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Goetz MP, Bagegni NA, Batist G, Brufsky A, Cristofanilli MA, Damodaran S, Daniel BR, Fleming GF, Gradishar WJ, Graff SL, Grosse Perdekamp MT, Hamilton E, Lavasani S, Moreno-Aspitia A, O'Connor T, Pluard TJ, Rugo HS, Sammons SL, Schwartzberg LS, Stover DG, Vidal GA, Wang G, Warner E, Yerushalmi R, Plourde PV, Portman DJ, Gal-Yam EN. Lasofoxifene versus fulvestrant for ER+/HER2- metastatic breast cancer with an ESR1 mutation: results from the randomized, phase II ELAINE 1 trial. Ann Oncol 2023; 34:1141-1151. [PMID: 38072514 DOI: 10.1016/j.annonc.2023.09.3104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Acquired estrogen receptor alpha (ER/ESR1) mutations commonly cause endocrine resistance in ER+ metastatic breast cancer (mBC). Lasofoxifene, a novel selective ER modulator, stabilizes an antagonist conformation of wild-type and ESR1-mutated ER-ligand binding domains, and has antitumor activity in ESR1-mutated xenografts. PATIENTS AND METHODS In this open-label, randomized, phase II, multicenter, ELAINE 1 study (NCT03781063), we randomized women with ESR1-mutated, ER+/human epidermal growth factor receptor 2 negative (HER2-) mBC that had progressed on an aromatase inhibitor (AI) plus a cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) to oral lasofoxifene 5 mg daily or IM fulvestrant 500 mg (days 1, 15, and 29, and then every 4 weeks) until disease progression/toxicity. The primary endpoint was progression-free survival (PFS); secondary endpoints were safety/tolerability. RESULTS A total of 103 patients received lasofoxifene (n = 52) or fulvestrant (n = 51). The most current efficacy analysis showed that lasofoxifene did not significantly prolong median PFS compared with fulvestrant: 24.2 weeks (∼5.6 months) versus 16.2 weeks (∼3.7 months; P = 0.138); hazard ratio 0.699 (95% confidence interval 0.434-1.125). However, PFS and other clinical endpoints numerically favored lasofoxifene: clinical benefit rate (36.5% versus 21.6%; P = 0.117), objective response rate [13.2% (including a complete response in one lasofoxifene-treated patient) versus 2.9%; P = 0.124], and 6-month (53.4% versus 37.9%) and 12-month (30.7% versus 14.1%) PFS rates. Most common treatment-emergent adverse events with lasofoxifene were nausea, fatigue, arthralgia, and hot flushes. One death occurred in the fulvestrant arm. Circulating tumor DNA ESR1 mutant allele fraction (MAF) decreased from baseline to week 8 in 82.9% of evaluable lasofoxifene-treated versus 61.5% of fulvestrant-treated patients. CONCLUSIONS Lasofoxifene demonstrated encouraging antitumor activity versus fulvestrant and was well tolerated in patients with ESR1-mutated, endocrine-resistant mBC following progression on AI plus CDK4/6i. Consistent with target engagement, lasofoxifene reduced ESR1 MAF, and to a greater extent than fulvestrant. Lasofoxifene may be a promising targeted treatment for patients with ESR1-mutated mBC and warrants further investigation.
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Affiliation(s)
- M P Goetz
- Department of Oncology, Mayo Clinic, Rochester.
| | - N A Bagegni
- Division of Oncology, Washington University School of Medicine, St. Louis, USA
| | - G Batist
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - A Brufsky
- University of Pittsburgh Medical Center-Magee Women's Hospital, Pittsburgh
| | - M A Cristofanilli
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York
| | - S Damodaran
- The University of Texas MD Anderson Cancer Center, Department of Breast Medical Oncology, Houston
| | | | - G F Fleming
- The University of Chicago Medical Center, Chicago
| | - W J Gradishar
- Division of Hematology/Oncology, Northwestern University, Chicago
| | - S L Graff
- Lifespan Cancer Institute/Legorreta Cancer Center at Brown University, Providence
| | | | - E Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville
| | - S Lavasani
- Division of Hematology and Medical Oncology, UC Irvine, Orange
| | | | - T O'Connor
- Roswell Park Comprehensive Cancer Center, Department of Medicine, Buffalo
| | - T J Pluard
- Saint Luke's Cancer Institute, Kansas City
| | - H S Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco, San Francisco
| | - S L Sammons
- Dana Farber Cancer Institute, Harvard Medical School, Boston
| | | | - D G Stover
- Ohio State University Comprehensive Cancer Center, Ohio State University, Columbus
| | - G A Vidal
- Breast Oncology Division, West Cancer Center, Memphis
| | - G Wang
- Medical Oncology, Miami Cancer Institute at Baptist Health, Miami, USA
| | - E Warner
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - R Yerushalmi
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - E N Gal-Yam
- Breast Oncology Institute, Sheba Medical Center, Ramat Gan, Israel
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2
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Murtha A, Warner E, van der Eecken K, Kwan E, Herberts C, Sipola J, Ng S, Chen E, Fonseca N, Schönlau E, Bernales C, Donnellan G, Verbeke S, Lumen N, van Dorpe J, De Laere B, Annala M, Vandekerkhove G, Ost P, Wyatt A. 4MO Multi-focal genomic dissection of synchronous primary and metastatic tissue from de novo metastatic prostate cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Mohammed S, Ravikumar V, Warner E, Patel S, Bakas S, Rao A, Jain R. Quantifying T2-FLAIR Mismatch Using Geographically Weighted Regression and Predicting Molecular Status in Lower-Grade Gliomas. AJNR Am J Neuroradiol 2022; 43:33-39. [PMID: 34764084 PMCID: PMC8757555 DOI: 10.3174/ajnr.a7341] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/03/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The T2-FLAIR mismatch sign is a validated imaging sign of isocitrate dehydrogenase-mutant 1p/19q noncodeleted gliomas. It is identified by radiologists through visual inspection of preoperative MR imaging scans and has been shown to identify isocitrate dehydrogenase-mutant 1p/19q noncodeleted gliomas with a high positive predictive value. We have developed an approach to quantify the T2-FLAIR mismatch signature and use it to predict the molecular status of lower-grade gliomas. MATERIALS AND METHODS We used multiparametric MR imaging scans and segmentation labels of 108 preoperative lower-grade glioma tumors from The Cancer Imaging Archive. Clinical information and T2-FLAIR mismatch sign labels were obtained from supplementary material of relevant publications. We adopted an objective analytic approach to estimate this sign through a geographically weighted regression and used the residuals for each case to construct a probability density function (serving as a residual signature). These functions were then analyzed using an appropriate statistical framework. RESULTS We observed statistically significant (P value = .05) differences between the averages of residual signatures for an isocitrate dehydrogenase-mutant 1p/19q noncodeleted class of tumors versus other categories. Our classifier predicts these cases with area under the curve of 0.98 and high specificity and sensitivity. It also predicts the T2-FLAIR mismatch sign within these cases with an under the curve of 0.93. CONCLUSIONS On the basis of this retrospective study, we show that geographically weighted regression-based residual signatures are highly informative of the T2-FLAIR mismatch sign and can identify isocitrate dehydrogenase-mutation and 1p/19q codeletion status with high predictive power. The utility of the proposed quantification of the T2-FLAIR mismatch sign can be potentially validated through a prospective multi-institutional study.
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Affiliation(s)
- S. Mohammed
- From the Departments of Biostatistics (S.M., A.R.),Computational Medicine & Bioinformatics (S.M., V.R., E.W., A.R.)
| | - V. Ravikumar
- Computational Medicine & Bioinformatics (S.M., V.R., E.W., A.R.)
| | - E. Warner
- Computational Medicine & Bioinformatics (S.M., V.R., E.W., A.R.)
| | - S.H. Patel
- Department of Radiology & Medical Imaging (S.H.P.), University of Virginia School of Medicine, Charlottesville, Virginia
| | - S. Bakas
- Departments of Radiology (S.B.),Pathology & Laboratory Medicine (S.B.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - A. Rao
- From the Departments of Biostatistics (S.M., A.R.),Computational Medicine & Bioinformatics (S.M., V.R., E.W., A.R.),Radiation Oncology (A.R.),Michigan Institute for Data Sciences (A.R.),Department of Biomedical Engineering (A.R.), University of Michigan, Ann Arbor, Michigan
| | - R. Jain
- Departments of Radiology (R.J.),Neurosurgery (R.J.), New York University Grossman School of Medicine, New York, New York
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4
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Quan ML, Olivotto IA, Baxter NN, Friedenreich CM, Metcalfe K, Warner E, MacLennan K, Stephen JE, Akbari MR, Howell D, Narod S. A pan-Canadian prospective study of young women with breast cancer: the rationale and protocol design for the RUBY study. Curr Oncol 2020; 27:e516-e523. [PMID: 33173392 PMCID: PMC7606039 DOI: 10.3747/co.27.6751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction The understanding of the biology and epidemiology of, and the optimal therapeutic strategies for, breast cancer (bca) in younger women is limited. We present the rationale, design, and initial recruitment of Reducing the Burden of Breast Cancer in Young Women (ruby), a unique national prospective cohort study designed to examine the diagnosis, treatment, quality of life, and outcomes from the time of diagnosis for young women with bca. Methods Over a 4-year period at 33 sites across Canada, the ruby study will use a local and virtual recruitment model to enrol 1200 women with bca who are 40 years of age or younger at the time of diagnosis, before initiation of any treatment. At a minimum, comprehensive patient, tumour, and treatment data will be collected to evaluate recurrence and survival. Patients may opt to complete patient-reported questionnaires, to provide blood and tumour samples, and to be contacted for future research, forming the core dataset from which 4 subprojects evaluating genetics, lifestyle factors, fertility, and local management or delivery of care will be performed. Summary The ruby study will be the most comprehensive repository of data, biospecimens, and patient-reported outcomes ever collected with respect to young women with bca from the time of diagnosis, enabling research unique to that population now and into the future. This research model could be used for other oncology settings in Canada.
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Affiliation(s)
- M L Quan
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB
- Department of Community Health Sciences, University of Calgary, Calgary, AB
| | - I A Olivotto
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - N N Baxter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
- Women's College Hospital, University of Toronto, Toronto, ON
| | - C M Friedenreich
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB
- Department of Community Health Sciences, University of Calgary, Calgary, AB
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, AB
| | - K Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, Alberta Health Services, Calgary, AB
| | - E Warner
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON
| | - K MacLennan
- Applied Health Research Centre (ahrc), Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON
| | - J E Stephen
- Clinical Neurosciences Program, Alberta Health Services, Calgary, AB
| | - M R Akbari
- Women's College Hospital, University of Toronto, Toronto, ON
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - D Howell
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, AB
| | - S Narod
- Women's College Hospital, University of Toronto, Toronto, ON
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Califaretti N, Ferrario C, Warner E, Joy A, Chia S, Wu J, Zarate J, Menon-Singh L, Leite R, Haftchenary S, Perri S, Dent S. 317P Updated results from the Canadian sub-population of the phase IIIb CompLEEment-1 ribociclib + letrozole HR+ HER2- advanced breast cancer trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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6
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Lipton NJ, Jesin J, Warner E, Cao X, Kiss A, Desautels D, Jerzak KJ. Willingness of women with early estrogen receptor-positive breast cancer to take adjuvant CDK4/6 inhibitors. ACTA ACUST UNITED AC 2020; 27:127-134. [PMID: 32669921 DOI: 10.3747/co.27.6131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The steady decline in breast cancer (bca) mortality has come at the cost of increasingly toxic and expensive adjuvant therapies. Trials evaluating the addition of 2 or 3 years of cyclin-dependent kinase 4/6 (cdk4/6) inhibitors to adjuvant endocrine therapy (et) are ongoing, but the willingness of patients to take such additional therapy is unknown. Methods We surveyed 100 consecutive postmenopausal women with nonmetastatic estrogen receptor-positive bca who had initiated adjuvant et within the preceding 2 years. Participants were asked about perceived recurrence risk, bca worry, and overall health. They were then asked about their willingness to accept 2 years of treatment with an additional oral drug that would reduce recurrence by 40% for a range of baseline recurrence risks in 2 hypothetical scenarios. Results Mean age of the 99 evaluable participants was 61.7 years. In the scenario with no drug toxicity, 85% of respondents were likely to accept the new drug for a reduction in recurrence to 30% from 50%, but only 49% would take the drug if risk was reduced to 3% from 5%. In a scenario with drug-induced fatigue, the corresponding drug acceptance rates were 55% and 39% respectively. For the second scenario, bca worry was correlated with increased willingness to take the drug, even for only a 2% absolute reduction in recurrence risk. Conclusions The willingness of patients with estrogen receptor-positive bca to take an adjuvant cdk4/6 inhibitor will greatly depend on the expected benefit and toxicities described to them as well as on worry about bca recurrence.
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Affiliation(s)
- N J Lipton
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - J Jesin
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - E Warner
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON.,Sunnybrook Research Institute, Toronto, ON
| | - X Cao
- Sunnybrook Research Institute, Toronto, ON
| | - A Kiss
- Sunnybrook Research Institute, Toronto, ON
| | - D Desautels
- CancerCare Manitoba, University of Manitoba, Winnipeg, MB.,Department of Medicine, University of Manitoba, Winnipeg, MB
| | - K J Jerzak
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON.,Sunnybrook Research Institute, Toronto, ON
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7
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Ferrario C, Warner E, Califaretti N, Joy A, Chia S, Wu J, Zarate J, Lakshmi M, Perri S, Haftchenary S, Dent S. First Canadian interim analysis from the phase IIIb CompLEEment-1 ribociclib + letrozole HR+ HER2- advanced breast cancer trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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8
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Kim HJ, Dominici L, Rosenberg S, Pak LM, Poorvu PD, Ruddy K, Tamimi R, Schapira L, Come S, Peppercorn J, Borges V, Warner E, Vardeh H, Collins L, King T, Partridge A. Abstract GS6-01: Surgical treatment after neoadjuvant systemic therapy in young women with breast cancer: Results from a prospective cohort study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs6-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Young women are more likely than older women to present with higher stage breast cancer (BC) and may benefit to a greater extent from downstaging with neoadjuvant systemic treatment (NST). Young age is also associated with greater likelihood of pathologic complete response (pCR). Using a large prospective cohort of young women with BC, we investigated response to neoadjuvant therapy, eligibility for breast conserving surgery (BCS) pre- and post-NST, and surgical treatment.
Methods
The Young Women's Breast Cancer Study (YWS) is a multi-center cohort of women diagnosed with BC at age ≤40, that enrolled 1302 patients from 2006 to 2016. Disease characteristics and treatment information were obtained through medical record and central pathology review. Surgical recommendation before and after NST, conversion from BCS borderline/ineligible to BCS eligible, surgery, documented reasons for choosing mastectomy (MTX) among BCS eligible women, and final pathologic response were independently reviewed.
Results
Among 1302 women enrolled in YWS, 801 (62%) presented with unilateral stage I-III breast cancer and 317(40%) received NST. Median age was 36 years old (22-40). Pre-NST, 85/317 (27%) were BCS eligible, 49 (15%) were borderline, and 169 (53%) were not eligible (16 inflammatory breast cancer (IBC), 88 large tumor size /cosmetic, 48 diffuse calcifications, and 83 multicentricity). Among the 218 patients who were BCS ineligible/borderline pre-NST, 82 (38%) became eligible for BCS after NST. 4 patients who were BCS eligible pre-NST became ineligible. Of all patients eligible for BCS post-NST (n=163), 80 (49%) attempted BCS, 74 (93%) of whom were successful, and 83 (51%) chose MTX. Reasons for choosing MTX included: patient preference (38/83 (46%)), BRCA or TP53 mutation (31 (37%)), family history (3 (4%)), unknown (11 (13%)). On final pathology, 75 (24%) patients had pCR. Among patients who achieved a pCR, 48 (64%) underwent MTX, fewer than half (21/48 (44%)) were for anatomic indications (IBC, large tumor at diagnosis, diffuse calcifications, multicentric disease).
Conclusion
While NST doubled the proportion of young women eligible for BCS, nearly half chose MTX regardless of response to NST, mostly for personal preference or high-risk preventative reasons. These data highlight that surgical decision making among young women with breast cancer is often driven by factors beyond extent of disease and clinical response to therapy.
Table 1.Clinical-pathologic characteristicsCharacteristicsNumber%Pre NST surgical recommendation BCS eligible8526.8Borderline4915.5BCS ineligible16953.3Unknown144.4Clinical Response Complete20263.7Partial9229.0Stable30.9Progressing72.2Unknown134.1Pathologic Response pCR (No invasive or DCIS)7524No pCR24276Post NST Surgical recommendation BCS eligible16351.4BCS ineligible14445.4Unknown103.2Attempted surgery BCS8025.2MTX23674.1Unknown20.6Final Surgery BCS7423.3MTX24176unknown20.6
Citation Format: Kim HJ, Dominici L, Rosenberg S, Pak LM, Poorvu PD, Ruddy K, Tamimi R, Schapira L, Come S, Peppercorn J, Borges V, Warner E, Vardeh H, Collins L, King T, Partridge A. Surgical treatment after neoadjuvant systemic therapy in young women with breast cancer: Results from a prospective cohort study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS6-01.
