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Park KH, Loibl S, Sohn J, Park YH, Jiang Z, Tadjoedin H, Nag S, Saji S, Md Yusof M, Villegas EMB, Lim EH, Lu YS, Ithimakin S, Tseng LM, Dejthevaporn T, Chen TWW, Lee SC, Galvez C, Malwinder S, Kogawa T, Bajpai J, Brahma B, Wang S, Curigliano G, Yoshino T, Kim SB, Pentheroudakis G, Im SA, Andre F, Ahn JB, Harbeck N. Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with early breast cancer. ESMO Open 2024; 9:102974. [PMID: 38796284 PMCID: PMC11145753 DOI: 10.1016/j.esmoop.2024.102974] [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: 01/22/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 05/28/2024] Open
Abstract
The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with early breast cancer were updated and published online in 2023, and adapted, according to previously established standard methodology, to produce the Pan-Asian adapted (PAGA) ESMO consensus guidelines for the management of Asian patients with early breast cancer. The adapted guidelines presented in this manuscript represent the consensus opinions reached by a panel of Asian experts in the treatment of patients with breast cancer representing the oncological societies of China (CSCO), Indonesia (ISHMO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO), co-ordinated by ESMO and KSMO. The voting was based on scientific evidence and was independent of the current treatment practices, drug access restrictions and reimbursement decisions in the different Asian regions represented by the 10 oncological societies. The latter are discussed separately in the manuscript. The aim is to provide guidance for the optimisation and harmonisation of the management of patients with early breast cancer across the different regions of Asia, drawing on the evidence provided by both Western and Asian trials, whilst respecting the differences in screening practices, molecular profiling, as well as the age and stage at presentation. Attention is drawn to the disparity in the drug approvals and reimbursement strategies, between the different regions of Asia.
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Affiliation(s)
- K H Park
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
| | - S Loibl
- German Breast Group, Neu-Isenburg, Goethe University Centre for Haematology and Oncology, Bethanien, Frankfurt, Germany
| | - J Sohn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul
| | - Y H Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Z Jiang
- Department of Oncology, The Fifth Medical Center of PLA General Hospital, Bejing, China
| | - H Tadjoedin
- Department of Internal Medicine, Division of Hematology-Medical Oncology, Dharmais Hospital, National Cancer Center, Jakarta, Indonesia
| | - S Nag
- Department of Medical Oncology, Sahyadri Speciality Hospitals, Pune, Maharashtra, India
| | - S Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - M Md Yusof
- Cancer Centre at PHKL, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - E M B Villegas
- Cebu Cancer Institute, Perpertual Succour Hospital, Cebu Doctors' University Hospital, Cho-ing Hua Hospital, Cebu City, Philippines
| | - E H Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Y-S Lu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - S Ithimakin
- Division of Medical Oncology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - L-M Tseng
- Department of Surgery, Taipei-Veterans General Hospital, and School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - T Dejthevaporn
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - T W-W Chen
- Department of Oncology, National Taiwan University Hospital and Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - S C Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), Singapore, Singapore
| | - C Galvez
- St. Luke's Medical Center Global City, Taguig City, Philippines
| | - S Malwinder
- Cancer Centre at PHKL, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - T Kogawa
- Advanced Medical Development, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - J Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - B Brahma
- Department of Surgical Oncology, Dharmais Hospital, National Cancer Center, Jakarta, Indonesia
| | - S Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - G Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy; Department of Oncology and Haematology, University of Milano, Milan, Italy
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - S-B Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - S-A Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - F Andre
- Breast Cancer Unit, Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - J B Ahn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul
| | - N Harbeck
- Breast Center, Department of Obstetrics and Gynaecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
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Iacob R, Iacob ER, Stoicescu ER, Ghenciu DM, Cocolea DM, Constantinescu A, Ghenciu LA, Manolescu DL. Evaluating the Role of Breast Ultrasound in Early Detection of Breast Cancer in Low- and Middle-Income Countries: A Comprehensive Narrative Review. Bioengineering (Basel) 2024; 11:262. [PMID: 38534536 DOI: 10.3390/bioengineering11030262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/28/2024] Open
Abstract
Breast cancer, affecting both genders, but mostly females, exhibits shifting demographic patterns, with an increasing incidence in younger age groups. Early identification through mammography, clinical examinations, and breast self-exams enhances treatment efficacy, but challenges persist in low- and medium-income countries due to limited imaging resources. This review assesses the feasibility of employing breast ultrasound as the primary breast cancer screening method, particularly in resource-constrained regions. Following the PRISMA guidelines, this study examines 52 publications from the last five years. Breast ultrasound, distinct from mammography, offers advantages like radiation-free imaging, suitability for repeated screenings, and preference for younger populations. Real-time imaging and dense breast tissue evaluation enhance sensitivity, accessibility, and cost-effectiveness. However, limitations include reduced specificity, operator dependence, and challenges in detecting microcalcifications. Automatic breast ultrasound (ABUS) addresses some issues but faces constraints like potential inaccuracies and limited microcalcification detection. The analysis underscores the need for a comprehensive approach to breast cancer screening, emphasizing international collaboration and addressing limitations, especially in resource-constrained settings. Despite advancements, notably with ABUS, the primary goal is to contribute insights for optimizing breast cancer screening globally, improving outcomes, and mitigating the impact of this debilitating disease.
