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Dufour O, Houvenaeghel G, Classe JM, Cohen M, Faure C, Mazouni C, Chauvet MP, Jouve E, Darai E, Azuar AS, Gimbergues P, Gonçalves A, de Nonneville A. Early breast cancer in women aged 35 years or younger: A large national multicenter French population-based case control-matched analysis. Breast 2023; 68:163-172. [PMID: 36774756 PMCID: PMC9945754 DOI: 10.1016/j.breast.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND There is a scarcity of data exploring early breast cancer (eBC) in very young patients. We assessed shared and intrinsic prognostic factors in a large cohort of patients aged ≤35, compared to a control group aged 36 to 50. METHODS Patients ≤50 were retrospectively identified from a multicentric cohort of 23,134 eBC patients who underwent primary surgery between 1990 and 2014. Multivariate Cox analyses for DFS and OS were built. To assess the independent impact of age, 1 to 3 case-control analysis was performed by matching ≤35 and 36-50 years patients. RESULTS Of 6481 patients, 556 were aged ≤35, and 5925 from 36 to 50. Age ≤35 was associated with larger tumors, higher grade, ER-negativity, macroscopic lymph node involvement (pN + macro), lymphovascular invasion (LVI), mastectomy, and chemotherapy (CT) use. In multivariate analysis, age ≤35 was associated with worse DFS [HR 1.56, 95% CI 1.32-1.84; p < 0.001], and OS [HR 1.29, 95% CI 1.03-1.60; p = 0.025], as were high grade, large tumor, LVI, pN + macro, ER-negativity, period of diagnostic, and absence of ET or CT (for DFS). Adverse prognostic impact of age ≤35 was maintained in the case control-matched analysis for DFS [HR 1.56, 95%CI 1.28-1.91, p < 0.001], and OS [HR 1.33, 95%CI 1.02-1.73, p = 0.032]. When only considering patients ≤35, ER, tumor size, nodal status, and LVI were independently associated with survival in this subgroup. CONCLUSIONS Age ≤35 is associated with less favorable presentation and more aggressive treatment strategies. Our results support the poor prognosis value of young age, which independently persisted when adjusting for other prognostic factors and treatments.
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Affiliation(s)
- Ondine Dufour
- Institut Paoli-Calmettes, CRCM, Département d'Oncologie Médicale, CNRS, Aix-Marseille Université, Marseille, France
| | - Gilles Houvenaeghel
- Institut Paoli-Calmettes, CRCM, Département de Chirurgie Oncologique, CNRS, Aix-Marseille Université, Marseille, France
| | - Jean-Marc Classe
- Institut René Gauducheau, Site Hospitalier Nord, St Herblain, France
| | - Monique Cohen
- Institut Paoli-Calmettes, CRCM, Département de Chirurgie Oncologique, CNRS, Aix-Marseille Université, Marseille, France
| | | | - Chafika Mazouni
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, France
| | | | - Eva Jouve
- Centre Claudius Regaud, 20-24 Rue du Pont St Pierre, Toulouse, France
| | - Emile Darai
- Hôpital Tenon, 4 Rue de la Chine, Paris, France
| | | | | | - Anthony Gonçalves
- Institut Paoli-Calmettes, CRCM, Département d'Oncologie Médicale, CNRS, Aix-Marseille Université, Marseille, France
| | - Alexandre de Nonneville
- Institut Paoli-Calmettes, CRCM, Département d'Oncologie Médicale, CNRS, Aix-Marseille Université, Marseille, France.
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Yang H, Qiu M, Feng Y, Wen N, Zhou J, Qin X, Li J, Liu X, Wang X, Du Z. The role of radiotherapy in HER2+ early-stage breast cancer patients after breast-conserving surgery. Front Oncol 2023; 12:903001. [PMID: 36686782 PMCID: PMC9845557 DOI: 10.3389/fonc.2022.903001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
Background Due to radioresistance, some HER2+ patients may gain limited benefit from radiotherapy (RT) after breast-conserving surgery (BCS). This study aimed to develop an individualized nomogram to identify early-stage HER2+ patients who could omit RT after BCS. Methods The data of HER2+ patients with T0-2N0M0 breast cancer after BCS between 2010 and 2015 were extracted from Surveillance, Epidemiology, and End Results (SEER). Based on the independent prognostic factors determined by the Cox analysis in patients without RT after propensity score matching (PSM), the nomogram and risk stratification model were constructed, and then the prognosis of patients with and without RT was compared in each stratified group. Results A total of 10799 early-stage HER2+ patients after BCS were included. Baseline characteristics were similar between groups after PSM. Multivariate Cox analysis indicated that RT could improve overall survival (OS) (HR: 0.45, P<0.001) and breast cancer-specific survival (BCSS) (HR: 0.53, P<0.001). Age, marital status, tumor location, tumor size, and chemotherapy were identified by multivariate Cox analysis in patients without RT and were incorporated into a well-validated nomogram. The risk stratification model based on the nomogram indicated that RT was associated with improved OS (HR 0.40, P< 0.001) and BCSS (HR 0.39, P< 0.001) in the high-risk group but not in the low-risk group [OS: HR 1.04, P = 0.94; BCSS: HR 1.06, P = 0.93]. Conclusion RT could significantly improve the OS and BCSS of HER2+ early-stage breast cancer patients after BCS on the whole. For high-risk patients, RT is an essential component of cancer therapy. However, the omission of radiotherapy may be considered for low-risk HER2+ early-stage patients. Further validation and improvement of the nomogram by prospective study or randomized controlled trials are warranted.
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Affiliation(s)
- Huanzuo Yang
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mengxue Qiu
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Feng
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Nan Wen
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiao Zhou
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangquan Qin
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Juan Li
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, Sichuan Academy of Medical Sciences, Sichuan Province People’s Hospital, Chengdu, China
| | - Xinran Liu
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaodong Wang
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Zhenggui Du, ; Xiaodong Wang,
| | - Zhenggui Du
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, China,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Zhenggui Du, ; Xiaodong Wang,
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The mediating effect of pleasure and menopausal symptoms on sexual activity among young breast cancer survivors. Support Care Cancer 2022; 30:5085-5092. [PMID: 35218415 DOI: 10.1007/s00520-022-06923-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/15/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Young breast cancer survivors often go through a rapid change in menopause status due to cancer treatment and suffer from abrupt symptoms. This transition compels them to deal with unique medical and psychological side effects on their quality of life. One of the most affected quality of life domains is sexual functioning. This study explored the differences in frequency of sexual activity between young breast cancer survivors and young healthy women. It also examined whether this difference in sexual activity frequency was mediated by discomfort and/or pleasure during intercourse, both of which are affected by symptoms of premature menopause. METHODS A total of 97 young breast cancer survivors and 75 young healthy women completed a sociodemographic questionnaire: the Fallowfield's Sexual Activity Questionnaire (FSAQ) and the Menopausal Rating Scale (MRS). Additionally, the breast cancer participants completed a medical data questionnaire. RESULTS Findings revealed a significant direct effect between group and menopausal symptoms, menopausal symptoms and pleasure, and pleasure and frequency of sexual activity. Structural equation modeling explained the differences between the groups in frequency of sexual activity as mediated by menopausal symptoms and both pleasure and discomfort. CONCLUSIONS AND IMPLICATIONS These results highlight the impact of pleasure on the frequency of young breast cancer survivors' sexual activity, and its relation to menopausal symptoms. These young women should be provided with appropriate information and interventions that will help them experience increased pleasure during sexual activity despite their early and induced menopausal symptoms.
