Breast Cancer Survival Defined by Biological Receptor and Menopausal Status in Vietnamese Women

Financial struggles and coping with the aftermath of breast cancer care: An ethnographic study in Vietnam

Breast cancer, the most common cancer diagnosed among women, disproportionately affects low- and middle-income countries (LMICs). Based on an ethnographic study conducted in Central Vietnam in 2019, including observation and interviews with 33 women patients, we investigate how women and their families managed the financial burden of breast cancer care. Our findings suggest that in a context where health-related risk protection is poorly organised and out-of-pocket expenses are burdensome, despite the presence of universal health coverage, patients must rely heavily on informal arrangements to finance their treatment. They proactively researched available information and undertook extensive and ramified work to prove their deservingness for some types of assistance, including strategically disclosing their cancer status or using tactics to accelerate the process of applying for state welfare. Affected families must make hard calculations to prioritise the pressing health need of a member diagnosed with cancer and in many circumstances, forfeited the education of their young children. We offer theoretical understanding of 'patient work' beyond the routine management of the biological aspects of an illness. In addition, we demonstrate how engaging in those various coping practices can reinforce one's vulnerability to a vicious cycle of illness and poverty and amplify socio-economic inequalities among the affected community and the larger society. We argue this situation, if not tackled urgently and appropriately, can impede the progress towards achieving Sustainable Development Goal 3 (Good Health and Wellbeing) and Goal 10 (Reduced Inequalities) in LMICs amidst the non-communicable disease epidemic.

Illuminating the breast cancer survival rates among Southeast Asian women: A systematic review and meta-analysis spanning four decades

In Southeast Asia, breast cancer is the most prevalent cancer among women and ranks as the second leading cause of cancer-related deaths. This systematic review and meta-analysis, encompassing 27 observational cohort studies with a minimum one-year follow-up period, aimed to examine temporal trends in breast cancer survival rates. Among the subset of five out of eleven Southeast Asian nations with available data, our analysis revealed pooled survival rates of 88.8 % at 1 year, 73.8 % at 3 years, 70.8 % at 5 years, and 49.3 % at 10 years for breast cancer patients. The mean age at diagnosis was 50.77±10.07 years, with 52.81 % of patients presenting with positive lymph nodes. Notably, stages I and II remained predominant even five years post-diagnosis. Although an overall amelioration in survival rates transpired over the preceding four decades, a noticeable exception pertained to the 3-year rate, demonstrating limited improvement. These findings underscore the pressing need for enhanced research efforts, particularly in countries within the region that lack survival data, to enable accurate estimations. Furthermore, our review also emphasizes the crucial need for future comprehensive, well-designed studies to delve into the factors behind survival rate disparities in Southeast Asia and the younger age at diagnosis compared to other regions.

The prognostic impact of body mass index on female breast cancer patients in underdeveloped regions of northern China differs by menopause status and tumor molecular subtype

There is growing evidence that higher body mass index (BMI) is associated with lower survival in breast cancer patients. The aim of this study was to investigate whether there is an association between body mass index (BMI) at breast cancer diagnosis and breast cancer prognosis and whether this association is dependent on menopausal status and tumor subtype in a less developed population in northern China. We collected 1,225 patients with primary invasive cancer in stage I-IIIC for retrospective analysis from October 2010 to December 2020. We used Kaplan-Meier and Cox regression analyses and estimated the relationship between baseline BMI and breast cancer-specific survival (BCSS). Next, we further evaluated whether the effect of BMI on breast cancer prognosis differed by menopausal status and tumor subtype. We found that death rate and prognosis were worse for patients with BMI ≥ 24, more than four positive lymph nodes, and triple negative status. Interestingly, BMI played a different prognostic role depending on tumor subtype and menopausal status. For premenopausal women, patients with BMI ≥ 24 had significantly lower BCSS compared to those with BMI < 24 in human epidermal growth factor receptor 2 (HER2) overexpression (HR: 4.305, p = 0.004) and triple negative subtypes (HR: 1.775, p = 0.048). By contrast, there was no association between BMI ≥ 24 and higher death regardless of tumor subtype in post-menopausal patients (p > 0.05). BMI influences breast cancer outcome depending on tumor subtype and menopause. BMI ≥ 24 might be a risk factor for BCSS, particularly in premenopausal women with HER2 overexpression or triple negative subtype. In contrast, BMI ≥ 24 was not associated with higher death regardless of tumor subtype in post-menopausal patients.

