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Leusink AE, Godden AR, Yildirim N, Randawa A, Law R, Rusby JE. Capturing longer term surgical outcome measures as part of routine care of breast cancer patients. Breast 2024; 76:103758. [PMID: 38852210 PMCID: PMC11193046 DOI: 10.1016/j.breast.2024.103758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024] Open
Abstract
INTRODUCTION The transition away from routine clinical follow up after breast cancer towards imaging surveillance and patient-initiated contact limits opportunities for patients and doctors to communicate about the long-term effects of treatment. The ABS oncoplastic guidelines (2021) recommend that post-operative 2D images and patient-reported outcomes (PROMs) are routinely collected but give no guidance as to how best to implement this. METHODS From December 2019 until March 2024, women due for their year 3 or 5 surveillance mammogram at The Royal Marsden Sutton site were invited to complete a BREAST-Q questionnaire and attend medical photography. Panel assessment of photographs was undertaken. Results were presented to the oncoplastic MDT, including summary PROMs and illustrative case presentations. Free-text comments were shared with the relevant teams. Associations between demographic or clinic-pathological factors and uptake were investigated. RESULTS Of the 1211 women invited, 246 patients (20.3 %) completed BREAST-Q questionnaires, 182 (15.0 %) attended for medical photography and 114 (9.4 %) completed both. Uptake was not associated with age, ethnicity or surgical factors but patients with higher BMI were less likely to respond to the questionnaire. Patients who had undergone complex oncoplastic procedures were more likely to respond than those who had simple procedures. Patient-reported outcome results were in line with the published literature. CONCLUSION Reviewing images with their paired PROMs and discussing free-text feedback was instructive for the team. Work is needed to identify barriers to patient participation and improve uptake to be representative of the overall patient population. Quantifying appearance in photographs would help summarise aesthetic outcome data.
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Affiliation(s)
- Astrid E Leusink
- Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK; The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK; The Royal Marsden NHS Foundation Trust, Downs Road, Sutton Surrey, SM2 5PT, UK
| | - Amy R Godden
- Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK; The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Nihal Yildirim
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton Surrey, SM2 5PT, UK
| | - Antonia Randawa
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Rebekah Law
- Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK; The Royal Marsden NHS Foundation Trust, Downs Road, Sutton Surrey, SM2 5PT, UK
| | - Jennifer E Rusby
- Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK; The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
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Voelkel V, Draeger T, van Mossel S, Siesling S, Koffijberg H. The value of time-dependent risk predictions in a screening context - a comprehensive simulation analysis validated on German cancer registry data. BMC Med Res Methodol 2022; 22:239. [PMID: 36088300 PMCID: PMC9464381 DOI: 10.1186/s12874-022-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Risk-prediction tools allow classifying individuals into risk groups based on risk thresholds. Such risk categorization is often used to inform screening schemes by offering screening only to individuals at increased risk of harmful events. Adding information concerning an individual’s risk development over time would allow assessing not just who to screen but also when to screen. This paper illustrates the value of personalised, time-dependent risk predictions to optimize risk-based screening schemes. Methods In a simulation analysis, two different time-dependent risk-based screening approaches are compared to another risk-based, but time-independent approach regarding their impact on screening efficiency. For this purpose, 81 scenarios featuring 5000 patients with five consecutive annual risk estimations for a hypothetical disease D are simulated, using different parameters to model disease progression and risk distribution. This simulation analysis is validated using a real-world clinical case study based on German breast cancer patients and the INFLUENCE-nomogram for locoregional breast cancer recurrence. Results If individual risk estimations were used to personalise screening for a disease D aiming at detecting a 90% of curable cases, more than 20% of screening examinations could be avoided relative to a conventional uninformed approach, depending on the simulated scenario. Whereas an individual but time-independent approach is associated with acceptable saving potentials in case of a relatively homogenous risk distribution, the time-dependent approaches are superior when the complexity of a scenario increases. With slowly progressing diseases, risk-accumulation over time needs to be considered to achieve the highest screening efficiency on population level, for rapidly progressing diseases, an interval-specific approach is superior. The possible benefits of time-dependent risk-based screening were confirmed in the real-world clinical case study. Conclusions Appropriate approaches to use time-dependent risk predictions may considerably enhance screening efficiency on individual and population level. Therefore, predicting risk development over time should be supported by future prediction tools and be incorporated in decision algorithms. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01718-2.
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Anoop TM, Joseph P R, Soman S, Chacko S, Mathew M. Significance of serum carcinoembryonic antigen in metastatic breast cancer patients: A prospective study. World J Clin Oncol 2022; 13:529-539. [PMID: 35949431 PMCID: PMC9244974 DOI: 10.5306/wjco.v13.i6.529] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/16/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Carcinoembryonic antigen (CEA) is an important serum tumour marker with a substantial role in diagnosis and monitoring of various solid tumours. About 36%-70% of breast cancers have elevated serum CEA. And the available studies show discrepancy in addressing the prognostic significance of CEA in advanced breast cancer.
AIM To estimate the serum CEA level in our metastatic breast cancer patients and correlate it with response to treatment and clinical outcome.
METHODS This was a prospective clinical study conducted on 50 metastatic breast cancer patients treated at breast clinic, with newly diagnosed metastatic breast cancer planned for palliative chemotherapy, targeted therapy, and hormonal treatment. We estimated the proportion of patients with elevated serum CEA level at baseline and after palliative treatment and also studied the association of serum CEA levels with known prognostic factors. The response to treatment was correlated with the serum CEA levels in the context of responders and non-responders.
RESULTS The median pre-treatment and post-treatment CEA levels were 7.9 (1.8-40.7) ng/mL and 4.39 (1.4-12.15) ng/mL, respectively, in the whole study population (P = 0.032). No statistically significant difference was seen in baseline serum CEA between responders and non-responders. Even in the luminal group, pre-treatment serum CEA was not a predictor of response, but post-treatment CEA was a significant predictor of tumour progression. In patients with liver and lung metastases, post-treatment CEA level difference was not statistically significant in both responders and non-responders though the values were higher in non-responders. Among those with bone metastases, 69.5% had elevated post-treatment serum CEA, and only 37.5% had elevated serum CEA in those with no bone metastases.
CONCLUSION Elevated post-treatment serum CEA levels are associated with disease progression and poor response to therapy. Persistently elevated post-treatment serum CEA levels are significantly associated with bone metastases. Elevated serum CEA and hormonal status are significant predictors of treatment response.
