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Fasola CE, Graham E, Sha W, Schepel CR, Trufan SJ, Hecksher A, White RL, Hadzikadic-Gusic L. Assessment of Postmastectomy Radiation Therapy Receipt by Age and Association With Outcomes in Women With Breast Cancer. Clin Breast Cancer 2024; 24:e396-e407.e4. [PMID: 38492996 DOI: 10.1016/j.clbc.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Postmastectomy radiation therapy (PMRT) reduces locoregional recurrence (LRR) and improves overall survival (OS) in patients with breast cancer. Young age has been recognized as a risk factor for LRR. The primary objective of this study was to determine if recommendations for PMRT differed among patients younger than 50 years as compared to women aged 50 years or older. METHODS We reviewed medical records of patients with breast cancer who underwent mastectomy with or without PMRT from 2010 through 2018. Univariable and multivariable models were used to estimate the association of age with PMRT. RESULTS Of 2471 patients, 839 (34%) were <50 years; 1632 (66%) were ≥50 years. Patients <50 years had a higher percentage of grade 3 tumors, hormone receptor (HR) negative and/or Her-2/neu positive tumors, clinical stage T2/T3 tumors, and nodal involvement. Compared with patients ≥50 years, patients <50 years were more likely to undergo PMRT (OR 1.57; P = .001) and regional node irradiation (RNI) to the internal mammary nodes. Advanced clinical and pathologic stage, invasive tumor histology, the presence of lymphovascular invasion, and treatment with systemic chemotherapy were predictors of PMRT receipt for patients <50 years (P < .05). PMRT was associated with improved OS and recurrence free survival (RFS) among all patients (P < .01). CONCLUSION Patients <50 years were more likely to undergo PMRT and to receive RNI to the internal mammary nodes but were also more likely to have other risk factors for recurrence that would warrant a PMRT recommendation. PMRT improved OS and RFS for all patients.
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Affiliation(s)
- Carolina E Fasola
- Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Elaina Graham
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC
| | - Wei Sha
- Department of Biostatistics and Data Sciences, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Courtney R Schepel
- Clinical Trials Office, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Sally J Trufan
- Department of Biostatistics and Data Sciences, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Anna Hecksher
- Clinical Trials Office, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Richard L White
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC
| | - Lejla Hadzikadic-Gusic
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC.
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Giaquinto AN, Sung H, Miller KD, Kramer JL, Newman LA, Minihan A, Jemal A, Siegel RL. Breast Cancer Statistics, 2022. CA Cancer J Clin 2022; 72:524-541. [PMID: 36190501 DOI: 10.3322/caac.21754] [Citation(s) in RCA: 591] [Impact Index Per Article: 295.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 12/14/2022] Open
Abstract
This article is the American Cancer Society's update on female breast cancer statistics in the United States, including population-based data on incidence, mortality, survival, and mammography screening. Breast cancer incidence rates have risen in most of the past four decades; during the most recent data years (2010-2019), the rate increased by 0.5% annually, largely driven by localized-stage and hormone receptor-positive disease. In contrast, breast cancer mortality rates have declined steadily since their peak in 1989, albeit at a slower pace in recent years (1.3% annually from 2011 to 2020) than in the previous decade (1.9% annually from 2002 to 2011). In total, the death rate dropped by 43% during 1989-2020, translating to 460,000 fewer breast cancer deaths during that time. The death rate declined similarly for women of all racial/ethnic groups except American Indians/Alaska Natives, among whom the rates were stable. However, despite a lower incidence rate in Black versus White women (127.8 vs. 133.7 per 100,000), the racial disparity in breast cancer mortality remained unwavering, with the death rate 40% higher in Black women overall (27.6 vs. 19.7 deaths per 100,000 in 2016-2020) and two-fold higher among adult women younger than 50 years (12.1 vs. 6.5 deaths per 100,000). Black women have the lowest 5-year relative survival of any racial/ethnic group for every molecular subtype and stage of disease (except stage I), with the largest Black-White gaps in absolute terms for hormone receptor-positive/human epidermal growth factor receptor 2-negative disease (88% vs. 96%), hormone receptor-negative/human epidermal growth factor receptor 2-positive disease (78% vs. 86%), and stage III disease (64% vs. 77%). Progress against breast cancer mortality could be accelerated by mitigating racial disparities through increased access to high-quality screening and treatment via nationwide Medicaid expansion and partnerships between community stakeholders, advocacy organizations, and health systems.
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Affiliation(s)
- Angela N Giaquinto
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Kimberly D Miller
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Joan L Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Lisa A Newman
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, New York, USA
| | - Adair Minihan
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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3
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Fu F, Yu L, Zeng B, Chen M, Guo W, Chen L, Lin Y, Hou J, Li J, Li Y, Li S, Chen X, Zhang W, Jin X, Cai W, Zhang K, Chen H, Qiu Y, Nie Q, Wang C, Jacobs L. Association of Adjuvant Hormone Therapy Timing With Overall Survival Among Patients With Hormone Receptor-Positive Human Epidermal Growth Factor Receptor-2-Negative Early Breast Cancer Without Chemotherapy. JAMA Netw Open 2022; 5:e2145934. [PMID: 35166783 PMCID: PMC8848199 DOI: 10.1001/jamanetworkopen.2021.45934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Studies have shown that delayed initiation of surgery and adjuvant chemotherapy is associated with lower rates of breast cancer survival. However, it remains unclear whether delayed initiation of adjuvant hormone therapy (AHT) is associated with survival. Objective To assess the association of time to adjuvant hormone therapy (TTH) with breast cancer survival and evaluate the factors associated with AHT. Design, Setting, and Participants This cohort study examined data from the National Cancer Database from 2004 through 2014 to assess the association of TTH (stratified as ≤150 and >150 days) with cancer survival. All patients included were diagnosed with stage I to stage III hormone receptor-positive, human epidermal growth factor receptor-2 (ERBB2; formerly