Association with pregnancy increases the risk of local recurrence but does not impact overall survival in breast cancer: A case–control study of 87 cases

Generalized reporter score-based enrichment analysis for omics data

Enrichment analysis contextualizes biological features in pathways to facilitate a systematic understanding of high-dimensional data and is widely used in biomedical research. The emerging reporter score-based analysis (RSA) method shows more promising sensitivity, as it relies on P-values instead of raw values of features. However, RSA cannot be directly applied to multi-group and longitudinal experimental designs and is often misused due to the lack of a proper tool. Here, we propose the Generalized Reporter Score-based Analysis (GRSA) method for multi-group and longitudinal omics data. A comparison with other popular enrichment analysis methods demonstrated that GRSA had increased sensitivity across multiple benchmark datasets. We applied GRSA to microbiome, transcriptome and metabolome data and discovered new biological insights in omics studies. Finally, we demonstrated the application of GRSA beyond functional enrichment using a taxonomy database. We implemented GRSA in an R package, ReporterScore, integrating with a powerful visualization module and updatable pathway databases, which is available on the Comprehensive R Archive Network (https://cran.r-project.org/web/packages/ReporterScore). We believe that the ReporterScore package will be a valuable asset for broad biomedical research fields.

Survival probabilities and prognostic factors of pregnancy-associated breast cancer in Malaysian women

OBJECTIVE

Pregnancy-associated breast cancer (PABC) is a rare cancer. This study aimed to determine the survival probabilities and prognostic factors in patients with PABC.

METHODS

A retrospective cohort study was conducted in two tertiary care hospitals in Kota Bharu. We included all patients with breast cancer who were diagnosed by histopathology while pregnant or within 2 years post-partum from 2001 through 2020. We matched patients with PABC to non-pregnant patients with breast cancer by age and year of diagnosis. The data were analyzed using Cox proportional hazard regression.

RESULTS

A total of 35 cases of PABC and 70 non-PABC controls were recruited. The 3-year, 5-year, and 10-year survival probabilities for patients with PABC were 58.6%, 47.54%, and 38.03%, respectively. The patients with PABC had a non-significant difference in survival probabilities compared with non-PABC patients. The significant prognostic factors of PABC were age (adjusted hazard ratio [aHR], 0.91; 95% confidence interval [CI], 0.86-0.96; P=0.001), advanced stage of cancer (aHR, 9.97; 95% CI, 3.96-25.2; P<0.001), and no surgery (aHR, 3.16; 95% CI, 1.01-9.85; P=0.047). Pregnancy was not found to be an independent factor in the prognosis of PABC (aHR, 0.72; 95% CI, 0.39-1.28; P=0.266).

CONCLUSION

Women diagnosed with PABC had similar survival probabilities compared with non-PABC patients. Pregnancy was not an independent prognostic factor for breast cancer. This information can be useful when women with breast cancer are counseled and supported with the option of beginning treatment with pregnancy continuation.

Pregnancy-associated breast cancer: a multicenter study comparing clinicopathological factors, diagnosis and treatment outcomes with non-pregnant patients

PURPOSE

Pregnancy-associated breast cancer (PABC), defined as breast carcinoma diagnosed during pregnancy or in the first post-partum year, is one of the most common gestation-related malignancies with reported differences in tumor characteristics and outcomes. This multicenter study aims to review cases of PABC in Singapore, including their clinicopathological features, treatment, and clinical outcomes compared to non-PABC patients.

METHODS

Demographic, histopathologic and clinical outcomes of 93 PABC patients obtained from our database were compared to 1424 non-PABC patients.

RESULTS

PABC patients presented at a younger age. They had higher tumor and nodal stages, higher tumor grade, were more likely to be hormone receptor negative and had a higher incidence of multicentric and multifocal tumors. Histological examination after definitive surgery showed no significant difference in tumor size and number of positive lymph nodes suggesting similar neoadjuvant treatment effects. Despite this, PABC patients had worse outcomes with poorer overall survival and disease-free survival, OS (P < 0.0001) and DFS (P < 0.0001). Termination of pregnancy did not improve survival.

CONCLUSION

Patients with PABC present at a higher stage with more aggressive disease and have poorer outcomes compared to non-PABC patients. Reducing delay in diagnosis and treatment may help improve survival.

