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Schaffar R, Benhamou S, Chappuis PO, Rapiti E. Risk of first recurrence after treatment in a population-based cohort of young women with breast cancer. Breast Cancer Res Treat 2024; 206:615-623. [PMID: 38687430 PMCID: PMC11208255 DOI: 10.1007/s10549-024-07338-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Breast cancer (BC) in women under 45 is rare yet often aggressive. We aim to analyze loco-regional recurrences (LR), distant recurrences (DR), second breast cancers, and mortality in young BC patients. METHODS We enrolled 776 women with non-metastatic BC ≤45 years diagnosed from 1970 to 2012. Variables included age, family history, tumor stage/grade, and treatment. We used multivariate Cox regression and competing risk models. RESULTS Among the participants, 37.0% were diagnosed before the age of 40. Most had stage I or II, grade II, ER- and PR-positive, HER2-negative tumors. Over a median follow-up of 8.7 years, 10.1% experienced LR, 13.7% developed DR, and 10.8% died, primarily due to BC. The majority of recurrences occurred within the first five years. Older age (>40) significantly reduced the risk of LR and DR. Advanced disease stage, certain surgical strategies, and positive margins increased DR risk. In the cohort diagnosed between 2001 and 2012, recent diagnosis, triple-negative cancer, and hormonal therapy were associated with reduced LR risk. Breast-conserving surgery appeared to offer protective effects against DR. CONCLUSION This study highlights that BC in young women carries a significant risk of early recurrence, with age, tumor characteristics, and treatment modalities influencing outcomes. The findings emphasize the need for tailored treatment strategies for young BC patients, focusing on surgical precision and aggressive adjuvant therapy for high-risk cases. This research contributes valuable insights into managing BC in younger patients, aiding in improving long-term outcomes.
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Affiliation(s)
- Robin Schaffar
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Geneva, Switzerland.
| | - Simone Benhamou
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Geneva, Switzerland
- INSERM Unit 1018, Research Centre on Epidemiology and Population Health, Villejuif, Île-de-France, France
| | - Pierre O Chappuis
- Division of Precision Oncology, Geneva University Hospitals, Geneva, Switzerland
- Division of Genetic Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Elisabetta Rapiti
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Geneva, Switzerland
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Rajan KK, Fairhurst K, Birkbeck B, Novintan S, Wilson R, Savović J, Holcombe C, Potter S. Overall survival after mastectomy versus breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer: meta-analysis. BJS Open 2024; 8:zrae040. [PMID: 38758563 PMCID: PMC11100524 DOI: 10.1093/bjsopen/zrae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/05/2024] [Accepted: 03/24/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Breast-conserving surgery with adjuvant radiotherapy and mastectomy are currently offered as equivalent surgical options for early-stage breast cancer based on RCTs from the 1970s and 1980s. However, the treatment of breast cancer has evolved and recent observational studies suggest a survival advantage for breast-conserving surgery with adjuvant radiotherapy. A systematic review and meta-analysis was undertaken to summarize the contemporary evidence regarding survival after breast-conserving surgery with adjuvant radiotherapy versus mastectomy for women with early-stage breast cancer. METHODS A systematic search of MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase that identified studies published between 1 January 2000 and 18 December 2023 comparing overall survival after breast-conserving surgery with adjuvant radiotherapy versus mastectomy for patients with unilateral stage 1-3 breast cancer was undertaken. The main exclusion criteria were studies evaluating neoadjuvant chemotherapy, rare breast cancer subtypes, and specific breast cancer populations. The ROBINS-I tool was used to assess risk of bias, with the overall certainty of evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Studies without critical risk of bias were included in a quantitative meta-analysis. RESULTS From 11 750 abstracts, 108 eligible articles were identified, with one article including two studies; 29 studies were excluded from the meta-analysis due to an overall critical risk of bias, 42 studies were excluded due to overlapping study populations, and three studies were excluded due to reporting incompatible results. A total of 35 observational studies reported survival outcomes for 909 077 patients (362 390 patients undergoing mastectomy and 546 687 patients undergoing breast-conserving surgery with adjuvant radiotherapy). The pooled HR was 0.72 (95% c.i. 0.68 to 0.75, P < 0.001), demonstrating improved overall survival for patients undergoing breast-conserving surgery with adjuvant radiotherapy. The overall certainty of the evidence was very low. CONCLUSION This meta-analysis provides evidence suggesting a survival advantage for women undergoing breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer compared with mastectomy. Although these results should be interpreted with caution, they should be shared with patients to support informed surgical decision-making.
