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Maximov PY. In memory of V. Craig Jordan (1947-2024): "Father of tamoxifen" and discoverer of SERMs. J Steroid Biochem Mol Biol 2024; 244:106598. [PMID: 39128816 DOI: 10.1016/j.jsbmb.2024.106598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
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2
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Tunç S, Alagoz O, Burnside ES. A new perspective on breast cancer diagnostic guidelines to reduce overdiagnosis. PRODUCTION AND OPERATIONS MANAGEMENT 2022; 31:2361-2378. [PMID: 35915601 PMCID: PMC9313854 DOI: 10.1111/poms.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/19/2022] [Indexed: 06/15/2023]
Abstract
Overdiagnosis of breast cancer, defined as diagnosing a cancer that would otherwise not cause symptoms or death in a patient's lifetime, costs U.S. health care system over $1.2 billion annually. Overdiagnosis rates, estimated to be around 10%-40%, may be reduced if indolent breast findings can be identified and followed with noninvasive imaging rather than biopsy. However, there are no validated guidelines for radiologists to decide when to choose imaging options recognizing cancer grades and types. The aim of this study is to optimize breast cancer diagnostic decisions based on cancer types using a large-scale finite-horizon Markov decision process (MDP) model with 4.6 million states to help reduce overdiagnosis. We prove the optimality of a divide-and-search algorithm that relies on tight upper bounds on the optimal decision thresholds to find an exact optimal solution. We project the high-dimensional MDP onto two lower dimensional MDPs and obtain feasible upper bounds on the optimal decision thresholds. We use real data from two private mammography databases and demonstrate our model performance through a previously validated simulation model that has been used by the policy makers to set the national screening guidelines in the United States. We find that a decision-analytical framework optimizing diagnostic decisions while accounting for breast cancer types has a strong potential to improve the quality of life and alleviate the immense costs of overdiagnosis. Our model leads to a20 % reduction in overdiagnosis on the screening population, which translates into an annual savings of approximately $300 million for the U.S. health care system.
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Affiliation(s)
- Sait Tunç
- Grado Department of Industrial and Systems EngineeringVirginia TechBlacksburgVirginiaUSA
| | - Oguzhan Alagoz
- Department of Industrial and Systems EngineeringUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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3
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Riley D, Chrischilles EA, Lizarraga IM, Charlton M, Smith BJ, Lynch CF. Rural-urban differences in secular trends of locoregional treatment for ductal carcinoma in situ: A patterns of care analysis. Cancer Med 2022; 11:2284-2295. [PMID: 35146946 PMCID: PMC9160801 DOI: 10.1002/cam4.4605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/29/2021] [Accepted: 01/01/2022] [Indexed: 11/25/2022] Open
Abstract
Precis Omission of PORT following BCS remains high among rural patients despite evidence that PORT leads to a significant reduction in the risk of local recurrence. Further research is needed to examine the impact of rural residence on treatment choices and develop methods to ensure equitable care among all breast cancer patients. Background Despite national guidelines, debate exists among clinicians regarding the optimal approach to treatment for patients diagnosed with ductal carcinoma in situ (DCIS). While regional variation in practice patterns has been well documented, population‐based information on rural–urban treatment differences is lacking. Methods Data from the SEER Patterns of Care studies were used to identify women diagnosed with histologically confirmed DCIS who underwent cancer‐directed surgery in the years 1991, 1995, 2000, 2005, 2010, and 2015. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using weighted multivariable logistic regression to evaluate cancer‐directed surgery and use of post‐operative radiation therapy (PORT). Results Of the 3337 patients who met inclusion criteria, 27% underwent mastectomy, 26% underwent breast‐conserving surgery (BCS) without PORT, and 47% underwent BCS with PORT. After adjustment for other covariates, there was no difference in the likelihood of receiving mastectomy between rural and urban patients (aOR = 0.65; 95% CI 0.37–1.14). However, rural residents were more likely than urban residents to have mastectomy during 1991/1995 (aOR = 1.78; 95% CI 1.09–2.91; pinteraction = 0.022). Across all diagnosis years, patients residing in rural areas were less likely to receive PORT following BCS compared to urban patients (aOR = 0.35; 95% CI 0.18–0.67). Conclusions Omission of PORT following BCS remains high among rural patients despite evidence that PORT leads to a significant reduction in the risk of local recurrence. Further research is needed to examine the impact of rural residence on treatment choices and develop methods to ensure equitable care among all breast cancer patients.
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Affiliation(s)
- Danielle Riley
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | | | - Ingrid M Lizarraga
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mary Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Brian J Smith
- Holden Comprehensive Cancer Center, University of Iowa, Iowa, USA
| | - Charles F Lynch
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
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4
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Farante G, Toesca A, Magnoni F, Lissidini G, Vila J, Mastropasqua M, Viale G, Penco S, Cassano E, Lazzeroni M, Bonanni B, Leonardi MC, Ripoll-Orts F, Curigliano G, Orecchia R, Galimberti V, Veronesi P. Advances and controversies in management of breast ductal carcinoma in situ (DCIS). Eur J Surg Oncol 2021; 48:736-741. [PMID: 34772587 DOI: 10.1016/j.ejso.2021.10.030] [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: 05/18/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 01/03/2023] Open
Abstract
Ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive breast cancer. It accounts for 25% of all breast cancers diagnosed, as a result of the expansion of breast cancer screening and is associated with a high survival rate. DCIS is particularly clinically challenging, due to its heterogeneous pathological and biological traits and its management is continually evolving towards more personalized and less aggressive therapies. This article suggests evidence-based guidelines for proper DCIS clinical management, which should be discussed within a multidisciplinary team in order to propose the most suitable approach in clinical practice, taking into account recent scientific studies. Here we include updated multidisciplinary treatment protocols and techniques in accordance with the most recent contributions published on this topic in the peer-reviewed medical literature, and we outline future perspectives.
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Affiliation(s)
- Gabriel Farante
- Division of Breast Surgery, European Institute of Oncology (EIO), IRCCS, Milan, Italy.
| | - Antonio Toesca
- Division of Breast Surgery, European Institute of Oncology (EIO), IRCCS, Milan, Italy
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology (EIO), IRCCS, Milan, Italy
| | - Germana Lissidini
- Division of Breast Surgery, European Institute of Oncology (EIO), IRCCS, Milan, Italy
| | - José Vila
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Giuseppe Viale
- Division of Anatomo-Pathology, European Institute of Oncology (EIO), Milan, Italy; School of Medicine, University of Milan, Italy
| | - Silvia Penco
- Division of Breast Radiology, European Institute of Oncology (EIO), IRCCS, Milan, Italy
| | - Enrico Cassano
- Division of Breast Radiology, European Institute of Oncology (EIO), IRCCS, Milan, Italy
| | - Matteo Lazzeroni
- Division of Cancer Prevention and Genetics, European Institute of Oncology (EIO), IRCCS, Milan, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology (EIO), IRCCS, Milan, Italy
| | | | | | - Giuseppe Curigliano
- School of Medicine, University of Milan, Italy; Division of Breast Radiology, European Institute of Oncology (EIO), IRCCS, Milan, Italy; Division of Cancer Prevention and Genetics, European Institute of Oncology (EIO), IRCCS, Milan, Italy; Division of Radiotherapy, European Institute of Oncology (EIO), IRCCS, Milan, Italy; Division of Early Drug Development for Innovative Therapy, European Institute of Oncology (EIO), IRCCS, Milan, Italy
| | - Roberto Orecchia
- School of Medicine, University of Milan, Italy; Division of Breast Radiology, European Institute of Oncology (EIO), IRCCS, Milan, Italy; Division of Cancer Prevention and Genetics, European Institute of Oncology (EIO), IRCCS, Milan, Italy; Division of Radiotherapy, European Institute of Oncology (EIO), IRCCS, Milan, Italy
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology (EIO), IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology (EIO), IRCCS, Milan, Italy; Hospital Universitario y Politécnico La Fe, Valencia, Spain; School of Medicine University of Bari "Aldo Moro", Italy; Division of Anatomo-Pathology, European Institute of Oncology (EIO), Milan, Italy; School of Medicine, University of Milan, Italy
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5
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Saleh T, Carpenter VJ. Potential Use of Senolytics for Pharmacological Targeting of Precancerous Lesions. Mol Pharmacol 2021; 100:580-587. [PMID: 34544896 DOI: 10.1124/molpharm.121.000361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/10/2021] [Indexed: 01/10/2023] Open
Abstract
Senescence is a cell state that contributes to several homeostatic and pathologic processes. In addition to being induced in somatic cells in response to replicative exhaustion (replicative senescence) as part of organismal aging, senescence can also be triggered prematurely by oncogene hyperactivation or tumor suppressor dysfunction [oncogene-induced senescence (OIS)]. Consequently, senescent cells comprise a major component of precancerous lesions of skin, oral mucosa, nasopharynx, prostate, gut, and lung. Unfortunately, invasive (or minimally invasive) interventions are currently the only available approach employed to eradicate premalignant lesions that carry the potential for cancer progression. Senolytics are a newly emerging drug class capable of selectively eliminating senescent cells. Although senolytics have been successfully demonstrated to mitigate a myriad of aging-related pathologies and to cull senescent cancer cells, there is a paucity of evidence for the potential use of senolytics as a novel approach to eliminate oncogene-induced senescent cells. This Emerging Concepts commentary will 1) summarize evidence in established models of OIS including B-Raf-induced nevi, transgenic lung cancer, and pancreatic adenocarcinoma models, as well as evidence from clinical precancerous lesions; 2) suggest that OIS is targetable; and 3) propose the utilization of senolytic agents as a revolutionary means to interfere with the ability of senescent premalignant cells to progress to cancer in vitro and in vivo If proven to be effective, senolytics will represent an emerging tool to pharmacologically treat precancerous lesions. SIGNIFICANCE STATEMENT: The treatment of premalignant lesions is largely based on the utilization of invasive (or minimally invasive) measures. Oncogene-induced senescence (OIS) is one form of senescence that occurs in response to oncogene overexpression in somatic cells and is present in precancerous lesions. Although the contribution of OIS to disease progression is undetermined, recent evidence suggests that senescent cells are permissive for malignant transformation. Accordingly, the pharmacological targeting of oncogene-induced senescent cells could potentially provide a novel, less invasive, means for the treatment of premalignant disease.
