351
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The potential of liquid biopsies for the early detection of cancer. NPJ Precis Oncol 2017; 1:36. [PMID: 29872715 PMCID: PMC5871864 DOI: 10.1038/s41698-017-0039-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 02/07/2023] Open
Abstract
Precision medicine refers to the choosing of targeted therapies based on genetic data. Due to the increasing availability of data from large-scale tumor genome sequencing projects, genome-driven oncology may have enormous potential to change the clinical management of patients with cancer. To this end, components of tumors, which are shed into the circulation, i.e., circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), or extracellular vesicles, are increasingly being used for monitoring tumor genomes. A growing number of publications have documented that these “liquid biopsies” are informative regarding response to given therapies, are capable of detecting relapse with lead time compared to standard measures, and reveal mechanisms of resistance. However, the majority of published studies relate to advanced tumor stages and the use of liquid biopsies for detection of very early malignant disease stages is less well documented. In early disease stages, strategies for analysis are in principle relatively similar to advanced stages. However, at these early stages, several factors pose particular difficulties and challenges, including the lower frequency and volume of aberrations, potentially confounding phenomena such as clonal expansions of non-tumorous tissues or the accumulation of cancer-associated mutations with age, and the incomplete insight into driver alterations. Here we discuss biology, technical complexities and clinical significance for early cancer detection and their impact on precision oncology.
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352
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Toyoda Y, Tabuchi T, Nakayama T, Hojo S, Yoshioka S, Wakabayashi Y, Maeura Y. Trends in the clinical stage distribution of breast cancer in Osaka, Japan. Breast Cancer 2017; 25:250-256. [PMID: 29027114 DOI: 10.1007/s12282-017-0807-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022]
Abstract
We examined the proportion of screen-detected breast cancer cases and clinical stage distribution by age group among female breast cancer cases in Osaka, Japan using population-based cancer registry from the period 1980 to 2012. The proportion of local cases increased and that of regional cases decreased gradually during the study period. The proportion of distant cases leveled off. The proportion of in situ cases increased rapidly after 2003. This increase was noticeable for women aged 30-39, 40-49, 50-59, and 60-69 years. The proportion of in situ cases for women aged 40-49, 50-59, and 60-69 years reached 15.4, 11.3, and 9.9% in 2010-2012, respectively. Regarding screening status, the proportion of screen-detected cases before 1988 was under 3%. Between 1989 and 2003, it leveled off at around 5%. After 2003, the proportion increased noticeably, and reached 25.4%:34.0% in aged 40-49 years, 32.8% in aged 50-59 years, and 26.7% in aged 60-69 years. The increase in local cases and decrease in regional cases would be due to awareness of breast cancer, probably a result of developments in medical diagnostic technology. On the other hand, the steep increase of in situ cases might be due to screening. We need careful monitoring of the trends in breast cancer incidence by clinical stage.
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Affiliation(s)
- Yasuhiro Toyoda
- Department of Surgery, Saiseikai Senri Hospital, 1-6, Tsukumodai 1-chome, Suita-shi, Osaka, 565-0862, Japan.
- Cancer Control Center, Osaka International Cancer Center, 1-69, Otemae 3-chome, Chuo-ku, Osaka-shi, Osaka, 541-8567, Japan.
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Center, 1-69, Otemae 3-chome, Chuo-ku, Osaka-shi, Osaka, 541-8567, Japan
| | - Tomio Nakayama
- Cancer Control Center, Osaka International Cancer Center, 1-69, Otemae 3-chome, Chuo-ku, Osaka-shi, Osaka, 541-8567, Japan
| | - Shigeyuki Hojo
- Department of Surgery, Saiseikai Senri Hospital, 1-6, Tsukumodai 1-chome, Suita-shi, Osaka, 565-0862, Japan
| | - Setsuko Yoshioka
- Department of Surgery, Saiseikai Senri Hospital, 1-6, Tsukumodai 1-chome, Suita-shi, Osaka, 565-0862, Japan
| | - Yukiko Wakabayashi
- Department of Nursing, Saiseikai Senri Hospital, 1-6, Tsukumodai 1-chome, Suita-shi, Osaka, 565-0862, Japan
| | - Yoshiichi Maeura
- Department of Surgery, Saiseikai Senri Hospital, 1-6, Tsukumodai 1-chome, Suita-shi, Osaka, 565-0862, Japan
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353
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Dasgupta P, Youl PH, Aitken JF, Turrell G, Baade P. Geographical differences in risk of advanced breast cancer: Limited evidence for reductions over time, Queensland, Australia 1997-2014. Breast 2017; 36:60-66. [PMID: 28985515 DOI: 10.1016/j.breast.2017.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/05/2017] [Accepted: 09/27/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Reducing geographical inequalities in breast cancer stage remains a key focus of public health policy. We explored whether patterns of advanced breast cancer by residential accessibility and disadvantage in Queensland, Australia, have changed over time. METHODS Population-based cancer registry study of 38,706 women aged at least 30 years diagnosed with a first primary invasive breast cancer of known stage between 1997 and 2014. Multilevel logistic regression was used to examine temporal changes in associations of area-level factors with odds of advanced disease after adjustment for individual-level factors. RESULTS Overall 19,401 (50%) women had advanced breast cancer. Women from the most disadvantaged areas had higher adjusted odds (OR = 1.23 [95%CI 1.13, 1.32]) of advanced disease than those from least disadvantaged areas, with no evidence this association had changed over time (interaction p = 0.197). Living in less accessible areas independently increased the adjusted odds (OR = 1.18 [1.09, 1.28]) of advanced disease, with some evidence that the geographical inequality had reduced over time (p = 0.045). Sensitivity analyses for un-staged cases showed that the original associations remained, regardless of assumptions made about the true stage distribution. CONCLUSIONS Both geographical and residential socioeconomic inequalities in advanced stage diagnoses persist, potentially reflecting barriers in accessing diagnostic services. Given the role of screening mammography in early detection of breast cancer, the lack of population-based data on private screening limits our ability to determine overall participation rates by residential characteristics. Without such data, the efficacy of strategies to reduce inequalities in breast cancer stage will remain compromised.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Council Queensland, PO Box 201, Spring Hill, QLD 4004, Australia.
| | - Philippa H Youl
- University of the Sunshine Coast, Sippy Downs, QLD, 4556, Australia.
| | - Joanne F Aitken
- Cancer Council Queensland, PO Box 201, Spring Hill, QLD 4004, Australia; School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD, 4059, Australia; School of Population Health, University of Queensland, Brisbane, Australia.
| | - Gavin Turrell
- Institute for Health and Ageing, Australian Catholic University, Melbourne, 3065, Victoria, Australia.
| | - Peter Baade
- Cancer Council Queensland, PO Box 201, Spring Hill, QLD 4004, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, 4222, Australia; School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD, 4000, Australia.
