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Prognosis of asymptomatic versus symptomatic metastatic breast cancer: a multicenter retrospective study. Sci Rep 2022; 12:14059. [PMID: 35982150 PMCID: PMC9388511 DOI: 10.1038/s41598-022-18069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/04/2022] [Indexed: 11/08/2022] Open
Abstract
In Japan, asymptomatic metastatic breast cancer (MBC) is often detected using tumor markers or imaging tests. We aimed to investigate differences in clinicopathological features, prognosis, and treatment between asymptomatic and symptomatic MBCs. Patients with MBC were retrospectively divided into asymptomatic and symptomatic groups to compare their prognosis by breast cancer subtype: luminal, human epidermal growth factor receptor 2 positive, and triple negative. Of 204 patients with MBC (114 asymptomatic, 90 symptomatic), the symptomatic group had a higher frequency of multiple metastatic sites and TN subtype. All cohorts in the asymptomatic group tended to or had longer post-recurrence survival (PRS) than those in the symptomatic group. In contrast, all cohorts and TN patients in the asymptomatic group tended to have or had longer overall survival (OS) than those in the symptomatic group, although no significant difference was observed in the luminal and HER2 subtypes. In the multivariate analysis, TN, recurrence-free survival, multiple metastatic sites, and symptomatic MBC were independently predictive of PRS. Regarding the luminal subtype, the asymptomatic group had longer chemotherapy duration than the symptomatic group, with no significant difference in OS between the groups. Asymptomatic and symptomatic MBCs differ in terms of subtypes and prognosis, and whether they require different treatment strategies for each subtype warrants further investigation.
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Myller S, Jukkola A, Jääskeläinen A, Roininen N, Karihtala P. How breast cancer recurrences are found - a real-world, prospective cohort study. Acta Oncol 2022; 61:417-424. [PMID: 34986730 DOI: 10.1080/0284186x.2021.2023756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND There is very limited data available on how most breast cancer recurrences, either distant metastases or locoregional recurrences (LRR), are actually discovered in routine clinical practice. PATIENTS AND METHODS From a prospective cohort of 621 women diagnosed and treated for early invasive breast cancer between 2003 and 2013, we analysed the patients who were later diagnosed with distant metastases (n = 61) and the patients who had locoregional recurrences (LRR; n = 34). The patients had routine control visits for up to 10 years from initial diagnosis, with annual clinical visits, mammography, blood count, plasma creatinine and liver function tests. RESULTS Most distant metastases (n = 38, 62%) were found when a patient contacted health care services because of a symptom; only ten (16%) were detected at pre-planned control visits. The most common first sign or symptom of metastasis was pain (n = 23, 38%). Pain as the first indicator of metastasis indicated a lower survival in metastatic disease (hazard ratio 4.40; 95% confidence interval 1.77-10.94; p = 0.001). How relapse was detected or whether patient was symptomatic did not affect overall survival (OS) of patients with distant metastases. LRRs were mostly found at pre-planned control visits (n = 14, 41%). Abnormalities in routine laboratory tests did not lead to any detection of recurrence. DISCUSSION In this prospective, contemporary, real-world study, the vast majority of both distant metastases and LRRs were detected outside the pre-planned control visits. These results highlight the importance of finding ways to lower the threshold for contacting the surveillance unit, rather than frequent routine controls.
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Affiliation(s)
- Sylvia Myller
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Arja Jukkola
- Department of Oncology and Radiotherapy, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere Cancer Center, Tampere University, Tampere, Finland
| | - Anniina Jääskeläinen
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Nelli Roininen
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Peeter Karihtala
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Centre and University of Helsinki, Helsinki, Finland
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The Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition. Breast Cancer 2019; 27:17-24. [PMID: 31734900 PMCID: PMC8134289 DOI: 10.1007/s12282-019-01025-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/09/2019] [Indexed: 12/14/2022]
Abstract
This article updates readers as to what is new in the Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition. Breast cancer screening issues are covered, including matters of breast density and possible supplemental modalities, along with appropriate pre-operative/follow-up diagnostic breast imaging tests. Up-to-date clinical practice guidelines for breast cancer screening and diagnosis should help to provide patients and clinicians with not only evidence-based breast imaging options, but also accurate and balanced information about the benefits and harms of intervention, which ultimately enables shared decision making about imaging test plans.
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Lin X, An X, Xiang H, Pei X, Li A, Tang G. Ultrasound Imaging for Detecting Metastasis to Level II and III Axillary Lymph Nodes after Axillary Lymph Node Dissection for Invasive Breast Cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2925-2934. [PMID: 30912182 DOI: 10.1002/jum.14998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The diagnostic value of axillary ultrasound (US) for level II and III axillary lymph node metastasis after axillary lymph node dissection for invasive breast cancer is currently not clear. The objectives of this study were to retrospectively analyze the diagnostic value of axillar US for level II and III axillary lymph node metastasis and compare it with palpation and to analyze the US features of level II and III axillary lymph nodes that are predictive of metastatic recurrence during follow-up. METHODS Cases with level II or III axillary lymph nodes detected by US between January 2005 and December 2017 at a cancer center were divided into 2 groups according to a retrospective analysis of US findings: potential malignancy group and follow-up group. Biopsy was performed in all patients in the potential malignancy group. In the follow-up group, the patients were followed for at least 2 years, and biopsy was performed if suspicious US features were detected. RESULTS The 401 enrolled cases were followed by axillary US and physical examination (PE) for comparison. Finally, 55 axillary metastases were pathologically confirmed (14%). The sensitivity, specificity, and area under the receiver operating characteristic curve for axillary US were 92.7%, 93.9%, and 0.933, respectively, and the corresponding values for PE were 49.1%, 91.3%, and 0.702 (P < .001). An increase in the major or minor axis diameter of the lymph nodes of greater than 2 mm, a Solbiati index value of less than 1.5, and the presence of new suspicious lesions in other regions were significant predictors of lymph node metastasis based on the US findings (P = .013, .006, .015, and .036). CONCLUSIONS Axillary is helpful in the follow-up of level II and III axillary lymph nodes after axillary lymph node dissection for invasive breast cancer and can detect cancer recurrence earlier than PE.