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Affiliation(s)
- Tareq Saleh
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan (T.S.); Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia (V.J.C.)
| | - Valerie J Carpenter
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan (T.S.); Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia (V.J.C.)
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Keelan S, Flanagan M, Hill ADK. Evolving Trends in Surgical Management of Breast Cancer: An Analysis of 30 Years of Practice Changing Papers. Front Oncol 2021; 11:622621. [PMID: 34422626 PMCID: PMC8371403 DOI: 10.3389/fonc.2021.622621] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/19/2021] [Indexed: 01/12/2023] Open
Abstract
The management of breast cancer has evolved into a multidisciplinary evidence-based surgical speciality, with emphasis on conservative surgery. A number of landmark trials have established lumpectomy followed by radiation as the standard of care for many patients. The aim of this study is to construct a narrative review of recent developments in the surgical management of breast cancer and how such developments have impacted surgical practice. A comprehensive literature search of Pubmed was conducted. The latest search was performed on October 31st, 2020. Search terms “breast cancer” were used in combinations with specific key words and Boolean operators relating to surgical management. The reference lists of retrieved articles were comprehensively screened for additional eligible publications. Articles were selected and reviewed based on relevance. We selected publications in the past 10 years but did not exclude commonly referenced and highly regarded previous publications. Review articles and book chapters were also cited to provide reference on details not discussed in the academic literature. This article reviews the current evidence in surgical management of early-stage breast cancer, discusses recent trends in surgical practice for therapeutic and prophylactic procedures and provides commentary on implications and factors associated with these trends.
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Affiliation(s)
- Stephen Keelan
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,The Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Michael Flanagan
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,The Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Arnold D K Hill
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,The Department of Surgery, Beaumont Hospital, Dublin, Ireland
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Hwang KT, Suh YJ, Park CH, Lee YJ, Kim JY, Jung JH, Kim S, Min J. Hormone Receptor Subtype in Ductal Carcinoma in Situ: Prognostic and Predictive Roles of the Progesterone Receptor. Oncologist 2021; 26:e1939-e1950. [PMID: 34402131 PMCID: PMC8571738 DOI: 10.1002/onco.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 08/05/2021] [Indexed: 11/08/2022] Open
Abstract
Background We investigated the prognostic and predictive roles of the hormone receptor (HRc) subtype in patients with ductal carcinoma in situ (DCIS). We focused on identifying the roles of the progesterone receptor (PR) independent of estrogen receptor (ER) status. Methods Nationwide data of 12,508 female patients diagnosed with DCIS with a mean follow‐up period of 60.7 months were analyzed. HRc subtypes were classified as ER−/PR−, ER−/PR+, ER+/PR−, and ER+/PR+ based on ER and PR statuses. The Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results The ER+/PR+ group showed better prognoses than the ER+/PR− and ER−/PR− groups in the patients who received tamoxifen therapy (p = .001 and p = .031, respectively). HRc subtype was an independent prognostic factor (p = .028). The tamoxifen therapy group showed better survival than the patients who did not receive tamoxifen, but only in the ER+/PR+ subgroup (p = .002). Tamoxifen therapy was an independent prognostic factor (HR, 0.619; 95% CI, 0.423 − 0.907; p = .014). PR status was a favorable prognostic factor in patients with DCIS who received tamoxifen therapy (p < .001), and it remained a prognostic factor independent of ER status (HR, 0.576; 95% CI, 0.349 − 0.951; p = .031). Conclusion The HRc subtype can be used as both a prognostic and predictive marker in patients with newly diagnosed DCIS. Tamoxifen therapy can improve overall survival in the ER+/PR+ subtype. PR status has significant prognostic and predictive roles independent of ER status. Testing for the PR status in addition to the ER status is routinely recommended in patients with DCIS to determine the HRc subtype in clinical settings. Implications for Practice The hormone receptor (HRc) subtype was an independent prognostic factor, and the estrogen receptor (ER)+/progesterone receptor (PR) + subtype showed a better survival in patients with ductal carcinoma in situ (DCIS) who received tamoxifen therapy. PR was an independent prognostic factor independent of ER, and PR was a favorable prognostic factor in patients with DCIS who received tamoxifen therapy. The HRc subtype could be used as both a prognostic and predictive marker in patients with newly diagnosed DCIS. Testing of PR status in addition to ER status is routinely recommended for patients with DCIS to determine the HRc subtype in clinical settings. This study investigated the prognostic and predictive roles of the hormone receptor subtype in patients with newly diagnosed ductal carcinoma in situ, focusing on the prognostic and predictive values of progesterone receptor status independent of estrogen receptor status. The prognostic effect of tamoxifen therapy was also investigated
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Affiliation(s)
- Ki-Tae Hwang
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Jin Suh
- Department of Surgery, The Catholic University of Korea St. Vincent's Hospital, Seoul, Republic of Korea
| | - Chan-Heun Park
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Joo Lee
- Department of Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Hyang Jung
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Seeyeong Kim
- Department of Surgery, SaeGyaeRo Hospital, Busan, Republic of Korea
| | - Junwon Min
- Department of Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
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8
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Zorzan MT, de Mello Pereira R, Lima LF, de Arruda Mattos TV, Sá R. Radiodermatitis as a consequence of radiation recall induced by acyclovir: case report. ACTA ACUST UNITED AC 2021; 26:475-480. [PMID: 34277104 PMCID: PMC8281915 DOI: 10.5603/rpor.a2021.0058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
Background Radiation recall dermatitis (RRD) is an inflammatory reaction in an area of the skin previously irradiated for cancer treatment. The reaction usually occurs following the administration of a cytotoxic drug. Manifestations range from mild to severe, resulting in tissue necrosis. It is treated with removal of the probable causative agent, daily dressings and surgical debridement of the necrotic area. Case presentation A 54-year-old woman had a previous diagnosis of intraductal carcinoma in situ, and had been submitted to lumpectomy and adjuvant radiotherapy and hormonal therapy. One year after surgery, sores suggestive of herpes zoster infection developed, and treatment with acyclovir was started. At the same time, there was the onset of pain and fever. In the skin area previously irradiated, there was breast hardening, skin infiltration and serosanguinolent discharge. An incisional biopsy was performed to rule out radioinduced sarcoma. The patient was treated with surgical debridement. Conclusions This case report describes acyclovir as a possible trigger of RRD, a rare condition that could have been mistaken for an eruption with other causes. In this case, the dermatitis reaction was confined to the previously irradiated area of the skin, which suggested radiation recall. A better understanding of the condition’s mechanism and about the possible joint effects of drugs and radiotherapy on the skin is necessary.
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Affiliation(s)
| | | | | | | | - Rafael Sá
- University of Western São Paulo, Presidente Prudente, Brazil.,Federal University of São Paulo, São Paulo, Brazil
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Keshavarz-Fathi M, Rezaei N. Cancer Immunoprevention: Current Status and Future Directions. Arch Immunol Ther Exp (Warsz) 2021; 69:3. [PMID: 33638703 DOI: 10.1007/s00005-021-00604-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/06/2021] [Indexed: 12/24/2022]
Abstract
Cancer is one of the most serious diseases affecting health and the second leading cause of death worldwide. Despite the development of various therapeutic modalities to deal with cancer, limited improvement in overall survival of patients has been yielded. Since there is no certain cure for cancer, detection of premalignant lesions, and prevention of their progression are vital to the decline of high morbidity and mortality of cancer. Among approaches to cancer prevention, immunoprevention has gained further attention in recent years. Deep understanding of the tumor/immune system interplay and successful prevention of virally-induced malignancies by vaccines have paved the way toward broadening cancer immunoprevention application. The identification of tumor antigens in premalignant lesions was the turning point in cancer immunoprevention that led to designing preventive vaccines for various malignancies including multiple myeloma, colorectal, and breast cancer. In addition to vaccines, immune checkpoint inhibitors are also being tested for the prevention of oral squamous cell carcinoma (SCC), and imiquimod which is an established drug for the prevention of skin SCC, is a non-specific immunomodulator. Herein, to provide a bench-to-bedside understanding of cancer immunoprevention, we will review the role of the immune system in suppression and promotion of tumors, immunoprevention of virally-induced cancers, identification of tumor antigens in premalignant lesions, and clinical advances of cancer immunoprevention.
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Affiliation(s)
- Mahsa Keshavarz-Fathi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd, 14194, Tehran, Iran.
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd, 14194, Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Stockholm, Sweden.
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10
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Hwang ES, Solin L. De-Escalation of Locoregional Therapy in Low-Risk Disease for DCIS and Early-Stage Invasive Cancer. J Clin Oncol 2020; 38:2230-2239. [PMID: 32442066 PMCID: PMC7343434 DOI: 10.1200/jco.19.02888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 01/29/2023] Open
Affiliation(s)
- E. Shelley Hwang
- Duke Cancer Institute and Duke University Health System, Durham, NC
| | - Lawrence Solin
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
- Deceased
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11
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Lam DL, Smith J, Partridge SC, Kim A, Javid SH, Hippe DS, Lehman CD, Lee JM, Rahbar H. The Impact of Preoperative Breast MRI on Surgical Management of Women with Newly Diagnosed Ductal Carcinoma In Situ. Acad Radiol 2020; 27:478-486. [PMID: 31281083 DOI: 10.1016/j.acra.2019.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/03/2019] [Accepted: 05/18/2019] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES Use of preoperative breast MRI (pMRI) to evaluate ductal carcinoma in situ (DCIS) extent is controversial due to limited data on its impact on surgical management. We sought to evaluate the effect of pMRI on surgical management of women with core needle biopsy (CNB)-diagnosed pure DCIS at a multidisciplinary academic institution. MATERIALS AND METHODS This retrospective study included all women with CNB-diagnosed DCIS (1/2004-12/2013) without prior ipsilateral breast cancer and who underwent surgery within 180 days of diagnosis. Patient features, number of CNBs and surgeries, and single successful breast conserving surgery (BCS) rate were compared between pMRI and no-pMRI cohorts. Number of surgeries and single BCS success rates were also compared to published US (SEER) and Danish National Registry data. RESULTS Among the 373 women included, no clinical differences were identified between the pMRI (n = 332) and no-pMRI (n = 41) cohorts (p > 0.05). The pMRI group experienced a higher additional CNB rate (30% vs. 7%, p = 0.002) but fewer total surgeries (mean = 1.2 vs. 1.5, p < 0.001) than the no-pMRI group. Among the 245 women for whom BCS was attempted, the pMRI cohort underwent fewer mean surgeries (1.3 vs. 1.7, p < 0.001) with a greater single successful BCS rate (77% vs. 43%, p < 0.001). Compared to published data, women with pMRI who underwent BCS experienced fewer surgeries (difference (Δ) = -0.22 vs. -0.17, p < 0.001) with a higher single successful BCS rate (Δ = +20% vs. +14%, p < 0.001). CONCLUSION pMRI may improve surgical management of DCIS at multidisciplinary centers with breast cancer specialists.
