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Munck F, Kroman NT, Tvedskov THF. Reply to "Staging of the Axilla After Neoadjuvant Chemotherapy: Which Technique is Better? The Endless Debate. Ann Surg Oncol 2024; 31:400. [PMID: 37932599 DOI: 10.1245/s10434-023-14512-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Affiliation(s)
- F Munck
- Herlev-Gentofte Hospital, Hellerup, Denmark.
| | - N T Kroman
- Herlev-Gentofte Hospital, Hellerup, Denmark
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Munck F, Kroman N, Tvedskov THF. ASO Author Reflections: Feasibility of 125I Seed Targeted Axillary Dissection. Ann Surg Oncol 2023; 30:4143-4144. [PMID: 37029862 DOI: 10.1245/s10434-023-13446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023]
Affiliation(s)
- F Munck
- Department of Breast Surgery, Gentofte Hospital, Gentofte, Denmark.
| | - N Kroman
- Department of Breast Surgery, Gentofte Hospital, Gentofte, Denmark
| | - T H F Tvedskov
- Department of Breast Surgery, Gentofte Hospital, Gentofte, Denmark
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Jensen MB, Pedersen CB, Misiakou MA, Talman MLM, Gibson L, Tange UB, Kledal H, Vejborg I, Kroman N, Nielsen FC, Ejlertsen B, Rossing M. Multigene profiles to guide the use of neoadjuvant chemotherapy for breast cancer: a Copenhagen Breast Cancer Genomics Study. NPJ Breast Cancer 2023; 9:47. [PMID: 37258527 DOI: 10.1038/s41523-023-00551-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
Estrogen receptor (ER) and human epidermal growth factor 2 (HER2) expression guide the use of neoadjuvant chemotherapy (NACT) in patients with early breast cancer. We evaluate the independent predictive value of adding a multigene profile (CIT256 and PAM50) to immunohistochemical (IHC) profile regarding pathological complete response (pCR) and conversion of positive to negative axillary lymph node status. The cohort includes 458 patients who had genomic profiling performed as standard of care. Using logistic regression, higher pCR and node conversion rates among patients with Non-luminal subtypes are shown, and importantly the predictive value is independent of IHC profile. In patients with ER-positive and HER2-negative breast cancer an odds ratio of 9.78 (95% CI 2.60;36.8), P < 0.001 is found for pCR among CIT256 Non-luminal vs. Luminal subtypes. The results suggest a role for integrated use of up-front multigene subtyping for selection of a neoadjuvant approach in ER-positive HER2-negative breast cancer.
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Affiliation(s)
- M-B Jensen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - C B Pedersen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Section for Bioinformatics, DTU Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - M-A Misiakou
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M-L M Talman
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - L Gibson
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - U B Tange
- Department of Clinical Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - H Kledal
- Department of Breast Examinations, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - I Vejborg
- Department of Breast Examinations, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - N Kroman
- Department of Breast Surgery, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - F C Nielsen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - B Ejlertsen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M Rossing
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Zachariae R, Offersen B, Kroman N, Melgaard Nielsen H, Damsgaard T, Overgaard J, Lauritsen S, Eskildsen E, Bonde Jensen A, Christiansen P. SP-0189 Nation-wide app-based collection of PROs in early breast cancer patients treated with radiation therapy - The DBCG experience. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03904-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vassard D, Pinborg A, Kamper-Jørgensen M, Lyng Forman J, Glazer CH, Kroman N, Schmidt L. Assisted reproductive technology treatment and risk of breast cancer: a population-based cohort study. Hum Reprod 2021; 36:3152-3160. [PMID: 34580714 DOI: 10.1093/humrep/deab219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/28/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is there an increased risk of breast cancer among women after ART treatment including ovarian hormone stimulation? SUMMARY ANSWER The risk of breast cancer was slightly increased among women after ART treatment compared to age-matched, untreated women in the background population, and the risk was further increased among women initiating ART treatment when aged 40+ years. WHAT IS KNOWN ALREADY The majority of breast cancer cases are sensitive to oestrogen, and ovarian hormone stimulation has been suggested to increase the risk of breast cancer by influencing endogenous oestrogen levels. Previous studies on ART treatment and breast cancer have varied in their findings, but several studies have small sample sizes or lack follow-up time and/or confounder adjustment. Recent childbirth, nulliparity and higher socio-economic status are breast cancer risk factors and the latter two are also associated with initiating ART treatment. STUDY DESIGN, SIZE, DURATION The Danish National ART-Couple II (DANAC II) cohort includes women treated with ART at public and private fertility clinics in 1994-2016. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with no cancer prior to ART treatment were included (n = 61 579). Women from the background population with similar age and no prior history of ART treatment were randomly selected as comparisons (n = 579 760). The baseline mean age was 33.1 years (range 18-46 years). Results are presented as hazard ratios (HRs) with corresponding CIs. MAIN RESULTS AND THE ROLE OF CHANCE During follow-up (median 9.69 years among ART-treated and 9.28 years among untreated), 5861 women were diagnosed with breast cancer, 695 among ART-treated and 5166 among untreated women (1.1% versus 0.9%, P < 0.0001). Using Cox regression analyses adjusted for nulliparity, educational level, partnership status, year, maternal breast cancer and age, the risk of breast cancer was slightly increased among women treated with ART (HR 1.14, 95% CI 1.12-1.16). All causes of infertility were slightly associated with breast cancer risk after ART treatment. The risk of breast cancer increased with higher age at ART treatment initiation and was highest among women initiating treatment at age 40+ years (HR 1.37, 95% CI 1.29-1.45). When comparing women with a first birth at age 40+ years with or without ART treatment, the increased risk among women treated with ART persisted (HR 1.51, 95% CI 1.09-2.08). LIMITATIONS, REASONS FOR CAUTION Although this study is based on a large, national cohort of women, more research with sufficient power and confounder adjustment is needed, particularly in cohorts with a broad age representation. WIDER IMPLICATIONS OF THE FINDINGS An increased risk of breast cancer associated with a higher age at ART treatment initiation has been shown. Ovarian stimulation may increase the risk of breast cancer among women initiating ART treatment when aged 40+ years. Age-related vulnerability to hormone exposure or higher hormone doses during ART treatment may explain the increased risk. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a PhD grant to D.V. from the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. Funding for establishing the DANAC II cohort was received from the Ebba Rosa Hansen Foundation. The authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- D Vassard
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - A Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - M Kamper-Jørgensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - J Lyng Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - C H Glazer
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - N Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen Ø, Denmark
| | - L Schmidt
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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Munck F, Clausen EW, Balslev E, Kroman N, Tvedskov TF, Holm-Rasmussen EV. Multicentre study of the risk of invasive cancer and use of sentinel node biopsy in women with a preoperative diagnosis of ductal carcinoma in situ. Br J Surg 2019; 107:96-102. [DOI: 10.1002/bjs.11377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/27/2019] [Accepted: 08/30/2019] [Indexed: 01/05/2023]
Abstract
Abstract
Background
Ductal carcinoma in situ (DCIS) in the breast that is diagnosed by biopsy implies a risk of upstaging to invasive carcinoma (IC) on final pathology. These patients require a sentinel lymph node biopsy (SLNB) for axillary staging. A two-stage procedure is not always feasible and precise selection of patients who should be offered SLNB is crucial. The aims were: to determine the rate of upstaging, and use of redundant and required SLNB in women with a preoperative diagnosis of DCIS; and to identify patient and tumour characteristics that increase the risk of upstaging.
Methods
Patients with DCIS treated between 2008 and 2016 were identified using Orbit operation planning system software, and those suitable for the study were selected based on review of the medical records. Upstaging rates and proportions of redundant and required SLNBs were calculated. Associations between clinicopathological characteristics and upstaging were analysed using univariable and multivariable logistic regression analyses.
Results
Of 1368 patients initially identified, 975 women with a preoperative diagnosis of DCIS were included in the study. Tumours in 246 of these patients (25·2 per cent) were upstaged to IC. Redundant SLNB was performed in 392 of 975 women (40·2 per cent). Forty-four patients (4·5 per cent) with a final diagnosis of IC were not offered SLNB and thus potentially undertreated. In adjusted analysis, DCIS size, palpability and mass formation identified by breast imaging were associated with increased risk of upstaging. The Van Nuys classification was not associated with upstaging.
Conclusion
Most patients with IC on final pathology underwent SLNB, but a considerable number of patients with DCIS had a redundant SLNB. Lesion size, palpability and mass formation, but not Van Nuys classification group, are suggested risk factors for upstaging.
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Affiliation(s)
- F Munck
- Department of Breast Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - E W Clausen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - E Balslev
- Department of Pathology, Herlev Hospital, Herlev, Denmark
| | - N Kroman
- Department of Breast Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - T F Tvedskov
- Department of Breast Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - E V Holm-Rasmussen
- Department of Breast Surgery, Copenhagen University Hospital, Copenhagen, Denmark
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Holm M, Olsen A, Au Yeung SL, Overvad K, Lidegaard Ø, Kroman N, Tjønneland A. Pattern of mortality after menopausal hormone therapy: long-term follow up in a population-based cohort. BJOG 2018; 126:55-63. [PMID: 30106241 DOI: 10.1111/1471-0528.15433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate long-term pattern of mortality in menopausal women according to different modalities of hormone therapy. DESIGN Population-based prospective cohort study. SETTING Denmark 1993-2013. POPULATION A total of 29 243 women aged 50-64 years at entry into the Diet, Cancer and Health Cohort, enrolled 1993-97 and followed through 31 December 2013. METHODS Cox' proportional hazards models for increasingly longer periods of follow-up time were used to estimate mortality pattern according to baseline hormone use adjusted for relevant potential confounders. MAIN OUTCOME(S) All-cause and cause-specific mortality. Outcome information was obtained from the Danish Register of Causes of Death (linkage 99.6%). RESULTS A total of 4098 women died during a median follow up of 17.6 years. After adjustment for relevant lifestyle risk factors, hormone use had no impact on all-cause mortality, regardless of modality. Among baseline users, lower cardiovascluar disease mortality was only evident after 5 years [hazard ratio (HR) 0.54; 95% CI 0.32-0.92], but dissipated with additional follow up. Conversely, lower colorectal cancer mortality (HR 0.64; 95% CI 0.46-0.89) and higher breast cancer mortality (HR 1.34; 95% CI 1.05-1.72) only became evident after 15 years of follow up. There were no significant associations for mortality from other types of cancer or from stroke. CONCLUSIONS In this long-term follow-up study, taking hormones during menopause was not associated with overall mortality among middle-aged women. Investigating cause-specific mortality revealed significant, albeit weak, differential associations according to both causes of death and over time, underlining the importance of carefully considering individual risks and duration of treatment when making decisions on hormone therapy. TWEETABLE ABSTRACT Long-term follow-up study confirms no association between menopausal hormone therapy and overall mortality.