Differential distribution of actual and surrogate oncotype DX recurrence scores in breast cancer patients by age, menopausal status, race, and body mass index

PURPOSE

The Oncotype DX Recurrence Score (RS) is a widely used prognostic tool for estrogen receptor-positive breast cancer patients. Multiple surrogate models can predict RS with good accuracy. In this study we aimed to determine whether the RS and two surrogate indices were differentially distributed by age, menopausal status, race, and body mass index (BMI).

METHODS

516 breast cancer cases treated at a single institution were analyzed. Epidemiologic data, RS, tumor size, grade, and biomarker data were abstracted. Breast Cancer Prognostic Score (BCPS) and modified Magee equation 2 were used to calculate surrogate RS. Patients were stratified into different groups based on age, menopausal status, race, BMI, or a combination of strata. Mean and standard deviation were calculated for each group/subgroup.

RESULTS

Age below median (< 63) was associated with higher RS, especially in obese and Black patients. RS was also higher in obese and Black patients in the premenopausal subgroup. Black patients had a higher RS compared to White women in the premenopausal and non-obese subgroups. BMI < 30 was associated with higher RS, especially in older, postmenopausal, and Black patients. Some of these observations were replicated by the two surrogate models. The surrogate recurrence scores were higher in the younger age group, in non-obese older/postmenopausal women, and in younger/premenopausal obese individuals.

CONCLUSIONS

Higher RS was observed in younger and premenopausal breast cancer patients, especially among the Black and obese subgroups, and in non-obese patients, especially among Black and older/postmenopausal women, suggesting more aggressive disease in these subgroups. Some statistical differences could be replicated by both surrogate models, suggesting that they may have utility in breast cancer epidemiology studies that do not have access to Oncotype DX RS or patient outcome data.

Clinicopathological Risk Factors of Unfavorable Outcomes in Vietnamese Women with Primary Invasive Breast Cancer: A Retrospective Cohort Study

Background

The rate of unfavorable outcomes, such as recurrence and death, in women with invasive breast cancer varies widely across countries and populations. Identifying those with high-risk profiles is critical so that early detection, prediction, and intervention can be made to improve their survival rate. Therefore, our study evaluated the rate of unfavorable outcomes and its association with clinicopathological characteristics in Vietnamese women with primary invasive breast cancer.

Methods

A retrospective open cohort study was conducted on Vietnamese women with invasive breast cancer who underwent a mastectomy and were regularly followed up by the hospitals. Kaplan-Meier method was used to estimate the rate of unfavorable outcomes to take into account the follow-up time of each patient. Univariate and multiple Cox regression analyses were conducted to examine the associations between unfavorable outcomes and clinicopathological characteristics.

Results

Among 204 women included in the data analysis, the mean age was 54.4 ± 10.9 years. The majority of patients were diagnosed with early-stage (76.5%) or locally advanced (22.5%) breast cancer. The 5-year rate of unfavorable outcomes was 12.8%, and the 8-year rate was 31.7%. Patients with advanced stages had a higher risk of unfavorable outcomes compared to those with early stages (IA, IIA, T2N1). Patients with lymph node metastases and those with triple-negative molecular classification had significantly higher rates of unfavorable outcomes.

Conclusion

Although Vietnamese women with breast cancer have a relatively low rate of unfavorable outcomes compared to other countries, findings from this study emphasize the importance of early detection and underscore the need for targeted interventions for patients with advanced stages, lymph node metastases, and triple-negative breast cancer to optimize their treatment, outcomes, and overall prognosis.

