The Risk Factors Influencing between the Early and Late Recurrence in Systemic Recurrent Breast Cancer

Oncologic Safety of One-Stage Implant-Based Breast Reconstruction in Breast Cancer Patients With Positive Sentinel Lymph Nodes: A Single-Center Retrospective Study Using Propensity Score Matching

OBJECTIVE

The purpose of this study is to evaluate the oncologic safety of one-stage implant-based breast reconstruction (OIBR) following mastectomy in breast cancer patients with positive sentinel lymph nodes (SLNs).

METHODS

We collected clinical and pathological data from breast cancer patients with positive SLNs who underwent OIBR or not after mastectomy between January 2015 and December 2018. A total of 194 patients were included, with 130 patients undergoing mastectomy alone (MA) and 64 patients receiving OIBR after mastectomy. The clinical and pathological features, as well as the postoperative oncologic outcomes, of the 2 groups were retrospectively analyzed. Propensity score matching (PSM) was employed to mitigate the effects of data bias and confounding factors.

RESULTS

The median follow-up time was 66 months for the OIBR group and 64 months for the MA group after PSM. The majority of reconstructive surgeries use an approach of prosthetic implantation (52.0%). This is followed by prosthetic implantation combined with a latissimus dorsi (LD) flap (32.0%), and acellular dermal matrix (ADM)-assisted implant placement (16.0%). During the follow-up period, a local recurrence was observed in 1 case, regional recurrence in 3 cases, and distant metastasis leading to death in 3 cases among the OIBR group patients. No significant difference was found between the OIBR and MA groups in disease-free survival (DFS) (P = .66), distant metastasis-free survival (DMFS) (P = .91), locoregional recurrence-free survival (LRRFS) (P = .44), and overall survival (OS) (P = .57).

CONCLUSION

OIBR is a safe option for breast cancer patients with positive SLNs and does not negatively impact cancer recurrence or overall survival.

Classification of breast cancer recurrence based on imputed data: a simulation study

Several studies have been conducted to classify various real life events but few are in medical fields; particularly about breast recurrence under statistical techniques. To our knowledge, there is no reported comparison of statistical classification accuracy and classifiers' discriminative ability on breast cancer recurrence in presence of imputed missing data. Therefore, this article aims to fill this analysis gap by comparing the performance of binary classifiers (logistic regression, linear and quadratic discriminant analysis) using several datasets resulted from imputation process using various simulation conditions. Our study aids the knowledge about how classifiers' accuracy and discriminative ability in classifying a binary outcome variable are affected by the presence of imputed numerical missing data. We simulated incomplete datasets with 15, 30, 45 and 60% of missingness under Missing At Random (MAR) and Missing Completely At Random (MCAR) mechanisms. Mean imputation, hot deck, k-nearest neighbour, multiple imputations via chained equation, expected-maximisation, and predictive mean matching were used to impute incomplete datasets. For each classifier, correct classification accuracy and area under the Receiver Operating Characteristic (ROC) curves under MAR and MCAR mechanisms were compared. The linear discriminant classifier attained the highest classification accuracy (73.9%) based on mean-imputed data at 45% of missing data under MCAR mechanism. As a classifier, the logistic regression based on predictive mean matching imputed-data yields the greatest areas under ROC curves (0.6418) at 30% missingness while k-nearest neighbour tops the value (0.6428) at 60% of missing data under MCAR mechanism.

Oncologic Safety of Immediate Breast Reconstruction: A Single-Center Retrospective Review of 138 Patients

OBJECTIVE

The purpose of this study was to assess the oncologic safety of mastectomies associated with immediate breast reconstruction (IBR) in terms of recurrence and survival.

METHODS

A retrospective review was conducted at a single center (CHU UCL Namur, Belgium). We analyzed the oncologic safety of IBR for patients with invasive and in situ breast cancer who underwent mastectomy associated with IBR. Patients who underwent palliative surgery and those with a diagnosis of breast sarcoma were excluded.

RESULTS

We retrospectively analyzed 138 patients who underwent mastectomy and IBR between January 2012 and December 2019. Most reconstruction procedures used deep inferior epigastric perforator free flaps (55.1%). The reconstructive failure rate was 8.7%. Among the patients included, 5 cases of local cancer recurrence, 1 case of local cancer recurrence associated with distant metastasis, and 2 cases of systemic recurrence were identified during a mean follow-up of 49.3 months (range, 8-104 months) after surgery. Overall survival was 97.8%, and disease-free survival was 94.2%.

