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Culha Y, Davarci SE, Ünlü B, Özaşkin D, Demir H, Baykara M. Comparison of clinicopathological and prognostic features of breast cancer patients younger than 40 years and older than 65 years. Discov Oncol 2024; 15:126. [PMID: 38649531 PMCID: PMC11035508 DOI: 10.1007/s12672-024-00952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE This study aims to compare the clinicopathological and prognostic features of women aged 40 years and younger and 65 years and older with breast cancer. METHODS Between January 2011 and December 2021, 136 female cases aged 40 years and younger and 223 female cases aged 65 and over were identified among all cases (1395 cases) registered as breast cancer in the file archives of Afyonkarahisar Health Sciences University Faculty of Medicine, Department of Medical Oncology for the study. A Chi-square (× 2) test was used for categorical variables, and an independent sample t-test for continuous variables. Log-rank test and Kaplan-Meier plots were used for survival analysis. For the statistical evaluation, p < 0.05 was considered significant. RESULTS Both overall survival (p < 0.01) and breast cancer-specific survival (BCSS) (p = 0.01) were significantly worse in the older group. BCSS were significantly worse in the older group in Luminal B (HER2-) (p = 0.013) and HR- HER2+ (p = 0.015) subtypes detected. In multivariate Cox regression analysis, only the presence of metastases at diagnosis or follow-up (p < 0.001) and ECOG PS 2-3 status (p = 0.001) were associated with an increased risk of breast cancer-specific death. CONCLUSION To our knowledge, no study directly compares these two groups. In our study, similar to many studies, more aggressive tumor features were found in young patients, but unlike many studies, mortality was found to be significantly higher in older patients. The presence of metastasis and poor ECOG PS were found to be the most influential factors in breast cancer-specific death risk.
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Affiliation(s)
- Yaşar Culha
- Department of Medical Oncology, Afyon Health Sciences University School of Medicine, Afyonkarahisar, Turkey.
| | - Sena Ece Davarci
- Department of Medical Oncology, Afyon Health Sciences University School of Medicine, Afyonkarahisar, Turkey
| | - Beyza Ünlü
- Department of Medical Oncology, Afyon Health Sciences University School of Medicine, Afyonkarahisar, Turkey
| | - Duygu Özaşkin
- Department of Medical Oncology, Afyon Health Sciences University School of Medicine, Afyonkarahisar, Turkey
| | - Hacer Demir
- Department of Medical Oncology, Afyon Health Sciences University School of Medicine, Afyonkarahisar, Turkey
| | - Meltem Baykara
- Department of Medical Oncology, Afyon Health Sciences University School of Medicine, Afyonkarahisar, Turkey
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Lee JW, Oh H, You JY, Lee ES, Lee JH, Song SE, Lee NK, Jung SP, An JS, Cho KR, Kim CY, Park KH. Therapy-related myeloid neoplasm in early breast cancer patients treated with adjuvant chemotherapy. Eur J Cancer 2023; 191:112952. [PMID: 37473463 DOI: 10.1016/j.ejca.2023.112952] [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: 01/24/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Long-term complications are becoming more important as the survival rate of breast cancer improves. Treatment-related myeloid neoplasm is an important long-term complication in breast cancer survivors as it has a poor prognosis. OBJECTIVE We evaluated the incidence and risk factors for the development of treatment-related acute myeloid leukaemia (AML)/myelodysplastic syndrome (MDS) in patients treated with early breast cancer. METHODS We accessed the national Korean database to identify 153,565 patients diagnosed with breast cancer between January 2007 and October 2016 who underwent surgery for breast cancer. We estimated the cumulative incidence of AML/MDS and analysed the risk factors for developing AML/MDS. RESULTS Of 153,575 patients, 79,321 received anthracycline-based adjuvant therapy, 14,317 received adjuvant therapy without anthracyclines and 46,657 did not receive adjuvant chemotherapy. Overall, 120 developed AML (105 in the anthracycline group, 9 in the non-anthracycline group and 6 in the control group), and 128 developed MDS (96, 9 and 23 in each group). The 10-year cumulative incidence of AML/MDS was the highest in the anthracycline group (0.221% and 0.199%), followed by the non-anthracycline group (0.122% and 0.163%) and the control group (0.024% and 0.089%). The risk of developing AML/MDS was significantly higher in patients treated with anthracyclines (hazard ratio [HR] 9.531; p < 0.0001 for AML and HR 2.559; p < 0.0001 for MDS) compared to patients in the control group. CONCLUSION This study found that anthracycline-based adjuvant therapy significantly increased the risk of AML/MDS in Korean breast cancer patients, with the risk persisting for at least 10 years. While the cumulative incidence was low, the long-term risks of AML/MDS should be taken into account considering the poor outcomes associated with these neoplasms.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/complications
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/epidemiology
- Myelodysplastic Syndromes/chemically induced
- Myelodysplastic Syndromes/epidemiology
- Chemotherapy, Adjuvant/adverse effects
- Combined Modality Therapy
- Anthracyclines
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/drug therapy
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
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Affiliation(s)
- Ji Won Lee
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Hoonji Oh
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Ji Young You
- Division of Breast and Endocrine, Department of Surgery, Departments of Breast Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Eun-Shin Lee
- Division of Breast and Endocrine, Department of Surgery, Departments of Breast Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jung Hyun Lee
- Department of Pathology, Korea University Anam Hospital, Seoul, South Korea
| | - Sung Eun Song
- Department of Radiology, Korea University Anam Hospital, Seoul, South Korea
| | - Nam Kwon Lee
- Department of Radiation Oncology, Korea University Anam Hospital, Seoul, South Korea
| | - Seung Pil Jung
- Division of Breast and Endocrine, Department of Surgery, Departments of Breast Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jung Seok An
- Department of Pathology, Korea University Anam Hospital, Seoul, South Korea
| | - Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Seoul, South Korea
| | - Cheol Yong Kim
- Department of Radiation Oncology, Korea University Anam Hospital, Seoul, South Korea
| | - Kyong Hwa Park
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea.
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Taylor C, McGale P, Probert J, Broggio J, Charman J, Darby SC, Kerr AJ, Whelan T, Cutter DJ, Mannu G, Dodwell D. Breast cancer mortality in 500 000 women with early invasive breast cancer diagnosed in England, 1993-2015: population based observational cohort study. BMJ 2023; 381:e074684. [PMID: 37311588 PMCID: PMC10261971 DOI: 10.1136/bmj-2022-074684] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To describe long term breast cancer mortality among women with a diagnosis of breast cancer in the past and estimate absolute breast cancer mortality risks for groups of patients with a recent diagnosis. DESIGN Population based observational cohort study. SETTING Routinely collected data from the National Cancer Registration and Analysis Service. PARTICIPANTS All 512 447 women registered with early invasive breast cancer (involving only breast and possibly axillary nodes) in England during January 1993 to December 2015, with follow-up to December 2020. MAIN OUTCOME MEASURES Annual breast cancer mortality rates and cumulative risks by time since diagnosis, calendar period of diagnosis, and nine characteristics of patients and tumours. RESULTS For women with a diagnosis made within each of the calendar periods 1993-99, 2000-04, 2005-09, and 2010-15, the crude annual breast cancer mortality rate was highest during the five years after diagnosis and then declined. For any given time since diagnosis, crude annual breast cancer mortality rates and risks decreased with increasing calendar period. Crude five year breast cancer mortality risk was 14.4% (95% confidence interval 14.2% to 14.6%) for women with a diagnosis made during 1993-99 and 4.9% (4.8% to 5.0%) for women with a diagnosis made during 2010-15. Adjusted annual breast cancer mortality rates also decreased with increasing calendar period in nearly every patient group, by a factor of about three in oestrogen receptor positive disease and about two in oestrogen receptor negative disease. Considering just the women with a diagnosis made during 2010-15, cumulative five year breast cancer mortality risk varied substantially between women with different characteristics: it was <3% for 62.8% (96 085/153 006) of women but ≥20% for 4.6% (6962/153 006) of women. CONCLUSIONS These five year breast cancer mortality risks for patients with a recent diagnosis may be used to estimate breast cancer mortality risks for patients today. The prognosis for women with early invasive breast cancer has improved substantially since the 1990s. Most can expect to become long term cancer survivors, although for a few the risk remains appreciable.
