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Jaya-Prakason S, Kong YC, Yip CH, See MH, Taib NA, Abdul Satar NF, Jamaris S, Teoh LY, Ibrahim RI, Bhoo-Pathy N. Trends in Presentation, Management, and Survival of Women With Breast Cancer in a Multiethnic, Middle-Income Asian Setting. JCO Glob Oncol 2024; 10:e2400054. [PMID: 39088780 DOI: 10.1200/go.24.00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/29/2024] [Accepted: 05/28/2024] [Indexed: 08/03/2024] Open
Abstract
PURPOSE Granular data on breast cancer (BC) are pertinent for surveillance, planning, and monitoring of cancer care delivery. We determined the trends in clinical presentation, management, and survival of women with BC in a multiethnic middle-income Asian setting over 15 years. METHODS Data of 7,478 Malaysian women newly diagnosed with invasive BC between 2005 and 2019 from three hospital-based cancer registries were included. Trends in demographic, tumor, and treatment characteristics were compared across period 1 (P1): 2005-2009, period 2 (P2): 2010-2014, and period 3 (P3): 2015-2019. Overall survival and net survival were determined. RESULTS More women in P3 than P1 were older than 60 years at diagnosis. Only a marginal increase in proportion of women with stage I disease was observed (23.7% v 27.2% in P1 and P3, respectively, P = .004). Nonetheless, patients were increasingly presenting with smaller tumors, fewer axillary node involvement, well-differentiated tumors, and hormone receptor expression in recent times. Proportion of women with human epidermal growth factor receptor 2 (HER2)-overexpressed tumors significantly decreased. Among indicated patients, receipt of anticancer therapies was somewhat similar over the calendar periods, except for neoadjuvant chemotherapy and anti-HER2 therapy, where increases in administration were noted. Significant improvements in survival were observed over the 15 years, particularly for HER2-overexpressed BCs. CONCLUSION Although the improvements in BC survival that we have observed validate ongoing cancer control efforts and treatment advances, study findings suggest that more could be done for earlier detection and improved access to effective therapies in our settings.
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Affiliation(s)
- Sharminii Jaya-Prakason
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Yek-Ching Kong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Cheng-Har Yip
- Ramsay Sime Darby Health Care, Jalan SS12, Subang Jaya, Malaysia
| | - Mee-Hoong See
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Nur Aishah Taib
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Nur Fadhlina Abdul Satar
- Department of Clinical Oncology, University of Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Suniza Jamaris
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Li Ying Teoh
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Rose Irnawaty Ibrahim
- Actuarial Science and Risk Management, Faculty of Science and Technology, Universiti Sains Islam Malaysia (USIM), Nilai, Negeri Sembilan, Malaysia
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Sewanywa L, Hale M, Michelow P, Mayne E, Wiggill T. Validation of the Xpert Breast Cancer STRAT 4 Assay on the GeneXpert instrument to Assess Hormone Receptor, Ki67, and HER2 Gene Expression Status in Breast Cancer Tissue Samples. Appl Immunohistochem Mol Morphol 2023; 31:613-620. [PMID: 37800656 DOI: 10.1097/pai.0000000000001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/19/2023] [Indexed: 10/07/2023]
Abstract
Breast cancer is the commonest cause of cancer-related mortality in African females where patients often present later and with advanced disease. Causes for delayed diagnosis include restricted diagnostic access and international controversy on interpretation of ancillary tests like immunohistochemistry (IHC). Fine needle aspirates (FNAC) are an attractive alternative although may have reduced sensitivity. The Xpert Breast Cancer STRAT4 (STRAT4) (CE-IVD*) assay (Cepheid, Sunnyvale) is a semi-quantitative reverse-transcription polymerase chain reaction assay which detects messenger RNA (mRNA) expression in breast samples for estrogen receptor ( ESR1 ), progesterone receptor ( PGR1 ), human epidermal growth factor receptor/Erb-B2 receptor tyrosine kinase 2 (HER2/ ERBB2 ) and the proliferation marker, MKi67 . We assessed the performance of this assay on both formalin-fixed paraffin-embedded (FFPE, n=31) and matched FNAC (n=20) samples from patients presenting with breast cancer to the Johannesburg academic hospitals. IHC and Fluorescent in situ hybridization analysis (performed on HER2-indeterminate samples) was compared with the mRNA expression of the corresponding target genes in FFPE samples, and mRNA expression on FNAC samples was compared with the FFPE results for both mRNA expression and IHC. Concordance between IHC/FISH and Xpert Breast Cancer STRAT4 in FFPE and FNAC samples using the Quick lysis (Q) method (a research-use-only modification of the validated FFPE-lysis method), showed an overall percentage agreement for ESR1 expression of 90.3% and 81.3%, and for PGR1 expression at 86.7% and 81.3% respectively in FFPE and FNAC samples. Concordance was lowest for Ki67 expression, using a binary IHC cutoff for Ki67 positivity at ≥20% staining) at 83.9% and 62.5%, for FFPE and FNAC samples, respectively. This suggests that the STRAT4 assay may be a useful ancillary test in determining HR and Ki67 status in FFPE samples and that use on FNAC samples may be feasible. Future studies should expand the sample numbers and establish locally relevant cutoffs.
