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Ward J, King I, Monroy-Iglesias M, Russell B, van Hemelrijck M, Ramsey K, Khan AA. A meta-analysis of the efficacy of vascularised lymph node transfer in reducing limb volume and cellulitis episodes in patients with cancer treatment-related lymphoedema. Eur J Cancer 2021; 151:233-244. [PMID: 34092349 DOI: 10.1016/j.ejca.2021.02.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Lymphoedema after cancer treatment is a chronic and disabling complication that presents a significant health care burden during survivorship with limited treatment options. Vascularised lymph node transfer (VLNT) can reconstruct lymphatic flow to reduce limb volumes, but limited higher-order evidence exists to support its effectiveness. AIM The aim of the study was to systematically review and meta-analyse the effectiveness of VLNT in reducing upper limb (UL) or lower limb (LL) volume and cellulitis episodes in patients with cancer treatment-related lymphoedema (CTRL). METHODS PubMed, Medline (Ovid) and Embase databases were searched between January 1974 and December 2019. Full-length articles where VLNT was the sole therapeutic procedure for CTRL, reporting volumetric limb, frequency of infection episodes and/or lymphoedema-specific quality-of-life data, were included in a random-effects meta-analysis of circumferential reduction rate (CRR). Methodological quality was assessed using STROBE/CONSORT, and a novel, lymphoedema-specific scoring tool was used to assess lymphoedema-specific methodological reporting. Sensitivity analyses on the site of VLNT harvest and recipient location were performed. RESULTS Thirty-one studies (581 patients) were eligible for inclusion. VLNT led to significant limb volume reductions in UL (above elbow pooled CRRs [CRRP] = 42.7% [95% confidence interval (CI): 36.5-48.8]; below elbow CRRP = 34.1% [95% CI: 33.0-35.1]) and LL (above knee CRRP = 46.8% [95% CI: 43.2-50.4]; below knee CRRP = 54.6% [95% CI: 39.0-70.2]) CTRL. VLNT flaps from extra-abdominal donor sites were associated with greater volume reductions (CRRP = 49.5% [95% CI: 46.5-52.5]) than those from intra-abdominal donor sites (CRRP = 39.6% [95% CI: 37.2-42.0]) and synchronous autologous breast reconstruction/VLNT flaps (CRRP = 32.7% [95% CI: 11.1-54.4]) (p < 0.05). VLNT was also found to reduce the mean number of cellulitis episodes by 2.1 episodes per year (95% CI: -2.7- -1.4) and increased lymphoedema-specific quality-of-life scores (mean difference in Lymphoedema-Specific Quality of Life (LYMQOL) "overall domain" = +4.26). CONCLUSIONS VLNT is effective in reducing excess limb volume and cellulitis episodes in both UL and LL lymphoedema after cancer treatment. However, significant heterogeneity exists in outcome reporting, and standardisation of reporting processes is recommended.
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Affiliation(s)
- Joseph Ward
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ian King
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Maria Monroy-Iglesias
- Department of Translational Oncology and Urology Research, King's College London, London, UK
| | - Beth Russell
- Department of Translational Oncology and Urology Research, King's College London, London, UK
| | - Mieke van Hemelrijck
- Department of Translational Oncology and Urology Research, King's College London, London, UK
| | - Kelvin Ramsey
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Aadil A Khan
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, London, UK.
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Hanis TM, Yaacob NM, Mohd Hairon S, Abdullah S. Net survival differences of breast cancer between stages at diagnosis and age groups in the east coast region of West Malaysia: a retrospective cohort study. BMJ Open 2021; 11:e043642. [PMID: 34006546 PMCID: PMC8130742 DOI: 10.1136/bmjopen-2020-043642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Estimation of the net survival of breast cancer helps in assessing breast cancer burden at a population level. Thus, this study aims to estimate the net survival of breast cancer at different cancer staging and age at diagnosis in the east coast region of West Malaysia. SETTING Kelantan, Malaysia. PARTICIPANTS All breast cancer cases diagnosed in 2007 and 2011 identified from Kelantan Cancer Registry. DESIGN This retrospective cohort study used a relative survival approach to estimate the net survival of patients with breast cancer. Thus, two data were needed; breast cancer data from Kelantan Cancer Registry and general population mortality data for Kelantan population. PRIMARY AND SECONDARY OUTCOME MEASURES Net survival according to stage and age group at diagnosis at 1, 3 and 5 years following diagnosis. RESULTS The highest net survival was observed among stage I and II breast cancer cases, while the lowest net survival was observed among stage IV breast cancer cases. In term of age at diagnosis, breast cancer cases aged 65 and older had the best net survival compared with the other age groups. CONCLUSION The age at diagnosis had a minimal impact on the net survival compared with the stage at diagnosis. The finding of this study is applicable to other populations with similar breast cancer profile.
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Affiliation(s)
- Tengku Muhammad Hanis
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Malaysia
| | - Najib Majdi Yaacob
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Malaysia
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Malaysia
| | - Sarimah Abdullah
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Malaysia
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Elobaid Y, Aamir M, Grivna M, Suliman A, Attoub S, Mousa H, Ahmed LA, Oulhaj A. Breast cancer survival and its prognostic factors in the United Arab Emirates: A retrospective study. PLoS One 2021; 16:e0251118. [PMID: 33951102 PMCID: PMC8099089 DOI: 10.1371/journal.pone.0251118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/20/2021] [Indexed: 12/27/2022] Open
Abstract
Background Data on breast cancer survival and its prognostic factors are lacking in the United Arab Emirates (UAE). Sociodemographic and pathologic factors have been studied widely in western populations but are very limited in this region. This study is the first to report breast cancer survival and investigate prognostic factors associated with its survival in the UAE. Methods This is a retrospective cohort study involving 988 patients who were diagnosed and histologically confirmed with breast cancer between January 2008 and December 2012 at Tawam hospital, Al Ain, UAE. Patient were followed from the date of initial diagnosis until the date of death from any cause, lost-to-follow up or the end of December 2018. The primary outcome is overall survival (OS). The Kaplan-Meier method was used to estimate the survival curve along with the 2- and 5-year survivals. Different group of patients categorized according to prognostic factors were compared using the log-rank test. Multiple Cox proportional hazards models was used to examine the impact of several prognostic factors on the overall survival. Results The median study follow-up was 35 months. Of the 988 patients, 62 had died during their follow-up, 56 were lost to follow-up and 870 were still alive at the end of the study. The average age of patients was 48 years. The majority of patients presented to the hospital with grade II or III, 24% with at least stage 3 and 9.2% had metastasis. The 2-year and 5-year survivals were estimated to 97% and 89% respectively. Results of the multiple Cox proportional hazard model show that tumor grade, and stage of cancer at presentation are jointly significantly associated with survival. Conclusion The 2- and 5-year survival are within the norms compared to other countries. Significant clinical and pathological prognostic factors associated with survival were tumor grade, and the stage of cancer at presentation.
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Affiliation(s)
- Yusra Elobaid
- Department of Medical and Health Sciences, Khawarizmi International College, Abu Dhabi, United Arab Emirates
| | - Maria Aamir
- Department of Medical and Health Sciences, Khawarizmi International College, Abu Dhabi, United Arab Emirates
- Cancer Registry, Tawam Hospital, SEHA, Al Ain, United Arab Emirates
| | - Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Abubaker Suliman
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Samir Attoub
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Hussam Mousa
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Luai A. Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Abderrahim Oulhaj
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Zayed Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- * E-mail:
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Factors associated with breast cancer recurrence and survival at Sangre Grande Hospital, Trinidad. Cancer Causes Control 2021; 32:763-772. [PMID: 33835281 DOI: 10.1007/s10552-021-01427-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study is to determine the demographic, pathological, and treatment-related factors that predict recurrence and survival in a Trinidadian cohort of breast cancer patients. METHODS The inclusion criteria for this study were female, over 18 years, and with a primary breast cancer diagnosis confirmed by a biopsy report occurring between 2010 and 2015 at Sangre Grande Hospital, Trinidad. Univariate associations with 5-year recurrence-free survival and 5-year overall survival were calculated using the Kaplan-Meier method for categorical variables and Cox Proportional Hazards for continuous variables. A multivariate model for prediction of recurrence and survival was determined using Cox regression. RESULTS For the period 2010-2015, 202 records were abstracted. Five-year overall survival and recurrence-free survival rates were found to be 74.3% and 56.4%, respectively. Median times from first suspicious finding to date of biopsy report, date of surgery, and date of chemotherapy were 63 days, 125 days, and 189 days, respectively. In the univariate analysis, age (p = 0.038), stage (p < 0.001), recurrence (p = 0.035), surgery (p = 0.016), ER (p < 0.001) status, PR status (p < 0.001), and subtype (p < 0.001) were significantly associated with survival. Additionally, stage (p = 0.004), N score (p = 0.002), ER (p = 0.028) status, PR (p = 0.018) status, and subtype (p = 0.025) were significantly associated with recurrence. In the Cox multivariate model, Stage 4 was a significant predictor of survival (HR 6.77, 95% CI [0.09-2.49], p = 0.047) and N3 score was a significant predictor of recurrence (HR 4.47, 95% CI [1.29-15.54], p = 0.018). CONCLUSION This study reports a 5-year breast cancer survival rate of 74.3%, and a recurrence-free survival rate of 56.4% in Trinidad for the period 2010-2015.
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Li M, Roder D, D'Onise K, Walters D, Farshid G, Buckley E, Karapetis C, Joshi R, Price T, Townsend A, Miller C, Currow D, Powell K, Buranyi-Trevarton D, Olver I. Female breast cancer treatment and survival in South Australia: Results from linked health data. Eur J Cancer Care (Engl) 2021; 30:e13451. [PMID: 33779005 PMCID: PMC8518966 DOI: 10.1111/ecc.13451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/03/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022]
Abstract
Objective We investigated treatment and survival by clinical and sociodemographic characteristics for service evaluation using linked data. Method Data on invasive female breast cancers (n = 13,494) from the South Australian Cancer Registry (2000–2014 diagnoses) were linked to hospital inpatient, radiotherapy and universal health insurance data. Treatments ≤12 months from diagnosis and survival were analysed, using adjusted odds ratios (aORs) from logistic regression, and adjusted sub‐hazard ratios (aSHRs) from competing risk regression. Results and conclusion Five‐year disease‐specific survival increased to 91% for 2010–2014. Most women had breast surgery (90%), systemic therapy (72%) and radiotherapy (60%). Less treatment applied for ages 80+ vs <50 years (aOR 0.10, 95% CI 0.05–0.20) and TNM stage IV vs stage I (aOR 0.13, 95% CI 0.08–0.22). Surgical treatment increased during the study period and strongly predicted higher survival. Compared with no surgery, aSHRs were 0.31 (95% CI 0.26–0.36) for women having breast‐conserving surgery, 0.49 (95% CI 0.41–0.57) for mastectomy and 0.42 (95% CI 0.33–0.52) when both surgery types were received. Patients aged 80+ years had lower survival and less treatment. More trial evidence is needed to optimise trade‐offs between benefits and harms in these older women. Survival differences were not found by residential remoteness and were marginal by socioeconomic status.
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Affiliation(s)
- Ming Li
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - David Roder
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.,Cancer Institute NSW, Eveleigh, New South Wales, Australia
| | - Katina D'Onise
- Prevention and Population Health, SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - David Walters
- Department of Surgery, Queen Elizabeth Hospital, Woodville South, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Gelareh Farshid
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,SA Pathology, Adelaide, South Australia, Australia
| | - Elizabeth Buckley
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Christos Karapetis
- Medical Oncology, Flinders University, Bedford Park, South Australia, Australia
| | - Rohit Joshi
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Cancer Research and Clinical Trials, Adelaide Oncology and Haematology, North Adelaide, South Australia, Australia
| | - Timothy Price
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Clinical Cancer Research, Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Amanda Townsend
- Clinical Cancer Research, Queen Elizabeth Hospital, Woodville South, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, Australia
| | - Caroline Miller
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Health Policy Centre, South Australian Health & Medical Research Institute (SAHMRI, Adelaide, South Australia, Australia
| | - David Currow
- Cancer Institute NSW, Eveleigh, New South Wales, Australia
| | - Kate Powell
- Health Policy Centre, South Australian Health & Medical Research Institute (SAHMRI, Adelaide, South Australia, Australia.,SA Clinical Cancer Registry, South Australian Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - Dianne Buranyi-Trevarton
- SA Clinical Cancer Registry, South Australian Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - Ian Olver
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Ranaivomanana M, Hasiniatsy NRE, Rakotomahenina H, Rafaramino F. [Epidemiology and clinical features of patients with breast cancers hospitalized in the Department of Oncology in Fianarantsoa, Madagascar from 2011 to 2018]. Pan Afr Med J 2021; 38:264. [PMID: 34122691 PMCID: PMC8180002 DOI: 10.11604/pamj.2021.38.264.20031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 03/01/2021] [Indexed: 01/12/2023] Open
Abstract
Introduction à notre connaissance, il s´agit d´une première étude épidémiologique des cancers du sein à Fianarantsoa. Notre objectif était de décrire les caractéristiques épidémio-cliniques de ces cancers au Service d´Oncologie de Fianarantsoa. Méthodes il s´agissait d´une étude rétrospective descriptive au Service d´Oncologie du Centre Hospitalier Universitaire de Tambohobe pendant 8 ans (2011 à 2018). Nous avons inclus toutes les patientes atteintes de cancer du sein avec une confirmation cytologique et/ou histologique. Les paramètres étudiés étaient l´âge, la profession, les antécédents familiaux de cancer du sein, la ménarche, la ménopause, la parité, la prise de contraception orale, le tabagisme, les circonstances de découverte, les symptômes mammaires, les signes d´extension, la localisation tumorale et le stade de la maladie. Résultats nous avons inclus 62 patientes d´âge moyen de 52,83 ± 10,47 ans. Les femmes au foyer constituaient 39% (n = 24) des cas. Aucune patiente n´avait une ménarche précoce. La ménopause tardive était survenue chez 6,45% (n = 4) et des antécédents familiaux de cancer du sein étaient retrouvés chez 8,06% (n = 5). La prise de tabac à chiquer a été retrouvée chez 17,74% (n = 11) des cas. Les symptômes mammaires étaient observés dans 95,2% (n = 59) des cas. Le quadrant supéro-externe était touché dans 53,23% (n = 33) des cas. Le stade III s´observait dans 55% (n = 34) des cas et le stade IV dans 32% (n = 20). Conclusion diagnostiqués à un stade avancé, les facteurs de risque de cancer du sein étaient peu observés.
