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Fefferman A, Beaulieu-Jones BR, Shewmaker G, Zhang T, Sachs T, Merrill A, Ko NY, Cassidy MR. Association of Race, Ethnicity, Insurance, and Language and Rate of Breast-Conserving Therapy Among Women With Nonmetastatic Breast Cancer at an Urban, Safety-Net Hospital. J Surg Res 2023; 291:403-413. [PMID: 37517348 DOI: 10.1016/j.jss.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/20/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Breast-conserving therapy (BCT), specifically breast-conserving surgery (BCS) and adjuvant radiation, provides an equivalent alternative to mastectomy for eligible patients. However, previous studies have shown that BCT is underused in the United States, particularly among marginalized demographic groups. In this study, we examine the association between race, ethnicity, insurance, and language and rate of BCS among patients treated at an academic, safety-net hospital. MATERIALS AND METHODS We conducted a retrospective cohort study of 520 women with nonmetastatic breast cancer diagnosed and treated at an academic, safety-net hospital (2009-2014). We assessed eligibility for BCT and then differences in the rate of BCT among eligible patients by race, ethnicity, insurance, and language. Reasons for not undergoing BCT were documented. RESULTS Median age was 60 y; 55.9% were non-White, 31.9% were non-English-speaking, 15.6% were Hispanic, and 47.4% were Medicaid/uninsured. Three hundred seventy one (86.3%) underwent BCS; within this group, 324 (87.3%) completed adjuvant radiation. Among patients undergoing mastectomy, 30 patients (36.7%) were eligible for BCT; within this group, reasons for mastectomy included patient preference (n = 28) and to avoid possible re-excision or adjuvant radiation in patients with significant comorbidities (n = 2). Eligibility for BCT varied by ethnicity (Hispanic [100%], Non-Hispanic [92%], P = 0.02), but not race, language, or insurance. Among eligible patients, rate of BCS varied by age (<50 y [84.9%], ≥50 y [92.9%], P = 0.01) and ethnicity (Hispanic [98.5%], Non-Hispanic [91.3%], P = 0.04), but not race, language, or insurance. CONCLUSIONS At our safety-net hospital, the rate of BCS among eligible patients did not vary by race, language, or insurance. Excluding two highly comorbid patients, all patients who underwent mastectomy despite being eligible for BCT were counseled regarding BCS and expressed a preference for mastectomy. Further research is needed to understand the value of BCT in the treatment of breast cancer, to ensure informed decision-making, address potential misconceptions regarding BCT, and advance equitable care for all patients.
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Affiliation(s)
- Ann Fefferman
- Boston University School of Medicine, Boston, Massachusetts
| | - Brendin R Beaulieu-Jones
- Boston University School of Medicine, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | | | - Tina Zhang
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Teviah Sachs
- Boston University School of Medicine, Boston, Massachusetts; Section of Surgical Oncology, Boston Medical Center, Boston University, Boston, Massachusetts
| | - Andrea Merrill
- Boston University School of Medicine, Boston, Massachusetts; Section of Hematology & Oncology, Boston Medical Center, Boston University, Boston, Massachusetts
| | - Naomi Y Ko
- Boston University School of Medicine, Boston, Massachusetts; Section of Hematology & Oncology, Boston Medical Center, Boston University, Boston, Massachusetts
| | - Michael R Cassidy
- Boston University School of Medicine, Boston, Massachusetts; Section of Surgical Oncology, Boston Medical Center, Boston University, Boston, Massachusetts.