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354
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Baker SG, Prorok PC, Kramer BS. Editorial: Challenges in Quantifying Overdiagnosis. J Natl Cancer Inst 2017; 109:3845956. [PMID: 29117354 DOI: 10.1093/jnci/djx064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/13/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stuart G Baker
- Affiliation of authors: Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Philip C Prorok
- Affiliation of authors: Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Barnett S Kramer
- Affiliation of authors: Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
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355
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Introduction of an organised programme and social inequalities in mammography screening: A 22-year population-based study in Geneva, Switzerland. Prev Med 2017; 103:49-55. [PMID: 28778819 DOI: 10.1016/j.ypmed.2017.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/28/2017] [Accepted: 07/24/2017] [Indexed: 12/15/2022]
Abstract
In developed countries, breast cancer mortality has decreased during the last decades due to, at least partially, the advent of mammography screening. Organised programmes aim, among other objectives, to increase participation and decrease social inequalities in screening access. We aimed to characterise the evolution of socioeconomic disparities in mammography screening before and after the implementation of an organised programme in Geneva, Switzerland. We included 5345 women, aged 50-74years, without past history of breast cancer who participated in the cross-sectional Bus Santé study, between 1992 and 2014. Outcome measures were: 1) never had a mammography (1992-2014) and 2) never had a mammography or not screened in the two years before being surveyed (subgroup analysis, 2007-2014). Educational attainment was divided in three groups (primary, secondary and tertiary) and period in two (before/after introduction of a screening programme in 1999). We calculated measures of relative and absolute change, including the relative (RII) and slope (SII) indices of social inequality adjusted for age and nationality. We compared the prevalence of screening before and after screening programme implementation using Poisson models. The proportion of unscreened women decreased during the study period from 30.5% to 3.6%. Lower educated women were more frequently unscreened (RII=2.39, p<0.001; SII=0.10, p<0.001). Organised screening decreased the proportion of unscreened women independently of education (prevalence ratiobefore vs. after=4.41, p<0.001), but absolute and relative inequalities persisted (RII=2.11, p=0.01; SII=0.04, p=0.01). Introduction of an organised programme increased women's adherence to mammography screening but did not eliminate social disparities in screening participation.
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356
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Freedman RA, Keating NL, Pace LE, Lii J, McCarthy EP, Schonberg MA. Use of Surveillance Mammography Among Older Breast Cancer Survivors by Life Expectancy. J Clin Oncol 2017; 35:3123-3130. [PMID: 28749724 PMCID: PMC5597254 DOI: 10.1200/jco.2016.72.1209] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose The benefits of annual surveillance mammography in older breast cancer survivors with limited life expectancy are not known, and there are important risks; however, little is known about mammography use among these women. Materials and Methods We used National Health Interview Study data from 2000, 2005, 2008, 2010, 2013, and 2015 to examine surveillance mammography use among women age ≥ 65 years who reported a history of breast cancer. Using multivariable logistic regression, we assessed the probability of mammography within the last 12 months by 5- and 10-year life expectancy (using the validated Schonberg index), adjusting for survey year, region, age, marital status, insurance, educational attainment, and indicators of access to care. Results Of 1,040 respondents, 33.7% were age ≥ 80 years and 88.6% were white. Approximately 8.6% and 35.1% had an estimated life expectancy of ≤ 5 and ≤ 10 years, respectively. Overall, 78.9% reported having routine surveillance mammography in the last 12 months. Receipt of mammography decreased with decreasing life expectancy ( P < .001), although 56.7% and 65.9% of those with estimated ≤ 5-year and ≤ 10-year life expectancy, respectively, reported mammography in the last year. Conversely, 14.1% of those with life expectancy > 10 years did not report mammography. In adjusted analyses, lower ( v higher) life expectancy was significantly associated with lower odds of mammography (odds ratio, 0.4; 95% CI, 0.3 to 0.8 for ≤ 5-year life expectancy and OR, 0.4; 95% CI, 0.3 to 0.6 for ≤ 10-year life expectancy). Conclusion Many (57%) older breast cancer survivors with an estimated short life expectancy (< 5 years) receive annual surveillance mammography despite unknown benefits, whereas 14% with estimated life expectancy > 10 years did not report mammography. Practice guidelines are needed to optimize and tailor follow-up care for older patients.
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Affiliation(s)
- Rachel A. Freedman
- Rachel A. Freedman, Dana-Farber Cancer Institute; Nancy L. Keating and Ellen P. McCarthy, Harvard Medical School; Nancy L. Keating, Lydia E. Pace, and Joyce Lii, Brigham and Women’s Hospital; and Ellen P. McCarthy and Mara A. Schonberg, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Nancy L. Keating
- Rachel A. Freedman, Dana-Farber Cancer Institute; Nancy L. Keating and Ellen P. McCarthy, Harvard Medical School; Nancy L. Keating, Lydia E. Pace, and Joyce Lii, Brigham and Women’s Hospital; and Ellen P. McCarthy and Mara A. Schonberg, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Lydia E. Pace
- Rachel A. Freedman, Dana-Farber Cancer Institute; Nancy L. Keating and Ellen P. McCarthy, Harvard Medical School; Nancy L. Keating, Lydia E. Pace, and Joyce Lii, Brigham and Women’s Hospital; and Ellen P. McCarthy and Mara A. Schonberg, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Joyce Lii
- Rachel A. Freedman, Dana-Farber Cancer Institute; Nancy L. Keating and Ellen P. McCarthy, Harvard Medical School; Nancy L. Keating, Lydia E. Pace, and Joyce Lii, Brigham and Women’s Hospital; and Ellen P. McCarthy and Mara A. Schonberg, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ellen P. McCarthy
- Rachel A. Freedman, Dana-Farber Cancer Institute; Nancy L. Keating and Ellen P. McCarthy, Harvard Medical School; Nancy L. Keating, Lydia E. Pace, and Joyce Lii, Brigham and Women’s Hospital; and Ellen P. McCarthy and Mara A. Schonberg, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Mara A. Schonberg
- Rachel A. Freedman, Dana-Farber Cancer Institute; Nancy L. Keating and Ellen P. McCarthy, Harvard Medical School; Nancy L. Keating, Lydia E. Pace, and Joyce Lii, Brigham and Women’s Hospital; and Ellen P. McCarthy and Mara A. Schonberg, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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357
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Schiller-Fruehwirth I, Jahn B, Einzinger P, Zauner G, Urach C, Siebert U. The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1048-1057. [PMID: 28964436 DOI: 10.1016/j.jval.2017.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 04/02/2017] [Accepted: 04/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND In 2014, Austrian health authorities implemented an organized breast cancer screening program. Until then, there has been a long-standing tradition of opportunistic screening. OBJECTIVES To evaluate the cost-effectiveness of organized screening compared with opportunistic screening, as well as to identify factors influencing the clinical and economic outcomes. METHODS We developed and validated an individual-level state-transition model and assessed the health outcomes and costs of organized and opportunistic screening for 40-year-old asymptomatic women. The base-case analysis compared a scenario involving organized biennial screening with a scenario reflecting opportunistic screening practice for an average-risk woman aged 45 to 69 years. We applied an annual discount rate of 3% and estimated the incremental cost-effectiveness ratio in terms of the cost (2012 euros) per life-year gained (LYG) from a health care perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. RESULTS Compared with opportunistic screening, an organized program yielded on average additional 0.0118 undiscounted life-years (i.e., 4.3 days) and cost savings of €41 per woman. In the base-case analysis, the incremental cost-effectiveness ratio of organized screening was approximately €20,000 per LYG compared with no screening. Assuming a willingness-to-pay threshold of €50,000 per LYG, there was a 70% probability that organized screening would be considered cost-effective. The attendance rate, but not the test accuracy of mammography, was an influential factor for the cost-effectiveness. CONCLUSIONS The decision to adopt organized screening is likely an efficient use of limited health care resources in Austria.