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Affiliation(s)
- Mampionona Ranaivomanana
- Service d´Oncologie, Centre Hospitalier Universitaire de Tambohobe Fianarantsoa, Faculté de Médecine de Fianarantsoa, Fianarantsoa, Madagascar
| | | | - Hajanirina Rakotomahenina
- Service de Gynécologie et Obstétrique, Centre Hospitalier Universitaire de Tambohobe Fianarantsoa, Faculté de Médecine de Fianarantsoa, Fianarantsoa, Madagascar
| | - Florine Rafaramino
- Faculté de Médecine d´Antananarivo, Université d´Antananarivo, Antananarivo, Madagascar
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piNET-An Automated Proliferation Index Calculator Framework for Ki67 Breast Cancer Images. Cancers (Basel) 2020; 13:cancers13010011. [PMID: 33375043 PMCID: PMC7792768 DOI: 10.3390/cancers13010011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Approximately 2.1 million women are affected by breast cancer every year. Invasive disease accounts for 80% of breast cancer cases and is the most common and aggressive type of breast cancer. Early diagnosis is the key to survival. Ki67 biomarkers have been shown to be a promising prognostic biomarker in this regard, but manual proliferation index (PI) calculation is time consuming and subject to inter/intra observer variability which reduces clinical utility. Computational pathology tools can aid pathologists to make the diagnostic process more efficient and accurate. With the advent of deep learning, there is great promise that this technology can solve problems that were difficult to tackle in the past, but more work needs to be done to combat the challenge of multi-center datasets. In this work, a novel Ki67 PI calculator based on deep learning is proposed, called piNET, which is shown to be accurate, reliable, and consistent across multi-center datasets. Abstract In this work, a novel proliferation index (PI) calculator for Ki67 images called piNET is proposed. It is successfully tested on four datasets, from three scanners comprised of patches, tissue microarrays (TMAs) and whole slide images (WSI), representing a diverse multi-centre dataset for evaluating Ki67 quantification. Compared to state-of-the-art methods, piNET consistently performs the best over all datasets with an average PI difference of 5.603%, PI accuracy rate of 86% and correlation coefficient R = 0.927. The success of the system can be attributed to several innovations. Firstly, this tool is built based on deep learning, which can adapt to wide variability of medical images—and it was posed as a detection problem to mimic pathologists’ workflow which improves accuracy and efficiency. Secondly, the system is trained purely on tumor cells, which reduces false positives from non-tumor cells without needing the usual pre-requisite tumor segmentation step for Ki67 quantification. Thirdly, the concept of learning background regions through weak supervision is introduced, by providing the system with ideal and non-ideal (artifact) patches that further reduces false positives. Lastly, a novel hotspot analysis is proposed to allow automated methods to score patches from WSI that contain “significant” activity.
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Tesfaw A, Alebachew W, Tiruneh M. Why women with breast cancer presented late to health care facility in North-west Ethiopia? A qualitative study. PLoS One 2020; 15:e0243551. [PMID: 33275642 PMCID: PMC7717512 DOI: 10.1371/journal.pone.0243551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Although early diagnosis is a key determinant factor for breast cancer survival, delay in presentation and advanced stage diagnosis are common challenges in low and middle income countries including Ethiopia. Long patient delays in presentation to health facility and advanced stage diagnosis are common features in breast cancer care in Ethiopia but the reasons for patient delays are not well explored in the country. Therefore we aimed to explore the reasons for patient delay in seeking early medical care for breast cancer in North-west Ethiopia. METHODS A qualitative study was conducted from November to December 2019 using in-depth interviews from newly diagnosed breast cancer patients in the two comprehensive specialized hospitals in North West Ethiopia. Verbal informed consent was taken from each participant before interviews. A thematic content analysis was performed using Open Code software version 4.02. RESULTS Lack of knowledge and awareness about breast cancer, cultural and religious beliefs, economic hardships, lack of health care and transportation access, fear of surgical procedures and lack of trusts on medical care were the major reasons for late presentation of breast cancer identified from the patient's narratives. CONCLUSIONS The reasons for late presentation of patients to seek early medical care for breast cancer had multidimensional nature in Northwest Ethiopia. Health education and promotion programs about breast cancer should be designed to increase public awareness to facilitate early detection of cases before advancement on the existing health care delivery system.
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Affiliation(s)
- Aragaw Tesfaw
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew
- Department of Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulu Tiruneh
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Mangieri CW, Ruffo J, Chiba A, Howard-McNatt M. Treatment and Outcomes of Women With Large Locally Advanced Breast Cancer. Am Surg 2020; 87:812-817. [PMID: 33228379 DOI: 10.1177/0003134820956335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Advances in breast cancer research have made breast cancer a treatable disease. However, there is a population of women who present with large, advanced, or sometimes neglected breast cancers who can prove difficult to treat. These women often require multiple modality treatment including chemotherapy, surgery, and radiation. The purpose of our study is to examine the treatment and outcomes on women with large, locally advanced breast cancers (LABCs). We identified 8 individuals who presented with LABCs requiring extensive treatment. Patients with inflammatory or metastatic cancer at the time of presentation were excluded. These patients' charts were reviewed and analyzed. Patient demographics, hormone receptor status, stage, types of treatment, presence of metastasis, survival, and presence of barriers for seeking treatment sooner were identified. The median age at presentation was 65 years old. The patients were equally African American and Caucasian. All patients presented with T4 or stage 3 tumors involving the skin and/or pectoralis muscle. Half of the patients were found to have triple-negative (estrogen receptor, progesterone receptor, Her-2/neu negative) tumors. 87% of the patients received chemotherapy; 1 refused. All 8 patients, either neoadjuvantly or adjuvantly, underwent a modified radical or radical mastectomy. Skin graft or flap coverage was necessary in half of the patients. Postmastectomy radiation was received in 87% of the patients; 1 patient refused the treatment. Half of the patients developed metastatic disease. Thirty-seven percent of the patients have since died with a median survival of 44 months. Reasons for delay in seeking care were monetary or social barriers. Many of the patients finally sought care via the emergency room due to symptoms they could no longer ignore. Women who present with LABC require complex multidisciplinary treatment consisting of chemotherapy, surgery, and radiation treatments. Many of these patients faced economic and social challenges to accessing care. Better access to care and more prompt connection to breast surgeons are required to assist this patient population.
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Affiliation(s)
- Christopher W Mangieri
- Division of Surgical Oncology, Baptist Medical Center, Wake Forest University, Winston-Salem NC
| | - Julia Ruffo
- School of Medicine, Wake Forest University, Winston-Salem NC
| | - Akiko Chiba
- Division of Surgical Oncology, Baptist Medical Center, Wake Forest University, Winston-Salem NC
| | - Marissa Howard-McNatt
- Division of Surgical Oncology, Baptist Medical Center, Wake Forest University, Winston-Salem NC
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Oprean CM, Negru SM, Popovici DI, Saftescu S, Han RA, Dragomir GM, Hoinoiu T, Dema A. Postmenopausal Breast Cancer in Women, Clinical and Epidemiological Factors Related to the Molecular Subtype: A Retrospective Cohort Study in a Single Institution for 13 Years. Follow-Up Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238722. [PMID: 33255341 PMCID: PMC7727650 DOI: 10.3390/ijerph17238722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/12/2020] [Accepted: 11/19/2020] [Indexed: 01/04/2023]
Abstract
This study focused on the characteristics of postmenopausal breast cancer in the population of southeastern Europe. This retrospective study explored the clinical, epidemiological, and molecular characteristics of women with postmenopausal breast cancer. MATERIAL AND METHODS A retrospective cohort study was performed on 721 postmenopausal breast cancer patients selected from the database of our institution. The data collected consisted of age, living environment, location of the breast tumor, stage of the disease, and molecular sub-type. Patient characteristics were collected based on a systematic chart audit from medical records. The data were analyzed using SPSS 20.0 and Pearson analysis. RESULTS The most frequent age range for breast cancer diagnosis was 51 to 70 years old. Most of the patients (80.7%) came from an urban environment. The vast majority of patients were initially diagnosed in stage II (40.3%) and III (30.3%). The most frequent molecular sub-types were luminal B (39%) and luminal A (35.4%). Almost half of the breast tumors were located in the upper outer quadrant (48.8%). CONCLUSIONS The results of this study describe the profile of patients in southeastern Europe within our institution diagnosed with postmenopausal breast cancer. In our study, patients were first diagnosed with more advanced stages of breast cancer compared with other European countries.
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Affiliation(s)
- Cristina Marinela Oprean
- Discipline of Morpho-pathology, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania; (C.M.O.); (A.D.)
- Department of Oncology—ONCOMED Outpatient Unit, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (S.M.N.); (D.I.P.); (S.S.)
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania;
| | - Serban Mircea Negru
- Department of Oncology—ONCOMED Outpatient Unit, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (S.M.N.); (D.I.P.); (S.S.)
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania;
- Discipline of Oncology, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania
| | - Dorel Ionel Popovici
- Department of Oncology—ONCOMED Outpatient Unit, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (S.M.N.); (D.I.P.); (S.S.)
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania;
- Discipline of Oncology, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania
| | - Sorin Saftescu
- Department of Oncology—ONCOMED Outpatient Unit, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (S.M.N.); (D.I.P.); (S.S.)
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania;
- Discipline of Oncology, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania
| | - Robert-Alexandru Han
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania;
| | - Gabriel-Mugurel Dragomir
- Department of Teaching Training—POLYTEHNICAL, University of Timisoara, 300223 Timisoara, Romania;
| | - Teodora Hoinoiu
- Department of Clinical Practical Skills, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania
- Correspondence: ; Tel./Fax: +40-256-216510
| | - Alis Dema
- Discipline of Morpho-pathology, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania; (C.M.O.); (A.D.)
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Tesfaw A, Getachew S, Addissie A, Jemal A, Wienke A, Taylor L, Kantelhardt EJ. Late-Stage Diagnosis and Associated Factors Among Breast Cancer Patients in South and Southwest Ethiopia: A Multicenter Study. Clin Breast Cancer 2020; 21:e112-e119. [PMID: 33536135 DOI: 10.1016/j.clbc.2020.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/19/2020] [Accepted: 08/30/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Breast cancer is a leading cause of cancer death in women in low- and middle-income countries, largely because of late-stage diagnosis. Yet studies are very limited in the Ethiopian context. Therefore, we determined the occurrence of late-stage disease and associated factors in selected public hospitals in south and southwest Ethiopia. PATIENTS AND METHODS A 5-year retrospective cross-sectional study was conducted on breast cancer patient medical records from January 2013 to December 2017 in 6 hospitals. Multivariable logistic regression was performed to identify factors associated with late-stage disease (stage III and IV). Adjusted odds ratios (AOR) with 95% confidence intervals were used. P < .05 was considered statistically significant. RESULTS Overall, 426 breast cancer patients were identified, and 72.5% were diagnosed with late-stage disease. The mean ± standard deviation patient age was 42.8 ± 13.4 years. Factors associated with late diagnosis were patient delay in seeking care (AOR = 2.50; 95% confidence interval [CI], 1.51-4.16); health system delays (AOR = 1.62; 95% CI, 1.02-2.59); female sex (AOR = 3.46; 95% CI, 1.50-7.98); rural residence (AOR = 2.37; 95% CI, 1.45-3.86); chief complaint of breast lump (AOR = 3.01; 95% CI, 1.49-6.07); and history of comorbidities (AOR = 1.72; 95% CI, 1.02-2.91). CONCLUSION The majority of patients were diagnosed with late-stage diagnosis of breast cancer. Patient delays in seeking care, health system delays, being female, rural residence, and patient comorbidities were associated factors. These findings provide evidence that efforts to increase public and health provider awareness to promote early breast cancer diagnosis, particularly in rural areas, are needed in south and southwest Ethiopia.
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Affiliation(s)
- Aragaw Tesfaw
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefonias Getachew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia; Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmedin Jemal
- American Cancer Society, Surveillance & Health Services Research, Atlanta, GA
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany
| | - Lesley Taylor
- City of Hope National Medical Center, Division of Breast Surgery, Department of Surgery, Duarte, Los Angeles County, CA
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany; Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Germany.