HER2)-negative invasive breast cancer and underwent AHT without chemotherapy. Data were analyzed from April 2019 to May 2020. Exposures AHT was administered at different time points following surgical procedures for breast cancer treatment. Main Outcomes and Measures An inverse probability of treatment weighting (IPTW) model was constructed to evaluate overall survival by adjusting for treatment facility, patient demographics, tumor characteristics, and treatment; multivariable logistic regression was conducted to assess factors associated with delayed treatment. Results A total of 144 103 patients (median [IQR] follow-up, 36.6 months [25.5-49.2 months]; mean [SD] age, 63.7 [11.6] years) were identified, which included 142 916 (99.2%) women, 11 574 (8.0%) Black patients, and 126 013 (87.4%) White patients. Of these, 134 873 patients (93.6%) had a TTH of 150 days or less and 9230 patients (6.4%) had a TTH longer than 150 days. The IPTW-based Cox model demonstrated that patients with delayed AHT (ie, a TTH past 150 days) were associated with decreased survival (hazard ratio [HR], 1.31; 95% CI, 1.26-1.35; P < .001) compared with those receiving the timely treatment (TTH ≤150 days). Several sensitivity analyses (including IPTW with stabilized weight [HR, 1.31; 95% CI, 1.19-1.45; P < .001], propensity score matching [HR, 1.41; 1.13-1.76; P = .002], and propensity score regression adjustment [HR, 1.29; 95% CI, 1.16-1.43; P < .001]) and exploratory subgroup analyses yielded similar trends. Factors associated with delayed AHT included Black racial identity (OR, 1.66; 95% CI, 1.55-1.77), nonprivate insurance (eg, no insurance: OR, 1.46; 95% CI, 1.26-1.70), living in large metropolitan or metropolitan areas (reference vs urban, less urban, or rural: OR, 0.82; 95% CI, 0.76-0.87), treatment in a community hospital (reference vs academic or research: OR, 0.91; 95% CI, 0.84-0.98), Charlson-Deyo Comorbidity Index score 2 or higher (OR, 1.17; 95% CI, 1.04-1.32), poor grade differentiation (OR, 1.42; 95% CI, 1.32-1.53), II and III pathological stage (stage III: OR, 3.13; 95% CI, 2.76-3.54), estrogen receptor-positive (ER+)/progesterone receptor-negative (PR-) or ER-/PR+ (OR, 1.22; 95% CI, 1.13-1.31), receiving breast conservation surgery (reference vs mastectomy: OR, 0.87; 95% CI, 0.79-0.94), and radiotherapy (reference vs no radiotherapy: OR, 0.56; 95% CI, 0.52-0.61). Conclusions and Relevance The delay of the initiation of AHT past 150 days was associated with diminished survival in hormone receptor-positive, ERBB2-negative patients with breast cancer who did not receive chemotherapy. Efforts should be made to address factors associated with delayed treatment to improve survival.
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Affiliation(s)
- Fangmeng Fu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Liuwen Yu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Bangwei Zeng
- Administration Department of Nosocomial Infection, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Minyan Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Wenhui Guo
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Lili Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Yuxiang Lin
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Jialin Hou
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Jing Li
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Yan Li
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Shengmei Li
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Xiaobin Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Wenzhe Zhang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Xuan Jin
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Weifeng Cai
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Kun Zhang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Hanxi Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Yibin Qiu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Qian Nie
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Chuan Wang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, Fujian Province, China
| | - Lisa Jacobs
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Azam M, Aslam M, Basharat J, Mughal MA, Nadeem MS, Anwar F. An empirical study on quality of life and related factors of Pakistani breast cancer survivors. Sci Rep 2021; 11:24391. [PMID: 34937873 PMCID: PMC8695584 DOI: 10.1038/s41598-021-03696-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/08/2021] [Indexed: 12/01/2022] Open
Abstract
A comprehensive understanding of the quality of life (QoL) is essential to establish long-term survivor care plans. The present study was aimed at the assessment of QoL of BC survivors with special emphasis on post-treatment physical, emotional, social, and spiritual challenges. We have assessed the QoL of 250 female BC survivors of all age groups through demographic factors. Volunteer BC survivors were registered in the present study who had got treatment from the Institute of Nuclear Medicine and Oncology (INMOL) hospital and Mayo hospital Lahore. An informed consent form was signed by each participant. The physical, psychological, and spiritual well-being was evaluated by a questionnaire filled with the help of respondents. The average age of BC survivors was 52 ± 7.8 years. Most of them (83%) complained of fatigue during daily life activities, 75.1% body pain or headache, 77.1% had problems with appetite, 63.2% reported weight loss, 77.1% had sleep problems, and 90.5% were feeling general weakness. Only 16.2% were satisfied with their physical health and 2% were not satisfied with their medication. Psychologically, 74.4% were feeling different levels of anxiety, only 10% of them were hoping to achieve a desired life. Age group 21 to 40 years reported better physical health, those with 40-50 years of age and family history of BC have shown better mental strength. The physical and psychological health of survivors from rural areas was comparatively better than those from urban areas. The BC survivor women have to face several physical, psychological and social challenges. The majorities of them complain of anxiety, body pain, fatigue, sleep problems, general weakness, and fear about the future. Our findings suggest the need for psychological support, physical activity a comprehensive post-diagnosis and post-treatment physical and mental health assistance plan for all BC survivors. Implications for Cancer Survivors. Survivors of breast cancer experience various challenges including anxiety, sleep problems, body pain, fatigue, and fear about the future. The psychological, physical and social factors make a great difference in their quality of life.
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Affiliation(s)
- Muhammad Azam
- grid.412967.f0000 0004 0609 0799Department of Statistics and Computer Science, University of Veterinary and Animal Sciences, Lahore, 54000 Pakistan
| | - Muhammad Aslam
- Department of Statistics, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.