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Salvador Bofill J, Moreno Anton F, Rodriguez Sanchez CA, Galve Calvo E, Hernando Melia C, Ciruelos Gil EM, Vidal M, Jiménez-Rodriguez B, De la Cruz Merino L, Martínez Jañez N, Villanueva Vazquez R, de Toro Salas R, Anton Torres A, Alvarez Lopez IM, Gavila Gregori J, Quiroga Garcia V, Vicente Rubio E, De la Haba-Rodriguez J, Gonzalez-Santiago S, Diaz Fernandez N, Barnadas Molins A, Cantos Sanchez de Ibargüen B, Delgado Mingorance JI, Bellet Ezquerra M, de Casa S, Gimeno A, Martin M. Safety and efficacy of ribociclib plus letrozole in patients with HR+, HER2- advanced breast cancer: Results from the Spanish sub-population of the phase 3b CompLEEment-1 trial. Breast 2022; 66:77-84. [PMID: 36206609 PMCID: PMC9535465 DOI: 10.1016/j.breast.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/20/2022] [Accepted: 09/24/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Breast cancer is the most common malignancy and the second leading cause of cancer-related mortality in Spanish women. Ribociclib in combination with endocrine therapy (ET) has shown superiority in prolonging survival in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC) vs. ET alone. METHODS CompLEEment-1 is a single-arm, open-label phase 3b trial evaluating ribociclib plus letrozole in a broad population of patients with HR+, HER2- ABC. The primary endpoints were safety and tolerability. Here we report data for Spanish patients enrolled in CompLEEment-1. RESULTS A total of 526 patients were evaluated (median follow-up: 26.97 months). Baseline characteristics showed a diverse population with a median age of 54 years. At study entry, 56.5% of patients had visceral metastases and 8.7% had received prior chemotherapy for advanced disease. Rates of all-grade and Grade ≥3 adverse events (AEs) were 99.0% and 76.2%, respectively; 21.3% of patients experienced a serious AE, and 15.8% of AEs led to treatment discontinuation. AEs of special interest of neutropenia, increased alanine aminotransferase, increased aspartate aminotransferase and QTcF prolongation occurred in 77.8%, 14.8%, 11.4% and 4.0% of patients, respectively. Patients aged >70 years experienced increased rates of all-grade and Grade ≥3 neutropenia and anemia. Efficacy results were consistent with the global study. CONCLUSIONS Results from Spanish patients enrolled in CompLEEment-1 are consistent with global data showing efficacy and a manageable safety profile for ribociclib plus letrozole treatment in patients with HR+, HER2- ABC, including populations of interest (NCT02941926). TRIAL REGISTRATION ClinicalTrials.gov NCT02941926.
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Affiliation(s)
- Javier Salvador Bofill
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,Corresponding author. Unidad de Oncología, Servicio de Oncología, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013 Sevilla, Spain.
| | | | | | | | - Cristina Hernando Melia
- Servicio de Oncología, Hospital Clínico Universitario de Valencia e Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | | | - Maria Vidal
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Vanesa Quiroga Garcia
- Departamento de Oncología, Badalona-Applied Research Group in Oncology (B-ARGO Group), Institut Català d’Oncologia, Badalona, Spain
| | | | - Juan De la Haba-Rodriguez
- Instituto Maimonides de Investigacion Biomedica (IMIBIC), Hospital Reina Sofía, Universidad de Córdoba, Spain
| | | | | | - Agusti Barnadas Molins
- Hospital Universitari Santa Creu i Sant Pau and CIBERONC Breast Cancer Programme, Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | | | | | - Meritxell Bellet Ezquerra
- Hospital Universitari Vall d’Hebron, Barcelona and Institut Oncològic Vall d’Hebron (VHIO), Barcelona, Spain
| | | | | | - Miguel Martin
- Hospital Universitario Gregorio Marañón, Madrid, Spain
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3
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Chen LJ, Chang YJ, Chang YJ. Treatment and long-term outcome of breast cancer in very young women: nationwide population-based study. BJS Open 2021; 5:6406857. [PMID: 34672342 PMCID: PMC8529521 DOI: 10.1093/bjsopen/zrab087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/03/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The study aimed to assess the correlation between long-term survival and treatment in very young women with breast cancer. METHODS Data on women with breast cancer were retrieved from the Taiwan Cancer Registry between 2004 and 2014. Patients who did not undergo surgery or who had stage 0 or IV disease were excluded. Survival analysis was conducted. The participants were divided into very young (20-29.9 years), young (30-39.9 years), and adult (40-50.0 years) groups. RESULTS Among 104 115 women, 24 474 (572 very young, 5565 young, and 18 337 adult) were eligible for the study. Median follow-up was 79.5 (range 24-158) months. The mortality rates in the very young, young, and adult groups were 12.9, 10.0, and 8.2 per cent respectively (P < 0.001). Very young patients had higher histological grade, unfavourable subtype, higher TNM stage, and received more breast-conserving surgery (BCS). Kaplan-Meier survival analysis showed that very young patients had the poorest long-term survival. Very young patients with stage II disease had the worst prognosis. In the multivariable regression model, radiotherapy was associated with decreased local recurrence but not with improved overall, cancer-specific, or disease-free survival for stage II disease in the very young group. Surgery type and chemotherapy were not associated with significant improvement in overall survival. CONCLUSION Very young patients with stage II disease had poor long-term outcomes. BCS had no detrimental effects on long-term outcomes.