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Tang RZ, Liu ZZ, Gu SS, Liu XQ. Multiple local therapeutics based on nano-hydrogel composites in breast cancer treatment. J Mater Chem B 2021; 9:1521-1535. [PMID: 33474559 DOI: 10.1039/d0tb02737e] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The locoregional recurrence of breast cancer after tumor resection represents several clinical challenges, and conventional post-surgical adjuvant therapeutics always bring about significant systemic side effects. Thus, the local therapy strategy has received considerable interest in breast cancer treatment, and hydrogels can function as ideal platforms due to their remarkable properties such as good biocompatibility, biodegradability, flexibility, and multifunctionality. The nano-hydrogel composites can further incorporate the advantages of nanomaterials into the hydrogel system, to fabricate hierarchical structures for stimulating controlled multi-stage release of different therapeutic agents and improving the synergistic effects of combination therapy. In this review, the problems of clinical treatments of breast cancer and properties of hydrogels in current biomedical applications are briefly overviewed. The focus is on recent advances in local therapy based on nano-hydrogel composites for both monotherapy (chemotherapy, photothermal and photodynamic therapy) and combination therapy (dual chemotherapy, photothermal chemotherapy, photothermal immunotherapy, radio-chemotherapy). Moreover, the challenges and perspectives in the development of advanced nano-hydrogel systems are also discussed.
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Affiliation(s)
- Rui-Zhi Tang
- School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P. R. China
| | - Zhen-Zhen Liu
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P. R. China.
| | - Sai-Sai Gu
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P. R. China.
| | - Xi-Qiu Liu
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P. R. China.
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Cheun JH, Won J, Jung JG, Kim HK, Han W, Lee HB. Impact of Trastuzumab on Ipsilateral Breast Tumor Recurrence for Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer after Breast-Conserving Surgery. J Breast Cancer 2021; 24:301-314. [PMID: 34190441 PMCID: PMC8250103 DOI: 10.4048/jbc.2021.24.e33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Trastuzumab is effective in early and advanced human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, few studies have reported the effect of trastuzumab on ipsilateral breast tumor recurrence (IBTR), whose incidence is higher in the HER2-positive subtype than in other subtypes. Methods We retrospectively investigated 959 patients who underwent breast-conserving surgery (BCS), chemotherapy, and radiotherapy for HER2-positive breast cancer between 2000 and 2017. IBTR was compared between the patients who received neoadjuvant or adjuvant trastuzumab (Tmab group) for a total duration of 1 year and those who received no trastuzumab (N-Tmab group). Results Propensity score matching designated 426 and 142 patients in the Tmab and N-Tmab groups, respectively. The median follow-up period for all patients after matching was 73.79 months. The IBTR-free survival rate was significantly higher in the Tmab group than in the N-Tmab group (10-year IBTR-free survival rate, 92.9% vs. 87.3%; p = 0.002). The multivariate analysis showed a significant association between the N-Tmab and Tmab group (hazard ratio, 3.03; 95% confidence interval, 1.07–8.59) and IBTR in addition to close or positive resection margin and hormone receptor (HR) positivity. The subgroup analysis showed that adjuvant treatment with trastuzumab significantly reduced IBTR among the patients with HR-negative or lymph node-negative breast cancer. Conclusion Significantly reduced IBTR after BCS was observed in the patients who received 1 year of adjuvant/neoadjuvant trastuzumab treatment for HER2-positive breast cancer.
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Affiliation(s)
- Jong Ho Cheun
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jiyoung Won
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Ji Gwang Jung
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Han Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea.
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Wang L, He Y, Li J, Wang T, Xie Y, Fan Z, Ouyang T. Comparisons of breast conserving therapy versus mastectomy in young and old women with early-stage breast cancer: long-term results using propensity score adjustment method. Breast Cancer Res Treat 2020; 183:717-728. [PMID: 32715444 DOI: 10.1007/s10549-020-05821-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/20/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to compare the effect of BCT versus mastectomy on the recurrence and survival of different-aged patients, and to investigate whether effects of BCT versus mastectomy on survival of young patients were consistent with those of old patients. METHODS Data on women with primary invasive breast cancer between 2007 and 2011 were extracted from the institutional database of Breast Center. Disparities in hormone receptor, tumor size, lymph node status, and Her-2 status between BCT and mastectomy groups were adjusted using the propensity score (PS) adjustment method. Patients were divided by age into two groups (≤ 40 years and > 40 years). We assessed proportions of local recurrence (LR), distant disease-free survival (DDFS), disease-free survival (DFS), and breast cancer-specific survival (BCSS) in different-aged groups; this assessment was further stratified by surgical treatment. RESULTS A total of 2964 patients were included; 565 (19%) were aged ≤ 40 years. In the entire cohort, hazard ratios (HR) of BCT versus mastectomy for DDFS and DFS were 0.56 (P = 0.029) and 0.55 (P = 0.008), respectively. After PS adjustment, there was no significant difference between BCT and mastectomy in LR, DDFS, DFS and BCSS in the young age group. In the old age group, women who underwent BCT exhibited improved DDFS (HR 0.57, 95% CI 0.39-0.84, P = 0.004). CONCLUSIONS BCT did not significantly affect survival outcomes of young patients with breast cancer. Superior survival of BCT compared to mastectomy was observed only in old patients.
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Affiliation(s)
- Lize Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Breast Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Yingjian He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Breast Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Jinfeng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Breast Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Tianfeng Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Breast Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Yuntao Xie
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Breast Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Zhaoqing Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Breast Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Tao Ouyang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Breast Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
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Abstract
Breast cancer is the most frequent cancer in women all over the world. The prognosis is generally good, with a five-year overall survival rate above 90% for all stages. It is still the second leading cause of cancer-related death among women. Surgical treatment of breast cancer has changed dramatically over the years. Initially, treatment involved major surgery with long hospitalization, but it is now mostly accomplished as an outpatient procedure with a quick recovery. Thanks to well-designed retrospective and randomly controlled prospective studies, guidelines are continually changing. We are presently in an era where safely de-escalating surgery is increasingly emphasized. Breast cancer is a heterogenous disease, where a "one-size-fits-all" treatment approach is not appropriate. There is often more than one surgical solution carrying equal oncological safety for an individual patient. In these situations, it is important to include the patient in the treatment decision-making process through well informed consent. For this to be optimal, the physician must be fully updated on the surgical options. A consequence of an improved prognosis is more breast cancer survivors, and therefore physical appearance and quality of life is more in focus. Modern breast cancer treatment is increasingly personalized from a surgical point of view but is dependent on a multidisciplinary approach. Detailed algorithms for surgery of the breast and the axilla are required for optimal treatment and quality control. This review illustrates how breast cancer treatment has changed over the years and how the current standard is based on high quality scientific research.
