scholarly journals Annual surveillance mammography after early-stage breast cancer and breast cancer mortality

2016 ◽  
Vol 23 (6) ◽  
pp. 538 ◽  
Author(s):  
L.E. Paszat ◽  
R. Sutradhar ◽  
S. Gu ◽  
E. Rakovitch
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Breast Cancer Mortality ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Initial Diagnosis ◽  
Early Stage Breast Cancer ◽  
Surveillance Mammography ◽  
Ipsilateral Recurrence ◽  
Median Interval

Background After treatment for early-stage breast cancer (bca), annual surveillance mammography (asm) is recommended based on the assumption that early detection of an invasive ipsilateral breast tumour recurrence or subsequent invasive contralateral primary bca reduces bca mortality.Methods We studied women with unilateral early-stage bca treated by breast-conserving surgery from 1994 to 1997 who subsequently developed an ipsilateral recurrence or contralateral primary more than 24 months after initial diagnosis, without prior regional or distant metastases. Annual surveillance mammography was defined as 2 episodes of bilateral mammography 11–18 months apart during the 2 years preceding the ipsilateral recurrence or contralateral primary. The association between asm and bca death was evaluated using a Cox proportional hazards model.Results We identified 669 women who experienced invasive ipsilateral recurrence (n = 455) or a contralateral primary (n = 214) at a median interval of 53 months [interquartile range (iqr): 37–72 months] after initial diagnosis, 64.7% of whom had received asm during the preceding 2 years. The median interval between the 2 bilateral mammograms was 12.3 months (iqr: 11.9–13.0 months), and the median interval between the 2nd mammogram and histopathologic confirmation of ipsilateral recurrence or contralateral primary was 1.5 months (iqr: 0.8–3.9 months). Median follow up after ipsilateral recurrence or contralateral primary was 7.76 years (iqr: 3.68–9.81 years). The adjusted hazard ratio for bca death associated with asm was 0.86 (95% confidence limits: 0.63, 1.16).Conclusions Annual surveillance mammography was associated with a modestly lowered hazard ratio for bca death.

Individualizing Surveillance Mammography for Older Patients After Treatment for Early-Stage Breast Cancer

JAMA Oncology ◽  
2021 ◽  
Author(s):  
Rachel A. Freedman ◽  
Christina A. Minami ◽  
Eric P. Winer ◽  
Monica Morrow ◽  
Alexander K. Smith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Patients ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Surveillance Mammography

Effect of Pregnancy on Overall Survival After the Diagnosis of Early-Stage Breast Cancer

2001 ◽  
Vol 19 (6) ◽  
pp. 1671-1675 ◽  
Author(s):  
Shari Gelber ◽  
Alan S. Coates ◽  
Aron Goldhirsch ◽  
Monica Castiglione-Gertsch ◽  
Gianluigi Marini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Proportional Hazards ◽  
Comparison Group ◽  
Early Stage ◽  
Pregnant Patient ◽  
Subsequent Pregnancy ◽  
Cox Proportional Hazards ◽  
Early Stage Breast Cancer ◽  
Study Group ◽  
The Impact

PURPOSE: To evaluate the impact of subsequent pregnancy on the prognosis of patients with early breast cancer. PATIENTS AND METHODS: One hundred eight patients who became pregnant after diagnosis of early-stage breast cancer were identified in institutions participating in International Breast Cancer Study Group (IBCSG) studies. Fourteen had relapse of breast cancer before their first subsequent pregnancy. The remaining 94 patients (including eight who relapsed during pregnancy) formed the study group reported here. A comparison group of 188 was obtained by randomly selecting two patients, matched for nodal status, tumor size, age, and year of diagnosis from the IBCSG database, who were free of relapse for at least as long as the time between breast cancer diagnosis and completion of pregnancy for each pregnant patient. Survival comparison used Cox proportional hazards regression models. RESULTS: Overall 5- and 10-year survival percentages (± SE) measured from the diagnosis of early-stage breast cancer among the 94 study group patients were 92% ± 3% and 86% ± 4%, respectively. For the matched comparison group survival was 85% ± 3% at 5 years and 74% ± 4% at 10 years (risk ratio, 0.44; 95% confidence interval, 0.21 to 0.96; P = .04). CONCLUSION: Subsequent pregnancy does not adversely affect the prognosis of early-stage breast cancer. The superior survival seen in this and other controlled series may merely reflect a healthy patient selection bias, but is also consistent with an antitumor effect of the pregnancy.