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Affiliation(s)
- L-J Chen
- Department of Surgery, HepingFuyou Branch, Taipei City Hospital, Taipei, Taiwan.,Department of Surgery, University of Taipei, Taipei, Taiwan
| | - Y-J Chang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.,Department of Surgery, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Y-J Chang
- Department of Surgery, Taipei Tzu Chi Hospital, New Taipei City, Taiwan.,Department of Surgery, School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
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Impact of Time to Initiation of Treatment on the Quality of Life of Women with Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228325. [PMID: 33187071 PMCID: PMC7696805 DOI: 10.3390/ijerph17228325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022]
Abstract
Introduction: Breast cancer is the most common malignancy in women. Due to the large number of women living with breast cancer and the increasing incidence of this cancer, it is very important to understand the factors determining the quality of life (QOL) of patients. The aim of the study. The aim of the study was to determine the impact of time to initiation of treatment on the quality of life of women with breast cancer. Materials and methods. The study involved 324 women with breast cancer, treated at the Podkarpackie Oncology Centre in Brzozów, Poland. The study was conducted using a diagnostic survey, using a standardised questionnaire to measure the quality of life of women treated for breast cancer, i.e., the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) QLQ-C30 and the QLQ-BR23 module, as well as a proprietary survey questionnaire. Statistical analysis was performed using the Statistica 10.0 software (StatSoft Inc., 2011). A p value of <0.05 was considered statistically significant. Results: The examined women had a reduced overall quality of life and health (M = 53.88). The quality of life was higher in women who consulted a doctor the earliest after noticing initial symptoms of the disease, i.e., up to one week (M = 57.58), compared to patients who delayed the decision (over four weeks; M = 47.8) (p = 0.002). The quality of life was also considered higher by women who received treatment within two weeks of diagnosis (M = 56.79) and was lower for patients who waited for treatment for more than two months (M = 43.68). Statistically significant relationships were demonstrated for functional scales and disease intensity. Conclusions: Women diagnosed with breast cancer had a considerably lower overall quality of life. A relatively higher quality of life was experienced by patients who consulted a doctor the earliest after discovering symptoms of the disease and those whose waiting time for treatment was shorter. In a systematic manner, the individual stages of diagnosis should be maximally reduced and breast cancer treatment initiated without delay.
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Müller C, Juhasz-Böss S, Schmidt G, Solomayer EF, Juhasz-Böss I, Breitbach GP. Factors Influencing the Onset of Neoadjuvant Therapy in Breast Cancer Patients. Breast Care (Basel) 2020; 15:182-187. [PMID: 32398988 PMCID: PMC7204773 DOI: 10.1159/000502223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Time to treatment onset (TTTO) is critical in breast cancer patients receiving neoadjuvant chemotherapy (NACT). We therefore investigated possible delaying factors of therapy onset. METHODS All patients were included who qualified for NACT in our hospital from 2015 to 2017. The time interval between core biopsy of tumor and date of therapy onset was defined as primary endpoint. Among other things, age, out- and in-patient presentation, and study or standard treatment were investigated as potentially delaying factors. RESULTS We analyzed 139 patients scheduled for NACT; 90 (64.7%) received standard NACT, and 49 (35.3%) were recruited for trials. The average age was 53 years (±13.2 years). A time interval of 30.7 days (±11.8 days) was seen between diagnosis and therapy onset. Patients had a mean of 5 (±1.9) pretherapeutic presentations, 4 (±1.8) on outpatient and 1 (±0.5) on inpatient basis, being of significant influence on TTTO. CONCLUSION Any outpatient presentation extended the time interval by 2 days, inpatient presentation by 4 days. These presentations should be merged in order to minimize TTTO. Neither the site of pathology examinations, additional consultations (genetics, reproductive medicine), nor study participation delayed therapy onset.