Relapse-free survival in Sudanese women with non-metastatic breast cancer

Background

Breast cancer (BC) is the most frequently diagnosed cancer and a major cause of cancer mortality in Sudan. However, there is lack of data related to BC relapse. Therefore, this study was undertaken to estimate the 5-year relapse free survival (RFS) rate and factors related to BC relapse in Sudanese women with non-metastatic BC.

Methods

Data of BC women with BC diagnosed and treated at the National Cancer Institute-University of Gezira during 2012 were retrieved from medical records. The cases were followed-up through hospital records and telephone contact. Survival functions were calculated using Kaplan-Meier method and compared by log-rank test. The prognostic factors were tested using univariate and multivariable Cox regression analyses.

Results

We included 168 women with median age of 45 years (range, 22-83 years). 53.5%of women had stage III at time of diagnosis, whereas 4.2% and 42.3% of women presented with stage I and stage II, respectively. At the end of 5 years follow-up, with median follow-up period of 64 months, 94 (56.0%) women were alive in remission, 11 (6.5%) were alive with BC relapse, 49 (29.2%) were dead, and survival status was unknown in 14 (8.3%) women. Most of the occurred relapses were distant relapses. The 5-year RFS was 59%. The independent predictors of relapse were: larger primary tumor size (HR:1.84, 95% CI: 1.54-5.48, p=0.018); involved axillary lymph nodes with tumour (HR:  2.91, 95% CI:  1.53-7.91, p=0.001); not receiving adjuvant radiotherapy (HR: 2.2, 95% CI: 1.22-3.95, p=0.009); and not receiving hormone therapy (HR: 1.67, 95% CI: 1.01-2.76, p= 0.046).

Conclusion

We found a high risk of BC relapse in our resource-constrained settings. Advanced stages, not receiving adjuvant radiotherapy, and not receiving adjuvant hormone therapy were independent predictors associated with worse 5-year RFS. Therefore, enhancing the early diagnosis of BC and improving timely access to appropriate treatments represent key approaches to achieving better treatment outcomes.

Health-related quality of life among breast cancer patients compared to cancer survivors and age-matched women in the general population in Vietnam

PURPOSE

This study compared the health-related quality of life (HRQoL) of breast cancer (BC) patients, survivors, and age-matched women from the general population in Vietnam to address the paucity of HRQoL research and contribute to the robust assessment of BC screening and care in Vietnam.

METHODS

The standardised EQ-5D-5L instrument was incorporated in an online survey and a hospital-based face-to-face survey, and together with data from the Vietnam EQ-5D-5L norms study. χ2 tests assessed EQ-5D health profile associations and a Tobit regression model investigated the association between overall health status (EQ-VAS/utility scores) and sociodemographic and clinical characteristics.

RESULTS

A total of 309 participants (107 patients undergoing treatment and 202 survivors who had completed treatment) provided usable responses. The dimensions that affected mostly the HRQoL of women with BC were pain/discomfort and anxiety/depression. Current patients and survivors differed significantly regarding HRQoL dimensions of mobility, self-care, usual activities, and anxiety/depression. Their health utilities were 0.74 and 0.84, respectively, compared with 0.91 for age-matched Vietnamese women in the general population (p < 0.001). Treatment status (survivor vs patient), younger age, higher monthly household income, and higher education levels were associated with higher health utility.

CONCLUSIONS

The results point to unmet needs in mental health support and well-being and for attention to be given to the development of a biopsychosocial system of cancer diagnosis, treatment, and care. The results will also inform future assessments of the comparative value for money of interventions intended to impact on breast cancer in Vietnam.

Association between Pre-Existing Sleep Disorders and Survival Rates of Patients with Breast Cancer

PURPOSE: To investigate the effects of pre-existing sleep disorders on the survival outcomes of women receiving standard treatments for breast invasive ductal carcinoma (IDC). METHODS: We recruited patients from the Taiwan Cancer Registry Database who had received surgery for clinical stage I–III breast IDC. The Cox proportional hazards model was used to analyze all-cause mortality. We categorized the patients into those with and without sleep disorders (Groups 1 and 2, respectively) through propensity score matching. RESULTS: In the multivariate Cox regression analysis, the adjusted hazard ratio for all-cause mortality for Group 1 compared with Group 2 was 1.51 (95% confidence interval: 1.19, 1.91; p < 0.001). CONCLUSION: Our study demonstrated that the sleep disorder group had poorer survival rates than the non-sleep disorder group in breast cancer. Therefore, patients should be screened and evaluated for pre-existing sleep disorders prior to breast surgery, with such disorders serving as a predictor of survival in patients with breast cancer. Future studies may investigate the survival benefits of pharmacological and behavioral treatments for sleep problems in patients with breast cancer.