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Affiliation(s)
- Carolyn Taylor
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Oxford University Hospitals, Oxford, UK
| | - Paul McGale
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jake Probert
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John Broggio
- National Disease Registration Service (NDRS), NHS England, Birmingham, UK
| | - Jackie Charman
- National Disease Registration Service (NDRS), NHS England, Birmingham, UK
| | - Sarah C Darby
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amanda J Kerr
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Timothy Whelan
- Department of Oncology, McMaster University and Juravinski Cancer Centre, Hamilton, ON Canada
| | - David J Cutter
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Oxford University Hospitals, Oxford, UK
| | - Gurdeep Mannu
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Oxford University Hospitals, Oxford, UK
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Lord SJ, Bahlmann K, O'Connell DL, Kiely BE, Daniels B, Pearson SA, Beith J, Bulsara MK, Houssami N. De novo and recurrent metastatic breast cancer - A systematic review of population-level changes in survival since 1995. EClinicalMedicine 2022; 44:101282. [PMID: 35128368 PMCID: PMC8804182 DOI: 10.1016/j.eclinm.2022.101282] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Advances in breast cancer (BC) care have reduced mortality, but their impact on survival once diagnosed with metastasis is less well described. This systematic review aimed to describe population-level survival since 1995 for de novo metastatic BC (dnMBC) and recurrent MBC (rMBC). METHODS We searched MEDLINE 01/01/1995-12/04/2021 to identify population-based cohort studies of MBC reporting overall (OS) or BC-specific survival (BCSS) over time. We appraised risk-of-bias and summarised survival descriptively for MBC diagnoses in 5-year periods from 1995 until 2014; and for age, hormone receptor and HER2 subgroups. FINDINGS We identified 20 eligible studies (14 dnMBC, 1 rMBC, 5 combined). Potential sources of bias in these studies were confounding and shorter follow-up for the latest diagnosis period.For dnMBC, 13 of 14 studies reported improved OS or BCSS since 1995. In 2005-2009, the median OS was 26 months (range 24-30), a median gain of 6 months since 1995-1999 (range 0-9, 4 studies). Median 5-year OS was 23% in 2005-2009, a median gain of 7% since 1995-1999 (range -2 to 14%, 4 studies). For women ≥70 years, the median and 5-year OS was unchanged (1 study) with no to modest difference in relative survival (range: -1·9% (p = 0.71) to +2·1% (p = 0.045), 3 studies). For rMBC, one study reported no change in survival between 1998 and 2006 and 2007-2013 (median OS 23 months). For combined MBC, 76-89% had rMBC. Three of four studies observed no change in median OS after 2000. Of these, one study reported median OS improved for women ≤60 years (1995-1999 19·1; 2000-2004 22·3 months) but not >60 years (12·7, 11·6 months). INTERPRETATION Population-level improvements in OS for dnMBC have not been consistently observed in rMBC cohorts nor older women. These findings have implications for counselling patients about prognosis, planning cancer services and trial stratification. FUNDING SL was funded in part by a National Health and Medical Research Council (NHMRC) Project Grant ID: 1125433. NH was funded by the NBCF Chair in Breast Cancer Prevention grant (EC-21-001) and a NHMRC Investigator (Leader) grant (194410). BD and SAP were funded in part by the NHMRC Centre of Research Excellence in Medicines Intelligence (1196900).
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Affiliation(s)
- SJ Lord
- The School of Medicine, University of Notre Dame Australia, Darlinghurst, Australia
- The National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, Australia
- NHMRC Centre of Research Excellence in Medicines Intelligence, Australia
- Corresponding author at: School of Medicine, University of Notre Dame Australia, Darlinghurst, NSW 2011, Australia.
| | - K Bahlmann
- The School of Medicine, University of Notre Dame Australia, Darlinghurst, Australia
| | - DL O'Connell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Australia
| | - BE Kiely
- The National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, Australia
| | - B Daniels
- NHMRC Centre of Research Excellence in Medicines Intelligence, Australia
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, Australia
| | - SA Pearson
- NHMRC Centre of Research Excellence in Medicines Intelligence, Australia
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, Australia
| | - J Beith
- Chris O'Brien Lifehouse, Camperdown, The University of Sydney, Camperdown, Australia
| | - MK Bulsara
- The Institute of Health Research and the School of Medicine, University of Notre Dame, Fremantle, Australia
| | - N Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Draeger T, Voelkel V, Groothuis-Oudshoorn CGM, Lavric M, Veltman J, Dassen A, Boersma LJ, Witteveen A, Sonke GS, Koffijberg H, Siesling S. Applying Risk-Based Follow-Up Strategies on the Dutch Breast Cancer Population: Consequences for Care and Costs. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1149-1156. [PMID: 32940232 DOI: 10.1016/j.jval.2020.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES An important aim of follow-up after primary breast cancer treatment is early detection of locoregional recurrences (LRR). This study compares 2 personalized follow-up scheme simulations based on LRR risk predictions provided by a time-dependent prognostic model for breast cancer LRR and quantifies their possible follow-up efficiency. METHODS Surgically treated early patients with breast cancer between 2003 and 2008 were selected from the Netherlands Cancer Registry. The INFLUENCE nomogram was used to estimate the 5-year annual LRR. Applying 2 thresholds, they were defined according to Youden's J-statistic and a predefined follow-up sensitivity of 95%, respectively. These patient's risk estimations served as the basis for scheduling follow-up visits; 2 personalized follow-up schemes were simulated. The number of potentially saved follow-up visits and corresponding cost savings for each follow-up scheme were compared with the current Dutch breast cancer guideline recommendation and the observed utilization of follow-up on a training and testing cohort. RESULTS Using LRR risk-predictions for 30 379 Dutch patients with breast cancer from 2003 to 2006 (training cohort), 2 thresholds were calculated. The threshold according to Youden's approach yielded a follow-up sensitivity of 62.5% and a potential saving of 62.1% of follow-up visits and €24.8 million in 5 years. When the threshold corresponding to 95% follow-up sensitivity was used, 17% of follow-up visits and €7 million were saved compared with the guidelines. Similar results were obtained by applying these thresholds to the testing cohort of 11 462 patients from 2007 to 2008. Compared with the observed utilization of follow-up, the potential cost-savings decline moderately. CONCLUSIONS Personalized follow-up schemes based on the INFLUENCE nomogram's individual risk estimations for breast cancer LRR could decrease the number of follow-up visits if one accepts a limited risk of delayed LRR detection.
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Affiliation(s)
- Teresa Draeger
- Tumor Center Regensburg/ University of Regensburg, Institute for Quality Control and Health Services Research, Regensburg, Germany; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Vinzenz Voelkel
- Tumor Center Regensburg/ University of Regensburg, Institute for Quality Control and Health Services Research, Regensburg, Germany; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - Miha Lavric
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Jeroen Veltman
- Department of Radiology, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands
| | - Anneriet Dassen
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Annemieke Witteveen
- Personalized eHealth Technology, University of Twente, Enschede, The Netherlands
| | - Gabe S Sonke
- Department Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
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Jansen L, Holleczek B, Kraywinkel K, Weberpals J, Schröder CC, Eberle A, Emrich K, Kajüter H, Katalinic A, Kieschke J, Nennecke A, Sirri E, Heil J, Schneeweiss A, Brenner H. Divergent Patterns and Trends in Breast Cancer Incidence, Mortality and Survival Among Older Women in Germany and the United States. Cancers (Basel) 2020; 12:cancers12092419. [PMID: 32858964 PMCID: PMC7565138 DOI: 10.3390/cancers12092419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Breast cancer treatment has changed tremendously over the last decades. In addition, the use of mammography screening for early detection has increased strongly. To evaluate the impact of these developments, long-term trends in incidence, mortality, stage distribution and survival were investigated for Germany and the United States (US). Methods: Using population-based cancer registry data, long-term incidence and mortality trends (1975–2015), shifts in stage distributions (1998–2015), and trends in five-year relative survival (1979–2015) were estimated. Additionally, trends in five-year relative survival after standardization for stage were explored (2004–2015). Results: Age-standardized breast cancer incidence rates were much higher in the US than in Germany in all periods, whereas age-standardized mortality began to lower in the US from the 1990s on. The largest and increasing differences were observed for patients aged 70+ years with a 19% lower incidence but 45% higher mortality in Germany in 2015. For this age group, large differences in stage distributions were observed, with 29% (Germany) compared to 15% (US) stage III and IV patients. Age-standardized five-year relative survival increased strongly between 1979–1983 and 2013–2015 in Germany (+17% units) and the US (+19% units) but was 9% units lower in German patients aged 70+ years in 2013–2015. This difference was entirely explained by differences in stage distributions. Conclusions: Overall, our results are in line with a later uptake and less extensive utilization of mammography screening in Germany. Further studies and efforts are highly needed to further explore and overcome the increased breast cancer mortality among elderly women in Germany.
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Affiliation(s)
- Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (J.W.); (C.C.S.); (H.B.)
- Correspondence:
| | | | - Klaus Kraywinkel
- German Centre for Cancer Registry Data (ZfKD), Robert Koch-Institute, 13353 Berlin, Germany;
| | - Janick Weberpals
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (J.W.); (C.C.S.); (H.B.)
| | - Chloé Charlotte Schröder
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (J.W.); (C.C.S.); (H.B.)
| | - Andrea Eberle
- Cancer Registry of Bremen, Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany;
| | - Katharina Emrich
- Cancer Registry of Rhineland-Palatinate, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, 55116 Mainz, Germany;
| | - Hiltraud Kajüter
- Cancer Registry of North Rhine-Westphalia, 44801 Bochum, Germany;
| | | | - Joachim Kieschke
- Cancer Registry of Lower Saxony, 26121 Oldenburg, Germany; (J.K.); (E.S.)
| | | | - Eunice Sirri
- Cancer Registry of Lower Saxony, 26121 Oldenburg, Germany; (J.K.); (E.S.)
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University Women’s Clinic, 69120 Heidelberg, Germany;
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Division Gynecologic Oncology, University Hospital and German Cancer Research Center, 69120 Heidelberg, Germany;
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (J.W.); (C.C.S.); (H.B.)