| | - Javeria Basharat
- grid.444922.d0000 0000 9205 361XDepartment of Statistics, Kinnaird College for Women, 93-Jail Road, Lahore, 54000 Pakistan
| | - Muhammad Anwar Mughal
- grid.444905.80000 0004 0608 7004Department of Statistics, Forman Christian College (A Chartered University), Ferozepur Road, Lahore, 54600 Pakistan
| | - Muhammad Shahid Nadeem
- grid.412125.10000 0001 0619 1117Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, 21589 Saudi Arabia
| | - Firoz Anwar
- grid.412125.10000 0001 0619 1117Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, 21589 Saudi Arabia
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5
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Ghaffari F, Ghahramanian A, Zamanzadeh V, Onyeka TC, Davoodi A, Mazaheri E, Asghari-Jafarabadi M. Patient-centred communication for women with breast cancer: Relation to body image perception. J Clin Nurs 2020; 29:4674-4684. [PMID: 32956571 DOI: 10.1111/jocn.15508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/26/2020] [Accepted: 09/06/2020] [Indexed: 12/27/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to determine the predictive values of patient-centred communication (PCC) and patient's characteristics on the body image (BI) perception in postmastectomy patients. BACKGROUND Patient-centred communication has been touted as a means of addressing BI issues, especially for postmastectomy patients. DESIGN AND METHODS This predictive correlational study was conducted on 275 surgically treated breast cancer patients admitted to the Oncology Departments of two hospitals in Tabriz, Iran. These patients were selected using a convenience sampling method. The Body Image after Breast Cancer Questionnaire (BIBCQ) and patient-centred communication questionnaire (PCCQ) were used for collecting the data. Descriptive and inferential statistics were applied to the data. Reporting was in accordance with the STROBE guideline. RESULTS A multivariable model significantly predicted BI perception in participants using surgery type and time elapsed following surgery. Participants' limitations were significantly affected by surgery type and participants' perception of the nurses' PCC skills. Arm concern was significantly affected by surgery type and nurses' PCC skills. CONCLUSION Patient-centred skills in nurse-patient communication are critical for resolving BI difficulties such as arm concerns and limitations regarding the disease and its treatment. RELEVANCE TO CLINICAL PRACTICE Patient-centred communication skills can be taught nurses in the clinical setting to help alleviate patients' BI problems.
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Affiliation(s)
- Fariba Ghaffari
- Department of Medical Surgical Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Medical Surgical Department, Nursing and Midwifery Faculty, Hematology & Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Medical Surgical Department, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tonia C Onyeka
- Department of Anaesthesia/Pain and Palliative Care Unit, Multidisciplinary Oncology Centre, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Arefeh Davoodi
- Department of Medical Surgical, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Effat Mazaheri
- Department of Medical Surgical, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari-Jafarabadi
- Department of Statistics and Epidemiology, Faculty of Health, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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6
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DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Breast cancer statistics, 2019. CA Cancer J Clin 2019; 69:438-451. [PMID: 31577379 DOI: 10.3322/caac.21583] [Citation(s) in RCA: 1771] [Impact Index Per Article: 354.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022] Open
Abstract
This article is the American Cancer Society's biennial update on female breast cancer statistics in the United States, including data on incidence, mortality, survival, and screening. Over the most recent 5-year period (2012-2016), the breast cancer incidence rate increased slightly by 0.3% per year, largely because of rising rates of local stage and hormone receptor-positive disease. In contrast, the breast cancer death rate continues to decline, dropping 40% from 1989 to 2017 and translating to 375,900 breast cancer deaths averted. Notably, the pace of the decline has slowed from an annual decrease of 1.9% during 1998 through 2011 to 1.3% during 2011 through 2017, largely driven by the trend in white women. Consequently, the black-white disparity in breast cancer mortality has remained stable since 2011 after widening over the past 3 decades. Nevertheless, the death rate remains 40% higher in blacks (28.4 vs 20.3 deaths per 100,000) despite a lower incidence rate (126.7 vs 130.8); this disparity is magnified among black women aged <50 years, who have a death rate double that of whites. In the most recent 5-year period (2013-2017), the death rate declined in Hispanics (2.1% per year), blacks (1.5%), whites (1.0%), and Asians/Pacific Islanders (0.8%) but was stable in American Indians/Alaska Natives. However, by state, breast cancer mortality rates are no longer declining in Nebraska overall; in Colorado and Wisconsin in black women; and in Nebraska, Texas, and Virginia in white women. Breast cancer was the leading cause of cancer death in women (surpassing lung cancer) in four Southern and two Midwestern states among blacks and in Utah among whites during 2016-2017. Declines in breast cancer mortality could be accelerated by expanding access to high-quality prevention, early detection, and treatment services to all women.
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Affiliation(s)
- Carol E DeSantis
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Jiemin Ma
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Mia M Gaudet
- Behavioral and Epidemiology Research, American Cancer Society, Atlanta, Georgia
| | - Lisa A Newman
- Department of Surgery, Weill Cornell Medical Center, New York, New York
| | - Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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7
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Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, Jemal A, Kramer JL, Siegel RL. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin 2019; 69:363-385. [PMID: 31184787 DOI: 10.3322/caac.21565] [Citation(s) in RCA: 2790] [Impact Index Per Article: 558.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.
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Affiliation(s)
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | | | - Ahmedin Jemal
- Surveillance Research, American Cancer Society, Atlanta, Georgia
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Joan L Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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8
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Thomas A, Rhoads A, Pinkerton E, Schroeder MC, Conway KM, Hundley WG, McNally LR, Oleson J, Lynch CF, Romitti PA. Incidence and Survival Among Young Women With Stage I-III Breast Cancer: SEER 2000-2015. JNCI Cancer Spectr 2019; 3:pkz040. [PMID: 31392297 PMCID: PMC6668585 DOI: 10.1093/jncics/pkz040] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/23/2019] [Accepted: 06/05/2019] [Indexed: 01/24/2023] Open
Abstract
Background Although recent findings suggest that de novo stage IV breast cancer is increasing in premenopausal women in the United States, contemporary incidence and survival data are lacking for stage I-III cancer. Methods Women aged 20-29 (n = 3826), 30-39 (n = 34 585), and 40-49 (n = 126 552) years who were diagnosed with stage I-III breast cancer from 2000 to 2015 were identified from the Surveillance, Epidemiology, and End Results 18 registries database. Age-adjusted, average annual percentage changes in incidence and 5- and 10-year Kaplan-Meier survival curves were estimated by race and ethnicity, stage, and hormone receptor (HR) status and grade (low to well and moderately differentiated; high to poorly and undifferentiated) for each age decade. Results The average annual percentage change in incidence was positive for each age decade and was highest among women aged 20-29 years. Increased incidence was driven largely by HR+ cancer, particularly HR+ low-grade cancer in women aged 20-29 and 40-49 years. By 2015, incidence of HR+ low- and high-grade cancer each independently exceeded incidence of HR- cancer in each age decade. Survival for HR+ low- and high-grade cancer decreased with decreasing age; survival for HR- cancer was similar across age decades. Among all women aged 20-29 years, 10-year survival for HR+ high-grade cancer was lower than that for HR+ low-grade or HR- cancer. Among women aged 20-29 years with stage I cancer, 10-year survival was lowest for HR+ high-grade cancer. Conclusions HR+ breast cancer is increasing in incidence among premenopausal women, and HR+ high-grade cancer was associated with reduced survival among women aged 20-29 years. Our findings can help guide further evaluation of preventive, diagnostic, and therapeutic strategies for breast cancer among premenopausal women.