CONCLUSIONS

Patients had a low incidence of cancer recurrence in this review. Immediate breast reconstruction after mastectomy had no negative impact on recurrence or patient survival, even in patients with advanced disease. The study findings suggest that mastectomy associated with IBR can be a safe surgical option for patients with invasive and noninvasive breast cancers. Longer follow-ups are needed to confirm these preliminary results.

A world-wide survey on kidney transplantation practices in breast cancer survivors: The need for new management guidelines

Kidney transplantation reduces mortality in patients with end stage renal disease (ESRD). Decisions about performing kidney transplantation in the setting of a prior cancer are challenging, as cancer recurrence in the setting of immunosuppression can result in poor outcomes. For cancer of the breast, rapid advances in molecular characterization have allowed improved prognostication, which is not reflected in current guidelines. We developed a 19-question survey to determine transplant surgeons' knowledge, practice, and attitudes regarding guidelines for kidney transplantation in women with breast cancer. Of the 129 respondents from 32 states and 14 countries, 74.8% felt that current guidelines are inadequate. Surgeons outside the United States (US) were more likely to consider transplantation in a breast cancer patient without a waiting period (p = .017). Within the US, 29.2% of surgeons in the Western region would consider transplantation without a waiting period, versus 3.6% of surgeons in the East (p = .004). Encouragingly, 90.4% of providers surveyed would consider eliminating wait-times for women with a low risk of cancer recurrence based on the accurate prediction of molecular assays. These findings support the need for new guidelines incorporating individualized recurrence risk to improve care of ESRD patients with breast cancer.

Long non-coding RNA NEAT1 transported by extracellular vesicles contributes to breast cancer development by sponging microRNA-141-3p and regulating KLF12

Objective

Breast cancer (BC) remains a public-health issue on a global scale. Long non-coding RNAs (lncRNAs) play functional roles in BC. This study focuses on effects of NEAT1 on BC cell invasion, migration and chemotherapy resistance via microRNA (miR)-141-3p and KLF12.

Methods

After extraction and identification of serum extracellular vesicles (EVs), NEAT1 expression in EVs was detected and its association with clinical characteristics of BC patients was analyzed. Besides, the gain-of function was performed to investigate the roles of NEAT1 and miR-141-3p in BC, and levels of NEAT1, miR-141-3p, KLF12 and MDR1 after EV treatment were detected by RT-qPCR and Western blot analysis. Furthermore, the in vitro findings were confirmed via lung metastases in nude mice.

Results

NEAT1 expression in serum EVs was high and related to lymph node metastasis, progesterone receptor, estrogen receptor and Ki-67 in BC patients. After EV treatment, NEAT1 and KLF12 levels were increased, miR-141-3p expression was decreased, the abilities of proliferation, invasion, migration and in vivo metastasis were enhanced, and the sensitivity of cells to cisplatin, paclitaxel and 5-fluorouracil was decreased. After NEAT1 interference, NEAT1 and KLF12 levels in BC cells treated with EVs were decreased, miR-141-3p expression was increased, cell proliferation, invasion, migration and in vivo metastasis were decreased, and drug resistance sensitivity was increased. NEAT1 can bind to miR-141-3p and upregulates KLF12 expression.

Conclusions

EVs inhibit the regulation of KLF12 by miR-141-3p by transporting NEAT1 to BC cells, thus promoting BC cell invasion, migration, and chemotherapy resistance.

Thrombin generation predicts early recurrence in breast cancer patients

BACKGROUND

Cancer patients present with a hypercoagulable state often associated with poor disease prognosis.

OBJECTIVES

This study aims to evaluate whether thrombin generation (TG), a global coagulation test, may be a useful tool to improve the identification of patients at high risk of early disease recurrence (ie, E-DR within 2 years) after breast cancer surgery.

PATIENTS/METHODS

A cohort of 522 newly diagnosed patients with surgically resected high-risk breast cancer were enrolled in the ongoing prospective HYPERCAN study. TG potential was measured in plasma samples collected before starting systemic chemotherapy. Significant predictive hemostatic and clinic-pathological parameters were identified in the derivation cohort by Cox regression analysis. A risk prognostic score for E-DR was generated in the derivation and tested in the validation cohort.