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center, 69120 Heidelberg, Germany
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Hübner J, Katalinic A, Waldmann A, Kraywinkel K. Long-term Incidence and Mortality Trends for Breast Cancer in Germany. Geburtshilfe Frauenheilkd 2020; 80:611-618. [PMID: 32565551 PMCID: PMC7299687 DOI: 10.1055/a-1160-5569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/17/2020] [Indexed: 10/27/2022] Open
Abstract
Introduction Changes in risk factors and the introduction of mammography screening in 2005 have led to dramatic changes in the breast cancer-associated burden of disease in Germany. This study aimed to investigate long-term disease-related incidence and mortality trends in women from East and West Germany since the reunification of Germany. Methods Total and stage-specific incidence rates were evaluated based on data obtained from selected cancer registries. Sufficiently complete data going back to 1995 were available for 4 East German and 3 West German regions. The figures were weighted for population size, and rates were calculated for the whole of Germany based on the rates for East and West Germany. The study particularly focused on 3 different age groups: women eligible for mammography screening (50 - 69 years), younger women (30 - 49 years) and older women (70+ years). All rates were standardised for age. The mortality rates obtained from the official statistics on cause of death since 1990 were processed accordingly. Results Incidence rates in the observation period increased, as they were affected by the increasing number of cases with early-stage cancers being diagnosed in the screening age group. The total incidence for this group, which included the incidence of non-invasive breast cancers, increased by 14.5% between 2005 and 2016. Early-stage cancers (UICC stages 0 and I) increased by 48.1% while late-stage diagnoses (UICC stages III and IV) decreased by 31.6%. Qualitatively similar changes were noted for the other age groups, although they were less pronounced. The decrease in breast cancer mortality observed since the mid-1990s ended around 2008 for the group of younger women but continued in the screening age group. After 2008, an increase in mortality was observed in the group of older women. The differences in disease burden between East and West Germany (in favour of East Germany) decreased in younger women during the observation period but tended to increase in the group of older women. Conclusion The analysis suggests that the introduction of mammography screening contributed to a decrease in the incidence of advanced-stage breast cancers and in breast cancer-related mortality rates but also resulted in a substantial number of overdiagnoses. The relatively unfavourable incidence trend in the group of younger women, particularly in East Germany, should be interpreted in the context of lifestyle changes. The slight increase in mortality observed in the group of older women after 2008 requires further analysis.
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Affiliation(s)
- Joachim Hübner
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Alexander Katalinic
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.,Institute for Cancer Epidemiology, University of Lübeck, Lübeck, Germany
| | - Annika Waldmann
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.,Hamburg Cancer Registry, Hamburg, Germany
| | - Klaus Kraywinkel
- German Centre for Cancer Registry Data (ZfKD), Robert Koch Institute, Berlin, Germany
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The intra-tumoural stroma in patients with breast cancer increases with age. Breast Cancer Res Treat 2019; 179:37-45. [PMID: 31535319 PMCID: PMC6985058 DOI: 10.1007/s10549-019-05422-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/24/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE The tumour microenvironment in older patients is subject to changes. The tumour-stroma ratio (TSR) was evaluated in order to estimate the amount of intra-tumoural stroma and to evaluate the prognostic value of the TSR in older patients with breast cancer (≥ 70 years). METHODS Two retrospective cohorts, the FOCUS study (N = 619) and the Nottingham Breast Cancer series (N = 1793), were used for assessment of the TSR on haematoxylin and eosin stained tissue slides. RESULTS The intra-tumoural stroma increases with age in the FOCUS study and the Nottingham Breast Cancer series (B 0.031, 95% CI 0.006-0.057, p = 0.016 and B 0.034, 95% CI 0.015-0.054, p < 0.001, respectively). Fifty-one per cent of the patients from the Nottingham Breast Cancer series < 40 years had a stroma-high tumour compared to 73% of the patients of ≥ 90 years from the FOCUS study. The TSR did not validate as an independent prognostic parameter in patients ≥ 70 years. CONCLUSIONS The intra-tumoural stroma increases with age. This might be the result of an activated tumour microenvironment. The TSR did not validate as an independent prognostic parameter in patients ≥ 70 years in contrast to young women with breast cancer as published previously.
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Kocik J, Pajączek M, Kryczka T. Worse survival in breast cancer in elderly may not be due to underutilization of medical procedures as observed upon changing healthcare system in Poland. BMC Cancer 2019; 19:749. [PMID: 31362702 PMCID: PMC6668291 DOI: 10.1186/s12885-019-5930-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 07/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background Evidence is emerging that older women may tolerate breast cancer therapies equally well as the young ones, providing that they receive good supportive care. It has also been reported that these patients remain outside the current therapeutic standards. The aim of this observational study was to assess the access of breast cancer patients to medical procedures. Methods We retrospectively reviewed a database of breast cancer patients registered in the National Cancer Registry in Poland, searching for the numbers of new cases and deaths in the years 2010–2015. We obtained the numbers and costs of key medical procedures provided for these patients from the National Health Fund in Poland. Breast cancer survival in the years 2010–2015 was estimated based on the mortality/incidence ratio. The t-Student test and Spearman correlation coefficient were used for the analysis of data obtained from both databases. Results There was no increase in survival throughout the years 2010–2015 in both analysed subpopulations of all breast cancer patients below and over 65 years of age, despite an unprecedented rise in healthcare funding in Poland. We noted 37% lower probability of 5-year survival in patients older than 65 years. The average number of outpatient visits and surgical procedures per person per year were slightly, yet significantly (p < 0.01), higher in younger vs. older patients (3.9 vs. 3.4 and 1.18 vs. 1.02, respectively). Outpatient chemotherapy was more common in older patients (6.0 vs. 5.25 cycles a year per person on average, p < 0.01). There were no significant differences in the average numbers of hospitalisations for chemotherapy, frequencies of radiotherapy and in the use of targeted therapy programmes (calculated per person per year), between younger and older patients. Conclusions Older women with breast cancer are treated similarly to younger patients, but have significantly worse chances to survive breast cancer in Poland. A simple increase in healthcare financing will not improve the survival in the elderly with breast cancer without developing funded individualised care and survivorship programmes. Electronic supplementary material The online version of this article (10.1186/s12885-019-5930-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Janusz Kocik
- Gerontooncology Department, School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland.
| | | | - Tomasz Kryczka
- Department of Development of Nursing & Medical Sciences, Medical University of Warsaw, Warsaw, Poland.,Department of Experimental Pharmacology, Mosakowski Medical Research Center of Polish Academy of Science, Warsaw, Poland
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10
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Müller D, Danner M, Schmutzler R, Engel C, Wassermann K, Stollenwerk B, Stock S, Rhiem K. Economic modeling of risk-adapted screen-and-treat strategies in women at high risk for breast or ovarian cancer. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:739-750. [PMID: 30790097 DOI: 10.1007/s10198-019-01038-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The 'German Consortium for Hereditary Breast and Ovarian Cancer' (GC-HBOC) offers women with a family history of breast and ovarian cancer genetic counseling. The aim of this modeling study was to evaluate the cost-effectiveness of genetic testing for BRCA 1/2 in women with a high familial risk followed by different preventive interventions (intensified surveillance, risk-reducing bilateral mastectomy, risk-reducing bilateral salpingo-oophorectomy, or both mastectomy and salpingo-oophorectomy) compared to no genetic test. METHODS A Markov model with a lifelong time horizon was developed for a cohort of 35-year-old women with a BRCA 1/2 mutation probability of ≥ 10%. The perspective of the German statutory health insurance (SHI) was adopted. The model included the health states 'well' (women with increased risk), 'breast cancer without metastases', 'breast cancer with metastases', 'ovarian cancer', 'death', and two post (non-metastatic) breast or ovarian cancer states. Outcomes were costs, quality of life years gained (QALYs) and life years gained (LYG). Important data used for the model were obtained from 4380 women enrolled in the GC-HBOC. RESULTS Compared with the no test strategy, genetic testing with subsequent surgical and non-surgical treatment options provided to women with deleterious BRCA 1 or 2 mutations resulted in additional costs of €7256 and additional QALYs of 0,43 (incremental cost-effectiveness ratio of €17,027 per QALY; cost per LYG: €22,318). The results were robust in deterministic and probabilistic sensitivity analyses. CONCLUSION The provision of genetic testing to high-risk women with a BRCA1 and two mutation probability of ≥ 10% based on the individual family cancer history appears to be a cost-effective option for the SHI.
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Affiliation(s)
- Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Marion Danner
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Straße 34, 50931, Cologne, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | - Kirsten Wassermann
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Straße 34, 50931, Cologne, Germany
| | - Björn Stollenwerk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Straße 34, 50931, Cologne, Germany
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11
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Predicting the risk of locoregional recurrence after early breast cancer: an external validation of the Dutch INFLUENCE-nomogram with clinical cancer registry data from Germany. J Cancer Res Clin Oncol 2019; 145:1823-1833. [PMID: 30927074 PMCID: PMC6571079 DOI: 10.1007/s00432-019-02904-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/22/2019] [Indexed: 12/13/2022]
Abstract
Purpose Follow-up after breast cancer treatment aims for an early detection of locoregional breast cancer recurrences (LRR) to improve the patients’ outcome. By estimating individual’s 5-year recurrence-risks, the Dutch INFLUENCE-nomogram can assist health professionals and patients in developing personalized risk-based follow-up pathways. The objective of this study is to validate the prediction tool on non-Dutch patients. Material and methods Data for this external validation derive from a large clinical cancer registry in southern Germany, covering a population of 1.1 million. Patients with curative resection of early-stage breast cancer, diagnosed between 2000 and 2012, were included in the analysis (n = 6520). For each of them, an individual LRR-risk was estimated by the INFLUENCE-nomogram. Its predictive ability was tested by comparing estimated and observed LRR-probabilities using the Hosmer–Lemeshow goodness-of-fit test and C-statistics. Results In the German validation-cohort, 2.8% of the patients developed an LRR within 5 years after primary surgery (n = 184). While the INFLUENCE-nomogram generally underestimates the actual LRR-risk of the German patients (p < 0.001), its discriminative ability is comparable to the one observed in the original Dutch modeling-cohort (C-statistic German validation-cohort: 0.73, CI 0.69–0.77 vs. C-statistic Dutch modeling-cohort: 0.71, CI 0.69–0.73). Similar results were obtained in most of the subgroup analyses stratified by age, type of surgery and intrinsic biological subtypes. Conclusion The outcomes of this external validation underline the generalizability of the INFLUENCE-nomogram beyond the Dutch population. The model performance could be enhanced in future by incorporating additional risk factors for LRR.