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Haste A, Lambert M, Sharp L, Thomson R, Sowden S. Patient experiences of the urgent cancer referral pathway-Can the NHS do better? Semi-structured interviews with patients with upper gastrointestinal cancer. Health Expect 2020; 23:1512-1522. [PMID: 32989907 PMCID: PMC7752202 DOI: 10.1111/hex.13136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/28/2020] [Accepted: 09/08/2020] [Indexed: 01/22/2023] Open
Abstract
Background Timeliness is viewed as a key feature of health‐care quality. Internationally, this is challenging. In England, cancer waiting time targets are currently not being met. For example, between 2015 and 2018 only 71% of patients with upper gastrointestinal (UGI) cancer started treatment within the recommended 62 days of referral. Objective We explored patients’ experiences to identify areas for service improvement. Design Semi‐structured interviews were conducted. Setting and participants Twenty patients who were referred through the urgent (two‐week) GP referral route and were within six months of receiving first treatment were recruited. Data analysis Data from the interviews were analysed thematically. Results Four themes were developed: organization of care; diagnosis; support; and views and expectations of the NHS. Patients described cross‐cutting issues such as complex and varied pathways and uncertainty about what would happen next. They felt daunted by the intensity and speed of investigations. They were presented with a recommended course of action rather than options and had little involvement in decision making. They were grateful for care, reluctant to complain and resigned to the status quo. Discussion and conclusions In order to meet patient needs, the NHS needs to improve communication and streamline pathways. Future cancer pathways also need to be designed to support shared decision making, be truly person‐centred and informed by patient experience.
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Affiliation(s)
- Anna Haste
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Mark Lambert
- Public Health England, North East Centre, Newcastle, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Davie A, Carter GC, Rider A, Pike J, Lewis K, Bailey A, Price GL, Ringeisen F, Pivot X. Real-world patient-reported outcomes of women receiving initial endocrine-based therapy for HR+/HER2- advanced breast cancer in five European countries. BMC Cancer 2020; 20:855. [PMID: 32894087 PMCID: PMC7487722 DOI: 10.1186/s12885-020-07294-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 08/11/2020] [Indexed: 12/24/2022] Open
Abstract
Background Endocrine therapy (ET)-based regimens are the mainstay of treatment for patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) advanced breast cancer. With the introduction of new treatment classes, it is important to examine patient symptoms and health-related quality of life (HRQoL) at the start of this changing therapeutic landscape. This real-world study describes the patient-reported outcomes (PROs) of women with HR+/HER2− advanced breast cancer receiving ET-based regimens who were naïve to systemic treatment in the advanced setting across five European countries (EU5). Methods Data were collected between March and July 2017 from surveyed oncologists and their patients at a single time point using the multinational Adelphi Advanced Breast Cancer Disease Specific Programme™. Patients completed PRO questionnaires on HRQoL (EORTC QLQ-C30), pain severity and interference, and work and activity impairment. A multiple linear regression model explored factors associated with HRQoL. Results Across EU5, 226 physicians provided data on 781 women with HR+/HER2− advanced breast cancer taking their first ET-based regimen for advanced disease, of whom 252 provided PRO data. This subset had a mean age of 67.1 years, 94% were postmenopausal, 89% were diagnosed with advanced breast cancer at initial presentation, 79% had stage IV disease (66% of these patients had bone metastases and 38% had visceral metastases, including 18% with liver metastases) and 77% were on endocrine-only therapy as their initial treatment for advanced disease. The mean EORTC QLQ-C30 global health score (50.9) was worse than the reference value for patients with advanced breast cancer (60.2). Fatigue, pain, and insomnia were the most severe symptoms, and mean functioning scores were also worse than reference values. “Worst pain” and “pain interference” were moderate/severe for 42 and 80% of patients. Mean activity impairment was 44%, and greater activity impairment was associated with poorer HRQoL. Conclusions Despite receiving first-line ET-based regimens for advanced disease, these women had a poor HRQoL and high levels of symptoms, pain, pain interference and activity impairment. New treatments that maintain a stable disease state and reduce activity impairment may have a positive effect on the HRQoL of those living with advanced breast cancer.
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Affiliation(s)
- Alison Davie
- Eli Lilly and Co Ltd, Windlesham, Surrey, GU20 6PH, UK.
| | | | - Alex Rider
- Adelphi Real World, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
| | - James Pike
- Adelphi Real World, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
| | - Katie Lewis
- Adelphi Real World, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
| | - Abigail Bailey
- Adelphi Real World, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
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Tangkhuenkhan P, Harncharoen K, Thanasitthichai S, Tiwawech D, Purisa W, Saelee P, Wattanalai R. Frequency and Association Of GSTM1 and GSTT1 Gene Polymorphisms with Survival in Breast Cancer Patients. Asian Pac J Cancer Prev 2020; 21:2251-2257. [PMID: 32856852 PMCID: PMC7771926 DOI: 10.31557/apjcp.2020.21.8.2251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Indexed: 12/09/2022] Open
Abstract
Objective: Glutathione S-transferase M1 and T1 (GSTM1 and GSTT1) are the key detoxification enzymes of xenobiotics, including chemotherapeutic drugs. The deletion polymorphisms of GSTM1 and GSTT1 genes are associated with reduced enzyme activity that influenced clinical outcomes of chemotherapeutic agents in breast cancer. However, there is limited information among Thai patients. This research aims to explore the frequency and role of GSTM1 and GSTT1 polymorphisms on survival among Thai patients with breast cancer. Methods: The retrospective cohort study was performed. Demographic data and clinicopathology characteristics were collected from hospital base registry data and medical records. A multiplex qualitative real-time PCR method was used to detect the presence or absence of the GSTM1 and GSTT1 gene in the genomic DNA samples of the participants. Results: The frequencies of the GSTM1 and GSTT1 null genotypes in 198 breast cancer patients were 65.70% and 33.30%, respectively. The overall survival at 1, 3 and 5 years were 95.00%, 83.00%, 71.00% respectively. The log rank test and Cox proportional hazards revealed a significant different in the 5-years overall survival according to lymph node metastasis and tumor stage (P = 0.014 and P < 0.001). No associations between overall survival and GSTM1 or GSTT1 genotype were found in single or combined genotypes analyses (P = 0.76 and P= 0.15). Conclusion: The results of our study provided the epidemiological information for prognostic of survival in breast cancer patients treated with chemotherapy.
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Affiliation(s)
| | | | | | - Danai Tiwawech
- Faculty of Pharmacy, Naresuan University, Phitsanulok, Thailand
| | - Wichai Purisa
- Research Division, National Cancer Institute, Bangkok, Thailand
| | - Pensri Saelee
- Research Division, National Cancer Institute, Bangkok, Thailand
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Terkelsen T, Russo F, Gromov P, Haakensen VD, Brunak S, Gromova I, Krogh A, Papaleo E. Secreted breast tumor interstitial fluid microRNAs and their target genes are associated with triple-negative breast cancer, tumor grade, and immune infiltration. Breast Cancer Res 2020; 22:73. [PMID: 32605588 PMCID: PMC7329449 DOI: 10.1186/s13058-020-01295-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 05/14/2020] [Indexed: 12/21/2022] Open
Abstract
Background Studies on tumor-secreted microRNAs point to a functional role of these in cellular communication and reprogramming of the tumor microenvironment. Uptake of tumor-secreted microRNAs by neighboring cells may result in the silencing of mRNA targets and, in turn, modulation of the transcriptome. Studying miRNAs externalized from tumors could improve cancer patient diagnosis and disease monitoring and help to pinpoint which miRNA-gene interactions are central for tumor properties such as invasiveness and metastasis. Methods Using a bioinformatics approach, we analyzed the profiles of secreted tumor and normal interstitial fluid (IF) microRNAs, from women with breast cancer (BC). We carried out differential abundance analysis (DAA), to obtain miRNAs, which were enriched or depleted in IFs, from patients with different clinical traits. Subsequently, miRNA family enrichment analysis was performed to assess whether any families were over-represented in the specific sets. We identified dysregulated genes in tumor tissues from the same cohort of patients and constructed weighted gene co-expression networks, to extract sets of co-expressed genes and co-abundant miRNAs. Lastly, we integrated miRNAs and mRNAs to obtain interaction networks and supported our findings using prediction tools and cancer gene databases. Results Network analysis showed co-expressed genes and miRNA regulators, associated with tumor lymphocyte infiltration. All of the genes were involved in immune system processes, and many had previously been associated with cancer immunity. A subset of these, BTLA, CXCL13, IL7R, LAMP3, and LTB, was linked to the presence of tertiary lymphoid structures and high endothelial venules within tumors. Co-abundant tumor interstitial fluid miRNAs within this network, including miR-146a and miR-494, were annotated as negative regulators of immune-stimulatory responses. One co-expression network encompassed differences between BC subtypes. Genes differentially co-expressed between luminal B and triple-negative breast cancer (TNBC) were connected with sphingolipid metabolism and predicted to be co-regulated by miR-23a. Co-expressed genes and TIF miRNAs associated with tumor grade were BTRC, CHST1, miR-10a/b, miR-107, miR-301a, and miR-454. Conclusion Integration of IF miRNAs and mRNAs unveiled networks associated with patient clinicopathological traits, and underlined molecular mechanisms, specific to BC sub-groups. Our results highlight the benefits of an integrative approach to biomarker discovery, placing secreted miRNAs within a biological context.
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Affiliation(s)
- Thilde Terkelsen
- Computational Biology Laboratory, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Francesco Russo
- Computational Biology Laboratory, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pavel Gromov
- Breast Cancer Biology Group, Genome Integrity Unit, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Vilde Drageset Haakensen
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Irina Gromova
- Breast Cancer Biology Group, Genome Integrity Unit, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Anders Krogh
- Unit of Computational and RNA Biology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Elena Papaleo
- Computational Biology Laboratory, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark. .,Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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66
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Li M, Roder D, D'Onise K, Walters D, Farshid G, Buckley E, Karapetis C, Joshi R, Price T, Townsend A, Miller CL, Currow D, Powell K, Buranyi-Trevarton D, Olver I. Monitoring TNM stage of female breast cancer and survival across the South Australian population, with national and international TNM benchmarking: A population-based cohort study. BMJ Open 2020; 10:e037069. [PMID: 32595164 PMCID: PMC7322288 DOI: 10.1136/bmjopen-2020-037069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Using linked cancer registry and administrative data to monitor, tumour, node and metastases (TNM) stage and survival from female breast cancer in Australia. METHOD Analysis of 2000-2014 diagnoses with linked population-based data to investigate: (1) sociodemographic predictors of advanced stage (stages III and IV), using unadjusted and adjusted logistic regression; and (2) sociodemographic factors and stage as predictors of breast cancer survival using competing risk regression. DESIGN Population-based registry cohort. SETTING AND PARTICIPANTS 14 759 South Australian women diagnosed in 2000-2014. PRIMARY AND SECONDARY OUTCOME MEASURES Stage and survival. RESULTS At diagnosis, 46% of women were classified as stage I, 39% as stage II, 12% as stage III and 4% as stage IV. After adjusting for sociodemographic factors, advanced stage was more common: (1) for ages <50 years; and although not statistically significant, for ages 80+ years; and (2) in women from socioeconomically disadvantaged areas. Compared with 2000-2004 diagnoses, stage and sociodemographic adjusted risks (sub-HRs (SHRs)) of breast cancer death were lower in 2005-2009 (SHR 0.75, 95% CI 0.67 to 0.83) and 2010-2015 (SHR 0.57, 95% CI 0.48 to 0.67). Compared with stage I, the SHR was 3.87 (95% CI 3.32 to 4.53) for stage II, 10.87 (95% CI 9.22 to 12.81) for stage III, and 41.97 (95% CI 34.78 to 50.65) for stage IV. Women aged 70+ years at diagnosis and those living in the most socioeconomically disadvantaged areas were at elevated risk of breast cancer death, independent of stage and sociodemographic factors. CONCLUSIONS Stage varied by age, diagnostic period and socioeconomic status, and was a stronger predictor of survival than other statistically significant sociodemographic predictors. Achieving earlier diagnosis outside the original BreastScreen target of 50-69 years (as applying <2014) and in residents of socioeconomically disadvantaged areas likely would increase cancer survival at a population level.
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Affiliation(s)
- Ming Li
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - David Roder
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Katina D'Onise
- Prevention and Population Health, SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - David Walters
- Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Gelareh Farshid
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, SA Pathology, Rundle Mall, South Australia, Australia
| | - Elizabeth Buckley
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Chris Karapetis
- Medical Oncology, Flinders University, Adelaide, South Australia, Australia
| | - Rohit Joshi
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Cancer Research and Clinical Trials, Adelaide Oncology and Haematology, North Adelaide, South Australia, Australia
| | - Timothy Price
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Clinical Cancer Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Amanda Townsend
- Clinical Cancer Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Solid Tumour Group, Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, Australia
| | - Caroline Louise Miller
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - David Currow
- Chief Executive Officer, Cancer Institute NSW, Eveleigh, New South Wales, Australia
| | - Kate Powell
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- SA Clinical Cancer Registry, SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - Dianne Buranyi-Trevarton
- SA Clinical Cancer Registry, SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - Ian Olver
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Vijaykumar DK, Arun S, Abraham AG, Hopman W, Robinson AG, Booth CM. Breast Cancer Care in South India: Is Practice Concordant With National Guidelines? J Glob Oncol 2020; 5:1-7. [PMID: 31260396 PMCID: PMC6613671 DOI: 10.1200/jgo.19.00052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The National Cancer Grid (NCG) of India has recently published clinical practice guidelines that are relevant in the Indian context. We evaluated the extent to which breast cancer care at a teaching hospital in South India was concordant with NCG guidelines. METHODS All patients who had surgery for breast cancer at a single center from January 2014 to December 2015 were included. Demographic, pathologic, and treatment characteristics were extracted from the electronic medical record. Patients were classified as being concordant with six elements selected from the NCG guideline. The indicators related to appropriate use of sentinel lymph node (SLN) biopsy, lymph node harvest, adjuvant radiotherapy, adjuvant chemotherapy, human epidermal growth factor receptor 2 (HER2) testing, and delivery of adjuvant trastuzumab. RESULTS A total of 401 women underwent surgery for breast cancer; mean age (standard deviation) was 57 (12) years. Lymph node involvement was present in 47% (188 of 401) of the cohort; 23% (94 of 401) had T1 disease. Ninety-two percent (368 of 401) underwent radical modified mastectomy. SLN biopsy was performed in 75% (167 of 222) of eligible patients. Eighty percent (208 of 261) of patients with a positive SLN biopsy or no SLN biopsy had a lymph node harvest of more than 10. Adjuvant chemotherapy with an anthracycline and a taxane was delivered to 67% of patients (118 of 177) with node-positive disease. Adjuvant radiotherapy was delivered to 84% (180 of 213) of patients with breast-conserving surgery, T4 tumors, or 3+ positive lymph nodes. Fluorescent in situ hybridization testing was performed in 59% of patients (43 of 73) with 2+ HER2-positive lymph nodes on immunohistochemistry. Among patients with HER2 overexpression, 40% (36 of 91) received adjuvant trastuzumab. CONCLUSION Concordance with NCG guidelines for breast cancer care ranged from 40% to 84%. Guideline concordance was lowest for those elements of care associated with the highest direct costs to patients.