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Arnould L, Penault-Llorca F, Dohollou N, Caron O, Levy C. [Breast cancer in young women. Histological and prognostic specificities: how are they different from older women?]. Bull Cancer 2020; 106:S10-S18. [PMID: 32008732 DOI: 10.1016/s0007-4551(20)30042-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Early-onset of breast cancer (under the age of 40) represents only 7% of all breast cancers, but is the most common cancer in this age group in women. It is also known to be of worse prognosis, with a more aggressive tumoral behavior. The interaction of different prognostic factors contributes to the complexity of this population: tumor burden and biological features (using classical histopronostic features and genomic data) show differences from older women. Nevertheless, the prognostic impact of age varies according to the histological subtypes and seems pejorative mainly for the luminal subtype, probably with a crucial role of the hormonal environment and the treatments targeting the endocrine sensitivity of these tumors. In other subtypes, the influence of young age appears to be less significant, especially in HER2+ breast cancers.
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Affiliation(s)
- Laurent Arnould
- Département de biologie et de pathologie des tumeurs, Centre Georges-François-Leclerc, 21000 Dijon
| | | | - Nadine Dohollou
- Oncologie médicale, Polyclinique Bordeaux Nord Aquitaine, 33300 Bordeaux
| | - Olivier Caron
- Oncologie génétique, Institut Gustave-Roussy, 94800 Villejuif
| | - Christelle Levy
- Institut Normand du Sein, Centre François Baclesse, 14000 Caen.
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Fu J, Wu L, Xu T, Li D, Ying M, Jiang M, Jiang T, Fu W, Wang F, Du J. Young-onset breast cancer: a poor prognosis only exists in low-risk patients. J Cancer 2019; 10:3124-3132. [PMID: 31289582 PMCID: PMC6603374 DOI: 10.7150/jca.30432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/13/2019] [Indexed: 11/29/2022] Open
Abstract
The number of reported young breast cancer cases has increased dramatically recently. The impact of age on the outcomes of breast cancers remains controversial. Our study aimed to explore the factors that can stratify the impact of young age on the prognosis of early breast cancer patients. In total, 244,324 patients with early breast cancer in the Surveillance, Epidemiology, and End Results database were identified from 1990 to 2007. Survival curves were generated using the Kaplan-Meier method. The 5- and 10-year cancer-specific survival (CSS) rates were calculated using the Life-Table method. Multivariable analyses were used to identify prognosti c variables (without age) to construct the nomograms. The risk score developed from the nomogram was used to classify the cohort into three subgroups (low-, medium- and high-risk subgroup). Approximately 8.89% of women were diagnosed with breast cancer at a young age (≤ 40 years). Clinical nomogram had the potential ability to predict CSS accurately with a well C-index (0.785). Subgroup analysis indicated that the risk score as the sole factor can stratify the impact of young age on the prognosis of early breast cancer patients. Young breast cancer patients had a worse prognosis in the low-risk (HR=0.61; 95% CI: 0.57-0.65; P<0.001) or medium-risk subgroup (HR=0.89; 95% CI: 0.85-0.93; P<0.01) than in the high-risk subgroup (P=0.431). In conclusion, the worse prognosis of young women only appeared in the low- and medium-risk subgroups rather than in the high-risk subgroup. The risk score yielded from the nomogram model can assist clinical decision making for young breast cancer patients.
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Affiliation(s)
- Jianfei Fu
- Department of Medical Oncology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Lunpo Wu
- Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China.,Institute of Gastroenterology, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Tiantian Xu
- Institute of Translational Medicine, School of Medicine, Zhejiang University, Hangzhou 310029, Zhejiang Province, China
| | - Dan Li
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, Chinese National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China.,Department of Medical Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Mingliang Ying
- Department of Radiology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Mengjie Jiang
- Department of Radiation Oncology. The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang Province, China
| | - Ting Jiang
- Department of Nuclear Medicine, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Wei Fu
- Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Fan Wang
- Department of Oncology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Jinlin Du
- Department of Colorectal Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
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10
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Age-related risk factors associated with primary contralateral breast cancer among younger women versus older women. Breast Cancer Res Treat 2018; 173:657-665. [PMID: 30377870 DOI: 10.1007/s10549-018-5031-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/27/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Contralateral prophylactic mastectomy is increasing, despite unclear evidence of improving survival. To investigate the age-related risk factors for contralateral breast cancer (CBC). METHODS This study included 8716 patients diagnosed with non-metastatic unilateral invasive breast cancer between 1989 and 2008. Data on primary tumor size, node metastasis, grade and subtype using individual matching were used to adjust for differences in the primary tumor and treatment between younger and older age groups. CBC risk factors, CBC-free survival, and annual CBC risk were analyzed by age. RESULTS The younger group included 652 patients aged under 35 years, and the older group included 2608 women aged 35 years or older. The median time to CBC development was 6.1 years. CBC was detected in 6.6% of the women in the younger group and 2.5% of those in the older group. Multivariable analysis revealed a relative CBC risk of 2.48 in younger women compared to older women. The risk was significantly higher among women with human epidermal growth factor receptor 2 (HER2)-overexpressing tumors (hazard ratio [HR] 4.98), a family history of breast cancer (HR 7.79), and anti-hormone therapy (HR 3.46). In younger women with HER2-positive cancer, CBC occurrence peaked at 4.6 years after surgery, in those with hormone receptor-positive cancer, it peaked at 7.1 years after surgery, and in triple-negative disease cases, and it increased steadily over time. CONCLUSIONS After adjusting for primary breast tumor characteristics, patients < 35 years old had 2.5 times the risk of CBC development compared to the older women. CBC occurrence peaked within 5 years after primary breast cancer in younger women with the HER2-positive subtype and after 5 years in cases with the hormone receptor-positive subtype.
