas
- Croix Rousse University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France ; Lyon University, Lyon, France
| | | | - Gilles Freyer
- Medical Oncology Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France ; Lyon University, Lyon, France
| | - Marc Bonnefoy
- Lyon University, Lyon, France ; Geriatric Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Claire Falandry
- Lyon University, Lyon, France ; Geriatric Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
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Zirkzee EJM, Huizinga TWJ, Bollen ELEM, Buchem MAV, Middelkoop HAM, Wee NJAVD, Cessie SL, Steup-Beekman GM. Mortality in neuropsychiatric systemic lupus erythematosus (NPSLE). Lupus 2013; 23:31-8. [DOI: 10.1177/0961203313512540] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The standardized mortality ratio (SMR) for systemic lupus erythematosus (SLE) is three; SMR increases to six in case of renal involvement. Up to now data on survival in case of neuropsychiatric involvement in SLE (NPSLE) have been scarce, therefore we calculated an SMR for NPSLE. Furthermore, we identified characteristics that influenced survival by Cox regression analyses. All patients suspected of NPSLE in our center since 1989 were evaluated and included in this study when a diagnosis of primary NPSLE could be established. Patient’s life/death status was tracked using the civic registries. Thirty-two (19%) of the 169 included NPSLE patients died within a median follow-up period of six years (range 0.5–24 years). This resulted in a significantly increased mortality rate compared to the general population: SMR 9.5 (95% CI 6.7–13.5). Hazard ratios (HRs) were highest in patients with acute confusional state (HR 3.4) and older age at diagnosis of NPSLE (HR 1.1). A decreased mortality risk was seen with the prescription of antiplatelet therapy (HR 0.22). The time period in which NPSLE was diagnosed did not significantly influence survival. Most frequent causes of death were infection and NPSLE itself.
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Affiliation(s)
- EJM Zirkzee
- Department of Rheumatology, Leiden University Medical Center, Netherlands
| | - TWJ Huizinga
- Department of Rheumatology, Leiden University Medical Center, Netherlands
| | - ELEM Bollen
- Department of Neurology, Leiden University Medical Center, Netherlands
| | - MA van Buchem
- Department of Radiology, Leiden University Medical Center, Netherlands
| | - HAM Middelkoop
- Department of Neurology and Clinical Neuropsychology, Leiden University Medical Center, Netherlands
- Institute of Psychology, Clinical Neuropsychology Unit, University of Leiden, Netherlands
| | - NJA van der Wee
- Department of Psychiatry, Leiden University Medical Center, Netherlands
- Leiden Institute for Brain and Cognition, University of Leiden, Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology and Medical Statistics, Leiden University Medical Center, Netherlands
| | - GM Steup-Beekman
- Department of Rheumatology, Leiden University Medical Center, Netherlands
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[Breast cancer diagnosis among women aged 75 and over: study on information delivered by organized breast cancer screening agencies to women reaching the limit age]. Bull Cancer 2013; 100:671-6; quiz 677-8. [PMID: 23823935 DOI: 10.1684/bdc.2013.1786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Breast cancer among older women is a major and increasing public health issue. No clear recommendation has been established in France after 74 years, the age limit for state-organised screening program. A survey was performed among all regional agencies in charge of the breast screening to analyse which information is delivered to women reaching the age of 75 years. A postal survey sent to 91 French organised cancer screening agencies. Among the 89 agencies that answered, only 22 deliver a systematic written information. Twelve suggest that mammographic screening should be continued, and five mention clinical examination. Twenty agencies dispatch the screening to general practitioners or gynaecologists. Two information letters insist on the ongoing risk of breast cancer. Most of the written information is given with the last mammography report. No impact study has ever been performed. In our study, only 25% of the screening agencies give systematic information to women. The modalities and the substance of this information are heterogeneous. A better information seems to be a key-point for earlier clinical breast cancer diagnosis among older women, for whom there is little direct evidence of the benefit of systematic mammographic screening.