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Affiliation(s)
- HJ Kim
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - L Dominici
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - S Rosenberg
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - LM Pak
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - PD Poorvu
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - K Ruddy
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - R Tamimi
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - L Schapira
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - S Come
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - J Peppercorn
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - V Borges
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - E Warner
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - H Vardeh
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - L Collins
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - T King
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - A Partridge
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
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Pagani O, Partridge AH, Peccatori F, Azim HA, Colleoni M, Saura C, Kroep JR, Warner E, Gombos A, Sætersdal AB, Ruggeri M, Gelber RD, Sun Z. Abstract OT1-01-06: POSITIVE: A study evaluating Pregnancy, disease outcome and safety of interrupting endocrine therapy for premenopausal women with endocrine responsIVE breast cancer who desire pregnancy (IBCSG 48-14/BIG 8-13). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot1-01-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Young patients with breast cancer (BC) are often diagnosed with the disease before completing their families. The best available retrospective evidence suggests that pregnancy after BC does not negatively impact disease outcomes in patients with endocrine responsive BC and is safe for the offspring. However, given the possibility of extended adjuvant endocrine therapy (ET) (5-10 years), it is not feasible for many of these women to delay pregnancy until completion of therapy and thus there is a need to study the safety of interrupting ET to allow pregnancy. To date, no prospective study has been conducted in BC survivors attempting future pregnancy.
Trial Design
Young patients with endocrine responsive early BC who desire pregnancy will interrupt ET for up to 2 yrs to attempt pregnancy. As resumption of menses and conception depends on many factors (e.g. patient's age and adjuvant treatment received), the 2-yr interruption period is approximate, intended to include treatment wash-out (3 mos), conception (˜3-6 mos), delivery (˜9 mos), and breast feeding (˜6 mos). Patients will be strongly advised to resume ET as soon as pregnancy attempts/deliveries are concluded, and to complete the planned 5-10 yrs of ET.
Major Eligibility Criteria
- Histologically-proven stage I-III endocrine-responsive BC.
- Patient's wish to become pregnant.
- Age ≥ 18 and ≤ 42 years at enrollment.
- Adjuvant ET (selective estrogen receptor modulator [SERM] alone, GnRH analogue plus SERM or aromatase inhibitor) for ≥18 months but ≤30 months, stopped within 1 month prior to enrollment.
- Premenopausal status at BC diagnosis.
Specific Aim
To assess the risk of BC relapse associated with the interruption of ET to permit pregnancy, and to evaluate pregnancy success rate and offspring outcome.
Statistical Methods
With 500 pts enrolled and followed for a median of 3 years, the statistical design is based on the 95% CI for the 3-year BC recurrence rate. Interim monitoring assumes a 2% BC recurrence risk/yr with continuous ET and a recommendation to stop the study early if the BC risk exceeds 4%/yr with ET interruption.
Translational Research will investigate various ovarian function and uterine parameters and circulating tumour DNA. Fresh frozen paraffin embedded tissue of the primary tumour will be collected to evaluate parameters related to the biology of BC in young women. All material will be banked centrally.
Psycho-oncological Companion Study (POCS) will evaluate fertility concerns, psychological well-being and decisional conflict. It is mandatory in North America and open to interested centers elsewhere.
Accrual: Target: 500; Actual: 262 (30 June 2018)
Psycho-oncological Companion Study Accrual: Target: 200; Actual: 138 (30 June 2018)
Citation Format: Pagani O, Partridge AH, Peccatori F, Azim HA, Colleoni M, Saura C, Kroep JR, Warner E, Gombos A, Sætersdal AB, Ruggeri M, Gelber RD, Sun Z. POSITIVE: A study evaluating Pregnancy, disease outcome and safety of interrupting endocrine therapy for premenopausal women with endocrine responsIVE breast cancer who desire pregnancy (IBCSG 48-14/BIG 8-13) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-01-06.
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Affiliation(s)
- O Pagani
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - AH Partridge
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - F Peccatori
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - HA Azim
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - M Colleoni
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - C Saura
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - JR Kroep
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - E Warner
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - A Gombos
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - AB Sætersdal
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - M Ruggeri
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - RD Gelber
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - Z Sun
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
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Pak LM, Rosenberg SM, Ruddy KJ, Tamimi RM, Peppercorn J, Schapira L, Borges VF, Come SE, Warner E, Snow C, Collins L, King TA, Partridge AH. Abstract P6-22-03: Tumor phenotype and concordance in synchronous bilateral breast cancer in young women. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-22-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Synchronous bilateral breast cancer is rare, with reported incidence from 0.3-12%; the incidence and pattern of bilateral breast cancer among younger women is unknown. Here we report the incidence and phenotypes of bilateral breast cancer in women ≤40 years of age enrolled in the Young Women's Study (YWS) cohort.
Methods: The YWS is a multi-center, prospective cohort study that enrolled women with newly diagnosed breast cancer at age ≤40 years from 2006-2016. Those with synchronous bilateral breast cancer (in-situ and/or invasive) formed our study cohort. Disease characteristics and treatment were obtained by medical record review. Central pathology review was performed to capture histologic features and categorize the tumor phenotype as either luminal A (hormone receptor (HR)+, HER2-, grade 1 or 2), luminal B (HR+, HER2+, or HER2- and grade 3), HER2-type (HR-, HER2+), or triple negative (TNC; HR/HER2-). Tumor phenotypes of bilateral breast cancers were compared and evaluated for concordance.
Results: Among 1302 patients enrolled in the YWS, 20 (1.5%) patients presented with bilateral disease, with median age of diagnosis of 38 years (range 18-40). The majority of patients (13 (65%)) presented with unilateral symptoms and contralateral disease was identified on subsequent imaging. 12 (60%) reported a positive family history of breast cancer and 17 (85%) underwent genetic testing; resulting in the identification of 6 mutation carriers (2 BRCA1, 3 BRCA2, 1 TP53). The majority of patients (15 (75%)) underwent bilateral mastectomy, 1 underwent unilateral mastectomy with contralateral lumpectomy, and 4 underwent bilateral lumpectomy. On pathology, 2 patients had bilateral in-situ disease, 5 had unilateral invasive and contralateral in-situ disease, and 13 had bilateral invasive disease. Of those with bilateral invasive disease, all had concordant tumor histology (92% ductal, 8% ductal and lobular), 10 (77%) patients had bilateral luminal tumors and when fully characterized 6 were of the same luminal type. Only one patient had bilateral basal-like breast cancer.
Patient ID ERPRHer2 amplifiedGradePhenotype1Left++-2Luminal A Right++-3Luminal B3Left++-3Luminal B Right++-3Luminal B6Left++-3Luminal B Right++-3Luminal B9Left++-2Luminal A Right++-2Luminal A10Left+++3Luminal B Right++-2Luminal A12Left+--3Luminal B Right+--2Luminal A13Left---NABasal-like Right++-NALuminal A or B14Left+++2Luminal B Right++-3Luminal B15Left++-3Luminal B Right+++3Luminal B16Left+++3Luminal B Right--+NAHEr2-type17Left---3Basal-like Right---3Basal-like19Left++-2Luminal A Right++-3Luminal B20Left++-1Luminal A Right++-2Luminal A
Conclusions: Among a large cohort of young women, only 20 (1.5%) had bilateral disease, and the majority of the invasive tumors were of the luminal phenotype, yet frequently differed by grade or HER2 status; supporting the need for thorough pathologic evaluation of bilateral disease to determine risk and tailor treatment. Overall the low incidence of bilateral disease and preponderance of the luminal phenotype in this population is reassuring.
Citation Format: Pak LM, Rosenberg SM, Ruddy KJ, Tamimi RM, Peppercorn J, Schapira L, Borges VF, Come SE, Warner E, Snow C, Collins L, King TA, Partridge AH. Tumor phenotype and concordance in synchronous bilateral breast cancer in young women [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-22-03.
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Affiliation(s)
- LM Pak
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
| | - SM Rosenberg
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
| | - KJ Ruddy
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
| | - RM Tamimi
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
| | - J Peppercorn
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
| | - L Schapira
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
| | - VF Borges
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
| | - SE Come
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
| | - E Warner
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
| | - C Snow
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
| | - L Collins
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
| | - TA King
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
| | - AH Partridge
- Brigham and Women's Hospital, Boston; Dana-Farber Cancer Institute, Boston; Mayo Clinic, Rochester; Massachusetts General Hospital, Boston; Stanford University, Palo Alto; University of Colorado Cancer Center, Aurora; Beth Israel Deaconess Medical Center, Boston; Sunnybrook Hospital, Toronto, Canada
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Dominici LS, Hu J, King TA, Ruddy KJ, Tamimi RM, Peppercorn J, Schapira L, Borges VF, Come SE, Warner E, Partridge AH, Rosenberg SM. Abstract GS6-06: Local therapy and quality of life outcomes in young women with breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs6-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Increasing rates of mastectomy, primarily bilateral mastectomy (BMx), have been most dramatic in young women with breast cancer (BC). Impact on long-term quality of life (QOL) is largely unknown.
Methods: Between 10/2016-11/2017, we administered the BREAST-Q, a validated patient-reported outcomes measure, to women dx with BC at age ≤40 in a large prospective cohort study. Demographic and treatment information was obtained by surveys and chart review. Mean BREAST-Q scores for each domain (breast satisfaction, physical, psychosocial, and sexual) were compared by surgery types; higher BREAST-Q scores (range: 0-100) indicate better QOL. Linear regression was used to identify predictors of BREAST-Q domain scores.
Results: 581 women with stage 0-3 BC completed the BREAST-Q a median of 5.8 years from dx. Median age at dx was 37 (range: 26-40) years; 86% had stage 0, 1 or 2 disease; 28% had breast-conserving surgery (BCS); 72% had mastectomy (Mx), among whom 72% underwent BMx and 89% had reconstruction. Mean BREAST-Q scores (unadjusted) for breast satisfaction, psychosocial, and sexual well-being were lower for patients having unilateral mastectomy (UMx) or BMx compared to BCS; physical function was similar among groups. In multivariate analysis, lower BREAST-Q psychosocial scores were associated with radiation and Mx (UMx or BMx). Lower sexual well-being scores were also associated with Mx. Lower satisfaction with breast scores following radiation were of a clinically significant magnitude (β -8.1 95% CI -11.9- -4.3, p-value 0.03). Lower scores for physical well-being were seen for patients reporting lymphedema and higher for those who had undergone surgery more than 5 years prior. Lower scores across all 4 domains were associated with reported financial distress.
BREAST-Q domain mean scores (SD) BMxUMxBCSp-valueBreast satisfaction60.3 (18.9)59.5 (21.3)65.9 (20.7)0.008Physical well-being78.6 (14.9)79.7 (15.1)78.9 (15.5)0.8Psychosocial well-being68.1 (20.8)70.5 (21.2)76.1 (20.5)<0.001Sexual well-being48.6 (21.3)53.2 (21.7)57.5 (18.7)<0.001SD Standard deviation
Conclusion: Local therapy in young breast cancer survivors may have a persistent impact on their breast satisfaction, psychosocial, and sexual outcomes, with particular effects from UMx or BMx. Socio-economic stressors also appear to play a role. When counseling young women about their surgical decisions, knowledge of potential long-term QOL impact is of critical importance.
Citation Format: Dominici LS, Hu J, King TA, Ruddy KJ, Tamimi RM, Peppercorn J, Schapira L, Borges VF, Come SE, Warner E, Partridge AH, Rosenberg SM. Local therapy and quality of life outcomes in young women with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS6-06.
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Affiliation(s)
- LS Dominici
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Mayo Clinic, Rochester, MN; Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University Medical Center, Stanford, CA; University of Colorado, Denver, CO; Beth Israel Deaconess Medical Center, Boston, MA; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - J Hu
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Mayo Clinic, Rochester, MN; Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University Medical Center, Stanford, CA; University of Colorado, Denver, CO; Beth Israel Deaconess Medical Center, Boston, MA; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - TA King
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Mayo Clinic, Rochester, MN; Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University Medical Center, Stanford, CA; University of Colorado, Denver, CO; Beth Israel Deaconess Medical Center, Boston, MA; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - KJ Ruddy
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Mayo Clinic, Rochester, MN; Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University Medical Center, Stanford, CA; University of Colorado, Denver, CO; Beth Israel Deaconess Medical Center, Boston, MA; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - RM Tamimi
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Mayo Clinic, Rochester, MN; Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University Medical Center, Stanford, CA; University of Colorado, Denver, CO; Beth Israel Deaconess Medical Center, Boston, MA; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - J Peppercorn
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Mayo Clinic, Rochester, MN; Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University Medical Center, Stanford, CA; University of Colorado, Denver, CO; Beth Israel Deaconess Medical Center, Boston, MA; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Schapira
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Mayo Clinic, Rochester, MN; Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University Medical Center, Stanford, CA; University of Colorado, Denver, CO; Beth Israel Deaconess Medical Center, Boston, MA; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - VF Borges
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Mayo Clinic, Rochester, MN; Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University Medical Center, Stanford, CA; University of Colorado, Denver, CO; Beth Israel Deaconess Medical Center, Boston, MA; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - SE Come
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Mayo Clinic, Rochester, MN; Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University Medical Center, Stanford, CA; University of Colorado, Denver, CO; Beth Israel Deaconess Medical Center, Boston, MA; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E Warner
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Mayo Clinic, Rochester, MN; Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University Medical Center, Stanford, CA; University of Colorado, Denver, CO; Beth Israel Deaconess Medical Center, Boston, MA; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - AH Partridge
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Mayo Clinic, Rochester, MN; Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University Medical Center, Stanford, CA; University of Colorado, Denver, CO; Beth Israel Deaconess Medical Center, Boston, MA; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - SM Rosenberg
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Mayo Clinic, Rochester, MN; Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University Medical Center, Stanford, CA; University of Colorado, Denver, CO; Beth Israel Deaconess Medical Center, Boston, MA; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Poorvu PD, Gelber SI, Rosenberg SM, Ruddy KJ, Tamimi RM, Collins LC, Peppercorn J, Schapira L, Borges VF, Come SE, Warner E, Jakubowski DM, Russell C, Winer EP, Partridge AH. Abstract P2-08-07: Prognostic impact of the 21-gene recurrence score assay among young women with node-negative and node-positive ER+/HER2- breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The 21-gene Recurrence Score (RS) assay is prognostic among women with early-stage estrogen receptor (ER) positive and human epidermal growth factor receptor 2 (HER2) negative breast cancer (BC) and is used to select patients for chemotherapy (CT). Young women (age <40) have represented a minority in studies evaluating gene expression assays, including TAILORx, and additional data in young women are needed.
Methods: In the Young Women's Breast Cancer Study, a prospective cohort study of women diagnosed with BC at age <40 enrolling between 2006-2016 (N=1302), we identified those with stage I-III ER+/HER2- BC. Disease and treatment information were obtained through serial surveys and medical record review. The RS was performed on banked specimens for those not tested clinically. Distant recurrence free interval (DRFI), defined as distant recurrence or BC specific death, by risk group was assessed using Cox regression and Kaplan-Meier survival estimates. Outcomes by receipt of CT were explored in the RS 11-25 group, and due to small number of events, reported descriptively.
Results: Among eligible women (N=577), 189 (33%) had undergone RS testing and 320 (56%) had banked specimens sufficient for testing. Median follow-up was 6 years. Median age at diagnosis was 37, most had N0 BC (300/509, 59%), and the majority had RS 11-25 (306/509, 60%). RS result was significantly associated with DRFI in N0 BC, with hazard ratio (HR) (95% CI) of 0.29 (0.07,1.30) and 0.21 (0.09,0.50) for RS<11 and RS 11-25, respectively, relative to RS>26 (and trended towards significance in N1 BC). Results were similar using conventional RS groups. Among women with N0 BC and RS 11-25, 44% received CT, with two events in the 86 receiving CT (2.3%) and 6 events in the 109 without CT (5.5%); 5/8 (63%) occurred in those with RS 20-25.