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Corter AL, Quan ML, Wright FL, Kennedy ED, Simunovic MR, Shao J, Baxter NN. Scoping clinicians' perspectives on pre-treatment multidisciplinary care for young women with breast cancer. J Multidiscip Healthc 2018; 11:547-555. [PMID: 30349286 PMCID: PMC6183552 DOI: 10.2147/jmdh.s173735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Young women with breast cancer (YWBC) experience worse medical and psychosocial outcomes than their older counterparts. Early input from a multidisciplinary team via pre-treatment multidisciplinary cancer conferences (pMCCs) may be important for addressing the complex needs of YWBC. However, pMCCs are not common. This study has two parts: a survey and workshop aimed at assessing clinicians' perspectives on pMCCs, including the importance of pMCCs in the care of YWBC, as well as barriers to, and strategies for supporting their implementation. METHODS Survey results highlight variability across sites in the delivery of multidisciplinary care in general. However, both survey and workshop results emphasize clinicians' agreement on the importance of pMCCs and suggest that numerous practical and systems levels barriers be addressed before pMCCs can be implemented. CONCLUSIONS pMCCs have the potential to improve surgical treatment and psychosocial outcomes for YWBC. A combined practical and policy approach to their implementation, which sees extension of existing standards to include pMCCs, may support their adoption and subsequent audit practices to assess the effect of pMCCs on outcomes for YWBC.
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Affiliation(s)
- Arden L Corter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada,
| | - May Lynn Quan
- Department of Surgery and Oncology, University of Calgary, Calgary, Canada
| | | | - Erin D Kennedy
- Division of General Surgery, University Health Network, Mount Sinai Hospital, Toronto, Canada
| | | | - Juliet Shao
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada,
| | - Nancy N Baxter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada,
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,
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Wang MX, Ren JT, Tang LY, Ren ZF. Molecular features in young vs elderly breast cancer patients and the impacts on survival disparities by age at diagnosis. Cancer Med 2018; 7:3269-3277. [PMID: 29761914 PMCID: PMC6051220 DOI: 10.1002/cam4.1544] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/03/2018] [Accepted: 04/15/2018] [Indexed: 01/02/2023] Open
Abstract
Young and elderly breast cancer patients are more likely to have a poorer outcome than middle‐aged patients. The intrinsic molecular features for this disparity are unclear. We obtained data from the Cancer Genome Atlas (TCGA) on May 15, 2017 to test the potential mediation effects of the molecular features on the association between age and prognosis with a four‐step approach. The relative contributions of the molecular features (PAM50 subtype, risk stratification, DNAm age, and mutations in TP53,PIK3CA,MLL3,CDH1,GATA3, and MAP3K1) to age disparities in survival were estimated by Cox proportional hazard models with or without the features. Young patients were significantly more likely to have basal‐like subtype, GATA3 mutations, and younger DNA methylation (DNAm) age than middle‐aged patients (P < .05). Both the young and elderly patients had a significantly increased risk of breast cancer recurrence after adjusted by race, tumor size, and node status (Hazard ratio [HR] (95% confidence interval [CI]): 2.81 [1.44, 5.45], 2.37 [1.45, 3.89], respectively). This increased risk was weakened in the young patients after further adjustments in the molecular features, particularly basal‐like subtype, GATA3 mutations, and DNAm age (HR [95%CI]: 1.87 [0.81, 4.32]), resulting in 33.5% decreased risk of recurrence. Meanwhile, the adjustments of the molecular features did not alter the recurrence risk for the elderly patients. Compared with middle‐aged patients of breast cancer, poorer prognosis of elderly patients may be caused by aging, while poorer prognosis of young patients was probably mediated through intrinsic characteristics, such as basal‐like subtype, GATA3 mutations, and DNAm age of the cancerous tissues.
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Affiliation(s)
- Mei-Xia Wang
- The School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jun-Ting Ren
- The School of Public Health, Sun Yat-sen University, Guangzhou, China.,Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lu-Ying Tang
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ze-Fang Ren
- The School of Public Health, Sun Yat-sen University, Guangzhou, China
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Spronk I, Schellevis FG, Burgers JS, de Bock GH, Korevaar JC. Incidence of isolated local breast cancer recurrence and contralateral breast cancer: A systematic review. Breast 2018; 39:70-79. [PMID: 29621695 DOI: 10.1016/j.breast.2018.03.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 12/21/2022] Open
Abstract
An increasing number of women is surviving breast cancer and due to that at risk of developing an isolated ipsilateral breast tumor recurrence (IBTR) or a contralateral breast cancer (CBC). Patients' main concern is cancer recurrence. Patient counseling on breast cancer recurrence is challenging. In order to provide healthcare professionals and patients more guidance, a systematic literature review of the incidence of isolated IBTR and CBC in women diagnosed with early invasive breast cancer was performed. Medline, EMBASE and the Cochrane Library were searched from 2000 until October 2015. Multicenter studies reporting an IBTR or CBC rate in curatively treated adult females diagnosed with invasive breast cancer were included. The initial search yielded 6998 potentially relevant articles. Twenty were eligible for inclusion, representing 25 recurrence incidence rates. Both isolated IBTR and CBC incidence rates steadily increased with the length of follow-up, indicating that IBTR and CBC occur even more than 15 years after diagnosis. The annual incidence rate of isolated IBTR and CBC in women diagnosed with an early invasive breast cancer was 0.6% (range: 0.4-1.1%) and 0.5% (range: 0.2-0.7%), respectively. Analyzed data were lacking information about important risk factors and given treatment with regard to the incidence of recurrence, which hampers the prediction of patient tailored recurrence risks. The presented rates are therefore the best available estimates of isolated IBTR and CBC annual incidence rates based on the current literature. Healthcare professionals could use these rates in their communication with patients diagnosed with early invasive breast cancer.
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Affiliation(s)
- Inge Spronk
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, The Netherlands.
| | - François G Schellevis
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, The Netherlands; Department of General Practice & Elderly Care Medicine/ Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Jako S Burgers
- Dutch College of General Practitioners, P.O. Box 3231, 3502 GE, Utrecht, The Netherlands; School CAPHRI, Department Family Medicine, Universiteitssingel 40, 6229 ER, Maastricht University, Maastricht, The Netherlands.
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Joke C Korevaar
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, The Netherlands.
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Yoon TI, Hwang UK, Kim ET, Lee S, Sohn G, Ko BS, Lee JW, Son BH, Kim S, Ahn SH, Kim HJ. Survival improvement in hormone-responsive young breast cancer patients with endocrine therapy. Breast Cancer Res Treat 2017; 165:311-320. [PMID: 28601930 DOI: 10.1007/s10549-017-4331-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/02/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE We investigated the oncologic outcomes by intrinsic subtype and age in young breast cancer patients and whether survival differences were related to treatment changes over time. METHODS A retrospective analysis was performed on 9633 invasive breast cancer patients treated at Asan Medical Center from January 1989 to December 2008. We also enrolled a matched cohort adjusting for tumor size, lymph node metastasis, subtypes, and tumor grade. Patients aged <35 years were included in the younger group (n = 602) and those aged ≥35 years were included in the older group (n = 3009). RESULTS The younger patients showed a significantly higher T stage, a more frequent axillary node presentation, higher histologic grade, and higher incidence of triple-negative subtype tumors than older patients and also received more chemotherapy and were less likely to undergo hormone therapy. The younger patients with hormone receptor (HR)-positive tumors showed significantly poorer disease-free survival (DFS), loco-regional recurrence-free survival, distant metastasis-free survival, and breast cancer-specific survival outcomes than older patients. Younger patients with HR-positive and human epidermal growth factor receptor 2 (HER2)-negative tumor subtypes had a significantly improved DFS over time (p = 0.032). Within the HR-positive/Her2-negative subtype, more women received gonadotropin-releasing hormone agonist and tamoxifen treatment from 2003 to 2008 compared with 1989 to 2002 (p = 0.001 and p = 0.075, respectively). CONCLUSIONS HR-positive young breast cancer patients have a poorer survival compared with older patients, even with more frequent chemotherapy, but more recent use of tamoxifen and ovarian suppression might improve this outcome in these patients.