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12
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Derks MGM, Bastiaannet E, Kiderlen M, Hilling DE, Boelens PG, Walsh PM, van Eycken E, Siesling S, Broggio J, Wyld L, Trojanowski M, Kolacinska A, Chalubinska-Fendler J, Gonçalves AF, Nowikiewicz T, Zegarski W, Audisio RA, Liefers GJ, Portielje JEA, van de Velde CJH. Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group. Br J Cancer 2018; 119:121-129. [PMID: 29875471 PMCID: PMC6035184 DOI: 10.1038/s41416-018-0090-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/23/2018] [Accepted: 03/28/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Older patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival. METHODS Population-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. Proportions of local and systemic treatments, five-year relative survival and relative excess risks (RER) between countries were calculated. RESULTS In total, 236,015 patients were included. The proportion of stage I BC receiving endocrine therapy ranged from 19.6% (Netherlands) to 84.6% (Belgium). The proportion of stage III BC receiving no breast surgery varied between 22.0% (Belgium) and 50.8% (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95%CI 1.30-6.72, P < .001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium. CONCLUSIONS There is substantial variation in treatment strategies and survival outcomes in elderly with BC in Europe. For early-stage BC, we observed large variation in endocrine therapy but no variation in relative survival, suggesting potential overtreatment. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment.
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Affiliation(s)
- Marloes G M Derks
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.,Department of Gerontology & Geriatrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Mandy Kiderlen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Denise E Hilling
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Petra G Boelens
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Paul M Walsh
- National Cancer Registry of Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, T12 CDF7, Ireland
| | | | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, Utrecht, 3511 DT, The Netherlands
| | - John Broggio
- Public Health England, 5 St Philip's Place, Birmingham, B3 2PW, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Western Bank, Sheffield, S10 2TN, UK
| | - Maciej Trojanowski
- Greater Poland Cancer Registry, Greater Poland Cancer Center, Garbary 15, Poznań, 60-101, Poland
| | - Agnieszka Kolacinska
- Department of Head and Neck Cancer Surgery, Department of Surgical Oncology, Medical University of Lodz, Kościuszki 4, Łódź, 90-419, Poland
| | | | - Ana Filipa Gonçalves
- Portuguese Oncology Institute of Porto, R. Dr. António Bernardino de Almeida 62, Porto, 4200-162, Portugal
| | - Tomasz Nowikiewicz
- Department of Surgical Oncology, Ludwik Rydygier's Collegium Medicum, Jagiellońska 13-15, Bydgoszcz, 85-067, Poland
| | - Wojciech Zegarski
- Department of Surgical Oncology, Ludwik Rydygier's Collegium Medicum, Jagiellońska 13-15, Bydgoszcz, 85-067, Poland
| | - Riccardo A Audisio
- Department of Surgery, St Helens Teaching Hospital, University of Liverpool, Marshalls Cross Rd, Saint Helens, St Helens, WA9 3DA, UK
| | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Johanneke E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Cornelis J H van de Velde
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
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Abstract
This article presents the current status of the implementation of clinical cancer registration across all German federal states that started in 2013 and that is basis for setting up comprehensive clinical and population-based cancer registries (CRs). A nationwide definition of relevant cancers, a common model of passive registration, a standard basic set of data items as well as a sustainable funding are prerequisites for a standardized collection of cancer data in Germany. For the collected information, the tools and methods used for data collection and processing, for statistical analyses and reporting, the potential synergies of a comprehensive CR implementing the tasks of both a clinical CR and a population-based CR become evident. Many different tasks of clinical and population-based CRs have already been implemented in Germany. This includes usage of individual patient data for quality assurance and the certification of cancer centers or comparative analyses on the adherence to guideline recommendations. CRs further provided unselected data on the cancer burden in the underlying populations and actively contribute in a variety of ways to many collaborative research projects on cancer etiology, the effectiveness of screening programs or cancer care, or provide patient or outcome data for clinical or population-based studies. Although many tasks of clinical and population-based CRs have already been implemented, a number of great efforts still lay ahead. Major challenges include the harmonization of data collection, the development of required standards and methods for data processing and usage, but first and foremost, the collection of complete and valid data for the different tasks of comprehensive CRs.
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14
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Müller D, Danner M, Rhiem K, Stollenwerk B, Engel C, Rasche L, Borsi L, Schmutzler R, Stock S. Cost-effectiveness of different strategies to prevent breast and ovarian cancer in German women with a BRCA 1 or 2 mutation. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:341-353. [PMID: 28382503 DOI: 10.1007/s10198-017-0887-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 03/14/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND Women with a BRCA1 or BRCA2 mutation are at increased risk of developing breast and/or ovarian cancer. This economic modeling study evaluated different preventive interventions for 30-year-old women with a confirmed BRCA (1 or 2) mutation. METHODS A Markov model was developed to estimate the costs and benefits [i.e., quality-adjusted life years (QALYs), and life years gained (LYG)] associated with prophylactic bilateral mastectomy (BM), prophylactic bilateral salpingo-oophorectomy (BSO), BM plus BSO, BM plus BSO at age 40, and intensified surveillance. Relevant input data was obtained from a large German database including 5902 women with BRCA 1 or 2, and from the literature. The analysis was performed from the German Statutory Health Insurance (SHI) perspective. In order to assess the robustness of the results, deterministic and probabilistic sensitivity analyses were performed. RESULTS With costs of €29,434 and a gain in QALYs of 17.7 (LYG 19.9), BM plus BSO at age 30 was less expensive and more effective than the other strategies, followed by BM plus BSO at age 40. Women who were offered the surveillance strategy had the highest costs at the lowest gain in QALYs/LYS. In the probabilistic sensitivity analysis, the probability of cost-saving was 57% for BM plus BSO. At a WTP of 10,000 € per QALY, the probability of the intervention being cost-effective was 80%. CONCLUSIONS From the SHI perspective, undergoing BM plus immediate BSO should be recommended to BRCA 1 or 2 mutation carriers due to its favorable comparative cost-effectiveness.
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Affiliation(s)
- Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Marion Danner
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, The University Hospital of Cologne (AöR), Kerpener Straße 34, 50931, Cologne, Germany
| | - Björn Stollenwerk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | - Linda Rasche
- Department of Controlling, The University Hospital of Cologne (AöR), Kerpener Straße 62, 50937, Cologne, Germany
| | - Lisa Borsi
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, The University Hospital of Cologne (AöR), Kerpener Straße 34, 50931, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
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15
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Brantley KD, Kjærsgaard A, Cronin-Fenton D, Yacoub R, Nielsen AS, Lauridsen KL, Hamilton-Dutoit S, Lash TL. Stanniocalcin Expression as a Predictor of Late Breast Cancer Recurrence. Cancer Epidemiol Biomarkers Prev 2018; 27:653-659. [PMID: 29593009 DOI: 10.1158/1055-9965.epi-17-0905] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/12/2017] [Accepted: 03/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Expression of human paracrine hormones stanniocalcin 1 (STC1) and stanniocalcin 2 (STC2) may potentiate late breast cancer recurrence. We tested the hypothesis that expression of STC1 and STC2 in primary breast tumors is more strongly associated with late versus early recurrences.Methods: A total of 541 estrogen receptor-positive, tamoxifen-treated (ER+/TAM+) and 300 ER-negative, tamoxifen-untreated (ER-/TAM-) breast cancer patients who experienced recurrence within 10 years of primary diagnosis and matched recurrence-free controls were selected from a cohort of 11,251 Danish breast cancer patients diagnosed with stage I, II, or III breast cancer during 1985 to 2001. The association between IHC expression of STC1 and STC2 in primary breast tumor tissue microarrays and breast cancer recurrence was evaluated within median time to recurrence quintiles.Results: The association between STC1 expression, dichotomized as positive or negative, and recurrence was strongly positive for the final time quintile (6-10 years postdiagnosis) in the ER+/TAM+ group [aOR = 2.70; 95% confidence interval (CI): 1.22-5.98]. Regression of the log ORs relating dichotomous STC1 and STC2 expression to recurrence by median time to recurrence (year) resulted in a relatively large positive effect estimate for STC1 (β = 0.16; 95% CI, -0.03-0.36) and a near-null positive effect estimate for STC2 (β = 0.04; 95% CI, -0.14-0.21).Conclusions: Our results suggest a stronger association between primary tumor STC1 expression and late recurrence, as opposed to early recurrence, although no clear trend was apparent.Impact: STC1 expression in the primary tumor may potentiate late recurrences, suggesting dormancy pathways that merit further investigation. Cancer Epidemiol Biomarkers Prev; 27(6); 653-9. ©2018 AACR.
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Affiliation(s)
- Kristen D Brantley
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Rami Yacoub
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Anja S Nielsen
- Institute of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Winship Cancer Institute, Atlanta, Georgia
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16
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Mohar-Betancourt A, Alvarado-Miranda A, Torres-Domínguez JA, Cabrera P, Lara Medina F, Villarreal-Gómez YS, Reynoso-Noverón N. Factores pronósticos en pacientes con cáncer de mama y metástasis cerebral como primer sitio de recurrencia. ACTA ACUST UNITED AC 2018; 60:141-150. [DOI: 10.21149/9082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/11/2018] [Indexed: 01/08/2023]
Abstract
Objetivo. Evaluar los factores pronósticos (características clínico-patológicas y tratamientos) en las pacientes con cáncer de mama y metástasis al sistema nervioso central (SNC) como primer sitio de afección. Material y métodos. Cohorte retrospectiva, formada por 125 pacientes con cáncer de mama atendidas en el Instituto Nacional de Cancerología durante 2007-2015, quienes presentaron afección en el SNC como primer sitio de metástasis. A través del método Kaplan-Meier y tablas de vida se estimó la supervivencia global. El modelo de riesgos proporcionales de Cox fue utilizado para determinar los factores pronósticos. Resultados. La mediana de supervivencia global fue de 14.2 meses (IC95% 11.8-26.9). Pacientes clasificadas por inmunohistoquímica como triple negativo (TN) presentaron tiempos de supervivencia más cortos (p<0.004) y con dos veces más riesgo de fallecer, en comparación con los otros inmunofenotipos (HR= 2.77; IC95% 1.10-6.99); asimismo, se identificó que un grado intermedio en la escala Scarff-Bloom-Richardson incrementa el riesgo de morir en pacientes con metástasis (HR=2.76; IC95% 1.17- 6.51). Conclusiones. La metástasis al SNC continúa siendo un factor de mal pronóstico que reduce la supervivencia y afecta la calidad de vida. Se recomienda vigilar puntualmente la presencia de manifestaciones clínicas neurológicas durante el seguimiento, para una rápida intervención. Las pacientes TN tienen peor pronóstico, y las HER2+ (es decir, con resultado positivo para el receptor 2 del factor de crecimiento humano epidérmico), mejor control a mediano plazo.