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Affiliation(s)
- Xi Lin
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Departments of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin An
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Departments of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Huiling Xiang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Departments of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaoqing Pei
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Departments of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Anhua Li
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Departments of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Guoxue Tang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Natoli C, Brocco D, Sperduti I, Nuzzo A, Tinari N, De Tursi M, Grassadonia A, Mazzilli L, Iacobelli S, Gamucci T, Vici P. Breast cancer "tailored follow-up" in Italian oncology units: a web-based survey. PLoS One 2014; 9:e94063. [PMID: 24714591 PMCID: PMC3979748 DOI: 10.1371/journal.pone.0094063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/10/2014] [Indexed: 12/04/2022] Open
Abstract
Purpose Breast cancer follow-up procedures after primary treatment are still a controversial issue. Aim of this study was to investigate, through a web-based survey, surveillance methodologies selected by Italian oncologists in everyday clinical practice. Methods Referents of Italian medical oncology units were invited to participate to the study via e-mail through the SurveyMonkey website. Participants were asked how, in their institution, exams of disease staging and follow-up are planned in asymptomatic women and if surveillance continues beyond the 5th year. Results Between February and May 2013, 125 out of 233 (53.6%) invited referents of Italian medical oncology units agreed to participate in the survey. Ninety-seven (77.6%) referents state that modalities of breast cancer follow-up are planned according to the risk of disease progression at diagnosis and only 12 (9.6%) oncology units apply the minimal follow-up procedures according to international guidelines. Minimal follow-up is never applied in high risk asymptomatic women. Ninety-eight (78.4%) oncology units continue follow-up in all patients beyond 5 years. Conclusions Our survey shows that 90.4% of participating Italian oncology units declare they do not apply the minimal breast cancer follow-up procedures after primary treatment in asymptomatic women, as suggested by national and international guidelines. Interestingly, about 80.0% of interviewed referents performs the so called “tailored follow-up”, high intensity for high risk, low intensity for low risk patients. There is an urgent need of randomized clinical trials able to determine the effectiveness of risk-based follow-up modalities, their ideal frequency and persistence in time.
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Affiliation(s)
- Clara Natoli
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
- * E-mail:
| | - Davide Brocco
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Isabella Sperduti
- Unit of Biostatistics, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Nuzzo
- Oncology Department, “Floraspe Renzetti” Hospital, Lanciano, Italy
| | - Nicola Tinari
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Michele De Tursi
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Antonino Grassadonia
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Lorenzo Mazzilli
- Clinical Governance Unit, “SS. Annunziata” Hospital, Chieti, Italy
| | - Stefano Iacobelli
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Teresa Gamucci
- Department of Oncology, “S.S. Trinita′” Hospital, Sora, Italy
| | - Patrizia Vici
- Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
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Breast cancer follow-up strategies in randomized phase III adjuvant clinical trials: a systematic review. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2013; 32:89. [PMID: 24438135 PMCID: PMC3828573 DOI: 10.1186/1756-9966-32-89] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/07/2013] [Indexed: 01/02/2023]
Abstract
The effectiveness of different breast cancer follow-up procedures to decrease breast cancer mortality are still an object of debate, even if intensive follow-up by imaging modalities is not recommended by international guidelines since 1997. We conducted a systematic review of surveillance procedures utilized, in the last ten years, in phase III randomized trials (RCTs) of adjuvant treatments in early stage breast cancer with disease free survival as primary endpoint of the study, in order to verify if a similar variance exists in the scientific world. Follow-up modalities were reported in 66 RCTs, and among them, minimal and intensive approaches were equally represented, each being followed by 33 (50%) trials. The minimal surveillance regimen is preferred by international and North American RCTs (P = 0.001) and by trials involving more than one country (P = 0.004), with no relationship with the number of participating centers (P = 0.173), with pharmaceutical industry sponsorship (P = 0.80) and with trials enrolling > 1000 patients (P = 0.14). At multivariate regression analysis, only geographic location of the trial was predictive for a distinct follow-up methodology (P = 0.008): Western European (P = 0.004) and East Asian studies (P = 0.010) use intensive follow-up procedures with a significantly higher frequency than international RCTs, while no differences have been detected between North American and international RCTs. Stratifying the studies according to the date of beginning of patients enrollment, before or after 1998, in more recent RCTs the minimal approach is more frequently followed by international and North American RCTs (P = 0.01), by trials involving more than one country (P = 0.01) and with more than 50 participating centers (P = 0.02). It would be highly desirable that in the near future breast cancer follow-up procedures will be homogeneous in RCTs and everyday clinical settings.
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