Table 1 N0N1Total Cohort N%N%N% 3005916332509100Median Age37.137.537.2Tumor Stage T120869694229358T28227784817635T3103159357T4001151Grade I4716855711II16555794926652III8829754618536Not assessed 1 1 PR status by IHC Negative (<1%)2071710398Positive (>=1%)280931469047092Chemotherapy No1414712715430Yes159531519335570Ovarian Suppression No263881499145289Yes37121495711TAILORx RS Groups RS <1133111495411RS 11-2519565885430660RS >=267224613714929Conventional RS Groups RS <1812742543319939RS 18-3012542694221142RS >=31481640259919
Table 2 6-year freedom from distant recurrence or breast cancer deathDRFI HR (95% CI) N0N1N0N1TAILORx RS Groups RS <1194.4%92.3%0.29 (0.07,1.30)0.21 (0.03,1.61)RS 11-2596.9%85.2%0.21 (0.09, 0.50)0.55 (0.27,1.12)RS >=2685.1%71.3%RefRefConventional RS Groups RS <1897.5%85.9%0.19 (0.06,0.59)0.31 (0.13,0.74)RS 18-3093.1%87.3%0.39 (0.16,1.00)0.32 (0.14,0.73)RS >=3186.4%62.8%RefRef
Conclusions: The RS is prognostic among young women with node-negative and node-positive BC, and is a valuable tool for risk stratification. Disease outcomes among young women with N0 disease and RS 11-25, a minority of whom received CT, are very good. Evaluation of the effect of ovarian suppression/CT-induced amenorrhea by RS/treatment strata is ongoing.
Citation Format: Poorvu PD, Gelber SI, Rosenberg SM, Ruddy KJ, Tamimi RM, Collins LC, Peppercorn J, Schapira L, Borges VF, Come SE, Warner E, Jakubowski DM, Russell C, Winer EP, Partridge AH. Prognostic impact of the 21-gene recurrence score assay among young women with node-negative and node-positive ER+/HER2- breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-07.
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Affiliation(s)
- PD Poorvu
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - SI Gelber
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - SM Rosenberg
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - KJ Ruddy
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - RM Tamimi
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - LC Collins
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - J Peppercorn
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - L Schapira
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - VF Borges
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - SE Come
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - E Warner
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - DM Jakubowski
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - C Russell
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
| | - AH Partridge
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford University, Palo Alto, CA; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Genomic Health Inc., Redwood City, CA
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13
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Warner E, Liu ZW, Lechner M, Kotecha B. Attitudes to local anaesthesia in radiofrequency thermotherapy sleep surgery: Our experience in a single centre with 42 adult patients. Clin Otolaryngol 2018; 43:1401-1402. [PMID: 29856532 DOI: 10.1111/coa.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Z-W Liu
- Royal National Throat Nose and Ear, London, UK
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14
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Thomas W, Warner E, Cameron E, Symington E. Successful treatment of acquired von Willebrand disease with lenalidomide leading to dramatic resolution of intractable gastrointestinal bleeding: A case report. Haemophilia 2018; 24:e140-e142. [DOI: 10.1111/hae.13464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2018] [Indexed: 12/14/2022]
Affiliation(s)
- W. Thomas
- Haemophilia & Thrombophilia Centre; Addenbrooke's Hospital; Cambridge UK
| | - E. Warner
- Haemophilia & Thrombophilia Centre; Addenbrooke's Hospital; Cambridge UK
| | - E. Cameron
- Department of Gastroenterology; Addenbrooke's Hospital; Cambridge UK
| | - E. Symington
- Haemophilia & Thrombophilia Centre; Addenbrooke's Hospital; Cambridge UK
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15
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Jerzak KJ, Zhu S, Nofech-Mozes S, Pond G, Warner E. Abstract P3-08-12: Prognostic relevance of neutrophil-to-lymphocyte ratio (NLR) in young women with breast cancer (BC). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-08-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Many studies suggest that a high NLR prior to systemic treatment is an adverse prognostic marker for BC but its role in women ≤ age 40 in general, and in those with pregnancy associated BC (PABC) in particular is unknown. We investigated whether the NLR is independently prognostic for recurrence-free survival (RFS) in a prospective database of young BC patients.
Methods: A prospective database of women ≤40 years of age diagnosed with BC from 02-2008 to 01-2015 was analyzed. Data regarding age, stage at diagnosis, pathology, treatment and clinical outcomes were available; the NLR was abstracted from the patients' medical record retrospectively with all values obtained post-diagnosis and prior to systemic therapy. The Kaplan-Meier method was used to estimate time-to-event outcomes, with a primary outcome of RFS. Insufficient events had occurred to analyze overall survival. Univariable Cox proportional hazards regression models were used to evaluate factors that were potentially prognostic for RFS; a subsequent multivariable Cox proportional hazards model adjusted for nodal involvement, PABC status and tumor size. All tests were two-sided and statistical significance was defined as a p-value ≤0.05.
Results: Of 233 women in the database, 208 had a NLR and outcomes available for analysis. The mean age of patients was 35.1 and 24% (n=66/233) had PABC (BC diagnosed during pregnancy or ≤ 24 months postpartum); the median size of their tumors was 2.8 cm (range 0.1 cm – 19.0 cm) and 48% (n=102/211) were node positive. The majority of women had hormone receptor positive (92%; n=206/223) and HER2 negative 75% (n=160/212) disease, 50% (n=112/223) were treated with breast conserving surgery, 61% (n=142/233) received adjuvant radiotherapy and 83% (n=184/223) received adjuvant chemotherapy. With a median follow-up of 41 months, 16 patients (7%) experienced a local recurrence and 25 (11%) had distant recurrent disease. A higher NLR was prognostic for an adverse RFS in both uni- and multi-variable models (Table). The neutrophil count, individually, was also prognostic for adverse RFS but the lymphocyte count was not. The findings for patients with PABC and non-PABC were similar (interaction tests >0.05).
Prognostic association between NLR and RFSVariableNumber of patients (total N=223)Univariable HR (95% CI)P valueMultivariable HR (95% CI)P valueSize ( /cm)1981.1 (0.9 - 1.2)0.261.0 (0.5 - 1.9)0.99Node positive (yes vs no)2042.1 (0.9 - 4.8)0.0912.6 (1.0 - 6.7)0.050PABC (yes vs no)2232.2 (1.0 - 4.8)0.0481.8 (0.8 - 4.3)0.17Log[NLR] ( /unit)2082.6 (1.3 - 5.0)0.0062.5 (1.2 - 5.0)0.006Log[neutrophils] ( /unit)2082.9 (1.2 - 7.3)0.023--Log[lymphocytes] ( /unit)2080.54 (0.16 - 1.8)0.31--
Conclusions: A higher NLR is prognostic for adverse RFS in our cohort of women ≤40 years of age with BC, including those with PABC. In our study, a higher neutrophil count drives the prognostic effects of NLR, suggesting an inflammatory state. If our results are confirmed in larger data sets, these findings may warrant the investigation of anti-inflammatory agents in the treatment of young women with BC. As BC in this age group has a worse prognosis than BC in older women, the potential benefit of anti-inflammatory agents may be easier to observe in this population.
Citation Format: Jerzak KJ, Zhu S, Nofech-Mozes S, Pond G, Warner E. Prognostic relevance of neutrophil-to-lymphocyte ratio (NLR) in young women with breast cancer (BC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-08-12.
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Affiliation(s)
- KJ Jerzak
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - S Zhu
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - S Nofech-Mozes
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - G Pond
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - E Warner
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada
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16
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Warner E, Corbridge R. A technique for teaching and photodocumentation of direct endoscopic rigid oesophagoscopy. Clin Otolaryngol 2018; 43:995-996. [PMID: 29431899 DOI: 10.1111/coa.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
- E Warner
- Royal Berkshire Hospital, Reading, UK
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17
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Bird JH, Warner E, Corbridge R. Five-year outcome of endoscopic laser cricopharyngeal myotomy: Our experience in ten patients. Clin Otolaryngol 2018; 43:935-937. [PMID: 29327499 DOI: 10.1111/coa.13064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J H Bird
- Department of ENT Surgery, Royal Berkshire Hospital, Reading, UK
| | - E Warner
- Department of ENT Surgery, Royal Berkshire Hospital, Reading, UK
| | - R Corbridge
- Department of ENT Surgery, Royal Berkshire Hospital, Reading, UK
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18
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Warner E, Brar S, Corbridge R. Drape crimping: a novel technique for retracting skin flaps. Ann R Coll Surg Engl 2018; 100:498-499. [PMID: 29364020 DOI: 10.1308/rcsann.2018.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- E Warner
- Royal Berkshire Hospital , Reading , UK
| | - S Brar
- Royal Berkshire Hospital , Reading , UK
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19
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Morarji K, McArdle O, Hui K, Gingras-Hill G, Ahmed S, Greenblatt EM, Warner E, Sridhar S, Ali AMF, Azad A, Hodgson DC. Ovarian function after chemotherapy in young breast cancer survivors. ACTA ACUST UNITED AC 2017; 24:e494-e502. [PMID: 29270058 DOI: 10.3747/co.24.3335] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background As cure rates for breast cancer improve, there is increasing evidence that late effects of treatment-and impaired fertility in particular-are emerging as important concerns among young breast cancer survivors. Older reports have evaluated the occurrence of amenorrhea after treatment, but few data have been reported about the incidence of biochemical evidence for impaired ovarian function in patients who do not become overtly menopausal. Methods We conducted a cross-sectional study evaluating anti-Müllerian hormone (amh) in premenopausal chemotherapy-treated breast cancer survivors and control patients. Random serum levels of amh and other relevant clinical data were collected for 100 premenopausal chemotherapy-treated breast cancer survivors and 76 control subjects. Subgroup analyses were performed for women with regular menstrual cycles at the time of amh testing. Results After adjustment for age, amh was significantly lower in the overall group of patients receiving chemotherapy (p = 0.002) and in the subgroup reporting normal cycles (p = 0.03). Cyclophosphamide produced a significant dose-dependent reduction in amh (p < 0.001); trastuzumab was associated with increased amh in survivors with normal cycles. Overall, serum amh in survivors was roughly equivalent to that measured in control patients 12 years older. Conclusions Young breast cancer survivors often experience significant impairment of ovarian function despite having normal menstrual cycles after treatment. Those results have important implications for patient counselling and the timing of possible referral to a fertility specialist.
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Affiliation(s)
- K Morarji
- Department of Radiation Oncology, Princess Margaret Hospital
| | - O McArdle
- Department of Radiation Oncology, Princess Margaret Hospital
| | - K Hui
- Department of Radiation Oncology, Princess Margaret Hospital
| | - G Gingras-Hill
- Department of Radiation Oncology, Princess Margaret Hospital
| | - S Ahmed
- Department of Radiation Oncology, Princess Margaret Hospital
| | - E M Greenblatt
- Department of Obstetrics and Gynecology, Mount Sinai Hospital.,University of Toronto
| | - E Warner
- Department of Medical Oncology, Odette Cancer Centre
| | - S Sridhar
- Department of Medical Oncology, Princess Margaret Hospital; and
| | - A M F Ali
- Department of Medical Oncology, Odette Cancer Centre
| | - A Azad
- Pathology and Laboratory Medicine Unit, Mount Sinai Hospital, Toronto, ON
| | - D C Hodgson
- Department of Radiation Oncology, Princess Margaret Hospital
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20
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Warner E, Weston C, Barclay-Klingle N, Corbridge R. The swollen pinna. BMJ 2017; 359:j5073. [PMID: 29146730 DOI: 10.1136/bmj.j5073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- E Warner
- Royal Berkshire Hospital, Reading, UK
| | - C Weston
- Royal Berkshire Hospital, Reading, UK
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21
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Cohen L, Schwartz N, Guth A, Kiss A, Warner E. User survey of Nanny Angel Network, a free childcare service for mothers with cancer. ACTA ACUST UNITED AC 2017; 24:220-227. [PMID: 28874889 DOI: 10.3747/co.24.3512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of the present study was to determine user satisfaction with Nanny Angel Network (nan), a free childcare service for mothers undergoing cancer treatment. METHODS All 243 living mothers who had used the nan service were invited by telephone to participate in an online research survey; 197 mothers (81%) consented to participate. The survey, sent by e-mail, consisted of 39 items divided into these categories: demographics, supports, use, satisfaction, and general comments. RESULTS Of the 197 mothers who consented to receive the e-mailed survey, 104 (53%) completed it. More than 90% of the mothers were very satisfied with the help and support from their Nanny Angel. Many mothers mentioned that the Nanny Angel was most helpful during treatment and medical appointments, with 75% also mentioning that their Nanny Angel helped them to adhere to their scheduled medical appointments. However, 64% felt that they had not received enough visits from their Nanny Angel. CONCLUSIONS Satisfaction with the nan childcare provider was high, but mothers wished the service had been available to them more often. Our study highlights the importance of providing childcare to mothers with inadequate support systems, so as to allow for greater adherence to treatment and medical appointments, and for more time to recover.
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Affiliation(s)
- L Cohen
- Faculty of Medicine, University of Toronto, and.,Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - N Schwartz
- Technion American Medical School, Haifa, Israel
| | - A Guth
- Nanny Angel Network, Toronto, ON
| | - A Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, University of Toronto, Toronto, ON
| | - E Warner
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON
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22
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Abstract
When I first went into practice, my preferred referral was a patient under age 50 with a potentially curable malignancy [...]
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Affiliation(s)
- E Warner
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON
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23
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Nadler M, Al Attar H, Curpen B, Martel AL, Balasingham S, Zhang L, Eisen A, Warner E. Abstract P3-02-06: Magnetic resonance imaging (MRI) surveillance for patients with dense breasts and a previous breast cancer (BC) and/or high risk lesion. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-02-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND AND PURPOSE
The benefits of breast MRI for screening women at high risk of developing BC is established, but its role in women with a personal history of BC or dense breasts is unknown. We sought to estimate the performance of annual surveillance MRI added to mammography in women at moderately increased BC risk due to a personal history of breast cancer and/or a high-risk breast lesion and dense breasts.
METHOD AND MATERIALS
We performed a retrospective chart review of the clinical, radiological, and pathological parameters of women who received annual, concurrent surveillance breast MRI and mammography between 04/2013 and 12/2015. We included women who met all of the following criteria: age<69; prior diagnosis of high-risk lesion (ADH, ALH, LCIS), DCIS, or invasive BC; heterogeneously (50-75%) or extremely dense (>75%) breasts; and did not qualify for our provincial MRI screening program for high risk women (calculated lifetime BC risk ≥ 25%). Results of each scan were analyzed using descriptive statistics and Chi squared for comparisons between subgroups.
RESULTS
A total of 199 patients (267 MRI exams) were included in this study. The mean age at initial diagnosis was 45 years and at subsequent diagnosis of DCIS or invasive cancer was 53 years. Mean time to new diagnosis was 86 months (range 14-202). All 15 cancers diagnosed during the study period were MRI detected: 11 invasive stage I (66% IDC, 7% ILC) and 4 DCIS (27%). Of these 15, all but 1 were mammographically occult. Five (33%) were found in the breast ipsilateral to the original lesion. The cancer detection rate was 6% (12/199) on the first screening round and 4.7% (3/64) on the second screening round. Specificity and positive predictive value respectively for MRI exams increased from 77% and 22% on the first screening round to 88% and 30% on the second round. Of women who developed BC, 57% had a history of breast or ovarian cancer in a first degree relative. None of the 72 women who were on hormonal therapy at the time of surveillance imaging had a new cancer detected compared to 11% (14/125) of those who were not on hormonal therapy (p=0.0025).
CONCLUSIONS
The incremental early-stage BC detection rate and specificity of MRI in this population are comparable to what is observed in screening women at high risk. The addition of annual MRI to mammography should be considered for surveillance of women with a personal history of BC / premalignant lesion and heterogeneous / extremely dense breasts, particularly if they have a family history of BC and are not on hormonal therapy.
Citation Format: Nadler M, Al Attar H, Curpen B, Martel AL, Balasingham S, Zhang L, Eisen A, Warner E. Magnetic resonance imaging (MRI) surveillance for patients with dense breasts and a previous breast cancer (BC) and/or high risk lesion [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-02-06.
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Affiliation(s)
- M Nadler
- McMaster University, Hamilton, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada; Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - H Al Attar
- McMaster University, Hamilton, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada; Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - B Curpen
- McMaster University, Hamilton, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada; Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - AL Martel
- McMaster University, Hamilton, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada; Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - S Balasingham
- McMaster University, Hamilton, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada; Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - L Zhang
- McMaster University, Hamilton, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada; Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - A Eisen
- McMaster University, Hamilton, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada; Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - E Warner
- McMaster University, Hamilton, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada; Medical Biophysics, University of Toronto, Toronto, ON, Canada
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Jerzak KJ, Zhu S, Li N, Mandel R, Warner E. Abstract PD6-05: A prospective evaluation of clinical outcomes in women with pregnancy-associated breast cancer (PABC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-pd6-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Many studies suggest that women with PABC- breast cancer (BC) diagnosed during pregnancy or within 12 months post partum- have adverse outcomes compared to age matched women whose BC is not associated with pregnancy (non-PABC). However, it is unclear whether this is due to diagnostic delay alone or biological differences. Hence, we investigated whether PABC is independently prognostic for disease-free survival (DFS) and overall survival (OS) in a prospective database of young BC patients.