Clinicopathologic features, treatment, and prognosis of pregnancy-associated breast cancer

Purpose

To identify the clinicopathological features, treatment, and prognosis of patients with breast cancer, who were diagnosed during and after pregnancy.

Methods

We searched for patients with pregnancy-associated breast cancer (PABC) using the big data query and analysis system of Peking Union Medical College Hospital from between January 1, 2013, and December 31, 2021, and matched each patient with two non-PABC patients by age at diagnosis, year at diagnosis, and tumor stage. The clinicopathologic features, treatment, and outcomes of breast cancer during pregnancy (BC-P) and breast cancer during the first-year post-partum (BC-PP) were examined retrospectively in two case-control studies.

Results

Eighteen BC-P cases, 36 controls for BC-P cases, 62 BC-PP cases, and 124 controls for BC-PP cases were enrolled in our study. The expression of HER-2 and Ki-67 was higher in BC-PP cases than in its controls (P=0.01, 0.018, respectively). Patients with BC-PP were more likely to choose mastectomy than breast-conserving surgery (P=0.001). There were no significant differences in event-free survival (EFS) between patients with BC-P and BC-PP and their controls.

Conclusion

BC-P and BC-PP patients displayed adverse clinicopathological features in our population. However, when matched by age at diagnosis, year of diagnosis, and tumor stage, BC-P and BC-PP patients did not show inferior outcomes to controls, probably due to aggressive multimodality therapy.

Breast Imaging in Pregnancy and Lactation

All breast disorders found during pregnancy and lactation should be carefully evaluated. Most of them are benign, but it is essential to exclude pregnancy-associated breast cancer (PABC), which is too often diagnosed late. The first-line imaging technique is ultrasound (US), which must be completed by mammography if there is any clinical or US suspicious sign . In lactating patients with PABC , breast magnetic resonance imaging (MRI) can be useful for local assessment.Management depends on the precise analysis and BI-RADS classification of the lesion. During pregnancy and lactation, there is an overlap in imaging: many benign lesions can grow, infarct, become heterogeneous and thus suspicious, and on the other hand, PABC does not always present with typical malignant features. That is why biopsy must be performed if after the clinical and radiological evaluation the doubt persists, i.e. for all BI-RADS 4 and 5 lesions, and for some BI-RADS 3 lesions.

Prognosis of pregnancy-associated breast cancer: a meta-analysis

BACKGROUND

Pregnancy-associated breast cancer (PABC) is defined as breast cancer that is diagnosed during pregnancy and/or the postpartum period. Definitions of the duration of the postpartum period have been controversial, and this variability may lead to diverse results regarding prognosis. Moreover, evidence on the dose-response association between the time from the last pregnancy to breast cancer diagnosis and overall mortality has not been synthesized.

METHODS

We systematically searched PubMed, Embase, and the Cochrane Library for observational studies on the prognosis of PABC published up to June 1, 2019. We estimated summary-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs). Subgroup analyses based on diagnosis time, PABC definition, geographic region, year of publication and estimation procedure for HR were performed. Additionally, dose-response analysis was conducted by using the variance weighted least-squares regression (VWLS) trend estimation.

RESULTS

A total of 54 articles (76 studies) were included in our study. PABC was associated with poor prognosis for overall survival (OS), disease-free survival (DFS) and cause-specific survival (CSS), and the pooled HRs with 95% CIs were 1.45 (1.30-1.63), 1.39 (1.25-1.54) and 1.40 (1.17-1.68), respectively. The corresponding reference category was non-PABC patients. According to subgroup analyses, the varied definition of PABC led to diverse results. The dose-response analysis indicated a nonlinear association between the time from the last delivery to breast cancer diagnosis and the HR of overall mortality (P < 0.001). Compared to nulliparous women, the mortality was almost 60% higher in women with PABC diagnosed at 12 months after the last delivery (HR = 1.59, 95% CI 1.30-1.82), and the mortality was not significantly different at 70 months after the last delivery (HR = 1.14, 95% CI 0.99-1.25). This finding suggests that the definition of PABC should be extended to include patients diagnosed up to approximately 6 years postpartum (70 months after the last delivery) to capture the increased risk.

CONCLUSION

This meta-analysis suggests that PABC is associated with poor prognosis, and the definition of PABC should be extended to include patients diagnosed up to approximately 6 years postpartum.