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Affiliation(s)
- D K Vijaykumar
- Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Sujana Arun
- Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Aswin G Abraham
- Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Wilma Hopman
- Kingston General Hospital Research Institute, Kingston, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | - Andrew G Robinson
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
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Mathew A, George PS, Ramadas K, Mathew BS, Kumar A, Roshni S, Jayakumar KNL, Booth CM. Sociodemographic Factors and Stage of Cancer at Diagnosis: A Population-Based Study in South India. J Glob Oncol 2020; 5:1-10. [PMID: 31322993 PMCID: PMC6690651 DOI: 10.1200/jgo.18.00160] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Lower socioeconomic status is associated with inferior cancer survival in high-income countries, but whether this applies to low- and middle-income countries is not well described. Here, we use a population-based cancer registry to explore the association between educational level and stage of cancer at diagnosis in South India. METHODS We used the Trivandrum District population-based cancer registry to identify all cases of breast and cervical cancer (women) and oral cavity (OC) and lung cancer (men) who were diagnosed from 2012 to 2014. Educational status—classified as illiterate/primary school, middle school, or secondary school or higher—was the primary exposure of interest. Primary outcome was the proportion of patients with advanced stage disease at diagnosis defined as stage III and IV (breast, cervix, or OC) or regional/metastatic (lung). RESULTS The study population included 4,547 patients with breast (n = 2,283), cervix (n = 481), OC (n = 797), and lung (n = 986) cancer. Educational status was 22%, 19%, and 26% for illiterate/primary, middle, and secondary school or higher, respectively. Educational status was missing for 33% of patients. The proportion of all patients with advanced stage disease was 37% (breast), 39% (cervix), 67% (OC), and 88% (lung). Patients with illiterate/primary school educational status were considerably more likely to have advanced breast cancer (50% v 39% v 36%; P < .001), cervix cancer (46% v 43% v 24%; P = .002), and OC cancer (77% v 76% v 59%; P < .001) compared with patients with higher educational levels. The proportion of patients with advanced lung cancer did not vary across educational levels (89% v 84% v 88%; P = .350). CONCLUSION A substantial proportion of patients in South India have advanced cancer at the time of diagnosis. This is particularly true among those with the lowest levels of education. Future health awareness and preventive interventions must target less-educated communities to reduce delays in seeking medical care for cancer.
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69
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Li M, Holliday L, Roder D, Tervonen H, Anazodo A, Dallapozza L, Hesketh E, Currow D. Degree of Cancer Spread at Presentation and Survival Among Adolescents and Young Adults in New South Wales, Australia. J Adolesc Young Adult Oncol 2020; 10:156-163. [PMID: 32456575 DOI: 10.1089/jayao.2020.0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Five-year relative cancer survival increased from 80% to 89% among adolescent and young adult (AYA) Australians between 1985-1989 and 2011-2015. New South Wales (NSW), with a third of the Australian population, has long recorded degree of spread (localized, regional, or distant) at diagnosis. This study complements national data by investigating survival increases after adjusting for differences in degree of spread, cancer type, and sociodemographic characteristics. Methods: Population-based NSW Cancer Registry data, for malignant solid cancers where degree of spread was applicable, were analyzed for ages 15-24 years in 1980-2015. Subhazard ratios (SHRs) from competing risk regression indicated risk of death from the primary cancer as opposed to other causes. Multiple logistic regression was used to model odds ratios for more extensive compared with localized spread at diagnosis. Results: Approximately 72% of cancers had a localized degree of spread. Adjusted SHRs for cancer-specific mortality decreased from 1980-1989 to 2010-2015 (SHR: 0.73, 95% confidence interval: 0.55-0.95). Adjusted odds ratios (aORs) for more advanced versus localized spread were lowest for melanoma and lip, oral cavity, and pharyngeal carcinoma, and highest for breast carcinoma, Ewing tumor, and colorectal carcinoma. The aOR for more advanced versus localized cancer was higher for men than women. Conclusions: Cancer survival increased to a statistically significantly in AYAs during 1980-2015, after adjusting for degree of spread, cancer type, and sociodemographic characteristics. We attribute this mostly to treatment gains. Linked data should be used to explore treatment contributions.
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Affiliation(s)
- Ming Li
- Cancer Information & Analysis, Cancer Institute NSW, Alexandria, Sydney, Australia.,Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Laura Holliday
- Cancer Information & Analysis, Cancer Institute NSW, Alexandria, Sydney, Australia
| | - David Roder
- Cancer Information & Analysis, Cancer Institute NSW, Alexandria, Sydney, Australia.,Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Hanna Tervonen
- Cancer Information & Analysis, Cancer Institute NSW, Alexandria, Sydney, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, University of New South Wales, Randwick, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - Luciano Dallapozza
- Cancer Centre for Children, Royal Alexandra Hospital for Children, Westmead Hospital, Westmead, Australia
| | - Elizabeth Hesketh
- Hunter and Northern New South Wales Youth Cancer Service, Calvary Mater Newcastle, Australia
| | - David Currow
- Cancer Information & Analysis, Cancer Institute NSW, Alexandria, Sydney, Australia
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Meyer AC, Drefahl S, Ahlbom A, Lambe M, Modig K. Trends in life expectancy: did the gap between the healthy and the ill widen or close? BMC Med 2020; 18:41. [PMID: 32192480 PMCID: PMC7082956 DOI: 10.1186/s12916-020-01514-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/06/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND During the past decades, life expectancy has continued to increase in most high-income countries. Previous research suggests that improvements in life expectancy have primarily been driven by advances at the upper end of the health distribution, while parts of the population have lagged behind. Using data from the entire Swedish population, this study aims to examine the life expectancy development among subgroups of individuals with a history of common diseases relative to that of the general population. METHODS The remaining life expectancy at age 65 was estimated for each year in 1998-2017 among individuals with a history of disease, and for the total Swedish population. We defined population subgroups as individuals with a history of myocardial infarction, ischemic or hemorrhagic stroke, hip fracture, or colon, breast, or lung cancer. We further distinguished between different educational levels and Charlson comorbidity index scores. RESULTS Life expectancy gains have been larger for men and women with a history of myocardial infarction, ischemic or hemorrhagic stroke, and colon or breast cancer than for the general population. The life expectancy gap between individuals with a history of hip fracture or lung cancer and the general population has, however, been growing. Education and comorbidity have affected mortality levels, but have not altered the rate of increase in life expectancy among individuals with disease history. The female advantage in life expectancy was less pronounced among individuals with disease history than among the general population. CONCLUSIONS Life expectancy has increased faster in many subpopulations with a history of disease than in the general population, while still remaining at lower levels. Improvements in life expectancy have been observed regardless of comorbidity or educational level. These findings suggest that the rise in overall life expectancy reflects more than just improved survival among the healthy or the delayed onset of disease.
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Affiliation(s)
- Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77, Stockholm, Sweden.
| | - Sven Drefahl
- Demography Unit, Stockholm University, SE-10691, Stockholm, Sweden
| | - Anders Ahlbom
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, SE-17177, Stockholm, Sweden.,Regional Cancer Centre, University Hospital, SE-751 85, Uppsala, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77, Stockholm, Sweden
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71
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Murchie P, Adam R, McNair E, Swann R, Witt J, Wood R, Weller D. Cancer diagnosis in Scottish primary care: Results from the National Cancer Diagnosis Audit. Eur J Cancer Care (Engl) 2020; 29:e13234. [PMID: 32154635 DOI: 10.1111/ecc.13234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/21/2020] [Accepted: 02/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To characterize cancer diagnosis in Scottish primary care and draw comparisons with cancer diagnostic activity in England. METHOD A national audit of cancer diagnosis was conducted in Scottish and English general practices. Participating GPs collected diagnostic pathway data on patients diagnosed in 2014 from medical records. Data were supplemented by linkage to national cancer registries. Analysis explored and compared patient characteristics, diagnostic intervals, and routes to diagnosis. RESULTS 7.7% of all Scottish general practices in 2017 provided data on 2,014 cancer diagnoses. 71.5% of cases presented to GPs and 37.4% were referred using the "Urgent-Suspected Cancer" route. The median primary care interval was 5 days (IQR 0-23 days) and median diagnostic interval was 30 days (IQR 13-68). Both varied by cancer-site. Diagnostic intervals were longer in the most remote patients and those with more comorbidities. Scottish and English samples corresponded closely in key characteristics. CONCLUSIONS Most people diagnosed with cancer in Scotland present to a GP first. Most are referred and diagnosed quickly, with variations by cancer-site. Intervals were longest for the most remote patients. GPs in Scotland and England appear to perform equally but, in view of growing differences between health systems, future comparative audits may be informative.
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Affiliation(s)
- Peter Murchie
- Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Rosalind Adam
- Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Emma McNair
- Information Services Division (ISD), NHS National Services Scotland, Edinburgh, UK
| | - Ruth Swann
- Cancer Research UK, London, UK.,Public Health England, London, UK
| | | | - Rose Wood
- Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - David Weller
- Usher Institute, University of Edinburgh, Old Medical School, Edinburgh, UK
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72
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Katalinic A, Eisemann N, Kraywinkel K, Noftz MR, Hübner J. Breast cancer incidence and mortality before and after implementation of the German mammography screening program. Int J Cancer 2019; 147:709-718. [DOI: 10.1002/ijc.32767] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/04/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Alexander Katalinic
- Institute for Social Medicine and EpidemiologyUniversity of Lübeck Lübeck Germany
- Institute for Cancer EpidemiologyUniversity of Lübeck Lübeck Germany
| | - Nora Eisemann
- Institute for Social Medicine and EpidemiologyUniversity of Lübeck Lübeck Germany
| | - Klaus Kraywinkel
- Department for Epidemiology and Health ReportingGerman Centre for Cancer Registry Data, Robert Koch‐Institute Berlin Germany
| | - Maria R. Noftz
- Institute for Social Medicine and EpidemiologyUniversity of Lübeck Lübeck Germany
| | - Joachim Hübner
- Institute for Social Medicine and EpidemiologyUniversity of Lübeck Lübeck Germany
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Arnold M, Rutherford MJ, Bardot A, Ferlay J, Andersson TML, Myklebust TÅ, Tervonen H, Thursfield V, Ransom D, Shack L, Woods RR, Turner D, Leonfellner S, Ryan S, Saint-Jacques N, De P, McClure C, Ramanakumar AV, Stuart-Panko H, Engholm G, Walsh PM, Jackson C, Vernon S, Morgan E, Gavin A, Morrison DS, Huws DW, Porter G, Butler J, Bryant H, Currow DC, Hiom S, Parkin DM, Sasieni P, Lambert PC, Møller B, Soerjomataram I, Bray F. Progress in cancer survival, mortality, and incidence in seven high-income countries 1995-2014 (ICBP SURVMARK-2): a population-based study. Lancet Oncol 2019; 20:1493-1505. [PMID: 31521509 PMCID: PMC6838671 DOI: 10.1016/s1470-2045(19)30456-5] [Citation(s) in RCA: 578] [Impact Index Per Article: 115.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/11/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Population-based cancer survival estimates provide valuable insights into the effectiveness of cancer services and can reflect the prospects of cure. As part of the second phase of the International Cancer Benchmarking Partnership (ICBP), the Cancer Survival in High-Income Countries (SURVMARK-2) project aims to provide a comprehensive overview of cancer survival across seven high-income countries and a comparative assessment of corresponding incidence and mortality trends. METHODS In this longitudinal, population-based study, we collected patient-level data on 3·9 million patients with cancer from population-based cancer registries in 21 jurisdictions in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the UK) for seven sites of cancer (oesophagus, stomach, colon, rectum, pancreas, lung, and ovary) diagnosed between 1995 and 2014, and followed up until Dec 31, 2015. We calculated age-standardised net survival at 1 year and 5 years after diagnosis by site, age group, and period of diagnosis. We mapped changes in incidence and mortality to changes in survival to assess progress in cancer control. FINDINGS In 19 eligible jurisdictions, 3 764 543 cases of cancer were eligible for inclusion in the study. In the 19 included jurisdictions, over 1995-2014, 1-year and 5-year net survival increased in each country across almost all cancer types, with, for example, 5-year rectal cancer survival increasing more than 13 percentage points in Denmark, Ireland, and the UK. For 2010-14, survival was generally higher in Australia, Canada, and Norway than in New Zealand, Denmark, Ireland, and the UK. Over the study period, larger survival improvements were observed for patients younger than 75 years at diagnosis than those aged 75 years and older, and notably for cancers with a poor prognosis (ie, oesophagus, stomach, pancreas, and lung). Progress in cancer control (ie, increased survival, decreased mortality and incidence) over the study period was evident for stomach, colon, lung (in males), and ovarian cancer. INTERPRETATION The joint evaluation of trends in incidence, mortality, and survival indicated progress in four of the seven studied cancers. Cancer survival continues to increase across high-income countries; however, international disparities persist. While truly valid comparisons require differences in registration practice, classification, and coding to be minimal, stage of disease at diagnosis, timely access to effective treatment, and the extent of comorbidity are likely the main determinants of patient outcomes. Future studies are needed to assess the impact of these factors to further our understanding of international disparities in cancer survival. FUNDING Canadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; National Health Service England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; The Scottish Government; Western Australia Department of Health; and Wales Cancer Network.