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Affiliation(s)
- Alexandra Thomas
- Department of Internal Medicine, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Anthony Rhoads
- Department of Epidemiology, College of Public Health, Division of Health Services Research, Department of Biostatistics, , University of Iowa, Iowa City, IA
| | - Elizabeth Pinkerton
- Department of Epidemiology, College of Public Health, Division of Health Services Research, Department of Biostatistics, , University of Iowa, Iowa City, IA
| | | | - Kristin M Conway
- Department of Epidemiology, College of Public Health, Division of Health Services Research, Department of Biostatistics, , University of Iowa, Iowa City, IA
| | - William G Hundley
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Lacey R McNally
- Department of Cancer Biology, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Jacob Oleson
- College of Public Health, University of Iowa, Iowa City, IA.,Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA
| | - Charles F Lynch
- Department of Epidemiology, College of Public Health, Division of Health Services Research, Department of Biostatistics, , University of Iowa, Iowa City, IA
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, Division of Health Services Research, Department of Biostatistics, , University of Iowa, Iowa City, IA.,College of Public Health, University of Iowa, Iowa City, IA.,Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA
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9
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Lazow SP, Riba L, Alapati A, James TA. Comparison of breast-conserving therapy vs mastectomy in women under age 40: National trends and potential survival implications. Breast J 2019; 25:578-584. [PMID: 31090168 DOI: 10.1111/tbj.13293] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Despite initial increased rates of breast-conserving therapy compared to mastectomy after 1990, mastectomy rates have increased in women under age 40 since 2000. Our study explores the demographic and survival implications of this trend. METHODS The National Cancer Database was used to study stage 1 breast cancer diagnosed in women under age 40 between 2004 and 2014. Demographic and clinical data were obtained. Multivariable regression and survival analyses were performed. RESULTS Of 11 859 patients under age 40, 57.2% underwent mastectomy (39.0% unilateral and 61.0% bilateral) rather than breast-conserving therapy (42.8%). The rate of mastectomy was significantly higher in 2014 compared to 2004 (43.6% in 2004 vs 62.4% in 2014; P < 0.001). The rate of bilateral mastectomy was significantly higher in 2014 compared to 2004 in contrast to unilateral mastectomy (31.7% in 2004 vs 73.0% in 2014; P < 0.001). Non-Hispanic Caucasian ethnicity and private insurance status were predictors of bilateral mastectomy (OR 2.06 [95% CI: 1.84-2.30], P < 0.001; OR 1.39 [95% CI: 1.21-1.59], P < 0.001). Controlling for demographics, tumor grade, and adjuvant therapies, bilateral mastectomy was associated with significantly increased 10-year survival vs unilateral mastectomy (HR 0.75 [0.59-0.96], P = 0.023). Additionally, breast-conserving therapy was associated with significantly increased 10-year survival vs unilateral (HR 2.36 [95% CI: 1.83-3.05]; P < 0.001) and bilateral mastectomy (HR 2.30 [95% CI: 1.61-3.27]; P < 0.001). CONCLUSIONS The majority of women under age 40 with stage 1 invasive breast cancer underwent mastectomy instead of breast-conserving therapy. This largely reflects increased rates of contralateral prophylactic mastectomy. Bilateral mastectomy and breast-conserving therapy vs unilateral mastectomy were associated with a small but significant increase in survival. This finding warrants further investigation to determine the clinical implications of decision-making in younger women.
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Affiliation(s)
- Stefanie P Lazow
- Department of Surgery, BreastCare Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Luis Riba
- Department of Surgery, BreastCare Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Amulya Alapati
- Department of Surgery, BreastCare Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ted A James
- Department of Surgery, BreastCare Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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10
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McCrate F, Dicks E, Powell E, Chafe J, Roome R, Simmonds C, Etchegary H. Surgical treatment choices for breast cancer in Newfoundland and Labrador: a retrospective cohort study. Can J Surg 2019; 61:377-384. [PMID: 30265635 DOI: 10.1503/cjs.015217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Mastectomy is often chosen by women for treatment of breast cancer, even when breast-conserving surgery (BCS) is an option. Newfoundland and Labrador has a high mastectomy rate. We documented the number of breast cancers over a given period in the province and their related surgical treatments, and explored the impact of several variables on surgical choice. METHODS A retrospective cohort design linked diagnosis data from the Newfoundland and Labrador tumour registry to surgery data from the Canadian Institute for Health Information Discharge Abstract Database. Data were extracted for all women aged 19 years or more in whom breast cancer was diagnosed in 2009-2014. RESULTS A total of 2346 cases of breast cancer with a linked surgical procedure were included. Most operations (1605 [68.4%]) were mastectomy procedures, with the remainder being BCS. Logistic regression analysis revealed that women were 1.82 times (95% confidence interval [CI] 1.64-2.02) more likely to have mastectomy for each unit of stage increase from 0 to IV and 1.15 times (95% CI 1.11-1.21) more likely for each unit of driving time increase. CONCLUSION Tumour stage and driving time to a radiation facility significantly predicted Newfoundland and Labrador women's surgical treatment choices for breast cancer. Notably, mastectomy was the favoured choice across all age groups, tumour stages and geographical regions of the province. We hope that these results will galvanize efforts to better understand local surgical practices and assist in improving the quality of surgical care of women with breast cancer.
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Affiliation(s)
- Farah McCrate
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Elizabeth Dicks
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Erin Powell
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Joanne Chafe
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Rebecca Roome
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Charlene Simmonds
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Holly Etchegary
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
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11
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Chen H, Zhang P, Zhang M, Wang M, Bai F, Wu K. Growing Trends of Contralateral Prophylactic Mastectomy and Reconstruction in Young Breast Cancer. J Surg Res 2019; 239:224-232. [PMID: 30856515 DOI: 10.1016/j.jss.2019.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 01/29/2019] [Accepted: 02/01/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the trends of surgical treatments among young patients in T1N0-1M0 stage based on the Surveillance, Epidemiology, and End Results database. MATERIALS AND METHODS Patients aged less than 40 y diagnosed between 1998 and 2015 were enrolled, with tumors in T1N0-1M0 stage and not located in the central area. Differences in clinical-pathological characteristics were evaluated using chi-square tests. Multivariate logistic regression was used to measure the various factors associated with contralateral prophylactic mastectomy (CPM). Independent prognostic factors were evaluated by Cox model. RESULTS The total rate of breast-conserving surgery (BCS) was 51.6%, which declined from 64.5% in 1998 to 39.6% in 2015. The total rate of CPM was 22.7%, which increased from 3.7% in 1998 to 38.7% in 2014 despite a decline to 32.7% in 2015. Meanwhile, the rate of reconstruction increased in line with that of CPM, from 9.4% in 1998 to 35.0% in 2015. There was a trend of increasing use of implant-based reconstruction. Significant higher odds of CPM were found in recent year of diagnosis between 2010 and 2015 and in implant-based reconstruction. Patients undergoing CPM had similar survival outcomes compared with those undergoing BCS and unilateral mastectomy, whereas those undergoing BCS had better survival outcomes compared with those undergoing unilateral mastectomy. CONCLUSIONS A trend of growing preference for CPM and reconstruction was observed among young patients in early stage in recent years without survival benefits. Efforts should be made to promote efficient communication and evidence-based decision-making.