Clinical features and survival of pregnancy-associated breast cancer: a retrospective study of 203 cases in China

Background

Pregnancy-associated breast cancer (PABC) is an aggressive disease, and since Chinese authority began to encourage childbearing in 2015, the incidence of PABC has increased. This study investigated the characteristics and survival of PABC patients.

Methods

Patients with PABC who underwent surgery at Fudan University, Shanghai Cancer Center between 2005 and 2018 were enrolled. Data concerning the tumor characteristics, maternal state (whether first or non-first pregnancy) and survival outcome were recorded. Pearson Chi-square tests were used to compare the characteristics of the tumors, and Kaplan-Meier methods were used to perform the survival analysis.

Results

Overall, 203 PABC patients were recruited. Since 2015, 65.5% of non-first pregnant women were diagnosed with breast cancer, it’s 5.7 fold of the incidence of PABC in non-first pregnant women. No significant differences in tumor characteristics were observed between the patients who were in their first pregnancy and those in non-first pregnancy. Among the entire PABC population, luminal B breast cancer accounted for the largest proportion (38.4%), followed by triple-negative breast cancer (TNBC, 30.0%). The distribution of the molecular subtypes of PABC and non-PABC differed (P < 0.001) as follows: in the PABC patients, Luminal B 38.4%, Triple negative breast cancer (TNBC) 30.1%, Human Epidermal Growth Factor Receptor 2 (HER-2) overexpression 15.8%, and Luminal A 10.8%; in the non-PABC patients, Luminal A 50.9%, Luminal B 20.1%, TNBC 17.4%, and HER-2 overexpression 8.0%. The 3-year disease free survival (DFS) of all PABC patients was 80.3%. The 3-year DFS of the patients in the first-pregnancy group was 78.4%, and that of the patients in the non-first-pregnancy group was 83.7% (P = 0.325).

Conclusions

Our study proved that the proportion of women who developed PABC during the second or third pregnancy was extremely high relative to the newborn populations. The patients in the PABC population tended to present more luminal B and TNBC breast cancer than the non-PABC patients.

Clinicopathological characteristics, diagnosis, and prognosis of pregnancy-associated breast cancer

Background

The aim of this study was to evaluate the characteristics, diagnosis, prognosis, and effective treatment modalities of pregnancy‐associated breast cancer (PABC).

Methods

From 1 January 2005 to 31 December 2015, 142 patients with PABC were identified in the Cancer Institute and Hospital of Tianjin Medical University database. The clinicopathological features, treatment methods, and outcomes were retrospectively evaluated.

Results

The median age at diagnosis was 30 years. All patients presented with a palpable mass in the breast. The sensitivity of ultrasound and mammography in PABC diagnosis was 86% and 83.3%, respectively, which increased to 91.3% when a combination of mammography and ultrasound was used. The median tumor size was 5.5 cm, and 63.1% of patients had associated axillary lymph node metastases. The proportions of ER negative, PR negative and HER2 positive were 45.7%, 45.7% and 30%, respectively. The five‐year overall survival (OS) and disease‐free survival (DFS) rates were 76.8% and 63.5%, respectively. According to univariate analysis, T stage, N stage, and HER2 status were significant prognostic factors for OS and DFS. The time interval between the onset of the first symptom and the first meeting with a health professional was also significant for OS. Multivariate analysis showed that T stage and HER2 status were independent prognostic risk factors for OS and DFS.

Conclusion

PABC is an aggressive form of breast cancer associated with advanced stage at diagnosis. Despite the existing difficulties in diagnosis, imaging examinations are indispensable. Early diagnosis and multidisciplinary therapy, including anti‐HER2 targeted therapy, may be important to improve prognosis.

Diagnostic pathways and management in women with pregnancy-associated breast cancer (PABC): no evidence of treatment delays following a first healthcare contact

Background

Women with pregnancy-associated breast cancer (PABC), i.e. diagnosed during or within 2 years of pregnancy, have a poor prognosis. We compared symptoms, diagnostics, treatments, and waiting times from first symptoms to treatment initiation in women diagnosed with PABC and non-PABC.

Materials and methods

Women diagnosed with PABC and non-PABC at ages 15–44 were identified in Swedish healthcare registers. Chart information was retrieved for 546 women (273 PABC cases and 273 age- and hospital-matched non-PABC controls) treated at 11 hospitals across Sweden between 1992 and 2009. Distributions of symptoms, diagnostics and treatments were compared. Median waiting times from initial symptoms to start of treatment, and time periods within, were estimated from Kaplan–Meier curves.