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Affiliation(s)
- Irmgard Schiller-Fruehwirth
- Department of Evidence-Based Economic Health Care, Main Association of Austrian Social Security Institutions, Vienna, Austria; Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
| | - Beate Jahn
- Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Patrick Einzinger
- dwh Simulation Services, Vienna, Austria; Institute for Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria
| | | | | | - Uwe Siebert
- Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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358
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Wong G, Au E, Badve SV, Lim WH. Breast Cancer and Transplantation. Am J Transplant 2017; 17:2243-2253. [PMID: 28544474 DOI: 10.1111/ajt.14368] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/12/2017] [Accepted: 05/04/2017] [Indexed: 01/25/2023]
Abstract
Breast cancer is an important cancer among solid organ transplant recipients. While the incidence of breast cancer in solid organ transplant recipients is comparable to the age-matched general population, the outcomes are generally poor. Interventions such as cancer screening that preclude the development of late-stage disease through early detection are not well studied, and clinical practice guidelines for cancer screening rely solely on recommendations from the general population. Among patients with a prior breast cancer history, disease recurrence after transplantation is a rare but fearful event. Once disease recurs, the risk of death is high. The focus of this review is to present the epidemiology of breast cancer in solid organ transplant recipients, screening and preventive strategies for those who may be at risk, novel genomic profiling for determining tumor progression, and the newer targeted interventions for recipients who have developed breast cancers after solid organ transplantation.
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Affiliation(s)
- G Wong
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - E Au
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - S V Badve
- Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia
| | - W H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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359
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Lee J, Park HY, Kim WW, Jeong JY, Lee YD, Choi MH, Kim S, Park JY, Jung JH. Combination Treatment with Photodynamic Therapy and Laser Ablation in Breast Cancer: An Animal Model Study. Photomed Laser Surg 2017; 35:505-512. [DOI: 10.1089/pho.2017.4291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jeeyeon Lee
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Wan Wook Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Ji Yun Jeong
- Department of Pathology, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Yong-Deok Lee
- Center for Theragnosis, Korea Institute of Science and Technology, Republic of Korea
| | - Mi-Hwa Choi
- Center for Theragnosis, Korea Institute of Science and Technology, Republic of Korea
| | - Sehoon Kim
- Center for Theragnosis, Korea Institute of Science and Technology, Republic of Korea
| | - Ji-Young Park
- Department of Pathology, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jin Hyang Jung
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
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360
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Vallès Fernández R, González Martín-Moro J, Prat Gil N, Bonet Simó JM, Mingo-Botín D. Too much Ophthalmology? Ophthalmology in the era of over-diagnosis and over-treatment. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2017; 92:403-405. [PMID: 28502639 DOI: 10.1016/j.oftal.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 06/07/2023]
Affiliation(s)
- R Vallès Fernández
- Dirección de Atención Primaria Metropolitana Nord, Institut Català de la Salut, Barcelona, España.
| | - J González Martín-Moro
- Servicio de Oftalmología, Hospital Universitario del Henares, Madrid, España; Grado de Medicina, Universidad Francisco de Vitoria, Madrid, España
| | - N Prat Gil
- Dirección de Atención Primaria Metropolitana Nord, Institut Català de la Salut, Barcelona, España
| | - J M Bonet Simó
- Dirección de Atención Primaria Metropolitana Nord, Institut Català de la Salut, Barcelona, España
| | - D Mingo-Botín
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España
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361
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Sagara Y, Julia W, Golshan M, Toi M. Paradigm Shift toward Reducing Overtreatment of Ductal Carcinoma In Situ of Breast. Front Oncol 2017; 7:192. [PMID: 28894698 PMCID: PMC5581351 DOI: 10.3389/fonc.2017.00192] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/11/2017] [Indexed: 12/27/2022] Open
Abstract
The prevalence of ductal carcinoma in situ (DCIS) of the breast has increased substantially after the introduction of breast cancer screening programs, although the clinical effects of early DCIS detection and treatment remain unclear. The standard treatment for DCIS has involved local breast-conserving surgery (BCS) followed by radiotherapy (RT) or total mastectomy with/without endocrine therapy, and the choice of local treatment is not usually based on clinicopathologic or biological factors. However, we have investigated the effectiveness of local treatment using breast surgery and RT using Surveillance, Epidemiology, and End Results data, and found that the effectiveness of breast surgery was modified by the nuclear grade. Furthermore, breast cancer-specific survival was identical between patients with low-grade DCIS who did and did not undergo surgery. Moreover, we found that RT after BCS for DCIS was only associated with a survival benefit among patients with risk factors for local recurrence, such as nuclear grade, age, and tumor size. Ongoing clinical trials and translational research have attempted to develop a treatment strategy that prevents the overdiagnosis and overtreatment of low-risk DCIS, as well as a biology-based treatment strategy for using targeted therapy. Therefore, to develop a tailored treatment strategy for DCIS, we need to identify molecular and biological classifications based on the results from translational research, national databases, and clinical trials.