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Affiliation(s)
- Melina Arnold
- Cancer Surveillance Section, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
| | - Mark J Rutherford
- Cancer Surveillance Section, International Agency for Research on Cancer (IARC/WHO), Lyon, France; Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Aude Bardot
- Cancer Surveillance Section, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Jacques Ferlay
- Cancer Surveillance Section, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tor Åge Myklebust
- Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway; Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | | | - Vicky Thursfield
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, VIC, Australia
| | - David Ransom
- WA Cancer and Palliative Care Network Policy Unit, Health Networks Branch, Department of Health, Perth, WA, Australia
| | - Lorraine Shack
- Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada
| | | | - Donna Turner
- Population Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | | | - Susan Ryan
- Newfoundland Cancer Registry, Cancer Care Program - Eastern Health, Dr H Bliss Murphy Cancer Centre, St John's, Newfoundland, NL, Canada
| | - Nathalie Saint-Jacques
- Nova Scotia Health Authority Cancer Care Program, Registry & Analytics, Halifax, NS, Canada
| | - Prithwish De
- Surveillance and Cancer Registry, Cancer Care Ontario, Toronto, ON, Canada
| | - Carol McClure
- Prince Edward Island Cancer Registry, Charlottetown, PE, Canada
| | | | | | | | | | | | - Sally Vernon
- National Cancer Registration and Analysis Service, Public Health England, Cambridge, UK
| | - Eileen Morgan
- Northern Ireland Cancer Registry, Queen's University Belfast, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, UK
| | - David S Morrison
- Scottish Cancer Registry, Information Services Division, National Health Services Scotland, Edinburgh, UK
| | - Dyfed W Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Geoff Porter
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | | | - Heather Bryant
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | | | | | - D Max Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter Sasieni
- King's College London, Clinical Trials Unit, London, UK
| | - Paul C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Bjørn Møller
- Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
| | - Isabelle Soerjomataram
- Cancer Surveillance Section, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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Pontalba JT, Gwynne-Timothy T, David E, Jakate K, Androutsos D, Khademi A. Assessing the Impact of Color Normalization in Convolutional Neural Network-Based Nuclei Segmentation Frameworks. Front Bioeng Biotechnol 2019; 7:300. [PMID: 31737619 PMCID: PMC6838039 DOI: 10.3389/fbioe.2019.00300] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/15/2019] [Indexed: 02/03/2023] Open
Abstract
Image analysis tools for cancer, such as automatic nuclei segmentation, are impacted by the inherent variation contained in pathology image data. Convolutional neural networks (CNN), demonstrate success in generalizing to variable data, illustrating great potential as a solution to the problem of data variability. In some CNN-based segmentation works for digital pathology, authors apply color normalization (CN) to reduce color variability of data as a preprocessing step prior to prediction, while others do not. Both approaches achieve reasonable performance and yet, the reasoning for utilizing this step has not been justified. It is therefore important to evaluate the necessity and impact of CN for deep learning frameworks, and its effect on downstream processes. In this paper, we evaluate the effect of popular CN methods on CNN-based nuclei segmentation frameworks.
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Affiliation(s)
| | | | - Ephraim David
- Image Analysis in Medicine Lab (IAMLAB), Ryerson University, Toronto, ON, Canada
| | | | - Dimitrios Androutsos
- Image Analysis in Medicine Lab (IAMLAB), Ryerson University, Toronto, ON, Canada
| | - April Khademi
- Image Analysis in Medicine Lab (IAMLAB), Ryerson University, Toronto, ON, Canada
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de Lemos LLP, Carvalho de Souza M, Pena Moreira D, Ribeiro Fernandes Almeida PH, Godman B, Verguet S, Guerra AA, Leal Cherchiglia M. Stage at diagnosis and stage-specific survival of breast cancer in Latin America and the Caribbean: A systematic review and meta-analysis. PLoS One 2019; 14:e0224012. [PMID: 31618268 PMCID: PMC6799865 DOI: 10.1371/journal.pone.0224012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/03/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Female breast cancer is the most common cancer in Latin American and Caribbean (LAC) countries and is the leading cause of cancer deaths. The high mortality-to-incidence ratio in the regions is associated with mainly the high proportion of advanced stage diagnosis, and also to inadequate access to health care. In this study we aimed to systematically review the proportion of advanced stage (III-IV) at diagnosis (pas) and the five-year stage-specific survival estimates of breast cancer in LAC countries. METHODS We searched MEDLINE, Embase, and LILACS (Latin American and Caribbean Health Science Literature) to identify studies, in any language, indexed before Nov 5, 2018. We also conducted manual search by reviewing citations of papers found. pas was summarized by random effects model meta-analysis, and meta-regression analysis to identify sources of variation. Stage-specific survival probabilities were described as provided by study authors, as it was not possible to conduct meta-analysis. PROSPERO CRD42017052493. RESULTS For pas we included 63 studies, 13 of which population-based, from 22 countries comprising 221,255 women diagnosed from 1966 to 2017. The distribution of patients by stage varied greatly in LAC (pas 40.8%, 95%CI 37.0% to 44.6%; I2 = 99%; p<0.0001). The heterogeneity was not explained by any variable included in the meta-regression. There was no difference in pas among the Caribbean (pas 43.0%, 95%CI 33.1% to 53.6%), Central America (pas 47.0%, 95%CI 40.4% to 53.8%) and South America (pas 37.7%, 95%CI 33.1% to 42.5%) regions. For 5-year stage-specific survival we included 37 studies, comprising 28,988 women from ten countries. Seven of these studies were included also for pas. Since we were unable to adjust for age, comparability between countries and regions was hampered, and as expected, the results varied widely from study to study. CONCLUSIONS LAC countries should look to address concerns with early detection and diagnosis of breast cancer, and wherever viable implement screening programs and to provide timely treatment.
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Affiliation(s)
- Lívia Lovato Pires de Lemos
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Mirian Carvalho de Souza
- Divisão de Pesquisa Populacional, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniela Pena Moreira
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Henrique Ribeiro Fernandes Almeida
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, Scotland
- Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Karolinska Institutet, Huddinge, Sweden
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Augusto Afonso Guerra
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mariangela Leal Cherchiglia
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Lawrance S, Bui C, Mahindra V, Arcorace M, Cooke-Yarborough C. Assessing a modified-AJCC TNM staging system in the New South Wales Cancer Registry, Australia. BMC Cancer 2019; 19:850. [PMID: 31462255 PMCID: PMC6714314 DOI: 10.1186/s12885-019-6062-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background In 2017, the New South Wales Cancer Registry (NSWCR) participated in a project, supported by Cancer Australia, aiming to provide national stage data for melanoma, prostate, colorectal, breast, and lung cancers diagnosed in 2011. Simplified business rules based on the American Joint Committee for Cancer (AJCC) Tumour-Node-Metastasis (TNM) stage were applied to obtain Registry-Derived (RD) stage, defined as the best estimate of TNM stage at diagnosis using routine notifications available within cancer registries. RD-stage was compared with Degree of Spread (DoS), which has been recorded for all applicable cancers in NSWCR at a population-based level since 1972, and a summary AJCC-TNM stage group, which has been collected variably since 2006. For each of the five high incidence cancers, we compared the level of improvements RD-staging provided in terms of completeness and accuracy (alignment to more clinically relevant AJCC-TNM) over DoS. Methods For each of the five cancers, stage data were extracted from NSWCR pre- and post- RD-staging to compare data completeness across all three staging systems. The alignment between DoS/RD-stage and AJCC-TNM was compared, as were the expected and observed cross-tabulated frequency distributions using a subset of NSWCR data. To determine differences between use of DoS, RD-stage, and AJCC-TNM in an epidemiological analysis, we compared survival models developed from each of the three stage variables. Results We found RD-staging provided greatest stage data completeness and alignment to AJCC-TNM for prostate cancers, followed by breast, then melanoma and lung cancers. For colorectal cancer, summary stage from DoS was confirmed as an equivalent surrogate staging system to both AJCC-TNM and RD-stage. Conclusions This analysis provides an evidence-based approach that can be used to inform decision-making for resource planning and potential implementation of a new stage data field in population-based cancer registries. Electronic supplementary material The online version of this article (10.1186/s12885-019-6062-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheena Lawrance
- Cancer Institute NSW, PO Box 41, Alexandria, Sydney, NSW, 1435, Australia.
| | - Chau Bui
- Cancer Institute NSW, PO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Vidur Mahindra
- Cancer Institute NSW, PO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Maria Arcorace
- Cancer Institute NSW, PO Box 41, Alexandria, Sydney, NSW, 1435, Australia
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Understanding Differences in Cancer Survival between Populations: A New Approach and Application to Breast Cancer Survival Differentials between Danish Regions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173093. [PMID: 31454922 PMCID: PMC6747104 DOI: 10.3390/ijerph16173093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/09/2019] [Accepted: 08/21/2019] [Indexed: 12/29/2022]
Abstract
Large variations in cancer survival have been recorded between populations, e.g., between countries or between regions in a country. To understand the determinants of cancer survival differentials between populations, researchers have often applied regression analysis. We here propose the use of a non-parametric decomposition method to quantify the exact contribution of specific components to the absolute difference in cancer survival between two populations. Survival differences are here decomposed into the contributions of differences in stage at diagnosis, population age structure, and stage-and-age-specific survival. We demonstrate the method with the example of differences in one-year and five-year breast cancer survival between Denmark’s five regions. Differences in stage at diagnosis explained 45% and 27%, respectively, of the one- and five-year survival differences between Zealand and Central Denmark for patients diagnosed between 2008 and 2010. We find that the introduced decomposition method provides a powerful complementary analysis and has several advantages compared with regression models: No structural or distributional assumptions are required; aggregated data can be used; and the use of absolute differences allows quantification of the survival that could be gained by improving, for example, stage at diagnosis relative to a reference population, thus feeding directly into health policy evaluation.
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Jensen H, Møller H, Vedsted P. Characteristics of customary non-attenders in general practice who are diagnosed with cancer: A cross-sectional study in Denmark. Eur J Cancer Care (Engl) 2019; 28:e13143. [PMID: 31433525 DOI: 10.1111/ecc.13143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/22/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to explore individual and structural factors in patients with cancer and their potential association with customary non-attendance in general practice. MATERIALS AND METHODS We conducted a population-based cross-sectional study of all patients aged 50-89 years who were diagnosed with an incident cancer in 2009-2013 in Denmark. We investigated associations between being a customary non-attender (defined as having no consultations in general practice in the 19-36 months before diagnosis) and selected patient-related factors (demography, socioeconomic status), health-related factors (multimorbidity) and structural factors (urbanisation degree, list size of general practice and use of out-of-hours services) using logistic regression. RESULTS A total of 123,943 cancer patients were included; 11,567 (9.3%) of these were non-attenders. Non-attendance was associated with being more than 70 years of age, being single, having short or long education and being financially affluent. Non-attendance was rarely seen in cancer patients with (multi)morbidity, in individuals living in an area with 2,000-99,999 inhabitants and in individuals having contact with the out-of-hours services. CONCLUSION Specific groups of cancer patients were more often customary non-attenders in general practice. General practice may need to reach out more directly to these patients to ensure more timely cancer diagnosis.
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Affiliation(s)
- Henry Jensen
- Research Centre for Cancer Diagnosis in Primary Care, Department of Public Health, Aarhus University, Aarhus, Denmark.,Research Unit for General Practice, Aarhus, Denmark
| | - Henrik Møller
- Research Centre for Cancer Diagnosis in Primary Care, Department of Public Health, Aarhus University, Aarhus, Denmark.,The Danish Clinical Registries (RKKP), Aarhus, Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care, Department of Public Health, Aarhus University, Aarhus, Denmark.,Research Unit for General Practice, Aarhus, Denmark
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Steponaviciene L, Briediene R, Vanseviciute R, Smailyte G. Trends in Breast Cancer Incidence and Stage Distribution Before and During the Introduction of the Mammography Screening Program in Lithuania. Cancer Control 2019; 26:1073274818821096. [PMID: 30808202 PMCID: PMC6327347 DOI: 10.1177/1073274818821096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to analyze the incidence trends of localized and advanced breast cancer (BC) before and during the implementation of the mammography screening program (MSP) in Lithuania. Methods: The study period was divided into 2 intervals: the prescreening period (1998-2005) and implementation period (2006-2012). Analysis was performed for 3 age-groups: 0 to 49 years, 50 to 69 (target population), and older than 70. Results: In all age-groups, the incidence of localized BC has shown a steady increase, while the incidence of advanced stage BC has decreased. In the target population, during the study period, the stage I BC incidence increased statistically significantly by 10.3% per year (from 3.3 per 100 000 in 1998 to 12.2 per 100 000 in 2012). The increase in localized BC was faster in the period before the implementation of the MSP than during the implementation in 2006 to 2012 (10.3% and 5.7%). A slightly statistically significant decrease was observed for advanced BC during the study period (−1.1% per year), while during the implementation of the MSP, significant changes were not seen. Conclusions: The results of our study indicate that the implementation of the MSP in Lithuania did not significantly influence trends of localized and advanced BC. Changes observed during the study period, including the prescreening and screening introduction periods, may reflect the general trends in the awareness of BC and improvements in diagnostics.