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Affiliation(s)
- Lina Sewanywa
- Departments of Molecular Medicine and Haematology
- National Health Laboratory Service, Johannesburg
| | - Martin Hale
- Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand
| | - Pamela Michelow
- Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand
- National Health Laboratory Service, Johannesburg
| | - Elizabeth Mayne
- National Health Laboratory Service, Johannesburg
- Department of Pathology, Division of Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Tracey Wiggill
- National Health Laboratory Service, Johannesburg
- Division of Immunology and Medical Microbiology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South Africa
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Sinha S, Bhatia R, Narasimamurthy M, Rayne S, Grover S. Epidemiology of Breast Cancer Presentation in Botswana, South Africa, and the United States. J Surg Res 2022; 279:533-539. [PMID: 35868037 PMCID: PMC10033457 DOI: 10.1016/j.jss.2022.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION This study sought to compare the clinicopathologic features of women with breast cancer presenting in South Africa, Botswana, and the United States (US). METHODS Breast cancer samples from Botswana (n = 384, 2011-2015), South Africa (n = 475, 2016-2017), and the US (n = 361,353, 2011-2012) were retrospectively reviewed. RESULTS The median age of sub-Saharan African women presenting with breast cancer (age 54 in Botswana and South Africa) was younger than that of those in the US (age 61) (P < 0.001). Sub-Saharan women were more likely to present with advanced stage disease than US counterparts (64.7% in Botswana, 63.3% in South Africa, 13% in the US, P < 0.001). Triple negative disease was highest in Botswana (21.3%) compared to South Africa (11.4%) and the US (12.94%) (P < 0.001). Differences in receptor status at presentation among the three cohorts (P < 0.001) were not observed when the cohorts were stratified by ethnicity. Black/multiracial patients in Botswana and the US were the most likely subsets to present with the adverse characteristic of triple negative disease (21.3% and 23.2%, respectively). No correlation was found between HIV and receptor status in the Botswana (P = 0.513) or South African (P = 0.352) cohorts. CONCLUSIONS Here we report receptor status patterns at presentation in Botswana and South Africa. This study reveals important similarities and differences which may inform policy and provide context for future epidemiologic trends of breast cancer in low- and-middle-income countries particularly in sub-Saharan Africa.
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Affiliation(s)
- Sumi Sinha
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Rohini Bhatia
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | | | - Sarah Rayne
- Department of Surgery, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Oncologic Anthropology: An Interdisciplinary Approach to Understanding the Association Between Genetically Defined African Ancestry and Susceptibility for Triple Negative Breast Cancer. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Brandão M, Guisseve A, Bata G, Alberto M, Ferro J, Garcia C, Zaqueu C, Lorenzoni C, Leitão D, Come J, Soares O, Gudo-Morais A, Schmitt F, Tulsidás S, Carrilho C, Lunet N. Breast cancer subtypes: implications for the treatment and survival of patients in Africa-a prospective cohort study from Mozambique. ESMO Open 2020; 5:e000829. [PMID: 33020218 PMCID: PMC7537337 DOI: 10.1136/esmoopen-2020-000829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Data regarding breast cancer epidemiology, treatment and survival in Africa are scarce. We aimed to assess the distribution of breast cancer subtypes in Mozambique and its impact on patients' treatment and survival. The concordance of biomarker assessment between cytological and histological samples was also evaluated. METHODS Prospective cohort study including 210 patients diagnosed between January 2015 and August 2017, followed to November 2019. Clinicopathological characteristics, treatment, 3-year overall survival (OS) and disease-free survival (DFS) were compared across classic tumour subtypes (oestrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive and triple-negative breast cancer (TNBC)) and surrogate intrinsic subtypes (St. Gallen classification). Concordance was measured using Cohen's κ statistics. RESULTS A total of 51% of patients had ER-positive/HER2-negative tumours, 24% HER2-positive and 25% TNBC. Concordance between cytological and histological samples regarding ER and HER2 status was substantial (κ=0.762 and κ=0.603, respectively). There were no significant differences across subtypes regarding clinical characteristics and treatment, except for HIV positivity and high histological grade (more prevalent among TNBC) or endocrine therapy (higher use among ER-positive/HER2-negative and HER2-positive patients). Three-year OS was 52.5% (95% CI, 44.3% to 60.0%), being