Methods:
A prospective database of women ≤40 years of age diagnosed with BC between February 2008 and January 2015 was analyzed. Data regarding, stage at diagnosis, pathology, treatment, and clinical outcomes were available. Statistically significant differences in baseline characteristics and administered therapies in women with and without PABC were evaluated using the chi-square or Fisher's Exact tests. Kaplan-Meier curves for DFS and OS in the PABC and non-PABC cohorts were compared using the log-rank test. A multivariate Cox proportional hazards model adjusted for age, nodal involvement and tumor size.
Results:
Of 224 women in the database who provided consent for research, 32 (12%) had PABC. Mean age of the PABC and non-PABC patients respectively was 34 (range 27 to 39) and 37 (range 21 to 40) and the median follow-up was 40 months in both groups. PABC was more likely to be locally advanced at diagnosis (44% vs. 22%, p<0.01) and less likely to be hormone receptor positive (75% versus 85%; p <0.01). There was no significant difference in age at diagnosis, tumor grade, lymphovascular invasion, HER2 expression or administered treatments between the two groups. Among the 166 women with early stage BC (not locally advanced), PABC was associated with positive lymph node status in a univariate model [OR 3.2 (95%CI 1.2-8.4), p=0.02] but just missed significance in a multivariate analysis that adjusted for age and tumor size (p=0.06).
Eight patients (22%) in the PABC group and 19 (10%) in the non-PABC group experienced local or distant disease recurrence; 3 patients (8%) in the PABC group and 11 (6%) in the non-PABC group died. The 3-year DFS in the PABC and non-PABC cohorts was 79% vs. 90% (p=0.22) and the 3-year OS was 97% in both groups.
Conclusion:
Diagnostic delay could account for the higher rate of locally advanced disease in the PABC group. However, the lower hormone receptor expression and strong trend toward greater lymph node involvement independent of size suggest that women with PABC may have intrinsically worse disease biology. Event rates may still be too low to detect a statistically significant difference in recurrence risk. Further research is necessary to identify unique molecular features of PABC that may be amenable to targeting.
Citation Format: Jerzak KJ, Zhu S, Li N, Mandel R, Warner E. A prospective evaluation of clinical outcomes in women with pregnancy-associated breast cancer (PABC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD6-05.
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Affiliation(s)
- KJ Jerzak
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - S Zhu
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - N Li
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - R Mandel
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - E Warner
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
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25
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Lipton JH, Wong WWL, Warner E, Greenblatt EM, Lee EK, Chan KKW. Abstract P4-15-01: Cost-effectiveness of pre-implantation genetic diagnosis for BRCA mutation carriers. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-15-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Management of BRCA mutation carriers is very expensive due to preventive surgeries and/or screening tests, as well as greater likelihood of cancer treatment. The related cancer burden and costs continue from generation to generation. One relatively new option for male or female BRCA mutation carriers, who wish to have children, is pre-implantation genetic diagnosis (PGD) of in vitro fertilized embryos. PGD eliminates the mutation from the descendants of these carriers. The purpose of this study was to model the cost-effectiveness of PGD.
Methods: We developed a Markov Model using TreeAge Pro 2016 and compared incidence of cancers, cancers-related death, costs, quality adjusted life-years (QALY), and incremental cost-effectiveness ratio (ICER) in the 2nd generation associated with conventional management of BRCA mutation carriers vs. PGD using a U.S. third-party payer's perspective with a lifetime horizon at a discount rate of 3% per year. In the model, health states were implemented to reflect the natural history of breast and ovarian cancer for women, and prostate cancer (and breast cancer in BRCA2 mutation carriers) for men. Model data were obtained from published literature. Costs were determined from published data and insurance payment schedules.
Results: Our preliminary results show that for BRCA1 mutation carriers, the PGD with IVF strategy is associated with an increase of 0.29 QALYs and costs an additional $292.68 per person, translating to an ICER of $1,014.25/QALY when compared with “No PGD”, making it highly cost-effective. For BRCA2 mutation carriers, the PGD with IVF strategy is associated with an increase of 0.17 QALYs and costs an additional $4,916.88 per person, translating to an ICER of $28,436.10/QALY when compared with “No PGD”, making it cost-effective.
Table 1StrategyCost ($)Incr Cost ($)Eff (QALY)Incr Eff (QALY)Incr C/E ($/QALY) BRCA 1 No PGD323,347.22 28.41 PGD323,639.89292.6828.70.291,014.25BRCA 2 No PGD318,723.02 28.52 PGD323,639.894,916.8828.70.1728,436.10
Conclusion: PGD for both BRCA1 and BRCA2 mutation carriers reduces cancer burden, increases QALYs and, is very cost-effective in the 2nd generation cohort, making this an attractive option from the perspectives of patients and public payers. Our estimates are conservative because the cost-effectiveness of PGD will likely improve further if subsequent generations are included in the model, given the expected further reduction in cancer burden and associated cost-savings in subsequent generations.
Citation Format: Lipton JH, Wong WWL, Warner E, Greenblatt EM, Lee EK, Chan KKW. Cost-effectiveness of pre-implantation genetic diagnosis for BRCA mutation carriers [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-15-01.
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Affiliation(s)
- JH Lipton
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada; Mount Sinai, Torontno, ON, Canada
| | - WWL Wong
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada; Mount Sinai, Torontno, ON, Canada
| | - E Warner
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada; Mount Sinai, Torontno, ON, Canada
| | - EM Greenblatt
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada; Mount Sinai, Torontno, ON, Canada
| | - EK Lee
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada; Mount Sinai, Torontno, ON, Canada
| | - KKW Chan
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada; Mount Sinai, Torontno, ON, Canada
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Torres S, Trudeau M, Gandhi S, Warner E, Verma S, Pritchard K, Petrella T, Slodkowska E, Hew-Shue M, Chao C, Eisen A. Prospective evaluation of the impact of the 21-gene recurrence score® assay on adjuvant treatment decisions for women with node-positive breast cancer in Ontario, Canada. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wyatt A, Annala M, Beja K, Parimi S, Vandekerkhove G, Warner E, Zulfiqar M, Finch D, Oja C, Vergidis J, Nykter M, Gleave M, Chi K. Genomic alterations in circulating tumor DNA (ctDNA) are associated with clinical outcomes in treatment-naive metastatic castration-resistant prostate cancer (mCRPC) patients commencing androgen receptor (AR)-targeted therapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cohen L, Hamer J, Helwig C, Fergus K, Kiss A, Mandel R, Dawson B, Landsberg A, Shein K, Kay N, Warner E. Formal evaluation of PYNK: Breast Cancer Program for Young Women-the patient perspective. ACTA ACUST UNITED AC 2016; 23:e102-8. [PMID: 27122977 DOI: 10.3747/co.23.2773] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of the present study was to assess patient satisfaction with pynk: Breast Cancer Program for Young Women so as to determine how the program might be improved and to provide feedback to donors. METHODS All pynk patients who had consented to have their information entered in our database and who supplied us with their e-mail address were invited to complete a 58-item online questionnaire consisting of multiple choice and open-ended questions. Domains included demographics, provision of written and spoken information, support, infertility risk, research awareness, attitudes toward discharge, and general feedback. RESULTS Of 120 pynk patients approached, 61 (51%) participated. More than 90% were satisfied or very satisfied with the timing, usefulness, and clarity of spoken and written information given, and 69% found the service and support provided by the nurse navigator to be the most helpful component of the program. Of those who had received systemic therapy, 93% recalled a health care provider initiating a discussion of the risk of treatment-related infertility, and 67% were referred to a fertility clinic. On the negative side, 11%-27% were unaware of various services provided by pynk, and 11% were unaware of pynk's ongoing research. One third of patients were unhappy or ambivalent about the prospect of discharge from the program. CONCLUSIONS Patient satisfaction with this novel program for young women with breast cancer is high. This study highlights the critical role that the nurse navigator plays in patient support and dissemination of information. In contrast to other reported surveys of young cancer patients, pynk patients are routinely given the opportunity to undergo fertility preservation.
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Affiliation(s)
- L Cohen
- Division of Medical Oncology, Sunnybrook Research Institute, University of Toronto, Toronto, ON
| | - J Hamer
- Division of Medical Oncology, Sunnybrook Research Institute, University of Toronto, Toronto, ON
| | - C Helwig
- Division of Medical Oncology, Sunnybrook Research Institute, University of Toronto, Toronto, ON
| | - K Fergus
- Division of Psychology, Patient and Family Support Program, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - A Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, University of Toronto, Toronto, ON
| | - R Mandel
- Division of Medical Oncology, Sunnybrook Research Institute, University of Toronto, Toronto, ON
| | - B Dawson
- Division of Medical Oncology, Sunnybrook Research Institute, University of Toronto, Toronto, ON
| | - A Landsberg
- Division of Medical Oncology, Sunnybrook Research Institute, University of Toronto, Toronto, ON
| | - K Shein
- Division of Medical Oncology, Sunnybrook Research Institute, University of Toronto, Toronto, ON
| | - N Kay
- Division of Medical Oncology, Sunnybrook Research Institute, University of Toronto, Toronto, ON
| | - E Warner
- Division of Medical Oncology, Sunnybrook Research Institute, University of Toronto, Toronto, ON
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Srikanthan A, Amir E, Warner E. Abstract P6-12-02: Association between a dedicated program for young breast cancer patients and discussion about fertility preservation. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-12-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: To assess whether a dedicated program, including a nurse navigator, improves the frequency of: a) documentation of fertility discussion and b) referrals for fertility preservation (FP).
Methods: A retrospective chart review and prospective survey were undertaken of a cohort of young breast cancer patients diagnosed between 2011-2013 at two academic centres in Toronto, Ontario. The Odette Cancer Center (OCC) has a dedicated program for young breast cancer patients while Princess Margaret Cancer Centre (PM) does not. Documentation of fertility discussion prior to receipt of systemic therapy was extracted from patient records. Prospective surveys were administered to the same cohort to corroborate data collected. Descriptive statistics were used to characterize baseline patient variables. Chi-squared was used to compare categorical variables and t-tests for continuous variables between the two cancer centres. Statistical significance was defined as p<0.05.
Results: At OCC and PM respectively, 91 and 81 patient charts were reviewed while 54 and 49 women returned surveys for response rates of 59% and 60% . Chart reviews demonstrated no difference in the frequency of documentation of fertility discussion (80% versus 75% for OCC and PM, p=0.44); however, surveys demonstrated higher recall of fertility discussion rates at OCC (96% versus 83%, p=0.046). A greater proportion of women were offered FP referrals at OCC, as observed in both chart reviews (53% versus 41%, p=0.18) and surveys (70% versus 46%, p=0.02). Time to initiation of chemotherapy did not significantly differ between women who underwent FP and those who did not.
Conclusion: A dedicated program for young women with breast cancer including a nurse navigator is associated with a higher frequency of FP referrals without delaying systemic therapy.
Citation Format: Srikanthan A, Amir E, Warner E. Association between a dedicated program for young breast cancer patients and discussion about fertility preservation. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-02.
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Affiliation(s)
- A Srikanthan
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - E Amir
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - E Warner
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
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Warner E, Jassar B, Samandouras G. Holes in the brain: Virchow–Robin spaces (giant perivascular spaces). J Clin Neurosci 2015; 22:1360-1374. [PMID: 26351708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Warner E, Ofo E, Connor S, Odell E, Jeannon JP. Mucoepidermoid carcinoma in a thyroglossal duct remnant. Int J Surg Case Rep 2015; 13:43-7. [PMID: 26101054 PMCID: PMC4529606 DOI: 10.1016/j.ijscr.2015.04.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/20/2015] [Accepted: 04/26/2015] [Indexed: 11/30/2022] Open
Abstract
Thyroglossal duct remnants should be surgically excised, if possible due to the risk of malignant transformation. Mucoepidermoid carcinomas can present in diverse locations outside of salivary glands. A high index of suspicion for malignancy is required with neck masses in adults, especially following a period of rapid growth. If aggressively treated, patients with mucoepidermoid carcinoma outside of salivary glands may still have a favourable prognosis.
Introduction Thyroglossal duct cysts (TDC) are common midline neck swellings resulting from embryological remnants of the thyroglossal duct. They often contain ectopic thyroid tissue and malignant transformation has been reported, most commonly to papillary thyroid carcinoma. Mucoepidermoid carcinoma (MEC) usually occurs in the salivary glands and only rarely in the thyroid. This is the first case of a MEC occurring within a thyroglossal duct remnant. Presentation of a case A 73 year old lady presented with a thyroglossal duct cyst. She declined surgical excision, as she was adamant she wanted to avoid surgery. The neck mass rapidly enlarged at two years following initial diagnosis. Fine needle aspiration cytology was suspicious for carcinoma. She underwent total thyroidectomy and selective central compartment neck dissection with adjuvant radiotherapy. She remains alive and well two years post treatment. Discussion Mucoepidermoid carcinoma is the most common malignant neoplasm of salivary glands, although it has rarely been reported in diverse locations including the thyroid, lung and pancreas. To the best of our knowledge, this is the first reported case of mucoepidermoid carcinoma arising from a thyroglossal duct remnant. Conclusion This case adds weight to the literature favouring surgical excision of thyroglossal duct remnants due to the risk of malignant transformation.
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Affiliation(s)
- E Warner
- Department of Otolaryngology and Head and Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK.
| | - E Ofo
- Department of Otolaryngology and Head and Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK
| | - S Connor
- Head and Neck Radiology, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK
| | - E Odell
- Head and Neck Pathology, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK
| | - J P Jeannon
- Department of Otolaryngology and Head and Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK
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Kepka D, Balch A, Warner E, Spigarelli M. Statewide Vaccine Registry Data Indicate High Number of Missed Opportunities for the HPV Vaccine Among Eligible Girls. Cancer Epidemiol Biomarkers Prev 2015. [DOI: 10.1158/1055-9965.epi-15-0110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
This study investigates the rate of missed opportunities for the HPV vaccine among eligible girls using statewide vaccine registry data. Methods: Using data from the Utah Statewide Immunization Information System (USIIS) from 2008–2012 for approximately 55,000 girls ages 11–18, we assessed the frequency of missed opportunities (receipt of other recommended vaccinations such as TDap, MCV4, and/or flu and not the HPV vaccine) among eligible female patients for the HPV vaccine. USIIS is a free, confidential, web-based information system that contains immunization histories for Utah residents of all ages. Records of all persons born in Utah since 1998 are in USIIS. USIIS is designed to help enrolled healthcare providers track immunization records for patient care by consolidating immunizations from enrolled providers into one centralized record. Vaccine administration from 86% of healthcare providers in Utah is reported to USIIS. USIIS data used for the study include date of birth, age, gender, ethnicity and race, zip code, and date and type of vaccine received. Descriptive statistics and chi- square tests were used to assess rate of missed opportunities for the HPV vaccine and associated demographic factors. Results: Approximately 65% of preteens (ages 11–12; N = 2,593) and 32% of female teens (ages 13–18; N = 4,937) had a missed opportunity for the HPV vaccine between years 2008–2012 in Utah (P < 0.001). Race and ethnicity related to rates of missed opportunities for the HPV vaccine among all girls ages 11–18 (Whites = 36%, N = 2,454; Hispanics = 21%, N = 254) (P < 0.001). Rural and urban locations were also associated with rates of missed opportunities for the HPV vaccine (urban = 31%, N = 4,448; large rural town = 42%, N = 202) (P < 0.001). Conclusions: For more than eight years, a vaccine to prevent cervical and other HPV-related cancers has been available, yet receipt of the 3-dose HPV vaccine in the United States is far below national goals for girls (33% vs. 80%; actual vs. target). Using statewide vaccine registry data, our study demonstrates that administering the HPV vaccine when providing other recommended adolescent vaccinations may dramatically improve rates of HPV vaccination among girls in a state with low HPV vaccine uptake. In addition, targeting rural communities and non-Hispanic White patients may further reduce missed opportunities.
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Richter S, Haroun I, Graham TC, Eisen A, Kiss A, Warner E. Variants of unknown significance in BRCA testing: impact on risk perception, worry, prevention and counseling. Ann Oncol 2014; 24 Suppl 8:viii69-viii74. [PMID: 24131974 DOI: 10.1093/annonc/mdt312] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Sequence-based BRCA testing can identify variants of unknown significance (VUS). Relatively little is known about how well a test outcome of VUS is understood by patients and referring physicians, and whether genetic counselors have an interest in the development of VUS management guidelines. DESIGN Self-administered questionnaires were completed by 36 VUS counselees, 75 women with a BRCA mutation and 33 with no mutation found (NMF). We also surveyed 24 genetic counselors and 22 referring family physicians. RESULTS One-third of VUS failed to recall the clinical significance of their result. Incorrect recall was significantly higher among VUS with high-school-only education (70% versus 19%, P = 0.02). Risk perception, cancer worry and uptake of surveillance and risk-reducing surgeries among VUS counselees were more similar to NMF than to mutation carriers. Genetic counselors accurately predicted the difficulties counselees would have with a VUS result and identified the need for VUS management guidelines. Referring physicians unanimously stated that genetic testing was indicated for unaffected siblings of VUS carriers. CONCLUSIONS While VUS seems to be correctly perceived by counselees as more similar to NMF than to a pathogenic mutation, miscomprehension of VUS is more common, particularly in counselees with lower education. VUS-related educational interventions for both VUS counselees and their referring physicians are needed. We encourage the development of national VUS-related guidelines for genetic counselors.