scholarly journals Diagnosis of second breast cancer events after initial diagnosis of early stage breast cancer

2010 ◽  
Vol 124 (3) ◽  
pp. 863-873 ◽  
Author(s):  
Diana S. M. Buist ◽  
◽  
Linn A. Abraham ◽  
William E. Barlow ◽  
Arun Krishnaraj ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Initial Diagnosis ◽  
Early Stage Breast Cancer ◽  
Second Breast Cancer

Survival in male breast cancer (MaBC) over the past three decades.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 569-569
Author(s):  
Jose Pablo Leone ◽  
Rachel A. Freedman ◽  
Julieta Leone ◽  
Michael J. Hassett ◽  
Sara M. Tolaney ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Mortality ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Rank Test ◽  
Cancer Specific Survival ◽  
Cox Models ◽  
The Past ◽  
Significant Difference ◽  
Over Time

569 Background: Breast cancer mortality in women has declined significantly over the past several years. In men, it is unclear whether survival has changed over time. The aim of this study was to evaluate changes in breast cancer-specific survival (BCSS) and overall survival (OS) in MaBC over the past three decades. Methods: We evaluated men diagnosed with breast cancer between 1988 and 2017, with known cause of death reported in the Surveillance, Epidemiology, and End Results registry. Patients were categorized into 3 groups by year of diagnosis: 1988-1997, 1998-2007 and 2008-2017. BCSS and OS were estimated by Kaplan-Meier and differences between groups were compared by log-rank test. Cox proportional hazards regression was used to evaluate the independent association of tumor and patient characteristics with BCSS and OS. Results: We included 8,412 men diagnosed between 1988-1997 (N = 1,033), 1998-2007 (N = 2,938) and 2008-2017 (N = 4,441). Median age for the overall population and within each decade of diagnosis was 68 years. Median follow-up was 23.6 years, 14.3 years and 4.5 years in periods 1988-1997, 1998-2007 and 2008-2017, respectively. Overall, BCSS at 5 years was 83.5%, 83.6% and 84.3% in periods 1988-1997, 1998-2007 and 2008-2017, respectively; p = 0.8. There was no significant difference in BCSS between the three periods of diagnosis within each stage of breast cancer (stage I, II, III and IV). Among all patients, OS at 5 years was 64.7%, 67.2% and 69.3% in periods 1988-1997, 1998-2007 and 2008-2017, respectively; p = 0.01. In multivariate Cox models, older age at diagnosis, black race, grade 3 disease, increasing stage, hormone receptor negative status and no surgery were all independently associated with worse BCSS and OS. In these adjusted Cox models, each additional year of diagnosis had no significant association with BCSS (hazard ratio, 1.0; 95% CI, 0.99 – 1.01; p = 0.78), and a significant improvement in OS (hazard ratio, 0.99; 95% CI, 0.98 – 0.99; p = 0.01). Conclusions: Over the past three decades, there has been no significant improvement in BCSS in MaBC. The changes in OS over time suggest increasing life expectancy. Efforts to improve BCSS in MaBC are warranted.

Effect of Obesity on Prognosis After Early-Stage Breast Cancer

2011 ◽  
Vol 29 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Marianne Ewertz ◽  
Maj-Britt Jensen ◽  
Katrín Á. Gunnarsdóttir ◽  
Inger Højris ◽  
Erik H. Jakobsen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Adjuvant Treatment ◽  
Proportional Hazards ◽  
Early Stage ◽  
Cancer Recurrence ◽  
Distant Metastases ◽  
Cox Proportional Hazards ◽  
Early Stage Breast Cancer ◽  
The Impact