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Affiliation(s)
- Tae In Yoon
- Department of Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Ui-Kang Hwang
- Department of Trauma Surgery, Andong Medical Group Hospital, Andong, Republic of Korea
| | - Eui Tae Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - SaeByul Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Guiyun Sohn
- Division of Breast and Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Beom Seok Ko
- Division of Breast and Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jong Won Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Byung Ho Son
- Division of Breast and Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sei Hyun Ahn
- Division of Breast and Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Hee Jeong Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
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Anastasiadi Z, Lianos GD, Ignatiadou E, Harissis HV, Mitsis M. Breast cancer in young women: an overview. Updates Surg 2017; 69:313-317. [PMID: 28260181 DOI: 10.1007/s13304-017-0424-1] [Citation(s) in RCA: 375] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 02/16/2017] [Indexed: 02/06/2023]
Abstract
Despite dramatic advances in cancer research setting, breast cancer remains a major health problem and represents currently a top biomedical research priority. Worldwide, breast cancer is the most common cancer affecting women, and its incidence and mortality rates are expected to increase significantly the next years. Recently the researchers' interest has been attracted by breast cancer arising in young women. Current evidence suggests that in women aged <45 years, breast cancer is unquestionably the leading cause of cancer-related deaths. This type of cancer seems to be highly heterogeneous and has potentially aggressive and complex biological features. However, management strategies, recommendations and options are not age based and the 'complex' biology of this type of cancer remains uncertain and unexplored. In this review, we summarize the latest scientific information on breast cancer arising in young women highlighting the heterogeneity and the complex nature of this type of cancer.
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Affiliation(s)
- Zoi Anastasiadi
- Department of Surgery, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Georgios D Lianos
- Department of Surgery, School of Medicine, University of Ioannina, Ioannina, Greece.
| | | | | | - Michail Mitsis
- Department of Surgery, School of Medicine, University of Ioannina, Ioannina, Greece
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16
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Kim SW, Chun M, Han S, Jung YS, Choi JH, Kang SY, Yim H, Kang SH. Young Age Is Associated with Increased Locoregional Recurrence in Node-Positive Breast Cancer with Luminal Subtypes. Cancer Res Treat 2016; 49:484-493. [PMID: 27554479 PMCID: PMC5398391 DOI: 10.4143/crt.2016.246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/09/2016] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The effects of biological subtypes within breast cancer on prognosis are influenced by age at diagnosis. We investigated the association of young age with locoregional recurrence (LRR) between patients with luminal subtypes versus those with nonluminal subtypes. MATERIALS AND METHODS Medical records of 524 breast cancer patients with positive lymph nodes between 1999 and 2010 were reviewed retrospectively. All patients received curative surgery and adjuvant chemotherapy based on contemporary guidelines. Radiation was delivered for patients who underwent breast conserving surgery or those who had four or more positive lymph nodes after mastectomy. Adjuvant hormone therapy was administered to 413 patients with positive hormone receptors according to their menstrual status. RESULTS During median follow-up of 84 months, the 10-year locoregional recurrence-free survival rate (LRRFS) was 84.3% for all patients. Patients < 40 years showed significantly worse 10-year LRRFS than those ≥ 40 years (73.2% vs. 89.0%, respectively; p=0.01). The negative effect of young age on LRRFS was only observed in luminal subtypes (69.7% for < 40 years vs. 90.8% for ≥ 40 years; p < 0.01). Multivariate analysis using luminal subtypes ≥ 40 years as a reference revealed luminal subtypes < 40 years were significantly associated with increased risk of LRR (hazard ratio, 2.33; p < 0.01). CONCLUSION Young breast cancer patients with positive lymph nodes had a higher risk of LRR than those aged ≥ 40 years. This detrimental effect of young age on LRR was confined in luminal subtypes.
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Affiliation(s)
- Sang-Won Kim
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Sehwan Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Yong Sik Jung
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jin Hyuk Choi
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Seok Yun Kang
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Hyunee Yim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Hee Kang
- Department of Radiation Oncology, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Korea
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17
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Choi YJ, Shin YD, Song YJ. Comparison of ipsilateral breast tumor recurrence after breast-conserving surgery between ductal carcinoma in situ and invasive breast cancer. World J Surg Oncol 2016; 14:126. [PMID: 27122132 PMCID: PMC4848787 DOI: 10.1186/s12957-016-0885-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/21/2016] [Indexed: 12/03/2022] Open
Abstract
Background We aimed to evaluate the differences in the rates and predictive factors for ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) between ductal carcinoma in situ (DCIS) and invasive breast cancer. And, we evaluated the impact of IBTR on overall survival and distant metastasis. Methods We retrospectively reviewed 322 consecutive patients with DCIS or invasive breast cancer who underwent BCS between 2004 and 2010. We evaluated the rates of IBTR of DCIS and invasive breast cancer. Univariate and multivariate analyses were performed to determine the predictive factors for IBTR, and survival rates were analyzed with Kaplan-Meier estimates. Results With a median follow-up period of 57 months, 5 (10 %) out of 50 DCIS patients and 14 (5.1 %) out of 272 invasive cancer patients had developed IBTR. Factors associated with IBTR on univariate and multivariate analyses were positive resection margin status in DCIS and omission of radiotherapy in invasive cancer, respectively. The hormone receptor negativity was strong independent predictive factors for IBTR in both DCIS and invasive breast cancer. Although the differences of survival curve did not reach statistical significance, the 5-year overall survival and distant metastasis-free survival of invasive cancer patients who suffered IBTR were inferior to those without (84 vs. 98 % and 63.3 vs. 96.5 %, respectively). Advanced initial stage, lymph node metastasis and experience of IBTR were associated with poor overall survival and distant metastasis on univariate and multivariate analyses. Conclusions The hormone receptor negativity was revealed as independent predictive factor for IBTR after BCS in both DCIS and invasive cancer. Experience of IBTR was independent prognostic factor for poor overall outcome in patients with invasive breast cancer. Aggressive local control and adjuvant therapy should be made in hormone receptor-negative patients who receive treatment with BCS.
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Affiliation(s)
- Young Jin Choi
- Department of Surgery, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 361-763, South Korea
| | - Young Duck Shin
- Department of Anesthesiology, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 361-763, South Korea
| | - Young Jin Song
- Department of Surgery, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 361-763, South Korea.
