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Li Y, Lu S, Zhang Y, Wang S, Liu H. Loco-regional recurrence trend and prognosis in young women with breast cancer according to molecular subtypes: analysis of 1099 cases. World J Surg Oncol 2021; 19:113. [PMID: 33849563 PMCID: PMC8042870 DOI: 10.1186/s12957-021-02214-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The number of young patients diagnosed with breast cancer is on the rise. We studied the rate trend of local recurrence (LR) and regional recurrence (RR) in young breast cancer (YBC) patients and outcomes among these patients based on molecular subtypes. METHODS A retrospective cohort study was conducted based on data from Tianjin Medical University Cancer Institute and Hospital for patients ≤ 35 years of age with pathologically confirmed primary invasive breast cancer surgically treated between 2006 and 2014. Patients were categorized according to molecular subtypes on the basis of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. The 5-year rates for LR, RR, and distant metastases (DM) were estimated by Kaplan-Meir statistics. Nelson-Aalen cumulative-hazard plots were used to describe local recurrence- and distant metastasis-free intervals. RESULTS We identified 25,284 patients with a median follow-up of 82 months, of whom 1099 (4.3%) were YBC patients ≤ 35 years of age. The overall 5-year LR, RR, and DM rates in YBC patients were 6.7%, 5.1%, and 16.6%, respectively. The LR and RR rates demonstrated a decreasing trend over time (P = 0.028 and P = 0.015, respectively). We found that early-stage breast cancer and less lymph node metastases increased over time (P = 0.004 and P = 0.007, respectively). Patients with HR-/HER2+ status had a significantly higher LR (HR 20.4; 95% CI, 11.8-35.4) and DM (HR 37.2; 95% CI, 24.6-56.3) at 10 years. Breast-conserving surgery (BCS) or mastectomy did not influence rates of LR and RR. In the overall population, the 5-year survival of YBC patients exceeded 90%. CONCLUSIONS The rates of LR and RR with YBC patients demonstrated a downward trend and the proportion of early-stage breast cancer increased between 2006 and 2014. We report the highest LR rates in this young population were associated with HR-/HER2+ tumors.
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Affiliation(s)
- Yang Li
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer & Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Su Lu
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer & Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Yuhan Zhang
- Oncology Department, Taikang Xianlin Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, 210046, Jiangsu Province, China
| | - Shuaibing Wang
- Oncology Department, Hebei PetroChina Central Hospital, Langfang, 065000, Hebei Province, China
| | - Hong Liu
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer & Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
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Chou HH, Kuo WL, Yu CC, Tsai HP, Shen SC, Chu CH, Yu MC, Lo YF, Dabora MA, Chang HK, Lin YC, Ueng SH, Chen SC. Impact of age on pathological complete response and locoregional recurrence in locally advanced breast cancer after neoadjuvant chemotherapy. Biomed J 2019; 42:66-74. [PMID: 30987708 PMCID: PMC6468039 DOI: 10.1016/j.bj.2018.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 10/05/2018] [Accepted: 10/23/2018] [Indexed: 12/31/2022] Open
Abstract
Background Neoadjuvant chemotherapy (NAC) is the standard approach for downstaging of locally advanced breast cancer and can improve breast conservation rates. A pathological complete response (pCR) after NAC associated with favorable long-term outcomes has been described. There is still a high locoregional recurrence (LRR) rate after NAC and the influence of age on LRR after NAC is unclear. This study analyzed the relationship between age and LRR after NAC. Methods Two hundred and sixty-three patients with invasive breast cancer who received NAC followed by mastectomy or breast conserving surgery (BCS) were enrolled. Concurrent weekly epirubicin and docetaxel was the NAC regimen. Results Twenty-nine patients (11%) achieved a pCR after NAC. In univariate analysis, age <50 years, luminal B (HER2 positive) subtype, HER2 overexpression subtype, and triple-negative subtype were factors to predict a pCR. In multivariate analysis, age <50 years, luminal B (HER2 positive) type, HER2 overexpression, and triple-negative subtype were the independent factors to predict a pCR. No patients in the pCR group developed LRR compared with 31 patients in the non-pCR group. Eleven patients (6.9%) in the younger group (age <50 years) developed LRR compared with 20 patients (19.4%) in the older group (age ≥50 years). In multivariate analysis, younger age (<50 years) was the only independent prognostic factor for a LRR-free survival. Conclusion Younger age can predict a pCR and is an independent prognostic factor for LRR in locally advanced breast cancer patients after NAC as concurrent epirubicin and docetaxel.