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Affiliation(s)
- Diana L Lam
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109.
| | - Jacob Smith
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109
| | - Savannah C Partridge
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109
| | - Adrienne Kim
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109
| | - Sara H Javid
- Department of Surgery, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, Washington
| | - Daniel S Hippe
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109
| | - Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109
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12
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Grossberg AJ, Lei X, Xu T, Shaitelman SF, Hoffman KE, Bloom ES, Stauder MC, Tereffe W, Schlembach PJ, Woodward WA, Buchholz TA, Smith BD. Association of Transforming Growth Factor β Polymorphism C-509T With Radiation-Induced Fibrosis Among Patients With Early-Stage Breast Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol 2019; 4:1751-1757. [PMID: 30027292 DOI: 10.1001/jamaoncol.2018.2583] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Whether genetic factors can identify patients at risk for radiation-induced fibrosis remains unconfirmed. Objective To assess the association between the C-509T variant allele in the promoter region of TGFB1 and breast fibrosis 3 years after radiotherapy. Design, Setting, and Participants This is an a priori-specified, prospective, cohort study nested in an open-label, randomized clinical trial, which was conducted in community-based and academic cancer centers to compare hypofractionated whole-breast irradiation (WBI) (42.56 Gy in 16 fractions) with conventionally fractionated WBI (50 Gy in 25 fractions) after breast-conserving surgery. In total, 287 women 40 years or older with pathologically confirmed stage 0 to IIA breast cancer treated with breast-conserving surgery were enrolled from February 2011 to February 2014. Patients were observed for a minimum of 3 years. Outcomes were compared using the 1-sided Fisher exact test and multivariable logistic regression. Exposures A C-to-T single-nucleotide polymorphism at position -509 relative to the first major transcription start site (C-509T) of the TGFB1 gene. Main Outcomes and Measures The primary outcome was grade 2 or higher breast fibrosis as assessed using the Late Effects Normal Tissue/Subjective, Objective, Medical Management, Analytic scale (range, 0 to 3) three years after radiotherapy. Results Among 287 women enrolled in the trial, TGFB1 genotype and 3-year radiotherapy-induced toxicity data were available for 174 patients, of whom 89 patients (51%) with a mean (SD) age of 60 (8) years had at least 1 copy of C-509T. Grade 2 or higher breast fibrosis was present in 12 of 87 patients with C-509T (13.8%) compared with 3 of 80 patients without the allele variant (3.8%) (absolute difference, 10.0%; 95% CI, 1.7%-18.4%; P = .02). The results of multivariable analyses indicated that only C-509T (odds ratio, 4.47; 95% CI, 1.25-15.99; P = .02) and postoperative cosmetic outcome (odds ratio, 7.09; 95% CI, 2.41-20.90; P < .001) were significantly associated with breast fibrosis risk. Conclusions and Relevance To date, this study seems to be the first prospective validation of a genomic marker for radiation fibrosis. The C-509T allele in TGFB1 is a key determinant of breast fibrosis risk. Assessing TGFB1 genotype may facilitate a more personalized approach to locoregional treatment decisions in breast cancer. Trial Registration ClinicalTrials.gov identifier: NCT01266642.
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Affiliation(s)
- Aaron J Grossberg
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.,Department of Radiation Medicine, Oregon Health and Science University, Portland
| | - Xiudong Lei
- Division of Cancer Prevention, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Ting Xu
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Simona F Shaitelman
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Karen E Hoffman
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Elizabeth S Bloom
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael C Stauder
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Welela Tereffe
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Pamela J Schlembach
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Wendy A Woodward
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Thomas A Buchholz
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Benjamin D Smith
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
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13
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Dessources K, Sebastiao APM, Pareja F, Weigelt B, Reis-Filho JS. How Did We Get There? The Progression from Ductal Carcinoma In Situ to Invasive Ductal Carcinoma. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-00318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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GÜZELÖZ Z, ARICAN ALICIKUŞ Z, AKTÜRK N, GÜRAY M, SEVİNÇ Aİ, BALCI P, BİLKAY GÖRKEN İ. Treatment results in patients with ductal carcinoma in situ treated with adjuvant radiotherapy. Turk J Med Sci 2019; 49:1151-1156. [PMID: 31382732 PMCID: PMC7018213 DOI: 10.3906/sag-1810-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background/aim The aim of this study was to evaluate the treatment results of patients undergoing adjuvant radiotherapy (ART) after breast surgery with the diagnosis of ductal carcinoma in situ (DCIS). Materials and methods A total of 61 women who had undergone radiotherapy following extensive surgical excision were enrolled. All patients underwent 50 Gy ART. Survival analysis was performed using Kaplan–Meier analysis and SPSS 20.0. Results The median age was 52 years (range: 28–86). The median follow-up period after RT was 92 months (range: 23–237). The median overall survival and distant and regional recurrence-free and disease-specific survival was 96 months (range: 26–240), while disease-free and local recurrence-free survival was 96 months (range: 22–240). While the 15-year and 20-year overall survival rates were 87% and 87%, respectively, the recurrence-free survival rates were 98% and 98%, respectively; the rates of disease-specific survival were 100% and 100%, respectively. Conclusion The results of this study with a long follow-up period have shown that ART in DCIS is an effective treatment method to provide local disease control. However, further large studies are needed to identify the prognostic factors.
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Affiliation(s)
- Zeliha GÜZELÖZ
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of Radiation Oncology, Tepecik Regional Training and Research Hospital, University of Health Sciences, İzmirTurkey
| | - Zümre ARICAN ALICIKUŞ
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Nesrin AKTÜRK
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Merih GÜRAY
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of Pathology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Ali İbrahim SEVİNÇ
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Pınar BALCI
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - İlknur BİLKAY GÖRKEN
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
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15
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Co-expression network analysis identified candidate biomarkers in association with progression and prognosis of breast cancer. J Cancer Res Clin Oncol 2019; 145:2383-2396. [PMID: 31280346 DOI: 10.1007/s00432-019-02974-4] [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: 04/25/2019] [Accepted: 07/04/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Breast cancer is one of the most common malignancies among females, and its prognosis is affected by a complex network of gene interactions. Weighted gene co-expression network analysis was used to construct free-scale gene co-expression networks and to identify potential biomarkers for breast cancer progression. METHODS The gene expression profiles of GSE42568 were downloaded from the Gene Expression Omnibus database. RNA-sequencing data and clinical information of breast cancer from TCGA were used for validation. RESULTS A total of ten modules were established by the average linkage hierarchical clustering. We identified 58 network hub genes in the significant module (R2 = 0.44) and 6 hub genes (AGO2, CDC20, CDCA5, MCM10, MYBL2, and TTK), which were significantly correlated with prognosis. Receiver-operating characteristic curve validated that the mRNA levels of these six genes exhibited excellent diagnostic efficiency in the test data set of GSE42568. RNA-sequencing data from TCGA showed that the expression levels of these six genes were higher in triple-negative tumors. One-way ANOVA suggested that these six genes were upregulated at more advanced stages. The results of independent sample t test indicated that MCM10 and TTK were associated with tumor size, and that AGO2, CDC20, CDCA5, MCM10, and MYBL2 were overexpressed in lymph-node positive breast cancer. CONCLUSIONS AGO2, CDC20, CDCA5, MCM10, MYBL2, and TTK were identified as candidate biomarkers for further basic and clinical research on breast cancer based on co-expression analysis.
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16
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Tang J, Yang Q, Cui Q, Zhang D, Kong D, Liao X, Ren J, Gong Y, Wu G. Weighted gene correlation network analysis identifies RSAD2, HERC5, and CCL8 as prognostic candidates for breast cancer. J Cell Physiol 2019; 235:394-407. [PMID: 31225658 DOI: 10.1002/jcp.28980] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/29/2019] [Indexed: 01/24/2023]
Abstract
As the most commonly diagnosed malignant tumor in female population, the prognosis of breast cancer is affected by complex gene interaction networks. In this research weighted gene co-expression network analysis (WGCNA) would be utilized to build a gene co-expression network to identify potential biomarkers for prediction the prognosis of patients with breast cancer. We downloaded GSE25065 from Gene Expression Omnibus database as the test set. GSE25055 and GSE42568 were utilized to validate findings in the research. Seven modules were established in the GSE25065 by utilizing average link hierarchical clustering. Three hub genes, RSAD2, HERC5, and CCL8 were screened out from the significant module (R 2 = 0.44), which were considerably interrelated to worse prognosis. Within test dataset GSE25065, RSAD2, and CCL8 were correlated with tumor stage, grade, and lymph node metastases, whereas HERC5 was correlated with lymph node metastases and tumor grade. In the validation dataset GSE25055 and RSAD2 expression was correlated with tumor grade, stage, and size, whereas HERC5 was related to tumor stage and tumor grade, and CCL8 was associated with tumor size and tumor grade. Multivariable survival analysis demonstrated that RSAD2, HERC5, and CCL8 were independent risk factors. In conclusion, the WGCNA analysis conducted in this study screened out novel prognostic biomarkers of breast cancer. Meanwhile, further in vivo and in vitro studies are required to make the clear molecular mechanisms.