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Affiliation(s)
- Hongliang Chen
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Peng Zhang
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Mingdi Zhang
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Maoli Wang
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Fang Bai
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Kejin Wu
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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12
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Latosinsky S, Jenkyn KMB, Li L, Shariff SZ. Post-mastectomy radiation in node-positive breast cancer in Ontario. Breast J 2019; 25:301-306. [PMID: 30790386 DOI: 10.1111/tbj.13208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
More recent guidelines are more supportive for post-mastectomy radiation in all node-positive breast cancer patients. We examined the rate and predictors of post-mastectomy radiation receipt in Ontario Canada from 2010 to 2014. Of 6535 node-positive post-mastectomy patients, 73.9% received radiation. The rate was 68.7% (2903/4227) among women with 1-3 positive nodes. Radiation was less likely to be administered to women who were older, had high levels of comorbidity, or presented with early stages of breast cancer. Regional practice variation was reassuringly modest.
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Affiliation(s)
- Steven Latosinsky
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Institute of Clinical Evaluative Sciences, Western Site (ICES Western), London, Ontario, Canada
| | - Krista M Bray Jenkyn
- Institute of Clinical Evaluative Sciences, Western Site (ICES Western), London, Ontario, Canada
| | - Lihua Li
- Institute of Clinical Evaluative Sciences, Western Site (ICES Western), London, Ontario, Canada
| | - Salimah Z Shariff
- Institute of Clinical Evaluative Sciences, Western Site (ICES Western), London, Ontario, Canada.,Arthur Labatt School of Nursing, University of Western Ontario, London, Ontario, Canada
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13
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Treatment Patterns Among Women Diagnosed With Stage I-III Triple-negative Breast Cancer. Am J Clin Oncol 2017; 41:997-1007. [PMID: 29278527 DOI: 10.1097/coc.0000000000000418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine contemporary treatment patterns for women diagnosed with stage I-III triple-negative breast cancer (TNBC) in the United States. METHODS We identified 48,961 patients diagnosed with stage I-III TNBC from 2010 to 2013 in the National Cancer Data Base and created 3 treatment subcohorts (definitive locoregional therapy [appropriate local therapy, including surgery/radiation], adjuvant chemotherapy [stage II-III disease or stage I tumors with tumor size ≥1 cm], and adjuvant chemotherapy for small tumors [stage I tumors with tumor size <1 cm and node negative]). We performed descriptive analyses, calculated percentages for treatment receipt, and used multivariable modified Poisson regression models to estimate risk ratios (RRs) with 95% confidence intervals (CIs) predicting receipt of treatments. RESULTS Older age, larger tumor size, positive nodal status, and Southern/Pacific US regions, but not race/ethnicity, were strongly associated with a lower probability of receiving definitive locoregional therapy. Older age was also strongly associated with lower likelihood of adjuvant chemotherapy receipt, as were grade, negative nodal status, and higher comorbidity. For example, compared with women aged 18 to 39 years, those aged 75 to 90 years were 17% less likely to receive definitive locoregional therapy (RR, 0.83; 95% CI, 0.73-0.88), and 62% less likely to receive adjuvant chemotherapy (RR, 0.38; 95% CI, 0.35-0.41). Age, tumor grade, tumor size, and comorbidity score were also independently associated with receipt of chemotherapy for women with small TNBC. CONCLUSIONS Advancing age but not race/ethnicity was associated with lower likelihood of recommended treatment receipt among women with TNBC. Although omission of therapy among older patients with breast cancer may be appropriate in the case of smaller and lower risk TNBC, some were likely undertreated.
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14
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Shih YCT, Xu Y, Chavez-MacGregor M, Guadagnolo BA, Smith BD, Giordano SH. Association Between Quality of Care for Breast Cancer and Health Insurance Exchange Coverage: An Analysis of Use of Radiation Therapy After Breast-Conserving Surgery. JAMA Oncol 2017; 3:1425-1426. [PMID: 28570719 DOI: 10.1001/jamaoncol.2017.1287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ya-Chen Tina Shih
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ying Xu
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mariana Chavez-MacGregor
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - B Ashleigh Guadagnolo
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D Smith
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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15
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Kataoka A, Iwamoto T, Tokunaga E, Tomotaki A, Kumamaru H, Miyata H, Niikura N, Kawai M, Anan K, Hayashi N, Masuda S, Tsugawa K, Aogi K, Ishida T, Masuoka H, Iijima K, Kinoshita T, Nakamura S, Tokuda Y. Young adult breast cancer patients have a poor prognosis independent of prognostic clinicopathological factors: a study from the Japanese Breast Cancer Registry. Breast Cancer Res Treat 2016; 160:163-172. [PMID: 27647460 PMCID: PMC5050233 DOI: 10.1007/s10549-016-3984-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to investigate whether young age at onset of breast cancer is an independent prognostic factor in patients from the Japanese Breast Cancer Registry, after adjustment of known clinicopathological prognostic factors. METHODS Of the 53,670 patients registered between 2004 and 2006 and surveyed after a 5-year follow-up prognosis, 25,898 breast cancer patients (48.3 %), who were obtained prognostic data, were examined. Clinicopathological factors were compared between young adult (YA; <35 years), middle-aged adult (MA; 35-50 years), and older adult (OA; >50 years) patients. Five-year disease-free survival (DFS) and overall survival (OS) rates were studied. RESULTS YA patients were associated with an advanced TNM stage and aggressive characteristics (e.g. human epidermal growth factor receptor 2 (HER2)-positive or oestrogen receptor (ER)-negative breast cancers) compared to MA and OA patients (P < 0.001). The 5-year DFS and OS rates were 79.4 % and 90.8, 88.5 and 95.0 %, and 87.8 % and 91.6 % for YA, MA, and OA patients, respectively. From the multivariable regression analysis, young age at onset was confirmed as an independent prognostic factor for both DFS (hazard ratio 1.73, 95 % confidence interval 1.42-2.10; P < 0.001) and OS (hazard ratio 1.58, 95 % confidence interval 1.16-2.15; P = 0.004). CONCLUSIONS Young age at onset is an independent negative prognostic factor in breast cancer. Further studies are required to develop new therapeutic strategies for YA breast cancer patients.