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18
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Ribnikar D, Ribeiro JM, Pinto D, Sousa B, Pinto AC, Gomes E, Moser EC, Cardoso MJ, Cardoso F. Breast cancer under age 40: a different approach. Curr Treat Options Oncol 2015; 16:16. [PMID: 25796377 DOI: 10.1007/s11864-015-0334-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Breast cancer (BC) under age 40 is a complex disease to manage due to the additionally fertility-related factors to be taken in consideration. More than 90% of young patients with BC are symptomatic. Women<40 years are more likely to develop BC with worse clinicopathological features and more aggressive subtype. This has been frequently associated with inferior outcomes. Recently, the prognostic significance of age<40 has been shown to differ according to the BC subtype, being associated with worst recurrence-free survival (RFS) and overall survival (OS) for luminal BC. The biology of BC<40 has also been explored through analysis of large genomic data set, and specific pathways overexpressed in these tumors have been identified which can lead to the development of targeted therapy in the future. A multidisciplinary tumor board should determine the optimal locoregional and systemic management strategies for every individual patient with BC before the start of any therapy including surgery. This applies to both early (early breast cancer (EBC)) and advanced (advanced breast cancer (ABC)) disease, before the start of any therapy. Mastectomy even in young patients confers no overall survival advantage when compared to breast-conserving treatment (BCT), followed by radiotherapy. Regarding axillary approach, indications are identical to other age groups. Young age is one of the most important risk factors for local recurrence after both breast-conserving surgery (BCS) and mastectomy, associated with a higher risk of distant metastasis and death. Radiation after BCS reduces local recurrence from 19.5 to 10.2% in BC patients 40 years and younger. The indications for and the choice of systemic treatment for invasive BC (both early and advanced disease) should not be based on age alone but driven by the biological characteristics of the individual tumor (including hormone receptor status, human epidermal growth factor receptor 2 (HER-2) status, grade, and proliferative activity), disease stage, and patient's comorbidities. Recommendations regarding the use of genomic profiles such as MammaPrint, Oncotype Dx, and Genomic grade index in young women are similar to the general BC population. Especially in the metastatic setting, patient preferences should always be taken into account, as the disease is incurable. The best strategy for these patients is the inclusion into well-designed, independent, prospective randomized clinical trials. Metastatic disease should always be biopsied whenever feasible for histological confirmation and reassessment of biology. Endocrine therapy is the preferred option for hormone receptor-positive disease (HR+ve), even in presence of visceral metastases, unless there is concern or proof of endocrine resistance or there is a need for rapid disease response and/or symptom control. Recommendations for chemotherapy (CT) should not differ from those for older patients with the same characteristics of the metastatic disease and its extent. Young age by itself should not be an indication to prescribe more intensive and combination CT regimens over the sequential use of monotherapy. Poly(ADP-ribose) polymerase inhibitors (PARP inhibitors) represent an important group of promising drugs in managing patients with breast cancer susceptibility gene (BRCA)-1- or BRCA-2-associated BC. Specific age-related side effects of systemic treatment (e.g., menopausal symptoms, change in body image, bone morbidity, cognitive function impairment, fertility damage, sexual dysfunction) and the social impact of diagnosis and treatment (job discrimination, taking care for children) should also be carefully addressed when planning systemic long-lasting therapy, such as endocrine therapy. Survivorship concerns for young women are different compared to older women, including issues of fertility, preservation, and pregnancy.
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Affiliation(s)
- D Ribnikar
- Medical Oncology Department, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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McGuire A, Brown JAL, Malone C, McLaughlin R, Kerin MJ. Effects of age on the detection and management of breast cancer. Cancers (Basel) 2015; 7:908-29. [PMID: 26010605 PMCID: PMC4491690 DOI: 10.3390/cancers7020815] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/12/2015] [Indexed: 12/15/2022] Open
Abstract
Currently, breast cancer affects approximately 12% of women worldwide. While the incidence of breast cancer rises with age, a younger age at diagnosis is linked to increased mortality. We discuss age related factors affecting breast cancer diagnosis, management and treatment, exploring key concepts and identifying critical areas requiring further research. We examine age as a factor in breast cancer diagnosis and treatment relating it to factors such as genetic status, breast cancer subtype, hormone factors and nodal status. We examine the effects of age as seen through the adoption of population wide breast cancer screening programs. Assessing the incidence rates of each breast cancer subtype, in the context of age, we examine the observed correlations. We explore how age affects patient's prognosis, exploring the effects of age on stage and subtype incidence. Finally we discuss the future of breast cancer diagnosis and treatment, examining the potential of emerging tests and technologies (such as microRNA) and how novel research findings are being translated into clinically relevant practices.
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Affiliation(s)
- Andrew McGuire
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland.
| | - James A L Brown
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland.
| | - Carmel Malone
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland.
| | - Ray McLaughlin
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland.
| | - Michael J Kerin
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland.
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Rezai M, Kellersmann S, Knispel S, Lax H, Kimmig R, Kern P. Translating the concept of intrinsic subtypes into an oncoplastic cohort of more than 1000 patients - predictors of recurrence and survival. Breast 2015; 24:384-90. [PMID: 25987488 DOI: 10.1016/j.breast.2015.02.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 02/01/2015] [Accepted: 02/22/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION A paradigm shift in breast cancer was introduced by Sørlie's concept of intrinsic subtypes [1]. We validated this concept - which was originally based on 84 individuals - in a large cohort study of 1035 patients with oncoplastic surgery and analyzed if early and late recurrences are linked to a specific intrinsic tumor subtype or resection margins. MATERIALS AND METHODS 1035 patients with oncoplastic surgery (2004-2009) were analyzed with regard to treatment characteristics and patterns of early (<5 years) and late recurrence (>5 years) and survival related to the intrinsic subtypes. Data was retrieved from patient's charts, customized patients questionnaires and cancer registries. RESULTS 944 patients with primary, unilateral breast cancer, median age 58 years, were eligible for analysis. At a median FU of 5.2 years, LRR was 4.0%, 5-year-OS 94.5% and DFS 90.9%. Intrinsic subtypes, but not T-size, nodal-status, resections margins nor histopathology, governed local control and survival. There was no signal for prevelance of unclear margins in any of intrinsic subgroups and no preference of any oncoplastic technique attributed to them. TNBC and Her2 non-luminal breast cancer had highest recurrence and lowest survival rates. Although sentinel involvement (SLN+) was prevailing in the Luminal-B-Her 2 negative subtype at 34.3%, this did not translate into a higher axillary dissection rate. CONCLUSION This study confirmed the intrinsic subtype concept on a large clinical basis and describes the patterns of early and late recurrence in oncoplastic surgery, concluding that bigger risk may not be overcome by bigger surgery.