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Affiliation(s)
- Jianing Tang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qian Yang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qiuxia Cui
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Dan Zhang
- Department of Thyroid and Breast Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Deguang Kong
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xing Liao
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jiangbo Ren
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yan Gong
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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17
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Tang J, Lu M, Cui Q, Zhang D, Kong D, Liao X, Ren J, Gong Y, Wu G. Overexpression of ASPM, CDC20, and TTK Confer a Poorer Prognosis in Breast Cancer Identified by Gene Co-expression Network Analysis. Front Oncol 2019; 9:310. [PMID: 31106147 PMCID: PMC6492458 DOI: 10.3389/fonc.2019.00310] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/05/2019] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is one of the most common malignancies among females, and its prognosis is affected by a complex network of gene interactions. In this study, we constructed free-scale gene co-expression networks using weighted gene co-expression network analysis (WGCNA). The gene expression profiles of GSE25055 were downloaded from the Gene Expression Omnibus (GEO) database to identify potential biomarkers associated with breast cancer progression. GSE42568 was downloaded for validation. A total of 9 modules were established via the average linkage hierarchical clustering. We identified 3 hub genes (ASPM, CDC20, and TTK) in the significant module (R 2 = 0.52), which were significantly correlated with poor prognosis both in test and validation datasets. In the datasets GSE25055 and GSE42568, higher expression levels of ASPM, CDC20, and TTK correlated with advanced tumor grades. Immunohistochemistry data from the Human Protein Atlas also demonstrated that their protein levels were higher in tumor samples. According to gene set enrichment analysis, 4 commonly enriched pathways were identified: cell cycle pathway, DNA replication pathway, homologous recombination pathway, and P53 signaling pathway. In addition, strong correlations were found among their expression levels. In conclusion, our WGCNA analysis identified candidate prognostic biomarkers for further basic and clinical researches.
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Affiliation(s)
- Jianing Tang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Mengxin Lu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiuxia Cui
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dan Zhang
- Department of Thyroid and Breast Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Deguang Kong
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xing Liao
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiangbo Ren
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yan Gong
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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18
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Qualitative Radiogenomics: Association Between BI-RADS Calcification Descriptors and Recurrence Risk as Assessed by the Oncotype DX Ductal Carcinoma In Situ Score. AJR Am J Roentgenol 2019; 212:919-924. [DOI: 10.2214/ajr.18.20306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Solin LJ. Management of Ductal Carcinoma In Situ (DCIS) of the Breast: Present Approaches and Future Directions. Curr Oncol Rep 2019; 21:33. [PMID: 30834994 DOI: 10.1007/s11912-019-0777-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Ductal carcinoma in situ (DCIS; intraductal carcinoma) of the breast is commonly found in an asymptomatic woman on routine screening mammography. The purpose of this review is to describe current approaches to the management of DCIS as well as areas for future investigation. RECENT FINDINGS Randomized trials have demonstrated that adding radiation treatment after breast conservation surgery (lumpectomy; surgical excision) reduces the rate of ipsilateral local recurrence by about half, and that adding hormonal therapy reduces the rate of all breast cancer events (ipsilateral plus contralateral). Early clinical studies attempted to stratify the risk of recurrence using conventional clinical and pathologic features. More recent clinical studies have attempted to define prospectively patients with lower risk DCIS for whom omission of radiation treatment after lumpectomy is a reasonable option. Molecular profiling is a newer approach to define risk stratification for DCIS. Combining molecular profiling with clinical and pathologic features appears to be more accurate in defining and stratifying the risk of recurrence after lumpectomy. After lumpectomy for DCIS, risk stratification using clinical and pathologic characteristics, and more recently molecular profiling, can help guide clinical decision-making for the use of radiation treatment and hormonal therapy. Ongoing studies are evaluating the possibility of de-escalating therapy, and in some studies, even using core biopsy alone, without surgical excision.
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Affiliation(s)
- Lawrence J Solin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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20
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Early-Stage Breast Cancer Radiotherapy. Breast Cancer 2019. [DOI: 10.1007/978-3-319-96947-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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In Situ Cancer Treatment. Breast Cancer 2019. [DOI: 10.1007/978-3-319-96947-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Ozkaya Akagunduz O, Ergen A, Erpolat P, Gultekin M, Akkus Yildirim B, Parvizi M, Ikiz D, Colpan Oksuz D, Onal C, Yildiz F, Ozsaran Z. Local recurrence outcomes after breast conserving surgery and adjuvant radiotherapy in ductal carcinoma in situ of the breast and a comparison with ECOG E5194 study. Breast 2018; 42:10-14. [DOI: 10.1016/j.breast.2018.08.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 11/24/2022] Open
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23
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Yan Y, Zhang L, Tan L, Ma X, Zhang Y, Shao S, Liu J, Xue C, Li Z, Zhang X, Drokow EK, Shi X, Ren J. Endocrine Therapy for Ductal Carcinoma In Situ (DCIS) of the Breast with Breast Conserving Surgery (BCS) and Radiotherapy (RT): a Meta-Analysis. Pathol Oncol Res 2018; 26:521-531. [DOI: 10.1007/s12253-018-0553-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
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24
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Becherini C, Meattini I, Livi L, Garlatti P, Desideri I, Scotti V, Orzalesi L, Sanchez LJ, Bernini M, Casella D, Nesi S, Nori J, Bianchi S, Pallotta S, Marrazzo L. External accelerated partial breast irradiation for ductal carcinoma in situ: long-term follow-up from a phase 3 randomized trial. TUMORI JOURNAL 2018; 105:205-209. [DOI: 10.1177/0300891618811278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: For a long time, accelerated partial breast irradiation (APBI) effectiveness for ductal carcinoma in situ (DCIS) has been debated, due to conflicting published results. Recent encouraging data from phase 3 trials reopened new perspectives for this radiation approach. The aim of the present study was to analyze the long-term efficacy and safety results of the series of patients with DCIS enrolled in the APBI arm of the APBI-IMRT-Florence phase 3 trial (NCT02104895). Methods: Patients were treated in a phase 3 randomized trial comparing whole breast irradiation (50 Gy in 25 fractions to the whole breast, plus 10 Gy in 5 fractions to the tumor bed) to APBI (30 Gy in 5 nonconsecutive fractions) using the intensity-modulated radiotherapy technique. Results: Overall, 22 patients were treated in the APBI arm. Median age was 62 years (mean 59; range 42–75 years). At a median follow-up of 9.2 years (mean 8.8; range 3.8–12.1 years), no contralateral invasive/DCIS occurrence, distant metastasis, or breast cancer–related death were recorded. The 5- and 10-year local recurrence, distant metastasis–free survival, and breast cancer–specific survival were 100%. The 10-year overall survival rate was 90.9%. No late toxicity at 5 and 10 years was recorded. Conclusions: Waiting for pending studies and mature follow-up, we confirmed the efficacy and safety of APBI for low-risk DCIS.
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Affiliation(s)
- Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Pietro Garlatti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Luis Jose Sanchez
- Breast Surgery Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Marco Bernini
- Breast Surgery Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Donato Casella
- Breast Surgery Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Silvia Nesi
- Breast Surgery Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Stefania Pallotta
- Medical Physics Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Livia Marrazzo
- Medical Physics Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
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Punglia RS, Bifolck K, Golshan M, Lehman C, Collins L, Polyak K, Mittendorf E, Garber J, Hwang SE, Schnitt SJ, Partridge AH, King TA. Epidemiology, Biology, Treatment, and Prevention of Ductal Carcinoma In Situ (DCIS). JNCI Cancer Spectr 2018; 2:pky063. [PMID: 30627695 PMCID: PMC6307658 DOI: 10.1093/jncics/pky063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) is a highly heterogeneous disease. It presents in a variety of ways and may or may not progress to invasive cancer, which poses challenges for both diagnosis and treatment. On May 15, 2017, the Dana-Farber/Harvard Cancer Center hosted a retreat for over 80 breast specialists including medical oncologists, surgical oncologists, radiation oncologists, radiologists, pathologists, physician assistants, nurses, nurse practitioners, researchers, and patient advocates to discuss the state of the science, treatment challenges, and key questions relating to DCIS. Speakers and attendees were encouraged to explore opportunities for future collaboration and research to improve our understanding and clinical management of this disease. Participants were from Dana-Farber Cancer Institute, Brigham and Women's Hospital, Massachusetts General Hospital, Beth Israel Deaconess Medical Center, Duke University Medical Center, and MD Anderson Cancer Center. The discussion focused on three main themes: epidemiology, detection, and pathology; state of the science including the biology of DCIS and potential novel treatment approaches; and risk perceptions, communication, and decision-making. Here we summarize the proceedings from this event.
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Affiliation(s)
| | | | - Mehra Golshan
- Surgical Oncology, Division of Breast Surgery, Department of Surgery
| | - Constance Lehman
- Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Laura Collins
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Elizabeth Mittendorf
- Surgical Oncology, Division of Breast Surgery, Department of Surgery
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Shelley E Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
- Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA
| | | | - Tari A King
- Surgical Oncology, Division of Breast Surgery, Department of Surgery
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26
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O'Sullivan CC, Loprinzi CL, Haddad TC. Updates in the Evaluation and Management of Breast Cancer. Mayo Clin Proc 2018; 93:794-807. [PMID: 29866283 DOI: 10.1016/j.mayocp.2018.03.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/20/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer worldwide. More than 200,000 new cases of invasive breast cancer are diagnosed annually in the United States; approximately 40,000 patients die of the disease. The etiology of most breast cancer cases is unknown, although multiple factors predisposing to the disease have been identified. Apart from increasing age and female sex, these other factors account for only a minority of breast cancer diagnoses. This article provides an overview of the management of noninvasive and invasive breast cancer, which is often complex and varies according to patient factors, disease stage, and breast cancer subtype. Although much progress has been made, continued research endeavors are ongoing; enrollment of eligible patients in prospective clinical trials is an essential way to improve patient outcomes.
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Affiliation(s)
| | | | - Tufia C Haddad
- Division of Medical Oncology, Mayo Clinic, Rochester, MN.
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27
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Abstract
Ductal carcinoma in situ has been stable in incidence for a decade and has an excellent prognosis. Breast conservation therapy is safe and effective for most patients. Adjuvant whole breast radiation therapy is recommended to reduce the risk of local recurrence. Accelerated partial breast irradiation is a promising alternative to decrease toxicity and improve cosmetic results. Adjuvant hormonal therapy can reduce local recurrence, but should be used cautiously. Future directions in management include developing predictive tools for guidance for use of adjuvant therapy and selecting low-risk patients with ductal carcinoma in situ in whom surgery may be safely omitted.