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Affiliation(s)
- Carolin Müller
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical School, Homburg, Germany
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6
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Konieczny M, Cipora E, Sygit K, Fal A. Quality of Life of Women with Breast Cancer and Socio-Demographic Factors. Asian Pac J Cancer Prev 2020; 21:185-193. [PMID: 31983183 PMCID: PMC7294011 DOI: 10.31557/apjcp.2020.21.1.185] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Breast cancer treatment is an aggressive therapy that affects the deterioration of women's quality of life (QOL) in many areas. Knowledge about factors that influence the assessment of the QOL is of particular importance. The aim of the study was to analyse areas of the quality of life of women with breast cancer, taking into account social and demographic factors. METHODS The research was carried included 324 women with breast cancer. The research was carried out using a diagnostic survey, the author's questionnaire and a standardized questionnaire for measuring the QOL of women treated for breast cancer, ie the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire (EORTC) QLQ-C30 and QLQ-QLQ module BR23. Statistical analysis uses Statistica 10.0 software. The results were considered statistically significant when the calculated probability met the inequality of p.
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Affiliation(s)
- Magdalena Konieczny
- 1Jan Grodek State University in Sanok, Medical Institute, Mickiewicza 21, 38-500 Sanok, Poland
| | - Elżbieta Cipora
- 1Jan Grodek State University in Sanok, Medical Institute, Mickiewicza 21, 38-500 Sanok, Poland
| | - Katarzyna Sygit
- The President Stanisław Wojciechowski State University of Applied Sciences in Kalisz, Nowy Świat 4, 62-800 Kalisz, Poland
| | - Andrzej Fal
- Polish Public Health Association, Bartla 5, 51-618 Wrocław, Poland
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Abdel-Razeq H, Almasri H, Abdel Rahman F, Abdulelah H, Abu Nasser M, Salam M, Al-Dairi A, Natour O, Rimawi D. Clinicopathological Characteristics And Treatment Outcomes Of Breast Cancer Among Adolescents And Young Adults In A Developing Country. Cancer Manag Res 2019; 11:9891-9897. [PMID: 31819626 PMCID: PMC6878996 DOI: 10.2147/cmar.s229337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/18/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Compared to Western societies, breast cancer diagnosis in our region is usually made at a younger age and at a more advanced stage. Breast cancer in younger patients tends to be more aggressive, and may result in a higher likelihood of long-term treatment-related toxicity and unique psychosocial problems. This study highlights the clinicopathological features and treatment outcomes in this age-group in a developing country like ours. Methods Consecutive patients aged 40 years or younger with a pathologically confirmed diagnosis of breast cancer treated and followed up at our institution were included. Medical records and hospital databases were searched for patients' characteristics and treatment outcomes. Results A total of 417 patients were enrolled. Median age at diagnosis was 35 (21-40) years. On presentation, 63 (15.1%) patients had metastatic disease, 50 (79.4%) with visceral metastasis. Patients with nonmetastatic disease had poor pathological features, including node-positivity (66.9%), grade III (51.4%), lymphovascular invasion (48.6%) and positive HER2 (31.5%). Breast-conserving surgery was performed on 32.9%, and only 36.5% of women had breast-reconstruction surgery. At a median follow-up of 59 months, 5-year overall survival for the whole group was 72%: 84% for nonmetastatic and 13% for those with metastatic disease. On Cox regression, nodal metastasis (adjusted HR 3.46, 95% CI 1.48-8.10; p=0.004) and grade III disease (HR 1.97, 95% CI 1.14-3.39; p=0.015) were associated with poor outcome. Conclusion Adolescents and young Jordanian adults with breast cancer present with more advanced-stage disease and more aggressive pathological features that reflect poorly on treatment outcomes.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.,School of Medicine, University of Jordan, Amman, Jordan
| | - Hanan Almasri
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Fadwa Abdel Rahman
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Hazem Abdulelah
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mahmoud Abu Nasser
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mourad Salam
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Ammer Al-Dairi
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Osama Natour
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Dalia Rimawi
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
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8