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Affiliation(s)
| | - Rona Joseph P
- Department of Medical Oncology, Regional Cancer Center, Trivandrum 695011, Kerala, India
| | - Saikumar Soman
- Department of Medical Oncology, Regional Cancer Center, Trivandrum 695011, Kerala, India
| | - Steffi Chacko
- Department of Medical Oncology, Regional Cancer Center, Trivandrum 695011, Kerala, India
| | - Mintu Mathew
- Department of Medical Oncology, Regional Cancer Center, Trivandrum 695011, Kerala, India
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Prediction of distant metastatic recurrence by tumor-infiltrating lymphocytes in hormone receptor-positive breast cancer. BMC WOMENS HEALTH 2021; 21:225. [PMID: 34051785 PMCID: PMC8164786 DOI: 10.1186/s12905-021-01373-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Breast cancer subtypes are known to have different metastatic recurrence sites. Distant metastases are often observed during the post-operative course in patients with human epidermal growth factor receptor 2 (HER2)-enriched breast cancer and triple-negative breast cancer, but are relatively rare in those with hormone receptor-positive and HER2-negative (HR+/HER2-) breast cancer. Tumor-infiltrating lymphocytes (TILs) serve as an index to monitor tumor immune microenvironment and may possibly predict the prognosis and therapeutic effect in breast cancer. This study aimed to investigate the correlation between TIL density and recurrence site in HR+/HER2- breast cancer. METHODS In stages I-II of HR+/HER2- breast cancer patients who underwent surgery as the first treatment and received adjuvant endocrine therapy (except adjuvant chemotherapy), forty-two patients relapsed after surgery. TILs were evaluated using needle biopsy specimens for the diagnosis of breast cancer. Morphological assessment was conducted using conventional hematoxylin and eosin staining. RESULTS Six patients had no TILs density. In them, local recurrence was significantly less (p = 0.022), while distant metastases were significantly more (p = 0.015) compared to those in patients with TIL density. Therefore, for the prediction of distant metastases in HR+/HER2- breast cancer without chemotherapy, TILs could be used as predictors in univariate analysis (p = 0.015, odds ratio [OR] = 0.127), although not as independent factors (p = 0.285, OR = 0.144). CONCLUSIONS Our findings indicate that TILs may predict distant metastatic recurrence in stages I-II of HR+/HER2- breast cancer in patients who do not undergo chemotherapy.
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PET/CT in breast cancer staging is useful for evaluation of axillary lymph node and distant metastases. Surg Oncol 2021; 38:101567. [PMID: 33866190 DOI: 10.1016/j.suronc.2021.101567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/11/2020] [Accepted: 03/28/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Breast cancer outcome is dependent on disease stage. The aim of the study was to assess the role of PET/CT in the evaluation of axillary lymph node and distant metastases in women with newly diagnosed primary breast cancer. MATERIALS AND METHODS We assessed, among patients with newly diagnosed primary breast cancer, associations of [18F] fluorodeoxyglucose (FDG) uptake (maximum standardized uptake value [SUVmax]) with clinical variables of the primary tumor, including regional nodal status and the presence of distant metastases. RESULTS Of 324 patients, 265 (81.8%) had focal uptake of FDG that corresponded with the cancerous lesion, and 21 (6.5%) had no FDG-avid findings. The remaining 38 patients had diffuse or nonspecific uptake of FDG. Among patients with a focal uptake of FDG (n = 265), the mean tumor size was 2.6 ± 1.9 (range 0.5-13.5), and the mean SUVmax was 5.3 ± 4.9 (range 1.2-25.0). In 83 patients (25.6%), PET/CT demonstrated additional suspected foci in the same breast. FDG-avid lymphadenopathy was observed in 156 patients (48.1%). Further assessment of lymph node involvement was available for 55/156 patients (axillary lymph node dissection [n = 21]; core needle biopsy [n = 34]) and confirmed axillary lymph node metastases in 47 (85.5%)). Thirteen patients (4.0%) had FDG-avid supraclavicular lymph nodes and six (1.9%) had FDG-avid internal mammary lymph nodes. Distant FDG-avid lesions were detected in 33 patients (10.2%). CONCLUSION PET/CT is a useful diagnostic tool for staging breast cancer patients, but its use should be limited to specific clinical situations; further evaluation is needed.
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Understanding the organ tropism of metastatic breast cancer through the combination of liquid biopsy tools. Eur J Cancer 2020; 143:147-157. [PMID: 33307492 DOI: 10.1016/j.ejca.2020.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/01/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Liquid biopsy provides real-time data about prognosis and actionable mutations in metastatic breast cancer (MBC). The aim of this study was to explore the combination of circulating tumour DNA (ctDNA) analysis and circulating tumour cells (CTCs) enumeration in estimating target organs more susceptible to MBC involvement. METHODS This retrospective study analysed 88 MBC patients characterised for both CTCs and ctDNA at baseline. CTCs were isolated through the CellSearch kit, while ctDNA was analysed using the Guardant360 NGS-based assay. Sites of disease were collected on the basis of imaging. Associations were explored both through uni- and multivariate logistic regression and Fisher's exact test and the random forest machine learning algorithm. RESULTS After multivariate logistic regression, ESR1 mutation was the only significant factor associated with liver metastases (OR 8.10), while PIK3CA was associated with lung localisations (OR 3.74). CTC enumeration was independently associated with bone metastases (OR 10.41) and TP53 was associated with lymph node localisations (OR 2.98). The metastatic behaviour was further investigated through a random forest machine learning algorithm. Bone involvement was described by CTC enumeration and alterations in ESR1, GATA3, KIT, CDK4 and ERBB2, while subtype, CTC enumeration, inflammatory BC diagnosis, ESR1 and KIT aberrations described liver metastases. PIK3CA, MET, AR, CTC enumeration and TP53 were associated with lung organotropism. The model, moreover, showed that AR, CCNE1, ESR1, MYC and CTC enumeration were the main drivers in HR positive MBC metastatic pattern. CONCLUSIONS These results indicate that ctDNA and CTCs enumeration could provide useful insights regarding MBC organotropism, suggesting a possible role for future monitoring strategies that dynamically focus on high-risk organs defined by tumourbiology.