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Affiliation(s)
- Kiran K Rajan
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Katherine Fairhurst
- Bristol Medical School, University of Bristol, Bristol, UK
- Linda McCartney Centre, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Beth Birkbeck
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Rebecca Wilson
- Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jelena Savović
- Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Chris Holcombe
- Linda McCartney Centre, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Shelley Potter
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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Hou J, Li L, Wang J, Huang X, Xue J, Wu J. Young age is associated with inferior outcomes in early-stage luminal B breast cancer patients who undergo mastectomy. Future Oncol 2023; 19:715-726. [PMID: 37129057 DOI: 10.2217/fon-2023-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Background: This retrospective study aimed to evaluate the effect of age on cancer relapse and survival in breast cancer patients undergoing different treatments. Methods: The propensity score method was used to correct for disparities between two groups; 2049 young patients were matched to 4053 older patients. Kaplan-Meier curves and Cox proportional hazards models were used to assess disease-free survival. Results: In the original cohort, young patients showed higher lymph node metastasis, hormone-receptor positivity and high Ki-67 levels. After propensity score matching, the disease-free survival of young patients with the luminal B-like subtype who received mastectomy with early stage disease exhibited inferior survival. Conclusion: Decisions about biology-driven systemic treatment strategies for young patients are worthy of discussion with a multidisciplinary tumor board.
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Affiliation(s)
- Jianjing Hou
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Lun Li
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jia Wang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Xiaoyan Huang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jingyan Xue
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
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Offersen BV, Overgaard M, Overgaard J. Breast cancer radiotherapy: Is it time to rethink the indication? Radiother Oncol 2022; 177:238-239. [PMID: 36265681 DOI: 10.1016/j.radonc.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Affiliation(s)
| | - Marie Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
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Schumacher JR, Zahrieh D, Chow S, Taylor J, Wills R, Hanlon BM, Rathouz PJ, Tucholka JL, Neuman HB. Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial. BMJ Open 2022; 12:e063895. [PMID: 36396308 PMCID: PMC9677005 DOI: 10.1136/bmjopen-2022-063895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Socioeconomic disparities for breast cancer surgical care exist. Although the aetiology of the observed socioeconomic disparities is likely multifactorial, patient engagement during the surgical consult is critical. Shared decision-making may reduce health disparities by addressing barriers to patient engagement in decision-making that disproportionately impact socioeconomically disadvantaged patients. In this trial, we test the impact of a decision aid on increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making. METHODS AND ANALYSIS This multisite randomised trial is conducted through 10 surgical clinics within the National Cancer Institute Community Oncology Research Program (NCORP). We plan a stepped-wedge design with clinics randomised to the time of transition from usual care to the decision aid arm. Study participants are female patients, aged ≥18 years, with newly diagnosed stage 0-III breast cancer who are planning breast surgery. Data collection includes a baseline surgeon survey, baseline patient survey, audio-recording of the surgeon-patient consultation, a follow-up patient survey and medical record data review. Interviews and focus groups are conducted with a subset of patients, surgeons and clinic stakeholders. The effectiveness of the decision aid at increasing patient engagement (primary outcome) is evaluated using generalised linear mixed-effects models. The extent to which the effect of the decision aid intervention on patient engagement is mediated through the mitigation of barriers is tested in joint linear structural equation models. Qualitative interviews explore how barriers impact engagement, especially for socioeconomically disadvantaged women. ETHICS AND DISSEMINATION This protocol has been approved by the National Cancer Institute Central Institutional Review Board, and Certificate of Confidentiality has been obtained. We plan to disseminate the findings through journal publications and national meetings, including the NCORP network. Our findings will advance the science of medical decision-making with the potential to reduce socioeconomic health disparities. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03766009).