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Affiliation(s)
- M Holm
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - A Olsen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - S L Au Yeung
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Ø Lidegaard
- Gynaecological Clinic, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - N Kroman
- Department of Breast Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Centre, Copenhagen, Denmark
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Hassing CMS, Tvedskov TF, Kroman N, Klausen TL, Drejøe JB, Tvedskov JF, Lambine TL, Kledal H, Lelkaitis G, Langhans L. Reply to: Adequate use of radioactive seed localisation. Where we are? Eur J Surg Oncol 2018; 44:1667. [PMID: 30170882 DOI: 10.1016/j.ejso.2018.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- C M S Hassing
- Department of Breast Surgery, Herlev Hospital, Denmark.
| | - T F Tvedskov
- Department of Breast Surgery, Herlev Hospital, Denmark
| | - N Kroman
- Department of Breast Surgery, Herlev Hospital, Denmark
| | - T L Klausen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Denmark
| | - J B Drejøe
- Department of Plastic Surgery and Burns, Rigshospitalet, University of Copenhagen, Denmark
| | - J F Tvedskov
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, University of Copenhagen, Denmark
| | - T-L Lambine
- Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark
| | - H Kledal
- Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark
| | - G Lelkaitis
- Department of Pathology, Rigshospitalet, University of Copenhagen, Denmark
| | - L Langhans
- Department of Breast Surgery, Herlev Hospital, Denmark
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Hassing C, Tvedskov T, Kroman N, Klausen T, Drejøe J, Tvedskov J, Lambine TL, Kledal H, Lelkaitis G, Langhans L. Radioactive seed localisation of non-palpable lymph nodes – A feasibility study. Eur J Surg Oncol 2018; 44:725-730. [DOI: 10.1016/j.ejso.2018.02.211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/14/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022] Open
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Mertz B, Duriaud H, Kroman N, Andersen K. Psychological distress, pain and sensory disturbances among women with carcinoma in situ. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30330-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Holm-Rasmussen E, Jensen M, Balslev E, Kroman N, Filtenborg Tvedskov T. Risk factors for sentinel node metastases in patients with ductal carcinoma in situ in the breast. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Mellemkjaer L, Albieri V, Kroman N. Risk of second primary breast cancer after pregnancy-associated breast cancer and Hodgkin lymphoma. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30343-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pedersen RN, Bhaskaran K, Heide-Jørgensen U, Nørgaard M, Christiansen PM, Kroman N, Sørensen HT, Cronin-Fenton DP. Breast cancer recurrence after reoperation for surgical bleeding. Br J Surg 2017; 104:1665-1674. [PMID: 28782800 PMCID: PMC5655703 DOI: 10.1002/bjs.10592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/01/2017] [Accepted: 04/07/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS Using the Danish Breast Cancer Group database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from the DNPR. Follow-up began 14 days after primary surgery and continued until breast cancer recurrence, death, emigration, 10 years of follow-up, or 1 January 2013. Incidence rates of breast cancer recurrence were calculated and Cox regression models were used to quantify the association between reoperation and recurrence, adjusting for potential confounders. Crude and adjusted hazard ratios according to site of recurrence were calculated. RESULTS Among 30 711 patients (205 926 person-years of follow-up), 767 patients had at least one reoperation within 14 days of primary surgery, and 4769 patients developed breast cancer recurrence. Median follow-up was 7·0 years. The incidence of recurrence was 24·0 (95 per cent c.i. 20·2 to 28·6) per 1000 person-years for reoperated patients and 23·1 (22·5 to 23·8) per 1000 person-years for non-reoperated patients. The overall adjusted hazard ratio was 1·06 (95 per cent c.i. 0·89 to 1·26). The estimates did not vary by site of breast cancer recurrence. CONCLUSION In this large cohort study, there was no evidence of an association between reoperation for bleeding and breast cancer recurrence.
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Affiliation(s)
- R N Pedersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - K Bhaskaran
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - U Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - M Nørgaard
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - P M Christiansen
- Breast and Endocrine Section, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.,Danish Breast Cancer Group, Copenhagen, Denmark
| | - N Kroman
- Danish Breast Cancer Group, Copenhagen, Denmark.,Department of Breast Surgery, Rigshospitalet, Copenhagen, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - D P Cronin-Fenton
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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Kjaer A, Persson M, Skovgaard D, Brandt-Larsen M, Christensen C, Madsen J, Nielsen CH, Loft A, Berthelsen AK, Kroman N, Højgaard L. Abstract P5-01-04: uPAR PET imaging in breast cancer: First-in-humans studies using 64Cu-DOTA-AE105 and 68Ga-NOTA-AE105. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-01-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective
The urokinase-type plasminogen activator receptor (uPAR) is a well-established prognostic biomarker in many cancer types including breast cancer (BC). Numerous studies using immunohistochemically evaluation of uPAR expression in tissue samples from BC patients have shown that not only is uPAR consistently overexpressed, but also carries strong prognostic value and is associates with overall survival. Accordingly, uPAR is an obvious target for identifying BC and for phenotyping aggressiveness in BC. Using whole body Positron Emission Tomography (PET) imaging rather than tissue specimens circumvents possible sampling error and allows for staging. Our objective was therefore to perform first-in-humans studies of uPAR-specific PET imaging in BC using either 64Cu-DOTA-AE105 or 68Ga-NOTA-AE105
Methods
Six patients with BC and scheduled for surgery were included. Prior to operation, patients were either PET/CT scanned 1, 3 and 24 h after injection of the uPAR PET ligand 64Cu-DOTA-AE105 (n=3; half life of 64Cu: 13 h) or PET/CT scanned 10 min, 1 h or 2 h after injection of 68Ga-NOTA-AE105 (n=3; half life of 68Ga: 1 h). PET Images were visually analyzed for visible tumor uptake of 64Cu-DOTA-AE105 or 68Ga-NOTA-AE105 and Standardized Uptake Values (SUV) were obtained by manually drawing volumes of interest (VOIs) around the primary tumor as well as identified metastases. Results are given as SUVmax. Tumor-to-background ratios relative to liver, kidney, blood and muscle were also calculated. Surgical tumor specimens were obtained from all patients during subsequent surgery. In addition to routine pathological examination, tissue was analyzed for ex vivo uPAR expression as target validation.