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17
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Yoshimura A, Ito H, Nishino Y, Hattori M, Matsuda T, Miyashiro I, Nakayama T, Iwata H, Matsuo K, Tanaka H, Ito Y. Recent Improvement in the Long-term Survival of Breast Cancer Patients by Age and Stage in Japan. J Epidemiol 2018; 28:420-427. [PMID: 29479003 PMCID: PMC6143379 DOI: 10.2188/jea.je20170103] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Recent improvements in 5-year survival of breast cancer have been reported in Japan and other countries. Though the number of long-term breast cancer survivors has been increasing, recent improvements in 10-year survival have not been reported. Moreover, the degree of improvement according to age and disease stage remains unclear. Methods We calculated long-term survival using data on breast cancer diagnosed from 1993 through 2006 from six prefectural population-based cancer registries in Japan. The recent increase in 10-year relative survival was assessed by comparing the results of period analysis in 2002–2006 with the results of cohort analysis in 1993–1997. We also conducted stratified analyses by age group (15–34, 35–49, 50–69, and 70–99 years) and disease stage (localized, regional, and distant). Results A total of 63,348 patients were analysed. Ten-year relative survival improved by 2.4% (76.9% vs 79.3%) from 1993 through 2006. By age and stage, 10-year relative survival clearly improved in the age 35–49 years (+2.9%; 78.1% vs 81.0%), 50–69 years (+2.8%; 75.2% vs 78.0%) and regional disease (+3.4%; 64.9% vs 68.3%). In contrast, the degree of improvement was small in the age 15–34 years (+0.1%; 68.2% vs 68.3%), 70–99 years (+1.0%; 87.6% vs 88.6%), localized disease (+1.1%; 92.6% vs 93.7%) and distant metastasis (+0.9%; 13.8% vs 14.7%). Conclusions These population-based cancer registry data show that 10-year relative survival improved 2.4% over this period in Japan. By age and stage, improvement in the age 15–34 years and distant metastasis was very small, which suggests the need for new therapeutic strategies in these patients.
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Affiliation(s)
- Akiyo Yoshimura
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Research Institute.,Department of Breast Oncology, Aichi Cancer Center Hospital.,Department of Epidemiology, Nagoya University Graduate School of Medicine
| | - Hidemi Ito
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Research Institute.,Department of Epidemiology, Nagoya University Graduate School of Medicine.,Division of Epidemiology & Prevention, Aichi Cancer Research Institute
| | - Yoshikazu Nishino
- Department of Epidemiology and Public Health, Kanazawa Medical University
| | | | - Tomohiro Matsuda
- Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center
| | - Isao Miyashiro
- Department of Cancer Strategy, Cancer Control Center, Osaka International Cancer Institute
| | - Tomio Nakayama
- Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital
| | - Keitaro Matsuo
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Research Institute.,Department of Epidemiology, Nagoya University Graduate School of Medicine
| | - Hideo Tanaka
- Division of Epidemiology & Prevention, Aichi Cancer Research Institute
| | - Yuri Ito
- Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute
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18
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Fallahpour S, Navaneelan T, De P, Borgo A. Breast cancer survival by molecular subtype: a population-based analysis of cancer registry data. CMAJ Open 2017; 5:E734-E739. [PMID: 28951445 PMCID: PMC5621954 DOI: 10.9778/cmajo.20170030] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The relation between breast cancer molecular subtype and survival has been studied in several jurisdictions, but limited information is available for Ontario. The aim of this study was to determine breast cancer survival by molecular subtype and to assess the effect on survival of selected demographic and tumour-based characteristics. METHODS We extracted 29 833 breast cancer cases (in 26 538 girls and women aged ≥ 15 yr) diagnosed between 2010 and 2012 from the Ontario Cancer Registry. Cancers were categorized into 4 molecular subtypes: 1) luminal A (estrogen-receptor-positive and/or progesterone-receptor-positive [ER+ and/or PR+] and negative for human epidermal growth factor receptor 2 [HER2-]), 2) luminal B (ER+ and/or PR+/HER2+), 3) HER2-enriched (ER- and PR-/HER2+) and 4) triple-negative (ER- and PR-/HER2-). We estimated associations with predictor variables (age, stage at diagnosis, histologic type, comorbidity and place of residence [urban or rural]) using a multivariate Cox proportional hazards model. Likelihood ratio testing was used to evaluate differences in risk of death. RESULTS Luminal A was the most commonly diagnosed subtype (59.0%) and had the greatest survival, whereas triple-negative had the poorest survival. For all subtypes, a dose-response effect was observed between the hazard of death and age and stage at diagnosis, with the greatest effect found for the HER2-enriched subtype (age: hazard ratio [HR] 7.87 [95% confidence interval (CI) 3.68-11.81]; stage at diagnosis: HR 37.71 [95% CI 34.64-41.27]). Moderate comorbidity (Charlson Comorbidity Index score 1 or 2) was associated with increased risk of death for triple-negative cancers (HR 2.42 [95% CI 1.36-4.31]), and severe comorbidity (Charlson Comorbidity Index score ≥ 3) increased the risk for all molecular subtypes. INTERPRETATION The results indicate the importance of including molecular subtype, along with age, stage at diagnosis and comorbidity, in assessing breast cancer survival. They highlight the need to address outcomes related to hormone-receptor-negative cancers, for which survival lags behind that for hormone-receptor-positive cancers.
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Affiliation(s)
- Saber Fallahpour
- Affiliations: Surveillance and Cancer Registry (Fallahpour, Navaneelan, De) and ColonCancerCheck and Gastrointestinal Endoscopy (Borgo), Cancer Care Ontario, Toronto, Ont
| | - Tanya Navaneelan
- Affiliations: Surveillance and Cancer Registry (Fallahpour, Navaneelan, De) and ColonCancerCheck and Gastrointestinal Endoscopy (Borgo), Cancer Care Ontario, Toronto, Ont
| | - Prithwish De
- Affiliations: Surveillance and Cancer Registry (Fallahpour, Navaneelan, De) and ColonCancerCheck and Gastrointestinal Endoscopy (Borgo), Cancer Care Ontario, Toronto, Ont
| | - Alessia Borgo
- Affiliations: Surveillance and Cancer Registry (Fallahpour, Navaneelan, De) and ColonCancerCheck and Gastrointestinal Endoscopy (Borgo), Cancer Care Ontario, Toronto, Ont
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Lodi M, Scheer L, Reix N, Heitz D, Carin AJ, Thiébaut N, Neuberger K, Tomasetto C, Mathelin C. Breast cancer in elderly women and altered clinico-pathological characteristics: a systematic review. Breast Cancer Res Treat 2017; 166:657-668. [PMID: 28803352 DOI: 10.1007/s10549-017-4448-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/07/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Breast cancer is the most common malignancy in women in terms of incidence and mortality. Age is undoubtedly the biggest breast cancer risk factor. In this study we examined clinical, histological, and biological characteristics and mortality of breast cancer in elderly women along with their changes with advancing age. METHODS We reviewed 63 original articles published between 2006 and 2016 concerning women over 70 years with breast cancer. RESULTS Compared to patients 70-79 years, patients aged 80 and over had larger tumor size with fewer T1 (42.9% vs 57.7%, p < 0.01) and more T2 lesions (43.5% vs 33.0%, p < 0.01). Lymph nodes and distant metastases were more frequent, with more N + (49.5% vs 44.0%, p < 0.01) and more M1 (8.0% vs 5.9%, p < 0.01). Infiltrating mucinous carcinomas were more frequent (4.3% vs 3.7%, p < 0.01). Tumors had lower grades, with more grade 1 (23.2% vs 19.8%, p = 0.01) and fewer grade 3 (21.5% vs 25.5%, p < 0.01), and were more hormone-sensitive: PR was more often expressed (72.6% vs 67.3%, p < 0.01). Lympho-vascular invasion was less frequent in the 80 years and over (22.9% vs 29.7%, p = 0.01). Breast cancer-specific mortality was higher both at 5 years (25.8% vs 17.2%, p < 0.01) and 10 years (32.7% vs 26.6%, p < 0.01). CONCLUSION Clinico-pathological characteristics, increased incidence, and mortality associated with aging can be explained on one hand by biological changes of the breast such as increased estrogen sensitivity, epithelial cell alterations, immune senescence, and tumor microenvironment modifications. However, sociologic factors such as increased life expectancy, under-treatment, late diagnosis, and insufficient individual screening, are also involved.