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Affiliation(s)
- FangMeng Fu
- Fujian Medical University Union Hospital, 29 Xinquan Rd, DongJieKou SangQuan, Gulou Qu, Fuzhou Shi, Fujian Sheng 350001, China
| | - Richard C Gilmore
- Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Lisa K Jacobs
- Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
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De Lorenzi F, Di Bella J, Maisonneuve P, Rotmensz N, Corso G, Orecchia R, Colleoni M, Mazzarol G, Rietjens M, Loschi P, Marcelli S, Veronesi P, Galimberti V. Oncoplastic breast surgery for the management of ductal carcinoma in situ (DCIS): is it oncologically safe? A retrospective cohort analysis. Eur J Surg Oncol 2018; 44:957-962. [PMID: 29759643 DOI: 10.1016/j.ejso.2018.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Few data exist in literature regarding oncoplastic surgery (ONC) and ductal carcinoma in situ (DCIS). The role of ONC in the treatment of DCIS has not been elucidated yet: no case-control study has yet been published on the issue and no long-term oncologic results are reported. METHODS Using the European Institute of Oncology (IEO) institutional breast cancer data base we investigated the oncologic safety of ONC for DCIS comparing a consecutive series of 44 patients who have underwent ONC followed by external irradiation for DCIS (Group A-study group) with 375 patients who received conservation alone followed by external irradiation for DCIS (Group B control group) in the same period. We excluded patients presenting with secondary tumors or local relapses and those requiring re-excision or completion mastectomy for positive margins. Primary endpoints were disease-free survival (DFS) and ipsilateral breast tumor recurrence (IBTR) within the study group and comparison with the control group. RESULTS Events rates and death rates were similar in the two groups. The average annual rate of invasive IBTR in group A and B was 1.6% and 1.0% respectively. No difference in the rate of lymphnode metastasis, distant metastasis, contralateral breast cancer, other primary cancer or death was observed across the two groups. CONCLUSIONS Our findings suggest the safety of ONC and irradiation for the management of DCIS extending the indications for conservation in DCIS patients otherwise treated with mastectomy. It provides the best available evidence supporting ONC as a valid treatment option for the management of DCIS.
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Affiliation(s)
- Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
| | - Julien Di Bella
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Nicole Rotmensz
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Giovanni Corso
- Department of Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Roberto Orecchia
- Division of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Marco Colleoni
- Medical Senology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Giovanni Mazzarol
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Mario Rietjens
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Pietro Loschi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Stefano Marcelli
- Department of Plastic and Reconstructive Surgery, IRCCS Policlinico San Donato, piazza Edmondo Malan 1, San Donato Milanese, 20097, Milan, Italy
| | - Paolo Veronesi
- Department of Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Viviana Galimberti
- Department of Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
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Hwang KT, Kim EK, Jung SH, Lee ES, Kim SI, Lee S, Park HK, Kim J, Oh S, Kim YA. Tamoxifen therapy improves overall survival in luminal A subtype of ductal carcinoma in situ: a study based on nationwide Korean Breast Cancer Registry database. Breast Cancer Res Treat 2018; 169:311-322. [DOI: 10.1007/s10549-018-4681-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/18/2018] [Indexed: 11/28/2022]
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30
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Rosso KJ, Weiss A, Thompson AM. Are There Alternative Strategies for the Local Management of Ductal Carcinoma in Situ? Surg Oncol Clin N Am 2018; 27:69-80. [DOI: 10.1016/j.soc.2017.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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31
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Abstract
The nonobligate precursor lesions columnar cell change/hyperplasia and flat epithelial atypia, atypical ductal hyperplasia and atypical lobular hyperplasia, lobular carcinoma in situ, and low-grade ductal carcinoma in situ share morphologic, immunophenotypic, and molecular features supporting the existence of a low-grade breast neoplasia pathway. The practical implication for pathologists is that the identification of one of these lesions should prompt careful search for others. From a clinical management perspective, however, their designation as "precursor lesions" should not be overemphasized, as the risk of progression among the earliest lesions is exceedingly low. Factors determining which lesions will progress remain unknown.
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Affiliation(s)
- Laura C Collins
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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32
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Kanbayashi C, Iwata H. Current approach and future perspective for ductal carcinoma in situ of the breast. Jpn J Clin Oncol 2017; 47:671-677. [PMID: 28486668 PMCID: PMC5896693 DOI: 10.1093/jjco/hyx059] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/25/2017] [Indexed: 11/14/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) has a good prognosis with the current treatment approach, with a 10-year breast cancer-specific survival rate of 97-98%. In ductal carcinoma in situ without micrometastasis, surgery and postoperative adjuvant therapy significantly improve local control, however it has been reported that the selection of the surgical procedure and adjuvant therapy does not influence breast cancer death. On the other hand, owing to widespread mammography screening, the frequency of early breast cancer detection has increased. In early breast cancer, increased incidence of DCIS is remarkable. However, there is not enough reduction of advanced cancer to match it. Problems with overdiagnosis are now being discussed all over the world. It has been reported that surgery for low-grade ductal carcinoma in situ does not contribute to breast cancer-specific survival. However, it is currently impossible to reliably identify a population that does not progress to invasive cancer even without treatment. Recently, a non-surgery clinical trial for low-risk ductal carcinoma in situ was started. There is a possibility of achieving individualized treatment for ductal carcinoma in situ with less treatment intervention, without compromising the good prognosis obtained with the current treatment approach. This review presents an overview of the current treatment approaches, problems with overdiagnosis and potential future management strategies for ductal carcinoma in situ of the breast.
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Affiliation(s)
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Clinical risk score to predict likelihood of recurrence after ductal carcinoma in situ treated with breast-conserving surgery. Breast Cancer Res Treat 2017; 167:751-759. [PMID: 29079937 DOI: 10.1007/s10549-017-4553-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE A majority of women with ductal carcinoma in situ (DCIS) receive breast-conserving surgery (BCS) but then face a risk of ipsilateral breast tumor recurrence (IBTR) which can be either recurrence of DCIS or invasive breast cancer. We developed a score to provide individualized information about IBTR risk to guide treatment decisions. METHODS Data from 2762 patients treated with BCS for DCIS at centers within the National Comprehensive Cancer Network (NCCN) were used to identify statistically significant non-treatment-related predictors for 5-year IBTR. Factors most associated with IBTR were estrogen-receptor status of the DCIS, presence of comedo necrosis, and patient age at diagnosis. These three parameters were used to create a point-based risk score. Discrimination of this score was assessed in a separate DCIS population of 301 women (100 with IBTR and 200 without) from Kaiser Permanente Northern California (KPNC). RESULTS Using NCCN data, the 5-year likelihood of IBTR without adjuvant therapy was 9% (95% CI 5-12%), 23% (95% CI 13-32%), and 51% (95% CI 26-75%) in the low, intermediate, and high-risk groups, respectively. Addition of the risk score to a model including only treatment improved the C-statistic from 0.69 to 0.74 (improvement of 0.05). Cross-validation of the score resulted in a C-statistic of 0.76. The score had a c-statistic of 0.67 using the KPNC data, revealing that it discriminated well. CONCLUSIONS This simple, no-cost risk score may be used by patients and physicians to facilitate preference-based decision-making about DCIS management informed by a more accurate understanding of risks.
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Gangi A, Topham A, Lee MC, Sun W, Laronga C. Genomic Assays in Ductal Carcinoma In Situ: Implications for Management Decisions. South Med J 2017; 110:649-653. [PMID: 28973706 DOI: 10.14423/smj.0000000000000712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Breast cancer is the most common cancer in women and a leading cause of cancer death worldwide. The management of breast cancer depends on clinical and pathologic prognostic factors that help guide patient treatment. Ductal carcinoma in situ (DCIS) is a noninvasive form of breast cancer with an unpredictable risk of either progression to invasive disease or recurrence. To evaluate the utilization of the DCIS score in a large single-institution population and understand reasons for avoidance in eligible patients. METHODS A retrospective chart review of eligible patients with pure DCIS treated by lumpectomy (January 2011-May 2015) was performed. Patients were considered eligible for the assay if they met the Eastern Cooperative Oncology Group E5194 pathology criteria. All of the patients underwent breast-conserving surgery and were estrogen receptor positive. RESULTS Of 182 estrogen receptor-positive patients with DCIS who underwent breast-conserving surgery, 31 (17%) had a DCIS assay performed; however, most of the patients did not have a DCIS score assay performed, yet 47.9% of this cohort would have met the pathologic eligibility criteria. Conversely, 82.5% of the patients having the DCIS score evaluated actually met these criteria. CONCLUSIONS Tumor size, grade, ER status, and calcifications were drivers of patient selection for 12-gene assay use. E5194 eligibility criteria selected for low risk population. Although a large proportion of patients met eligibility criteria, DCIS Score was infrequently considered for recurrence risk estimation. When performed, assay scores supported omission of radiation for over 75% of cases.
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Affiliation(s)
- Alexandra Gangi
- From the Division of Breast Oncology, Department of Surgical Oncology, H. Lee Moffitt Cancer Center and Research Institute, and the University of South Florida Morsani College of Medicine, Tampa Florida
| | - Annie Topham
- From the Division of Breast Oncology, Department of Surgical Oncology, H. Lee Moffitt Cancer Center and Research Institute, and the University of South Florida Morsani College of Medicine, Tampa Florida
| | - M Catherine Lee
- From the Division of Breast Oncology, Department of Surgical Oncology, H. Lee Moffitt Cancer Center and Research Institute, and the University of South Florida Morsani College of Medicine, Tampa Florida
| | - Weihong Sun
- From the Division of Breast Oncology, Department of Surgical Oncology, H. Lee Moffitt Cancer Center and Research Institute, and the University of South Florida Morsani College of Medicine, Tampa Florida
| | - Christine Laronga
- From the Division of Breast Oncology, Department of Surgical Oncology, H. Lee Moffitt Cancer Center and Research Institute, and the University of South Florida Morsani College of Medicine, Tampa Florida
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Wang L, Xia Y, Liu D, Zeng Y, Chang L, Li L, Hou Y, Ge L, Li W, Liu Z. Evaluating the efficacy of post-surgery adjuvant therapies used for ductal carcinoma in situ patients: a network meta-analysis. Oncotarget 2017; 8:79257-79269. [PMID: 29108304 PMCID: PMC5668037 DOI: 10.18632/oncotarget.17366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/16/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Post-surgery adjuvant therapies are very important for patients suffering from ductal carcinoma in situ (DCIS). In this study we conducted a network meta-analysis (NMA) to evaluate the efficacy of different post-surgery adjuvant therapies including tamoxifen, anastrozole and radiation therapy (RT) and their combinations (RT+ tamoxifen and RT+ anastrozole). METHODS We searched several databases, including Embase, MEDLINE / PUBMED, Cochrane Library, and Science Citation Index, for relevant studies. We then extracted the data from eligible studies in order to perform our NMA. We measured the comparative efficacy of each treatment option based on the calculated odds ratios (ORs) and the corresponding 95% credibility interval (95%CrI) for each treatment option. We calculated the surfaces under the cumulative ranking curves (SUCRA) in order to rank the therapies according to their different outcomes. RESULTS In this study, local recurrence (LC) was chosen as the primary outcome. Metastasis, contralateral-breast cancer (CBC), ipsilateral-breast cancer (IBC) and death were secondary outcomes. Patients treated with RT and RT + tamoxifen exhibited a lower risk of LC compared with control group (OR=0.54, 95%CrI: 0.40-0.73; OR=0.41, 95%CrI: 0.19-0.90). Patients treated by RT and RT + tamoxifen also exhibited a significantly lower risk of IBC compared with control group (OR=0.55, 95%CrI: 0.37-0.82; OR=0.42, 95%CrI: 0.18-0.99). Results from the SUCRA indicated that RT + anastrozole and RT + tamoxifen were potentially the best adjuvant treatments for patients with DCIS. CONCLUSIONS In conclusion, the RT + anastrozole and RT + tamoxifen are recommended for their performance and effectiveness.