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Affiliation(s)
| | - David Zahrieh
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, New York, USA
| | - Selina Chow
- Medicine-Geriatrics and Palliative Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - John Taylor
- Medicine-Geriatrics and Palliative Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Rachel Wills
- Medicine-Geriatrics and Palliative Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Bret M Hanlon
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Paul J Rathouz
- Population Health, University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA
| | - Jennifer L Tucholka
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Faeni H, Yarso KY, Wasita B, Rahayu RF, Suyatmi S, Wiyono N, Persik RN, Wicaksana IH, Azmiardi A, Ramadhanty Z. Age as a Determinant in Selecting Type of Breast Cancer Surgery in Lovely Pink Solo Cancer Community. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast-Conserving Surgery as a treatment option for older patients with early breast cancerHanum Faeni, MD1., Kristanto Yuli Yarso, MD2., Brian Wasita, MD3., Rachmi Fauziah Rahayu, MD4., Suyatmi Suyatmi, MD5., Nanang Wiyono, MD6., Riza Novierta Persik, MD3., Iman Hakim Wicaksana, MD1., Akhmad Azmiardi, MD7., Zhafira Ramadhanty, MD8.1 Resident of Surgery, Department of Surgery, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia2 Oncology Surgeon, Department of Surgery, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia3 Department of Anatomical Pathology, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia4 Department of Radiology, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia5 Department of Histology, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia6 Department of Anatomy, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia7 Doctoral Program on Public Health, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia8 Medical Student, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
Objective: Breast cancer is one of the most common malignancies in Indonesia. Breast cancer occurs due to rapid and abnormal cell growth due to infiltration of lymphatic tissue and blood vessels. For this reason, surgery is vital to use as a treatment for breast cancer at an early stage. There are two surgical methods: Breast-Conserving Surgery (BCS) and mastectomy. In this regard, several factors have been studied to influence patients in choosing BCS or mastectomy. Looking at the age factor, the results varied and differed significantly throughout the study.Method: This analytical study used a retrospective cross-sectional approach. The research subjects were patients with breast cancer who were the Lovely Pink community members in Surakarta City, Central Java. Subjects were selected by simple random sampling with inclusion criteria consisting of female patients aged 20 to 80 years, being diagnosed with stage 1 and 2 breast cancer, and having received surgery employing BCS or mastectomy techniques.Result: This study was conducted on 218 breast cancer patients who had undergone mastectomy or BCS in Surakarta City, Central Java. It was found that 104 patients were < 50 years old and 114 patients > 50 years old. 76 patients (34.9%) and 142 patients (65.1%) had a total income of more or less than Rp2.5 million/month. As many as 155 patients (71.1%) and 63 patients (28.9%) had no history of disease. Based on the type of surgery performed, 141 people (64.7%) underwent mastectomy, and 77 people (35.3%) underwent BCS.Conclusion: It can be concluded that patients prefer to undergo mastectomy with significant results at the age of under and above 50 years supported by income, medical history, and work history.Keywords: breast-conserving surgery, mastectomy, age
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Pedersen RN, Esen BÖ, Mellemkjær L, Christiansen P, Ejlertsen B, Lash TL, Nørgaard M, Cronin-Fenton D. The Incidence of Breast Cancer Recurrence 10-32 Years after Primary Diagnosis. J Natl Cancer Inst 2021; 114:391-399. [PMID: 34747484 PMCID: PMC8902439 DOI: 10.1093/jnci/djab202] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/01/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background Extended, more effective breast cancer treatments have increased the prevalence of long-term survivors. We investigated the risk of late breast cancer recurrence (BCR), 10 years or more after primary diagnosis, and associations between patient and tumor characteristics at primary diagnosis and late BCR up to 32 years after primary breast cancer diagnosis. Methods Using the Danish Breast Cancer Group clinical database, we identified all women with an incident early breast cancer diagnosed during 1987-2004. We restricted to women who survived 10 years without a recurrence or second cancer (10-year disease-free survivors) and followed them from 10 years after breast cancer diagnosis date until late recurrence, death, emigration, second cancer, or December 31, 2018. We calculated incidence rates per 1000 person-years and cumulative incidences for late BCR, stratifying by patient and tumor characteristics. Using Cox regression, we calculated adjusted hazard ratios for late BCR accounting for competing risks. Results Among 36 924 women with breast cancer, 20 315 became 10-year disease-free survivors. Of these, 2595 developed late BCR (incidence rate = 15.53 per 1000 person-years, 95% confidence interval = 14.94 to 16.14; cumulative incidence = 16.6%, 95% confidence interval = 15.8% to 17.5%) from year 10 to 32 after primary diagnosis. Tumor size larger than 20 mm, lymph node–positive disease, and estrogen receptor–positive tumors were associated with increased cumulative incidences and hazards for late BCR. Conclusions Recurrences continued to occur up to 32 years after primary diagnosis. Women with high lymph node burden, large tumor size, and estrogen receptor–positive tumors had increased risk of late recurrence. Such patients may warrant extended surveillance, more aggressive treatment, or new therapy approaches.