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Affiliation(s)
- Hsu-Huan Chou
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wen-Ling Kuo
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chi-Chang Yu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hsiu-Pei Tsai
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shih-Cheh Shen
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chia-Hui Chu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yung-Feng Lo
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | | | - Hsien-Kun Chang
- Department of Medical Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yung-Chang Lin
- Department of Medical Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shin-Cheh Chen
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Engelhardt EG, van den Broek AJ, Linn SC, Wishart GC, Rutgers EJT, van de Velde AO, Smit VTHBM, Voogd AC, Siesling S, Brinkhuis M, Seynaeve C, Westenend PJ, Stiggelbout AM, Tollenaar RAEM, van Leeuwen FE, van 't Veer LJ, Ravdin PM, Pharaoh PDP, Schmidt MK. Accuracy of the online prognostication tools PREDICT and Adjuvant! for early-stage breast cancer patients younger than 50 years. Eur J Cancer 2017; 78:37-44. [PMID: 28412587 DOI: 10.1016/j.ejca.2017.03.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/29/2016] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
Abstract
IMPORTANCE Online prognostication tools such as PREDICT and Adjuvant! are increasingly used in clinical practice by oncologists to inform patients and guide treatment decisions about adjuvant systemic therapy. However, their validity for young breast cancer patients is debated. OBJECTIVE To assess first, the prognostic accuracy of PREDICT's and Adjuvant! 10-year all-cause mortality, and second, its breast cancer-specific mortality estimates, in a large cohort of breast cancer patients diagnosed <50 years. DESIGN Hospital-based cohort. SETTING General and cancer hospitals. PARTICIPANTS A consecutive series of 2710 patients without a prior history of cancer, diagnosed between 1990 and 2000 with unilateral stage I-III breast cancer aged <50 years. MAIN OUTCOME MEASURES Calibration and discriminatory accuracy, measured with C-statistics, of estimated 10-year all-cause and breast cancer-specific mortality. RESULTS Overall, PREDICT's calibration for all-cause mortality was good (predicted versus observed) meandifference: -1.1% (95%CI: -3.2%-0.9%; P = 0.28). PREDICT tended to underestimate all-cause mortality in good prognosis subgroups (range meandifference: -2.9% to -4.8%), overestimated all-cause mortality in poor prognosis subgroups (range meandifference: 2.6%-9.4%) and underestimated survival in patients < 35 by -6.6%. Overall, PREDICT overestimated breast cancer-specific mortality by 3.2% (95%CI: 0.8%-5.6%; P = 0.007); and also overestimated it seemingly indiscriminately in numerous subgroups (range meandifference: 3.2%-14.1%). Calibration was poor in the cohort of patients with the lowest and those with the highest mortality probabilities. Discriminatory accuracy was moderate-to-good for all-cause mortality in PREDICT (0.71 [95%CI: 0.68 to 0.73]), and the results were similar for breast cancer-specific mortality. Adjuvant!'s calibration and discriminatory accuracy for both all-cause and breast cancer-specific mortality were in line with PREDICT's findings. CONCLUSIONS Although imprecise at the extremes, PREDICT's estimates of 10-year all-cause mortality seem reasonably sound for breast cancer patients <50 years; Adjuvant! findings were similar. Prognostication tools should be used with caution due to the intrinsic variability of their estimates, and because the threshold to discuss adjuvant systemic treatment is low. Thus, seemingly insignificant mortality overestimations or underestimations of a few percentages can significantly impact treatment decision-making.