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Affiliation(s)
- M Lodi
- Senology Unit, Strasbourg University Hospital, Hôpital de Hautepierre 1, Avenue Molière, 67200, Strasbourg, France.
| | - L Scheer
- Senology Unit, Strasbourg University Hospital, Hôpital de Hautepierre 1, Avenue Molière, 67200, Strasbourg, France
| | - N Reix
- ICube, UMR 7357, Strasbourg University/CNRS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 300 Boulevard Sébastien Brant, 67400, Illkirch-Graffenstaden, France.,Biochemistry and Molecular Biology Laboratory, Strasbourg University Hospital, 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - D Heitz
- Onco-geriatric Unit, Strasbourg University Hospital, 1 Avenue Molière, 67200, Strasbourg, France
| | - A-J Carin
- Gynecology Department, Haguenau General Hospital, 64 Avenue du Professeur Leriche, 67504, Haguenau, France
| | - N Thiébaut
- Quantmetry, 128 rue du Faubourg Saint-Honoré, 75008, Paris, France
| | - K Neuberger
- Quantmetry, 128 rue du Faubourg Saint-Honoré, 75008, Paris, France
| | - C Tomasetto
- Institue de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), CNRS, UMR7104 INSERM U964, 1 rue Laurent Fries, 67400, Illkirch-Graffenstaden, France
| | - C Mathelin
- Senology Unit, Strasbourg University Hospital, Hôpital de Hautepierre 1, Avenue Molière, 67200, Strasbourg, France.,Institue de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), CNRS, UMR7104 INSERM U964, 1 rue Laurent Fries, 67400, Illkirch-Graffenstaden, France.,Hôpital Saint Nicolas, Sarrebourg General Hospital, 25 Avenue du Général de Gaulle, 57400, Sarrebourg, France
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20
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Chen JG, Zhu J, Zhang YH, Zhang YX, Yao DF, Chen YS, Lu JH, Ding LL, Chen HZ, Zhu CY, Yang LP, Zhu YR, Qiang FL. Cancer survival in Qidong between 1972 and 2011: A population-based analysis. Mol Clin Oncol 2017; 6:944-954. [PMID: 28588795 PMCID: PMC5451853 DOI: 10.3892/mco.2017.1234] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 03/07/2017] [Indexed: 01/07/2023] Open
Abstract
Population-based cancer survival is an improved index for evaluating the overall efficiency of cancer health services in a given region. The current study analysed the observed survival and relative survival of leading cancer sites from a population-based cancer registry between 1972 and 2011 in Qidong, China. A total of 92,780 incident cases with cancer were registered and followed-up for survival status. The main sites of the cancer types, based on the rank order of incidence, were the liver, stomach, lung, colon and rectum, oesophagus, breast, pancreas, leukaemia, brain and central nervous system (B and CNS), bladder, blood [non-Hodgkin's lymphoma (NHL)] and cervix. For all malignancies combined, the 5-year observed survival was 13.18% and the relative survival was 15.80%. Females had higher observed survival and relative survival (19.32 and 22.71%, respectively) compared with males (9.63 and 11.68%, respectively). The cancer sites with the highest five-year relative survival rates were the female breast, bladder, cervix and colon and rectum; followed by NHL, stomach, B and CNS cancer and leukaemia. The poorest survival rates were cancers of oesophagus, lung, pancreas and liver. Higher survival rates were observed in younger patients compared with older patients. Cancers of the oesophagus, female breast and bladder were associated with higher survival in middle-aged groups. Improved survival rates in the most recent two 5-year calendar periods were identified for stomach, lung, colon and rectum, oesophagus, female breast and bladder cancer, as well as leukaemia and NHL. The observations of the current study provide the opportunity for evaluation of the survival outcomes of frequent cancer sites that reflects the changes and improvement in a rural area in China.
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Affiliation(s)
- Jian-Guo Chen
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
- Nantong University Tumour Hospital/Institute, Nantong, Jiangsu 226361, P.R. China
| | - Jian Zhu
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
| | - Yong-Hui Zhang
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
| | - Yi-Xin Zhang
- Nantong University Tumour Hospital/Institute, Nantong, Jiangsu 226361, P.R. China
| | - Deng-Fu Yao
- Affiliated Hospital of Nantong University, Nantong, Jiangsu 226000, P.R. China
| | - Yong-Sheng Chen
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
| | - Jian-Hua Lu
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
| | - Lu-Lu Ding
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
| | - Hai-Zhen Chen
- Nantong University Tumour Hospital/Institute, Nantong, Jiangsu 226361, P.R. China
| | - Chao-Yong Zhu
- Nantong University Tumour Hospital/Institute, Nantong, Jiangsu 226361, P.R. China
| | - Li-Ping Yang
- Nantong University Tumour Hospital/Institute, Nantong, Jiangsu 226361, P.R. China
| | - Yuan-Rong Zhu
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
| | - Fu-Lin Qiang
- Nantong University Tumour Hospital/Institute, Nantong, Jiangsu 226361, P.R. China
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Peters E, Anzeneder T, Jackisch C, Dimpfl T, Kunz G, Katalinic A, Waldmann A. The Treatment of Primary Breast Cancer in Older Women With Adjuvant Therapy: A Retrospective Analysis of Data From Over 3000 Patients From the PATH Biobank, With Two-Year Follow-up. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:577-84. [PMID: 26377529 DOI: 10.3238/arztebl.2015.0577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/02/2015] [Accepted: 06/02/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer in women in Germany. Mortality from breast cancer has declined over the past 15 years, but less so in women aged 70 or older than in younger women. The discrepancy might be explained by age-related differences in treatment. METHODS Data from the Patients' Tumor Bank of Hope (PATH) database of women who underwent adjuvant treatment for the treatment of an invasive primary tumor without distant metastases (year of diagnosis, 2006-2011) were retrospectively analyzed. The clinical and tumor-biological findings and treatment data over two years of follow-up were compared across three age groups (under age 50, ages 50 to 69, and ages 70 and up). Chi-square tests were carried out to reveal significant differences, and post-hoc multiple comparisons were performed with and without Bonferroni correction. Treatment data were adjusted for staging and grading and tested for age-dependence with logistic regression. RESULTS Follow-up data were available for 3257 (65% ) of 4981 women, of whom 61% were in the middle age group and 22% in the oldest. Compared to women aged 50 to 69, those aged 70 and up less commonly received breast-conserving treatment (68.8% vs. 86.4% ), chemotherapy (27.5% vs. 44.1% ), radiotherapy (81.8% vs. 92.4% ), and trastuzumab (52.9% vs. 79.3% ; p<0.001 for all differences). All differences remained significant after stastistical adjustment. CONCLUSION The cause of these age-related differences is unclear. It cannot be determined from these data whether concomitant disease, the older patients' individual decisions, or other factors were responsible for their not receiving treatment as often as the younger patients did.
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Affiliation(s)
- Elke Peters
- Institute of Social Medicine and Epidemiology, University Medical Center, Lübeck, PATH Biobank, Augsburg, Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Department of Obstetrics and Gynecology, Klinikum Kassel, Department of Obstetrics and Gynecology, St. Johannes Hospital, Dortmund, Institute for Cancer Epidemiology e.V., University of Lübeck
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Rack B, Jückstock J, Trapp E, Weissenbacher T, Alunni-Fabbroni M, Schramm A, Widschwendter P, Lato K, Zwingers T, Lorenz R, Tesch H, Schneeweiss A, Fasching P, Mahner S, Beckmann MW, Lichtenegger W, Janni W. CA27.29 as a tumour marker for risk evaluation and therapy monitoring in primary breast cancer patients. Tumour Biol 2016; 37:13769-13775. [PMID: 27481512 DOI: 10.1007/s13277-016-5171-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/12/2016] [Indexed: 11/26/2022] Open
Abstract
Several trials showed that tumour markers are associated with an impaired prognosis for breast cancer. Whether earlier treatment can improve the course of the disease remains controversial. The SUCCESS Trial compares FEC (500/100/500)-docetaxel (100) vs. FEC (500/100/500)-docetaxel/gemcitabine (75/2000) as well as 2 vs. 5 years of zoledronate in high-risk primary breast cancer patients. In 2669 patients, CA27.29 was measured before and after chemotherapy with the ST AIA-PACK CA27.29 reagent for the AIA-600II automated enzyme immunoassay (Tosoh Bioscience, Belgium). Values above 31 U/ml were considered positive. Of the patients, 7.6 % (n = 202, mean 19, range 3-410) and 19.1 % (n = 511, mean 21, range 3-331) had elevated marker levels before and after chemotherapy, respectively. Of the patients, 4.9 and 78 % showed elevated and low CA27.29, respectively, at both time points. After treatment, 35 % of the pre-therapy positive patients were negative, and 15 % of the initially negative patients became positive. The correlation between both time points was significant (p < 0.0001). No correlations among nodal status, grading, hormonal status, HER2 status and CA27.29 levels were found. However, tumour size (p = 0.02), older age (p < 0.001) and post-menopausal status (p = 0.006) were significantly associated with higher CA27.29 levels. Before treatment, the prevalence of elevated CA27.29 was equally distributed between both treatment arms, whereas after chemotherapy, 13.7 % of the patients in the FEC-doc arm showed an increased level vs. 25.4 % of the patients in the FEC-doc/gemcitabine arm (p < 0.0001). However, we could not show a significant association between the G-CSF application (yes vs. no) and CA27.29 status before/after chemotherapy (p = 0.75). These results indicate a close relationship between CA27.29 levels and tumour mass. Increased values after the completion of chemotherapy might be attributed to treatment effects and should be considered with caution.