Results
Both primary tumors and metastases were visually detectable. For 64Cu-DOTA-AE105 SUVmax values were 2.9–4.0., and 2.9-4.0 after 1 and 3 h, respectively. Tumor-to-background ratios after 1 h were 0.91 (tumor-liver), 1.65 (tumor-kidney), 0.96 (tumor-blood) and 8.9 (tumor-muscle), respectively. Tumor-to-background ratios after 3 h were 0.50 (tumor-liver), 0.96 (tumor-kidney), 4.2 (tumor-blood) and 11.4 (tumor-muscle), respectively. Ex vivo analysis by immunohistochemistry confirmed uPAR expression in all primary cancer lesions. For 68Ga-NOTA-AE105, SUVmax was 5.0, 3.8 and 4.2 after 10 min, 1 h and 3 h, respectively (first patient analyzed). Tumor-to-background ratios after 10 min were 2.8 (tumor-liver), 0.4 (tumor-kidney), 1.6 (tumor-blood) and 8.4 (tumor-muscle), respectively. Tumor-to-background ratios after 1 h were 3.2 (tumor-liver), 0.6 (tumor-kidney), 1.7 (tumor-blood) and 7.1 (tumor-muscle), respectively.
Conclusion
This is the first study in humans using PET imaging of uPAR in BC. Both primary tumors and metastases were clearly visible with robust PET tracer uptake and a high and sufficient contrast between tumors and background. Our data supports continuation into phase II clinical studies using uPAR PET for staging and risk stratification, which potentially may be used for selection of treatment strategy in BC.
Citation Format: Kjaer A, Persson M, Skovgaard D, Brandt-Larsen M, Christensen C, Madsen J, Nielsen CH, Loft A, Berthelsen AK, Kroman N, Højgaard L. uPAR PET imaging in breast cancer: First-in-humans studies using 64Cu-DOTA-AE105 and 68Ga-NOTA-AE105. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-01-04.
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Affiliation(s)
- A Kjaer
- Rigshospitalet and University of Copenhagen
| | - M Persson
- Rigshospitalet and University of Copenhagen
| | | | | | | | - J Madsen
- Rigshospitalet and University of Copenhagen
| | - CH Nielsen
- Rigshospitalet and University of Copenhagen
| | - A Loft
- Rigshospitalet and University of Copenhagen
| | | | - N Kroman
- Rigshospitalet and University of Copenhagen
| | - L Højgaard
- Rigshospitalet and University of Copenhagen
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Anderson WF, Pfeiffer RM, Wohlfahrt J, Ejlertsen B, Jensen MB, Kroman NT. Abstract P1-07-03: Reproductive factors and subtype specific breast cancer risk. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-07-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Reproductive history and breast cancer risk reportedly differ by the estrogen receptor (ER±) and by the joint expression of ER and the human epidermal growth factor-2 receptor (ER±/HER2±). However, large sample sizes are needed to identify risk factor associations for the relatively less common ER- subtypes.
Material and Methods: We, therefore, linked two large-scale and population-based Danish registries to assess the associations for parity, number of live births, and age at first live birth (AFLB) with receptor-specific breast cancer risk. Relative risks (RRs) and 95% confidence intervals (CIs) for associations were estimated with Poisson regression models.
Results: With nearly 31 million women-years of follow-up, there were 45786 Danish women between the ages 20-84 years who developed an invasive breast cancer during the study period 1992-2011. Parity significantly reduced risk for ER+ and ER+/HER2- subtypes (RR for ER+/HER2- = 0.92; 0.87, 0.98) and suggestively increased risk for ER- and ER-/HER2- subtypes (RR for ER-/HER2- = 1.16; 0.99, 1.36). RRs increased with advancing AFLB for ER+ cancers, especially among premenopausal women; and were elevated for ER- cancers among age groups 12-19 years and 30-34 years compared to the reference age group 20-24 years.
Conclusion: Associations of breast cancer risk and reproductive history varied among Danish women by ER± and by ER±/HER2±, consistent with receptor-specific etiological heterogeneity. Risk estimates for ER+ and ER+/HER2- cancers were similar to the well-established associations for breast cancer overall, whereas relative risks for ER- and ER/HER2- cancers tended to be null or the inverse of ER+ associations.
Citation Format: Anderson WF, Pfeiffer RM, Wohlfahrt J, Ejlertsen B, Jensen M-B, Kroman NT. Reproductive factors and subtype specific breast cancer risk. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-07-03.