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Affiliation(s)
- Li Wang
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
- The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Yaoxiong Xia
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
- The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Dequan Liu
- Department of Breast surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
- The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Yueqin Zeng
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Li Chang
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
- The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Lan Li
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
- The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Yu Hou
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
- The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Lv Ge
- The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Wenhui Li
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
- The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Zhijie Liu
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan, China
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Cambra M, Farrús B, Moreno F, Anglada L, Arenas M, Ballester R, Casals J, Cusidó M, García V, Gutiérrez C, Mollà M, Pedro A, Reyes V, Sanz X. Management of breast ductal carcinoma in situ in Catalonia, Spain: Results from the Grup Oncologic Calalà-Occità-Catalonia survey with 9-year follow up. Breast 2017; 35:196-202. [DOI: 10.1016/j.breast.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/31/2017] [Accepted: 08/07/2017] [Indexed: 12/25/2022] Open
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Meattini I, Saieva C, Bastiani P, Martella F, Francolini G, Lo Russo M, Paoletti L, Doria M, Desideri I, Terziani F, De Luca Cardillo C, Bendinelli B, Ciabatti C, Muntoni C, Tinacci G, Nori J, Smith H, Brancato B, Galli L, Sanchez LJ, Casella D, Bernini M, Orzalesi L, Carta GA, Bianchi S, Rossi F, Livi L. Impact of hormonal status on outcome of ductal carcinoma in situ treated with breast-conserving surgery plus radiotherapy: Long-term experience from two large-institutional series. Breast 2017; 33:139-144. [PMID: 28384565 DOI: 10.1016/j.breast.2017.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 03/15/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) is a heterogeneous disease, for which the best adjuvant treatment is still uncertain. Many attempts of risk-groups stratification have been made over time, developing prognostic scores to predict risk of local recurrence (LR) on the basis of features such as age, final surgical margins (FSM) status, grade, and tumor size. The aim of our analysis was to evaluate the patterns of recurrence from a two large-institutional retrospective series. PATIENTS AND METHODS We collected data on 457 patients treated with BCS and adjuvant RT between 1990 and 2012. Final analysis was performed on 278 patients, due to missing data about hormonal status (HS). Patients were treated at the Radiation Oncology Unit of the University of Florence (n = 195), and S. Maria Annunziata Hospital (n = 83) (Florence, Italy). RESULTS At a median follow up time of 10.8 years (range 3-25), we observed 20 LR (7.2%). The 5-year and 10-year LR rates were 4.9% and 10.2%, respectively. At Cox regression univariate analysis, estrogen receptor (ER) positive status (p = 0.001), HS positive (p = 0.003), and FSM <1 mm (p = 0.0001) significantly impacted on LR. At Cox regression multivariate analysis positive ER status maintained a protective role (p = 0.003), and FSM status <1 mm its negative impact (p = 0.0001) on LR rate. CONCLUSIONS Our experience confirmed the wide heterogeneity of DCIS. Inadequate FSM and negative ER status negatively influenced LR rates. Tumor biology should be integrated in adjuvant treatment decision-making process.
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Affiliation(s)
- Icro Meattini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Italy
| | - Paolo Bastiani
- Breast Unit, S. Maria Annunziata Hospital, Florence, Italy
| | | | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Monica Lo Russo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Lisa Paoletti
- Breast Unit, S. Maria Annunziata Hospital, Florence, Italy
| | - Morena Doria
- Breast Unit, S. Maria Annunziata Hospital, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Francesca Terziani
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Carla De Luca Cardillo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Benedetta Bendinelli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Italy
| | - Cinzia Ciabatti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Cristina Muntoni
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | | | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Herd Smith
- Breast Unit, S. Maria Annunziata Hospital, Florence, Italy
| | - Beniamino Brancato
- Struttura Complessa di Senologia Clinica, Cancer Research and Prevention Institute (ISPO), Italy
| | - Lorenzo Galli
- Breast Unit, S. Maria Annunziata Hospital, Florence, Italy
| | - Luis Jose Sanchez
- Department of Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Donato Casella
- Department of Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Marco Bernini
- Department of Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Lorenzo Orzalesi
- Department of Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Giulio Alberto Carta
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | | | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
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Current treatment trends and the need for better predictive tools in the management of ductal carcinoma in situ of the breast. Cancer Treat Rev 2017; 55:163-172. [PMID: 28402908 DOI: 10.1016/j.ctrv.2017.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 12/14/2022]
Abstract
Ductal carcinoma in situ (DCIS) of the breast represents a group of heterogeneous non-invasive lesions the incidence of which has risen dramatically since the advent of mammography screening. In this review we summarise current treatment trends and up-to-date results from clinical trials studying surgery and adjuvant therapy alternatives, including the recent consensus on excision margin width and its role in decision-making for post-excision radiotherapy. The main challenge in the clinical management of DCIS continues to be the tailoring of treatment to individual risk, in order to avoid the over-treatment of low-risk lesions or under-treatment of DCIS with higher risk of recurring or progressing into invasion. While studies estimate that only about 40% of DCIS would become invasive if untreated, heterogeneity and complex natural history have prevented adequate identification of these higher-risk lesions. Here we discuss attempts to develop prognostic tools for the risk stratification of DCIS lesions and their limitations. Early results of a UK-wide audit of DCIS management (the Sloane Project) have also demonstrated a lack of consistency in treatment. In this review we offer up-to-date perspectives on current treatment and prediction of DCIS, highlighting the pressing clinical need for better prognostic indices. Tools integrating both clinical and histopathological factors together with molecular biomarkers may hold potential for adequate stratification of DCIS according to risk. This could help develop standardised practices for optimal management of patients with DCIS, improving clinical outcomes while providing only the amount of therapy required for each individual patient.
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Rastogi P, Wickerham DL, Geyer CE, Mamounas EP, Julian TB, Wolmark N. Milestone clinical trials of the National Surgical Adjuvant Breast and Bowel Project (NSABP). Chin Clin Oncol 2017; 6:7. [PMID: 28285537 DOI: 10.21037/cco.2017.02.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/08/2017] [Indexed: 11/06/2022]
Abstract
The National Surgical Adjuvant Breast and Bowel Project (NSABP) has made significant contributions in reducing the extent of breast surgery and in improving outcomes of patients with early-stage breast cancer through the conduct of large randomized clinical trials evaluating local and systemic therapy. In 2014, the NSABP merged with two other US National Cancer Institute-funded cooperative groups, the Radiation Therapy Oncology Group (RTOG) and the Gynecologic Oncology Group (GOG), to form NRG Oncology. The combined organization has 218 member institutions with more than 600 affiliate centers located throughout the United States, Canada, Puerto Rico, and other international sites. Over the past half century, the NSABP has entered more than 150,000 women into clinical trials of breast cancer treatment and breast cancer prevention. Many of these trials have been instrumental in establishing new standards of care for patients with breast cancer.
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Affiliation(s)
- Priya Rastogi
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; University of Pittsburgh Cancer Institute School of Medicine, Pittsburgh, PA, USA.
| | - D Lawrence Wickerham
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Charles E Geyer
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Virginia Commonwealth University, Massey Cancer Center, Richmond, VA, USA
| | - Eleftherios P Mamounas
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; UF Health Cancer Center at Orland Health, Orlando, FL, USA
| | - Thomas B Julian
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Norman Wolmark
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
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40
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Management of Intraepithelial Disease. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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41
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Mele A, Mehta P, Slanetz PJ, Brook A, Recht A, Sharma R. Breast-Conserving Surgery Alone for Ductal Carcinoma In Situ: Factors Associated with Increased Risk of Local Recurrence. Ann Surg Oncol 2016; 24:1221-1226. [DOI: 10.1245/s10434-016-5711-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Indexed: 11/18/2022]
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Mathew J, Karia R, Morgan DAL, Lee AHS, Ellis IO, Robertson JFR, Bello AM. Factors influencing local control in patients undergoing breast conservation surgery for ductal carcinoma in situ. Breast 2016; 31:181-185. [PMID: 27871025 DOI: 10.1016/j.breast.2016.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/09/2016] [Accepted: 11/03/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of our study was to assess various predictors for local recurrence (LR) in patients undergoing breast conservation surgery (BCS) for ductal carcinoma in situ (DCIS). MATERIALS AND METHODS An audit was performed of 582 consecutive patients with DCIS between Jan 1975 to June 2008. In patients undergoing BCS, local guidelines reported a margin of ≥10 mm during the above period. Guideline with regard to margin of excision changes soon after this period. We retrospectively analysed clinical and pathological risk factors for local recurrence in patients undergoing BCS. Statistical analysis was carried out using SPSS version 19, and a cox regression model for multivariate analysis of local recurrence was used. RESULTS Overall 239 women had BCS for DCIS during the above period. The actuarial 5-year recurrence rate was 9.6%. The overall LR rate was 17% (40/239. LR was more common in patients ≤50 years: (10/31 patients, 32%) compared to patients > 50 years (30/208, 14%, P = 0.02). Forty three per cent of patients (6/14) with <5 mm margin developed LR which was significantly higher compared to patients with 5-9 mm margin (12%, 3/25) and with ≥10 mm margin (14%, 27/188, P = 0.01). On multivariate analysis age ≤50 years, <5 mm pathological margin were independent prognostic factors for local recurrence. CONCLUSION Our study shows that younger age (≤50 years) and a margin < 5 mm are poor prognostic factors for LR in patients undergoing breast conservation surgery for DCIS.