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Affiliation(s)
- Rikke Nørgaard Pedersen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Buket Öztürk Esen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | | | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Breast Cancer Group, Rigshospitalet. Copenhagen University Hospital, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Rigshospitalet. Copenhagen University Hospital, Denmark
| | - Timothy Lee Lash
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Wang J, Lian CL, Zhou P, Lei J, Hua L, He ZY, Wu SG. The prognostic and predictive value of the 8th American Joint Committee on Cancer (AJCC) staging system among early breast cancer patients aged <50 years. Gland Surg 2021; 10:233-241. [PMID: 33633979 DOI: 10.21037/gs-20-587] [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: 12/24/2022]
Abstract
Background This study respectively analyzed the prognostic value and the role in treatment decision-making [breast-conserving surgery (BCS) + radiotherapy (RT) or mastectomy (MAST)] of the 8th American Joint Committee on Cancer (AJCC) pathological prognostic staging system compared with the 7th AJCC anatomical staging system among early breast cancer patients aged <50 years. Methods Patients with T1-2N0M0 breast cancer aged <50 years were extracted from the Surveillance, Epidemiology, and End Results database between 2010 and 2014. Breast cancer-specific survival (BCSS) was used as the primary endpoint. Chi-squared test, receiver operating characteristics analysis, Kaplan-Meier method, and multivariate Cox proportional models were used to conduct statistical analysis. Results A total of 22,640 female patients were identified, and 24.4% of them reallocated to new stage groups from the 7th to the 8th AJCC staging. Among them, 46.2% (n=10,450) and 53.8% (n=12,190) of patients received BCS + RT and MAST, respectively. The 8th AJCC staging system was an independent prognostic factor for BCSS. Patients treated with BCS + RT had better BCSS compared to those treated with MAST (P<0.001). According to the 8th AJCC staging, BCS + RT could improve 5-year BCSS compared with MAST in patients with stage IA (P=0.006) and stage IB (P=0.001) diseases, while comparable BCSS was found between the two treatment arms in patients' stage IIA disease (P=0.366). Multivariate analyses replicated similar findings after stratification by the 8th AJCC stages. Conclusions In patients with T1-2N0 breast cancer and aged <50 years, the 8th AJCC pathological staging system provides accurate prognostic information than the 7th anatomical staging. BCS + RT is the optimal local management for stage IA and IB diseases, while it is the optional management in stage IIA disease according to the 8th AJCC staging.
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Affiliation(s)
- Jun Wang
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Chen-Lu Lian
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ping Zhou
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jian Lei
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Li Hua
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - San-Gang Wu
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, China
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Aagaard Rasmussen L, Jensen H, Flytkjær Virgilsen L, Jellesmark Thorsen LB, Vrou Offersen B, Vedsted P. A validated algorithm for register-based identification of patients with recurrence of breast cancer-Based on Danish Breast Cancer Group (DBCG) data. Cancer Epidemiol 2019; 59:129-134. [PMID: 30743224 DOI: 10.1016/j.canep.2019.01.016] [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: 10/24/2018] [Revised: 12/20/2018] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cancer recurrence is not routinely and completely registered in Danish national health registers, which challenges register-based research. The aim of this study was to develop and validate a register-based algorithm to identify patients with recurrence of breast cancer (BC). METHODS We conducted a cohort study based on data from Danish national health registers and used the Danish National Patient Register and the Danish National Pathology Register as sources to identify BC recurrence. We used data from the Danish Breast Cancer Group (DBCG) validated against medical records on recurrence status and recurrence date for 471 women with early stage unilateral BC as the gold standard of BC recurrence to assess the accuracy of the algorithm to identify BC recurrence. RESULTS The algorithm displayed a sensitivity of 97.3% (95% confidence interval (CI): 93.2-99.3), a specificity of 97.2% (95% CI: 94.8-98.7) and a positive predictive value of 94.4% (95% CI: 89.2-97.3). The concordance correlation coefficient for the agreement between recurrence dates generated by the algorithm and the gold standard was 0.97 (95% CI: 0.96-0.98), and the date was estimated within +/-30 days of the gold standard in 66% of the patients and within +/-60 days in 76% of the patients. CONCLUSION The developed algorithm almost perfectly identified BC recurrence and with reasonable timing compared to the gold standard.