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Affiliation(s)
- Akemi Kataoka
- Breast Surgical Oncology Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takayuki Iwamoto
- Department of Breast and Endocrine Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama City, Okayama, 700-8558, Japan.
| | - Eriko Tokunaga
- Department of Breast Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Ai Tomotaki
- Department of Healthcare Quality Assessment, Graduate School of Medicine, Tokyo University, Tokyo, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, Tokyo University, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, Tokyo University, Tokyo, Japan
| | - Naoki Niikura
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Masaaki Kawai
- Department of Breast Surgery, Miyagi Cancer Center, Natori, Japan
| | - Keisei Anan
- Department of Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Naoki Hayashi
- Department of Breast Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Shinobu Masuda
- Department of Pathology, Nihon University School of Medicine, Tokyo, Japan
| | - Koichiro Tsugawa
- Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kenjiro Aogi
- Department of Breast Surgery, Shikoku Cancer Center, Matsuyama, Japan
| | - Takanori Ishida
- Department of Surgical Oncology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | | | - Kotaro Iijima
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University, Tokyo, Japan
| | - Yutaka Tokuda
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan
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16
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Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016; 66:271-89. [PMID: 27253694 DOI: 10.3322/caac.21349] [Citation(s) in RCA: 3404] [Impact Index Per Article: 425.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The number of cancer survivors continues to increase because of both advances in early detection and treatment and the aging and growth of the population. For the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborate to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results cancer registries. In addition, current treatment patterns for the most prevalent cancer types are presented based on information in the National Cancer Data Base and treatment-related side effects are briefly described. More than 15.5 million Americans with a history of cancer were alive on January 1, 2016, and this number is projected to reach more than 20 million by January 1, 2026. The 3 most prevalent cancers are prostate (3,306,760), colon and rectum (724,690), and melanoma (614,460) among males and breast (3,560,570), uterine corpus (757,190), and colon and rectum (727,350) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost one-half (47%) are aged 70 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by primary care providers. Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care. CA Cancer J Clin 2016;66:271-289. © 2016 American Cancer Society.
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Affiliation(s)
- Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Strategic Director, Surveillance Information, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Chun Chieh Lin
- Director, Health Services Research, Intramural Research Department, American Cancer Society, Atlanta, GA
| | - Angela B Mariotto
- Branch Chief, Surveillance Research Program, National Cancer Institute, Bethesda, MD
| | - Joan L Kramer
- Assistant Professor, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Julia H Rowland
- Director, Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD
| | - Kevin D Stein
- Vice President, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - Rick Alteri
- Medical Editor, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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17
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Bellavance EC, Kesmodel SB. Decision-Making in the Surgical Treatment of Breast Cancer: Factors Influencing Women's Choices for Mastectomy and Breast Conserving Surgery. Front Oncol 2016; 6:74. [PMID: 27066455 PMCID: PMC4810034 DOI: 10.3389/fonc.2016.00074] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/14/2016] [Indexed: 01/04/2023] Open
Abstract
One of the most difficult decisions a woman can be faced with when choosing breast cancer treatment is whether or not to undergo breast conserving surgery or mastectomy. The factors that influence these treatment decisions are complex and involve issues regarding access to health care, concerns for cancer recurrence, and the impact of surgery on body image and sexuality. Understanding these factors will help practitioners to improve patient education and to better guide patients through this decision-making process. Although significant scientific and societal advances have been made in improving women’s choices for the breast cancer treatment, there are still deficits in the decision-making processes surrounding the surgical treatment of breast cancer. Further research is needed to define optimal patient education and shared decision-making practices in this area.
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Affiliation(s)
| | - Susan Beth Kesmodel
- Department of General and Oncologic Surgery, University of Maryland , Baltimore, MD , USA
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18
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Factors associated with radiation therapy incompletion for patients with early-stage breast cancer. Breast Cancer Res Treat 2015; 155:187-99. [PMID: 26683609 DOI: 10.1007/s10549-015-3660-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of the study was to examine factors associated with adjuvant radiation treatment (RT) incompletion for women with breast cancer within a large national cancer database. METHODS We identified 394,334 women diagnosed with stage I-III breast cancer during 2004-2012 in the national cancer database who initiated adjuvant external beam adjuvant RT and examined the proportion of women not completing treatment. We used multivariable logistic regression to examine patient, clinical, and facility factors associated with RT incompletion for those who had breast-conserving surgery (BCS), defined as <15 fractions and <3990 centiGray [cGy] (accounting for adoption of hypofractionation), and mastectomy (PMRT, defined as <5000 cGy and <25 fractions), separately. We also examined RT incompletion after BCS using more traditional definitions of <25 fractions and <4500 cGy for diagnosis years ≤2010. RESULTS Among the 319,003 women who underwent BCS and the 75,331 women who underwent mastectomy and initiated RT, 98.4 and 97.8 % completed radiation, respectively. In adjusted analyses, older age was associated with RT incompletion (odds ratio [O.R.] for age ≥80 = 2.53 for BCS-treated, 95 % confidence interval [CI] 2.19-2.92; O.R. for PMRT incompletion = 2.33, 95 % CI 1.84-2.96; both versus age <50). In addition, those with ≥2 comorbidities and lower-risk disease had higher odds of RT incompletion. After defining RT completion using more traditional definitions, 94.0 % completed treatment. CONCLUSIONS Reassuringly, we found a very low proportion of patients not completing RT, though we observed a higher likelihood for treatment incompletion in some sub-groups, most notably older women. Further studies should focus on reasons for treatment discontinuation in populations at risk for suboptimal treatment.