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Affiliation(s)
- WF Anderson
- National Cancer Institute, Bethesda, MD; Statens Serum Institut, Copenhagen; Danish Breast Cancer Group, Copenhagen; Righopitalet, Copenhagen, Denmark
| | - RM Pfeiffer
- National Cancer Institute, Bethesda, MD; Statens Serum Institut, Copenhagen; Danish Breast Cancer Group, Copenhagen; Righopitalet, Copenhagen, Denmark
| | - J Wohlfahrt
- National Cancer Institute, Bethesda, MD; Statens Serum Institut, Copenhagen; Danish Breast Cancer Group, Copenhagen; Righopitalet, Copenhagen, Denmark
| | - B Ejlertsen
- National Cancer Institute, Bethesda, MD; Statens Serum Institut, Copenhagen; Danish Breast Cancer Group, Copenhagen; Righopitalet, Copenhagen, Denmark
| | - M-B Jensen
- National Cancer Institute, Bethesda, MD; Statens Serum Institut, Copenhagen; Danish Breast Cancer Group, Copenhagen; Righopitalet, Copenhagen, Denmark
| | - NT Kroman
- National Cancer Institute, Bethesda, MD; Statens Serum Institut, Copenhagen; Danish Breast Cancer Group, Copenhagen; Righopitalet, Copenhagen, Denmark
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Tvedskov TF, Jensen MB, Balslev E, Garne JP, Vejborg I, Christiansen P, Ejlertsen B, Kroman N. Risk of non-sentinel node metastases in patients with symptomatic cancers compared to screen-detected breast cancers. Acta Oncol 2015; 55:455-9. [PMID: 26452696 DOI: 10.3109/0284186x.2015.1094186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Symptomatic breast cancers may be more aggressive as compared to screen-detected breast cancers. This could favor axillary lymph node dissection (ALND) in patients with symptomatic breast cancer and positive sentinel nodes. METHOD We identified 955 patients registered in the Danish Breast Cancer Cooperative Group (DBCG) Database in 2008 - 2010 with micrometastases (773) or isolated tumor cells (ITC) (182) in the sentinel node. Patients were cross-checked in the Danish Quality Database of Mammography Screening and 481 patients were identified as screen-detected cancers. The remaining 474 patients were considered as having symptomatic cancers. Multivariate analyses of the risk of non-sentinel node metastases were performed including known risk factors for non-sentinel node metastases as well as method of detection. RESULTS 18% of the patients had metastases in non-sentinel nodes. This was evenly distributed between patients with symptomatic and screen-detected cancers; 18.5% vs 17.5% (OR 1.07; 95% CI 0.77-1.49; p = 0.69). In patients with micrometastases 21% had non-sentinel node metastases in the group with symptomatic cancers compared to 19% of patients with screen-detected cancers. This difference was not significant (OR 1.16; 95% CI 0.81-1.65, p = 0.43). Neither the multivariate analysis showed an increased risk of non-sentinel node metastases in patients with symptomatic cancers compared to screen-detected cancers (OR 1.12, CI 0.77-1.62, p = 0.55). In patients with ITCs 8% of patients with symptomatic cancers had non-sentinel node metastases compared to 13% of patients with screen-detected cancers. This difference was not significant (OR 0.58; 95% CI 0.22-1.54, p = 0.27). In the multivariate analysis, the risk of non-sentinel node metastases was still not significantly increased in patients with symptomatic cancers compared to screen-detected cancers (OR 0.45; 95% CI 0.16-1.27, p = 0.13). CONCLUSION We did not find any clinically relevant difference in the risk of non-sentinel node metastases between patients with symptomatic and screen-detected cancers with micrometastases or ITC in the sentinel node.
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Affiliation(s)
- Tove F. Tvedskov
- Department of Breast Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Balslev
- Department of Pathology, Herlev Hospital, Copenhagen, Denmark
| | - Jens P. Garne
- Department of Breast Surgery, Ringsted Hospital, Ringsted, Denmark
| | - Ilse Vejborg
- Department of Radiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peer Christiansen
- Department of Surgery, Breast Surgery Unit, Aarhus University Hospital/Randers Regional Hospital, Aarhus, Denmark, and
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - N. Kroman
- Department of Breast Surgery, Copenhagen University Hospital, Copenhagen, Denmark
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Duriaud H, Mertz B, Kroman N, Andersen K. 1738 Psychological distress, pain and sensory disturbances among Danish women treated for ductal carcinoma in situ: Results from a pilot study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30747-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mertz B, Kroman N, Johansen C, Bidstrup P. 1712 Screening-based nurse navigation for women with newly diagnosed breast cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30728-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tvedskov TF, Meretoja TJ, Jensen MB, Leidenius M, Kroman N. Cross-validation of three predictive tools for non-sentinel node metastases in breast cancer patients with micrometastases or isolated tumor cells in the sentinel node. Eur J Surg Oncol 2014; 40:435-41. [PMID: 24534362 DOI: 10.1016/j.ejso.2014.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/14/2014] [Accepted: 01/23/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We cross-validated three existing models for the prediction of non-sentinel node metastases in patients with micrometastases or isolated tumor cells (ITC) in the sentinel node, developed in Danish and Finnish cohorts of breast cancer patients, to find the best model to identify patients who might benefit from further axillary treatment. MATERIAL AND METHOD Based on 484 Finnish breast cancer patients with micrometastases or ITC in sentinel node a model has been developed for the prediction of non-sentinel node metastases. Likewise, two separate models have been developed in 1577 Danish patients with micrometastases and 304 Danish patients with ITC, respectively. The models were cross-validated in the opposite cohort. RESULTS The Danish model for micrometatases was accurate when tested in the Finnish cohort, with a slight change in AUC from 0.64 to 0.63. The AUC of the Finnish model decreased from 0.68 to 0.58 when tested in the Danish cohort, and the AUC of the Danish model for ITC decreased from 0.73 to 0.52, when tested in the Finnish cohort. The Danish micrometastatic model identified 14-22% of the patients as high-risk patients with over 30% risk of non-sentinel node metastases while less than 1% was identified by the Finish model. In contrast, the Finish model predicted a much larger proportion of patients being in the low-risk group with less than 10% risk of non-sentinel node metastases. CONCLUSION The Danish model for micrometastases worked well in predicting high risk of non-sentinel node metastases and was accurate under external validation.