higher in ER-positive/HER2-negative (61.1%) compared with HER2-positive (53.2%) and TNBC (31.9%) patients. Adjusted HRs were 1.96 (95% CI, 1.13 to 3.39) among HER2-positive and 3.10 (95% CI, 1.81 to 5.31) among TNBC versus ER-positive/HER2-negative patients. Three-year DFS was 46.6% (95% CI, 38.0% to 54.8%), being lower among TNBC versus ER-positive/HER2-negative patients (HR 2.91; 95% CI, 1.64 to 5.16). Results were similar between surrogate intrinsic subtypes. CONCLUSION There was a high proportion of HER2-positive and TNBC among Mozambican patients and their survival was poor compared with ER-positive/HER2-negative patients, partly due to the limited treatment options. A systematic assessment of ER, PR and HER2 status is feasible and may help tailoring and optimise the treatment of patients with breast cancer in low-resource settings, potentially leading to survival gains in this underserved population.
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Affiliation(s)
- Mariana Brandão
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Academic Trials Promoting Team, Institut Jules Bordet, Bruxelles, Belgium
| | - Assucena Guisseve
- Department of Pathology, Faculty of Medicine, University of Eduardo Mondlane, Maputo, Mozambique; Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Genoveva Bata
- Oncology Unit, Maputo Central Hospital, Maputo, Mozambique
| | - Matos Alberto
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Josefo Ferro
- Department of Pathology, Beira Central Hospital, Beira, Mozambique
| | - Carlos Garcia
- Department of Pathology, Beira Central Hospital, Beira, Mozambique
| | - Clésio Zaqueu
- Department of Pathology, Nampula Central Hospital, Nampula, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Faculty of Medicine, University of Eduardo Mondlane, Maputo, Mozambique; Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Dina Leitão
- Department of Pathology, São João University Hospital Center, Porto, Portugal; Department of Pathology and Oncology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jotamo Come
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Otília Soares
- Oncology Unit, Maputo Central Hospital, Maputo, Mozambique
| | - Alberto Gudo-Morais
- Oncology Unit, Maputo Central Hospital, Maputo, Mozambique; Radiotherapy Unit, Maputo Central Hospital, Maputo, Mozambique
| | - Fernando Schmitt
- Department of Pathology and Oncology, Faculty of Medicine, University of Porto, Porto, Portugal; Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Satish Tulsidás
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Oncology Unit, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, University of Eduardo Mondlane, Maputo, Mozambique; Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
| | - Nuno Lunet
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
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Lambert M, Mendenhall E, Kim AW, Cubasch H, Joffe M, Norris SA. Health system experiences of breast cancer survivors in urban South Africa. ACTA ACUST UNITED AC 2020; 16:1745506520949419. [PMID: 32842917 PMCID: PMC7453471 DOI: 10.1177/1745506520949419] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer globally and among South African women. Women from socioeconomically disadvantaged South African communities more often present later and receive total mastectomy compared to those from more affluent communities who have more breast conserving surgery (which is less invasive but requires mandatory radiation treatment post-operatively). Standard chemotherapy and total mastectomy treatments are known to cause traumatizing side effects and emotional suffering among South African women; moreover, many women face limited communication with physicians and psychological support. OBJECTIVE This article investigates the experiences of women seeking breast cancer treatment at the largest public hospital in South Africa. METHODS We interviewed 50 Black women enrolled in the South African Breast Cancer Study to learn more about their health system experiences with detection, diagnosis, treatment, and follow-up care for breast cancer. Each interview was between 2-3 hours, addressing perceptions, experiences, and concerns associated with breast cancer and comorbidities such as HIV and hypertension. RESULTS We found most women feared diagnosis, in part, because of the experience of chemotherapy and physical mutilation related to mastectomy. The importance of social support from family, religion, and clinical staff was fundamental for women coping with their condition and adhering to treatment and medication. CONCLUSIONS These findings exemplify how interventions might promote early detection of breast cancer and better adherence to treatment. Addressing community perceptions of breast cancer, patient needs and desires for treatment, structural barriers to intensive therapies, and the burden of invasive treatments are imperative next steps for delivering better breast cancer care in Soweto and other resource-constrained settings.