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Affiliation(s)
- Linda Aagaard Rasmussen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Bartholins Allé 2, 8000 Aarhus C, Denmark; Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Henry Jensen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Line Flytkjær Virgilsen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Lise Bech Jellesmark Thorsen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark; Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark; Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Bartholins Allé 2, 8000 Aarhus C, Denmark
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Sinnadurai S, Kwong A, Hartman M, Tan EY, Bhoo-Pathy NT, Dahlui M, See MH, Yip CH, Taib NA, Bhoo-Pathy N. Breast-conserving surgery versus mastectomy in young women with breast cancer in Asian settings. BJS Open 2018; 3:48-55. [PMID: 30734015 PMCID: PMC6354186 DOI: 10.1002/bjs5.50111] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/07/2018] [Indexed: 01/01/2023] Open
Abstract
Background Mastectomy rates among women with early breast cancer in Asia have traditionally been high. This study assessed trends in the surgical management of young women with early‐stage breast cancer in Asian settings. Survival in women treated with breast‐conserving surgery (BCS; lumpectomy with adjuvant radiotherapy) and those undergoing mastectomy was compared. Methods Young women (aged less than 50 years) newly diagnosed with stage I or II (T1–2 N0–1 M0) breast cancer in four hospitals in Malaysia, Singapore and Hong Kong in 1990–2012 were included. Overall survival (OS) was compared for patients treated by BCS and those who had a mastectomy. Propensity score analysis was used to account for differences in demographic, tumour and treatment characteristics between the groups. Results Some 63·5 per cent of 3536 women underwent mastectomy. Over a 15‐year period, only a modest increase in rates of BCS was observed. Although BCS was significantly associated with favourable prognostic features, OS was not significantly different for BCS and mastectomy; the 5‐year OS rate was 94·9 (95 per cent c.i. 93·5 to 96·3) and 92·9 (91·7 to 94·1) per cent respectively. Inferences remained unchanged following propensity score analysis (hazard ratio for BCS versus mastectomy: 0·81, 95 per cent c.i. 0·64 to 1·03). Conclusion The prevalence of young women with breast cancer treated by mastectomy remains high in Asian countries. Patients treated with BCS appear to survive as well as those undergoing mastectomy.
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Affiliation(s)
- S Sinnadurai
- Department of Surgery, University Malaya Medical Centre University of Malaya Kuala Lumpur Malaysia
| | - A Kwong
- Department of Surgery University of Hong Kong Pokfulam Hong Kong
| | - M Hartman
- Division of General Surgery (Breast Surgery) National University Hospital Singapore
| | - E Y Tan
- Department of General Surgery Tan Tock Seng Hospital Singapore
| | - N T Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - M Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - M H See
- Department of Surgery, University Malaya Medical Centre University of Malaya Kuala Lumpur Malaysia
| | - C H Yip
- Department of Surgery, University Malaya Medical Centre University of Malaya Kuala Lumpur Malaysia
| | - N A Taib
- Department of Surgery, University Malaya Medical Centre University of Malaya Kuala Lumpur Malaysia
| | - N Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
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Christiansen P, Carstensen SL, Ejlertsen B, Kroman N, Offersen B, Bodilsen A, Jensen MB. Breast conserving surgery versus mastectomy: overall and relative survival-a population based study by the Danish Breast Cancer Cooperative Group (DBCG). Acta Oncol 2018; 57:19-25. [PMID: 29168674 DOI: 10.1080/0284186x.2017.1403042] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Observational studies have pointed at a better survival after breast conserving surgery (BCS) compared with mastectomy. The aim of the present study was to evaluate whether this remains true when more extensive tumor characteristics and treatment data were included. METHODS The cohort included patients registered after primary surgery for early invasive breast cancer in the database of the Danish Breast Cancer Cooperative Group, in the period 1995-2012. The cohort was divided into three groups: (i) patients who primarily had a mastectomy, (ii) patients treated by BCS, and (iii) patients who primarily had BCS and then mastectomy [intention to treat (ITT) by BCS]. The association between overall mortality and standard mortality ratio (SMR) and risk factors was analyzed in univariate and multivariate Poisson regression models. RESULTS A total of 58,331 patients were included: 27,143 in the mastectomy group, 26,958 in the BCS group, and 4230 in the BCS-ITT group. After adjusting for patient and treatment characteristics, the relative risk (RR) was 1.20 (95% CI: 1.15-1.25) after mastectomy and 1.08 (95% CI: 1.01-1.15) after BCS first and then mastectomy, as compared to BCS. Statistically significant interactions were not observed for age, period of treatment, and nodal status, but patients with Charlson's Comorbidity Index (CCI) score 2+ had no increased mortality after mastectomy, as opposed to patients with CCI 0-1. Loco-regional radiation therapy (RT) in node positive patients did not reduce the increased risk associated with mastectomy [RR = 1.28 (95% CI 1.19-1.38)]. CONCLUSION Patients assigned to BCS have a better survival than patients assigned to mastectomy. Residual confounding after adjustment for registered characteristics presumably explained the different outcomes, thus consistent with selection bias. Diversities in RT did not appear to explain the observed difference in survival after BCS and mastectomy.