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Affiliation(s)
- Ellen G Engelhardt
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandra J van den Broek
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Sabine C Linn
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Division of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gordon C Wishart
- Faculty of Medical Science, Anglia Ruskin University, Cambridge, UK
| | - Emiel J Th Rutgers
- Division of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anthonie O van de Velde
- Biometrics Department, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Adri C Voogd
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | | | - Caroline Seynaeve
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Anne M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Laura J van 't Veer
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Peter M Ravdin
- University of Texas, Health Sciences Center, San Antonio, USA
| | - Paul D P Pharaoh
- Department of Oncology, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, UK
| | - Marjanka K Schmidt
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Division of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Potential Safety Loophole of Fat Grafting in Breast Cancer Patients. Aesthetic Plast Surg 2016; 40:380-6. [PMID: 27071383 DOI: 10.1007/s00266-016-0634-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/16/2016] [Indexed: 12/19/2022]
Abstract
UNLABELLED Autologous fat grafting (AFG) accounts for 9.1 % of all cosmetic surgical procedures in the world. Its use has been increasing tremendously in breast reconstruction and produces satisfying outcomes. However, the lack of standard guidelines for routine screening protocols in breast cancer patients before and after AFG warrants consideration of the safety of AFG use in post-mastectomy and post-lumpectomy reconstruction. This manuscript examines AFG in breast reconstruction publications and details the complications, the mechanism of AFG, as well as the relationship between adipose stem cells (ASCs) and cancer recurrence. The ASCs transferred in AFG act as multiple potent stem cells, which can impact cancer recurrence in various ways. Both in vitro and in vivo studies show that ASCs can stimulate the recurrence of breast cancer. Based on a review of existing evidence, we provide recommendations and guidelines for AFG use in breast reconstruction to aid in clinical decision-making. Further investigations are needed to evaluate the long-term clinical safety of AFG as well as the proposed guidelines. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Feigelson HS, Carroll NM, Weinmann S, Haque R, Yu CL, Butler MG, Waitzfelder B, Wrenn MG, Capra A, McGlynn EA, Habel LA. Treatment patterns for ductal carcinoma in situ from 2000-2010 across six integrated health plans. SPRINGERPLUS 2015; 4:24. [PMID: 25625043 PMCID: PMC4300310 DOI: 10.1186/s40064-014-0776-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 12/23/2014] [Indexed: 02/06/2023]
Abstract
Considerable debate exists about the optimal treatment of ductal carcinoma in situ (DCIS). Using electronic data sources, we examined first course treatment patterns among women aged 18 years and older diagnosed with DCIS between 2000–2010 from six Kaiser Permanente (KP) regions. We calculated the proportion of patients receiving breast conserving surgery (BCS), BCS plus radiation therapy, unilateral mastectomy, bilateral mastectomy, and hormone therapy. Multinomial logistic regression was used to assess the association between patient characteristics and treatment. We included 9,437 women: 1,086 (11.5%) African-American; 1,455 (15.4%) Asian; 918 (9.7%) Hispanic; and 5,978 (63.3%) non-Hispanic white. Most cases (42.2%) received BCS plus radiation as their initial treatment. Nearly equal numbers of women received BCS without radiation (28.5%) or unilateral mastectomy (24.6%). Use of bilateral mastectomy was uncommon (4.7%), and most women (72.2%) did not receive hormone therapy has part of their first course treatment. We observed statistically significant differences in treatment patterns for DCIS by KP region and patient age. Predictably, nuclear grade and the presence of comorbidities were associated with first course treatment for DCIS. We observed statistically significant increases in BCS plus radiation therapy and bilateral mastectomy over time. Although still uncommon, the frequency of bilateral mastectomy increased from 2.7% in 2000 to 7.0% in 2010. We also observed differences in treatment by race/ethnicity. Our findings help illustrate the complex nature of DCIS treatment in the United States, and highlight the need for evidence based guidelines for DCIS care.