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Affiliation(s)
- J Mathew
- Division of Breast Surgery, University of Nottingham, UK.
| | - R Karia
- Division of Breast Surgery, University of Nottingham, UK
| | - D A L Morgan
- Department of Radiation Oncology, Nottingham University Hospitals, Nottingham, UK
| | - A H S Lee
- Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - I O Ellis
- Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | | | - A M Bello
- Division of Breast Surgery, University of Nottingham, UK
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Marinovich ML, Azizi L, Macaskill P, Irwig L, Morrow M, Solin LJ, Houssami N. The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis. Ann Surg Oncol 2016; 23:3811-3821. [PMID: 27527715 PMCID: PMC5160992 DOI: 10.1245/s10434-016-5446-2] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE There is no consensus on adequate negative margins in breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS). We systematically reviewed the evidence on margins in BCS for DCIS. METHODS A study-level meta-analysis of local recurrence (LR), microscopic margin status and threshold distance for negative margins. LR proportion was modeled using random-effects logistic meta-regression (frequentist) and network meta-analysis (Bayesian) that allows for multiple margin distances per study, adjusting for follow-up time. RESULTS Based on 20 studies (LR: 865 of 7883), odds of LR were associated with margin status [logistic: odds ratio (OR) 0.53 for negative vs. positive/close (p < 0.001); network: OR 0.45 for negative vs. positive]. In logistic meta-regression, relative to >0 or 1 mm, ORs for 2 mm (0.51), 3 or 5 mm (0.42) and 10 mm (0.60) showed comparable significant reductions in the odds of LR. In the network analysis, ORs relative to positive margins for 2 (0.32), 3 (0.30) and 10 mm (0.32) showed similar reductions in the odds of LR that were greater than for >0 or 1 mm (0.45). There was weak evidence of lower odds at 2 mm compared with >0 or 1 mm [relative OR (ROR) 0.72, 95 % credible interval (CrI) 0.47-1.08], and no evidence of a difference between 2 and 10 mm (ROR 0.99, 95 % CrI 0.61-1.64). Adjustment for covariates, and analyses based only on studies using whole-breast radiotherapy, did not change the findings. CONCLUSION Negative margins in BCS for DCIS reduce the odds of LR; however, minimum margin distances above 2 mm are not significantly associated with further reduced odds of LR in women receiving radiation.
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Affiliation(s)
- M Luke Marinovich
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - Lamiae Azizi
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Petra Macaskill
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Les Irwig
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Monica Morrow
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Lawrence J Solin
- Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, PA, USA
| | - Nehmat Houssami
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Campbell MJ, Baehner F, O'Meara T, Ojukwu E, Han B, Mukhtar R, Tandon V, Endicott M, Zhu Z, Wong J, Krings G, Au A, Gray JW, Esserman L. Characterizing the immune microenvironment in high-risk ductal carcinoma in situ of the breast. Breast Cancer Res Treat 2016; 161:17-28. [PMID: 27785654 DOI: 10.1007/s10549-016-4036-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/21/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE The recent increase in the incidence of ductal carcinoma in situ (DCIS) has sparked debate over the classification and treatment of this disease. Although DCIS is considered a precursor lesion to invasive breast cancer, some DCIS may have more or less risk than is realized. In this study, we characterized the immune microenvironment in DCIS to determine if immune infiltrates are predictive of recurrence. METHODS Fifty-two cases of high-grade DCIS (HG-DCIS), enriched for large lesions and a history of recurrence, were age matched with 65 cases of non-high-grade DCIS (nHG-DCIS). Immune infiltrates were characterized by single- or dual-color staining of FFPE sections for the following antigens: CD4, CD8, CD20, FoxP3, CD68, CD115, Mac387, MRC1, HLA-DR, and PCNA. Nuance multispectral imaging software was used for image acquisition. Protocols for automated image analysis were developed using CellProfiler. Immune cell populations associated with risk of recurrence were identified using classification and regression tree analysis. RESULTS HG-DCIS had significantly higher percentages of FoxP3+ cells, CD68+ and CD68+PCNA+ macrophages, HLA-DR+ cells, CD4+ T cells, CD20+ B cells, and total tumor infiltrating lymphocytes compared to nHG-DCIS. A classification tree, generated from 16 immune cell populations and 8 clinical parameters, identified three immune cell populations associated with risk of recurrence: CD8+HLADR+ T cells, CD8+HLADR- T cells, and CD115+ cells. CONCLUSION These findings suggest that the tumor immune microenvironment is an important factor in identifying DCIS cases with the highest risk for recurrence and that manipulating the immune microenvironment may be an efficacious strategy to alter or prevent disease progression.
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MESH Headings
- Adult
- Aged
- Biomarkers
- Breast Neoplasms/immunology
- Breast Neoplasms/metabolism
- Breast Neoplasms/mortality
- Breast Neoplasms/therapy
- Carcinoma, Intraductal, Noninfiltrating/immunology
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Intraductal, Noninfiltrating/mortality
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Combined Modality Therapy
- Female
- Humans
- Lymphocyte Count
- Lymphocyte Subsets/immunology
- Lymphocyte Subsets/metabolism
- Lymphocyte Subsets/pathology
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Lymphocytes, Tumor-Infiltrating/pathology
- Macrophages/immunology
- Macrophages/metabolism
- Macrophages/pathology
- Middle Aged
- Neoplasm Grading
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Patient Outcome Assessment
- Prognosis
- Tumor Burden
- Tumor Microenvironment/immunology
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Affiliation(s)
- Michael J Campbell
- Department of Surgery, University of California, 2340 Sutter St, N321, San Francisco, CA, 94115, USA.
| | - Frederick Baehner
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Tess O'Meara
- Mt Zion Carol Franc Buck Breast Care Center, University of California, San Francisco, CA, USA
| | - Ekene Ojukwu
- Mt Zion Carol Franc Buck Breast Care Center, University of California, San Francisco, CA, USA
| | - Booyeon Han
- Mt Zion Carol Franc Buck Breast Care Center, University of California, San Francisco, CA, USA
| | - Rita Mukhtar
- Department of Surgery, University of California, 2340 Sutter St, N321, San Francisco, CA, 94115, USA
| | - Vickram Tandon
- Mt Zion Carol Franc Buck Breast Care Center, University of California, San Francisco, CA, USA
| | - Max Endicott
- Mt Zion Carol Franc Buck Breast Care Center, University of California, San Francisco, CA, USA
| | - Zelos Zhu
- Mt Zion Carol Franc Buck Breast Care Center, University of California, San Francisco, CA, USA
| | - Jasmine Wong
- Department of Surgery, University of California, 2340 Sutter St, N321, San Francisco, CA, 94115, USA
| | - Gregor Krings
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Alfred Au
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Joe W Gray
- Oregon Health and Science University, Portland, OR, USA
| | - Laura Esserman
- Department of Surgery, University of California, 2340 Sutter St, N321, San Francisco, CA, 94115, USA
- Mt Zion Carol Franc Buck Breast Care Center, University of California, San Francisco, CA, USA
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45
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Kinsey-Trotman S, Shi Z, Fosh B. Breast Ductal Carcinoma In Situ: A Literature Review of Adjuvant Hormonal Therapy. Oncol Rev 2016; 10:304. [PMID: 28058096 PMCID: PMC5178844 DOI: 10.4081/oncol.2016.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/02/2016] [Indexed: 11/23/2022] Open
Abstract
This review paper analyzed publications of adjuvant tamoxifen and aromatase inhibitor use following surgery for breast ductal carcinoma in situ (DCIS). Key endpoint analyses were risk of invasive and noninvasive malignancies and new contralateral breast cancers. Metaanalysis of three studies showed a relative risk of 0.69 (95% confidence interval, 0.60-0.79, P<0.05) for breast malignancies with tamoxifen treatment in a mixed radiotherapy treatment/naïve cohort. Subgroup analysis of DCIS populations in multiple studies showed a trend to benefit with aromatase inhibitor treatment.