Purpose This study was performed to characterize the impact of obesity on the risk of breast cancer recurrence and death as a result of breast cancer or other causes in relation to adjuvant treatment. Patients and Methods Information on body mass index (BMI) at diagnosis was available for 18,967 (35%) of 53,816 women treated for early-stage breast cancer in Denmark between 1977 and 2006 with complete follow-up for first events (locoregional recurrences and distant metastases) up to 10 years and for death up to 30 years. Information was available on prognostic factors and adjuvant treatment for all patients. Univariate analyses were used to compare the associations of known prognostic factors and risks of recurrence or death according to BMI categories. Cox proportional hazards regression models were used to assess the influence of BMI after adjusting for other factors. Results Patients with a BMI of 30 kg/m2 or more were older and had more advanced disease at diagnosis compared with patients with a BMI below 25 kg/m2 (P < .001). When data were adjusted for disease characteristics, the risk of developing distant metastases after 10 years was significantly increased by 46%, and the risk of dying as a result of breast cancer after 30 years was significantly increased by 38% for patients with a BMI of 30 kg/m2 or more. BMI had no influence on the risk of locoregional recurrences. Both chemotherapy and endocrine therapy seemed to be less effective after 10 or more years for patients with BMIs greater than 30 kg/m2. Conclusion Obesity is an independent prognostic factor for developing distant metastases and for death as a result of breast cancer; the effects of adjuvant therapy seem to be lost more rapidly in patients with breast cancer and obesity.

scholarly journals Local and distant tumor dormancy during early stage breast cancer are associated with the predominance of infiltrating T effector subsets

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Hussein F. Aqbi ◽  
Cara Coleman ◽  
Melika Zarei ◽  
Saeed H. Manjili ◽  
Laura Graham ◽  
...  
Keyword(s):  
Breast Cancer ◽  
T Cells ◽  
Tumor Cells ◽  
Early Stage ◽  
Breast Cancer Mortality ◽  
Distant Recurrence ◽  
Tumor Dormancy ◽  
Early Stage Breast Cancer ◽  
T Cell Subsets ◽  
Dormant Cells

Abstract Background Although breast cancer mortality is a result of distant recurrences associated with the establishment of tumor dormancy, current clinical practice guidelines recommend a wait and watch approach for tumor recurrences. This is because of our limited understanding of tumor dormancy and insufficient evidence in support of immunological control of tumor dormancy. Methods We used FVBN202 transgenic mice expressing rat neu oncogene in the mammary glands, and their parental FVB strain lacking neu expression. These models allowed the detection of tumor dormancy at distant sites using the rat neu protein as a tumor marker. We also used Ki67 for the detection of the indolent and quiescent types of tumor dormancy. Multicolor flow cytometry was used to detect dormant tumor cells and T cell subsets. Co-culture studies were performed to determine the role of T cells in preventing regrowth of dormant cells. Results We demonstrated that dormant tumor cells were present at the site of primary breast cancer and at distant sites in the lungs and in the liver very early in the course of early stage breast cancer when no distant metastasis was evident. Dormant tumor cells were characterized as neu expressing Ki67− and Ki67low fractions associated with the induction of local immune responses predominated by CD4+ and CD8+ T effector cell subsets. The presence of neu-autoreactive T cells from FVBN202 mice only prevented regrowth of dormant cells. On the other hand, presence of neu-alloreactive anti-tumor T cells in FVB mice prior to tumor challenge resulted in the protection of mice from the dissemination of dormant tumor cells to distant organs. Conclusion Our results suggest that immunotherapeutic targeting of semi-allogeneic mutant neoantigens during tumor dormancy might prevent distant recurrence of the disease.

Chemotherapy for Early-Stage Breast Cancer: A Paradigm in Flux

2008 ◽  
Vol 21 (1) ◽  
pp. 46-56
Author(s):  
Lan-Phuong P. Tran ◽  
Jodi L. Grabinski
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Chemotherapy ◽  
Early Stage ◽  
Breast Cancer Mortality ◽  
The United States ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Chemotherapy ◽  
Therapeutic Decisions ◽  
Adjuvant Breast Cancer