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Affiliation(s)
| | - Nikki M Carroll
- Institute for Health Research, Kaiser Permanente, Denver, CO USA
| | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR USA
| | - Reina Haque
- Kaiser Permanente Southern California, Pasadena, CA USA
| | - Chu-Ling Yu
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, MD USA
| | | | - Beth Waitzfelder
- Center for Health Research, Kaiser Permanente Hawaii, Honolulu, HI USA
| | - Michelle G Wrenn
- Institute for Health Research, Kaiser Permanente, Denver, CO USA
| | - Angela Capra
- Kaiser Permanente Division of Research, Oakland, CA USA
| | - Elizabeth A McGlynn
- Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, CA USA
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6
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Factors associated with the incidence of local recurrences of breast cancer in women who underwent conservative surgery. Int J Breast Cancer 2014; 2014:639534. [PMID: 25530886 PMCID: PMC4235109 DOI: 10.1155/2014/639534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 10/09/2014] [Indexed: 12/02/2022] Open
Abstract
Conservative surgery is considered the procedure of choice for women who are affected by early stage tumours. The local recurrence of cancer as a consequence of breast tissue conservation is a growing concern. This study aimed to describe the sociodemographic and clinical profiles of women who had local recurrences of breast cancer after conservative surgery and to examine the associations between sociodemographic and clinical variables and the incidence of tumour recurrence in these women. The retrospective cohort included 880 women who were diagnosed with breast cancer and underwent conservative surgery between January 2000 and December 2010. Recurrences occurred in 60 patients, and the mean age of the women at diagnosis was 48.8 years. Predictive factors for local recurrence were young age (<39 years) (P = 0.028 and OR = 10.93), surgical margin involvement (P = 0.001 and OR = 3.66), and Her-2 overexpression (P = 0.045 and OR = 1.94). The establishment of sociodemographic and clinical characteristics might help to select optimum treatments, which is a crucial challenge for public health in Brazil, especially with regard to reductions of surgery and hospitalisation expenditures in the Unified Health System (Sistema Único de Saúde—SUS).
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Dent R, Valentini A, Hanna W, Rawlinson E, Rakovitch E, Sun P, Narod SA. Factors associated with breast cancer mortality after local recurrence. ACTA ACUST UNITED AC 2014; 21:e418-25. [PMID: 24940101 DOI: 10.3747/co.21.1563] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE We aimed to identify risk factors for mortality after local recurrence in women treated for invasive breast cancer with breast-conserving surgery. EXPERIMENTAL DESIGN Our prospective cohort study included 267 women who were treated with breast-conserving surgery at Women's College Hospital from 1987 to 1997 and who later developed local recurrence. Clinical information and tumour receptor status were abstracted from medical records and pathology reports. Patients were followed from the date of local recurrence until death or last follow-up. Survival analysis used a Cox proportional hazards model. RESULTS Among the 267 women with a local recurrence, 97 (36.3%) died of breast cancer within 10 years (on average 2.6 years after the local recurrence). The actuarial risk of death was 46.1% at 10 years from recurrence. In a multivariable model, predictors of death included short time from diagnosis to recurrence [hazard ratio (hr) for <5 years compared with ≥10 years: 3.40; 95% confidence interval (ci): 1.04 to 11.1; p = 0.04], progesterone receptor positivity (hr: 0.35; 95% ci: 0.23 to 0.54; p < 0.001), lymph node positivity (hr: 2.1; 95% ci: 1.4 to 3.3; p = 0.001), and age at local recurrence (hr for age >45 compared with age ≤45 years: 0.61; 95% ci: 0.38 to 0.95; p = 0.03). CONCLUSIONS The risk of death after local recurrence varies widely. Risk factors for death after local recurrence include node positivity, progesterone receptor negativity, young age at recurrence, and short time from diagnosis to recurrence.