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Affiliation(s)
- M Rezai
- Breast Center Düsseldorf Luisenkrankenhaus, Director: Dr.Mahdi Rezai, Hans-Günther-Sohl-Str.6-10, 40235 Düsseldorf, Germany
| | - S Kellersmann
- Breast Center Düsseldorf Luisenkrankenhaus, Director: Dr.Mahdi Rezai, Hans-Günther-Sohl-Str.6-10, 40235 Düsseldorf, Germany; University Hospital of Essen, Department of Gynecology and Obstetrics, West German Cancer Center, Hufelandstr.55, D-45147 Essen, Germany
| | - S Knispel
- Breast Center Düsseldorf Luisenkrankenhaus, Director: Dr.Mahdi Rezai, Hans-Günther-Sohl-Str.6-10, 40235 Düsseldorf, Germany; University Hospital of Essen, Department of Gynecology and Obstetrics, West German Cancer Center, Hufelandstr.55, D-45147 Essen, Germany
| | - H Lax
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Zweigertstr. 37, D-45130 Essen, Germany
| | - R Kimmig
- University Hospital of Essen, Department of Gynecology and Obstetrics, West German Cancer Center, Hufelandstr.55, D-45147 Essen, Germany
| | - P Kern
- Breast Center Düsseldorf Luisenkrankenhaus, Director: Dr.Mahdi Rezai, Hans-Günther-Sohl-Str.6-10, 40235 Düsseldorf, Germany; University Hospital of Essen, Department of Gynecology and Obstetrics, West German Cancer Center, Hufelandstr.55, D-45147 Essen, Germany
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Lee HB, Han W. Unique features of young age breast cancer and its management. J Breast Cancer 2014; 17:301-7. [PMID: 25548576 PMCID: PMC4278047 DOI: 10.4048/jbc.2014.17.4.301] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 11/05/2014] [Indexed: 12/16/2022] Open
Abstract
Young age breast cancer (YABC) has unique clinical and biological features that are not seen in older patients. Breast tumor biology is more aggressive and is associated with an unfavorable prognosis in younger women. The diagnosis of breast cancer is often delayed, resulting in their initial presentation with more advanced disease. Together, these characteristics lead to a poorer prognosis in younger women than in older women. Young women who receive breast-conserving therapy have a higher rate of local recurrence. Therefore, it is important to secure sufficient resection margins and consider boost radiotherapy to prevent local treatment failure. Based on age alone, patients with YABC should be regarded as high-risk cases, and they should be treated with adjuvant chemotherapy. Special considerations regarding psychosocial factors and fertility should be taken into account for young patients. This review discusses the major considerations and principles concerning the management of patients with YABC.
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Affiliation(s)
- Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
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22
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Jia WJ, Jia HX, Feng HY, Yang YP, Chen K, Su FX. HER2-enriched tumors have the highest risk of local recurrence in Chinese patients treated with breast conservation therapy. Asian Pac J Cancer Prev 2014; 15:315-20. [PMID: 24528048 DOI: 10.7314/apjcp.2014.15.1.315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the recurrence pattern and characteristics of patients based on the 2013 St. Gallen surrogate molecular subtypes after breast-conserving surgery (BCS) in Chinese women. METHODS This retrospective analysis included 709 consecutive breast cancer patients undergoing BCS from 1999-2010 at our institution. Five different surrogate subtypes were created using combined expression of the estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2. Locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) rates were calculated. RESULTS The 5-year LRRFS, DMFS, and DFS rates were 90.5%, 88.2%, and 81.5%, respectively. Multivariate analysis revealed that young age, node-positive disease, and HER2 enrichment were independent prognostic factors in LRRFS patients. There was also an independent prognostic role of lymph node-positive disease in DMFS and DFS patients. Patients with luminal A tumors had the most favorable prognosis, with LRRFS, DMFS, and DFS rates of 93.2%, 91.5%, and 87.5% at 5 years, respectively. Conversely, HER-2-enriched tumors exhibited the highest rate of recurrence (27.5%) and locoregional recurrence (11.4%). CONCLUSION Surrogate subtypes present with significant differences in RFS, DMFS, and LRRFS. Luminal A tumors have the best prognosis, whereas HER2-enriched tumors have the poorest.
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Affiliation(s)
- Wei-Juan Jia
- Department of breast cancer, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, China E-mail :
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Jia H, Jia W, Yang Y, Li S, Feng H, Liu J, Rao N, Jin L, Wu J, Gu R, Zhu L, Chen K, Deng H, Zeng Y, Liu Q, Song E, Su F. HER-2 positive breast cancer is associated with an increased risk of positive cavity margins after initial lumpectomy. World J Surg Oncol 2014; 12:289. [PMID: 25241216 PMCID: PMC4190445 DOI: 10.1186/1477-7819-12-289] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 09/02/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The effect of breast cancer subtype on margin status after lumpectomy remains unclear. This study aims to determine whether approximated breast cancer subtype is associated with positive margins after lumpectomy, which could be used to determine if there is an increased risk of developing local recurrence (LR) following breast-conserving surgery. METHODS We studied 1,032 consecutive patients with invasive cancer who received lumpectomies and cavity margin (CM) assessments from January 2003 to November 2012. The following data were collected: patient age, cT stage, pT stage, grade, status of CM, lymph node status, menopausal status, ER, PR, HER-2, and Ki67, as well as the presence of extensive intraductal component (EIC) and lymphovascular invasion (LVI). A χ2 test was used to compare categorical baseline characteristics. Univariate and multivariate logistic regression analyses were performed to evaluate associations between pathologic features of CM status. Kaplan-Meier actuarial cumulative rates of LR (ipsilateral in-breast) were calculated. RESULTS A total of 7,884 pieces of marginal tissue were collected from 1,032 patients, and 209 patients had positive CMs. Of the patients tested, 52.3% had luminal A subtype, 14.9% were luminal B, 12.8% were luminal-HER-2, 8.1% were HER-2 enriched, and 11.8% were triple negative. Univariate analysis showed that EIC (P < 0.001), LVI (P = 0.026), pN stage (N1 vs. N0: P = 0.018; N3 vs. N0: P < 0.001), and luminal B (P = 0.001) and HER-2 (P < 0.001) subtypes were associated with positive CMs. Multivariable analysis indicated that only EIC (P < 0.001), pN stage (P = 0.003), and HER-2 subtype (P < 0.001) were significantly correlated with positive CMs. On multivariable analysis, HER-2 subtype was an independent prognostic factor in LR (P = 0.031). CONCLUSIONS The HER-2 subtype was the predictive factor most associated with positive CMs and an independent prognostic factor for LR. This result suggests that the increased risk of LR in HER-2 breast cancer is due to an increased microscopic invasive tumor burden, which is indicated by margin status after lumpectomy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Fengxi Su
- Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiangxi Road, Guangzhou 510120, PR China.