Breast cancer is the most common malignancy among women in the United States. A reduction in breast cancer mortality has been observed over recent years and is in part attributable to general use of adjuvant chemotherapy and trastuzumab. Besides the addition of specific therapeutic agents, the therapy of early-stage breast cancer has benefited from dose-dense approaches, identification of molecular markers, and translational research innovations such as prognostic gene expression assays. Treatment recommendations for adjuvant breast cancer chemotherapy are traditionally guided by results from clinical studies reflecting a general population; however, molecular and genomic information can potentially enable clinicians to formulate more refined therapeutic decisions. These advances also generate further questions regarding situations where application of therapy is necessary to optimize efficacy and circumstances where sparing therapy is appropriate. Taken together, the advances made through early-stage breast cancer chemotherapy positions us closer to fulfilling the promise of personalized medicine. This article reviews the recent progress of adjuvant chemotherapy and trastuzumab in breast cancer.

Neutropenic complications with neo/adjuvant adriamycin and cyclophosphamide in early stage breast cancer patients: A prospective study at the McGill University health center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12127-e12127
Author(s):  
Ramy Saleh ◽  
Arielle Elkrief ◽  
Elmira Afshar ◽  
Laurent Azoulay ◽  
Sarkis H. Meterissian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prospective Study ◽  
Health Center ◽  
Proportional Hazards ◽  
Early Stage ◽  
Cox Proportional Hazards ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Glucose Levels ◽  
Mcgill University

e12127 Background: We prospectively investigated the incidence of neutropenic complications (NC) with neo/adjuvant AC (doxorubicin and cyclophosphamide) chemotherapy (CTX) among early-stage breast cancer (ESBC) patients. NC was defined as febrile neutropenia (FN), dose delay/reduction or need of granulocyte colony-stimulating factors (G-CSF) to proceed with CTX. Methods: This was a single-center, observational, prospective cohort study conducted at the McGill University Health Center. All ESBC patients who received AC regimen as neo/adjuvant CTX between February 2016 and February 2017 were included. Hazard ratios (HRs) with 95% confidence intervals (CIs) of predictors of NC were estimated using Cox-proportional hazards models. Results: A total of 118 patients, corresponding to 409 cycles of AC were analyzed. Most patients underwent Q3week cycles (83.1%). Median age was 52 years old (IQR 43-61). Prophylactic G-CSF was given to 20 dose-dense patients and 10 Q3weeks patients. In patients not receiving prophylactic G-CSF, 57 (65.5%) manifested at least one episode of NC (corresponding to an incidence rate of 26.4%/cycle of CTX [95% CI: 20.0%-34.2%]), of which 9 developed FN requiring hospital admission. In the final prediction model, body mass index < 25 kg/m2(HR: 2.36, 95% CI: 1.16-4.78) and increasing glucose levels (HR: 1.56, 95% CI: 1.14-2.14) were significantly associated with NC. Baseline absolute neutrophil count (ANC) was protective. Conclusions: The incidence of NC in our prospective study is significantly higher than previously reported in retrospective studies (26.4% vs. 12%). Normal BMI and high glucose were associated with the highest risk of NC. More importantly, 65% of ESBC on AC will require G-CSF during their treatment due to a NC episode. [Table: see text]

scholarly journals Tamoxifen Pharmacogenetics and Metabolism: Results From the Prospective CYPTAM Study

2019 ◽  
Vol 37 (8) ◽  
pp. 636-646 ◽  
Author(s):  
Anabel Sanchez-Spitman ◽  
Vincent Dezentjé ◽  
Jesse Swen ◽  
Dirk Jan A.R. Moes ◽  
Stefan Böhringer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Outcome ◽  
Cox Regression ◽  
Early Stage ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Early Stage Breast Cancer ◽  
Adjuvant Tamoxifen ◽  
Cyp2d6 Genotype ◽  
Cox Regression Analysis