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Affiliation(s)
- T F Tvedskov
- Department of Breast Surgery, Copenhagen University Hospital, Afsnit 4124, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - T J Meretoja
- Breast Surgery Unit, Helsinki University Central Hospital, P.O. Box 140, 00029 HUS, Helsinki, Finland
| | - M B Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Afsnit 2501, Blegdamsvej 9, Copenhagen, Denmark
| | - M Leidenius
- Breast Surgery Unit, Helsinki University Central Hospital, P.O. Box 140, 00029 HUS, Helsinki, Finland
| | - N Kroman
- Department of Breast Surgery, Copenhagen University Hospital, Afsnit 4124, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Andersen K, Jensen M, Tvedskov T, Kehlet H, Gärtner R, Kroman N. Persistent pain, sensory disturbances and functional impairment after immediate or delayed axillary lymph node dissection. Eur J Surg Oncol 2013; 39:31-5. [DOI: 10.1016/j.ejso.2012.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 09/17/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022] Open
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Bigaard J, Stahlberg C, Jensen MB, Ewertz M, Kroman N. Breast cancer incidence by estrogen receptor status in Denmark from 1996 to 2007. Breast Cancer Res Treat 2012; 136:559-64. [PMID: 23053655 DOI: 10.1007/s10549-012-2269-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 09/20/2012] [Indexed: 11/25/2022]
Abstract
During the past 50 years, breast cancer incidence has increased by 2-3 % annually. Despite many years of testing for estrogen receptors (ER), evidence is scarce on breast cancer incidence by ER status. The aim of this paper was to investigate the increase in breast cancer incidence by ER status. Data were obtained from the clinical database of the Danish Breast Cancer Cooperative Group which holds nationwide data on diagnosis, including pathology, treatment, and follow-up on primary breast cancers since 1977. All Danish women <80 years diagnosed with primary breast cancer 1996-2007 were identified in this prospective register based study. ER status was evaluated using immunohistochemical staining by standardized laboratory methods in the Danish Pathology Departments and reported to the database. From 1996 to 2007, breast cancer incidence increased overall with a tendency to level off after 2002. In all women a significant decrease was found in ER unknown tumors. However, in both pre- and postmenopausal women, significant increases were seen in incidence of ER+ tumors; though the increase levelled off for premenopausal women after 2002. In postmenopausal women, the incidence of ER- breast cancer decreased significantly throughout the period. In women <35 years, we found a minor non-significant increase in both ER+ and ER- tumors. ER unknown decreased in all women and was the most distinct in premenopausal women aged 35+. We found a significant increase in ER+ breast cancer incidence in postmenopausal women whereas the incidence in premenopausal women (aged 35+) levelled off after 2002.
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Affiliation(s)
- J Bigaard
- Department of Breast Surgery, Ringsted Hospital, Ringsted, Denmark.
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Bernsdorf M, Berthelsen AK, Wielenga VT, Kroman N, Teilum D, Binderup T, Tange UB, Andersson M, Kjær A, Loft A, Graff J. Preoperative PET/CT in early-stage breast cancer. Ann Oncol 2012; 23:2277-2282. [PMID: 22357250 DOI: 10.1093/annonc/mds002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer. PATIENTS AND METHODS A total of 103 consecutive patients with newly diagnosed operable breast cancer with tumors ≥2 cm were independently examined preoperatively with conventional assessment (mammography, breast/axillary ultrasound, chest X-ray and blood samples) and PET/CT with no prior knowledge of the other. RESULTS PET/CT identified a primary tumor in all but three patients (97%). PET/CT solely detected distant metastases (ovary, bones and lung) in 6 patients and new primary cancers (ovary, lung) in another two patients, as well as 12 cases of extra-axillary lymph node involvement. In 15 patients (15%), extra-axillary malignancy was detected by PET/CT only, leading to an upgrade of initial staging in 14% (14/103) and ultimately a modification of planned treatment in 8% (8/103) of patients. CONCLUSIONS PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases and other occult primary cancers. Preoperative (18)F-fluorodeoxyglucose-PET/CT has a substantial impact on initial staging and on clinical management in patients with early-stage breast cancer with tumors ≥2 cm.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/secondary
- Carcinoma, Lobular/surgery
- Diagnosis, Differential
- Female
- Fluorodeoxyglucose F18
- Humans
- Lymphatic Metastasis
- Middle Aged
- Multimodal Imaging
- Neoplasm Staging
- Positron-Emission Tomography
- Preoperative Care
- Prospective Studies
- Radiopharmaceuticals
- Sensitivity and Specificity
- Tomography, X-Ray Computed
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Affiliation(s)
| | - A K Berthelsen
- Departments of Clinical Physiology, Nuclear Medicine & PET
| | | | - N Kroman
- Departments of Breast Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen
| | - D Teilum
- Departments of Breast Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen
| | - T Binderup
- Departments of Clinical Physiology, Nuclear Medicine & PET; Cluster for Molecular imaging, Faculty of Health Sciences, University of Copenhagen, Copenhagen
| | | | | | - A Kjær
- Departments of Clinical Physiology, Nuclear Medicine & PET; Cluster for Molecular imaging, Faculty of Health Sciences, University of Copenhagen, Copenhagen
| | - A Loft
- Departments of Clinical Physiology, Nuclear Medicine & PET
| | - J Graff
- Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