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MESH Headings
- Adult
- Aged
- Antigens, Tumor-Associated, Carbohydrate/blood
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/blood
- Breast Neoplasms/blood
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/secondary
- Chemotherapy, Adjuvant
- Female
- Follow-Up Studies
- Humans
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Staging
- Prognosis
- Prospective Studies
- Risk Assessment
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Affiliation(s)
- Brigitte Rack
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe Campus Innenstadt, Ludwig-Maximilians-Universitaet Muenchen, Maistr. 11, 80337, Munich, Germany.
| | - Julia Jückstock
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe Campus Innenstadt, Ludwig-Maximilians-Universitaet Muenchen, Maistr. 11, 80337, Munich, Germany
| | - Elisabeth Trapp
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe Campus Innenstadt, Ludwig-Maximilians-Universitaet Muenchen, Maistr. 11, 80337, Munich, Germany
| | - Tobias Weissenbacher
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe Campus Innenstadt, Ludwig-Maximilians-Universitaet Muenchen, Maistr. 11, 80337, Munich, Germany
| | - Marianna Alunni-Fabbroni
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe Campus Innenstadt, Ludwig-Maximilians-Universitaet Muenchen, Maistr. 11, 80337, Munich, Germany
| | - Amelie Schramm
- Universitätsfrauenklinik Ulm, Prittwitzstrasse, 43 89075, Ulm, Germany
| | | | - Krisztian Lato
- Universitätsfrauenklinik Ulm, Prittwitzstrasse, 43 89075, Ulm, Germany
| | - Thomas Zwingers
- estimate GmbH, Konrad-Adenauer-Allee 1, 86150, Augsburg, Germany
| | - Ralf Lorenz
- Praxis Lorenz/Hecker, Hagenmarkt 19-20, 38100, Braunschweig, Germany
| | - Hans Tesch
- Praxis Prof. Tesch, Im Prüfling 17-19, 60389, Frankfurt, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital, Im Neuenheimer Feld 460, D-69120, Heidelberg, Germany
| | - Peter Fasching
- Universitaetsfrauenklinik Erlangen, Universitaetsstrasse 21-23, D-, 91054, Erlangen, Germany
| | - Sven Mahner
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe Campus Innenstadt, Ludwig-Maximilians-Universitaet Muenchen, Maistr. 11, 80337, Munich, Germany
| | - Matthias W Beckmann
- National Center for Tumor Diseases, University Hospital, Im Neuenheimer Feld 460, D-69120, Heidelberg, Germany
| | - Werner Lichtenegger
- Frauenklinik des Universitaetsklinikums Charité Campus Virchow-Klinikum, Augustenburger Platz 1, D-, 13353, Berlin, Germany
| | - Wolfgang Janni
- Universitätsfrauenklinik Ulm, Prittwitzstrasse, 43 89075, Ulm, Germany
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Yan X, Han R, Zhou J, Yu H, Yang J, Wu M. Incidence, mortality and survival of female breast cancer during 2003-2011 in Jiangsu province, China. Chin J Cancer Res 2016; 28:321-9. [PMID: 27478317 PMCID: PMC4949277 DOI: 10.21147/j.issn.1000-9604.2016.03.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the incidence, mortality and survival status of female breast cancer in Jiangsu province of China. METHODS Population-based cancer registry data in Jiangsu province were collected during 2003-2011. Crude rates, age-specific rates, age-standardized rates and annual percent changes of incidence and mortality were calculated to describe the epidemiologic characteristics and time trends. Patients diagnosed from 2003 to 2005 were chosen for analyzing the survival status of breast cancer. RESULTS From 2003 to 2011, 17,605 females were diagnosed with breast cancer and 4,883 died in selected registry areas in Jiangsu province. The crude incidence rate was 25.18/100,000, and the age-standardized rates by Chinese population (ASRC) and by world population (ASRW) were 19.03/100,000 and 17.92/100,000, respectively. During the same period, the crude mortality rate was 6.98/100,000 and the ASRC and ASRW were 4.93/100,000 and 4.80/100,000, respectively. From 2003 to 2011, the incidence and mortality increased with annual percent change of 11.37% and 5.78%, respectively. For survival analysis, 1,392 patients in 7 areas were identified in 2003-2005 and finished 5 years of follow-up. Survival rates were found to decrease with survival years, the 5-year observed survival rate was 45.9% and the relative survival rate was 52.0%. We also found that the survival rate varied across the province, which was lower in the north and higher in the south of Jiangsu province. CONCLUSIONS Breast cancer has become a significant public health problem in Jiangsu province and China. More resources should be invested in primary prevention, earlier diagnosis and better health services in order to increase survival rates among Chinese females.
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Affiliation(s)
- Xinran Yan
- Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Renqiang Han
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Jinyi Zhou
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Hao Yu
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Jie Yang
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Ming Wu
- Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing 210009, China; Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
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Fallahzadeh H, Momayyezi M, Akhundzardeini R, Zarezardeini S. Five year survival of women with breast cancer in Yazd. Asian Pac J Cancer Prev 2015; 15:6597-601. [PMID: 25169494 DOI: 10.7314/apjcp.2014.15.16.6597] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer is a non-communicable disease that is considered deadly in many cases. In recent years, the mortality rates from breast cancer have increased with increasing incidences. The present study was conducted to determine five year survival of women with breast cancer in Yazd, in the central region of Iran. MATERIALS AND METHODS In a prospective study, data were obtained from the patient's medical records with breast cancer that were referred to the Shahid Sadoughi hospital and radiotherapy center from 2002-2007 and followed up for 5 years. The data collected were analyzed by SPSS/16 and Kaplan-Meyer test and log-rank test and Cox proportional hazard model was used. RESULTS The mean age of breast cancer diagnosis was 48.3±11.7 years. The 1-, 2-, 3-, 4- and 5-year cumulative survivals for breast cancer patients were 95%, 86%, 82%, 76% and 70%, respectively. There were significant differences with age distribution (p=0.006). A significant decrease in the 5-year survival in patients with involvement of lymph nodes was lso observed. CONCLUSIONS Education for early diagnosis in women must be considered and these findings support the need for breast cancer screening programs.
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Affiliation(s)
- Hossein Fallahzadeh
- Department of Biostatistics and Epidemiology, Research Center of Prevention and Epidemiology of Non-Communicable Disease, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran E-mail :
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25
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Zhang J, Wang LS, Ye SL, Luo P, Wang BL. Blockage of tropomyosin receptor kinase a (TrkA) enhances chemo-sensitivity in breast cancer cells and inhibits metastasis in vivo. Int J Clin Exp Med 2015; 8:634-641. [PMID: 25785038 PMCID: PMC4358493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/26/2014] [Indexed: 06/04/2023]
Abstract
Hyper-activation of the Neurotrophin Receptor Signaling contributes to the development and metastasis of breast cancer. The inhibition of growth factor-dependent growth of breast cancer cell demonstrated a promising way for cancer therapy. In this study, the signaling pathway of tropomyosin receptor kinase A (TrkA) had been investigated for the role it played in the proliferation of chemo-resistance of breast cancer cells. Small interference RNA (siRNA) was used to down-regulate the expression of TrkA in breast cancer cell and tumor xenograft mice model. Our results indicated that siRNA mediated down-regulation of TrkA lead to the proliferation inhibition of cancer cells and arrested cells cycle at G0/G1 phase via inactivation of NF-κBp65. Application of TrkA siRNA to cancer cell also increased the chemo-sensitivity to paclitaxel, and further promoted apoptosis in cancer cell through the activation of caspase-3. Moreover, TrkA siRNA increased the efficacy of paclitaxel and decreased the incidence of lung metastasis in tumor xenografted mice. In sum, these results indicate that TrkA signaling plays an important role in breast cancer chemo-resistance and metastasis. It could be a potential pharmacologic target to enhance the effectiveness of chemo-therapy for breast cancer.
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Affiliation(s)
- Ju Zhang
- The Affiliated Provincial Hospital of Anhui Medical UniversityAnhui 230000, China
| | - Lun-Shan Wang
- The Affiliated PLA Clinical College of Anhui Medical UniversityHefei 230000, Anhui, China
| | - Shu-Lai Ye
- The Affiliated Provincial Hospital of Anhui Medical UniversityAnhui 230000, China
| | - Peng Luo
- The Affiliated Provincial Hospital of Anhui Medical UniversityAnhui 230000, China
| | - Bao-Long Wang
- The Affiliated Provincial Hospital of Anhui Medical UniversityAnhui 230000, China
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26
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Jacke CO, Albert US, Reinhard I, Kalder M. Convergence with SEER database achieved by a breast cancer network: a longitudinal benchmark of 5-year relative survival. J Cancer Res Clin Oncol 2014; 141:1109-18. [PMID: 25512079 DOI: 10.1007/s00432-014-1879-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/18/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE To benchmark outcomes of a German breast cancer network with the Surveillance Epidemiology and End Results programme (SEER) of the USA from a longitudinal point of view. METHODS All women receiving primary breast cancer therapy of three hospitals in a rural district of Marburg-Biedenkopf (Germany) of time intervals 1996-1997 and 2003-2004 were used to define local benchmark objects. Data from SEER-programme contributed longitudinal benchmark objects from national level (1988-2004). All benchmark objects were compared with the time-fixed benchmark reference of SEER (2004). Stage distributions and 5-year relative survival ratios were combined to estimate standardized screening-, case-mix-, work-up-, treatment- and relative overall performance index. RESULTS From the entry cohort of 877 German women, 97.7 % of the patients accounted for the institutional sample (N = 857) and 65.8 % accounted for the regional sample (N = 577). Stage distributions, relative survival ratios and indices of the German breast cancer network improved over time. Developed indices converged with SEER (2004). CONCLUSIONS Effectiveness gap between one exemplary German breast cancer network and international benchmark defined by SEER has been closed. Reasons are manifold, and further research is recommended.