PURPOSE Tamoxifen is widely prescribed as adjuvant therapy in patients with early-stage breast cancer. It has been postulated that concentrations of endoxifen, the active metabolite of tamoxifen, are a better predictor of tamoxifen efficacy than CYP2D6 genotypes. Although in a retrospective study, an endoxifen threshold of 5.9 ng/mL for efficacy was described, confirmation based on prospective studies is lacking. The objective of the prospective CYPTAM (The Netherlands National Trial Register: NTR1509) study was to associate endoxifen concentrations and CYP2D6 genotypes with clinical outcome in patients with early-stage breast cancer receiving tamoxifen. PATIENTS AND METHODS From February 2008 to December 2010, patients with breast cancer treated with adjuvant tamoxifen were included. Patients could be enrolled up to a maximum of 12 months after tamoxifen initiation. Blood samples were retrieved for CYP2D6 genotyping and endoxifen measurements by Amplichip (Roche Diagnostics, Indianapolis, IN) and high-performance liquid chromatography–tandem mass spectrometry, respectively. Endoxifen concentrations were analyzed as a continuous variable, classifying patients into quartiles and using an endoxifen threshold of 5.9 ng/mL. Endoxifen concentrations and CYP2D6 genotypes were associated with relapse-free survival (censored at the time of tamoxifen discontinuation; RFSt) by Cox regression analysis. RESULTS A total of 667 pre- and postmenopausal patients were enrolled and had received tamoxifen for a median time of 0.37 years (range, 0.23 to 0.6 years) before study entry. No association was found between endoxifen concentrations and RFSt (adjusted hazard ratio, 0.991; 95% CI, 0.946 to 1.038; P = .691). Also, neither categorizing endoxifen concentrations into quartiles nor using 5.9 ng/mL as threshold altered these results. In addition, no association was found between CYP2D6 genotype and RFSt (adjusted hazard ratio, 0.929; 95% CI, 0.525 to 1.642; P = .799). CONCLUSION This prospective clinical study shows no association between endoxifen concentrations or CYP2D6 genotypes and clinical outcome in patients with early-stage breast cancer receiving adjuvant tamoxifen.

Impact on Survival of Time From Definitive Surgery to Initiation of Adjuvant Chemotherapy for Early-Stage Breast Cancer

2006 ◽  
Vol 24 (30) ◽  
pp. 4888-4894 ◽  
Author(s):  
Caroline Lohrisch ◽  
Charles Paltiel ◽  
Karen Gelmon ◽  
Caroline Speers ◽  
Suzanne Taylor ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Early Stage ◽  
Hazard Ratio ◽  
Early Stage Breast Cancer ◽  
Curative Surgery ◽  
Free Survival ◽  
Cancer Agency ◽  
Impact On Survival ◽  
Definitive Surgery

Purpose To determine if time to start of adjuvant chemotherapy after curative surgery influences survival in early-stage breast cancer. Patients and Methods A retrospective review was conducted of 2,594 patients receiving adjuvant chemotherapy for stage I and II breast cancer between 1989 and 1998 at the British Columbia Cancer Agency. Relapse-free survival (RFS) and overall survival (OS) were compared among patients grouped by time from definitive curative surgery to start of adjuvant chemotherapy (≤ 4 weeks, > 4 to 8 weeks, > 8 to 12 weeks, and >12 to 24 weeks). Results RFS and OS were similar for women starting chemotherapy up to 12 weeks after surgery. OS hazard ratio (univariate) for initiation of chemotherapy more than 12 weeks compared with 12 weeks or less after surgery was 1.5 (95% CI, 1.07 to 2.10; P = .017). Five-year OS rates were 84%, 85%, 89%, and 78%, (log-rank P = .013); RFS rates were 74%, 79%, 82%, and 69% (log-rank P = .004) for patients starting chemotherapy 4 weeks or fewer, more than 4 to 8 weeks, more than 8 to 12 weeks, and more than 12 to 24 weeks after surgery, respectively. In multivariate analysis, independent prognostic factors were grade, size, nodal status, estrogen receptor, age, and lymphatic and/or vascular invasion. Initiation of adjuvant chemotherapy more than 12 weeks from surgery remained significantly associated with inferior survival, with a hazard ratio of 1.6 (95% CI, 1.2 to 2.3; P = .005). Conclusion This retrospective analysis suggests that adjuvant chemotherapy is equally effective up to 12 weeks after definitive surgery but that RFS and OS appear to be compromised by delays of more than 12 weeks after definitive surgery.

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