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Mertz B, Kroman N, Christensen J, Dalton S, Johansen C, Bidstrup P. 41 Quality of Life Trajectories in the First Eight Months After Breast Cancer. Eur J Oncol Nurs 2012. [DOI: 10.1016/s1462-3889(12)70055-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tvedskov T, Jensen M, Ejlertsen B, Balslev E, Kroman N. 16 Prognostic Significance of Axillary Lymph Node Dissection in Breast Cancer Patients with Micrometastases or Isolated Tumor Cells in Sentinel Nodes – a Nationwide Study. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70084-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Azim H, Kroman N, Ameye L, Rotmensz N, Gelber S, Cordoba O, Pinto A, Jensen M, de Azambuja E, Peccatori F. 21 Pregnancy Following Estrogen Receptor-Positive Breast Cancer is Safe – Results From a Large Multi-center Case-control Study. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70089-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tvedskov T, Jensen M, Balslev E, Kroman N. 5014 ORAL High Risk of Non-sentinel Node Metastases in a Group of Breast Cancer Patients With Micrometastases in the Sentinel Node. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71456-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Andersen KG, Gártner R, Kroman N, Flyger H, Kehlet H. 5195 POSTER Persistent Pain After Targeted Intraoperative Radiotherapy (TARGIT) or External Breast Radiotherapy for Breast Cancer – a Randomized Trial. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71637-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Christiansen P, Bjerre K, Ejlertsen B, Jensen MB, Rasmussen BB, Laenkholm AV, Kroman N, Ewertz M, Offersen B, Toftdahl DB, Moller S, Mouridsen HT. Mortality Rates Among Early-Stage Hormone Receptor-Positive Breast Cancer Patients: A Population-Based Cohort Study in Denmark. J Natl Cancer Inst 2011; 103:1363-72. [DOI: 10.1093/jnci/djr299] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kamper-Jørgensen M, Biggar RJ, Stamper CL, Hjalgrim H, Tjønneland A, Olsen A, Andersen AN, Rostgaard K, Kroman N, Gadi VK. Fetal microchimerism in breast and colon cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ejlertsen B, Christiansen P, Bjerre K, Jensen M, Rasmussen B, Lænkholm A, Kroman N, Kvistgaard M, Offersen B, Toftdahl D, Møller S, Mouridsen H. S37 Characteristics of breast cancer patients unlikely to benefit from adjuvant therapy. Breast 2011. [DOI: 10.1016/s0960-9776(11)70039-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Tvedskov TF, Jensen MB, Kroman N, Balslev E. Abstract S5-2: Iatrogenic Displacement of Tumor Cells to the Sentinel Node after Surgical Excision Biopsy in Primary Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-s5-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: It is shown that isolated tumor cells are more common in the sentinel node after needle biopsy of a breast cancer, indicating iatrogenic displacement of epithelial cells. This may result in unnecessary axillary lymph node dissections. It is possible that a similar iatrogenic displacement occurs after surgical excision biopsy but the incidence and clinical significance is basically unknown.
Material and Methods: By linking data from the Danish Breast Cancer Cooporative Group database and data from the Danish National Health Registry we compared the incidence of isolated tumor cells and micrometastases in the sentinel node of 347 breast cancer patients with prior surgical excision biopsy to a group of 14401 patients without prior surgical excision biopsy in a multivariate analysis adjusting for tumor size, receptor status, type and histological grade. The incidence of isolated tumor cells in the sentinel node was further analysed by histological type. Finally, we investigated the incidence of non-sentinel node metastases in patients with isolated tumor cells and micrometastases in the sentinel node after prior surgical excision biopsy.
Results: We found an adjusted odds ratio on 3.99 (95% CI 2.67-5.97; P<0.0001) for having isolated tumor cells in the sentinel node after surgical excision biopsy. Likewise, we found an adjusted odds ratio for having micrometastases on 1.62 (95% CI 1.20 -2.18; P=0.002). Isolated tumor cells were, in general, more common in the sentinel node of lobular carcinomas compared to ductal carcinomas (adjusted OR 3.51; 95% CI 2.80-4.40; P<0.0001). In contrast, the increase in isolated tumor cells after surgical excision biopsy was especially seen in patients with ductal carcinomas with an adjusted odds ratio on 5.41 (95% CI 3.45-8.48; P=0.054) whereas the odds ratio for lobular carcinomas was only 1.53 (95% CI 0.45-5.14) (P=0.054 for heterogeneity). None of the 20 patients with isolated tumor cells in the sentinel node after prior surgical excision biopsy had non-sentinel node metastases compared to 13% in the group without prior surgical excision biopsy (P=0.15). In patients with micrometastases in the sentinel node after prior surgical excision biopsy 13% had non sentinel node metastases compared to 18% in the group without prior surgical excision biopsy (P=0.29).
Conclusions: The 4-fold increase in isolated tumor cells in the sentinel node after surgical excision biopsy indicates that this procedure induces iatrogenic displacement of epithelial cells. This displacement is more common in ductal carcinomas, despite the fact that lobular carcinomas, in general, are more likely to present with isolated tumor cells in the sentinel node. We found no further dissemination to non-sentinel lymph nodes, suggesting that isolated tumor cells in the sentinel node in these women do not indicate further spread of disease. Hence, in case of isolated tumor cells in the sentinel node after prior surgical excision biopsy, omission of axillary lymph node dissection should be considered.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr S5-2.
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Affiliation(s)
- TF Tvedskov
- Copenhagen University Hospital, Copenhagen, Denmark; Danish Breast Cancer cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Denmark
| | - M-B Jensen
- Copenhagen University Hospital, Copenhagen, Denmark; Danish Breast Cancer cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Denmark
| | - N Kroman
- Copenhagen University Hospital, Copenhagen, Denmark; Danish Breast Cancer cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Denmark
| | - E. Balslev
- Copenhagen University Hospital, Copenhagen, Denmark; Danish Breast Cancer cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Denmark
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Petersen MB, Berthelsen AK, Timmermans-Wielenga V, Kroman N, Binderup T, Tange UB, Andersson M, Kjaer A, Loft A, Graff J. Abstract P5-01-08: Preoperative Positron Emission Tomography/Computed Tomography (PET/CT) and 18F-Fluorodeoxyglucose (18F-FDG) Compared with Conventional Assessment in Patients with Early Primary Breast Cancer: Preliminary Results of a Prospective Study. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-01-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The prognosis and clinical management of patients with newly diagnosed breast cancer depends on the extent of disease. The aim of this study was to compare the diagnostic and therapeutic impact of preoperative PET/CT, using 18F-FDG in the initial extra-axillary staging of patients with early breast cancer, to the results of conventional assessment. One hundred patients are planned enrolled. We here report the results of the first fifty consecutive patients.