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Menopausal status does not predict Oncotype DX recurrence score. J Surg Res 2015; 198:27-33. [PMID: 26095420 DOI: 10.1016/j.jss.2015.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 05/11/2015] [Accepted: 05/21/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Adjuvant treatment for early stage, estrogen receptor (ER) positive invasive breast cancer has been based on prognosticators such as menopausal status. The recurrence score (RS) from the 21-gene assay Oncotype DX (ODX) is predictive of a 10-y distant recurrence in this population but is rarely applied to premenopausal patients. The relationship between menopausal status and RS was evaluated. MATERIALS AND METHODS An institutional review board-approved retrospective review was conducted of invasive breast cancer patients with known RS. ODX eligibility was based on National Comprehensive Cancer Network guidelines or physician discretion. Perimenopausal women were classified as premenopausal for statistical analyses. Comparisons of menopausal status and RS were made using general linear regression model and the exact Wilcoxon rank-sum test. RESULTS Menopausal status was available for 575 patients (142 premenopausal, 433 postmenopausal). Median age was 46 y for premenopausal and 62 y for postmenopausal. Median invasive tumor size was 1.5 cm for both cohorts. Mastectomy rate was higher in the premenopausal group (54.8%) than postmenopausal (42%; P = 0.0001). Premenopausal women had a higher local-regional recurrence rate (2.8% versus 0%; P = 0.0384) but distant recurrence and overall survival were not statistically different (P = 0.6808). Median ER H-score was lower in premenopausal (H-score = 270) than postmenopausal women (H-score = 280; P < 0.0001). Median RS was 16 for both premenopausal (range, 0-54) and postmenopausal (range, 0-63) women. Menopausal status as a categorical variable was not predictive of RS (P-value = 0.6780). CONCLUSIONS Menopausal status has limited predictive power for distant recurrence. Therefore, menopausal status alone should not preclude performance of ODX in ER-positive, early stage breast cancer.
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Fisher S, Gao H, Yasui Y, Dabbs K, Winget M. Treatment variation in patients diagnosed with early stage breast cancer in Alberta from 2002 to 2010: a population-based study. BMC Health Serv Res 2015; 15:35. [PMID: 25609420 PMCID: PMC4308832 DOI: 10.1186/s12913-015-0680-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 01/05/2015] [Indexed: 11/17/2022] Open
Abstract
Background Breast-conserving surgery (BCS) followed by radiotherapy is generally the preferred treatment for women diagnosed with early stage breast cancer. This study aimed to investigate the proportion of patients who receive BCS versus mastectomy and post-BCS radiotherapy, and explore factors associated with receipt of these treatments in Alberta, Canada. Methods A retrospective population-based study was conducted that including all patients surgically treated with stage I-III breast cancer diagnosed in Alberta from 2002–2010. Clinical characteristics, treatment information and patient age at diagnosis were collected from the Alberta Cancer Registry. Log binomial multiple regression was used to calculate stage-specific relative risk estimates of receiving BCS and post-BCS radiotherapy. Results Of the 14 646 patients included in the study, 44% received BCS, and of those, 88% received post-BCS radiotherapy. The adjusted relative risk of BCS was highest in Calgary and lowest in Central Alberta for all disease stages. Relative to surgeries performed in Calgary, those performed in Central Alberta were significantly less likely to be BCS for stage I (RR = 0.65; 95% 0.57, 0.72), II (RR = 0.58; 95% 0.49, 0.68), and III (RR = 0.62; 95% CI: 0.37, 0.95) disease, respectively, adjusting for patient age at diagnosis, clinical and treatment characteristics. No significant variation of post-BCS radiotherapy was found. Conclusions Factors such as region of surgical treatment should not be related to the receipt of standard care within a publicly-funded health care system. Further investigation is needed to understand the significant geographic variation present within the province in order to identify appropriate interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0680-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stacey Fisher
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
| | - He Gao
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
| | - Kelly Dabbs
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Marcy Winget
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada. .,Department of Medicine, Stanford University, Palo Alto, CA, USA.
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Reyna C, Lee MC. Breast cancer in young women: special considerations in multidisciplinary care. J Multidiscip Healthc 2014; 7:419-29. [PMID: 25300196 PMCID: PMC4189712 DOI: 10.2147/jmdh.s49994] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Breast cancer is one of the most prevalent cancers in females, and 5%-7% of breast cancer cases occur in women under 40 years of age. Breast cancer in the young has gained increased attention with an attempt to improve diagnosis and prognosis. Young patients tend to have different epidemiology, presenting with later stages and more aggressive phenotypes. Diagnostic imaging is also more difficult in this age group. Multidisciplinary care generally encompasses surgeons, medical oncologists, radiation oncologists, radiologists, and social workers. Other special considerations include reconstruction options, fertility, genetics, and psychosocial issues. These concerns enlarge the already diverse multidisciplinary team to incorporate new expertise, such as reproductive specialists and genetic counselors. This review encompasses an overview of the current multimodal treatment regimens and the unique challenges in treating this special population. Integration of diagnosis, treatment, and quality of life issues should be addressed and understood by each member in the interdisciplinary team in order to optimize outcomes.
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Affiliation(s)
- Chantal Reyna
- Comprehensive Breast Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Marie Catherine Lee
- Comprehensive Breast Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Abstract
Breast cancer is the leading cause of cancer-related deaths in women age 40 and younger in developed countries, and although generally improving, survival rates for young women with breast cancer remain lower than for older women. Young women are more likely to develop more aggressive subtypes of breast cancer and previous research has suggested that young age is an independent risk factor for disease recurrence and death, and there may be unique biologic features of breast cancer that occurs in young women. Certainly, there are host differences biologically as well as psychosocially that affect the management of breast cancer and survivorship concerns for young women compared to older women. Multi-agent chemotherapy and biologic therapy targeting the tumor similar to the treatment in older women is standard, with careful attention to unique survivorship concerns including genetics, infertility, and psychosocial issues. Select young women will do well with hormone therapy only, although at present, the optimal hormonal therapy for very young women remains unclear. Recent data demonstrating that 10 years of tamoxifen improves outcomes compared to 5 may be particularly beneficial for young women with hormone receptor-positive tumors given the risk benefit profile. Future and ongoing studies focused on breast cancer in young women, addressing both biology as well as psychosocial issues, including supportive care interventions should improve outcomes for young women with breast cancer.