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Murphy BL, Day CN, Hoskin TL, Habermann EB, Boughey JC. Adolescents and Young Adults with Breast Cancer have More Aggressive Disease and Treatment Than Patients in Their Forties. Ann Surg Oncol 2019; 26:3920-3930. [PMID: 31376035 DOI: 10.1245/s10434-019-07653-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs; age < 40 years) account for less than 2% of breast cancer patients. Therefore, little is known about the tumor characteristics and care provided to AYA patients. This study sought to describe demographic, tumor, and treatment variables among AYA patients. METHODS The study identified patients ages 15 to 49 years with breast cancer between 2010 and 2015 from the National Cancer Database. Patient and tumor factors were compared using Chi-square tests. Multivariable logistic regression was used to model the effect of age group on treatment while adjusting for confounding variables. RESULTS The study identified 46,265 AYA patients with stages 0 to 3 breast cancer and compared them with 169,423 breast cancer patients ages 40 to 49 years. A greater proportion of the AYA patients presented with clinical stage 2 or 3 disease than the adult patients 40 to 49 years old (stage 2 disease: 44.3% vs 29.9%, respectively; stage 3 disease: 14.0% vs 7.7%, respectively; both p < 0.001). A greater proportion of the AYA patients had triple-negative breast cancer (TNBC) or human epidermal growth factor receptor 2-positive (HER2+) cancer than the adult patients (TNBC: 21.2% vs 13.8%, respectively; HER2+: 26.0% vs 18.6%, respectively; both p < 0.001). Among the AYA patients, the very young (ages 15-29 years) had more advanced disease and TNBC or HER2+ disease than the older youth (ages 30 to 39 years). The multivariable analysis showed that the AYA patients were more likely to undergo mastectomy (odds ratio [OR] 2.1) and receive chemotherapy (OR 1.9) than patients in their forties (both p < 0.001). CONCLUSION A greater proportion of the AYA breast cancer patients had more advanced disease and TNBC and HER2+ disease. The AYA patients had higher rates of mastectomy and use of chemotherapy than the adult breast cancer patients, reflecting that more aggressive therapy is recommended or chosen for women in this age group.
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Affiliation(s)
- Brittany L Murphy
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.,The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Courtney N Day
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Tanya L Hoskin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth B Habermann
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.,The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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9
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Szollár A, Újhelyi M, Polgár C, Oláh E, Pukancsik D, Rubovszky G, Udvarhelyi N, Kovács T, Sávolt Á, Kenessey I, Mátrai Z. A long-term retrospective comparative study of the oncological outcomes of 598 very young (≤35 years) and young (36-45 years) breast cancer patients. Eur J Surg Oncol 2019; 45:2009-2015. [PMID: 31189512 DOI: 10.1016/j.ejso.2019.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/27/2019] [Accepted: 06/04/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Breast cancer diagnosed in very young women (VYWBC; ≤35 years) and young women (YWBC; 36-45 years) tends to be heterogeneous. The current study aimed to compare the clinicopathological characteristics and long-term clinical outcomes between YWBC and VYWBC subgroups. PATIENTS AND METHODS The institutional prospectively led database was retrospectively analysed from 2000 to 2014 at the National Institute of Oncology, Hungary. A total of 297 patients were assigned to the VYWBC group, and 301 patients were assigned to the YWBC group. RESULTS The median follow-up period was 69 months for the VYWBC group and 79 months for the YWBC group. Significant differences were observed based on breast cancer subtype. The proportion of Triple-negative and ER-negative patients was higher in the VYWBC group than in the YWBC group (P = 0.00008). The incidence of distant metastasis was significantly higher in the VYWBC group (P = 0.01). Significant differences in the frequency of chemotherapy (P = 0.049) and endocrine therapy (P = 0.037) were observed between the two groups. The YWBC group exhibited significantly better overall survival (OS) and disease-free survival (DFS) rates than did the VYWBC group (P = 0.00005 and P = 0.00004, respectively). CONCLUSION Breast cancers in VYWBC are biologically different from those in YWBC and tend to be more aggressive. Younger age was associated with worse OS and DFS. Young women with breast cancer should be subgrouped into VYWBC and YWBC populations, and these subgroups should be targeted by specialized clinical trials and further investigations.
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Affiliation(s)
- András Szollár
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9. 1122, Budapest, Hungary
| | - Mihály Újhelyi
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9. 1122, Budapest, Hungary.