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Affiliation(s)
| | - Zumin Shi
- The University of Adelaide , Adelaide, Australia
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46
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Manders JB, Kuerer HM, Smith BD, McCluskey C, Farrar WB, Frazier TG, Li L, Leonard CE, Carter DL, Chawla S, Medeiros LE, Guenther JM, Castellini LE, Buchholz DJ, Mamounas EP, Wapnir IL, Horst KC, Chagpar A, Evans SB, Riker AI, Vali FS, Solin LJ, Jablon L, Recht A, Sharma R, Lu R, Sing AP, Hwang ES, White J. Clinical Utility of the 12-Gene DCIS Score Assay: Impact on Radiotherapy Recommendations for Patients with Ductal Carcinoma In Situ. Ann Surg Oncol 2016; 24:660-668. [PMID: 27704370 PMCID: PMC5306072 DOI: 10.1245/s10434-016-5583-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Indexed: 12/02/2022]
Abstract
Objective The aim of this study was to determine the impact of the results of the 12-gene DCIS Score assay on (i) radiotherapy recommendations for patients with pure ductal carcinoma in situ (DCIS) following breast-conserving surgery (BCS), and (ii) patient decisional conflict and state anxiety. Methods Thirteen sites across the US enrolled patients (March 2014–August 2015) with pure DCIS undergoing BCS. Prospectively collected data included clinicopathologic factors, physician estimates of local recurrence risk, DCIS Score results, and pre-/post-assay radiotherapy recommendations for each patient made by a surgeon and a radiation oncologist. Patients completed pre-/post-assay decisional conflict scale and state-trait anxiety inventory instruments. Results The analysis cohort included 127 patients: median age 60 years, 80 % postmenopausal, median size 8 mm (39 % ≤5 mm), 70 % grade 1/2, 88 % estrogen receptor-positive, 75 % progesterone receptor-positive, 54 % with comedo necrosis, and 18 % multifocal. Sixty-six percent of patients had low DCIS Score results, 20 % had intermediate DCIS Score results, and 14 % had high DCIS Score results; the median result was 21 (range 0–84). Pre-assay, surgeons and radiation oncologists recommended radiotherapy for 70.9 and 72.4 % of patients, respectively. Post-assay, 26.4 % of overall recommendations changed, including 30.7 and 22.0 % of recommendations by surgeons and radiation oncologists, respectively. Among patients with confirmed completed questionnaires (n = 32), decision conflict (p = 0.004) and state anxiety (p = 0.042) decreased significantly from pre- to post-assay. Conclusions Individualized risk estimates from the DCIS Score assay provide valuable information to physicians and patients. Post-assay, in response to DCIS Score results, surgeons changed treatment recommendations more often than radiation oncologists. Further investigation is needed to better understand how such treatment changes may affect clinical outcomes. Electronic supplementary material The online version of this article (doi:10.1245/s10434-016-5583-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Henry M Kuerer
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | - Linna Li
- Bryn Mawr Hospital, Bryn Mawr, PA, USA
| | | | | | - Sheema Chawla
- Rochester Regional Health System, Rochester, NY, USA
| | | | | | | | | | | | - Irene L Wapnir
- Stanford Cancer Institute, Stanford University, Palo Alto, CA, USA
| | - Kathleen C Horst
- Stanford Cancer Institute, Stanford University, Palo Alto, CA, USA
| | | | | | - Adam I Riker
- Advocate Christ Medical Center, Oak Lawn, IL, USA.,Louisiana State University Health New Orleans, New Orleans, LA, USA
| | | | | | - Lisa Jablon
- Albert Einstein Healthcare Network, Philadelphia, PA, USA
| | - Abram Recht
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ranjna Sharma
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ruixiao Lu
- Genomic Health, Inc., Redwood City, CA, USA
| | - Amy P Sing
- Genomic Health, Inc., Redwood City, CA, USA
| | | | - Julia White
- Ohio State University James Cancer Hospital, Columbus, OH, USA
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47
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Raldow AC, Sher D, Chen AB, Recht A, Punglia RS. Cost Effectiveness of the Oncotype DX DCIS Score for Guiding Treatment of Patients With Ductal Carcinoma In Situ. J Clin Oncol 2016; 34:3963-3968. [PMID: 27621393 DOI: 10.1200/jco.2016.67.8532] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose The Oncotype DX DCIS Score short form (DCIS Score) estimates the risk of an ipsilateral breast event (IBE) in patients with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery without adjuvant radiation therapy (RT). We determined the cost effectiveness of strategies using this test. Materials and Methods We developed a Markov model simulating 10-year outcomes for 60-year-old women eligible for the Eastern Cooperative Oncology Group E5194 study (cohort 1: low/intermediate-grade DCIS, ≤ 2.5 cm; cohort 2: high-grade DCIS, ≤ 1 cm) with each of five strategies: (1) no testing, no RT; (2) no testing, RT only for cohort 2; (3) no RT for low-grade DCIS, test for intermediate- and high-grade DCIS, RT for intermediate- or high-risk scores; (4) test all, RT for intermediate- or high-risk scores; and (5) no testing, RT for all. We used utilities and costs extracted from the literature and Medicare claims to determine incremental cost-effectiveness ratios and examined the number of women needed to irradiate per IBE prevented. Results No strategy using the DCIS Score was cost effective. The most cost-effective strategy (RT for none or RT for all) was sensitive to small differences between the utilities of receiving or not receiving RT and remaining without recurrence. The numbers needed to irradiate per IBE prevented were 10.5, 9.1, 7.5, and 13.1 for strategies 2 to 5, respectively, relative to strategy 1. Conclusion Strategies using the DCIS Score lowered the proportion of women undergoing RT per IBE prevented. However, no strategy incorporating the DCIS Score was cost effective. The cost effectiveness of RT was exquisitely utility sensitive, highlighting the importance of engaging patient preferences in this decision. Physicians should discuss trade-offs associated with omitting or adding adjuvant RT with each patient to maximize quality-of-life outcomes.
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Affiliation(s)
- Ann C Raldow
- Ann C. Raldow, David Geffen School of Medicine at UCLA, Los Angeles, CA; Aileen B. Chen and Rinaa S. Punglia, Brigham and Women's Hospital/Dana-Farber Cancer Institute; and Abram Recht, Beth Israel Deaconess Medical Center, Boston, MA; and David Sher, University of Texas Southwestern Medical Center, Dallas, TX
| | - David Sher
- Ann C. Raldow, David Geffen School of Medicine at UCLA, Los Angeles, CA; Aileen B. Chen and Rinaa S. Punglia, Brigham and Women's Hospital/Dana-Farber Cancer Institute; and Abram Recht, Beth Israel Deaconess Medical Center, Boston, MA; and David Sher, University of Texas Southwestern Medical Center, Dallas, TX
| | - Aileen B Chen
- Ann C. Raldow, David Geffen School of Medicine at UCLA, Los Angeles, CA; Aileen B. Chen and Rinaa S. Punglia, Brigham and Women's Hospital/Dana-Farber Cancer Institute; and Abram Recht, Beth Israel Deaconess Medical Center, Boston, MA; and David Sher, University of Texas Southwestern Medical Center, Dallas, TX
| | - Abram Recht
- Ann C. Raldow, David Geffen School of Medicine at UCLA, Los Angeles, CA; Aileen B. Chen and Rinaa S. Punglia, Brigham and Women's Hospital/Dana-Farber Cancer Institute; and Abram Recht, Beth Israel Deaconess Medical Center, Boston, MA; and David Sher, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rinaa S Punglia
- Ann C. Raldow, David Geffen School of Medicine at UCLA, Los Angeles, CA; Aileen B. Chen and Rinaa S. Punglia, Brigham and Women's Hospital/Dana-Farber Cancer Institute; and Abram Recht, Beth Israel Deaconess Medical Center, Boston, MA; and David Sher, University of Texas Southwestern Medical Center, Dallas, TX
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48
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Abstract
The introduction of mammographic screening has considerably increased the detection rate of ductal carcinoma in situ (DCIS), which has a high probability of recurrence. We carried out a meta-analysis to evaluate the predictive factors including biomarkers, tumor characteristics, and modes of detection on the risk of local invasive recurrence (LIR) following DCIS. Searches were performed in PubMed and EMBASE up to 8 July 2014. Risk estimates (hazard ratios, odds ratios, and relative risks) and their 95% confidence intervals (CIs) were extracted to calculate the strength of the associations between predictive factors and the risk of LIR after treatment of DCIS. STATA 12.0 was used to combine results in this meta-analysis. A total of 18 articles were included in the analysis. Pooled risk estimates and 95% CIs were 1.36 (1.04-1.69) for the positive margin, 1.38 (1.12-1.63) for the nonscreening detection method, 1.04 (0.84-1.24) for high nuclear grade 1, 1.32 (0.98-1.66) for intermediate nuclear grade 2, 1.18 (0.98-1.37) for comedonecrosis, 1.00 (0.92-1.08) for large tumor size, 1.34 (0.82-1.87) for multifocality, 0.74 (0.36-1.12) for estrogen receptor-positive tumors, 0.89 (0.47-1.31) for progesterone receptor-positive tumors, and 1.25 (0.7-1.81) for HER2/neu-positive tumors. Positive margin and non-screening-detected cancers were associated with a higher risk of LIR following DCIS. These predictive factors, after further validation, could be considered to tailor treatment for individual patients.
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Šestak I, Cuzick J. Endometrial cancer risk in postmenopausal breast cancer patients treated with tamoxifen or aromatase inhibitors. Expert Rev Endocrinol Metab 2016; 11:425-432. [PMID: 30058908 DOI: 10.1080/17446651.2016.1216101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The gynaecological toxicity profile of tamoxifen presents a significant burden to the patients and oncologist as tamoxifen-related side effects result in additional investigations, procedures and referrals. Aromatase inhibitor have been shown to result in significant reduction in gynaecological problems, possibly including endometrial cancer. Areas covered: We reviewed the main breast cancer trials, observation or cohort studies investigating tamoxifen or an aromatase inhibitor to report on endometrial adverse events and cancer. Expert commentary: Evidence for an increase in endometrial cancers with tamoxifen in breast cancer treated patients is now very clear. Aromatase inhibitors have shown to have a beneficial effect on the endometrium. There is an important need for further studies to clearly determine the influence of aromatase inhibitors on the endometrial in tamoxifen-naïve women. The effect of aromatase inhibitors on gynaecological problems may have potentially a very important impact in clinical practice.
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Affiliation(s)
- Ivana Šestak
- a Centre for Cancer Pevention , Queen Mary University of London , London , United Kingdom of Great Britain and Northern Ireland
| | - Jack Cuzick
- a Centre for Cancer Pevention , Queen Mary University of London , London , United Kingdom of Great Britain and Northern Ireland
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50
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onlineDeCISion.org: a web-based decision aid for DCIS treatment. Breast Cancer Res Treat 2016; 154:181-90. [PMID: 26475704 DOI: 10.1007/s10549-015-3605-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Abstract
Women diagnosed with DCIS face complex treatment decisions and often do so with inaccurate and incomplete understanding of the risks and benefits involved. Our objective was to create a tool to guide these decisions for both providers and patients. We developed a web-based decision aid designed to provide clinicians with tailored information about a patient’s recurrence risks and survival outcomes following different treatment strategies for DCIS. A theoretical framework, microsimulation model (Soeteman et al., J Natl Cancer 105:774–781, 2013) and best practices for web-based decision tools guided the development of the decision aid. The development process used semi-structured interviews and usability testing with key stakeholders, including a diverse group of multidisciplinary clinicians and a patient advocate. We developed onlineDeCISion.org to include the following features that were rated as important by the stakeholders: (1) descriptions of each of the standard treatment options available; (2) visual projections of the likelihood of time-specific (10-year and lifetime) breast-preservation, recurrence, and survival outcomes; and (3) side-by-side comparisons of down-stream effects of each treatment choice. All clinicians reviewing the decision aid in usability testing were interested in using it in their clinical practice. The decision aid is available in a web-based format and is planned to be publicly available. To improve treatment decision making in patients with DCIS, we have developed a web-based decision aid onlineDeCISion.org that conforms to best practices and that clinicians are interested in using in their clinics with patients to better inform treatment decisions.
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