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Affiliation(s)
- Peer Christiansen
- Breast Unit, Aarhus University Hospital/Randers Regional Hospital, Aarhus, Denmark
| | - Stina Lyck Carstensen
- Danish Breast Cancer Cooperative Group Secretariat, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group Secretariat, Department of Oncology, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital, Herlev, Denmark
| | | | - Anne Bodilsen
- Department of Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group Secretariat, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
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12
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Ejlertsen B, Offersen BV, Overgaard J, Christiansen P, Jensen MB, Kroman N, Knoop AS, Mouridsen H. Forty years of landmark trials undertaken by the Danish Breast Cancer Cooperative Group (DBCG) nationwide or in international collaboration. Acta Oncol 2018; 57:3-12. [PMID: 29205077 DOI: 10.1080/0284186x.2017.1408962] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Over the past 40 years the Danish Breast Cancer Cooperative Group (DBCG) has made significant contributions to improve outcome and to make treatment of patients with early breast cancer more tolerable through nationwide and international trials evaluating loco-regional and systemic treatments. These trials have been instrumental to establish standards for the treatment of early breast cancer. METHODS The DBCG 82 trials had a global impact by documenting that the significant gain in loco-regional recurrence from postmastectomy radiation added to systemic therapy was associated with a reduction in distant recurrence and mortality in high-risk pre- and postmenopausal patients. The DBCG trials comparing breast conserving surgery and radiotherapy with mastectomy and more recently the trial of internal mammary node irradiation also had a major impact of practice. The trials initiated by the DBCG 40 years ago on tamoxifen and cyclophosphamide based chemotherapy became instrumental for the development of adjuvant systemic therapy not only due to their positive results but by sharing these important data with other members of the Early Breast Cancer Trialist' Collaborative Group (EBCTCG). Trials from the DBCG have also been important for highlighting the relative importance of anthracyclines and taxanes in the adjuvant setting. Furthermore, DBCG has made a major contribution to the development of aromatase inhibitors and targeted adjuvant treatment for human epidermal growth factor receptor 2 positive breast cancers. RESULTS The substantial impact of these treatment improvements is illustrated by a 46.7% 10-year overall survival of early breast cancer patients treated in 1978-1987 compared to 71.5% for patients treated 2008-2012. CONCLUSIONS The trials conducted and implemented by the DBCG appear to have a major impact on the substantial survival improvements in breast cancer.