RESULTS

After a median observation period of 3.4 years, DR occurred in 51 patients, 28 of whom were E-DR. E-DR subjects presented with the highest TG values as compared to both late-DR (from 2 to 5 years) and no relapse subjects (P < .01). Multivariate analysis in the derivation cohort identified TG, mastectomy, triple negative and Luminal B HER2-neg molecular subtypes as significant independent predictors for E-DR, which were utilized to generate a risk assessment score. In the derivation and validation cohorts, E-DR rates were 2.3% and 0% in the low-risk, 10.1% and 6.3% in the intermediate-risk, and 18.2% and 16.7%, in the high-risk categories, respectively.

CONCLUSIONS

Inclusion of TG in a risk-assessment model for E-DR significantly helps the identification of operated breast cancer patients at high risk of very early relapse.

Is mammographic density a marker of breast cancer phenotypes?

PURPOSE

To investigate the association between mammographic density (MD) phenotypes and both clinicopathologic features of breast cancer (BC) and tumor location.

METHODS

MD was measured for 297 BC-affected females using qualitative (visual method) and quantitative (fully automated area-based method) approaches. Radiologists' description, visible external markers, and surgical scar were used to establish the location of tumors. Binary logistic regression models were used to assess the association between MD phenotypes and BC clinicopathologic features.

RESULTS

Categorical and numerical MD measures showed no association with clinicopathologic features of BC (p > 0.05). Participants with higher BI-RADS scores [(51-75% glandular) and (> 75% glandular)] (p < 0.001), and percent density (PD) categories [PD (21-49%) and PD ≥ 50%] (p = 0.01) were more likely to have tumors emanating from dense areas. Additionally, tumors were commonly found in dense regions of the breast among patients with higher medians of PD (p = 0.001), dense area (DA) (p = 0.02), and lower medians of non-dense area (NDA) (p < 0.001). Adjusted logistic regression models showed that high BI-RADS density (> 75% glandular) has an almost fivefold increased odds of tumors developing within dense areas (OR 4.99, 95% CI 0.93-25.9; p = 0.05. PD (OR 1.02, 95% CI 1-1.03, p = 0.002) and NDA (OR 0.99, 95% CI 0.991-0.997, p < 0.001) had very small effect on tumor location. Compared to tumors within non-dense areas, tumors in dense areas tended to exhibit human epidermal growth factor receptor 2 positive (p = 0.05) and carcinoma in situ (p = 0.01) characteristics.

CONCLUSION

MD shows no significant association with clinicopathologic features of BC. However, BC was more likely to originate from dense tissue, with tumors in dense regions having human epidermal growth receptor 2 positive and carcinoma in situ characteristics.

Nipple-sparing mastectomy for breast cancer close to the nipple: a single institution's 11-year experience

BACKGROUND

This study aimed to analyze our 11-year experience using NSM with immediate breast reconstruction in breast cancer.

METHODS

Between January 2007 and December 2015, 251 NSMs were performed on 251 women with breast cancer for therapeutic purpose at Pusan National University Hospital.

RESULTS

The clinical and pathologic mean tumor size was 3.1 cm. Based on preoperative imaging, mean distance between tumor and nipple was 2.5 cm. Among 251 tumors, 119 cases (47.4%) and 69 cases (27.5%) with a distances ≤ 2 cm and ≤ 1 cm, respectively, were detected. There were 11 patients (4.4%) with locoregional recurrences during the mean follow-up period of 68.0 months. Of these 11 cases, one (0.4%) had local recurrence in the retained NAC, and the others had recurrence in the chest wall or skin.

CONCLUSION

Unless clinical and histological evidence of nipple involvement, NSM can be an oncologically safe surgical option for breast cancer, even if the tumor is located close to the nipple.

Early Recurrence of Breast Cancer after the Primary Treatment: Analysis of Clinicopathological and Radiological Predictive Factors

목적

유방암 일차치료 후 조기 재발 예측에 도움이 되는 임상병리학적 인자 및 원발암의 영상 의학적 특징을 알아보고자 하였다.

대상과 방법

본원에서 2010년 1월부터 2014년 12월까지 유방 보존 수술 및 보조요법 치료 후 추적관찰을 받은 480명을 대상으로 하였다. 일차치료 완결 후 3년 이내 재발한 경우를 조기 재발으로 정의하고, 이와 관련된 임상병리학적 및 영상의학적 예측인자를 알아보기 위해 단변량 및 다변량 로지스틱 회귀분석을 시행하였다.