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Affiliation(s)
- Madeleine Lambert
- Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Emily Mendenhall
- Walsh School of Foreign Service, Georgetown University, Washington, DC, USA.,SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Andrew Wooyoung Kim
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.,Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Herbert Cubasch
- Noncommunicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Maureen Joffe
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.,Noncommunicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.,Noncommunicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
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Riedel F, Hoffmann AS, Moderow M, Heublein S, Deutsch TM, Golatta M, Wallwiener M, Schneeweiss A, Heil J, Hennigs A. Time trends of neoadjuvant chemotherapy for early breast cancer. Int J Cancer 2020; 147:3049-3058. [PMID: 32468577 DOI: 10.1002/ijc.33122] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/25/2020] [Accepted: 05/14/2020] [Indexed: 11/09/2022]
Abstract
Neoadjuvant chemotherapy (NACT) in early breast cancer (EBC) enables in vivo sensitivity testing and less radical surgery as compared to primary surgery and adjuvant chemotherapy (ACT). The aim of our study is to illustrate trends of systemic treatment of EBC. The study analyzed chemotherapy usage and time trends for patients with EBC treated at 104 German breast units between January 2008 and December 2017. The data were obtained through a quality-controlled benchmarking process. Altogether, 124 084 patients were included, of whom 46 279 (37.3%) received chemotherapy. For 44 765 of these cases, detailed information on systemic treatment and surgery were available. Overall use of chemotherapy declined from 42.0% in 2008 to 32.0% in 2017. During that same time, the proportion of NACT increased from 20.0% to 57.7%, irrespective of tumor subtype. The pathological complete response (pCR) rate (defined as ypT0 ypN0) at surgery after NACT increased from 15.0% to 34.2%. The results from this large cohort from the clinical routine reflect the refined indications for chemotherapy in EBC.
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Affiliation(s)
- Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Ann Sophie Hoffmann
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Sabine Heublein
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas M Deutsch
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Schneeweiss
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
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O'Neil DS, Nietz S, Buccimazza I, Singh U, Čačala S, Stopforth LW, Joffe M, Jacobson JS, Neugut AI, Crew KD, Ruff P, Cubasch H. Neoadjuvant Chemotherapy Use for Nonmetastatic Breast Cancer at Five Public South African Hospitals and Impact on Time to Initial Cancer Therapy. Oncologist 2018; 24:933-944. [PMID: 30518615 PMCID: PMC6656461 DOI: 10.1634/theoncologist.2018-0535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/06/2018] [Indexed: 12/18/2022] Open
Abstract
In sub‐Saharan Africa, clinical decisions can be affected by resource constraints. This article analyzes the clinical and sociodemographic factors associated with receiving neoadjuvant chemotherapy among patients from a previously existing cohort: women enrolled in the prospective South African Breast Cancer and HIV Outcomes study. Background. In the U.S., neoadjuvant chemotherapy (NAC) for nonmetastatic breast cancer (BC) is used with extensive disease and aggressive molecular subtypes. Little is known about the influence of demographic characteristics, clinical factors, and resource constraints on NAC use in Africa. Materials and Methods. We studied NAC use in a cohort of women with stage I–III BC enrolled in the South African Breast Cancer and HIV Outcomes study at five hospitals. We analyzed associations between NAC receipt and sociodemographic and clinical factors, and we developed Cox regression models for predictors of time to first treatment with NAC versus surgery. Results. Of 810 patients, 505 (62.3%) received NAC. Multivariate analysis found associations between NAC use and black race (odds ratio [OR] 0.49; 95% confidence limit [CI], 0.25–0.96), younger age (OR 0.95; 95% CI, 0.92–0.97 for each year), T‐stage (T4 versus T1: OR 136.29; 95% CI, 41.80–444.44), N‐stage (N2 versus N0: OR 35.64; 95% CI, 16.56–76.73), and subtype (triple‐negative versus luminal A: OR 5.16; 95% CI, 1.88–14.12). Sites differed in NAC use (Site D versus Site A: OR 5.73; 95% CI, 2.72–12.08; Site B versus Site A: OR 0.37; 95% CI, 0.16–0.86) and time to first treatment: Site A, 50 days to NAC versus 30 days to primary surgery (hazard ratio [HR] 1.84; 95% CI, 1.25–2.71); Site D, 101 days to NAC versus 126 days to primary surgery (HR 0.49; 95% CI, 0.27–0.89). Conclusion. NAC use for BC at these South African hospitals was associated with both tumor characteristics and heterogenous resource constraints. Implications for Practice. Using data from a large breast cancer cohort treated in South Africa's public healthcare system, the authors looked at determinants of neoadjuvant chemotherapy use and time to initiate treatment. It was found that neoadjuvant chemotherapy was associated with increasing tumor burden and aggressive molecular subtypes, demonstrating clinically appropriate care in a lower resource setting. Results of this study also showed that time to treatment differences between chemotherapy and surgery varied by hospital, suggesting that differences in resource limitations were influencing clinical decision making. Practice guidelines and care quality metrics designed for low‐ and middle‐income countries should accommodate heterogeneity of available resources.