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Supplementation with babassu oil reduces fatigue and inflammation in breast cancer patients: A pilot randomized clinical trial. J Funct Foods 2020. [DOI: 10.1016/j.jff.2020.104105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Draeger T, Voelkel V, Groothuis-Oudshoorn CGM, Lavric M, Veltman J, Dassen A, Boersma LJ, Witteveen A, Sonke GS, Koffijberg H, Siesling S. Applying Risk-Based Follow-Up Strategies on the Dutch Breast Cancer Population: Consequences for Care and Costs. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1149-1156. [PMID: 32940232 DOI: 10.1016/j.jval.2020.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES An important aim of follow-up after primary breast cancer treatment is early detection of locoregional recurrences (LRR). This study compares 2 personalized follow-up scheme simulations based on LRR risk predictions provided by a time-dependent prognostic model for breast cancer LRR and quantifies their possible follow-up efficiency. METHODS Surgically treated early patients with breast cancer between 2003 and 2008 were selected from the Netherlands Cancer Registry. The INFLUENCE nomogram was used to estimate the 5-year annual LRR. Applying 2 thresholds, they were defined according to Youden's J-statistic and a predefined follow-up sensitivity of 95%, respectively. These patient's risk estimations served as the basis for scheduling follow-up visits; 2 personalized follow-up schemes were simulated. The number of potentially saved follow-up visits and corresponding cost savings for each follow-up scheme were compared with the current Dutch breast cancer guideline recommendation and the observed utilization of follow-up on a training and testing cohort. RESULTS Using LRR risk-predictions for 30 379 Dutch patients with breast cancer from 2003 to 2006 (training cohort), 2 thresholds were calculated. The threshold according to Youden's approach yielded a follow-up sensitivity of 62.5% and a potential saving of 62.1% of follow-up visits and €24.8 million in 5 years. When the threshold corresponding to 95% follow-up sensitivity was used, 17% of follow-up visits and €7 million were saved compared with the guidelines. Similar results were obtained by applying these thresholds to the testing cohort of 11 462 patients from 2007 to 2008. Compared with the observed utilization of follow-up, the potential cost-savings decline moderately. CONCLUSIONS Personalized follow-up schemes based on the INFLUENCE nomogram's individual risk estimations for breast cancer LRR could decrease the number of follow-up visits if one accepts a limited risk of delayed LRR detection.
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Affiliation(s)
- Teresa Draeger
- Tumor Center Regensburg/ University of Regensburg, Institute for Quality Control and Health Services Research, Regensburg, Germany; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Vinzenz Voelkel
- Tumor Center Regensburg/ University of Regensburg, Institute for Quality Control and Health Services Research, Regensburg, Germany; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - Miha Lavric
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Jeroen Veltman
- Department of Radiology, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands
| | - Anneriet Dassen
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Annemieke Witteveen
- Personalized eHealth Technology, University of Twente, Enschede, The Netherlands
| | - Gabe S Sonke
- Department Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
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Tyuryumina EY, Neznanov AA, Turumin JL. A Mathematical Model to Predict Diagnostic Periods for Secondary Distant Metastases in Patients with ER/PR/HER2/Ki-67 Subtypes of Breast Cancer. Cancers (Basel) 2020; 12:cancers12092344. [PMID: 32825078 PMCID: PMC7563940 DOI: 10.3390/cancers12092344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023] Open
Abstract
Previously, a consolidated mathematical model of primary tumor (PT) growth and secondary distant metastasis (sdMTS) growth in breast cancer (BC) (CoMPaS) was presented. The aim was to detect the diagnostic periods for visible sdMTS via CoMPaS in patients with different subtypes ER/PR/HER2/Ki-67 (Estrogen Receptor/Progesterone Receptor/Human Epidermal growth factor Receptor 2/Ki-67 marker) of breast cancer. CoMPaS is based on an exponential growth model and complementing formulas, and the model corresponds to the tumor-node-metastasis (TNM) staging system and BC subtypes (ER/PR/HER2/Ki-67). The CoMPaS model reflects (1) the subtypes of BC, such as ER/PR/HER2/Ki-67, and (2) the growth processes of the PT and sdMTSs in BC patients without or with lymph node metastases (MTSs) in accordance with the eighth edition American Joint Committee on Cancer prognostic staging system for breast cancer. CoMPaS correctly describes the growth of the PT in the ER/PR/HER2/Ki-67 subtypes of BC patients and helps to calculate the different diagnostic periods, depending on the tumor volume doubling time of sdMTS, when sdMTSs might appear. CoMPaS and the corresponding software tool can help (1) to start the early treatment of small sdMTSs in BC patients with different tumor subtypes (ER/PR/HER2/Ki-67), and (2) to consider the patient almost healthy if sdMTSs do not appear during the different diagnostic periods.
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Affiliation(s)
- Ella Ya. Tyuryumina
- International Laboratory for Intelligent Systems and Structural Analysis, Faculty of Computer Science, National Research University Higher School of Economics, 109028 Moscow, Russia;
- Correspondence:
| | - Alexey A. Neznanov
- International Laboratory for Intelligent Systems and Structural Analysis, Faculty of Computer Science, National Research University Higher School of Economics, 109028 Moscow, Russia;
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Hing JX, Mok CW, Tan PT, Sudhakar SS, Seah CM, Lee WP, Tan SM. Clinical utility of tumour marker velocity of cancer antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) in breast cancer surveillance. Breast 2020; 52:95-101. [PMID: 32485607 PMCID: PMC7375621 DOI: 10.1016/j.breast.2020.05.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/06/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Serum tumour markers, cancer antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) are not routinely recommended for detecting breast cancer recurrence and monitoring treatment. In this study, we aim to evaluate the diagnostic accuracy of absolute CA 15-3 and CEA levels and report on the clinical utility of tumour marker velocity in breast cancer surveillance. METHODS 67 consecutive patients over a 15-year period (1998-2012) with available serial serum CA 15-3 and CEA measurements at recurrence were matched to a control group of patients. Tumour marker velocity was derived from the average change in consecutive tumour marker values over time, expressed in unit/year. Logistic regression analysis was performed to investigate the association between tumour characteristics, tumour marker velocity and disease recurrence. RESULTS Using the Youden index values, the optimal cut-off values for absolute CA 15-3 and CEA corresponded to the normal assay reference range while tumour marker velocity values were derived to be 2.5U/mL/year and 1.2ng/mL/year respectively. CA 15-3 velocity > 2.5U/mL/year had the highest AUROC value of 0.85 than CEA velocity alone. When either tumour marker velocity exceeded threshold values, the sensitivity, specificity, negative predictive value and positive predictive value were 94.0%, 73.1%, 92.5%, and 77.8% respectively. In the multivariate logistic regression analysis, having both CA 15-3 and CEA velocity exceeding the cut-off values was shown to be a significant predictor for disease recurrence (p = 0.01). CONCLUSION These findings highlighted the clinical utility of serial tumour markers measurements and its velocity in breast cancer surveillance.