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Affiliation(s)
- Laura Steponaviciene
- 1 Laboratory of cancer epidemiology, National Cancer Institute, Vilnius, Lithuania.,2 Department of Public Health, Institute of Health Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - Ruta Briediene
- 3 Department of Radiology, National Cancer Institute, Vilnius, Lithuania.,4 Department of Radiology, Medical Physics and Nuclear Medicine, Vilnius University, Vilnius, Lithuania
| | - Rasa Vanseviciute
- 5 Department of Consulting Clinic, National Cancer Institute, Vilnius, Lithuania
| | - Giedre Smailyte
- 1 Laboratory of cancer epidemiology, National Cancer Institute, Vilnius, Lithuania.,2 Department of Public Health, Institute of Health Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
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Moskowitz CS, Chou JF, Neglia JP, Partridge AH, Howell RM, Diller LR, Novetsky Friedman D, Barnea D, Morton LM, Turcotte LM, Arnold MA, Leisenring WM, Armstrong GT, Robison LL, Oeffinger KC, Henderson TO. Mortality After Breast Cancer Among Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. J Clin Oncol 2019; 37:2120-2130. [PMID: 31260644 DOI: 10.1200/jco.18.02219] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Female survivors of childhood cancer have a high risk of subsequent breast cancer. We describe the ensuing risk for mortality and additional breast cancers. PATIENTS AND METHODS Female participants in the Childhood Cancer Survivor Study, a cohort of 5-year survivors of cancer diagnosed between 1970 and 1986 before age 21 years, and subsequently diagnosed with breast cancer (n = 274; median age at breast cancer diagnosis, 38 years; range, 20 to 58 years) were matched to a control group (n = 1,095) with de novo breast cancer. Hazard ratios (HRs) and 95% CIs were estimated from cause-specific proportional hazards models. RESULTS Ninety-two childhood cancer survivors died, 49 as a result of breast cancer. Overall survival after breast cancer was 73% by 10 years. Subsequent risk of death as a result of any cause was higher among childhood cancer survivors than among controls (HR, 2.2; 95% CI, 1.7 to 3.0) and remained elevated after adjusting for breast cancer treatment (HR, 2.4; 95% CI, 1.7 to 3.2). Although breast cancer-specific mortality was modestly elevated among childhood cancer survivors (HR, 1.3; 95% CI, 0.9 to 2.0), survivors were five times more likely to die as a result of other health-related causes, including other subsequent malignant neoplasms and cardiovascular or pulmonary disease (HR, 5.5; 95% CI, 3.4 to 9.0). The cumulative incidence of a second asynchronous breast cancer also was elevated significantly compared with controls (P < .001). CONCLUSION Mortality after breast cancer was higher in childhood cancer survivors than in women with de novo breast cancer. This increased mortality reflects the burden of comorbidity and highlights the need for risk-reducing interventions.
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Affiliation(s)
| | - Joanne F Chou
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph P Neglia
- 2University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | | | | | | | | | - Dana Barnea
- 5Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | | | | | | | | | - Tara O Henderson
- 11The University of Chicago Medicine Comer Children's Hospital, Chicago, IL
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81
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Slaoui A, Cherkaoui N, El Harmouchi O, Hachi H. Fortuitous discovery of ganglionic tuberculosis after conservative treatment of breast cancer: a case report and review of the literature. BMC Womens Health 2019; 19:79. [PMID: 31215419 PMCID: PMC6582589 DOI: 10.1186/s12905-019-0780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/11/2019] [Indexed: 11/25/2022] Open
Abstract
Background Ganglionic tuberculosis is the most common extrapulmonary localization in Morocco. It is still a diagnostic and therapeutic problem especially when the infection is concomitant to the management of a cancer. Case presentation Here, we report the uncommon case of a fortuitous discovery of ganglionic tuberculosis in the anatomopathological analysis of an axillary node dissection after conservative treatment of breast cancer for a 29-year-old patient without medical history. Her file was discussed in a multidisciplinary consultation meeting during which several decisions were made. We decided to start her antituberculosis treatment then after three weeks her adjuvant chemotherapy with radiotherapy and hormone therapy. Furthermore, giver her young age, she had an oncogenetic consultation. Despite difficulties of therapeutic compliance, the patient completed her cancer treatments after two years, she also cured of her tuberculosis. Being in remission, she is still on hormone therapy and consults every 3-months as part of her follow-up. Conclusions Cancer and tuberculosis presenting simultaneously creates clinical and histopathological difficulties for differential diagnosis and for therapeutic decisions. Anticancer chemotherapy is not an obstacle in anti-tuberculosis treatment but the compliance of patients to receive both at the same time with the associated side effects is one to consider.
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Affiliation(s)
- Aziz Slaoui
- Department of Gynaecology and Obstetrics, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco.
| | - Nivine Cherkaoui
- Department of Gynaecology and Obstetrics, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Othmane El Harmouchi
- Department of Gynaecology and Obstetrics, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Hafid Hachi
- Gynaecology Department, National Oncology Hospital, University Mohammed V, University Hospital Center IBN SINA, Rabat, Morocco
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82
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Vale DB, Filho CC, Shinzato JY, Spreafico FS, Basu P, Zeferino LC. Downstaging in opportunistic breast cancer screening in Brazil: a temporal trend analysis. BMC Cancer 2019; 19:432. [PMID: 31077162 PMCID: PMC6509851 DOI: 10.1186/s12885-019-5647-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Breast cancer is the most common female cancer in Brazil with an estimated 60 thousand new cases per year. Widespread use of mammography opportunistic screening has been observed in the last 20 years, including women under 50 years old. The present study aimed to analyse the trends in breast cancer stage distribution at diagnosis as a function of age in the study period. METHODS This paper examined temporal trends of stage distribution in women with breast cancer diagnosed between 2000 and 2015 in São Paulo state, Brazil. Data from the Hospital Cancer Registry of the region were utilized. Completeness was high. The sample was described according to age, stage and date of diagnosis using absolute frequency and proportions (%). For trends, the Cochran-Armitage test was used with a 5% level of significance (P-value< 0.05). RESULTS A total of 93,674 women were included in the analysis with a median age of 56 years old. One-third (34.4%) of the women were younger than 50 years old, and stage II was the most frequent stage (36.4%), even when analysed by age groups. Stage 0 corresponded to 7.7% (7247 women) of cases. In the study period, there was a significant trend towards an increase in Stages 0, I and IV (P < 0.01) and a trend towards a decrease in Stages IIA, IIB and IIIB (P < 0.001). Stage IIA was more prevalent until 2009, and stage I was more prevalent thereafter. The trends to increase the proportion of Stages 0 and I and to decrease the proportion of stages IIA, IIB and IIIB were significant in all age groups. CONCLUSIONS Breast cancer cases are diagnosed mainly at early stages, and approximately one-third of cases are younger than 50 years old. Downstaging has been shown. Opportunistic screening may have supported these results. Further studies are needed to show whether these results will impact the prognosis.
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Affiliation(s)
- Diama Bhadra Vale
- Obstetrics and Gynecology Department, School of Medical Sciences of Unicamp, Rua Alexander Fleming 101, Campinas, 13083-790 Brazil
| | - Cassio Cardoso Filho
- Obstetrics and Gynecology Department, School of Medical Sciences of Unicamp, Rua Alexander Fleming 101, Campinas, 13083-790 Brazil
| | - Julia Yoriko Shinzato
- Obstetrics and Gynecology Department, School of Medical Sciences of Unicamp, Rua Alexander Fleming 101, Campinas, 13083-790 Brazil
| | - Fernanda Servidoni Spreafico
- Obstetrics and Gynecology Department, School of Medical Sciences of Unicamp, Rua Alexander Fleming 101, Campinas, 13083-790 Brazil
- Medicine School of PUC-Campinas, Av. John Boyd Dunlop s/n, Campinas, 13060-904 Brazil
| | - Partha Basu
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, France
| | - Luiz Carlos Zeferino
- Obstetrics and Gynecology Department, School of Medical Sciences of Unicamp, Rua Alexander Fleming 101, Campinas, 13083-790 Brazil
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83
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Aronov DA, Zhukov VV, Semushina SG, Moiseeva EV. Imbalances in cellular immunological parameters in blood predetermine tumor onset in a natural mouse model of breast cancer. Cancer Immunol Immunother 2019; 68:721-729. [PMID: 30741325 PMCID: PMC11028144 DOI: 10.1007/s00262-019-02312-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/01/2019] [Indexed: 12/31/2022]
Abstract
The development of new approaches to breast cancer (BC) early diagnosis is an important objective of modern oncology. Although the role of the immune system in cancer initiation process was experimentally well established, the prognostic value of cellular blood immunological parameters (CBIPs) for BC onset prediction was not demonstrated either in clinics or in mouse models. In this study, we focused on revealing informative CBIPs for mammary cancer (MC) onset prediction in the BLRB/BYRB mouse model with a high incidence of natural MC development. Blood samples were collected from 80 aging females of these original mouse strains, 12 basic CBIPs were estimated by flow cytometry. Then mice were followed up for 28 weeks, and the outcome of females (MC diagnosis, death without MC or MC-free survival) was registered. We estimated the patterns of changes in CBIPs with age and in accordance with the outcome. An increasing imbalance in 11 CBIPs during natural aging of females clearly resembled human immunosenescence phenomenon and several patterns corresponded to the results obtained on cancer-free members of BC-affected families. We stratified heterogeneous female population into middle-aged and old subgroups. Low NK-cell levels in middle-aged mice and low B-cell along with high T-helper levels in old mice distinguished females with developed MC from the other groups. We found a reliable correlation of several CBIPs with age at MC diagnosis and survival of cancer-bearing females. Thus, we demonstrated the predictive potential of CBIPs as a basis for the development of prognostic models for BC onset in clinics.
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Affiliation(s)
- Dmitry A Aronov
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, GSP-7, ul. Miklukho-Maklaya, 16/10, Moscow, 117997, Russia.
| | - Viacheslav V Zhukov
- Peoples' Friendship University of Russia (RUDN University), ul. Miklukho-Maklaya, 6, Moscow, 117198, Russia
| | - Svetlana G Semushina
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, GSP-7, ul. Miklukho-Maklaya, 16/10, Moscow, 117997, Russia
| | - Ekaterina V Moiseeva
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, GSP-7, ul. Miklukho-Maklaya, 16/10, Moscow, 117997, Russia
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84
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Asphaug L, Melberg HO. The Cost-Effectiveness of Multigene Panel Testing for Hereditary Breast and Ovarian Cancer in Norway. MDM Policy Pract 2019; 4:2381468318821103. [PMID: 30746499 PMCID: PMC6360477 DOI: 10.1177/2381468318821103] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 11/21/2018] [Indexed: 12/20/2022] Open
Abstract
Background. Expansion of routine genetic testing for hereditary breast and ovarian cancer from conventional BRCA testing to a multigene test could improve diagnostic yield and increase the opportunity for cancer prevention in both identified carriers and their relatives. We use an economic decision model to assess whether the current knowledge on non-BRCA mutation prevalence, cancer risk, and patient preferences justifies switching to a multigene panel for testing of early-onset breast cancer patients. Methods. We evaluated routine testing by BRCA testing, a 7-gene panel, and a 14-gene panel using individual-level simulations of annual health state transitions over a lifetime perspective. Breast and ovarian cancer incidence is reduced and posttreatment survival is improved when high-risk mutations are detected and risk-reducing treatment offered. Most model inputs were synthesized from published literature. Intermediate health outcomes included breast and ovarian cancer incidence rates, along with organ-specific cancer mortality. Cost-effectiveness outcomes were health sector costs and quality-adjusted life years. Results. Intermediate health outcomes improved by testing with multigene panels. At a cost-effectiveness threshold of $77,000, a 7-gene panel test with five non-BRCA genes was the optimal strategy with an incremental cost-effectiveness ratio of $53,310 per quality-adjusted life year compared to BRCA-only testing. Limitations. Unable to stratify carriers to specific mutations within genes, we can only make predictions on the gene level, with combined risk estimates for known variants. As mutation prevalence is the absolute upper bound of returns to more expansive testing, the rarity of modelled mutations makes analysis outcomes sensitive to model implementation. Conclusions. A 7-gene panel to diagnose hereditary breast and ovarian cancer in early-onset breast cancer patients can be a cost-effective alternative to current BRCA-only testing in Norway.
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Affiliation(s)
- Lars Asphaug
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Hans Olav Melberg
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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85
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Postdiagnostic Calcium Channel Blocker Use and Breast Cancer Mortality: A Population-based Cohort Study. Epidemiology 2019; 29:407-413. [PMID: 29608546 DOI: 10.1097/ede.0000000000000814] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There have long been concerns that calcium channel blockers (CCBs), widely used to treat hypertension, may contribute to malignant growth through the evasion of apoptosis and proliferation of cancer cells. Worryingly, a recent cohort study found breast cancer patients who used CCBs had higher death rates, but interpreting these results was difficult as they were based on all-cause mortality and medication use before cancer diagnosis. We used UK population-based data to more robustly investigate the association between CCB use and cancer-specific mortality. METHODS We selected a cohort of patients with breast cancer diagnosed between 1998 and 2012 from English cancer registries. We linked to prescription and clinical records from the Clinical Practice Research Datalink, and to death records from the Office for National Statistics. We used adjusted, time-dependent Cox regression models to calculate hazard ratios (HRs) comparing breast cancer-specific and all-cause mortality between postdiagnostic CCB users and nonusers. RESULTS Our cohort included 23,669 breast cancer patients, of whom 5,141 used CCBs and 3,053 died due to their breast cancer during follow-up. After adjustment, CCB users had similar breast cancer-specific mortality to nonusers (HR = 0.98, 95% confidence interval [CI] = 0.88, 1.08). There was no evidence of a dose-response relationship. We found similar associations for specific CCBs, and for all-cause mortality. CONCLUSIONS In this large population-based breast cancer cohort, we did not find any evidence that CCB use is associated with increased mortality.