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Affiliation(s)
- Yasuaki Sagara
- Breast Cancer Unit, Kyoto University Hospital Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Breast Surgical Oncology, Hakuaikai Social Medical Cooperation, Kagoshima, Japan.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Wong Julia
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Mehra Golshan
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Masakazu Toi
- Breast Cancer Unit, Kyoto University Hospital Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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362
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Raffin E, Onega T, Bynum J, Austin A, Carmichael D, Bronner K, Goodney P, Hyams ES. Are there regional tendencies toward controversial screening practices? A study of prostate and breast cancer screening in a Medicare population. Cancer Epidemiol 2017; 50:68-75. [PMID: 28822325 DOI: 10.1016/j.canep.2017.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Prostate and breast cancer screening in older patients continue to be controversial. Balancing the desire for early detection with avoidance of over-diagnosis has led to competing and contradictory guidelines for both practices. Despite similarities, it is not known how these screening practices are related at the regional level. In this study, we examined how screening PSA and mammography are related within healthcare regions, and, to better understand what may be driving these practices, whether they are associated with local intensity of care. METHODS We performed a retrospective cross-sectional study of fee-for-service Medicare beneficiaries in 2012. For each of 306 hospital referral regions (HRRs), we calculated rates of PSA screening for men aged ≥68 years, as well as rates of screening mammography for women aged ≥75 years, adjusted for age and race. Additionally, we determined regional rates of "healthcare intensity", including spending on tests and procedures, and intensity of end-of-life care. Pearson correlations of adjusted rates were calculated within HRRs. RESULTS The mean adjusted rate of PSA screening was 22%. The mean age of screened and unscreened patients was 75.0 and 77.4 years, respectively (p<0.0001). The mean adjusted rate of screening mammography was 23%; mean ages of screened and non-screened women were 79.95 and 83.67, respectively (p<0.0001). HRR-level PSA screening rates were independent of screening mammography rates (r=0.06, p=0.31). PSA screening rates were associated with spending on testing and procedures (r=0.42, p<0.0001) and various measures of intensity of EOL care (e.g. r=0.40, p<0.0001 for mechanical ventilator use). Screening mammography had low correlation with both health care spending and EOL care intensity measures (all r-values <0.3). CONCLUSIONS Regional rates of PSA screening rates were independent of screening mammography, thus these practices appear to be driven by different factors. Unlike mammography, PSA screening was associated with local enthusiasm for testing and treatment. Efforts to reduce over-testing should contemplate these practices differently, and future research should examine the factors motivating these screening practices.
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Affiliation(s)
- Eric Raffin
- Section of Urology, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Suite 5B, Lebanon, NH 03756, United States.
| | - Tracy Onega
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States
| | - Julie Bynum
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States
| | - Andrea Austin
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States
| | - Donald Carmichael
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States
| | - Kristen Bronner
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States
| | - Philip Goodney
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States; Department of Surgery, Dartmouth Hitchcock Medical Center, United States
| | - Elias S Hyams
- Department of Urology, Columbia University Medical Center, United States
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363
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López-Soto A, Gonzalez S, Smyth MJ, Galluzzi L. Control of Metastasis by NK Cells. Cancer Cell 2017; 32:135-154. [PMID: 28810142 DOI: 10.1016/j.ccell.2017.06.009] [Citation(s) in RCA: 489] [Impact Index Per Article: 69.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/21/2017] [Accepted: 06/22/2017] [Indexed: 12/24/2022]
Abstract
The metastatic spread of malignant cells to distant anatomical locations is a prominent cause of cancer-related death. Metastasis is governed by cancer-cell-intrinsic mechanisms that enable neoplastic cells to invade the local microenvironment, reach the circulation, and colonize distant sites, including the so-called epithelial-to-mesenchymal transition. Moreover, metastasis is regulated by microenvironmental and systemic processes, such as immunosurveillance. Here, we outline the cancer-cell-intrinsic and -extrinsic factors that regulate metastasis, discuss the key role of natural killer (NK) cells in the control of metastatic dissemination, and present potential therapeutic approaches to prevent or target metastatic disease by harnessing NK cells.
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Affiliation(s)
- Alejandro López-Soto
- Departamento de Biología Funcional, Área de Inmunología, Universidad de Oviedo, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), 33006 Oviedo, Asturias, Spain.
| | - Segundo Gonzalez
- Departamento de Biología Funcional, Área de Inmunología, Universidad de Oviedo, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), 33006 Oviedo, Asturias, Spain
| | - Mark J Smyth
- Immunology of Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia
| | - Lorenzo Galluzzi
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY 10065, USA; Sandra and Edward Meyer Cancer Center, New York, NY 10065, USA; Université Paris Descartes/Paris V, 75006 Paris, France.
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364
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Badal K, Rampersad F, Warner WA, Toriola AT, Mohammed H, Scheffel HA, Ali R, Moosoodeen M, Konduru S, Russel A, Haraksingh R. A situational analysis of breast cancer early detection services in Trinidad and Tobago. Cancer Causes Control 2017; 29:33-42. [DOI: 10.1007/s10552-017-0937-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023]
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365
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Grimm LJ, Ryser MD, Partridge AH, Thompson AM, Thomas JS, Wesseling J, Hwang ES. Surgical Upstaging Rates for Vacuum Assisted Biopsy Proven DCIS: Implications for Active Surveillance Trials. Ann Surg Oncol 2017; 24:3534-3540. [PMID: 28795370 DOI: 10.1245/s10434-017-6018-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE This study was designed to determine invasive cancer upstaging rates at surgical excision following vacuum-assisted biopsy of ductal carcinoma in situ (DCIS) among women meeting eligibility for active surveillance trials. METHODS Patients with vacuum-assisted, biopsy-proven DCIS at a single center from 2008 to 2015 were retrospectively reviewed. Imaging and pathology reports were interrogated for the imaging appearance, tumor grade, hormone receptor status, and presence of comedonecrosis. Subsequent surgical reports were reviewed for upstaging to invasive disease. Cases were classified by eligibility criteria for the COMET, LORIS, and LORD DCIS active surveillance trials. RESULTS Of 307 DCIS diagnoses, 15 (5%) were low, 95 (31%) intermediate, and 197 (64%) high nuclear grade. The overall upstage rate to invasive disease was 17% (53/307). Eighty-one patients were eligible for the COMET Trial, 74 for the LORIS trial, and 10 for the LORD Trial, although LORIS trial eligibility also included real-time, multiple central pathology review, including elements not routinely reported. The upstaging rates to invasive disease were 6% (5/81), 7% (5/74), and 10% (1/10) for the COMET, LORIS, and LORD trials, respectively. Among upstaged cancers (n = 5), four tumors were Stage IA invasive ductal carcinoma and one was Stage IIA invasive lobular carcinoma; all were node-negative. CONCLUSIONS DCIS upstaging rates in women eligible for active surveillance trials are low (6-10%), and in this series, all those with invasive disease were early-stage, node-negative. The careful patient selection for DCIS active surveillance trials has a low risk of missing occult invasive cancer and additional studies will determine clinical outcomes.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University, Durham, NC, USA
| | - Marc D Ryser
- Department of Mathematics, Duke University, Durham, NC, USA
| | - Ann H Partridge
- Division of Oncology, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alastair M Thompson
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeremy S Thomas
- Department of Pathology, Western General Hospital, Edinburgh, UK
| | - Jelle Wesseling
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - E Shelley Hwang
- Department of Surgery, Duke University Comprehensive Cancer Center, Durham, NC, USA.