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Affiliation(s)
- J X Hing
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore; SingHealth Duke-NUS Breast Centre, Singapore.
| | - C W Mok
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore; SingHealth Duke-NUS Breast Centre, Singapore
| | - P T Tan
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - S S Sudhakar
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore
| | - C M Seah
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore
| | - W P Lee
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore; SingHealth Duke-NUS Breast Centre, Singapore
| | - S M Tan
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore; SingHealth Duke-NUS Breast Centre, Singapore
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The Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition. Breast Cancer 2019; 27:17-24. [PMID: 31734900 PMCID: PMC8134289 DOI: 10.1007/s12282-019-01025-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/09/2019] [Indexed: 12/14/2022]
Abstract
This article updates readers as to what is new in the Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition. Breast cancer screening issues are covered, including matters of breast density and possible supplemental modalities, along with appropriate pre-operative/follow-up diagnostic breast imaging tests. Up-to-date clinical practice guidelines for breast cancer screening and diagnosis should help to provide patients and clinicians with not only evidence-based breast imaging options, but also accurate and balanced information about the benefits and harms of intervention, which ultimately enables shared decision making about imaging test plans.
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Predicting the risk of locoregional recurrence after early breast cancer: an external validation of the Dutch INFLUENCE-nomogram with clinical cancer registry data from Germany. J Cancer Res Clin Oncol 2019; 145:1823-1833. [PMID: 30927074 PMCID: PMC6571079 DOI: 10.1007/s00432-019-02904-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/22/2019] [Indexed: 12/13/2022]
Abstract
Purpose Follow-up after breast cancer treatment aims for an early detection of locoregional breast cancer recurrences (LRR) to improve the patients’ outcome. By estimating individual’s 5-year recurrence-risks, the Dutch INFLUENCE-nomogram can assist health professionals and patients in developing personalized risk-based follow-up pathways. The objective of this study is to validate the prediction tool on non-Dutch patients. Material and methods Data for this external validation derive from a large clinical cancer registry in southern Germany, covering a population of 1.1 million. Patients with curative resection of early-stage breast cancer, diagnosed between 2000 and 2012, were included in the analysis (n = 6520). For each of them, an individual LRR-risk was estimated by the INFLUENCE-nomogram. Its predictive ability was tested by comparing estimated and observed LRR-probabilities using the Hosmer–Lemeshow goodness-of-fit test and C-statistics. Results In the German validation-cohort, 2.8% of the patients developed an LRR within 5 years after primary surgery (n = 184). While the INFLUENCE-nomogram generally underestimates the actual LRR-risk of the German patients (p < 0.001), its discriminative ability is comparable to the one observed in the original Dutch modeling-cohort (C-statistic German validation-cohort: 0.73, CI 0.69–0.77 vs. C-statistic Dutch modeling-cohort: 0.71, CI 0.69–0.73). Similar results were obtained in most of the subgroup analyses stratified by age, type of surgery and intrinsic biological subtypes. Conclusion The outcomes of this external validation underline the generalizability of the INFLUENCE-nomogram beyond the Dutch population. The model performance could be enhanced in future by incorporating additional risk factors for LRR.
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Kozak MM, Jacobson CE, von Eyben R, Walck E, Pollom EL, Telli M, Horst KC. Patterns of Distant Failure by Intrinsic Breast Cancer Subtype in Premenopausal Women Treated With Neoadjuvant Chemotherapy. Clin Breast Cancer 2018; 18:e1077-e1085. [DOI: 10.1016/j.clbc.2018.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/04/2018] [Accepted: 04/27/2018] [Indexed: 12/30/2022]
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Schunkert EM, Zhao W, Zänker K. Breast Cancer Recurrence Risk Assessment: Is Non-Invasive Monitoring an Option? Biomed Hub 2018; 3:1-17. [PMID: 31988964 PMCID: PMC6945973 DOI: 10.1159/000492929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Metastatic breast cancer (MBC) represents a life-threatening disease with a median survival time of 18-24 months that often can only be treated palliatively. The majority of women suffering from MBC are those who had been previously diagnosed with locally advanced disease and subsequently experienced cancer recurrence in the form of metastasis. However, according to guidelines, no systemic follow-up for monitoring purposes is recommended for these women. The purpose of this article is to review current methods of recurrent risk assessment as well as non-invasive monitoring options for women at risk for distant disease relapse and metastasis formation. METHODS We used PubMed and national guidelines, such as the National Comprehensive Cancer Network (NCCN), to find recently published studies on breast cancer recurrence risk assessment and systemic monitoring of breast cancer patients through non-invasive means. RESULTS The options for recurrence risk assessment of locally invasive breast cancer has improved due to diverse genetic tests, such as Oncotype DX, MammaPrint, the PAM50 (now known as the "Prosigna Test") assay, EndoPredict (EP), and the Breast Cancer Index (BCI), which evaluate a women's risk of relapse according to certain cancer-gene expression patterns. Different promising non-invasive urinary protein-based biomarkers with metastasis surveillance potential that have been identified are MMP-2, MMP-9, NGAL, and ADAM12. In particular, ααCTX, ββCTX, and NTX could help to monitor bone metastasis. CONCLUSION In times of improved recurrence risk assessment of women with breast cancer, non-invasive biomarkers are urgently needed as potential monitoring options for women who have an increased risk of recurrence. Urine as a bioliquid of choice provides several advantages - it is non-invasive, can be obtained easily and frequently, and is economical. Promising biomarkers that could help to follow up women with increased recurrence risk have been identified. In order for them to be implemented in clinical usage and national guideline recommendations, further validation in larger independent cohorts will be needed.