결과

단변량 분석에서 임상병리학적 인자 중 높은 종양 병기(p=0.021), 고등급 조직학적 분화도(p < 0.001), estrogen receptor 수용체 음성(p=0.002), Ki-67 과발현(p=0.017), 삼중음성유방 아형(p=0.019)과, 영상 소견 중 유방암의 다초점성(p < 0.001), 도플러 검사에서 테두리 혈류(p=0.012), 자기공명영상에서 테두리 조영증강(p < 0.001)이 조기 재발과 유의한 연관성을 보였다. 다변량 분석에서 원발암의 높은 종양 병기[odds ratio (이하 OR) = 3.47, 95% confidence interval (이하 CI) 1.12~10.73, p=0.031]와 도플러 검사에서 테두리 혈류 (OR = 3.32, 95% CI 1.38~8.02,p=0.008)가 조기 재발과 관련된 독립적인 예측인자였다.

결론

유방암 치료 전 도플러 검사에서 원발암의 테두리 혈류 소견은 유방암의 일차치료 후 조기 재발의 독립적인 영상의학적 예측인자이다.

Prognostic Factors of Local-Regional Recurrence in Patients with Operable Breast Cancer in Asia: A Meta-Analysis

BACKGROUND

Cause of recurrence of breast cancer is multifactorial. Also, the occurrence of breast cancer in Asian patients has some different factors from the recurrence of breast cancer in western countries.

AIM

This study aims to determine the prognostic factors of local-regional recurrence in patients with operable breast cancer in Asia.

METHODS

The authors conducted a meta-analysis of published research articles published in an online database of PubMed, ProQuest and EBSCO between January 2000 and July 2018. Pooled risk ratios (RR) were calculated using fixed and random-effect models. Data were processed by using Review Manager 5.3 (RevMan 5.3).

RESULTS

This study reviewed 879 articles. There were 11 studies conducted a systematic review then continued by meta-analysis of relevant data with total patients involved were 5,213 patients. The prognostic factors found of local-regional recurrence in patients with operable breast cancer were Nodal (N) stage with the highest risk ratio (RR = 6.35 [95% CI 3.78-10.67]) followed by HER2 positive (RR = 2.14 [95% CI 1.16-3.97]), stage of cancer (RR = 1.82 [95% CI 1.44-2.31]), tumor size (RR = 1.55 [95% CI 1.04-2.31]), tumor grade (RR = 1.43 [95% CI 1.23-1.65]), PR status (RR = 0.65 [95% CI 0.48-0.88]) and the least was ER status (RR = 0.60 [95% CI 0.39-0.91]). Homogeneity of variance was found in N stage, tumor size and tumor grade for recurrence of operable breast cancer.

CONCLUSION

This meta-analysis confirmed the correlation of N stage, HER2, stage of cancer, tumour size, tumour grade, ER and PR status with recurrence in patients with operable breast cancer in Asia.

Long-term survival outcomes in invasive lobular carcinoma patients with and without preoperative MR imaging: a matched cohort study

OBJECTIVE

To investigate and compare the effect of preoperative breast magnetic resonance (MR) imaging on recurrence-free survival (RFS) and overall survival (OS) outcomes among patients with invasive lobular carcinoma (ILC).

METHODS

A total of 287 ILC patients between January 2005 and December 2012 were included. One hundred twenty (41.8%) had undergone preoperative breast MR imaging (MR group) and 167 (58.2%) had not (no MR group). Two groups were matched for 21 covariates in terms of patient demographics, tumor characteristics, and clinical features. We compared unmatched variables between the patients with and without breast MR imaging using the chi-square or Student's t test. Comparisons of matched data were performed with McNemar's test or test of symmetry for categorical variables and paired t test for continuous variables. The RFS and OS outcomes were compared using the Kaplan-Meier estimates. MR effects were estimated after adjusting for significant potential confounders of specific outcomes in the multivariable modeling.

RESULTS

In the matched cohort, no statistically significant association was observed between MR imaging and total recurrence (hazard ratio [HR], 1.096; p = 0.821), loco-regional recurrence (HR, 1.204; p = 0.796), contralateral breast recurrence (HR, 0.945; p = 0.952), or distant recurrence (HR, 1.020; p = 0.973). MR imaging was associated with improved OS with 51% reduction, but not significantly (HR, 0.485; p = 0.231). Analysis with multivariable Cox regression model indicated that MR imaging was not significant independent factor for better RFS (HR, 0.823; p = 0.586) or improved OS (HR, 0.478; p = 0.168).