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Synnestvedt M, Borgen E, Russnes HG, Kumar NT, Schlichting E, Giercksky KE, Kåresen R, Nesland JM, Naume B. Combined analysis of vascular invasion, grade, HER2 and Ki67 expression identifies early breast cancer patients with questionable benefit of systemic adjuvant therapy. Acta Oncol 2013; 52:91-101. [PMID: 22934555 DOI: 10.3109/0284186x.2012.713508] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Over-treatment of low-risk early breast cancer patients with adjuvant systemic therapies is an important clinical challenge. Better techniques are required which can be used to distinguish between the large group of patients with no residual disease after surgery and consequently no benefit of adjuvant treatment, from the smaller group with high relapse risk. A better integration of available prognostic factors might contribute to improved prediction of clinical outcome. MATERIAL AND METHODS The current study included 346 unselected pT1pN0 patients who did not receive adjuvant systemic treatment. In Norway, no patients with this stage were recommended systemic treatment at the time of the study (1995-1998). Histological type, tumour size, grade, vascular invasion (VI), hormone receptor (HR) status, HER2 and Ki67 (cut-off 10%) were analysed. Median follow-up was 86 months for relapse and 101 months for death. RESULTS Thirty-eight patients experienced relapse, 31 with distant metastasis. Twenty-one patients died of breast cancer. In univariate analysis grade, HER2, HR, VI and Ki67 had impact on clinical outcome (p < 0.005, log rank). In multivariate analysis, only grade 1-2 vs. grade 3, HER2, VI, and Ki67 status were significant for disease free survival, distant disease free survival, and/or breast cancer specific survival. These factors were used in combination, to separate patients into groups based on the number of unfavourable factors present [combined prognostic score (CPS) 0-4]. Close to 2/3 of the patients (61.4%) had no unfavourable factor (CPS0), whilst 18.4% had CPS ≥ 2. Only 3.6% of those with CPS0 developed metastasis (p < 0.001). The outcome was clearly worse for patients with CPS ≥ 2 (p < 0.001), systemic relapse was detected in approximately 40%. CONCLUSIONS This study indicates that the combined use of grade, VI, HER2 and Ki67 identifies a subgroup of breast cancer patients with a relapse risk that may question the benefit of adjuvant systemic therapy.
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Affiliation(s)
- Marit Synnestvedt
- Department of Oncology, Division of Surgery and Cancer Medicine, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
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Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, Reed M, Ciatto S, Voogd AC, Brain E, Cutuli B, Terret C, Gosney M, Aapro M, Audisio R. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol 2012; 13:e148-60. [PMID: 22469125 DOI: 10.1016/s1470-2045(11)70383-7] [Citation(s) in RCA: 394] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
As the mean age of the global population increases, breast cancer in older individuals will be increasingly encountered in clinical practice. Management decisions should not be based on age alone. Establishing recommendations for management of older individuals with breast cancer is challenging because of very limited level 1 evidence in this heterogeneous population. In 2007, the International Society of Geriatric Oncology (SIOG) created a task force to provide evidence-based recommendations for the management of breast cancer in elderly individuals. In 2010, a multidisciplinary SIOG and European Society of Breast Cancer Specialists (EUSOMA) task force gathered to expand and update the 2007 recommendations. The recommendations were expanded to include geriatric assessment, competing causes of mortality, ductal carcinoma in situ, drug safety and compliance, patient preferences, barriers to treatment, and male breast cancer. Recommendations were updated for screening, primary endocrine therapy, surgery, radiotherapy, neoadjuvant and adjuvant systemic therapy, and metastatic breast cancer.
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Affiliation(s)
- Laura Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Istituto Toscano Tumori, Hospital of Prato, Prato, Italy.
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Griggs JJ, Hayes DF. Do all patients with breast cancer require systemic adjuvant therapy? J Natl Cancer Inst 2011; 103:1350-1. [PMID: 21881041 PMCID: PMC3176780 DOI: 10.1093/jnci/djr331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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