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366
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de Nonneville A, Gonçalves A, Zemmour C, Cohen M, Classe JM, Reyal F, Colombo PE, Jouve E, Giard S, Barranger E, Sabatier R, Bertucci F, Boher JM, Houvenaeghel G. Adjuvant chemotherapy in pT1ab node-negative triple-negative breast carcinomas: Results of a national multi-institutional retrospective study. Eur J Cancer 2017; 84:34-43. [PMID: 28780480 DOI: 10.1016/j.ejca.2017.06.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/19/2017] [Accepted: 06/27/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Triple-negative breast cancers (TNBCs) are considered as associated with poor outcome, but prognosis of subcentimetric, node-negative disease remains controversial and evidence that adjuvant chemotherapy (CT) is effective in these small tumours remains limited. PATIENTS AND METHODS Our objective was to investigate the impact of CT on survival in pT1abN0M0 TNBC. Patients were retrospectively identified from a cohort of 22,475 patients who underwent primary surgery in 15 French centres between 1987 and 2013. As rare pathological types may display very particular prognoses in these tumours, we retained only the invasive ductal carcinomas of no special type according to the last World Health Organisation (WHO) classification which is the most common TNBC histological type. End-points were disease-free survival (DFS) and metastasis-free survival (MFS). A propensity score for receiving CT was estimated using a logistic regression including age, tumour size, Scarff Bloom and Richardson (SBR) grade and lymphovascular invasion. RESULTS Of a total of 284 patients with pT1abN0M0 ductal TNBC, 144 (51%) received CT and 140 (49%) did not. Patients receiving CT had more adverse prognostic features, such as tumour size, high grade, young age, and lymphovascular invasion. CT was not associated with a significant benefit for DFS (Hazard ratio, HR = 0.77 [0.40-1.46]; p = 0.419, log-rank test) or MFS (HR = 1.00 [0.46-2.19]; p = 0.997), with 5-year DFS and MFS in the group with CT versus without of 90% [81-94%] versus 84% [74-90%], and 90% [81-95%] versus 90% [83%-95%], respectively. Results were consistent in all supportive analyses including multivariate Cox model and the use of the propensity score for adjustment and as a matching factor for case-control analyses. CONCLUSIONS This study did not identify a significant DFS or MFS advantage for CT in subcentimetric, node-negative ductal TNBC. Although current consensus guidelines recommend consideration of CT in all TNBC larger than 5 mm, clinicians should carefully discuss benefit/risk ratio with patients, given the unproven benefits.
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Affiliation(s)
- A de Nonneville
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France.
| | - A Gonçalves
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France.
| | - C Zemmour
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - M Cohen
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, Marseille, France
| | - J M Classe
- Institut René Gauducheau, Saint-Herblain, France
| | - F Reyal
- Institut Curie, Paris, France
| | | | - E Jouve
- Institut Claudius Regaud, Toulouse, France
| | - S Giard
- Centre Oscar Lambret, Lille, France
| | | | - R Sabatier
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - F Bertucci
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - J M Boher
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - G Houvenaeghel
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, Marseille, France
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367
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Trends in adjuvant therapies after breast-conserving surgery for hormone receptor-positive ductal carcinoma in situ: findings from the National Cancer Database, 2004-2013. Breast Cancer Res Treat 2017; 166:583-592. [PMID: 28776282 DOI: 10.1007/s10549-017-4436-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Breast-conserving surgery (BCS) followed by radiotherapy (RT) with or without endocrine therapy (ET) is a standard treatment option for ductal carcinoma in situ (DCIS). We sought to investigate national patterns in the use of adjuvant therapy after BCS for hormone receptor (HR)-positive DCIS over time. PATIENTS AND METHODS Using data from the National Cancer Data Base, we identified patients diagnosed with DCIS and treated with BCS between 2004 and 2013. Multivariable logistic regression was used to estimate the odds of adjuvant therapy use controlling for clinicopathologic demographic and facility-level characteristics. RESULTS We identified 66,079 patients who underwent BCS for DCIS. Overall, 21% received no adjuvant treatment, 71% received RT, 48% received ET, and 38% received the combination therapy. In adjusted analyses among the patients with HR-positive DCIS (n = 50,147), the administration of RT decreased (odds ratio [OR] 0.86, 95% CI 0.77-0.97), while the use of ET increased (OR 1.5, 95% CI 1.4-1.6) in 2013 compared to 2004. Young patients, elderly patients, positive margin status, and Medicare insurance were associated with lower use of both RT and ET. We observed both clinicopathologic and geographic variation in the use of adjuvant therapies. In the lowest risk subgroup, the use of RT decreased from 57% in 2004 to 48% in 2013 (OR 0.64, 95% CI 0.45-0.89). CONCLUSION Our study suggests a shift in patterns of care for DCIS that is impacted by both clinicopathologic and demographic factors, with the use of RT decreasing and the use of ET increasing in HR-positive DCIS patients. Current trials are designed to address the possible over-treatment of low-risk DCIS.
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368
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Monfared A, Ghanbari A, Jansar Hosseini L, Norozi N. Status of Screening by Mammography and its Related Factors in the General Population of Women in Rasht. ACTA ACUST UNITED AC 2017. [DOI: 10.29252/ijn.30.107.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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369
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Lynge E, Beau AB, Lophaven S. Impact of assumptions - the example of the Welch-analysis of mammography screening effectiveness. Acta Oncol 2017; 56:1131-1133. [PMID: 28488450 DOI: 10.1080/0284186x.2017.1288921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Elsebeth Lynge
- a Department of Public Health , University of Copenhagen , Copenhagen , Denmark
| | - Anna-Belle Beau
- a Department of Public Health , University of Copenhagen , Copenhagen , Denmark
| | - Søren Lophaven
- a Department of Public Health , University of Copenhagen , Copenhagen , Denmark
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370
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Persistent Untreated Screening-Detected Breast Cancer: An Argument Against Delaying Screening or Increasing the Interval Between Screenings. J Am Coll Radiol 2017; 14:863-867. [DOI: 10.1016/j.jacr.2017.01.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 11/20/2022]
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371
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Kopans DB. The Breast Cancer Screening "Arcade" and the "Whack-A-Mole" Efforts to Reduce Access to Screening. Semin Ultrasound CT MR 2017; 39:2-15. [PMID: 29317036 DOI: 10.1053/j.sult.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The effort to reduce access to breast cancer screening has been going on for decades. As each piece of misinformation has been published, scientific responses have exposed the fallacies, but then new "alternative facts" are generated. The effort has been compared to the arcade game "Whack-a-Mole" in which one false argument is addressed only to have a new one "pop up" to replace it. This has ranged from the false claim that early detection would have no effect on breast cancer, to the fallacious idea that early detection was leading to early deaths among young women, to the more recent false suggestion that tens of thousands of breast cancers found by mammography would disappear if left undetected. The following is a short review of a number of nonscientifically derived "Moles" that have been "Whacked" by science.
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Affiliation(s)
- Daniel B Kopans
- Emeritus at the Harvard Medical School, 20 Manitoba Road, Waban, Massachusetts 02468, MA.