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Affiliation(s)
- Elisa M. Schunkert
- Institute of Immunology, Faculty of Health Science, Department of Medicine and School of Life Sciences (ZBAF), University of Witten-Herdecke, Witten, Germany
| | - Wanzhou Zhao
- Nanjing Han and Zaenker Cancer Institute, Nanjing, China
| | - Kurt Zänker
- Institute of Immunology, Faculty of Health Science, Department of Medicine and School of Life Sciences (ZBAF), University of Witten-Herdecke, Witten, Germany
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15
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Mejri N, Benna M, El Benna H, Soumaya L, Afrit M, Zouari B, Boussen H. First site of recurrence after breast cancer adjuvant treatment in the era of multimodality therapy: which imaging for which patient during follow-up? Breast Dis 2017; 37:123-132. [PMID: 29171964 DOI: 10.3233/bd-170290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE We evaluated the relation between first site of recurrence of early breast cancer and disease profile at presentation and reported survival results, suggesting a personalized diagnostic imaging guidance during follow up. METHODS Among 1400 early breast cancer treated from 2000 to 2010, 324 relapses were divided into 4 groups according to first site: A-locoregional, B-bone, C-Brain and D-visceral. We analyzed redictive factors of each group compared to a control group of 100 non relapsing patients and the remaining groups matched. RESULTS In group A, patients were more likely to have histological tumor size above >2 cm, grade 1-2, HR positive and 0-3 involved lymph nodes. In group B, patients had more commonly grade 2-3, 1-3 positive lymph nodes and HR positive tumors. In group C, patients were more frequently young, with large tumor size, grade3, positive lymph nodes and HER2 positive tumors. In group D, patients were more likely to have tumors>2 cm in size, with nodal involvement, grade 3, HR negative and HER2 positive tumors. Annual recurrence rate in group A, was stable ranging between 15%-18%, within the first 3 years and peaked at 19.4% in the interval [1-2]year in group B. Median survival was 46 months in group A, 43 months in group B, with no significant difference. CONCLUSION Outcome of loco-regional and bone relapses was good, suggesting that both systematic mammography and bone-scan/CT scan for high risk patients (N+, gradeIII) during the first 2-3 years may represent a tailored relevant follow-up protocol for breast cancer patients.
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Affiliation(s)
- Nesrine Mejri
- University Tunis EI Manar Tunis, Faculty of Medicine, Medical Oncology Department, AbderrahmenMami Hospital, Ariana, Tunisia
| | - Mehdi Benna
- University Tunis EI Manar Tunis, Faculty of Medicine, Medical Oncology Department, AbderrahmenMami Hospital, Ariana, Tunisia
| | - Houda El Benna
- University Tunis EI Manar Tunis, Faculty of Medicine, Medical Oncology Department, AbderrahmenMami Hospital, Ariana, Tunisia
| | - Labidi Soumaya
- University Tunis EI Manar Tunis, Faculty of Medicine, Medical Oncology Department, AbderrahmenMami Hospital, Ariana, Tunisia
| | - Mehdi Afrit
- University Tunis EI Manar Tunis, Faculty of Medicine, Medical Oncology Department, AbderrahmenMami Hospital, Ariana, Tunisia
| | - Bechir Zouari
- University Tunis EI Manar Tunis, Faculty of Medicine, Department of Epidemiology and Statistics, Tunis, Tunisia
| | - Hamouda Boussen
- University Tunis EI Manar Tunis, Faculty of Medicine, Medical Oncology Department, AbderrahmenMami Hospital, Ariana, Tunisia.,"Clinique Taoufik" hospital, Tunis, Tunisia
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16
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Towards sustainable cancer care: Reducing inefficiencies, improving outcomes—A policy report from the All.Can initiative. J Cancer Policy 2017. [DOI: 10.1016/j.jcpo.2017.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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17
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Piva R, Ticconi F, Ceriani V, Scalorbi F, Fiz F, Capitanio S, Bauckneht M, Cittadini G, Sambuceti G, Morbelli S. Comparative diagnostic accuracy of 18F-FDG PET/CT for breast cancer recurrence. BREAST CANCER-TARGETS AND THERAPY 2017; 9:461-471. [PMID: 28740429 PMCID: PMC5503278 DOI: 10.2147/bctt.s111098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the last decades, in addition to conventional imaging techniques and magnetic resonance imaging (MRI), 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has been shown to be relevant in the detection and management of breast cancer recurrence in doubtful cases in selected groups of patients. While there are no conclusive data indicating that imaging tests, including FDG PET/CT, produce a survival benefit in asymptomatic patients, FDG PET/CT can be useful for identifying the site of relapse when traditional imaging methods are equivocal or conflicting and for identifying or confirming isolated loco-regional relapse or isolated metastatic lesions. The present narrative review deals with the potential role of FDG PET in these clinical settings by comparing its accuracy and impact with conventional imaging modalities such as CT, ultrasound, bone scan, 18F-sodium fluoride PET/CT (18F-NaF PET/CT) as well as MRI. Patient-focused perspectives in terms of patients' satisfaction and acceptability are also discussed.
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Affiliation(s)
- Roberta Piva
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa
| | - Flavia Ticconi
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa
| | - Valentina Ceriani
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa
| | - Federica Scalorbi
- Nuclear Medicine Unit, S. Orsola-Malpighi University Hospital, Bologna
| | - Francesco Fiz
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa
| | | | - Matteo Bauckneht
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa
| | | | - Gianmario Sambuceti
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa
| | - Silvia Morbelli
- Nuclear Medicine Unit, IRCCS AOU San Martino - IST, Genoa, Italy
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18
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Bond-Bero S. Filling the Gap for Early-Stage Breast Cancer Follow-Up: An Overview for Primary Care Providers. J Midwifery Womens Health 2017; 61:166-76; quiz 284. [PMID: 27037535 DOI: 10.1111/jmwh.12439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Earlier detection and newer treatments now make breast cancer highly survivable, and breast cancer survivors are the largest female cancer survivor group in the United States. With earlier detection, more women are being diagnosed with early-stage breast cancer and need follow-up care. With the increasing number of breast cancer survivors, there is a projected shortage in the workforce of oncology specialists to care for these women. The American Society of Clinical Oncology recommends that breast cancer follow-up care can be provided by an oncologist or primary care provider, as long as the primary care provider has spoken to the oncologist about appropriate follow-up care. Several studies have shown that primary care providers and oncologists have comparable outcomes for follow-up care of women with early-stage breast cancer. The National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) are considered the gold standard for breast cancer treatment and follow-up. These guidelines are clear and straightforward. Using knowledge of the NCCN Guidelines, primary care providers can fill the gap for follow-up care of women with early-stage breast cancer.