| | - Csaba Polgár
- National Institute of Oncology, Centre of Radiotherapy, Ráth György Str. 7-9. 1122, Budapest, Hungary; Semmelweis University, Department of Oncology, Ráth György Str. 7-9. 1122, Budapest, Hungary
| | - Edit Oláh
- National Institute of Oncology, Department of Molecular Genetics, Ráth György Str. 7-9. 1122, Budapest, Hungary
| | - Dávid Pukancsik
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9. 1122, Budapest, Hungary
| | - Gábor Rubovszky
- National Institute of Oncology, Department of Oncological Internal Medicine and Clinical Pharmacology, Ráth György Str. 7-9. 1122, Budapest, Hungary
| | - Nóra Udvarhelyi
- National Institute of Oncology, Centre of Pathology, Ráth György Str. 7-9. 1122 Budapest, Hungary
| | - Tibor Kovács
- Guy's Hospital, Breast Unit, London, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Ákos Sávolt
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9. 1122, Budapest, Hungary
| | - István Kenessey
- National Institute of Oncology, National Cancer Registry, Ráth György Str. 7-9. 1122, Budapest, Hungary; Semmelweis University, Second Department of Pathology, Üllői Str. 93. 1091, Budapest, Hungary
| | - Zoltán Mátrai
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9. 1122, Budapest, Hungary
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Kandagatla P, Shah NM, Jeruss JS. ASO Author Reflections: Challenges in the Management of Young Women with Breast Cancer-Fertility Preservation and Pregnancy. Ann Surg Oncol 2019; 26:1225-1226. [PMID: 30859353 DOI: 10.1245/s10434-019-07285-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Pridvi Kandagatla
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Surgery, Henry Ford Health System/Wayne State University, Detroit, MI, USA
| | - Nikita M Shah
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jacqueline S Jeruss
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI, USA. .,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA. .,Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
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11
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Matsen CB, Lyons S, Goodman MS, Biesecker BB, Kaphingst KA. Decision role preferences for return of results from genome sequencing amongst young breast cancer patients. PATIENT EDUCATION AND COUNSELING 2019; 102:155-161. [PMID: 30098907 PMCID: PMC6289762 DOI: 10.1016/j.pec.2018.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/23/2018] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To better understand decision role preferences in women diagnosed with breast cancer at a young age for return of results of genome sequencing in research and clinical settings. METHODS Participants were surveyed about communication and decision-making preferences related to genome sequencing results and factors that may affect these preferences. The primary outcome was decision role preference (Control Preference Scale) for selecting what results to receive within medical care or within a research study. RESULTS For results returned as part of medical care, most patients preferred a collaborative (N = 481, 45%) or active (N = 488, 45%) role with only 107 (10%) choosing a passive role. When making the decision as part of a research study, most patients preferred an active role (N = 617, 57%), 350 (33%) choosing a collaborative role, and110 (10%) choosing a passive role. CONCLUSION Most women in this study preferred to share in decision making. Participants had somewhat different role preferences for clinical and research contexts, with greater preference for active roles in the research context. PRACTICE IMPLICATIONS We advocate for practice guidelines that incorporate discussion of decision role as an integral part of patient centered care and shared decision-making and recognize that more work is needed to inform guidelines.
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Affiliation(s)
- Cindy B Matsen
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, 84112, USA; Department of Surgery, University of Utah, Salt Lake City, UT, 84132, USA.
| | - Sarah Lyons
- Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Melody S Goodman
- Department of Biostatistics, College of Global Public Health, New York University, New York, NY, 10003, USA
| | | | - Kimberly A Kaphingst
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, 84112, USA; Department of Communcation, University of Utah, Salt Lake City, UT, 84112, USA
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Corter AL, Quan ML, Wright FL, Kennedy ED, Simunovic MR, Shao J, Baxter NN. Scoping clinicians' perspectives on pre-treatment multidisciplinary care for young women with breast cancer. J Multidiscip Healthc 2018; 11:547-555. [PMID: 30349286 PMCID: PMC6183552 DOI: 10.2147/jmdh.s173735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Young women with breast cancer (YWBC) experience worse medical and psychosocial outcomes than their older counterparts. Early input from a multidisciplinary team via pre-treatment multidisciplinary cancer conferences (pMCCs) may be important for addressing the complex needs of YWBC. However, pMCCs are not common. This study has two parts: a survey and workshop aimed at assessing clinicians' perspectives on pMCCs, including the importance of pMCCs in the care of YWBC, as well as barriers to, and strategies for supporting their implementation. METHODS Survey results highlight variability across sites in the delivery of multidisciplinary care in general. However, both survey and workshop results emphasize clinicians' agreement on the importance of pMCCs and suggest that numerous practical and systems levels barriers be addressed before pMCCs can be implemented. CONCLUSIONS pMCCs have the potential to improve surgical treatment and psychosocial outcomes for YWBC. A combined practical and policy approach to their implementation, which sees extension of existing standards to include pMCCs, may support their adoption and subsequent audit practices to assess the effect of pMCCs on outcomes for YWBC.