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Affiliation(s)
- S Richter
- Department of Medicine, Division of Oncology, St Michael's Hospital, Toronto
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Carroll JC, Blaine S, Permaul J, Dicks E, Warner E, Esplen MJ, Rothenmund H, Semotiuk K, Worrall G, McLaughlin J. Efficacy of an educational intervention on family physicians' risk assessment and management of colorectal cancer. J Community Genet 2014; 5:303-11. [PMID: 24715212 DOI: 10.1007/s12687-014-0185-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 03/10/2014] [Indexed: 12/31/2022] Open
Abstract
We developed a point-of-care tool indicating risk categories for colorectal cancer (CRC) based on family history (FH) and management recommendations tailored to risk. The study objective was to determine if this CRC Risk Triage/Management Too would enable family physicians (FPs) to appropriately triage and make screening and genetics referral recommendations for patients with CRC FH. Baseline questionnaires were mailed to a random sample of FPs in Ontario and Newfoundland, Canada. Participants were asked to use the tool for 3 months and then complete a follow-up questionnaire. The primary outcomes were correct responses to questions regarding CRC risk category, screening method, starting age, frequency, and decision to refer to genetics, for eight clinical vignettes. The study was completed by 75/121 (62 %) participating FPs. Most (77 %) agreed they routinely recommended fecal occult blood testing for average risk patients age ≥50. This did not change significantly following the intervention. There was a significant increase in confidence in CRC risk assessment (52 % pre; 88 % post; p < 0.001), correct management recommendations for patients with CRC FH (51 % pre; 84 % post; p < 0.001), and improvement in total mean scores on outcome measures for all vignettes. Most (90 %) agreed the tool would improve practice. Receipt of the CRC Risk Triage/Management Tool was associated with improvement in FPs' CRC risk assessment, screening, and genetics referral recommendations for clinical vignettes. This demonstrates the value of point-of-care tools and illustrates a process for development, evaluation, and dissemination of tools needed by FPs if potential impacts of genomic advances are to be achieved.
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Affiliation(s)
- J C Carroll
- Department of Family and Community Medicine, Mount Sinai Hospital, University of Toronto, 60 Murray St., Toronto, ON, M5T 3L9, Canada,
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Fergus KD, McLeod D, Carter W, Warner E, Gardner SL, Granek L, Cullen KI. Development and pilot testing of an online intervention to support young couples' coping and adjustment to breast cancer. Eur J Cancer Care (Engl) 2014; 23:481-92. [PMID: 24472013 DOI: 10.1111/ecc.12162] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 11/26/2022]
Abstract
Couplelinks is an original, professionally facilitated online intervention tailored to the unique challenges facing young women with breast cancer and their male partners. The purpose of this evaluation was to determine the feasibility and acceptability of the intervention and areas for improvement. Sixteen couples were sequentially enrolled over an 18-month period. Couples provided feedback via a treatment satisfaction survey, and post-treatment interviews with a sub-group of participants. Qualitative information was analysed for themes relevant to the program's acceptability, perceived benefits and limitations, and directions for improvement. Of the 16 couples who enrolled, six completed four modules or less, and 10 completed the entire program. Completers reported satisfaction with the program overall, as well as with the website useability and professional facilitation. Reported benefits were: enhanced communication and self-other knowledge; creation of opportunities for meaningful, cancer-related discussion; affirmation of relationship strengths; and a greater sense of closeness between partners. The main reported limitation was how program participation disrupted the couple's usual routine. Themes related to non-completion suggest that partners with particularly elevated relational or illness-related distress, or with differential levels of motivation, are less likely to finish. These findings have led to targeted improvements to the website and intervention protocol.
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Affiliation(s)
- K D Fergus
- Department of Psychology, York University, Toronto, Canada; Patient and Family Support Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
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Yu JL, Kurin M, Pasetka M, Kiss A, Chan K, Sridhar SS, Warner E. Abstract P6-07-06: Primary prophylaxis of febrile neutropenia during adjuvant docetaxel and cyclophosphamide (TC) chemotherapy for breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-07-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The combination of docetaxel and cyclophosphamide (TC) for adjuvant treatment of early stage breast cancer improves overall survival compared with doxorubicin and cyclophosphamide (AC) (Jones et al., 2006). Although cardiotoxicity is avoided with TC, the risk of febrile neutropenia (FN) is higher. For TC, reported rates of FN without prophylactic granulocyte colony-stimulating factor (G-CSF) range from 5% in the phase III trial to as high as 46% in retrospective chart reviews. G-CSF is not covered by our provincial cancer funding agency for primary prophylaxis of FN with TC chemotherapy, however it is often prescribed for patients with private insurance. Our aims were twofold: i) to determine the incidence of FN with TC chemotherapy with and without prophylactic G-CSF or antibiotics in two Ontario comprehensive cancer centres, and ii) to evaluate the cost-effectiveness of primary prophylaxis with G-CSF vs. antibiotics.
Methods: Patients who received adjuvant TC chemotherapy between January 1, 2008 and December 31, 2012 were identified through pharmacy databases. Electronic charts were retrospectively reviewed to extract patient characteristics, treatment details including G-CSF and antibiotic use, as well as incidence of FN and duration of hospitalization. A Markov model comparing primary G-CSF prophylaxis, primary antibiotic prophylaxis and secondary G-CSF prophylaxis was constructed to compare the cost-effectiveness of these strategies over a four cycle time horizon. Costs were based on resource utilization from this retrospective cohort and supplemented by the published literature, adjusted to 2012 Canadian dollars. The model took the perspective of the third party payer. Both one-way and probabilistic sensitivity analyses were performed.
Results: 340 patients were treated with TC over the study period. Of the 73 (21%) who did not receive any primary prophylaxis with G-CSF or antibiotics, 23 (32%) developed FN requiring hospitalization and treatment with intravenous antibiotics. However, only 2 of the 192 patients (1%; P <0.0001) who received primary G-CSF prophylaxis (funded by the patient or a third party payer), and 6 of the 53 patients (11%; P <0.01) who received primary antibiotic prophylaxis (97% receiving ciprofloxacin) developed FN. Age ≥65 was a significant risk factor for FN in the absence of G-CSF (56% vs. 25%, P = 0.02). The results of the cost-effectiveness analysis will be presented at the meeting.
Conclusions: The FN rate associated with TC chemotherapy without primary prophylaxis exceeds 30% but may be reduced with prophylactic antibiotics or G-CSF. Unless prophylactic antibiotics are substantially more cost-effective than prophylactic G-CSF for TC chemotherapy in a particular region or country, primary prophylactic G-CSF should be funded, given its greater effectiveness than antibiotics and the global need to minimize the emergence of antibiotic resistance.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-07-06.
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Affiliation(s)
- JL Yu
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - M Kurin
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - M Pasetka
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - A Kiss
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - K Chan
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - SS Sridhar
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - E Warner
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Princess Margaret Cancer Centre, Toronto, ON, Canada
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Szumacher E, D'Alimonte L, Presutti R, McGuffin M, Chow E, Pignol J, Di Prospero L, Doherty M, Kiss A, Warner E, et al.. Decisional Support for Women 60 Years and Older During Their Treatment for Stage I and II Breast Cancer: A Single Institutional Study. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
CONSIDER THIS SCENARIO: A 35-year-old recently married woman is referred to a surgeon because of a growing breast lump. After a core biopsy shows cancer, she undergoes mastectomy for a 6-cm invasive lobular cancer that has spread to 8 axillary nodes. By the time she sees the medical oncologist, she is told that it is too late for a fertility consultation, and she receives a course of chemotherapy. At clinic appointments, she seems depressed and admits that her husband has been less supportive than she had hoped. After tamoxifen is started, treatment-related sexuality problems and the probability of infertility contribute to increasing strain on the couple's relationship. Their marriage ends two years after the woman's diagnosis.Six years after her diagnosis, this woman has completed all treatment, is disease-free, and is feeling extremely well physically. However, she is upset about being postmenopausal, and she is having difficulty adopting a child as a single woman with a history of breast cancer. Could this woman and her husband have been offered additional personalized interventions that might have helped them better cope with the breast cancer diagnosis and the effects of treatment?Compared with their older counterparts, young women with breast cancer often have greater and more complex supportive care needs. The present article describes the goals, achievements, and future plans of a specialized interdisciplinary program-the first of its kind in Canada-for women 40 years of age and younger newly diagnosed with breast cancer. The program was created to optimize the complex clinical care and support needs of this population, to promote research specifically targeting issues unique to young women, and to educate the public and health care professionals about early detection of breast cancer in young women and about the special needs of those women after their diagnosis.
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Affiliation(s)
- A Ali
- Division of Medical Oncology, King Fahad Medical City, Comprehensive Cancer Centre, Riyadh, Saudi Arabia
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Eisen A, Carroll J, Chiarelli AM, Horgan M, Meschino W, Rabeneck L, Shumak R, Warner E. Abstract P3-02-10: Implementation and uptake of a provincial, population-based, organized breast screening program for high risk women in Ontario: The Ontario breast screening program (OBSP) high risk program. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p3-02-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Genetic testing for mutations in BRCA1/2 has been clinically available in Ontario since 2000. Over 15000 individuals have been tested. Evidence from clinical trials has consistently shown that women at high risk of breast cancer (BrCa) benefit from BrCa screening that includes both magnetic resonance imaging (MRI) of the breast and mammography, yet access to MRI in Ontario was variable. In 2011, Cancer Care Ontario (CCO) established an expert panel to develop a protocol for expanding the OBSP, initially created for average risk women 50–74, to include MRI and mammography for eligible high risk women.
Methods: The panel's tasks included: 1. determining high risk criteria 2. estimating the prevalence of high risk women 3. selecting a cancer risk model 4. developing a referral and assessment pathway for potentially eligible subjects 5. developing educational resources, training plan and communication strategy for relevant stakeholders 6. developing indicators for program evaluation, 7. providing guidance for post-implementation issues.
Results: The program was initiated July, 2011 and now includes 28 sites. Women aged 30–69 with and without a history of breast cancer are eligible if they 1. are BRCA1/2 mutation carriers or untested first degree relatives of carriers, 2. have a lifetime risk of breast cancer >=25% based on family history according to IBIS or BOADICEA risk models, or 3. received prior radiation therapy to the chest. It is estimated that 34000 high risk women in the target age group live in Ontario. Preliminary volume data for the first 9 mos are shown in Table 1. Of the 5037 women participating, 802 have been referred directly by their physician and 4,235 have been referred for genetic assessment. Of the 2,946 women who received genetic assessment, 31% met the high risk criteria. To date, 729 high risk MRI scans have been performed.
Conclusions: A population based organized screening program for high risk women that includes genetic risk assessment has been implemented in Ontario. Further evaluation of risk assessment and screen results are underway. To our knowledge, this is the first organized screening program for women at high risk of breast cancer.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-10.
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Affiliation(s)
- A Eisen
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - J Carroll
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - AM Chiarelli
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - M Horgan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - W Meschino
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - L Rabeneck
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - R Shumak
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - E Warner
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
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Petrella TM, Laredo S, Oh P, Marzolini S, Warner E, Dent R, Verma S, Eisen A, Pritchard K, Trudeau M, Zhang L, Bjarnason G. Abstract P2-12-03: A pilot study evaluating the benefits and feasibility of an exercise program for breast cancer patients receiving adjuvant chemotherapy. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p2-12-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Breast cancer chemotherapy is frequently associated with a decline in general physical condition, exercise tolerance, muscle strength and quality of life (QOL). Evidence suggests that physical activity and exercise interventions during chemotherapy treatment may contribute to maintaining QOL, cardiorespiratory fitness and strength, however the results of studies conducted to date have not been consistent.
OBJECTIVES: This study aimed to determine the effect of a structured, tailored exercise program involving both aerobic and resistance training, on QOL, physical function, and body composition in breast cancer patients undergoing adjuvant chemotherapy.
METHODS: Women who were within 4–12 weeks of surgery for stage I-III breast cancer and undergoing adjuvant chemotherapy, were randomized to either a structured exercise program (6 months) or to usual oncology care. Functional assessment of cancer therapy-breast cancer (FACT-B), and Short Form Survey (SF-36), weight, waist circumference, waist hip ratio, percent body fat, peak oxygen, strength and arm volume were performed at baseline, and 3-month intervals through 12 months. One-way analysis of variance (ANOVA) was performed at baseline, 3, 6 and 12 months for all endpoints. The Wilcoxon Rank-sum Nonparametric test was applied for all Primary and Secondary endpoints with changing scores at each follow-up visit, p-value < 0.05 was considered as statistical significance.
RESULTS: Of the recruited 62 women, 51 completed all 12 months. One patient developed metastatic disease and 10 others withdrew (4 in the exercise arm and 6 in the standard arm). Median age was 48 (24–75) years. There was a general trend of improvement from baseline for most components of the FACT-B and SF-36 for the exercise group but only the FACT-B social wellbeing was statistically significant at 3 months with a p = 0.0164. Changes in other FACT-B and SF-36 scores were not significantly different between exercise and usual care groups. There were significant improvements at 6 months in weight (p = 0.0192), % body fat (p = 0.0337), max strength (p = 0.0029), and waist circumference (0.0359) and at 12 months in weight (p = 0.0293), % body fat (p = 0.0481), max strength (p = 0.0097) and endurance (p = 0.0037) in the exercise group compared to usual care.
CONCLUSIONS: This randomized prospective study suggests benefit of exercise during chemotherapy. This benefit continued 6 months beyond the completion of the exercise program with significant improvement in physical function, body composition, strength and endurance with no decline in quality of life. Regular moderate exercise may play an important role in improving function during adjuvant chemotherapy and should be further studied in a large randomized trial.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-12-03.
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Affiliation(s)
- TM Petrella
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - S Laredo
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - P Oh
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - S Marzolini
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - E Warner
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - R Dent
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - S Verma
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - A Eisen
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - K Pritchard
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - M Trudeau
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - L Zhang
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - G Bjarnason
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
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Ali A, Fergus K, Wright F, Pritchard K, Kiss A, Warner E. Abstract P6-08-04: The Impact of a Breast Cancer Diagnosis in Young Women on their Relationship with their Mothers. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-08-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer in younger women (≤ 40) is associated with greater physical and psychological morbidity than in older women. No study to our knowledge has examined the effect of a breast cancer diagnosis in young women on their relationship with their mothers, or the support needs of these mothers.
Methods: We developed and pre-tested a self-administered questionnaire on 10 survivors of breast cancer diagnosed ≤ age 40 for clarity, content and sensitivity (San Antonio, 2011). Then, consecutive recurrence-free women age ≤ 40 at diagnosis, within 4 years of a breast cancer diagnosis, whose mothers were alive at diagnosis, were asked to complete the modified questionnaire in a medical oncology follow-up clinic.
Results: Of 110 eligible daughters approached from 07/2011–05/2012, 90 with a mean age 36 (range 21–43) participated in the study. Stage at diagnosis: 1–23 (26%), 2–46 (51%) 3–21 (23%). Ethnicity: Asian: 29 (32%), Caucasian 43 (48%), Black 2 (2%), Mix/Other 16 (18%). At diagnosis, 15 were living with their mothers, 44 were not living in the same city including 23 who were in different countries, 7 of whom were not informed of the diagnosis as the daughters did not want to worry them. Mean age of the 88 mothers alive at time of study was 64 (range 48–84) and 16 had previously had breast cancer.
Illness attributions: Eight blamed their mothers for their developing breast cancer, and 22 believed their mothers felt responsible to some extent (overlap in 4).
Supports: Of the 43 daughters who had turned to their mothers for emotional support over the year prior to diagnosis, all but one did so after diagnosis, as did 20% of those who had not turned to mothers over the year prior to diagnosis. In 11 cases, the daughters turned to their mothers before approaching anyone else for support. Of the 83 daughters who informed mothers of their diagnosis, 76 (92%) reported their mothers were emotionally and/or practically supportive. The 4 most difficult issues faced by daughters were fatigue, anxiety, breast loss and menopausal symptoms, with 70 daughters discussing at least some issues with their mothers. Of the 35 working mothers, 27 took time off to support their daughters. Nineteen mothers slept over or moved in with the daughters during their treatment, 8 of whom had been living in a different country. Forty-four (44/83=53%) daughters reported that the breast cancer diagnosis had a favorable impact on their relationship with their mothers.