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Chen J, Jiang P, Wang HJ, Zhang JY, Xu Y, Guo MH, Zhang B, Tang CY, Cao HY, Wang S. The efficacy of molecular subtyping in predicting postoperative recurrence in breast-conserving therapy: a 15-study meta-analysis. World J Surg Oncol 2014; 12:212. [PMID: 25022995 PMCID: PMC4105249 DOI: 10.1186/1477-7819-12-212] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/04/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recent research displays that breast cancer (BC) is a heterogeneous disease and distinct molecular subtypes yield different prognostic outcomes. METHODS We conducted a meta-analysis to clarify the role of molecular subtypes in recurrence risk after breast-conserving therapy (BCT). Eligible studies of single- (ER, PR, Her-2, and p53) and triple-molecular (Luminal A, Luminal B, Her-2, triple-negative) subtypes were identified through multiple search strategies. Pooled hazard ratios with 95% confidence intervals were calculated to assess this research topic. RESULTS Fifteen studies involving 21,645 participants were included in the meta-analysis. Her-2 positive patients had a significantly higher recurrence risk in both overall merge (HR = 1.97, 95% CI: 1.41-2.75) and subtotal merge of local recurrence (LR) (HR = 1.93, 95% CI: 1.34-2.78). Significantly higher risk of recurrence was also observed in p53 positive patients by overall merge (HR = 1.78, 95% CI: 1.49 -2.12) and subtotal merge of LR (HR = 1.73, 95% CI: 1.44-2.07). When setting Luminal A as a baseline, Luminal B, Her-2, and triple-negative all showed significantly increased risk for both LR and distant recurrence (DR). Comparing triple-negative and non-triple-negative subtypes showed the biggest risk for overall recurrence (HR = 3.19, 95% CI: 1.91-5.31) and LR (HR = 3.31, 95% CI: 1.69-6.45). CONCLUSIONS Our meta-analysis showed significant differences in recurrence risk among various molecular subtypes after BCT. Although Her-2 and p53 positive subtypes can be considered independent prognostic biomarkers for indicating high LR risk, triple-molecular biomarkers showed higher clinical value. Triple-negative subtype showed the highest recurrence risk among all subtypes, and adjuvant chemotherapy should be considered for it.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Shui Wang
- Department of Breast Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Heil J, Fuchs V, Golatta M, Schott S, Wallwiener M, Domschke C, Sinn P, Lux MP, Sohn C, Schütz F. Extent of primary breast cancer surgery: standards and individualized concepts. ACTA ACUST UNITED AC 2014; 7:364-9. [PMID: 24647774 DOI: 10.1159/000343976] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Surgery is still a main therapeutic option in breast cancer treatment. Nowadays, methods of resection and reconstruction vary according to different tumors and patients. This review presents and discusses standards of care and arising questions on how radical primary breast cancer surgery should be according to different clinical situations. In most early breast cancer patients, breast conservation is the method of choice. The discussion on resection margins is still controversial as different studies show conflicting results. Modified radical mastectomy is the standard in locally advanced breast cancer patients, although there are different promising approaches to spare skin or even the nipple-areola complex. A sentinel node biopsy is the standard of care in clinically node-negative invasive breast cancer patients, whereas the significance of axillary lymphonodectomy seems to be questioned through a number of different findings. Although there are interesting findings to modify surgical approaches in very young or elderly breast cancer patients, it will always be an individualized approach if we do not adhere to current guidelines. Up to date, there are no special surgical procedures in BRCA mutation carriers or patients of high-risk families.
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Affiliation(s)
- Joerg Heil
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Valerie Fuchs
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Michael Golatta
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Sarah Schott
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | | | | | - Peter Sinn
- Institut für Pathologie, Universität Heidelberg, Germany
| | - Michael P Lux
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Germany
| | - Christof Sohn
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Florian Schütz
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
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HVEM gene polymorphisms are associated with sporadic breast cancer in Chinese women. PLoS One 2013; 8:e71040. [PMID: 23976978 PMCID: PMC3745383 DOI: 10.1371/journal.pone.0071040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 06/27/2013] [Indexed: 11/19/2022] Open
Abstract
As a costimulatory molecule, Herpesvirus entry mediator (HVEM) can bind with several costimulatory members, thus HVEM plays different roles in T cell immunity. HVEM and its ligands have been involved in the pathogenesis of various autoimmune, inflammatory diseases and tumors. In the current study, we conducted a case-control study comparing polymorphisms of HVEM and breast cancer. Subjects included 575 females with breast cancer and 604 age-matched healthy controls. Six HVEM SNPs (rs2281852, rs1886730, rs2234163, rs11573979, rs2234165, and rs2234167) were genotyped by PCR-RFLP. The results showed significant differences in genotypes and alleles between rs1886730 and rs2234167 (P<0.05). One haplotype (CTGCGG) that was associated with breast cancer was found via haplotype analysis. Our research also indicated an association between polymorphisms of HVEM and clinicopathologic features, including lymph node metastasis, estrogen receptor, progesterone receptor and P53. Our results primarily indicate that polymorphisms of the HVEM gene were associated with the risk of sporadic breast cancer in northeast Chinese females.
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Jackisch C, Schneeweiss A, Untch M, Wenz F, Bauerfeind I, Gerber B. Behandlung des lokoregionären Rezidivs unter besonderer Berücksichtigung der HER2-positiven Rezidive. Breast Care (Basel) 2013. [DOI: 10.1159/000354287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ponzone R, Baum M. Loco-regional therapy and breast cancer survival: searching for a link. Breast 2012; 22:510-4. [PMID: 23102939 DOI: 10.1016/j.breast.2012.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/24/2012] [Accepted: 10/03/2012] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The relationship between loco-regional (LR) control and breast cancer survival was investigated with the intention of generating a new biological hypothesis to explain some of the paradoxes unaccounted for by the prevailing conceptual model of the disease. BACKGROUND The progressive reduction of surgical aggressiveness has been accompanied by an increase of breast cancer survival mainly attributed to the adoption of adjuvant systemic therapies. More recently, it has been recognized that effective LR control may prolong the survival of breast cancer patients, although the reasons for this improvement have not yet been clearly defined. METHODS The literature (PubMed) was reviewed for publications related to breast cancer LR treatments using the following key words: breast cancer surgery, breast cancer radiotherapy, breast cancer loco-regional control, breast cancer survival. RESULTS Although breast cancer is frequently a multifocal disease, neither mastectomy nor whole breast irradiation are always mandatory to obtain adequate local control. Conversely, selected groups of patients carry a particularly elevated risk of LR relapse and require more effective treatments to be developed. True LR recurrences are associated with a decreased overall survival and this may be related to a complex relationship between circulating tumor cells, re-seeding of the primary tumor site and several metabolic effects linked to the act of surgery. CONCLUSION The prevention of LR recurrences is a major goal of breast cancer care, which requires a better understanding of the complex relationships between the primary tumor and its metastatic process.
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Affiliation(s)
- Riccardo Ponzone
- Division of Gynecological Oncology, Fondazione del Piemonte per l'Oncologia, Turin, Italy.
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