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Affiliation(s)
- Christian O Jacke
- Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Square J5, 68159, Mannheim, Germany,
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Holleczek B, Brenner H. Provision of breast cancer care and survival in Germany - results from a population-based high resolution study from Saarland. BMC Cancer 2014; 14:757. [PMID: 25304931 PMCID: PMC4213502 DOI: 10.1186/1471-2407-14-757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 09/24/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Studies on the implementation of Clinical Practice Guidelines (CPG) and particularly its effect on breast cancer (BRC) survival on a population-level are scant. This population-based high resolution study from Germany aims at providing data on the usage of BRC treatment, the extent of adherence to CPG and, as a novelty, survival of BRC patients according to major recommended treatment options. METHODS Data from the Saarland Cancer Registry including women diagnosed with invasive BRC without distant metastasis and followed up between 2000 and 2009 were used. Provision of cancer care according to major treatment options is presented by age, clinical subtypes of BRC, and over time. Conventional and modeled period analysis was used to derive estimates of most up-to-date 5-year relative survival (RS) and the effect of non-adherence to CPG on relative excess risk of death (RER). RESULTS The study revealed increasing guideline adherence, with high levels already seen for local treatment (e.g. 67% of the BRC patients in 2008/09 received breast conserving surgery), and substantial progress since the millennium change with regard to sentinel node dissection (SND) and adjuvant systemic treatments (e.g. SND and chemotherapy provided to 62% of all patients and 79% of the patients with nodal positive or hormone receptor negative BRC in 2008/09, respectively). It further demonstrated increased cancer related mortality among patients without guideline compliant cancer treatment (e.g. patients with nodal positive and hormone receptor negative BRC who were not treated with chemotherapy had a 5-year RS of 29% (RER: 2.89, 95% CI: 1.46-5.71) compared to 54% for patients obtaining chemotherapy). CONCLUSIONS This study provides data on the implementation of CPG in a highly developed European country and extends available population-based survival data of BRC patients and may provide evidence of increased cancer related excess mortality, if BRC patients do not receive guideline compatible treatment.
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Affiliation(s)
- Bernd Holleczek
- />Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- />Saarland Cancer Registry, Präsident Baltz-Straße 5, 66119 Saarbrücken, Germany
| | - Hermann Brenner
- />Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- />German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
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Trends in 5-year survival rates among breast cancer patients by hormone receptor status and stage. Breast Cancer Res Treat 2014; 147:609-16. [PMID: 25164974 DOI: 10.1007/s10549-014-3112-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 01/07/2023]
Abstract
Improvement in breast cancer survival has been observed in recent decades in the U.S., but it is unclear if similar survival gains are consistent across breast cancer subtypes, especially with regards to more advanced stages of the disease. Data were from 13 population-based cancer registries participating in the surveillance, epidemiology, and end results (SEER) program, consisting of women between 20 and 79 years of age diagnosed with invasive breast cancer between 1992 and 2008. 2-year (1992-2008) and 5-year (1992-2006) breast cancer cause-specific survival rates were calculated and stratified by estrogen receptor (ER)/progesterone receptor (PR) status, stage, and race. Annual percent changes in survival rates were assessed. From 1992 through 1998-1999, 5- and 2-year cause-specific survival rates significantly improved across ER+/PR+, ER-/PR-, and ER+/PR- subtypes, with an annual increase ranging from 0.5 to 1.0 % in the 5-year rates. From 1998-1999 to 2006, different patterns were observed by ER/PR subtypes with survival rates slightly improving for ER+/PR+, continuing to improve at a rate of 0.5 % per year for ER-/PR-, and dropping 0.3 % annually for ER+/PR-. No significant survival gains were experienced by patients with ER-/PR+ cancer during the study period. In terms of advanced diseases, greatest annual increases in survival rates were seen for patients with stage III-IV ER+/PR+ and ER-/PR- tumors but less progress was observed for advanced ER+/PR- breast cancers. Steady improvements in survival rates for breast cancer have been achieved over the past several decades. However, 5-year survival rates for stage IV disease remained dismally below 20 % for most ER/PR subtypes.
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Baburin A, Aareleid T, Padrik P, Valvere V, Innos K. Time trends in population-based breast cancer survival in Estonia: analysis by age and stage. Acta Oncol 2014; 53:226-34. [PMID: 23767956 DOI: 10.3109/0284186x.2013.806992] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Survival from breast cancer (BC) in Estonia has been consistently among the lowest in Europe. The aim of this study was to examine most recent trends in BC survival in Estonia by age and stage. The trends in overall BC incidence and mortality are also shown in the paper. MATERIAL AND METHODS Estonian Cancer Registry data on all cases of BC, diagnosed in women in Estonia during 1995-2007 (n = 7424) and followed up for vital status through 2009, were used to estimate relative survival ratios (RSR). Period hybrid approach was used to obtain the most recent estimates (2005-2009). Stage was classified as localized, local/regional spread or distant. RESULTS BC incidence continued to rise throughout the study period, but mortality has been in steady decline since 2000. The distribution of patients shifted towards older age and earlier stage at diagnosis. Overall age-standardized five-year RSR increased from 63% in 1995-1999 to 74% in 2005-2009. Younger age groups experienced a more rapid improvement compared to women over 60. Significant survival increase was observed for both localized and locally/regionally spread BC with five-year RSRs reaching 96% and 70% in 2005-2009, respectively; the latest five-year RSR for distant BC was 11%. Survival for T4 tumors was poor and large age difference was seen for locally/regionally spread BC. CONCLUSIONS Considerable improvement in BC survival was observed over the study period. Women under 60 benefited most from both earlier diagnosis and treatment advances of locally/regionally spread cancers. However, the survival gap with more developed countries persists. Further increase in survival, but also decline in BC mortality in Estonia could be achieved by facilitating early diagnosis in all age groups, but particularly among women over 60. Investigations should continue to clarify the underlying mechanisms of the stage-specific survival deficit in Estonia.
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Affiliation(s)
- Aleksei Baburin
- Department of Epidemiology and Biostatistics, National Institute for Health Development , Tallinn , Estonia
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Carvalho AF, Hyphantis T, Sales PMG, Soeiro-de-Souza MG, Macêdo DS, Cha DS, McIntyre RS, Pavlidis N. Major depressive disorder in breast cancer: a critical systematic review of pharmacological and psychotherapeutic clinical trials. Cancer Treat Rev 2013; 40:349-55. [PMID: 24084477 DOI: 10.1016/j.ctrv.2013.09.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 09/06/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND While women with breast cancer often face varying levels of psychological distress, there is a subgroup whose symptomatology reaches a threshold for diagnosis of major depressive disorder (MDD). Major depressive disorder is known to influence patient outcomes, such as health-related quality of life and treatment adherence. There are no systematic reviews that evaluate pharmacological and psychotherapeutic treatment trials for MDD among individuals with breast cancer. METHODS Two authors independently searched MEDLINE, EMBASE, Cochrane and Clinical Trials.gov databases through February 20, 2013 without language restrictions. Core journals, reference lists and citation tracking were also searched. Articles on breast cancer patients were included if they (1) included participants with a diagnosis of MDD; (2) investigated pharmacological or psychotherapeutic treatments for MDD compared to placebo or usual care in a randomized controlled trial (RCT). RESULTS Two RCTs on antidepressant treatment met inclusion criteria. However, no RCTs investigating the effects of psychological treatments for MDD in breast cancer were identified. Notwithstanding the paucity of data investigating the effects of psychological treatments for MDD in breast cancer, numerous psychotherapeutic strategies targeting depressive symptoms were identified. Mianserin had significant antidepressant effects when compared to placebo in a 6-week, parallel-group, RCT of Stage I-II breast cancer in women with MDD. Desipramine and paroxetine were reported to be no more efficacious than placebo in a 6-week, RCT of Stage I-IV breast cancer in women with MDD. CONCLUSIONS The evidence reviewed herein underscores the paucity of data available to guide clinicians in treatment decisions for MDD in individuals with breast cancer. Therefore, the treatment of MDD in breast cancer is primarily based on clinical experience. Some antidepressants (for example, paroxetine) should be avoided in women concurrently taking tamoxifen due to relevant interactions involving the cytochrome CYP2D6.
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Affiliation(s)
- André F Carvalho
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | - Thomas Hyphantis
- Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece
| | - Paulo Marcelo G Sales
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Márcio G Soeiro-de-Souza
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Danielle S Macêdo
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicholas Pavlidis
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
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Holleczek B, Jansen L, Brenner H. Breast cancer survival in Germany: a population-based high resolution study from Saarland. PLoS One 2013; 8:e70680. [PMID: 23936237 PMCID: PMC3729832 DOI: 10.1371/journal.pone.0070680] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/20/2013] [Indexed: 12/05/2022] Open
Abstract
Population-based survival studies of breast cancer patients are commonly restricted to age- and stage-specific analyses. This study from Germany aimed at extending available population-based survival data on further prognostic cancer characteristics such as tumor grade, hormone receptor status and human epidermal growth factor receptor type 2 (HER2/neu) expression. Data from the population-based Saarland Cancer Registry including female patients diagnosed with invasive breast cancer between 2000 and 2009 were included. Period analysis methodology and regression modelling were used to obtain estimates of 5-year relative survival and tumor related excess risks in 2005-2009. Overall age standardized 5-year relative survival was 83%. In addition to age and stage, tumor grade and hormone receptor status were independent predictors of 5-year relative survival. Detailed analyses by age, stage, morphology, tumor grade, hormone receptor status and HER2/neu expression consistently revealed lower survival of patients with high grade, hormone receptor negative or HER2/neu positive cancers and patients aged 70 years or older. This high resolution study extends available population-based survival data of breast cancer patients. Particular efforts should be made to overcome the persisting large survival deficits, which were observed for elderly patients in all clinical subgroups.
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Affiliation(s)
- Bernd Holleczek
- Saarland Cancer Registry, Saarbrücken, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- * E-mail:
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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Sankaranarayanan R, Alwan N, Denny L. How can we improve survival from breast cancer in developing countries? BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rengaswamy Sankaranarayanan
- Early Detection & Prevention Section – Screening Group, International Agency for Research on Cancer (WHO-IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Nada Alwan
- Baghdad University Medical College, National Cancer Research Center, Iraqi National Cancer Research Program, Baghdad, Iraq
| | - Lynette Denny
- Department of Obstetrics & Gynaecology, University of Cape Town, H45 Old Main Building, Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa
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