Formal supports for mothers: Thirty-two (32/83=39%) reported their mothers did not have adequate psychosocial support, and 59 (59/90=66%) indicated health care professionals could help mothers by providing brochures on caring for a daughter with breast cancer, having professionally led education sessions, as well as support groups.
Conclusion: Mothers are an important source of support for young breast cancer daughters, and most daughters perceived that the diagnosis resulted in the mother-daughter relationship becoming closer. However, the physical and emotional toll on mothers appears to be high. Future studies should address the effects of a breast cancer diagnosis in a young daughter from the mothers' perspective, and the benefit of formal, culturally sensitive supports for these mothers.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-08-04.
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Affiliation(s)
- A Ali
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto
| | - K Fergus
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto
| | - F Wright
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto
| | - K Pritchard
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto
| | - A Kiss
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto
| | - E Warner
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto
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Szumacher E, Wong J, D'Alimonte L, Angus J, Paszat L, Metcalfe K, Whelan T, Llewellyn-Thomas H, Warner E. Development of a Patient Decision Aid for Older Women With Stage I Breast Cancer Considering Adjuvant Treatment Postlumpectomy. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fayez R, AlMuntashery A, Bodie G, Almamar A, Gill R, Raîche I, Mueller C, AlMuntashery A, Fayez R, AlMuntashery A, Moustarah F, Khokhotva M, Anvari M, Kwong J, Elkassem S, Bonrath E, Zevin B, Sockalingam S, Smith C, Smith C, Whitlock K, Gill R, Suri M, Palter V, Wakeam E, Khan R, Martelli V, Malik A, Young P, Daigle C, McCreery G, Seth R, Paskar D, Sudarshan M, Richardson D, Haggar F, Davis V, Rivard J, Agzarian J, Racz J, Winocour J, Zilbert N, Decker C, Neumann K, Gosney J, Wissanji H, Chadi S, Alhabboubi M, Partridge E, Alhabboubi M, Olszewski M, Chan R, Nadler A, Hameed U, Brotherhood H, Menezes A, MacDonald B, Rakovich G, Hilsden R, Merani S, Davis P, Davis P, Cools-Lartigue J, Ojah J, Julien F, Carter D, Pitt D, Banks B, Rudovics A, Ravichandran P, Anantha R, Aad I, Kholdebarin R, Aird L, Wong S, Payne J, Hallet J, Farries L, Raiche I, Botkin C, Morency D, Berger-Richardson D, Isa A, Dupuis I, Schweigert M, Koubi S, Ernjakovic M, Grant K, Cools-Lartigue J, Carrott P, Stafford T, Malthaner R, Sudarshan M, Hanna W, Lee L, Markar S, Razzak R, Bharadwaj S, Ashrafi A, Ouellette D, Fergusson D, Forster A, Boushey R, Porter G, Johnson P, Gomes T, Chan B, Auer R, Moloo H, Mamdani M, Markar S, Al-Omran M, Al-Obaid O, Boushey R, Lim DR, Min BS, Baik SH, Gordon P, Kim NK, Lo A, Pinsk I, Bottoni D, Brown C, Raval M, Cheng H, Wong C, Johnston N, Farrokhyar F, Stephen W, Kelly S, Lindsay L, Forbes S, Knickle C, Bouchard A, Parry N, Leslie K, Ott M, Coughlin S, Gazala S, Gazala S, Donahoe L, Walker K, Li C, Alnasser S, Schweigert M, Schweigert M, Zhuruk A, Hanouf A, Vanounou T, Karanicolas P, Aubin JM, Yeung J, Dumitra S, Simoneau E, Vanounou T, Howe B, Hawel J, Jang JH, Bertens K, Rekman J, Wei A, Dumitra S, Koubi S, Ouellet JF, Wei A, Covelli A, Maniar R, Sun S, Davis V, Brackstone M, Boissonneault R, Kim S, Baliski C, Gazala S, Hameed U, Sudarshan M, Arnaout A, Wedman D, Nostedt M, Hebbard P, Shetty S, Dixon M, Wei A, Dixon M, Kazazian K, Lemke M, Wells B, Musselman R, Zih FSW, Menezes A, Nassif M, Leon-Carlyle M, Wei A, Krotneva S, Bradley N, Trabulsi N, Trabulsi N, Chin-Lenn L, Cheng H, Petrucci A, Sandhu L, Neville A, Lee L, Li C, Yang I, Prabhu KL, Melich G, Knowles S, Richardson D, Borowiec A, Hallet J, Boissonneault R, Kolozsvari N, Hallet J, Tuttle P, VanHouwelingen L, Haggar F, Boulanger-Gobeil C, Chan B, Chan B, Richardson D, Musselman R, Melich G, Phang P, Goldstein L, Wen C, Lebrun A, Chadi S, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, Fayez R, Demyttenaere S, Christou N, Court O, Bonrath E, Hagen J, Okrainec A, Sullivan P, Grantcharov T, Sharma A, Karmali S, Birch D, Majumdar S, Wang X, Tuepah R, Klarenbach S, Birch D, Karmali S, Sharma A, Padwal R, Smith C, Haggar F, Moloo H, Poulin E, Martel G, Yelle JD, Mamazza J, Jackson T, Penner T, Pitzul K, Urbach D, Okrainec A, Villeneuve S, Roy M, Fayez R, Demyttenaere S, Christou N, Court O, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, Fayez R, Demyttenaere S, Court O, Christou N, Biertho L, Hould FS, Lebel S, Lescelleur O, Marceau S, Marceau P, Biron S, Grantcharov T, Sharma A, Yusuf S, Okrainec A, Pitzul K, Urbach D, Jackson T, Lindsay D, Sullivan P, Smith L, Zevin B, Dedy N, Grantcharov T, Bonrath E, Aggarwal R, Grantcharov T, Cassin S, Crawford S, Pitzul K, Khan A, Hawa R, Jackson T, Okrainec A, Brar B, Mamazza J, Raîche I, Yelle JD, Haggar F, Moloo H, Brar B, Haggar F, Dent R, Mamazza J, Raîche I, Moloo H, Gill R, Ali T, Shi X, Birch D, Karmali S, Whitlock K, Shi X, Sarkhosh K, Birch D, Karmali S, Turner J, Nation P, Wizzard P, Brubaker P, Gisalet D, Wales P, Grantcharov T, Tien H, Spencer F, Brenneman F, Kowal J, Wiseman S, Fraser S, Vedel I, Deban M, Holcroft C, Monette M, Monette J, Bergman S, Bell C, Stukel T, Urbach D, Mueller T, Lucykx V, Lukowski C, Compston C, Churchill T, Khadaroo R, Grantcharov T, Vogt K, Dubois L, Gray D, Ananth A, Tai LH, Lam T, Falls T, Souza C, Bell J, Auer R, Crawford S, Parry N, Leslie K, Alhabboubi M, St-Louis E, Deckelbaum D, Razek T, Feldman L, Khwaja K, Porter G, Johnson P, Boushey R, Moloo H, Raiche I, Mamazza J, Schiller D, Eurich D, Sawyer M, Vergis A, Unger B, Hardy K, Andrew C, Gillman L, Park J, Prodger J, Kelly W, Kelly S, Prodger D, Ewara E, Martin J, Sarma S, Chu M, Schlachta C, Zaric G, Al-Ali K, Briggs K, George R, Murnaghan M, Leung A, Regehr G, Moulton CA, Mahmud S, Metcalfe J, McKay A, Park J, Hochman D, Burkle F, Redmond A, McQueen K, Desrosiers E, Gilbert A, Leslie K, Ott M, Sudarshan M, Jessula S, Alburakan A, Deckelbaum D, Razek T, Iqbal S, Khwaja K, Aikins C, Sudarshan M, Deckelbaum D, Iqbal S, Khwaja K, Razek T, Roberts N, Moulton CA, Murnaghan M, Cil T, Marshall J, Pederson K, Erichsen S, White J, Aarts MA, Okrainec A, Victor J, Pearsall E, McLeod R, Jackson T, Okrainec A, Penner T, Urbach D, Karimuddin A, Hall C, Bawan S, Malik S, Hayashi A, Gill R, McAlister C, Zhang N, DesRosiers E, Mills A, Crozier M, Lee L, Maxwell J, Partridge E, Chad S, Steigerwald S, Mapiour D, Roberts D, MacPherson C, Donahoe L, Mercer D, Hopman W, Latulippe JF, Knowles S, Moffat B, Parry N, Leslie K, Switzer N, Khadaroo R, Tul Y, Widder S, Molinari M, Levy A, Johnson P, Bailey J, Molinari M, Hayden J, Johnson P, Benlolo S, Marcus V, Ferri L, Finley R, Anderson D, Gagné JP, Chan S, Wong S, Li J, Michael A, Choi D, Liu E, Hoogenes J, Dath D, Aubin JM, Mew D, McConnell Y, Classen D, Kanthan S, Croome K, Kovacs M, Lazo-Langner A, Hernandez-Alejandro R, Vogt K, Crawford S, Parry N, Leslie K, Khoshgoo N, Iwasiow B, Keijzer R, Brown C, Isa D, Pace D, Widder S, Tul Y, Primrose M, Hudson D, Khadaroo R, Lauzier F, Mailloux O, Trottier V, ARchambault P, Zarychanski R, Turgeon A, Mailloux O, Hardy P, Muirhead R, Masters J, Haggar F, Poulin HME, Martel G, Mamazza J, Milbrandt C, Keijzer R, Sideris L, Grenier-Vallée P, Latulippe JF, Dubé P, Kurashima Y, Kaneva P, Feldman L, Fried G, Vassiliou M, Kwan AL, Fraser S, Solymosi N, Rauh N, Dubecz A, Renz M, Ofner D, Stein H, Borgaonkar M, Crystal P, Easson A, Escallon J, Reedijk M, Cil T, Leong W, McCready D, Clifton J, Mayo J, Finley R, Noreau-Nguyen M, Mulder D, Ferri L, Markar S, Hong J, Low D, Maslow A, Davignon K, Ng T, Tan L, Aruranian J, Kosa S, Ferri L, Murphy G, Allison F, Moshonov H, Darling G, Waddell T, De Perrot M, Cypel M, Yasufuku K, Keshavjee S, Paul N, Pierre A, Darling G, Pedneault C, Marcus V, Mulder D, Ferri L, Low D, Roa W, Löbenberg R, McEwan S, Bédard E, Louie B, Farivar A, McHugh S, Aye R, Tan-Tam C, De Vera M, Bond R, Ong S, Johal B, Schellenberg D, Po M, Nissar S, Lund C, Ahmadi S, Wakil N, Rakovich G, Beauchamps G, Preston S, Baker C, Low D, Campbell G, Malthaner R, Bethune D, Henteleff H, Johnston M, Buduhan G, Coughlin HE, Roth L, Bhandari M, Malthaner R, Johnson J, Kutsogiannis J, Bédard E, Rammohan K, Stewart K, Bédard E, Buduhan G, Gruchy J, Xu Z, Buduhan G, Ferri L, Mulder D, Ncuti A, Neville A, Kaneva P, Watson D, Vassiliou M, Carli F, Feldman L, Av R, Mayrand S, Franco E, Ferri L, Dubecz A, Renz M, Stadlhuber R, Ofner D, Stein H, Renz M, Dubecz A, Solymosi N, Thumfart L, Ofner D, Stein H, Croome K, Leeper R, Hernandez R, Livingstone S, Sapp J, Woodhall D, Alwayn I, Bergman S, Lam-McCulloch J, Balaa F, Jayaraman S, Quan D, Wei A, Guyatt G, Rekman J, Fairfull-Smith R, Mimeault R, Balaa F, Martel G, Boehnert M, Bazerbachi F, Knaak J, Selzner N, McGilvray I, Rotstein O, Adeyi O, Levy G, Keshavjee S, Grant D, Selzner M, Khalil JA, Jamal M, Chaudhury P, Zogopoulos G, Petrakos P, Tchervenkov J, Barkun J, Jamal M, Hassanain M, Chaudhury P, Wong S, Salman A, Tran T, Metrakos P, Groeschl R, Geller D, Marsh J, Gamblin T, Croome K, Croome K, Quan D, Hernandez R, Kim P, Greig PD, Gallinger S, Moulton CA, Wei A, Fischer S, Cleary S, Vogt K, Hernandez-Alejandro R, Gray D, Aubin J, Fairfull-Smith J, Mimeault R, Balaa F, Martel G, Devitt K, Ramjaun A, Gallingher S, Alabbad S, Constantinos D, Hassanein M, Barkun J, Metrakos P, Paraskevas S, Chaudhury P, Tchervenkov J, Borgaonkar M, Tanyingoh D, Dixon E, Kaplan G, Myers R, Howard T, Sutherland F, Zyromski N, Ball C, Coburn N, Moulton CA, Cleary S, Law C, Greig P, Steven G, Baxter N, Fitch M, Wright F, Hochman D, Wirtzfeld D, McKay A, Yaffe C, Yip B, Silverman R, Park J, McConnell Y, Temple W, Mack L, Schiller D, Bathe O, Sawyer M, Scott L, Vandenberg T, Perera F, Potvin K, Chambers A, Loungnarath R, DeBroux É, Lavertu S, Donath D, Ayoub JP, Tehfé M, Richard C, Cornacchi S, Heller B, Farrokhyar F, Babra M, Lovrics P, Liberto C, Ghosh S, McLean R, Schiller D, Jackson T, Okrainec A, Penner T, Urbach D, Dumitra S, Duplisea J, Wexler S, Seely J, Smylie J, Knight K, Robertson S, Watters J, Zhang T, Arneout A, Hochman D, Wirtzfeld D, McKay A, Yip B, Yaffe C, Silverman R, Park J, Baxter N, Yun L, Rakovitch E, Wright F, Warner E, McCready D, Hodgson N, Quan M, Natarajan B, Govindarajan V, Thomas P, Loggie B, Brar S, Mahar A, Law C, Coburn N, Devitt K, Wiebe M, Bathe O, McLeod R, Baxter N, Gagliardi A, Kennedy E, Urbach D, Brar S, Mahar A, Law C, Coburn N, Zih F, Rosario C, Dennis J, Gingras AC, Swallow C, Ko YJ, Rowsell C, Law C, Saskin R, Quan ML, Xie M, McLaughlin K, Marginean C, Moyana T, Moloo H, Boushey R, Auer R, Razik R, Haase E, Mathieson A, Smith A, Swallow C, Barnes A, Scheer A, Moloo H, Boushey R, Sabri E, Auer R, Reidel K, Trabulsi N, Meterissian S, Tamblyn R, Mayo N, Meguerditchian A, Brown J, Hamm J, Phang P, Raval M, Brown C, Devitt K, Wiebe M, Bathe O, McLeod R, Taylor B, Urbach D, Reidel K, Mayo N, Tamblyn R, Meguerditchian A, Hamm J, Wiseman S, Patakfalvi L, Nassif M, Turcotte R, Nichols A, Meguerditchian A, Riedel K, Winslade N, Grégoire JP, Meterissian S, Abrahamovicz M, Megueerditchian A, Pasieka J, McMillan C, Lipa J, Snell L, Sudarshan M, Dumitra S, Duplisea J, Wexler S, Meterissian S, Tomlinson G, Kennedy E, Wei A, Baxter N, Urbach D, Liberman A, Charlebois P, Stein B, Ncuti A, Vassiliou M, Fried G, Feldman L, Capretti G, Power A, Liberman A, Charlebois P, Stein B, Kaneva P, Carli F, Fried G, Feldman L, Carli F, Charlebois P, Stein B, Liberman A, Kaneva P, Augustin B, Gamsa A, Kim DJ, Vassiliou M, Feldman L, Boushey R, Moloo H, Vu L, Chan S, Phang P, Gown A, Jones S, Wiseman S, Jeong DH, Hur H, Baik SH, Kim NK, Faria J, Min BS, Lumb K, Colquhoun P, Porter G, Johnson P, Baxter N, Schmocker S, Huang H, Victor J, Krzyzanowska MK, Brierley J, McLeod R, Kennedy E, Milot H, Desrosiers E, Lebrun A, Drolet S, Bouchard A, Grégoire R, Vuong T, Loungnarath R, DeBroux E, Liberman A, Charlebois P, Stein B, Richard C, Capretti G, Kaneva P, Neville A, Carli F, Liberman S, Charlebois P, Stein B, Vassiliou M, Fried G, Feldman L, Milot H, Drolet S, Bouchard A, Grégoire R, Powell R, Fowler A, Mathieson A, Martin K, Vogt K, Ott M, Pereira G, Einarsdottir K, Moloo H, Boushey R, Mamazza J, Bouchard A, Gagné J, Grégoire R, Thibault C, Bouchard P, Gomes T, Musselman R, Auer R, Moloo H, Mamdani M, Al-Omran M, Boushey R, AlObeed O, Armstrong J. Canadian Surgery Forum1 Is laparoscopic sleeve gastrectomy a reasonable stand-alone procedure for super morbidly obese patients?2 Postoperative monitoring requirements of patients with obstructive sleep apnea undergoing bariatric surgery3 Role of relaparoscopy in the diagnosis and treatment of bariatric complications in the early postoperative period4 Changes of active and total ghrelin, GLP-1 and PYY following restrictive bariatric surgery and their impact on satiety: comparison of sleeve gastrectomy and adjustable gastric banding5 Prioritization and willingness to pay for bariatric surgery: the patient perspective6 Ventral hernia at the time of laparoscopic gastric bypass surgery: Should it be repaired?7 Linear stapled gastrojejunostomy with transverse handsewn enterotomy closure significantly reduces strictures for laparoscopic Roux-en-Y bypass8 Laparoscopic biliopancreatic diversion with duodenal switch as second stage for super super morbidly obese patients. Do all patients benefit?9 Sleeve gastrectomy in the super super morbidly obese (BMI > 60 kg/m2): a Canadian experience10 Laparoscopic gastric bypass for the treatment of refractory idiopathic gastroparesis: a report of 2 cases11 Duodeno-ileal switch as a primary bariatric and metabolic surgical option for the severely obese patient with comorbidities: review of a single-institution case series of duodeno-ileal intestinal bypass12 Management of large paraesophageal hernias in morbidly obese patients with laparoscopic sleeve gastrectomy: a case series13 Early results of the Ontario bariatric surgical program: using the bariatric registry14 Improving access to bariatric surgical care: Is universal health care the answer?15 Early and liberal postoperative exploration can reduce morbidity and mortality in patients undergoing bariatric surgery16 Withdrawn17 Identification and assessment of technical errors in laparoscopic Roux-en-Y gastric bypass18 A valid and reliable tool for assessment of surgical skill in laparoscopic Roux-en-Y gastric bypass19 Psychiatric predictors of presurgery drop-out following suitability assessment for bariatric surgery20 Predictors of outcomes following Roux-en-Y gastric bypass surgery at The Ottawa Hospital21 Prophylactic management of cholelithiasis in bariatric patients: Is routine cholecystectomy warranted?22 Early outcomes of Roux-en-Y gastric bypass in a publicly funded obesity program23 Similar incidence of gastrojejunal anastomotic stricture formation with hand-sewn and 21 mm circular stapler techniques during Roux-en-Y gastric bypass24 (CAGS Basic Science Award) Exogenous glucagon-like peptide-1 improves clinical, morphological and histological outcomes of intestinal adaptation in a distal-intestinal resection piglet model of short bowel syndrome25 (CAGS Clinical Research Award) Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial26 Negative-pressure wound therapy (iVAC) on closed, high-risk incisions following abdominal wall reconstruction27 The impact of seed granting on research in the University of British Columbia Department of Surgery28 Quality of surgical care is inadequate for elderly patients29 Recurrence of inguinal hernia in general and hernia specialty hospitals in Ontario, Canada30 Oncostatin M receptor deficiency results in increased mortality in an intestinal ischemia reperfusion model in mice31 Laparoscopic repair of large paraesophageal hernias with anterior gastropexy: a multicentre trial32 Response to preoperative medical therapy predicts success of laparoscopic splenectomy for immune thrombocytopenic purpura33 Perioperative sepsis, but not hemorrhagic shock, promotes the development of cancer metastases in a murine model34 Measuring the impact of implementing an acute care surgery service on the management of acute biliary disease35 Patient flow and efficiency in an acute care surgery service36 The relationship between treatment factors and postoperative complications after radical surgery for rectal cancer37 Risk of ventral hernia after laparoscopic colon surgery38 Urinary metabolomics as a tool for early detection of Barrett’s and esophageal cancer39 Construct validity of individual and summary performance metrics associated with a computer-based laparo-scopic simulator40 Impact of a city-wide health system reorganization on emergency department visits in hospitals in surrounding communities41 Transcatheter aortic valve implantation for the nonoperative management of aortic stenosis: a cost-effectiveness analysis42 Breast cancer: racial differences in age of onset. A potential confounder in Canadian screening recommendations43 Risk taking in surgery: in and out of the comfort zone44 A tumour board in the office: Track