CONCLUSION

Preoperative MR imaging is not significant prognostic factor and produces no apparent recurrence or survival outcome benefits in ILC patients.

KEY POINTS

• Preoperative breast MR imaging in invasive lobular carcinoma was associated with a better overall survival with 51% reduction, but not statistically significant. • Preoperative breast MR imaging does not show significant prognostic value in invasive lobular carcinoma as there is no apparent benefit in terms of recurrence or survival outcomes.

Prognostic factors predicting recurrence in invasive breast cancer: An analysis of radiological and clinicopathological factors

BACKGROUND/OBJECTIVE

The purpose of this study was to perform a comprehensive analysis of the radiological and clinicopathological factors that could predict recurrence of invasive breast cancer who underwent curative surgery without neoadjuvant chemotherapy.

METHODS

Three hundred and sixty-four consecutive women who underwent preoperative mammography, ultrasound, and breast magnetic resonance imaging for newly diagnosed invasive breast cancers and curative surgery between January and December 2010 were included. We analyzed the radiological findings of each modality and reviewed the histopathological features. A Cox proportional hazards model was used to determine the association between the radiological and clinicopathological parameters and disease-free survival (DFS).

RESULTS

During the median follow-up period of 5.3 years, 23 patients (6.3%) developed recurrences: locoregional recurrence in six patients, contralateral breast recurrence in three patients, and distant recurrences in 14 patients. Microcalcifications on mammography showed a tendency towards worse DFS. The multivariate Cox regression analysis showed that presence of lymphovascular invasion (LVI) (p = 0.006), negative progesterone receptor (PR) status (p < 0.001), and positive CK5/6 expression (p = 0.015) were independent significant variables predictive of worse DFS.

CONCLUSION

Understanding the prognostic factors in patients with invasive breast cancer may provide considerable practical information about future treatment strategies.

Dynamic contrast-enhanced breast magnetic resonance imaging for the prediction of early and late recurrences in breast cancer

The aim of the study was to evaluate dynamic contrast-enhanced breast magnetic resonance imaging (DCE-MRI) features for the prediction of early and late recurrences in patients with breast cancer.Of 1030 breast cancer patients who underwent surgery at our hospital from January 2007 to July 2011, 83 recurrent breast cancer patients were enrolled in this study. We compared MRI features (background parenchymal enhancement [BPE], internal enhancement, adjacent vessel sign, whole-breast vascularity, initial enhancement pattern, kinetic curve types, and quantitative kinetic parameters) and clinico-pathologic variables (age, stage, histologic grade, nuclear grade, existence of lymphovascular invasion and extensive intraductal carcinoma component, and immunohistochemical profiles) between patients with early (≤2.5 years after surgery) and late recurrence (>2.5 years after surgery). Cox proportional hazard regression analysis was performed to evaluate independent risk factors for early and late recurrence.On breast MRI, prominent ipsilateral whole-breast vascularity was independently associated with early recurrence (hazard ratio [HR], 2.86; 95% confidence intervals [CI], 1.39-5.88) and moderate or marked BPE (HR, 2.08; 95% CI, 1.04-4.18) and rim enhancement (HR, 2.14; 95% CI, 1.00-4.59) were independently associated with late recurrence. Clinico-pathologic variables independently associated with early recurrence included negative estrogen receptor (HR, 0.53; 95% CI, 0.29-0.96), whereas T2 stage (HR, 2.08; 95% CI, 1.04-4.16) and nuclear grade III (HR, 2.54; 95% CI, 1.29-4.98) were associated with late recurrence.In DCE-MRI, prominent ipsilateral whole-breast vascularity, moderate or marked BPE, and rim enhancement could be useful for predicting recurrence timing in patients with breast cancer.

Time to breast cancer relapse predicted by primary tumour characteristics, not lymph node involvement

INTRODUCTION

The risk of breast cancer recurrence has been linked to tumour size, grade, oestrogen (ER) receptor status, and degree of lymph node (LN) involvement. However, the role of these variables in predicting time to relapse is not well defined. This study was designed to identify patient and primary tumour characteristics that predict risk periods for breast cancer recurrence within our institution, to enable more tailored surveillance strategies.