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Affiliation(s)
- Arden L Corter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada,
| | - May Lynn Quan
- Department of Surgery and Oncology, University of Calgary, Calgary, Canada
| | | | - Erin D Kennedy
- Division of General Surgery, University Health Network, Mount Sinai Hospital, Toronto, Canada
| | | | - Juliet Shao
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada,
| | - Nancy N Baxter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada,
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,
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Guo L, Chen D, Yin X, Shu Q. GSK-3β Promotes Cell Migration and Inhibits Autophagy by Mediating the AMPK Pathway in Breast Cancer. Oncol Res 2018; 27:487-494. [PMID: 30037362 PMCID: PMC7848277 DOI: 10.3727/096504018x15323394008784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
GSK-3β is a versatile protein kinase participating in many reactions. Currently, there is insufficient understanding of its influence on breast cancer (BC). In order to explore its influence on migration and invasion in BC, we investigated its expression in BC cell lines using qRT-PCR and Western blot (WB). Immunohistochemistry (IHC) was used to examine the potential of GSK-3β to predict clinical outcome in BC patients. GSK-3β knockdown was achieved using an shRNA plasmid vector in T47D cells. Our research explored the biological reactions and downstream pathways involved. We found excessive GSK-3β expression in BC tissues, which was correlated with worse clinicopathological parameters and clinical outcome. Progression of BC was suppressed by GSK-3β knockdown. Furthermore, suppression of GSK-3β function led to a noticeable decrease in ATP generation, and this was associated with stimulation of AMP-activated protein kinase (AMPK) in T47D cells. Activation of AMPK, a typical sign of autophagy stimulation, was triggered after suppression of GSK-3β function, in parallel with increased generation of LC3 II. Our findings therefore indicate that GSK-3β participates in regulation of migration as well as stimulation of autophagy via mediating activation of the AMPK pathway. This suggests that GSK-3β has potential as a predictor of clinical outcome and as a target for BC therapy.
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Affiliation(s)
- Lu Guo
- Jinan University, Guangzhou, Guangdong, P.R. China
| | - Duankai Chen
- General Surgery, YouJiang Medical University for Nationalities, Guangxi, P.R. China
| | - Xing Yin
- Wound Regeneration and Vascular Surgery Department of the First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi, P.R. China
| | - Qingfeng Shu
- General Surgery, YouJiang Medical University for Nationalities, Guangxi, P.R. China
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Different prognosis of young breast cancer patients in their 20s and 30s depending on subtype: a nationwide study from the Korean Breast Cancer Society. Breast Cancer Res Treat 2017; 166:833-842. [PMID: 28831642 DOI: 10.1007/s10549-017-4472-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Numerous studies have demonstrated that breast cancer in young women (BCY) has unfavorable prognostic features and more unfavorable subtypes. However, few studies have evaluated the effect of subtype disparities on breast cancer prognosis by age, especially for BCY. We analyzed breast cancer mortality stratified by tumor subtype according to age among patients younger than 50 years. METHODS Data from the Korean Breast Cancer Society Registry for patients diagnosed with invasive breast cancer when aged less than 50 years between 2003 and 2010 were reviewed retrospectively. RESULTS We identified 30,793 patients with breast cancer who were eligible for analysis. Of these, 793 (2.6%) were aged 20-29 and 8926 (28.8%) were aged 30-39. Median follow-up duration was 84 months. Mean age was 42.4 years. Patients in their 20s were more likely to have cancer of advanced stage and higher nuclear grade, present with lymphovascular invasion, and have unfavorable subtypes. Patients in the 20s group showed worse prognosis. In multivariate analysis for overall survival (OS), the hazard ratio (HR) for patients in the 20s group was higher than that for the 30s and 40s groups, and patients with triple-negative breast cancer (TNBC) showed higher HR than patients with HER-2 or luminal subtype (all p < 0.0001). When stratified by subtype, luminal subtype showed significantly worse prognosis in the 20s group than the 30s and 40s groups, whereas HER-2 and TNBC subtypes showed no significant difference. CONCLUSION Patients in their 20s with breast cancer had unfavorable characteristics and worse prognosis than patients in their 30s and 40s. When stratified by tumor subtype, patients in their 20s with luminal subtype of breast cancer showed worse prognosis than older patients, whereas HER-2 and TNBC subtypes showed no significant differences.
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