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86
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Azemfac K, Christie SA, Carvalho MM, Nana T, Fonje AN, Halle-Ekane G, Dicker R, Chichom-Mefire A, Juillard C. A Community-Based Assessment of Knowledge and Practice of Breast Self-Examination and Prevalence of Breast Disease in Southwest Cameroon. J Cancer Epidemiol 2019; 2019:2928901. [PMID: 30713554 PMCID: PMC6333001 DOI: 10.1155/2019/2928901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/15/2018] [Accepted: 12/05/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the rising trend in breast cancer incidence and mortality across Sub-Saharan Africa, there remains a critical knowledge gap about the burden and patterns of breast disease and breast cancer screening practices at the population level. This study aimed to identify socioeconomic factors associated with knowledge and practice of breast self-examination (BSE) as well as assess the prevalence of breast disease symptoms among a mixed urban-rural population of women in the Southwest region of Cameroon. METHODS We conducted a household-level community-based study in Southwest Cameroon between January and March 2017, using a three-stage cluster sampling framework. We surveyed 1287 households and collected self-reported data on 4208 female subjects, 790 of whom were household representatives. Each household representative provided information on behalf of all female household members about any ongoing breast disease symptoms. Moreover, female household representatives were questioned about their own knowledge and practice of BSE. RESULTS Women demonstrated low frequency of knowledge of BSE, as 25% (n=201) of household representatives reported any knowledge of BSE; and among these only 15% (n=30) practiced BSE on a monthly basis. Age (aOR: 1.04), usage of Liquid Petroleum Gas fuel, a marker of higher socioeconomic status (aOR: 1.86), and speaking English as a primary language in the household (aOR: 1.59) were significant predictors of knowledge of BSE. Eleven women reported ongoing breast disease symptoms resulting in an overall prevalence of 2.3 cases of breast disease symptoms per 1000 women. CONCLUSIONS Socioeconomic disparities in access to health education may be a determinant of knowledge of BSE. Community-based strategies are needed to improve dissemination of breast cancer screening methods, particularly for women who face barriers to accessing care.
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Affiliation(s)
- Kareen Azemfac
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - S. Ariane Christie
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Melissa M. Carvalho
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Theophile Nana
- Department of Surgery, Regional Hospital Limbe, Limbe, Southwest Region, Cameroon
| | - Ahmed N. Fonje
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - Rochelle Dicker
- Department of Surgical Critical Care, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Catherine Juillard
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
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87
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Darden C, Mitra D, McSorley D, Davis K, Band J, Iyer S. Treatment satisfaction in women receiving palbociclib combination therapies for advanced/metastatic breast cancer. Future Oncol 2019; 15:141-150. [DOI: 10.2217/fon-2018-0531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aim: To understand treatment satisfaction in patients with advanced or metastatic breast cancer receiving palbociclib plus an aromatase inhibitor or palbociclib plus fulvestrant in a real-world setting. Patients & methods: We performed an observational, cross-sectional, web-based survey of 604 patients with self-reported hormone receptor-positive (HR+)/HER2-negative (HER2-) ABC/mBC in six countries. Results: Overall, more than 96% of patients reported the benefits of their palbociclib combination therapy met or exceeded their expectations. Patient expectations and satisfaction with therapy did not differ between patients on palbociclib plus letrozole and palbociclib plus fulvestrant, or between patients with visceral and nonvisceral metastases. Conclusion: The patients on palbociclib combination therapy reported high satisfaction scores across multiple countries.
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Affiliation(s)
| | | | - David McSorley
- RTI Health Solutions, Research Triangle Park, NC 27709, USA
| | - Kimberly Davis
- RTI Health Solutions, Research Triangle Park, NC 27709, USA
| | - Juliet Band
- RTI Health Solutions, Research Triangle Park, NC 27709, USA
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88
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Vasconcellos-Silva PR, Sormunen T, Craftman ÅG. Evolution of accesses to information on breast cancer and screening on the Brazilian National Cancer Institute website: an exploratory study. CIENCIA & SAUDE COLETIVA 2018; 23:1303-1312. [PMID: 29694575 DOI: 10.1590/1413-81232018234.14082016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/09/2016] [Indexed: 11/22/2022] Open
Abstract
Delays in diagnosis due to low Breast Cancer awareness are widespread in Brazil maybe owing to ineffective strategies to raise attention on early diagnosis. As a proxy of collective interest in BC screanning (BCS) we studied the monthly accesses to BC and BCS webpages in INCA's website along 48 months. A log analyzer built a time serie (2006-2009) of BC and BCS monthly means, which oscilations were studied by analysis of variance (ANOVA). We found significant increasing accesses to BC and transient "attention peaks". Enlargement in BC/BCS differences along all period were caused by increasing accesses to BC and decreasing/minor/stable oscillations to SBC pages. These results are consistent with previous reports on increasing interest to BC contrasting with indifference on BCS. In the context of an exploratory study, we discussed some aspects: weakness of a "prevention culture"; lack of confidence in health system and screening programs; "celebrity effect" in the context of media framing; collective perception of risks heightened by perception of social vulnerability. Findings suggest that culture-tailored communication strategies would be necessary to inform Brazilian people about BCS. Future research is needed to study social perceptions and constructions on BC topics.
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89
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Tang M, Horsley P, Lewis CR. Emergency department presentations in early stage breast cancer patients receiving adjuvant and neoadjuvant chemotherapy. Intern Med J 2018; 48:583-587. [PMID: 29722200 DOI: 10.1111/imj.13785] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 11/28/2022]
Abstract
(Neo)adjuvant chemotherapy for early stage breast cancer is associated with side-effects, resulting in increased emergency department (ED) presentations. Treatment-related toxicity can affect quality of life, compromise chemotherapy delivery and treatment outcomes, and increase healthcare use. We performed a retrospective study of ED presentations in patients receiving curative chemotherapy for early breast cancer to identify factors contributing to ED presentations. Of 102 patients, 39 (38%) presented to ED within 30 days of chemotherapy, resulting in 63 ED presentations in total. Most common reasons were non-neutropenic fever (17 presentations/27%), neutropenic fever (15/24%), pain (9/14%), drug reaction (6/10%) and infection (4/6%). Factors significantly associated with ED presentation were adjuvant chemotherapy timing compared to neoadjuvant timing (P = 0.031), prophylactic antibiotics (P = 0.045) and docetaxel-containing regimen (P = 0.018).
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Affiliation(s)
- Monica Tang
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Patrick Horsley
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Craig R Lewis
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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90
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Mortality of patients examined at a diagnostic centre: A matched cohort study. Cancer Epidemiol 2018; 55:130-135. [DOI: 10.1016/j.canep.2018.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 01/22/2023]
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91
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von Moos R, Body JJ, Rider A, de Courcy J, Bhowmik D, Gatta F, Hechmati G, Qian Y. Bone-targeted agent treatment patterns and the impact of bone metastases on patients with advanced breast cancer in real-world practice in six European countries. J Bone Oncol 2018; 11:1-9. [PMID: 29892519 PMCID: PMC5993954 DOI: 10.1016/j.jbo.2017.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Bone metastases (BMs) are common in patients with breast cancer and can lead to skeletal-related events (SREs), which are associated with increased pain and reduced quality of life (QoL). Bone-targeted agents (BTAs), like zoledronic acid and denosumab, reduce the incidence of SREs and delay progression of bone pain. MATERIALS AND METHODS We evaluated the management of BMs and pain in six European countries (Belgium, France, Germany, Italy, Spain, and UK) using the Adelphi Breast Cancer Disease Specific Programme, which included a physician survey and patient-reported outcomes (PROs) to assess the impact of BMs on pain and QoL. RESULTS 301 physicians completed patient record forms for 2984 patients with advanced breast cancer; 1408 with BMs and 1136 with metastases at sites other than bone (non-BMs). Most patients with BMs (88%) received a BTA, with 81% receiving treatment during 3 months following BM diagnosis. For those who did not receive a BTA, the main reasons given were: very recent BM diagnosis, perceived low risk of bone complications, and short life expectancy. Most patients with BMs (68%) were experiencing bone pain and, of these, 97% were taking analgesics (including 28% receiving strong opioids). Despite this, moderate to severe pain was reported in 20% of patients who were experiencing pain. PROs were assessed in 766 patients with advanced breast cancer (392 with BMs, 374 with non-BMs). Overall, patients with BMs reported worse pain and QoL outcomes than those with non-BMs, those not receiving a BTA reported worse pain. CONCLUSION Despite the large proportion of patients receiving BTAs in this study, some patients with BMs are still not receiving early treatment to prevent SREs or to manage pain. Improving physicians' understanding of the role of BTAs and the importance of early treatment following BM diagnosis has the potential to improve patient care.
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Key Words
- BMs, bone metastases
- BPI, Brief Pain Inventory
- BTA, bone-targeted agent
- Bone metastases
- Bone pain
- Bone-targeted agents
- CI, confidence interval
- DSP, Disease Specific Programme
- EQ-5D, 5-dimension (3-level) EuroQol questionnaire
- ER, estrogen receptor
- FACT-B, Functional Assessment of Cancer Therapy – Breast questionnaire
- HER2, human epidermal growth factor receptor 2
- ONJ, osteonecrosis of the jaw
- PRF, Patient Record Form
- PRO, patient-reported outcome
- PSCF, Patient Self-Completion Form
- QoL, quality of life
- SRE, Skeletal-related event
- ZA, zoledronic acid
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Affiliation(s)
- Roger von Moos
- Kantonsspital Graubünden, Loëstrasse 170, CH-7000 Chur, Switzerland
| | | | | | | | | | | | | | - Yi Qian
- Amgen Inc., Thousand Oaks, CA, USA
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92
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Quinlan A, O’Brien KK, Galvin R, Hardy C, McDonnell R, Joyce D, McDowell RD, Aherne E, Keogh C, O’Sullivan K, Fahey T. Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study. BMJ Open 2018; 8:e017286. [PMID: 29858402 PMCID: PMC5988058 DOI: 10.1136/bmjopen-2017-017286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Decision analysis study that incorporates patient preferences and probability estimates to investigate the impact of women's preferences for referral or an alternative strategy of watchful waiting if faced with symptoms that could be due to breast cancer. SETTING Community-based study. PARTICIPANTS Asymptomatic women aged 30-60 years. INTERVENTIONS Participants were presented with 11 health scenarios that represent the possible consequences of symptomatic breast problems. Participants were asked the risk of death that they were willing to take in order to avoid the health scenario using the standard gamble utility method. This process was repeated for all 11 health scenarios. Formal decision analysis for the preferred individual decision was then estimated for each participant. PRIMARY OUTCOME MEASURE The preferred diagnostic strategy was either watchful waiting or referral to a breast clinic. Sensitivity analysis was used to examine how each varied according to changes in the probabilities of the health scenarios. RESULTS A total of 35 participants completed the interviews, with a median age 41 years (IQR 35-47 years). The majority of the study sample was employed (n=32, 91.4%), with a third-level (university) education (n=32, 91.4%) and with knowledge of someone with breast cancer (n=30, 85.7%). When individual preferences were accounted for, 25 (71.4%) patients preferred watchful waiting to referral for triple assessment as their preferred initial diagnostic strategy. Sensitivity analysis shows that referral for triple assessment becomes the dominant strategy at the upper probability estimate (18%) of breast cancer in the community. CONCLUSIONS Watchful waiting is an acceptable strategy for most women who present to their general practitioner (GP) with breast symptoms. These findings suggest that current referral guidelines should take more explicit account of women's preferences in relation to their GPs initial management strategy.
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Affiliation(s)
- Aisling Quinlan
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kirsty K O’Brien
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rose Galvin
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Colin Hardy
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ronan McDonnell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Doireann Joyce
- Department of Surgery, National University of Ireland Galway, Galway, Ireland
| | - Ronald D McDowell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emma Aherne
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire Keogh
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Katriona O’Sullivan
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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93
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Omission of surgery in older women with early breast cancer has an adverse impact on breast cancer-specific survival. Br J Surg 2018; 105:1454-1463. [DOI: 10.1002/bjs.10885] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/03/2018] [Accepted: 04/03/2018] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Primary endocrine therapy is used as an alternative to surgery in up to 40 per cent of women with early breast cancer aged over 70 years in the UK. This study investigated the impact of surgery versus primary endocrine therapy on breast cancer-specific survival (BCSS) in older women.
Methods
Cancer registration data for 2002–2010 were obtained from two English regions. A retrospective analysis was performed for women with oestrogen receptor (ER)-positive disease, using statistical modelling to show the effect of treatment (surgery or primary endocrine therapy) and age and health status on BCSS. Missing data were handled using multiple imputation.