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372
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Huesch M, Chetlen A, Segel J, Schetter S. Frequencies of Private Mentions and Sharing of Mammography and Breast Cancer Terms on Facebook: A Pilot Study. J Med Internet Res 2017; 19:e201. [PMID: 28600279 PMCID: PMC5482928 DOI: 10.2196/jmir.7508] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/01/2017] [Accepted: 05/10/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The most popular social networking site in the United States is Facebook, an online forum where circles of friends create, share, and interact with each other's content in a nonpublic way. OBJECTIVE Our objectives were to understand (1) the most commonly used terms and phrases relating to breast cancer screening, (2) the most commonly shared website links that other women interacted with, and (3) the most commonly shared website links, by age groups. METHODS We used a novel proprietary tool from Facebook to analyze all of the more than 1.7 million unique interactions (comments on stories, reshares, and emoji reactions) and stories associated with breast cancer screening keywords that were generated by more than 1.1 million unique female Facebook users over the 1 month between November 15 and December 15, 2016. We report frequency distributions of the most popular shared Web content by age group and keywords. RESULTS On average, each of 59,000 unique stories during the month was reshared 1.5 times, commented on nearly 8 times, and reacted to more than 20 times by other users. Posted stories were most often authored by women aged 45-54 years. Users shared, reshared, commented on, and reacted to website links predominantly to e-commerce sites (12,200/1.7 million, 36% of all the most popular links), celebrity news (n=8800, 26%), and major advocacy organizations (n=4900, 15%; almost all accounted for by the American Cancer Society breast cancer site). CONCLUSIONS On Facebook, women shared and reacted to links to commercial and informative websites regarding breast cancer and screening. This information could inform patient outreach regarding breast cancer screening, indirectly through better understanding of key issues, and directly through understanding avenues for paid messaging to women authoring and reacting to content in this space.
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Affiliation(s)
- Marco Huesch
- Milton S Hershey Medical Center, Department of Radiology, Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Alison Chetlen
- Milton S Hershey Medical Center, Department of Radiology, Breast Imaging Division, Penn State College of Medicine, Hershey, PA, United States
| | - Joel Segel
- Milton S Hershey Medical Center, Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, United States.,Penn State Cancer Institute, Penn State University, Hershey, PA, United States
| | - Susann Schetter
- Milton S Hershey Medical Center, Department of Radiology, Breast Imaging Division, Penn State College of Medicine, Hershey, PA, United States
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373
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Lannin DR, Wang S. Are Small Breast Cancers Good because They Are Small or Small because They Are Good? N Engl J Med 2017; 376:2286-91. [PMID: 28591529 DOI: 10.1056/nejmsr1613680] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Donald R Lannin
- From the Department of Surgery, Yale University School of Medicine (D.R.L.), Yale University School of Public Health (S.W.), and Yale Comprehensive Cancer Center (D.R.L., S.W.), New Haven, CT
| | - Shiyi Wang
- From the Department of Surgery, Yale University School of Medicine (D.R.L.), Yale University School of Public Health (S.W.), and Yale Comprehensive Cancer Center (D.R.L., S.W.), New Haven, CT
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374
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Analytical validation of a 12-gene molecular test for the prediction of distant recurrence in breast cancer. Future Sci OA 2017; 3:FSO221. [PMID: 28884016 PMCID: PMC5583651 DOI: 10.4155/fsoa-2017-0051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/18/2017] [Indexed: 11/30/2022] Open
Abstract
Aim: To validate the analytical performance of a 12-gene molecular assay that predicts distant recurrence for early-stage ER+/HER2- invasive breast cancer as run within a central reference laboratory. Materials & methods: Formalin-fixed paraffin-embedded breast resections were evaluated by quantitative reverse transcription polymerase chain reaction for the expression of eight target genes, three housekeeper genes and one control gene to assess for DNA contamination. Results: The assay results were highly correlated with a validated reference laboratory. The assay had a broad linear range for input RNA, with similar amplicon efficiencies for target and housekeeper genes. The assay test was highly reproducible, with comparable inter- and intrabatch precision to the reference laboratory. Conclusion: These studies demonstrate that the 12-gene molecular assay is highly robust and accurate. Several tests have been developed to aid in breast cancer treatment decisions by assessing the likelihood that an individual’s breast cancer will recur. One such test is a 12-gene molecular assay. This test provides a clinical score that combines molecular information from genes within the tumor with clinical information to determine whether a breast cancer is at high or low risk of recurrence. The data presented here show that this test is very reproducible and robust, making it appropriate and reliable for clinical use.
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375
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Affiliation(s)
- Jeffrey A Tice
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Karla Kerlikowske
- General Internal Medicine Section, Department of Veteran Affairs and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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376
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Barranger E, Delpech Y. [Breast cancer screening: The controversy continues… What's the interest for women?!]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2017; 45:325-326. [PMID: 28479072 DOI: 10.1016/j.gofs.2017.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Indexed: 06/07/2023]
Affiliation(s)
- E Barranger
- Pôle de chirurgie oncologique générale, gynécologique et mammaire, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France.
| | - Y Delpech
- Pôle de chirurgie oncologique générale, gynécologique et mammaire, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
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377
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Reduction in advanced breast cancer after introduction of a mammography screening program in Tyrol/Austria. Breast 2017; 33:178-182. [DOI: 10.1016/j.breast.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/01/2017] [Accepted: 04/04/2017] [Indexed: 11/21/2022] Open
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378
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Screening Mammography for Women in Their 40s: The Potential Impact of the American Cancer Society and U.S. Preventive Services Task Force Breast Cancer Screening Recommendations. AJR Am J Roentgenol 2017; 209:697-702. [PMID: 28504572 DOI: 10.2214/ajr.16.17759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to review screening mammograms obtained in one practice with the primary endpoint of determining the rate of detection of breast cancer and associated prognostic features in women 40-44 and 45-49 years old. MATERIALS AND METHODS The retrospective cohort study included women in their 40s with breast cancer detected at screening from June 2014 through May 2016. The focus was on cancer detection rate, pathologic findings, and risk factors. RESULTS A total of 32,762 screens were performed, and 808 biopsies were recommended. These biopsies yielded 224 breast cancers (cancer detection rate, 6.84 per 1000 screens). Women 40-49 years old had 18.8% of cancers detected; 50-59 years, 21.8%; 60-69 years, 32.6%; and 70-79 years, 21.4%. Among the 40- to 49-year-old women, women 40-44 years old underwent 5481 (16.7%) screens, had 132 biopsies recommended, and had 20 breast cancers detected (cancer detection rate, 3.6/1000). Women 45-49 years old underwent 5319 (16.2%) screens, had 108 biopsies recommended, and had 22 breast cancers detected (cancer detection rate, 4.1/1000). Thus, women 40-44 years old had 8.9% and women 45-49 years old had 9.8% of all screen-detected breast cancers. Of these only a small percentage of women with detected cancers had a first-degree relative with breast cancer (40-44 years, 15%; 45-49 years, 32%) or a BRCA mutation (40-44 years, 5%; 45-49 years, 5%), and over 60% of the cancers were invasive. CONCLUSION Women 40-49 years old had 18.8% of all screen-detected breast cancers. The two cohorts (40-44 and 45-49 years old) had similar incidences of screen-detected breast cancer (8.9%, 9.8%) and cancer detection rates within performance benchmark standards, supporting a similar recommendation for both cohorts and the American College of Radiology recommendation of annual screening mammography starting at age 40.