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Affiliation(s)
- Daniel S O'Neil
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York New York, USA
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York New York, USA
| | - Sarah Nietz
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Ines Buccimazza
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Departments of Surgery and Oncology, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa
| | - Urishka Singh
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Departments of Surgery and Oncology, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa
| | - Sharon Čačala
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Departments of Surgery and Oncology, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Laura W Stopforth
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Departments of Surgery and Oncology, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Maureen Joffe
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- MRC Developmental Pathways to Health Research Unit, Department of Pediatrics, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York New York, USA
| | - Alfred I Neugut
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York New York, USA
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York New York, USA
| | - Katherine D Crew
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York New York, USA
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York New York, USA
| | - Paul Ruff
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Division of Medical Oncology, Department of Medicine, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Herbert Cubasch
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
- Department of Surgery, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
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9
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Bao X, Sun K, Tian X, Yin Q, Jin M, Yu N, Jiang H, Zhang J, Hu Y. Present and changing trends in surgical modalities and neoadjuvant chemotherapy administration for female breast cancer in Beijing, China: A 10-year (2006-2015) retrospective hospitalization summary report-based study. Thorac Cancer 2018; 9:707-717. [PMID: 29624915 PMCID: PMC5983198 DOI: 10.1111/1759-7714.12636] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study was conducted to describe present and changing trends in surgical modalities and neoadjuvant chemotherapy (NACT) in female breast cancer patients in China from 2006 to 2015. METHODS Data of 44 299 female breast cancer patients from 15 tertiary hospitals in Beijing were extracted from hospitalization summary reports. Surgeries were categorized into five modalities: breast-conserving surgery (BCS), simple mastectomy (SM), modified radical mastectomy (MRM), radical mastectomy (RM), and extensive radical mastectomy (ERM). RESULTS In total, 38 471 (86.84%) breast cancer patients underwent surgery: 22.64% BCS, 8.22% SM, 63.97% MRM, 4.24% RM, and 0.93% ERM. Older patients (> 60) underwent surgery more frequently than younger patients (< 60). The proportion of patients who underwent BCS was highest in the age ≥ 80 (39.24%) and < 40 (28.69%) subgroups and in patients with papillary carcinoma (35.48%), and lowest in the age 60- subgroup (18.17%) and in patients with Paget's disease (19.05%). SM was most frequently performed in patients with Paget's disease (29.00%), and MRM for ductal (64.99%), and lobular (63.78%) carcinomas. During the study period, the proportion of patients who underwent MRM dropped by 29.04%, SM and BCS increased from 15.78% and 30.83%, respectively, and NACT increased in all subgroups, particularly in patients with lymph node involvement (26.72%). CONCLUSIONS Surgical modalities varied significantly by age and histologic group. The use of BCS and SM increased dramatically, while MRM declined significantly. The proportion of patients treated with NACT has increased significantly, especially in patients with lymph node involvement.
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Affiliation(s)
- Xiaoyuan Bao
- Medical Informatics CenterPeking University Health Science CenterBeijingChina
| | - Kexin Sun
- Department of Epidemiology and BiostatisticsPeking University Health Science CenterBeijingChina
| | - Xin Tian
- School of Public HealthPeking University Health Science CenterBeijingChina
| | - Qiongzhou Yin
- Department of Epidemiology and BiostatisticsPeking University Health Science CenterBeijingChina
| | - Meng Jin
- Medical Informatics CenterPeking University Health Science CenterBeijingChina
| | - Na Yu
- Medical Informatics CenterPeking University Health Science CenterBeijingChina
| | - Hanfang Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Jun Zhang
- Department of NeurologyPeking University People's HospitalBeijingChina
| | - Yonghua Hu
- Medical Informatics CenterPeking University Health Science CenterBeijingChina
- Department of Epidemiology and BiostatisticsPeking University Health Science CenterBeijingChina
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