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Affiliation(s)
- Rachel A Freedman
- Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
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Pilewskie M, King TA. Age and molecular subtypes: impact on surgical decisions. J Surg Oncol 2014; 110:8-14. [PMID: 24691763 DOI: 10.1002/jso.23604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/27/2014] [Indexed: 12/27/2022]
Abstract
Both young patient age and breast cancer molecular subtype impact local recurrence rates and long-term prognosis for women with breast cancer. Although rates of local recurrence are consistently higher in young women and those with high-risk molecular subtypes, this risk does not appear to be overcome by more extensive surgery.
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Pan IW, Smith BD, Shih YCT. Factors contributing to underuse of radiation among younger women with breast cancer. J Natl Cancer Inst 2013; 106:djt340. [PMID: 24317177 DOI: 10.1093/jnci/djt340] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence-based literature has confirmed the effectiveness of radiation therapy (RT) after breast-conserving surgery (BCS), especially for young women. However, women with young children may be less likely to be compliant. This study explores factors associated with noncompliance of RT among insured young patients. METHOD Using the MarketScan Database, we identified the study cohort as women aged 20 to 64 years who had a BCS between January 1, 2004, and December 31, 2009, and had continuous enrollment 12 months before and after the date of BCS. Patients who had any radiation claims within a year of BCS were considered compliant. Adjusted odds of compliance were estimated from logistic regressions for the full sample and age-stratified subgroups. Sensitivity analyses were performed to evaluate the robustness of study findings. All statistical tests were two-sided. RESULTS Eighteen thousand one hundred twenty of 21 008 (86.25%) nonmetastatic BCS patients received RT. Among patients aged 20 to 64 years, those with children aged 7 to 12 years, those with children aged 13 to 17 years, and those with no children or children aged 18 years or older were more likely to receive RT than patients with at least one child aged less than 7 years (7-12 years: odds ratio (OR) = 1.32, 95% confidence interval (CI) = 1.05 to 1.66, P = .02; 13-17 years: OR = 1.41, 95% CI = 1.13 to 1.75, P = .002; no children or ≥18 years: OR = 1.38, 95% CI = 1.13 to 1.68, P = .001). Stratified analyses showed that the above association was primarily driven by women in the youngest age group (aged 20-50). Other important factors included breast cancer quality of care measures, enrollment in health maintenance organizations or capitated preferred provider organizations, travelled to a Census division outside their residence for BCS, and whether patients were primary holders of the insurance policy. CONCLUSIONS Competing demands from child care can constitute a barrier to complete guideline-concordant breast cancer therapy. Younger patients may be confronted by unique challenges that warrant more attention in future research.
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Affiliation(s)
- I-Wen Pan
- Affiliations of authors: Health Economics and Outcome Research, McKesson Specialty Health The Woodlands, TX (I-WP); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center Houston, TX (BDS); Section of Hospital Medicine, Department of Medicine, The University of Chicago Chicago, IL (Y-CTS)
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The Adolescent and Young Adult With Cancer: State of the Art—Epithelial Cancer. Curr Oncol Rep 2013; 15:287-95. [DOI: 10.1007/s11912-013-0322-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kataoka A, Tokunaga E, Masuda N, Shien T, Kawabata K, Miyashita M. Clinicopathological features of young patients (<35 years of age) with breast cancer in a Japanese Breast Cancer Society supported study. Breast Cancer 2013; 21:643-50. [PMID: 23588791 DOI: 10.1007/s12282-013-0466-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/28/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND To clarify the clinicopathological features of breast cancer in young females, surveillance data of the Registration Committee of the Japanese Breast Cancer Society were analyzed. METHODS The clinicopathological characteristics were compared between young (<35) patients and non-young (≥35) patients among 109,617 records registered between 2004 and 2009. RESULTS The numbers of young and non-young patients were 2,982 (2.7 %) and 106,295 (97.0 %), respectively. The young patients had more cases of a familial history of breast cancer, more subjective symptoms, fewer bilateral tumors, lower BMIs, larger tumors, more positive lymph nodes, fewer instances of an ER-positive status, more instances of an HER2-positive status, more triple-negative tumors and more advanced TNM stages. The young patients more frequently received neoadjuvant chemotherapy and breast-conserving therapy (BCT) compared with the non-young patients. Eighty percent of all patients received adjuvant therapy. The young patients were more frequently treated with chemotherapy, molecular targeted therapy and radiation therapy than the non-young patients. CONCLUSIONS In this study, young patients with breast cancer were diagnosed at more advanced stages and had more endocrine-unresponsive tumors than non-young patients. Further prognostic analyses should be conducted in this cohort.
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Affiliation(s)
- Akemi Kataoka
- Breast Surgery Clinic, 2nd Floor YCC-Takanawa Building, 2-21-43 Takanawa, Minato-ku, Tokyo, 108-0074, Japan,
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Rosenberg SM, Tamimi RM, Gelber S, Ruddy KJ, Kereakoglow S, Borges VF, Come SE, Schapira L, Winer EP, Partridge AH. Body image in recently diagnosed young women with early breast cancer. Psychooncology 2012; 22:1849-55. [PMID: 23132765 DOI: 10.1002/pon.3221] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 10/04/2012] [Accepted: 10/11/2012] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess body image concerns among young women following a breast cancer diagnosis. METHODS A total of 419 women with recently diagnosed stage 0-III breast cancer were surveyed following enrollment as part of a prospective cohort study of women age 40 or younger at diagnosis. Body image was assessed using three items from the psycho-social scale of the Cancer Rehabilitation Evaluation System (CARES). CARES scores range from 0 to 4, with higher scores indicative of greater image concerns. Mean CARES scores were calculated and compared between treatment groups using t-tests and analysis of variance. Multiple linear regression models were fit to evaluate the relationship between physical and psychological factors and body image. RESULTS Mean time from diagnosis to completion of the baseline survey was 5.2 months. The mean CARES score for all women was 1.28. Mean CARES scores in the mastectomy-only group (1.87) and in the mastectomy with reconstruction group (1.52) were significantly higher (p < 0.0001) compared with the scores in the lumpectomy group (0.85), indicating that radical surgery was associated with more body image concerns. Radiation (p = 0.01), anxiety (p = 0.0001), depression (p < 0.0001), fatigue (p = 0.04), musculoskeletal pain symptoms (p < 0.0001), weight gain (p = 0.01), and weight loss (p = 0.02), in addition to surgery type (p < 0.0001), were all associated with more body image concerns in the multi-variable analysis. CONCLUSION This analysis highlights the impact of treatment, along with physical and psychological factors, on body image early in the survivorship period. Our findings provide targets for potential future intervention and may aid young women in the surgical decision-making process.
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