Results

Initial symptoms in women with PABC and non-PABC were similar. Women with PABC more often underwent biopsy and ultrasound than mammography at initial examination. Compared to non-PABC, rates of mastectomy and axillary clearance were higher in women with PABC, while endocrine treatment was less common. The time from symptoms to first healthcare contact was non-significantly longer in women diagnosed during or within 6 months of pregnancy. Waiting times from contact with healthcare to diagnosis and treatment were shorter or similar in women with PABC compared to women with non-PABC.

Conclusions

These findings do not support the notion that diagnostic and treatment delays following a first healthcare contact are more common in women diagnosed with breast cancer during or shortly after pregnancy. However, there was some evidence of delays in seeking healthcare among pregnant and lactating women.

Electronic supplementary material

The online version of this article (10.1007/s10549-018-05083-x) contains supplementary material, which is available to authorized users.

Association of pregnancy and mortality in women diagnosed with breast cancer: A Nationwide Population Based Study in Taiwan

We examined the associations between breast cancer diagnosed during pregnancy and up to 5 years postpartum and total mortality. Breast cancer patients were identified from the Taiwan Cancer Registry (2002-2014). All pregnancies up to 5 years before breast cancer diagnosis were abstracted from the National Health Insurance database and data were then linked to the Taiwan National Death Certificate Database. Follow-up was calculated from the date of breast cancer diagnosis to the date of death or 31 December, 2014, whichever came first. The hazard ratios (HRs) and the 95% confidence intervals (CI) of the association between pregnancy and total mortality were estimated using Cox proportional hazard models. Among the 30,230 breast cancer patients, 90 were diagnosed during pregnancy, 347 within a year postpartum, and 1993 during 1-5 years postpartum. By the end of 2014, 2,920 patients were dead. The major cause of death was breast cancer (89%). Compared to patients without pregnancy records, the HRs were 1.42 (95% CI = 0.83-2.45) for patients diagnosed during pregnancy, 1.29 (0.96-1.74) for those diagnosed within a year postpartum, 1.27 (0.95-1.70) for those diagnosed within 1 to 2 years postpartum, and 1.06 (0.88-1.27) for those diagnosed ≥2 to 5 years postpartum, after adjustment for tumor characteristics and treatment. Subgroup analyses revealed an increased risk of mortality for patients diagnosed within a year postpartum in ER+ cancers (HR = 2.11, 95% CI = 1.28-3.47). Our results suggested a recent pregnancy may be associated with higher mortality among ER+ patients.

Propensity score to evaluate prognosis in pregnancy-associated breast cancer: Analysis from a French cancer network

PURPOSE

To compare the prognosis of pregnancy associated breast cancer occurring during pregnancy (BCP) to non-pregnancy associated breast cancers (non-BCP) in young women managed at a national expert center.

METHODS

Retrospective cohort study of a prospective database using propensity score matching (PSM) analysis with known prognostic factors.

RESULTS

We analyzed data of 49 patients with BCP and 104 with non-BCP diagnosed between 2002 and 2017 at Tenon University Hospital (Paris, France). The BCP tumors were often locally advanced (lymph node metastases in 59%), of high grade (55%) and highly proliferative (67% with Ki67 ≥ 20%). After PSM, breast cancer-free survival (p = 0.45) and breast cancer specific survival (p = 0.81) were similar in the two groups. The recurrence rate was 12% vs 18% (p = 0.45) and the death rate was 6% vs 8% (p = 0.74) for the BCP and non-BCP groups, respectively. No difference in recurrence type was observed between the groups (p = 0.60).

CONCLUSIONS

After PSM for known prognostic factors, the prognosis of BCP patients did not differ from that of young patients with non-BCP.

Breast reconstruction in pregnancy: a case report of multidisciplinary team approach in immediate autologous flap reconstruction for pregnancy-associated breast cancer

This report presents the results of immediate breast reconstruction with autologous flap in Pregnancy‐associated breast cancer (PABC). There was no obstetrics and surgical complications in our report. Immediate breast reconstruction can be performed in PABC after a careful selection. Multidisciplinary team approach is the key in managing these groups of patients.