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Affiliation(s)
- R Dent
- Department of Medical Oncology, Sunnybrook Odette Cancer Centre and University of Toronto, ON
| | - A Valentini
- Women's College Research Institute, Women's College Hospital and University of Toronto, Toronto, ON
| | - W Hanna
- Department of Pathology, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - E Rawlinson
- Women's College Research Institute, Women's College Hospital and University of Toronto, Toronto, ON
| | - E Rakovitch
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - P Sun
- Women's College Research Institute, Women's College Hospital and University of Toronto, Toronto, ON
| | - S A Narod
- Women's College Research Institute, Women's College Hospital and University of Toronto, Toronto, ON
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Pilewskie M, King TA. Age and molecular subtypes: impact on surgical decisions. J Surg Oncol 2014; 110:8-14. [PMID: 24691763 DOI: 10.1002/jso.23604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/27/2014] [Indexed: 12/27/2022]
Abstract
Both young patient age and breast cancer molecular subtype impact local recurrence rates and long-term prognosis for women with breast cancer. Although rates of local recurrence are consistently higher in young women and those with high-risk molecular subtypes, this risk does not appear to be overcome by more extensive surgery.
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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van der Sangen M, Poortmans P, Scheepers S, Lemaire B, van Berlo C, Tjan-Heijnen V, Voogd A. Prognosis following local recurrence after breast conserving treatment in young women with early breast cancer. Eur J Surg Oncol 2013; 39:892-8. [DOI: 10.1016/j.ejso.2013.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 04/06/2013] [Accepted: 05/08/2013] [Indexed: 01/08/2023] Open
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10
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Yang RL, Kelz RR, Czerniecki BJ. Immediate reconstruction following nipple-sparing mastectomy: one option for young breast cancer patients with early stage disease. J Thorac Dis 2013; 5:200-2. [PMID: 23825742 DOI: 10.3978/j.issn.2072-1439.2013.06.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/06/2013] [Indexed: 11/14/2022]
Abstract
The article entitled "Application of immediate breast reconstruction with silicon prosthetic implantation following bilateral mammary gland excision in treatment of young patients with early breast cancer" published in Journal of Thoracic Disease, examined the oncologic and cosmetic outcomes of the aforementioned procedures. We aimed to describe the unique circumstances of young breast cancer patients with early stage disease and highlight the multitude of surgical treatment and reconstructive options available to these patients.
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Affiliation(s)
- Rachel L Yang
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Feigelson HS, James TA, Single RM, Onitilo AA, Aiello Bowles EJ, Barney T, Bakerman JE, McCahill LE. Factors associated with the frequency of initial total mastectomy: results of a multi-institutional study. J Am Coll Surg 2013; 216:966-75. [PMID: 23490543 DOI: 10.1016/j.jamcollsurg.2013.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 01/11/2013] [Accepted: 01/16/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several previous studies have reported conflicting data on recent trends in use of initial total mastectomy (TM); the factors that contribute to TM variation are not entirely clear. Using a multi-institution database, we analyzed how practice, patient, and tumor characteristics contributed to variation in TM for invasive breast cancer. STUDY DESIGN We collected detailed clinical and pathologic data about breast cancer diagnosis, initial, and subsequent breast cancer operations performed on all female patients from 4 participating institutions from 2003 to 2008. We limited this analysis to 2,384 incident cases of invasive breast cancer, stages I to III, and excluded patients with clinical indications for mastectomy. Predictors of initial TM were identified with univariate analyses and random effects multivariable logistic regression models. RESULTS Initial TM was performed on 397 (16.7%) eligible patients. Use of preoperative MRI more than doubled the rate of TM (odds ratio [OR] = 2.44; 95% CI, 1.58-3.77; p < 0.0001). Increasing tumor size, high nuclear grade, and age were also associated with increased rates of initial TM. Differences by age and ethnicity were observed, and significant variation in the frequency of TM was seen at the individual surgeon level (p < 0.001). Our results were similar when restricted to tumors <20 mm. CONCLUSIONS We identified factors associated with initial TM, including preoperative MRI and individual surgeon, that contribute to the current debate about variation in use of TM for the management of breast cancer. Additional evaluation of patient understanding of surgical options and outcomes in breast cancer and the impact of the surgeon provider is warranted.
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