Results
Cancer registration data on 23 961 women were retrieved. After data preprocessing, 18 730 of 23 849 women (78·5 per cent) were identified as having ER-positive disease; of these, 10 087 (53·9 per cent) had surgery and 8643 (46·1 per cent) had primary endocrine therapy. BCSS was worse in the primary endocrine therapy group than in the surgical group (5-year BCSS rate 69·4 and 89·9 per cent respectively). This was true for all strata considered, although the difference was less in the cohort with the greatest degree of co-morbidity. For older, frailer patients the hazard of breast cancer death had less relative impact on overall survival.
Conclusion
BCSS in older women with ER-positive disease is worse if surgery is omitted. This treatment choice may contribute to inferior cancer outcomes. Selection for surgery on the basis of predicted life expectancy may permit choice of women for whom surgery confers little benefit.
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94
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Minicozzi P, Walsh PM, Sánchez MJ, Trama A, Innos K, Marcos-Gragera R, Dimitrova N, Botta L, Johannesen TB, Rossi S, Sant M. Is low survival for cancer in Eastern Europe due principally to late stage at diagnosis? Eur J Cancer 2018. [PMID: 29518726 DOI: 10.1016/j.ejca.2018.01.084] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cancer survival has persistently been shown to be worse for Eastern European and UK/Ireland patients than those of other European regions. This is often attributed to later stage at diagnosis. However, few stage-specific survival comparisons are available, so it is unclear whether poorer quality treatment or other factors also contribute. For the first time, European cancer registries have provided stage-at-diagnosis data to EUROCARE, enabling population-based stage-specific survival estimates across Europe. DATA AND METHODS In this retrospective observational study, stage at diagnosis (as TNM, condensed TNM, or Extent of Disease) was analysed for patients (≥15 years) from 15 countries grouped into 4 regions (Northern Europe: Norway; Central Europe: Austria, France, Germany, Switzerland, The Netherlands; Southern Europe: Croatia, Italy, Slovenia, and Spain; and Eastern Europe: Bulgaria, Estonia, Lithuania, Poland, and Slovakia), diagnosed with 7 malignant cancers in 2000-2007, and followed to end of 2008. A new variable (reconstructed stage) was created which used all available stage information. Age-standardised 5-year relative survival (RS) by reconstructed stage was estimated and compared between regions. Excess risks of cancer death in the 5 years after diagnosis were also estimated, taking age, sex and stage into account. RESULTS Low proportions of Eastern European patients were diagnosed with local stage cancers and high proportions with metastatic stage cancers. Stage-specific RS (especially for non-metastatic disease) was generally lower for Eastern European patients. After adjusting for age, sex, and stage, excess risks of death remained higher for Eastern European patients than for European patients in general. CONCLUSIONS Late diagnosis alone does not explain worse cancer survival in Eastern Europe: greater risk of cancer death together with worse stage-specific survival suggest less effective care, probably in part because fewer resources are allocated to health care than in the rest of Europe. We recommend that Eastern European cancer registries and other involved bodies to draw attention to poor cancer survival, so as to stimulate research and inform policies to improve outcomes.
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Affiliation(s)
- Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| | - Paul M Walsh
- National Cancer Registry, Cork Airport Business Park, Cork, Ireland
| | - Maria-José Sánchez
- Andalusian School of Public Health, Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, Spain; Centro de Investigación Biomédica en red de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry (Oncology Coordination Plan), Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute, Girona, Spain
| | - Nadya Dimitrova
- National Hospital of Oncology, Bulgarian National Cancer Registry, Sofia, Bulgaria
| | - Laura Botta
- Evaluative Epidemiology Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tom B Johannesen
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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95
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Exarchakou A, Rachet B, Belot A, Maringe C, Coleman MP. Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based study. BMJ 2018; 360:k764. [PMID: 29540358 PMCID: PMC5850596 DOI: 10.1136/bmj.k764] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the effectiveness of the NHS Cancer Plan (2000) and subsequent national cancer policy initiatives in improving cancer survival and reducing socioeconomic inequalities in survival in England. DESIGN Population based cohort study. SETTING England. POPULATION More than 3.5 million registered patients aged 15-99 with a diagnosis of one of the 24 most common primary, malignant, invasive neoplasms between 1996 and 2013. MAIN OUTCOME MEASURES Age standardised net survival estimates by cancer, sex, year, and deprivation group. These estimates were modelled using regression model with splines to explore changes in the cancer survival trends and in the socioeconomic inequalities in survival. RESULTS One year net survival improved steadily from 1996 for 26 of 41 sex-cancer combinations studied, and only from 2001 or 2006 for four cancers. Trends in survival accelerated after 2006 for five cancers. The deprivation gap observed for all 41 sex-cancer combinations among patients with a diagnosis in 1996 persisted until 2013. However, the gap slightly decreased for six cancers among men for which one year survival was more than 65% in 1996, and for cervical and uterine cancers, for which survival was more than 75% in 1996. The deprivation gap widened notably for brain tumours in men and for lung cancer in women. CONCLUSIONS Little evidence was found of a direct impact of national cancer strategies on one year survival, and no evidence for a reduction in socioeconomic inequalities in cancer survival. These findings emphasise that socioeconomic inequalities in survival remain a major public health problem for a healthcare system founded on equity.
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Affiliation(s)
- Aimilia Exarchakou
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Bernard Rachet
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Aurélien Belot
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Camille Maringe
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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96
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Abstract
Background The aim of this study was to estimate the total economic and health related burden of breast cancer in the Netherlands. Methods Data on incidence, prevalence, mortality and survival were extracted from the Dutch National Cancer Registry and were used to calculate the economic and health related burden of breast cancer for overall, DCIS (stage 0), early- (stage I), locally advanced- (stage II-III) and metastatic- (stage IV) breast cancer by age groups and by year (if applicable). Results The overall incidence of breast cancer increased from 103.4 up to 153.2 per 100,000 women between 1990 and 2014. The increase was driven by DCIS and early breast cancer as the incidence of locally advanced and metastatic breast cancer remained stable. Between 1990 and 2014, ten-year overall survival rates increased from 87% to 93% for early breast cancer, 41% to 62% for locally advanced- and from 6% to 9% for metastatic disease. Annually, breast cancer in the Netherlands is responsible for approximately 3100 deaths, 26,000 life years lost, 65,000 Disability Adjusted Life Years (DALYs) and an economic burden of €1.27 billion. Conclusions This study provides a comprehensive assessment of the burden of breast cancer and subsequent trends over time in the Netherlands. Electronic supplementary material The online version of this article (10.1186/s12885-018-4158-3) contains supplementary material, which is available to authorized users.
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97
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Nordin N, Yaacob NM, Abdullah NH, Mohd Hairon S. Survival Time and Prognostic Factors for Breast Cancer among
Women in North-East Peninsular Malaysia. Asian Pac J Cancer Prev 2018; 19:497-502. [PMID: 29480991 PMCID: PMC5980940 DOI: 10.22034/apjcp.2018.19.2.497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Breast cancer is the most common malignant disease and the leading cause of cancer death among women globally. This study aimed to determine the median survival time and prognostic factors for breast cancer patients in a North-East State of Malaysia. Methods: This retrospective cohort study was conducted from January till April 2017 using secondary data obtained from the state’s cancer registry. All 549 cases of breast cancer diagnosed from 1st January 2007 until 31st December 2011 were selected and retrospectively followed-up until 31st December 2016. Sociodemographic and clinical information was collected to determine prognostic factors. Results: The average (SD) age at diagnosis was 50.4 (11.2) years, the majority of patients having Malay ethnicity (85.8%) and a histology of ductal carcinoma (81.5%). Median survival times for those presenting at stages III and IV were 50.8 (95% CI:25.34, 76.19) and 6.9 (95% CI:3.21, 10.61) months, respectively. Ethnicity (Adj. HR for Malay vs non-Malay ethnicity=2.52; 95% CI: 1.54, 4.13; p<0.001), stage at presentation (Adj. HR for Stage III vs Stage I=2.31; 95% CI: 1.57, 3.39; p<0.001 and Adj. HR for Stage IV vs Stage I=6.20; 95%CI: 4.45, 8.65; p<0.001), and history of surgical treatment (Adj. HR for patients with no surgical intervention=1.95; 95%CI: 1.52, 2.52; p<0.001) were observed to be the statistically significant prognostic factors associated with death caused by breast cancer. Conclusion: The median survival time among breast cancer patients in North-East State of Malaysia was short as compared to other studies. Primary and secondary prevention aimed at early diagnosis and surgical management of breast cancer, particularly among the Malay ethnic group, could improve treatment outcome.
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Affiliation(s)
- Noorfariza Nordin
- Department of Community Medicine, School of Medical Sciences, Universiti Sains, Malaysia.
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98
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Rivera-Franco MM, Leon-Rodriguez E. Delays in Breast Cancer Detection and Treatment in Developing Countries. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2018; 12:1178223417752677. [PMID: 29434475 PMCID: PMC5802601 DOI: 10.1177/1178223417752677] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/18/2017] [Indexed: 01/07/2023]
Abstract
Breast cancer is the most common cancer in women in both developed and developing countries and the second most common cancer in the world. Developing countries are increasingly adopting a Western lifestyle, such as changes in diet and delayed first childbirth, lower parity, and shorter periods of breastfeeding, which are important determinants of a higher incidence of breast cancer among those regions. Low- and middle-income countries (LMICs) represent most of the countries with the highest mortality rates, ranging from 40% to 60%. Furthermore, developing countries account for scarce survival data, and the few data available coincide with the observed incidence and mortality differences. Five-year survival rates for breast cancer are much worse for LMICs countries such as Brazil, India, and Algeria in comparison with the United States and Sweden. Paucity of early detection programs explain these poor survival rates, which results in a high proportion of women presenting with late-stage disease, along with lack of adequate diagnosis and treatment facilities. Emphasis is urgently needed on health education, to promote early diagnosis of breast cancer, highlighting the importance of creating more public facilities that provide treatment, which are key components for the improvement in breast cancer care in developing countries.
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Affiliation(s)
- Monica M Rivera-Franco
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Eucario Leon-Rodriguez
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Larsen IK, Myklebust TÅ, Johannesen TB, Møller B, Hofvind S. Stage-specific incidence and survival of breast cancer in Norway: The implications of changes in coding and classification practice. Breast 2018; 38:107-113. [PMID: 29306771 DOI: 10.1016/j.breast.2017.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/23/2017] [Accepted: 12/02/2017] [Indexed: 11/30/2022] Open
Abstract
To describe the association between coding and classification practices and observed stage-specific incidence and survival trends in Norway over time. We identified all women diagnosed with invasive breast cancer in the period between 1980 and 2015. Changes in the coding and classification of breast cancer in the study period were described, and stage-specific incidence rates and relative survival were calculated. A total of 90 362 women were diagnosed with primary breast cancer, stage I-IV, or unknown stage, in the study period. Stage-specific incidence was significantly influenced by changes in coding practice, classification systems and the implementation of the screening program. These changes have mostly affected the proportion of stage I and "unknown", but also stages II, III and IV. The proportion of stage I showed a clear increase during the implementation period of the national screening program, and was most pronounced within the age group 50-69. Stage-specific trends for relative survival were less influenced by changes in coding and classification of stage. Our study showed that the stage-specific incidence trends in Norway were influenced by changes in the coding and classification practice. These findings should be taken into consideration in future research and evaluation related to stage-specific trends and stage migration of breast cancer in Norway.
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Affiliation(s)
- Inger Kristin Larsen
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Norway.
| | - Tor Åge Myklebust
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Norway; Department of Research and Innovation, Møre and Romsdal Hospital Trust, Norway.
| | - Tom Børge Johannesen
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Norway.
| | - Bjørn Møller
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Norway.
| | - Solveig Hofvind
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Norway; Oslo and Akershus University College of Applied Sciences, Norway.
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Başaran GA, Twelves C, Diéras V, Cortés J, Awada A. Ongoing unmet needs in treating estrogen receptor-positive/HER2-negative metastatic breast cancer. Cancer Treat Rev 2017; 63:144-155. [PMID: 29329006 DOI: 10.1016/j.ctrv.2017.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 12/26/2022]
Abstract
Estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2 negative (HER2-) advanced or metastatic breast cancer (MBC) is the most common MBC subtype and currently remains incurable, with a median overall survival of 24.8 months (95% confidence interval, 21.3-30.3). Common sites of metastases are bone, viscera, and brain, causing significant symptoms that negatively affect patient functioning, quality of life (QoL), and work productivity. Guidelines state that endocrine therapy (ET) is preferable to chemotherapy as first-line treatment for patients with ER+ MBC, regardless of limited visceral metastases, unless rapid tumor response is required or ET resistance is suspected. Although response rates up to 40% have been reported for first-line MBC treatment, the majority of initial responders eventually develop ET resistance. Notwithstanding the steep decline in efficacy between first and later lines of ET, some patients may receive chemotherapy earlier than necessary. Although new treatments have been approved for patients with ER+/HER2- advanced or MBC in the past decade, neither survival nor QoL appear to have improved significantly. Thus, there remain significant unmet needs for this patient population, including improved survival, maintaining or improving patient QoL, and emphasizing the importance of treatment selection to assist healthcare practitioners managing patient care. In this review, we identify current challenges and unmet needs in this patient population, review cutting-edge treatments, and provide clinically relevant suggestions for treatment selection that can optimize outcomes and patients' health-related QoL.
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Affiliation(s)
- Gül A Başaran
- Department of Medical Oncology, Acıbadem University School of Medicine, Istanbul, Turkey.
| | - Chris Twelves
- Cancer Research UK Clinical Centre, St James' University Hospital, Leeds, UK.
| | | | - Javier Cortés
- Medical Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain; Medical Oncology Department, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
| | - Ahmad Awada
- Medical Oncology Clinic, Institut Jules Bordet Universite Libre de Bruxelles, Brussels, Belgium.
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