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Affiliation(s)
- Bent Ejlertsen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Vrou Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Department of Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Ann Søgaard Knoop
- Department of Oncology, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Henning Mouridsen
- Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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13
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Lim YJ, Lee SW, Choi N, Kwon J, Eom KY, Kang E, Kim EK, Kim JH, Kim YJ, Kim SH, Park SY, Kim IA. A Novel Prognostic Nomogram for Predicting Risks of Distant Failure in Patients with Invasive Breast Cancer Following Postoperative Adjuvant Radiotherapy. Cancer Res Treat 2017; 50:1140-1148. [PMID: 29216710 PMCID: PMC6192903 DOI: 10.4143/crt.2017.508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/05/2017] [Indexed: 12/29/2022] Open
Abstract
Purpose This study aimed to identify predictors for distant metastatic behavior and build a related prognostic nomogram in breast cancer. Materials and Methods A total of 1,181 patients with non-metastatic breast cancer between 2003 and 2011 were analyzed. To predict the probability of distant metastasis, a nomogram was constructed based on prognostic factors identified using a Cox proportional hazards model. Results The 7-year overall survival and 5-year post-progression survival of locoregional versus distant recurrence groups were 67.6% versus 39.1% (p=0.027) and 54.2% versus 33.5% (p=0.043), respectively. Patients who developed distant metastasis showed early and late mortality risk peaks within 3 and after 5 years of follow-up, respectively, but a broad and low risk increment was observed in other patients with locoregional relapse. In multivariate analysis of distant metastasis-free interval, age (≥ 45 years vs. < 45 years), molecular subtypes (luminal A vs. luminal B, human epidermal growth receptor 2, and triple negative), T category (T1 vs. T2-3 and T4), and N category (N0 vs. N1 and N2-3) were independently associated (p < 0.05 for all). Regarding the significant factors, a well-validated nomogram was established (concordance index, 0.812). The risk score level of patients with initial brain failure was higher than those of non-brain sites (p=0.029). Conclusion The nomogram could be useful for predicting the individual probability of distant recurrence in breast cancer. In high-risk patients based on the risk scores, more aggressive systemic therapy and closer surveillance for metastatic failure should be considered.
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Affiliation(s)
- Yu Jin Lim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Noorie Choi
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeanny Kwon
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea.,Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, Korea
| | - Eunyoung Kang
- Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, Korea
| | - Eun-Kyu Kim
- Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, Korea
| | - Jee Hyun Kim
- Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, Korea
| | - Yu Jung Kim
- Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, Korea
| | - Se Hyun Kim
- Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, Korea
| | - So Yeon Park
- Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea.,Breast Care Center, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, Korea
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14
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Laurberg T, Overgaard J. Intrinsic subtype characterization of local recurrences and new contralateral primary tumors in patients with low risk breast cancer. Influence of age and primary surgery. Acta Oncol 2017; 56:1644-1647. [PMID: 28885116 DOI: 10.1080/0284186x.2017.1360514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Tinne Laurberg
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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15
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Hartmann-Johnsen OJ, Kåresen R, Schlichting E, Nygård JF. Better survival after breast-conserving therapy compared to mastectomy when axillary node status is positive in early-stage breast cancer: a registry-based follow-up study of 6387 Norwegian women participating in screening, primarily operated between 1998 and 2009. World J Surg Oncol 2017; 15:118. [PMID: 28673296 PMCID: PMC5496325 DOI: 10.1186/s12957-017-1184-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 06/22/2017] [Indexed: 11/21/2022] Open
Abstract
Background Recent registry studies on early-stage breast cancer have shown better survival rates when women underwent breast-conserving therapy (BCT) compared with mastectomy (MTX). The aim of this study is to investigate women participating in screening, in all four stages of early breast cancer (T1N0M0, T2N0M0, T1N1M0, and T2N1M0), as to whether there is a survival benefit when women undergo BCT compared to MTX. Method A cohort of 6387 women aged 50–69, with primary-operated breast cancer from January 1998 to December 2009, participating in screening and followed-up until the end of 2010. Life tables were calculated by stages (pT1N0M0, pT2N0M0, pT1N1M0, and pT2N1M0), surgery groups (BCT and MTX), and screening detection (first screening, later screening, or interval cancer). Cox regression was used to calculate hazard ratios (HR) between BCT and MTX in crude and adjusted analyses. Results In stage T1N1M0, women who underwent MTX had an HR of 2.91 (95% CI 1.30–6.48) for breast cancer death compared to women who underwent BCT, after adjusting for screening detection, years of diagnosis, age at diagnosis, histology, grade, and hormone receptor status. For all other TNM categories of early breast cancer, there was no difference in survival. 10-year breast cancer-specific survival (BCSS) in T1N0M0 was 98% for women undergoing BCT and 96% for women undergoing MTX. 10-year BCSS in T1N1M0 was 97% for women undergoing BCT and 89% for women undergoing MTX. Conclusions For women participating in screening, there is a benefit of BCT over MTX in stage T1N1M0. No such effects were observed in the other early stages of breast cancer.