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Affiliation(s)
- Roxana Iacob
- Department of Anatomy and Embriology, 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Doctoral School, 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Faculty of Mechanics, Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, 'Politehnica' University Timișoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania
| | - Emil Radu Iacob
- Department of Pediatric Surgery, 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Emil Robert Stoicescu
- Doctoral School, 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Faculty of Mechanics, Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, 'Politehnica' University Timișoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania
- Department of Radiology and Medical Imaging, 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Research Center for Pharmaco-Toxicological Evaluations, 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Delius Mario Ghenciu
- Doctoral School, 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Daiana Marina Cocolea
- Doctoral School, 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Amalia Constantinescu
- Department of Radiology and Medical Imaging, 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Laura Andreea Ghenciu
- Discipline of Pathophysiology, 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Diana Luminita Manolescu
- Department of Radiology and Medical Imaging, 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
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Bonometto JVB, Sette CVDM, Santi PX, Maselli-Schoueri JH, Giglio AD, Cubero DDIG. Critical assessment of resource waste in staging and follow-up of breast cancer. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230565. [PMID: 38055451 DOI: 10.1590/1806-9282.20230565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Breast cancer is a public health problem with both high incidence and cure rates. After treatment, patients are monitored for long periods of time due to the risk of recurrence. Thus, staging and follow-up strategies should consider not only the best results for the patient but also its costs for the public health system. OBJECTIVE The objective of this study was to quantify the waste of resources on breast cancer follow-up and evaluate its impact on the public health system. METHODS This is a retrospective analysis of consecutive medical records to identify the intervals between consultations and tests used for staging and during the first 2 years of follow-up of patients with breast cancer treated at a public hospital in Brazil. Data were compared with the guidelines of the main international consensus. RESULTS Medical records of 60 consecutive patients treated in 2018 were selected, of whom 52 had 2 or more years of follow-up, and 8 had only 1 year of complete follow-up. A total of 34 patients (56.67%) underwent excessive examinations for stating. During follow-up, 125 surplus consultations were performed (33.6%). In this phase, 111 surplus exams were also performed, representing an increase of 100.9%. A total of 423 laboratory tests were performed for 18 patients in the first year and 229 tests for 14 patients in the second year. CONCLUSION Excessive tests and consultations significantly burdened the Unified Health System without any benefit to patients. Better adherence to staging and follow-up recommendations could reduce costs and optimize the limited resources used in the public health system.
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Affiliation(s)
| | - Claudia Vaz de Melo Sette
- Centro Universitário Faculdade de Medicina do ABC, Department of Oncology - Santo André (SP), Brazil
| | - Patricia Xavier Santi
- Centro Universitário Faculdade de Medicina do ABC, Department of Oncology - Santo André (SP), Brazil
| | | | - Auro Del Giglio
- Centro Universitário Faculdade de Medicina do ABC, Department of Oncology - Santo André (SP), Brazil
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Jannes M, König A, Kolben M, Fridrich C, Kirn V. Staging for Breast Cancer: A Nationwide Survey about Adherence to Guidelines in German Breast Centers. Breast Care (Basel) 2022; 17:316-320. [DOI: 10.1159/000521967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/12/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction:
The risk for metastasis at primary diagnosis of breast cancer is about 4%. The German guidelines give clear indications for when, whom and how to stage breast cancer patients. Ideally, this should be done via CAT scan of the thorax and abdomen and an additional bone scan. But daily practice shows that the way health care providers handle staging recommendations can vary. To objectify adherence to guidelines we started a nation-wide survey.
Methods:
Between July and September 2020 we sent out a survey via email to all certified and non certified breast centers and in addition to all Departments of Obstetrics and Gynecology in Germany. We asked for timing of staging, conditions that cause staging and the applied method. In case we did not get back any reply we sent out a reminder.
Results:
A total of 220 certified breast centers/28 non-certified breast center/48 Departments of Gynecology and Obstetrics who care for breast cancer patients took part in our survey. A general pre-therapeutic staging was performed in 16,4%/39,3%/66,7% of all institutions and a general post-operative staging was performed in 4,1%/0%/6,3% of each institutional type, respectively.
In terms of the applied method, 75% of all certified breast centers used a CAT scan and bone scan, while 23,3% primarily use chest x-ray, ultrasound of the abdomen (27,7%) or MRI. As a potential reason for using x-ray and ultrasound the presence of a „low-risk“ breast cancer was mentioned.
Summary:
Although certified breast centers show the highest adherence to current guidelines, some still perform a general staging or do not use the recommended staging method. The low probability for primary metastatic breast cancer and the use of a reasonable exposure to radiation warrant a critical discussion.
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