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379
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Suh DH, Kim M, Kim K, Kim HJ, Lee KH, Kim JW. Major clinical research advances in gynecologic cancer in 2016: 10-year special edition. J Gynecol Oncol 2017; 28:e45. [PMID: 28382802 PMCID: PMC5391398 DOI: 10.3802/jgo.2017.28.e45] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 12/11/2022] Open
Abstract
In 2016, 13 topics were selected as major research advances in gynecologic oncology. For ovarian cancer, study results supporting previous ones regarding surgical preventive strategies were reported. There were several targeted agents that showed comparable responses in phase III trials, including niraparib, cediranib, and nintedanib. On the contrary to our expectations, dose-dense weekly chemotherapy regimen failed to prove superior survival outcomes compared with conventional triweekly regimen. Single-agent non-platinum treatment to prolong platinum-free-interval in patients with recurrent, partially platinum-sensitive ovarian cancer did not improve and even worsened overall survival (OS). For cervical cancer, we reviewed robust evidences of larger-scaled population-based study and cost-effectiveness of nonavalent vaccine for expanding human papillomavirus (HPV) vaccine coverage. Standard of care treatment of locally advanced cervical cancer (LACC) was briefly reviewed. For uterine corpus cancer, new findings about appropriate surgical wait time from diagnosis to surgery were reported. Advantages of minimally invasive surgery over conventional laparotomy were reconfirmed. There were 5 new gene regions that increase the risk of developing endometrial cancer. Regarding radiation therapy, Post-Operative Radiation Therapy in Endometrial Cancer (PORTEC)-3 quality of life (QOL) data were released and higher local control rate of image-guided adaptive brachytherapy was reported in LACC. In addition, 4 general oncology topics followed: chemotherapy at the end-of-life, immunotherapy with reengineering T-cells, actualization of precision medicine, and artificial intelligence (AI) to make personalized cancer therapy real. For breast cancer, adaptively randomized trials, extending aromatase inhibitor therapy, and ribociclib and palbociclib were introduced.
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Affiliation(s)
- Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Miseon Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
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380
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Katz A. Family doctors should engage with patients about mammography. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alan Katz
- Manitoba Centre for Health Policy (MCHP); Departments of Community Health Sciences and Family Medicine; Max Rady College of Medicine; Rady Faculty of Health Sciences; University of Manitoba; Winnipeg Canada
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381
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Bleyer A. Missteps in Estimates of Cancer Overdiagnosis. Acad Radiol 2017; 24:516-517. [PMID: 28189504 DOI: 10.1016/j.acra.2017.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/21/2017] [Accepted: 01/21/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Archie Bleyer
- Department of Radiation Medicine, Knight Cancer Institute at Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098
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382
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Peairs KS, Choi Y, Stewart RW, Sateia HF. Screening for breast cancer. Semin Oncol 2017; 44:60-72. [PMID: 28395765 DOI: 10.1053/j.seminoncol.2017.02.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/29/2017] [Accepted: 02/06/2017] [Indexed: 02/07/2023]
Abstract
This review will give a general overview of the impact of breast cancer, as well as breast cancer risk factors, identification of high-risk groups, screening modalities, and guidelines for screening average-risk and high-risk individuals, including a case discussion of the primary care provider's approach to screening.
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Affiliation(s)
- Kimberly S Peairs
- Johns Hopkins School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
| | - Youngjee Choi
- Johns Hopkins School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Rosalyn W Stewart
- Johns Hopkins School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Heather F Sateia
- Johns Hopkins School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
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383
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Hosseini A, Khoury AL, Esserman LJ. Precision surgery and avoiding over-treatment. Eur J Surg Oncol 2017; 43:938-943. [PMID: 28238520 DOI: 10.1016/j.ejso.2017.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/04/2017] [Indexed: 10/20/2022] Open
Abstract
Over-diagnosis and over-treatment are consequences of greater awareness about breast cancer, more intensive screening, and the resultant identification of more cases of breast cancer that are low or ultralow risk. This area represents an important opportunity to optimize the delivery of appropriate targeted therapy for breast cancer patients. Despite the evolution of breast cancer care over the last few decades and our ability to tailor treatment to biology, a one-size fits all approach is still prevalent in the local and regional management of and screening for breast cancer, failing to reflect the unique biology and tumor characteristics of each patient. In this review, we explore how we can use new tools to better define tumor biology and also how we can change current clinical practices based on already available data. Every surgeon should be knowledgeable about how to craft personalized breast cancer care in the areas of systemic therapy, adjuvant radiation therapy, management of ductal carcinoma in situ (DCIS), precision surgery, and breast cancer screening.
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Affiliation(s)
- A Hosseini
- University of California, 1600 Divisadero, 2nd Floor Box 1710, San Francisco, CA 94115, USA.
| | - A L Khoury
- University of California, 1600 Divisadero, 2nd Floor Box 1710, San Francisco, CA 94115, USA.
| | - L J Esserman
- University of California, 1600 Divisadero, 2nd Floor Box 1710, San Francisco, CA 94115, USA.
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384
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Abstract
Unfortunately, a great deal of misinformation has accumulated in the breast cancer screening literature that is based on flawed analyses in an effort to reduce access to screening. Quite remarkably, much of this has come from publications in previously highly respected medical journals. In several papers the intervention (mammography screening) is faulted yet the analyses provided no data on who participated in mammography screening, and which cancers were detected by mammography screening. It is remarkable that a highly respected journal can fault an intervention with no data on the intervention. Claims of massive over diagnosis of invasive breast cancer due to breast cancer screening have been made using "guesses" that have no scientific basis. No one has ever seen a mammographically detected, invasive breast cancer, disappear on its own, yet analysts have claimed that this occurs thousands of times each year. In fact, the" miraculous" resolution, without intervention, of a handful of breast cancers have all been palpable cancers, yet there is no suggestion to stop treating palpable cancers. A review of several publications in the New England Journal of Medicine shows some of the flaws in these analyses. There is clearly a problem with peer review that is allowing scientifically unsupportable material, which is misleading women and their physicians, to be published in prestigious journals.
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385
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Toledo-Chávarri A, Rué M, Codern-Bové N, Carles-Lavila M, Perestelo-Pérez L, Pérez-Lacasta MJ, Feijoo-Cid M. A qualitative study on a decision aid for breast cancer screening: Views from women and health professionals. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28145105 DOI: 10.1111/ecc.12660] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/28/2022]
Abstract
This qualitative study evaluates a decision aid that includes the benefits and harms of breast cancer screening and analyses women's perception of the information received and healthcare professionals' perceptions of the convenience of providing it. Seven focus groups of women aged 40-69 years (n = 39) and two groups of healthcare professionals (n = 23) were conducted in Catalonia and the Canary Islands. The focus groups consisted of guided discussions regarding decision-making about breast cancer screening, and acceptability and feasibility of the decision aid. A content analysis was performed. Women positively value receiving information regarding the benefits and harms of breast cancer screening. Several women had difficulties understanding some concepts, especially those regarding overdiagnosis. Women preferred to share the decisions on screening with healthcare professionals. The professionals noted the lack of inclusion of some harms and benefits in the decision aid, and proposed improving the clarity of the statistical information. The information on overdiagnosis generates confusion among women and controversy among professionals. Faced with the new information presented by the decision aid, the majority of women prefer shared decision-making; however, its feasibility might be limited by a lack of knowledge and attitudes of rejection from healthcare professionals.