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19
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Follow-Up of Patients with Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Kirshbaum MN, Dent J, Stephenson J, Topping AE, Allinson V, McCoy M, Brayford S. Open access follow-up care for early breast cancer: a randomised controlled quality of life analysis. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27717057 PMCID: PMC5516199 DOI: 10.1111/ecc.12577] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 12/11/2022]
Abstract
This study evaluated the acceptability of a supportive model of follow‐up. One hundred and twelve women recovering from breast cancer were randomised to receive standard breast clinic aftercare (Control n = 56) or on demand by open access aftercare by breast care nurses (Intervention n = 56). Participants attended a support‐based psycho‐educational programme delivered in four half‐day group sessions. Three quality of life questionnaires (EORTC QLQ‐C30, QLQ‐BR23, HADS) were administered at baseline and 6‐monthly intervals for 2 years. Multilevel linear regression modelling methods were used for evaluation. Age was found to be a statistically significant predictor of quality of life in several sub‐scales. Increasing age was negatively associated with sexual functioning, systematic therapy side effects and physical functioning, and positively associated with future perspective. Aftercare assignment was not found to be a statistically significant predictor. Women treated for early breast cancer were not disadvantaged by allocation to the open access supportive care model in terms of quality of life experienced. The model for follow‐up was demonstrated to be a feasible alternative to routinised hospital‐based follow‐up and adds to the evidence for stratified follow‐up for low‐risk cancer patients, incorporating self‐management education. Stratified follow‐up pathways are viewed as a preferable approach.
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Affiliation(s)
- M N Kirshbaum
- School of Health, Faculty of Engineering, Health, Science and the Environment, Charles Darwin University, Darwin, Casuarina, Northern Territory, Australia
| | - J Dent
- The Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | | | | | - V Allinson
- The Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | - M McCoy
- Breast Cancer Care, Sheffield, UK
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21
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Puglisi F, Agostinetto E, Gerratana L, Bozza C, Cancian M, Iannelli E, Ratti G, Cinieri S, Numico G. Caring for cancer survivors: perspectives of oncologists, general practitioners and patients in Italy. Future Oncol 2016; 13:233-248. [PMID: 27615389 DOI: 10.2217/fon-2016-0383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM The present survey investigates the views of medical oncologists, general practitioners (GPs) and patients about the various surveillance strategies. METHODS An online survey was conducted in Italy on a population of 329 medical oncologists, 380 GPs and 350 patients. RESULTS Most of GPs (n = 291; 76%) claim that follow-up should be provided by the collaboration between GPs and medical oncologists. Most medical oncologists report to have a poor relationship with GPs (n = 151; 46%) or no relationships at all (n = 14; 4%). Most patients believe there is no real collaboration between medical oncologists and GPs (n = 138; 54%). CONCLUSION GPs, medical oncologists and patients share the idea that the collaboration between oncologists and GPs for surveillance of cancer survivors is poor and should be improved.
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Affiliation(s)
- Fabio Puglisi
- Department of Medical & Biological Sciences, University of Udine, Udine, Italy.,Department of Medical Oncology, University Hospital of Udine, Udine, Italy
| | - Elisa Agostinetto
- Department of Medical & Biological Sciences, University of Udine, Udine, Italy.,Department of Medical Oncology, University Hospital of Udine, Udine, Italy
| | - Lorenzo Gerratana
- Department of Medical & Biological Sciences, University of Udine, Udine, Italy.,Department of Medical Oncology, University Hospital of Udine, Udine, Italy
| | - Claudia Bozza
- Department of Medical & Biological Sciences, University of Udine, Udine, Italy.,Department of Medical Oncology, University Hospital of Udine, Udine, Italy
| | - Maurizio Cancian
- Società Italiana di Medicina Generale e delle Cure Primarie (SIMG) - Italian College of General Practitioner, Conegliano, TV, Italy
| | - Elisabetta Iannelli
- Italian Federation of Volunteer-based Cancer Organizations FAVO, Rome, Italy
| | - Giovanni Ratti
- Segreteria Associazione Italiana di Oncologia Medica (AIOM)/AIOM Secretariat Staff, Milan, Italy
| | - Saverio Cinieri
- Medical Oncology Division & Breast Unit, Brindisi, Italy.,Medicine Department IEO (Istituto Europeo di Oncologia) IRCCS, Milan, Italy
| | - Gianmauro Numico
- Medical Oncology Unit, SS Antonio & Biagio & C Arrigo Hospital, Alessandria, Italy
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22
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Podlipnik S, Carrera C, Sánchez M, Arguis P, Olondo ML, Vilana R, Rull R, Vidal-Sicart S, Vilalta A, Conill C, Malvehy J, Puig S. Performance of diagnostic tests in an intensive follow-up protocol for patients with American Joint Committee on Cancer (AJCC) stage IIB, IIC, and III localized primary melanoma: A prospective cohort study. J Am Acad Dermatol 2016; 75:516-524. [PMID: 27183845 DOI: 10.1016/j.jaad.2016.02.1229] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/22/2016] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is no international consensus on optimal follow-up schedules and which supplementary tests should be used after resection of a primary melanoma. OBJECTIVE We sought to analyze the performance of the follow-up components and identify procedures that detect melanoma metastasis earlier. METHODS This was a prospective cohort from 290 consecutive patients given a diagnosis of stage IIB, IIC, and III melanoma. Patients were followed up with an intensive protocol based on imaging studies (computed tomography of the chest, abdomen, and pelvis, and brain magnetic resonance imaging), periodic laboratory tests, regular physical examinations, and patient self-examinations. RESULTS A total of 2382 clinical examinations and 3069 imaging tests were performed. The patients completed 899.8 person-years of follow-up, with a median of 2.5 years. In all, 115 recurrences in 290 patients were recorded, of which computed tomography detected 48.3%; brain magnetic resonance imaging, 7.6%; laboratory test, 2.5%; physician, 23.7%; and patient, 17.8%. LIMITATIONS Patients with stage III melanoma were not systematically classified into subgroups and overall survival was not evaluated. CONCLUSION We observed that this intensive monitoring is appropriate for early detection of recurrence in stage IIB, IIC, and III melanoma. Prompt diagnosis of metastasis and the recent development of new therapeutic targets may improve overall survival.