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Affiliation(s)
- Olaf Johan Hartmann-Johnsen
- Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304, Oslo, Norway. .,Department of Breast and Endocrine Surgery, Kalnes Hospital, Kalnes, Norway. .,University of Oslo, Oslo, Norway.
| | - Rolf Kåresen
- Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304, Oslo, Norway.,Department of Breast and Endocrine Surgery, Oslo University Hospital, Oslo, Norway
| | - Ellen Schlichting
- Department of Breast and Endocrine Surgery, Oslo University Hospital, Oslo, Norway
| | - Jan F Nygård
- Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304, Oslo, Norway
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16
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Laurberg T, Alsner J, Tramm T, Jensen V, Lyngholm CD, Christiansen PM, Overgaard J. Impact of age, intrinsic subtype and local treatment on long-term local-regional recurrence and breast cancer mortality among low-risk breast cancer patients. Acta Oncol 2017; 56:59-67. [PMID: 27846764 DOI: 10.1080/0284186x.2016.1246803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM To evaluate the long-term prognostic impact of age, local treatment and intrinsic subtypes on the risk of local-regional recurrence (LRR) and breast cancer mortality among low-risk patients. MATERIAL AND METHODS Cohort study with prospectively collected data, balanced five-year age groups, including 514 Danish lymph node negative breast cancer patients diagnosed between 1989 and 1998, treated with mastectomy (N = 320) or breast-conserving therapy (BCT) (N = 194) and without systemic treatment. Intrinsic subtype approximation was performed by combining information on estrogen-, progesterone-, HER2 receptor and Ki67. RESULTS The majority of the tumors had a luminal subtype: 70% Luminal-A (LumA), 16% Luminal-B (LumB), and 10% Luminal-HER2 + (Lum-HER2+). The distribution of intrinsic subtypes between younger (≤45 years) and older (>45 years) patients was similar. Intrinsic subtypes had no prognostic impact on the 20-year LRR risk, regardless of age. A distinct 20-year mortality pattern was observed among the younger patients: 11% of patients with LumB tumor died of breast cancer within the first five years after primary surgery, 23% of patients with Lum-HER2+ tumor died within a 5-10-year period, whereas patients with LumA tumor died with a constant low rate throughout the 20-year period. After 20 years of follow-up, patients with LumA tumor had breast cancer mortality comparable to that of patients with LumB tumor (20%) and lower than Lum-HER2+ tumor (39%). Among the older patients, no distinct mortality pattern was observed, and the 20-year breast cancer mortality was not associated with intrinsic subtypes. CONCLUSION Among low-risk patients, 96% of the tumors were Luminal and the distribution of intrinsic subtypes between younger (≤45 years) and older (>45 years) patients was similar. The observed higher frequency of LRR among younger low-risk BCT patients was not associated intrinsic subtype. The 20-year breast cancer mortality was non-significant for LumA tumors among the older patients, whereas among the younger patients, LumA tumors had a comparable mortality with LumB, but lower than for Lum-HER2 + tumors.
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Affiliation(s)
- Tinne Laurberg
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
- Department of Pathology, Aarhus University Hospital, Denmark
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Trine Tramm
- Department of Pathology, Aarhus University Hospital, Denmark
| | - Vibeke Jensen
- Department of Pathology, Aarhus University Hospital, Denmark
| | | | - Peer M. Christiansen
- Breast Surgery Unit, Aarhus University Hospital/Randers Regional Hospital, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
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17
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Bartelink H. The changing landscape in radiotherapy for breast cancer: Lessons from long term follow-up in some European breast cancer trials. Radiother Oncol 2016; 121:348-356. [PMID: 27890425 DOI: 10.1016/j.radonc.2016.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 02/01/2023]
Abstract
This review describes the developments in the radiation treatment of breast cancer based on some randomized European trials during the past decades. It will focus on the relevance of long term follow-up in breast cancer patients, starting with the surprising and important change in treatment results during follow-up shown in a locally advanced breast cancer trial. Breast conserving therapy (BCT) in stage I and II breast cancer was explored and tested in a randomized trial to prove equivalence between BCT and mastectomy. The positive outcome led to trials in breast conserving therapy with lower doses and partial breast irradiation. Finally the need for finding genetic profiles for predicting treatment response will be addressed in a trial with preoperative partial breast irradiation.
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Affiliation(s)
- Harry Bartelink
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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