those cancer patients!45 Increased patient BMI is not associated with advanced colon cancer stage or grade on presentation: a retrospective chart review46 Consensus statements regarding the multidisciplinary care of limb amputation patients in disasters or humanitarian emergencies. Report of the 2011 Humanitarian Action Summit Surgical Working Group on amputations following disasters or conflict47 Learning the CanMEDS role of professional: a pilot project of supervised discussion groups addressing the hidden curriculum48 Assessing the changing scope of training in Canadian general surgery programs: expected versus actual experience49 Predicting need for surgical management for massive gastrointestinal hemorrhage50 International health care experience: using CanMEDS to evaluate learning outcomes following a surgical mission in Mampong, Ghana51 The open abdomen: risk factors for mortality and rates of closure52 How surgeons think: an exploration of mental practice in surgical preparation53 The surgery wiki: a novel method for delivery of under-graduate surgical education54 Understanding surgical residents’ postoperative practices before implementing an enhanced recovery after surgery (ERAS) guideline at the University of Toronto55 From laparoscopic transabdominal to posterior retroperitoneal adrenalectomy: a paradigm shift in operative approach56 A retrospective audit of outcomes in patients over the age of 80 undergoing acute care abdominal surgery57 Canadian general surgery residents’ perspectives on work-hour regulations58 Timing of surgical intervention and its outcomes in acute appendicitis59 Preparing surgical trainees to deal with adverse events. An outline of learning issues60 Acute care surgical service: surgeon agreement at the time of handover61 Predicting discharge of elderly patients to prehospitalization residence following emergency general surgery62 Morbidity and mortality after emergency abdominal surgery in octo- and nonagenarians63 The impact of acute abdominal illness and urgent admission to hospital on the living situation of elderly patients64 A comparison of laparoscopic versus open subtotal gastrectomy for antral gastric adenocarcinoma: a North American perspective65 Minimally invasive excision of ectopic mediastinal parathyroid adenomas66 Perioperative outcomes of laparoscopic hernia repair in a tertiary care centre: a single institution’s experience67 Evaluation of a student-run, practical and didactic curriculum for preclerkship medical students68 Joseph Lister: Father of Modern Surgery69 Comparisons of melanoma sentinel lymph node biopsy prediction nomograms in a cohort of Canadian patients70 Local experience with myocutaneous flaps after extensive pelvic surgery71 The treatment of noncirrhotic splanchnic vein thrombosis: Is anticoagulation enough?72 Implementation of an acute care surgery service does not affect wait-times for elective cancer surgeries: an institutional experience73 Use of human collagen mesh for closure of a large abdominal wall defect, after colon cancer surgery, a case report74 The role of miR-200b in pulmonary hypoplasia associated with congenital diaphragmatic hernia75 Systematic review and meta-analysis of electrocautery versus scalpel for incising epidermis and dermis76 Accuracy of sentinel lymph node biopsy for early breast cancer in the community setting in St. John’s, New-foundland: results of a retrospective review77 Acute surgical outcomes in the 80 plus population78 The liberal use of platelets transfusions in the acute phase of trauma resuscitation: a systematic review79 Implementation of an acute care surgical on call program in a Canadian community hospital80 Short-term outcomes following paraesophageal hernia repair in the elderly patient81 First experience with single incision surgery: feasibility in the pediatric population and cost evaluation82 The impact of the establishment of an acute care surgery unit on the outcomes of appendectomies and cholecystectomies83 Description and preliminary evaluation of a low-cost simulator for training and evaluation of flexible endoscopic skills84 Tumour lysis syndrome in metastatic colon cancer: a case report85 Acute care surgery service model implementation study at a single institution86 Colonic disasters approached by emergent subtotal and total colectomy: lessons learned from 120 consecutive cases87 Acellular collagen matrix stent to protect bowel anastomoses88 Lessons we learned from preoperative MRI-guided wire localization of breast lesions: the University Health Network (UHN) experience89 Interim cost comparison for the use of platinum micro-coils in the operative localization of small peripheral lung nodules90 Routine barium esophagram has minimal impact on the postoperative management of patients undergoing esophagectomy for esophageal cancer91 Iron deficiency anemia is a common presenting issue with giant paraesophageal hernia and resolves following repair92 A randomized comparison of different ventilation strategies during thoracotomy and lung resection93 The Canadian Lung Volume Reduction Surgery study: an 8-year follow-up94 A comparison of minimally invasive versus open Ivor-Lewis esophagectomy95 A new paradigm in the follow-up after curative resection for lung cancer: minimal-dose CT scan allows for early detection of asymptomatic cancer activity96 Predictors of lymph node metastasis in early esophageal adenocarcinoma: Is endoscopic resection worth the risk?97 How well can thoracic surgery residents operate? Comparing resident and program director opinions98 The impact of extremes of age on short- and long-term outcomes following surgical resection of esophageal malignancy99 Epidermal growth factor receptor targeted gold nanoparticles for the enhanced radiation treatment of non–small cell lung cancer100 Laparoscopic Heller myotomy results in excellent outcomes in all subtypes of achalasia as defined by the Chicago classification101 Neoadjuvant chemoradiation versus surgery in managing esophageal cancer102 Quality of life postesophagectomy for cancer!103 The implementation, evolution and translocation of standardized clinical pathways can improve perioperative outcomes following surgical treatment of esophageal cancer104 A tissue-mimicking phantom for applications in thoracic surgical simulation105 Sublobar resection compared with lobectomy for early stage non–small cell lung cancer: a single institution study106 Not all reviews are equal: the quality of systematic reviews and meta-analyses in thoracic surgery107 Do postoperative complications affect health-related quality of life after video-assisted thoracoscopic lobectomy for patients with lung cancer? A cohort study108 Thoracoscopic plication for palliation of dyspnea secondary to unilateral diaphragmatic paralysis: A worthwhile venture?109 Thoracic surgery experience in Canadian general surgery residency programs110 Perioperative morbidity and pathologic response rates following neoadjuvant chemotherapy and chemoradiation for locally advanced esophageal carcinoma111 An enhanced recovery pathway reduces length of stay after esophagectomy112 Predictors of dysplastic and neoplastic progression of Barrett’s esophagus113 Recurrent esophageal cancer complicated by tracheoesophageal fistula: management by means of palliative airway stenting114 Pancreaticopleural fistula-induced empyema thoracis: principles and results of surgical management115 Prognostic factors of early postoperative mortality following right extended hepatectomy116 Optimizing steatotic livers for transplantation using a cell-penetrating peptide CPP-fused heme oxygenase117 Video outlining the technical steps for a robot-assisted laparoscopic pancreaticoduodenectomy118 Establishment of a collaborative group to conduct innovative clinical trials in Canada119 Hepatic resection for metastatic malignant melanoma: a systematic review and meta-analysis120 Acellular normothermic ex vivo liver perfusion for donor liver preservation121 Pancreatic cancer and predictors of survival: comparing the CA 19–9/bilirubin ratio with the McGill Brisbane Scoring System122 Staged liver resections for bilobar hepatic colorectal metastases: a single centre experience123 Economic model of observation versus immediate resection of hepatic adenomas124 Resection of colorectal liver metastasis in the elderly125 Acceptable long-term survival in patients undergoing liver resection for metastases from noncolorectal, non-neuroendocrine, nonsarcoma malignancies126 Patient and clinicopathological features and prognosis of CK19+ hepatocellular carcinomas: a case–control study127 The management of blunt hepatic trauma in the age of angioembolization: a single centre experience128 Liver resections for noncolorectal and non-neuroendocrine metastases: an evaluation of oncologic outcomes129 Developing an evidence-based clinical pathway for patients undergoing pancreaticoduodenectomy130 Hepatitis C infection and hepatocellular carcinoma in liver transplant: a 20 year experience131 The effect of medication on the risk of post-ERCP pancreatitis132 Temporal trends in the use of diagnostic imaging for patients with hepato-pancreato-biliary (HPB) conditions: How much ionizing radiation are we really using?196 A phase II study of aggressive metastasectomy for intra-and extrahepatic metastases from colorectal cancer133 Why do women choose mastectomy for breast cancer treatment? A conceptual framework for understanding surgical decision-making in early-stage breast cancer134 Synoptic operative reporting: documentation of quality of care data for rectal cancer surgery135 Learning curve analysis for cytoreductive surgery: a useful application of the cumulative sum (CUSUM) method136 Pancreatic cancer is strongly associated with a unique urinary metabolomic signature137 Concurrent neoadjuvant chemo/radiation in locally advanced breast cancer138 Impact of positron emission tomography on clinical staging of newly diagnosed rectal cancer: a specialized single centre retrospective study139 An evaluation of intraoperative Faxitron microradiography versus conventional specimen radiography for the excision of nonpalpable breast lesions140 Comparison of breast cancer treatment wait-times in the Southern Interior of British Columbia in 2006 and 2010141 Factors affecting lymph nodes harvest in colorectal carcinoma142 Laparoscopic adrenalectomy for metastases143 You have a message! Social networking as a motivator for fundamentals of laparoscopic surgery (FLS) training144 The evaluation and validation of a rapid diagnostic and support clinic for women assessment for breast cancer145 Oncoplastic breast surgery: oncologic benefits and limitations146 A qualitative study on rectal cancer patients’ preferences for location of surgical care147 The effect of surgery on local recurrence in young women with breast cancer148 Elevated IL-6 and IL-8 levels in tumour microenvironment is not associated with increased serum levels in humans with Pseudomyxoma peritonei and peritoneal mesothelioma149 Conversion from laparoscopic to open approach during gastrectomy: a population-based analysis150 A scoping review of surgical process improvement tools (SPITs) in cancer surgery151 Splenectomy during gastric cancer surgery: a population-based study152 Defining the polo-like kinase 4 (Plk4) interactome in cancer cell protrusions153 Neoadjuvant imatinib mesylate for locally advanced gastrointestinal stromal tumours154 Implementing results from ACOSOG Z0011: Practice-changing or practice-affirming?155 Should lymph node retrieval be a surgical quality indicator in colon cancer?156 Long-term outcomes following resection of retroperitoneal recurrence of colorectal cancer157 Clinical research in surgical oncology: an analysis of clinicaltrials.gov158 Radiation therapy after breast conserving surgery: When are we missing the mark?159 The accuracy of endorectal ultrasound in staging rectal lesions in patients undergoing transanal endoscopic microsurgery160 Quality improvement in gastrointestinal cancer surgery: expert panel recommendations for priority research areas161 Factors influencing the quality of local management of ductal carcinoma in situ: a cohort study162 Papillary thyroid microcarcinoma: Does size matter?163 Hyperthermic isolated limb perfusion for extremity soft tissue sarcomas: systematic review of clinical efficacy and quality assessment of reported trials164 Adherence to antiestrogen therapy in seniors with breast cancer: How well are we doing?165 Parathyroid carcinoma: Challenging the surgical dogma?166 A qualitative assessment of the journey to delayed breast reconstruction195 The role of yoga therapy in breast cancer patients167 Outcomes reported in comparative studies of surgical interventions168 Enhanced recovery pathways decrease length of stay following colorectal surgery, but how quickly do patients actually recover?169 The impact of complications on bed utilization after elective colorectal resection170 Impact of trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study171 Complex fistula-in-ano: Should the plug be abandoned in favour of the LIFT or BioLIFT?172 Prognostic utility of cyclooxygenase-2 expression by colon and rectal cancer173 Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is complex and time-consuming: analysis of learning curves for a novice minimally invasive surgeon174 Intraoperative quality assessment following double stapled circular colorectal anastomosis175 Improving patient outcomes through quality assessment of rectal cancer care176 Are physicians willing to accept a decrease in treatment effectiveness for improved functional outcomes for low rectal cancer?177 Turnbull-Cutait delayed coloanal anastomosis for the treatment of distal rectal cancer: a prospective cohort study178 Preoperative high-dose rate brachytherapy in preparation for sphincter preservation surgery for patients with advanced cancer of the lower rectum179 Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection180 The clinical results of the Turnbull-Cutait delayed coloanal anastomosis: a systematic review181 Is a vertical rectus abdominus flap (VRAM) necessary? An analysis of perineal wound complications182 Fistula plug versus endorectal anal advancement flap for the treatment of high transsphincteric cryptoglandular anal fistulas: a systematic review and meta-analysis183 Maternal and neonatal outcomes following colorectal cancer surgery184 Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option185 Trends in colon cancer in Ontario: 2002–2009186 Validation of electronically derived short-term outcomes in colorectal surgery187 A population-based assessment of transanal and endoscopic resection for adenocarcinoma of the rectum188 Laparoscopic colorectal surgery in the emergency setting: trends in the province of Ontario from 2002 to 2009189 Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with case series of internal hernia through pelvic mesh which was placed in attempt to prevent perineal hernia190 Effect of rectal cancer treatments on quality of life191 The use of antibacterial sutures as an adjunctive preventative strategy for surgical site infection in Canada: an economic analysis192 Impact of socioeconomic status on colorectal cancer screening and stage at presentation: preliminary results of a population-based study from an urban Canadian centre193 Initial perioperative results of the first transanal endoscopic microsurgery (TEM) program in the province of Quebec194 Use of negative pressure wound therapy decreases perineal wound infections following abdominal perineal resection. Can J Surg 2012; 55:S63-S135. [DOI: 10.1503/cjs.016712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Weinstock C, Bigenwald R, Hochman T, Sun P, Narod S, Warner E. Outcomes of surveillance for contralateral breast cancer in patients less than age 60 at the time of initial diagnosis. Curr Oncol 2012; 19:e160-4. [PMID: 22670105 PMCID: PMC3364776 DOI: 10.3747/co.19.890] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND After an initial diagnosis of breast cancer, the risk of contralateral breast cancer is approximately 0.5% per year. Annual mammography is recommended to identify local recurrences and contralateral new primaries. Because the sensitivity of mammography tends to be lower in younger women, we conducted a retrospective review of the method of detection and pathologic stage of metachronous contralateral primary breast cancers according to age at diagnosis in a cohort of breast cancer patients. METHODS The Henrietta Banting Database contains information on cases of breast cancer diagnosed at Women's College Hospital from 1987 to 2004. From among 1992 women in the database, 71 patients were identified who were initially diagnosed before age 60 and who subsequently developed a contralateral breast cancer. Medical records were obtained for 53 of the 71 patients. RESULTS Of the 53 contralateral cancers, 33 (62%) were detected by mammography, including 4 in 16 patients (25%) diagnosed before age 50 and 29 in 37 patients (78%) diagnosed at age 50 or older (p ≤ 0.001). CONCLUSIONS Mammography has poor sensitivity for the surveillance of contralateral breast cancer in early-onset breast cancer patients. Other imaging modalities should be evaluated in this setting.