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Affiliation(s)
- Sebastian Podlipnik
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
| | - Cristina Carrera
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
| | - Marcelo Sánchez
- Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pedro Arguis
- Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria L Olondo
- Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ramon Vilana
- Radiology Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ramon Rull
- Surgery Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sergi Vidal-Sicart
- Nuclear Medicine Service, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Antonio Vilalta
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Carles Conill
- Radiotherapy Oncology, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clinic, and Ititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) on Rare Disease, Instituto de Salud Carlos III, Barcelona, Spain.
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23
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Swetter SM. Commentary: Improved patient outcomes remain elusive after intensive imaging surveillance for high-risk melanoma. J Am Acad Dermatol 2016; 75:525-527. [PMID: 27317056 DOI: 10.1016/j.jaad.2016.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Susan M Swetter
- Dermatology Service, Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California.
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24
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How effective is mammography in detecting breast cancer recurrence in women after Breast Conservation Therapy (BCT) – A systematic literature review. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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25
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Moschetti I, Cinquini M, Lambertini M, Levaggi A, Liberati A. Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev 2016; 2016:CD001768. [PMID: 27230946 PMCID: PMC7073405 DOI: 10.1002/14651858.cd001768.pub3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Follow-up examinations are commonly performed after primary treatment for women with breast cancer. They are used to detect recurrences at an early (asymptomatic) stage. This is an update of a Cochrane review first published in 2000. OBJECTIVES To assess the effectiveness of different policies of follow-up for distant metastases on mortality, morbidity and quality of life in women treated for stage I, II or III breast cancer. SEARCH METHODS For this 2014 review update, we searched the Cochrane Breast Cancer Group's Specialised Register (4 July 2014), MEDLINE (4 July 2014), Embase (4 July 2014), CENTRAL (2014, Issue 3), the World Health Organization (WHO) International Clinical Trials Registry Platform (4 July 2014) and ClinicalTrials.gov (4 July 2014). References from retrieved articles were also checked. SELECTION CRITERIA All randomised controlled trials (RCTs) assessing the effectiveness of different policies of follow-up after primary treatment were reviewed for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for eligibility for inclusion in the review and risk of bias. Data were pooled in an individual patient data meta-analysis for the two RCTs testing the effectiveness of different follow-up schemes. Subgroup analyses were conducted by age, tumour size and lymph node status. MAIN RESULTS Since 2000, one new trial has been published; the updated review now includes five RCTs involving 4023 women with breast cancer (clinical stage I, II or III).Two trials involving 2563 women compared follow-up based on clinical visits and mammography with a more intensive scheme including radiological and laboratory tests. After pooling the data, no significant differences in overall survival (hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.84 to 1.15, two studies, 2563 participants, high-quality evidence), or disease-free survival (HR 0.84, 95% CI 0.71 to 1.00, two studies, 2563 participants, low-quality evidence) emerged. No differences in overall survival and disease-free survival emerged in subgroup analyses according to patient age, tumour size and lymph node status before primary treatment. In 1999, 10-year follow-up data became available for one trial of these trials, and no significant differences in overall survival were found. No difference was noted in quality of life measures (one study, 639 participants, high-quality evidence).The new included trial, together with a previously included trial involving 1264 women compared follow-up performed by a hospital-based specialist versus follow-up performed by general practitioners. No significant differences were noted in overall survival (HR 1.07, 95% CI 0.64 to 1.78, one study, 968 participants, moderate-quality evidence), time to detection of recurrence (HR 1.06, 95% CI 0.76 to 1.47, two studies, 1264 participants, moderate-quality evidence), and quality of life (one study, 356 participants, high-quality evidence). Patient satisfaction was greater among patients treated by general practitioners. One RCT involving 196 women compared regularly scheduled follow-up visits versus less frequent visits restricted to the time of mammography. No significant differences emerged in interim use of telephone and frequency of general practitioners's consultations. AUTHORS' CONCLUSIONS This updated review of RCTs conducted almost 20 years ago suggests that follow-up programs based on regular physical examinations and yearly mammography alone are as effective as more intensive approaches based on regular performance of laboratory and instrumental tests in terms of timeliness of recurrence detection, overall survival and quality of life.In two RCTs, follow-up care performed by trained and not trained general practitioners working in an organised practice setting had comparable effectiveness to that delivered by hospital-based specialists in terms of overall survival, recurrence detection, and quality of life.
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Affiliation(s)
- Ivan Moschetti
- Mario Negri Institute for Pharmacological Research IRCCSVia La Masa, 19MilanItaly20156
| | - Michela Cinquini
- Mario Negri Institute for Pharmacological Research IRCCSVia La Masa, 19MilanItaly20156
| | - Matteo Lambertini
- Institut Jules Bordet, and l'Université Libre de Bruxelles (U.L.B.)BrEAST Data Centre, Department of MedicineBrusselsBelgium
- U.O. Oncologia Medica 2, IRCCS AOU San Martino – ISTDepartment of Medical OncologyGenovaItaly
| | - Alessia Levaggi
- U.O. Oncologia Medica 2, IRCCS AOU San Martino – ISTDepartment of Medical OncologyGenovaItaly
| | - Alessandro Liberati
- Mario Negri Institute for Pharmacological ResearchItalian Cochrane CentreVia La Masa, 19MilanItaly20156
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26
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Fontanella C, Puglisi F. Translational and clinical research highlights from the 38th San Antonio Breast Cancer Symposium. Future Oncol 2016; 12:1005-8. [DOI: 10.2217/fon-2016-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
38th San Antonio Breast Cancer Symposium, San Antonio, TX, USA, 8-12 December 2015 In November 1978, during Breast Cancer Awareness Week, the first annual San Antonio Breast Cancer Symposium (SABCS) was held as a part of an educational program conceived to reduce breast cancer death rate. Only 141 physicians attended the conference. Recently, the 38th edition of the SABCS welcomed >7000 attendees from all over the world. We will discuss a selection of the most significant advances presented at the 2015 SABCS, specifically focusing on those data that could have an impact on the clinical practice in the near future.