METHODS

We retrospectively studied a cohort of 473 patients who presented to The Queen Elizabeth Hospital, Adelaide, Australia, with recurrent breast cancer between 1968 and 2008. Patient and primary tumour characteristics were collected, including age, menopausal status, tumour grade, size, ER and progesterone receptor (PR) status, and LN involvement and modeled against time to relapse using Kaplan-Meier survival curves.

RESULTS

High tumour grade, size ≥ 20 mm, ER negativity, and PR negativity were shown on univariate analysis to correlate significantly with earlier recurrence (P < 0.0001, P = 0.0012, P = 0.0006, and P = 0.006). Multivariate analysis identified tumour grade and size as significant predictors of timing of relapse after adjustment for other variables. LN involvement, menopausal status, and age did not significantly correlate with earlier recurrence.

CONCLUSIONS

High tumour grade and larger size were shown to independently predict earlier breast cancer relapse. While LN involvement increases absolute recurrence risk, our study proposes that it does not influence timing of relapse. Use of these predictors will enable key risk periods for onset of relapse to be characterised according to tumour profile with more appropriate discharge to primary care providers for ongoing surveillance.

Distinct outcomes in patients with different molecular subtypes of inflammatory breast cancer

OBJECTIVES

To determine the outcome of patients with luminal A, luminal B, human epidermal growth factor receptor-2 (HER-2) positive, and triple negative molecular subtypes of inflammatory breast cancer (IBC) using a retrospective analysis.

METHODS

This study was conducted between February 2004 and February 2010 in 3 different hospitals in China. The clinical outcomes, pathological features, and treatment strategies were analyzed in 67 cases of IBC without distant metastases. A chi-square test and one-way ANOVA were used to assess outcomes between different subtypes. Overall survival (OS) was analyzed using the Kaplan-Meier method and multivariate analysis was conducted using the Cox regression model.

RESULTS

The 2-year OS rate was 55% for the entire cohort. Median OS time among patients with luminal A was 35 months, luminal B was 30 months, HER-2 positive was 24 months, and triple negative subtypes was 20 months, and were significantly different from each other (p=0.001). Using multivariate analysis, luminal A had 76% (p=0.037), luminal B had 54% (p=0.048), and HER-2 positive subtypes had 47% (p=0.032) decreased risk of death compared with the triple negative subtype.  Furthermore, elevated Ki-67 labeling was associated with increased risk of death, while the surgical treatment significantly improved patient survival.

CONCLUSION

Breast cancer subtypes are associated with distinct outcomes in IBC patients. Patients that presented with triple negative IBC had poorer outcome than luminal A, luminal B, and HER-2 subtypes. These results indicate that IBC is a heterogeneous disease similar to the conventional breast cancer. 

Plasma microRNA panel for minimally invasive detection of breast cancer

Over the last few years, circulating microRNAs (miRNAs) have emerged as promising novel and minimally invasive markers for various diseases, including cancer. We already showed that certain miRNAs are deregulated in the plasma of breast cancer patients when compared to healthy women. Herein we have further explored their potential to serve as breast cancer early detection markers in blood plasma. Circulating miR-127-3p, miR-376a and miR-652, selected as candidates from a miRNA array-based screening, were found to be associated with breast cancer for the first time (n = 417). Further we validated our previously reported circulating miRNAs (miR-148b, miR-376c, miR-409-3p and miR-801) in an independent cohort (n = 210) as elevated in the plasma of breast cancer patients compared to healthy women. We described, for the first time in breast cancer, an over-representation of deregulated miRNAs (miR-127-3p, miR-376a, miR-376c and miR-409-3p) originating from the chromosome 14q32 region. The inclusion of patients with benign breast tumors enabled the observation that miR-148b, miR-652 and miR-801 levels are even elevated in the plasma of women with benign tumors when compared to healthy controls. Furthermore, an analysis of samples stratified by cancer stage demonstrated that miR-127-3p, miR-148b, miR-409-3p, miR-652 and miR-801 can detect also stage I or stage II breast cancer thus making them attractive candidates for early detection. Finally, ROC curve analysis showed that a panel of these seven circulating miRNAs has substantial diagnostic potential with an AUC of 0.81 for the detection of benign and malignant breast tumors, which further increased to 0.86 in younger women (up to 50 years of age).