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Affiliation(s)
- A Toledo-Chávarri
- Canary Islands Foundation of Health Research (FUNCANIS), Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - M Rué
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Basic Medical Sciences Department, University of Lleida-IRBLLEIDA, Lleida, Spain.,Research Group in Economic Analysis and Health (GRAES, 2014 SGR 978), Rovira i Virgili University (URV), Reus, Spain
| | - N Codern-Bové
- ÀreaQ, Evaluation and Qualitative Research, Barcelona, Spain.,Escola Universitària d'Infermeria i Teràpia Ocupacional (EUIT), Terrassa, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - M Carles-Lavila
- Research Group in Economic Analysis and Health (GRAES, 2014 SGR 978), Rovira i Virgili University (URV), Reus, Spain.,Department of Economics and CREIP, Rovira i Virgili University (URV), Tarragona, Spain
| | - L Perestelo-Pérez
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
| | - M J Pérez-Lacasta
- Research Group in Economic Analysis and Health (GRAES, 2014 SGR 978), Rovira i Virgili University (URV), Reus, Spain.,Department of Economics and CREIP, Rovira i Virgili University (URV), Tarragona, Spain
| | - M Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autónoma de Barcelona, Bellaterra, Spain.,Researcher in Grups de Recerca d'America i Àfrica Llatines (GRAAL) (2014 SGR 1175), Barcelona, Spain.,Researcher Collaborator of the Infectious Diseases Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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386
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Kazarian A, Blyuss O, Metodieva G, Gentry-Maharaj A, Ryan A, Kiseleva EM, Prytomanova OM, Jacobs IJ, Widschwendter M, Menon U, Timms JF. Testing breast cancer serum biomarkers for early detection and prognosis in pre-diagnosis samples. Br J Cancer 2017; 116:501-508. [PMID: 28081538 PMCID: PMC5318971 DOI: 10.1038/bjc.2016.433] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/14/2016] [Accepted: 12/08/2016] [Indexed: 02/08/2023] Open
Abstract
Background: Breast cancer is a leading cause of morbidity and mortality worldwide. Although mammography screening is available, there is an ongoing interest in improved early detection and prognosis. Herein, we have analysed a combination of serological biomarkers in a case–control cohort of sera taken before diagnosis. Methods: This nested case–control study within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) used serum samples from 239 women who subsequently developed breast cancer and 239 matched cancer-free controls. Sera were screened by ELISA for 9 candidate markers. Univariate and multivariate analyses were performed to examine associations with clinico-pathological features and between case controls in different time groups before diagnosis. Results: Significant associations with clinico-pathological features related to prognosis were found for several candidates (CA15-3, HSP90A and PAI-1). However, there were no consistent differences between cases and controls for any candidate in the lead up to diagnosis. Whilst combination models outperformed single markers, there was no increase in performance towards diagnosis. Conclusions: This study using unique pre-diagnosis samples shows that CA15-3, HSP90A and PAI-1 have potential as early prognostic markers and warrant further investigation. However, none of the candidates or combinations would be useful for screening.
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Affiliation(s)
- Anna Kazarian
- Department of Women's Cancer, Institute for Women's Health, University College London, London, W1T 7DN, UK
| | - Oleg Blyuss
- Department of Women's Cancer, Institute for Women's Health, University College London, London, W1T 7DN, UK
| | - Gergana Metodieva
- Department of Biological Sciences, University of Essex, Colchester, Essex CO4 3SQ, UK
| | - Aleksandra Gentry-Maharaj
- Department of Women's Cancer, Institute for Women's Health, University College London, London, W1T 7DN, UK
| | - Andy Ryan
- Department of Women's Cancer, Institute for Women's Health, University College London, London, W1T 7DN, UK
| | - Elena M Kiseleva
- Oles Honchar Dnipropetrovsk National University, Dnipropetrovsk, Ukraine
| | - Olga M Prytomanova
- Oles Honchar Dnipropetrovsk National University, Dnipropetrovsk, Ukraine
| | - Ian J Jacobs
- University of New South Wales, Sydney, NSW 2052, Australia
| | - Martin Widschwendter
- Department of Women's Cancer, Institute for Women's Health, University College London, London, W1T 7DN, UK
| | - Usha Menon
- Department of Women's Cancer, Institute for Women's Health, University College London, London, W1T 7DN, UK
| | - John F Timms
- Department of Women's Cancer, Institute for Women's Health, University College London, London, W1T 7DN, UK
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387
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Abstract
Overdiagnosis in breast cancer has been a focus of increasing concern with wide ranges of calculations made indirectly through the study of prospective randomized trials and analyses of large registries. While most admit that some degree of overdiagnosis is inherent with ductal carcinoma in situ (DCIS), the rate of overdiagnosis with invasive disease is highly controversial. Although it is generally accepted that overdiagnosis is calculated through indirect means and deductive reasoning, this is not entirely the case. Patients who refuse treatment, yet curiously return for follow-up, allow a direct glimpse at the natural history of screen-detected cancers. And historic autopsy studies offer information as to undiagnosed disease prevalence from the pre-screening era. While these autopsy studies support a modest degree of overdiagnosis in DCIS, they do not support widespread overdiagnosis for invasive cancer. The 1.3% mean incidence of invasive disease from seven autopsy studies correlates closely with disease prevalence, a direct observation that cancers do not remain quiescent in the breast until death. If invasive breast cancer does not regress in untreated patients and does not remain quiescent, then the high estimates being calculated for overdiagnosis are more likely to be length bias from long natural histories rather than true overdiagnosis.
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388
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Adami HO, Nyrén O. Enigmas, priorities and opportunities in cancer epidemiology. Eur J Epidemiol 2017; 31:1161-1171. [PMID: 28062968 DOI: 10.1007/s10654-016-0218-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/10/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O.B 281, 171 77, Stockholm, Sweden. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Olof Nyrén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O.B 281, 171 77, Stockholm, Sweden
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389
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Affiliation(s)
| | | | - Jack Cuzick
- Queen Mary University of London, London, United Kingdom
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390
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Affiliation(s)
- Joann G Elmore
- From the Department of Medicine, University of Washington School of Medicine, Seattle
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391
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Zahl PH. Re: Norsk mammografiscreening – mange selvmotsigelser i evalueringen. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1875. [DOI: 10.4045/tidsskr.16.0971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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