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Affiliation(s)
- Caterina Fontanella
- Department of Biological & Medical Sciences, University of Udine, Piazzale Kolbe, 4 – 33100 Udine, Italy
- Department of Oncology, University Hospital of Udine, Piazzale S M Misericordia, 33100 Udine, Italy
| | - Fabio Puglisi
- Department of Biological & Medical Sciences, University of Udine, Piazzale Kolbe, 4 – 33100 Udine, Italy
- Department of Oncology, University Hospital of Udine, Piazzale S M Misericordia, 33100 Udine, Italy
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27
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Hammon M, Dankerl P, Janka R, Wachter DL, Hartmann A, Schulz-Wendtland R, Uder M, Wenkel E. Fine needle aspiration cytology of lymph nodes in breast cancer follow-up is a feasible alternative to watchful waiting and to histology. BMC WOMENS HEALTH 2015; 15:114. [PMID: 26631071 PMCID: PMC4668692 DOI: 10.1186/s12905-015-0269-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/20/2015] [Indexed: 02/05/2023]
Abstract
Background Early detection of loco-regional breast cancer recurrence improves patients’ overall survival, as treatment can be initiated or active treatment can be changed. If a suspicious lymph node is diagnosed during a follow-up exam, surgical excision is often performed. The aim of this study was to evaluate the diagnostic performance of the minor invasive ultrasound-guided fine-needle aspiration cytology (FNAC) in sonomorphologically suspicious lymph nodes in breast cancer follow-up. Methods Between April 2010 and November 2012, we performed ultrasound-guided FNAC in 38 sonographically suspicious lymph nodes of 37 breast cancer follow-up patients. Cytological specimens were evaluated if the sample material was sufficient for diagnosis and if they contained cancer cells. Patients with negative cytology were followed up clinically and sonographically. To evaluate the diagnostic performance we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for physical examination, the different sonomorphological malignancy criteria and FNAC. Results In 36/38 (94.7 %) lymph nodes, the pathologist had enough material to establish a final diagnosis; in 2/38 (5.3 %) lymph nodes, the probe material was non-evaluable during cytology, these 2 were excluded from further statistical evaluation. Cytology revealed malignancy in 21 lymph nodes and showed no evidence for malignancy in 15 lymph nodes. There was no evidence for malignant disease in follow-up exams in the 15 cytologically benign lymph nodes with an average follow-up time of 3 years. The diagnostic performances of physical examination and FNAC were: Sensitivity 52/100 %, specificity 88/100 %, PPV 85/100 %, NPV 60/100 %, respectively. Conclusions Our preliminary results show that FNAC is a safe and fast diagnostic approach for the evaluation of suspicious lymph nodes in the follow-up of patients with breast cancer and, thus, together with follow-up represents a feasible alternative to surgery.
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Affiliation(s)
- Matthias Hammon
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Peter Dankerl
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Rolf Janka
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - David L Wachter
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany.
| | - Arndt Hartmann
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany.
| | - Rüdiger Schulz-Wendtland
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Evelyn Wenkel
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
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Fontanella C, Fanotto V, Rihawi K, Aprile G, Puglisi F. Skeletal metastases from breast cancer: pathogenesis of bone tropism and treatment strategy. Clin Exp Metastasis 2015; 32:819-33. [PMID: 26343511 DOI: 10.1007/s10585-015-9743-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/03/2015] [Indexed: 12/17/2022]
Abstract
Breast cancer (BC) is the most common female cancer worldwide with approximately 10 % of new cases metastatic at diagnosis and 20-50 % of patients with early BC who will eventually develop metastatic disease. Bone is the most frequent site of colonisation and the development of skeletal metastases depends on a complex multistep process, from dissemination and survival of malignant cells into circulation to the actual homing and metastases formation inside bone. Disseminated tumor cells (DTCs) can be detected in bone marrow in approximately 30 % of BC patients, likely reflecting the presence of minimal residual disease that would eventually account for subsequent metastatic disease. Patients with bone marrow DTCs have poorer overall survival compared with patients without them. Although bone-only metastatic disease seems to have a rather indolent behavior compared to visceral disease, bone metastases can cause severe and debilitating effects, including pain, spinal cord compression, hypercalcemia and pathologic fractures. Delivering an appropriate treatment is therefore paramount and ideally it should require interdisciplinary care. Multiple options are currently available, from bisphosphonates to new drugs targeting RANK ligand and radiotherapy. In this review we describe the mechanisms underlying bone colonization and provide an update on existing systemic and locoregional treatments for bone metastases.
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Affiliation(s)
- Caterina Fontanella
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy.
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
| | - Valentina Fanotto
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Karim Rihawi
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Giuseppe Aprile
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Fabio Puglisi
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
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Abdel-Rahman O, Alorabi M. Use of angiotensin-converting enzyme inhibitors in the prophylaxis of anthracycline or trastuzumab-related cardiac dysfunction: preclinical and clinical considerations. Expert Rev Anticancer Ther 2015; 15:829-837. [DOI: 10.1586/14737140.2015.1047766] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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30
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Pattern of metastasis and outcome in patients with breast cancer. Clin Exp Metastasis 2015; 32:125-33. [PMID: 25630269 DOI: 10.1007/s10585-015-9697-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/19/2015] [Indexed: 12/23/2022]
Abstract
There is growing evidence about differences in metastatic spread among breast cancer (BC) biologic subtypes (BS). Aim of this study was to analyze the pattern of metastasization according to BS and to explore the corresponding prognosis. A series of 544 consecutive patients receiving anticancer therapy for metastatic BC from 2004 to 2013, was analyzed. BS were defined by immunohistochemistry according to St Gallen 2013 criteria. Association between BS and the different distant localizations was analyzed. Prognosis was described in terms of overall survival (OS), progression free survival (PFS) and post progression survival (PPS). Results were reported taking luminal A BC as reference. Triple negative BC showed a higher tropism for lung (OR 4.30 95% CI 1.41-13.1), while non luminal HER2 subtype was associated with a higher rate of liver metastases (OR 3.61 95% CI 1.36-9.58). All subtypes were associated with a lower risk of bone-only localization. Central nervous system (CNS) involvement was more common in HER2 positive BC (OR 6.3, 95% CI 1.08-36.66). Liver, lung and CNS involvement influenced negatively OS (HR 1.64, 95% CI 1.29-2.07; HR 1.49, 95% CI 1.18-1.90; HR 2.891, 95% CI 1.85-4.51, respectively) and PFS (HR 1.39, 95% CI 1.13-1.71; HR 1.26, 95% CI 1.02-1.55; HR 1.75, 95% CI 1.12-2.71, respectively). Multivariate analysis confirmed liver involvement as independent predictor of worse OS (HR 1.64, 95% CI 1.15-2.34). Stratification by metastatic pattern showed significant differences in terms of PPS but not in terms of PFS. The study suggests that BS may be characterized by typical patterns of metastatic spread and have different impact on clinical outcome.
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