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Affiliation(s)
- C. Weinstock
- Division of Medical Oncology, Sunnybrook Health Sciences Center, Toronto, ON
- Current affiliation: Department of Hematology and Oncology, University of Maryland Greenbaum Cancer Center, Baltimore, MD, U.S.A
| | - R. Bigenwald
- Division of Medical Oncology, Sunnybrook Health Sciences Center, Toronto, ON
| | - T. Hochman
- Women’s College Research Institute, Women’s College Hospital and University of Toronto, Toronto, ON
| | - P. Sun
- Department of Biostatistics, NYU Cancer Center, New York, NY, U.S.A
| | - S.A. Narod
- Department of Biostatistics, NYU Cancer Center, New York, NY, U.S.A
| | - E. Warner
- Division of Medical Oncology, Sunnybrook Health Sciences Center, Toronto, ON
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Passaperuma K, Warner E, Causer PA, Hill KA, Messner S, Wong JW, Jong RA, Wright FC, Yaffe MJ, Ramsay EA, Balasingham S, Verity L, Eisen A, Curpen B, Shumak R, Plewes DB, Narod SA. Long-term results of screening with magnetic resonance imaging in women with BRCA mutations. Br J Cancer 2012; 107:24-30. [PMID: 22588560 PMCID: PMC3389408 DOI: 10.1038/bjc.2012.204] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: The addition of breast magnetic resonance imaging (MRI) to screening mammography for women with BRCA mutations significantly increases sensitivity, but there is little data on clinical outcomes. We report screening performance, cancer stage, distant recurrence rate, and breast cancer-specific mortality in our screening study. Methods: From 1997 to 2009, 496 women aged 25 to 65 years with a known BRCA1/2 mutation, of whom 380 had no previous cancer history, were enrolled in a prospective screening trial that included annual MRI and mammography. Results: In 1847 screening rounds, 57 cancers were identified (53 screen-detected, 1 interval, and 3 incidental at prophylactic mastectomy), of which 37 (65%) were invasive. Sensitivity of MRI vs mammography was 86% vs 19% over the entire study period (P<0.0001), but was 74% vs 35% from 1997 to 2002 (P=0.02) and 94% vs 9% from 2003 to 2009 (P<0.0001), respectively. The relative sensitivities of MRI and mammography did not differ by mutation, age, or invasive vs non-invasive disease. Of the incident cancers, 97% were Stage 0 or 1. Of 28 previously unaffected women diagnosed with invasive cancer, 1 BRCA1 mutation carrier died following relapse of a 3 cm, node-positive breast cancer diagnosed on her first screen at age 48 (annual breast cancer mortality rate=0.5%). Three patients died of other causes. None of the 24 survivors has had a distant recurrence at a median follow-up of 8.4 years since diagnosis. Conclusion: Magnetic resonance imaging surveillance of women with BRCA1/2 mutations will detect the majority of breast cancers at a very early stage. The absence of distant recurrences of incident cancers to date is encouraging. However, longer follow-up is needed to confirm the safety of breast surveillance.
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Affiliation(s)
- K Passaperuma
- Department of Medicine, Division of Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5
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Ali A, Fergus K, Wright F, Pritchard K, Kiss A, Warner E. P5-17-06: Pilot Study of a Questionnaire To Assess Impact of a Breast Cancer Diagnosis in Young Women on Their Relationship with Their Mothers. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-17-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Breast cancer in young women (≤ 40) is associated with greater morbidity, both physical and psychological, and mortality than in older women. For women in their 20s and 30s we would expect the mother daughter relationship to be uniquely impacted by breast cancer. However, no study has apparently looked at the effects of a breast cancer diagnosis in this situation. We completed a pilot study to assess the clarity, content and sensitivity of a questionnaire that will be used in a comprehensive assessment of this relationship in young women with breast cancer.
Methods: A questionnaire with a mixture of Likert and open-ended items was developed after a literature review, obtaining input from an interdisciplinary panel of experts in psychology, medical oncology, research methodology, and breast cancer, and informal interviews with 3 young breast cancer survivors. Topics covered include demographics, nature of the mother-daughter relationship pre and post diagnosis and sources of support to daughters and mothers. Ten breast cancer survivors (≤ age 40 at diagnosis and > 36 months after their diagnosis) were asked to assess the questionnaire.
Results: Ten patients, median age 37 years (range 31–52), participated in the pilot study. The average time to complete the questionnaire was about 30 minutes. No questions were reported to be upsetting. All but 1 patient indicated that the questionnaire was clear. The questionnaire was modified based on patient feedback. The number of items was reduced from 51 to 38. Items concerning, for example, nature of the mother-daughter relationship during childhood or teenage years, and openness to discussing personal gynecological matters prior to breast cancer diagnosis were ultimately excluded. A question inquiring about the most difficult issues the daughter faced after diagnosis was added. Some questions were changed from open ended format to relevant tick box options after reaching response item saturation during the pilot phase. Of the 10 patients, 8 felt close to their mothers in the year prior to their diagnosis. Seven patients reported turning to their mothers for support when they first learned of the diagnosis, and 4 stated their mother was the first person they turned to. All 10 felt their mothers were emotionally and practically supportive. Five indicated that their relationship got closer postdiagnosis. One patient reported that her mother was not coping, and 3 indicated that their mothers did not have adequate support. Many patients felt that health care providers could help mothers by being empathetic, providing information, and linking mothers with supports.
Discussion: The mother-daughter relationship is an important source of support for young breast cancer survivors. Our questionnaire will be used in 100 women ≤ age 40 and within 3 years of diagnosis to further study the impact of breast cancer in a young woman on the mother-daughter relationship and to determine whether any intervention targeted to the mothers (eg. information or support groups) might be helpful.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-17-06.
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Affiliation(s)
- A Ali
- 1Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - K Fergus
- 1Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - F Wright
- 1Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - K Pritchard
- 1Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Kiss
- 1Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E Warner
- 1Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Collins LC, Gelber S, Marotti JD, Cole K, Kereakoglow S, Ruddy KJ, Brachtel EF, Schapira L, Come SE, Borges VF, Schedin PJ, Warner E, Winer E, Partridge A. P4-11-12: Molecular Phenotype of Breast Cancers in a Large Cohort of Young Women According to Time Interval Since Pregnancy. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-11-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The increase in breast cancer risk during pregnancy and post partum is well recognized. The cross-over to protective effect does not occur until many years later and varies with age at first birth. Recently, a genomic signature specific to the pregnant compared with the non-pregnant breast has been identified; this signature remains present in the postmenopausal parous breast. Given this, we investigated whether time interval since pregnancy affects the phenotype of breast cancers arising in young women compared with nulliparous women. Methods: We examined molecular phenotype, according to histologic grade and biomarker status, in relation to time since pregnancy in an ongoing prospective cohort study (n=355) of young women (≤40yrs) with breast cancer. Medical records were reviewed for tumor stage and receptor status. Parity was ascertained from questionnaires completed within 9 months of diagnosis. Tumor grade was determined by central pathology review. Using tumor grade and biomarker expression, cancers were categorized as luminal A (ER+ and/or PR+, HER2−, histologic grade 1 or 2); luminal B ( ER+ and/or PR+, HER2+, or ER and/or PR+, HER2− and grade 3); HER2 type (ER-, PR-, HER2+); and triple negative (ER-, PR-, HER2−).
Results: The median age of the study population is 37 years (range 17–40). Overall, 80% of women had stage 1 or 2 disease; 67% of cancers were ER positive and 32% showed HER2 overexpression. The distribution of breast cancer molecular phenotypes by time interval since last pregnancy is shown in the table.
Distribution of molecular phenotype by interval between last pregnancy and diagnosis
In our large cohort of parous young women, we found no differences in the distribution of molecular phenotype according to time interval since pregnancy. However, nulliparous young women were more likely to develop luminal A cancers compared to parous women (40% vs. 29%; unadjusted chi square p-value=0.03) and appeared less likely to develop HER2−type and triple negative cancers (7% vs. 13%, p-value=0.09 and 17% vs. 23%, p-value=0.22 respectively). There were no differences in the distribution of luminal B cancers. Conclusions: The distribution of molecular phenotypes is similar among parous young women regardless of the time interval since parturition. Nulliparous young women appear more likely to develop luminal A cancers compared to parous women. Whether the difference in molecular phenotypes of pregnancy-associated breast cancers vs. cancers arising in nulliparous women is due to the effects of genomic alteration remains to be investigated. Effects of a prior pregnancy appear consistent across a 5-year period, in keeping with the concept of genomic alterations identified in the normal pregnant breast and thereafter.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-12.
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Affiliation(s)
- LC Collins
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - S Gelber
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - JD Marotti
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - K Cole
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - S Kereakoglow
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - KJ Ruddy
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - EF Brachtel
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - L Schapira
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - SE Come
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - VF Borges
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - PJ Schedin
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - E Warner
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - E Winer
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - A Partridge
- 1Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; Dana Farber Cancer Institute, Boston; Dartmouth-Hitchcock Medical Center, Lebanon, Hanover, NH; Brigham and Women's Hospital, Boston; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, CO; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
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Sousa BA, Nasim S, Cole DE, Wong BY, Hill K, Pritchard KI, Trudeau M, Verma S, Dent R, Petrella T, Gandhi S, Ueng S, Vandenberghe U, Romaschin A, Warner E. P4-01-04: Effects of CYP2D6 Phenotype and Drug Adherence on Tamoxifen Metabolite Levels. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-01-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Although the activity of cytochrome P450 2D6 (CYP2D6), the enzyme responsible for conversion of tamoxifen (TAM) to its most important active metabolite endoxifen, varies significantly with genotype. Routine genotype testing in patients on TAM has recently been discouraged. Conflicting results in publications regarding the prognostic utility of this test remain unexplained. Confounding factors could be lack of predicted correlation between CYP2D6 genotype and TAM active metabolites, or variability of patient compliance
Methods: Consecutive breast cancer patients on TAM were asked to enroll in a study to examine the relationship between CYP 2D6 phenotype, patient-reported treatment adherence, and TAM metabolites levels. Patients were genotyped for CYP2D6 polymorphisms using long-range PCR allele-specific amplification and single-nucleotide primer extension assay. From the genotypes, four phenotype groups were defined: Ultra rapid Metabolizer (UM), Extensive Metabolizer (EM), Intermediate Metabolizer (IM) and Poor Metabolizer (PM). Plasma was collected after at least 6 weeks of TAM (20 mg daily). The parent drug TAM, as well as 4-hydroxy N-desmethyl tamoxifen (endoxifen), 4 hydroxy tamoxifen (4OHtam) and N-desmethyl-tamoxifen (NDtam), were determined by Liquid Chromatography tandem mass-spectrometry (LC-MS/MS). Patients also completed a questionnaire about ethinicity, side effects, concurrent medications and tamoxifen adherence. Correlation between metabolite/TAM ratio and phenotype was tested by Spearman correlation test. Relationship between metabolite levels and adherence was tested by Wilcoxon rank sum test. Chi square test was used to compare proportions.
Results: Of the 100 patients enrolled there were 62 Caucasians, 25 Asians, 4 Africans and 6 Unknown. We found a strong correlation between ratio of endoxifen/TAM and phenotype (p <.0001) (Table 1) Over a 2 week period 68 never missed a TAM dose, 25 missed 1–2 times, 2 missed 3–5 times and 2 > 5times (2 missing data). In EM group we found significantly lower levels of TAM (p <.0001), NDtam (p=.008), 4OHtam (p=.003) in less adherent patients. A trend to decreased levels was also shown for endoxifen (p=.081). No associations were found between adherence or phenotype activity and side effects.
Conclusions: Our data suggests the predicted association between endoxifen levels and genotype. However, non-adherence may have a significant confounding effect. Prospective studies to evaluate the prognostic impact of CYP2D6 variants for patients on adjuvant tamoxifen should be done but results could be confounded by variable drug adherence if this is not measured concurrently.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-01-04.
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Affiliation(s)
- BA Sousa
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - S Nasim
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - DE Cole
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - BY Wong
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - K Hill
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - KI Pritchard
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - M Trudeau
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - S Verma
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - R Dent
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - T Petrella
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - S Gandhi
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - S Ueng
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - U Vandenberghe
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - A Romaschin
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
| | - E Warner
- 1Sunnybrook Health Sciences Odette Cancer Centre, Toronto, ON, Canada; Li Ka Shing Research Institute, Biochemistry, Toronto, ON, Canada
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Hill KA, Nadler T, Mandel R, Burlein-Hall S, Librach C, Warner E. The experience of young women diagnosed with breast cancer who undergo fertility preservation (FP) consultation. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
249 Background: In recent years FP has been a growing concern for young women diagnosed with breast cancer. ASCO has recommended that such women be referred to a reproductive specialist as early as possible before beginning systemic adjuvant therapy. Aim: To gather information about young breast cancer patients’ experiences with FP referral, consultation, and decision making. Methods: Anonymous questionnaires were mailed to consecutive breast cancer patients referred January 2005 through January 2010 from our center to the CReATe clinic in Toronto. Topics included information about demographics, cancer stage and treatment, previous fertility problems, referral source and timing, options presented and chosen, and satisfaction with the referral, consultation and decision making processes. Results: Of the 50 women identified 26 (52%) participated. Average age of respondents was 31 (range 24-41). 17 (65%) were married or in a long-term relationship, and 9 (35%) already had 1 child. Seven (27%) were referred before surgery, 16 (62%) after surgery but before systemic therapy, 2 (8%) after starting hormone therapy, and 1 after completing chemotherapy. Only 54% opted for FP. Of the 17 (66%) who reported plans to start/add to their family prior to diagnosis of breast cancer, 53% proceeded with FP and of the 9 who did not have plans to start/add to their family 5 (55%) pursued FP. 41% had difficulty with decision making and 50% found cost to be a significant barrier. A common theme among respondents was inadequate time for decision making. Several complained about the lack of written material before and/or after their consultation. 85% felt that access to a psychosocial counselor would have been beneficial to the decision making process. 57% were satisfied or extremely satisfied overall. Conclusions: (1) If appropriate, FP referral should be initiated by the surgeon as soon as a diagnosis of invasive cancer is made. Obtaining receptor and HER2 status on core biopsy samples may identify women who will require systemic therapy and may benefit from early FP referral. (2) Women need written materials before and after FP consultation. (3) There is a major role for a FP counselor who is able to spend additional time helping with decision making.
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Affiliation(s)
- K. A. Hill
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Create Fertility Centre, Toronto, ON, Canada
| | - T. Nadler
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Create Fertility Centre, Toronto, ON, Canada
| | - R. Mandel
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Create Fertility Centre, Toronto, ON, Canada
| | - S. Burlein-Hall
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Create Fertility Centre, Toronto, ON, Canada
| | - C. Librach
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Create Fertility Centre, Toronto, ON, Canada
| | - E. Warner
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Create Fertility Centre, Toronto, ON, Canada
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Sousa B, Nasim S, Cole D, Wong B, Hill K, Vandenberghe H, Ueng S, Romaschin A, Warner E. 5171 POSTER First Results From a Study Analyzing CYP2D6 Genotypes and Tamoxifen Metabolites in a Canadian Population With Endocrine Responsive Breast Cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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