Prevalence, treatment patterns, and prognosis of low estrogen receptor-positive (1% to 10%) breast cancer: a single institution's experience in Korea

PURPOSE

To determine prevalence, clinicopathological characteristics, initial treatments, and outcomes associated with low estrogen receptor (ER)-expressing invasive breast cancer.

METHODS

This retrospective, non-interventional database study included patients undergoing surgery with curative intent for invasive ductal or lobular breast cancer. Patients were treated between January 2003-December 2012. Demographics, clinicopathological characteristics, initial treatments, and outcomes were abstracted from patient records. Patients were categorized using immunohistochemistry to determine ER, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) levels. ER-positive patients were subclassified as ER-low (1% to 10%) and ER-high (> 10%) according to the Allred Proportion Score. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method and compared among groups by log-rank test.

RESULTS

5930 patients were included (median follow-up, 80.9 months). Of all patients included, 117 (2.0%) had ER-low tumors: 63 (53.8%) of whom had HER2- tumors and 54 (46.2%) HER2+ tumors. Five-year DFS and OS were highest in the ER-high/HER2- cohort (94.0% and 98.6%, respectively) and lowest in the triple-negative breast cancer (TNBC; 81.3% and 90.1%) and ER-low/HER2- (85.7% and 92.1%) cohorts. Menopausal status, elevated Ki-67, higher nuclear grade, higher tumor stage, presence of lymphovascular invasion, greater regional lymph node involvement, and larger tumor size were all potential prognostic factors for shorter DFS and OS.

CONCLUSION

Patients with ER-low/HER2- breast cancer had similar clinicopathological characteristics, treatments, and outcomes as patients with TNBC irrespective of disease setting. Further research is needed to understand predictive and prognostic factors associated with ER-low/HER2- disease.

Survival Outcomes of Breast Cancer in Sudanese Women: A Hospital-Based Study

PURPOSE

Breast cancer (BC) is the leading malignancy among Sudanese women. Yet, data on survival are limited. This study aimed to determine 5-year overall survival (OS) of BC in Sudanese women, and identify prognostic demographic and clinicopathologic factors.

PATIENTS AND METHODS

A hospital-based retrospective study was conducted by reviewing data of women with BC diagnosed and treated at the National Cancer Institute—University of Gezira during 2012, and followed up to end of August 2018. Data were retrieved from medical records and analyzed, OS was determined, and the prognostic factors were explored.

RESULTS

A total of 225 cases were recruited. The median age at presentation was 45 years (range, 22-85 years). Clinical stage I, II, III, and IV represented 3.1%, 31.6%, 48%, and 17.3%, respectively. Most women (81.3%) were treated with curative intent. Of those, 25.1% received neoadjuvant chemotherapy. Mastectomy was the commonest (61.7%) type of surgery. The median follow-up period was 59.8 months with mean OS time of 55.7 months. The 5-year cumulative survival rate was 58%. The 5-year OS rates for stages I, II, III, and IV were 71.5%, 82.4%, 56.5%, and 8.4%, respectively. For lymph node (LN)-positive cases, 5-year OS rate was 63% and for LN-negative was 83.5%. Presenting with advanced-stage disease and positive LN status associated with short OS times (P < .005).

CONCLUSION

OS of women with BC in Central Sudan is worse than in the developed world, but similar to African countries. Our findings indicate that advanced stage at diagnosis and lymph nodal involvement are strong predictors of short survival times. Raising awareness and introducing early detection programs are critical for better survival of these patients.