Patients and methods: Fifty consecutive patients with newly diagnosed early operable breast cancer with tumors ≥2 cm were examined preoperatively with conventional assessment (mammography, breast/axilla ultrasound, chest x-ray and blood samples) and PET/CT. Conventional assessment and PET/CT were evaluated independently with no prior knowledge of the other. Distant metastases/new primary cancers found on PET/CT were confirmed histologically, by other imaging modalities or with at least 1 year of follow-up.
Results: The mean age was 56 ± 11 years. PET/CT identified primary tumor in all but two patients (96%). Nine cases of extra-axillary lymph node involvement were solely revealed by PET/CT in the internal mammary chain (n=7) and the supraclavicular region (n=2). Additionally, PET/CT solely detected distant metastasis (ovary, bone) in two patients and new primary cancers (ovary, lung) in another two patients. Two patients (4%) had non-malignant focal uptake of 18F-FDG confirmed with histologic biopsies (schwannoma, colon adenoma).
In 12 patients (24%) extra-axillary malignancy was detected by PET/CT only, leading to an upgrade of initial staging in 20% (10/50) of patients and ultimately a modification of planned treatment in 4 (8%) patients. No patient was down staged by PET/CT.
Conclusion: PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases and other occult primary cancers. Preoperative 18F-FDG-PET/CT has a substantially impact on initial staging and on clinical management in patients with early stage breast cancer.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-01-08.
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Affiliation(s)
- MB Petersen
- Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - AK Berthelsen
- Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - V Timmermans-Wielenga
- Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - N Kroman
- Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - T Binderup
- Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - UB Tange
- Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - M Andersson
- Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - A Kjaer
- Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - A Loft
- Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - J. Graff
- Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
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Gärtner R, Kroman N, Callesen T, Kehlet H. Multimodal prevention of pain, nausea and vomiting after breast cancer surgery. Minerva Anestesiol 2010; 76:805-813. [PMID: 20935616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Despite many one- or two-modal attempts to relieve postoperative nausea and vomiting (PONV) and pain, postoperative issues following breast cancer surgery remain a substantial problem. Therefore, the aim of this explorative, hypothesis-generating study was to evaluate the effect of a multimodal, opiate-sparing, evidence-based regimen for prevention of PONV and pain. METHODS Two hundred consecutive patients scheduled for breast cancer surgery were included. The prevention regimen included a package consisting of preoperative paracetamol, dextromethorphan, celecoxib, gabapentin, dexamethasone, total intravenous anaesthesia and intraoperative ondansetron. The patients were prospectively scored according to PONV, pain during rest and mobilization and major side effects. RESULTS Of 200 consecutive breast cancer patients, 191 received the full package. During the first 36 postoperative hours, 79.1% reported no PONV at all and only 3.7% reported severe PONV. At rest, 69.6% reported no or light pain and 3.1% reported severe pain, with corresponding values of 59.7% and 8.9% during arm mobilization. Mean postoperative morphine consumption was 2.2 mg. The only significant side effect was transient dizziness. CONCLUSION A multimodal, opiate-sparing regimen to prevent pain and PONV seems to be more effective than one- or two-component regimens on PONV and pain after breast cancer surgery, a result which calls for large-scale multi-center or randomized studies.
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Affiliation(s)
- R Gärtner
- Department of Breast Cancer Surgery, Rigshospitalet, Copenhagen University, Denmark.
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Dalton SO, Suppli NP, Deltour I, Damkjær LH, Jensen AB, Kroman N, Johansen C. Factors associated with the prescription of antidepressive medication in breast cancer patients: A rehabilitation perspective. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tvedskov TF, Jensen M, Balslev E, Ejlertsen B, Kroman N. 3N Stage migration after introduction of sentinel lymph node dissection in breast cancer treatment in Denmark: a nationwide study. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Gärtner R, Jensen M, Kronborg L, Ewertz M, Kehlet H, Kroman N. 355 Impact of breast cancer treatment on lymphedema and impairment of function – A nationwide study of prevalence and associated factors. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Jensen M, Nielsen J, Ewertz M, Kroman N, Kehlet H, Gärtner R. 5012 Persistent pain following breast cancer surgery: a nationwide study of predictors and consequences. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70904-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kroman N. 300 Child-bearing in breast cancer survivors. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kempel M, Ewertz M, Andersson M, Christiansen P, Düring M, Kroman N, Overgaard M, Rasmussen B, Rytov N. 369 The quality of breast conserving treatment in Denmark, 1989–1998 — nationwide population-based study of the Danish breast cancer co-operative group. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Affiliation(s)
- M Blichert-Toft
- Surgical Department CE, Rigshospitalet, Copenhagen, Denmark.
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Affiliation(s)
- N Kroman
- Surgical Department CE, Rigshospitalet, Copenhagen, Denmark.
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Kroman NT, Mouridsen H, Melbye M. [The significance of reproductive history for prognosis of primary breast cancer]. Ugeskr Laeger 2001; 163:5205-9. [PMID: 11577528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The aetiological impact of a woman's reproductive history on breast cancer is well established, whereas the prognostic influence of the reproductive pattern is less well described. A literature search with focus on three Danish studies is described. Status as parous/nulliparous and number of births appear to have no prognostic influence. Women who have their first child at an early age have a lower survival than women who have postponed their first childbirth. This may eventually be explained by selection, i.e. that women with an early first full-term pregnancy represent a group with a more malignant disease. Women diagnosed in the first two years after childbirth have a significantly lower survival, probably because the cancer, being subclinical during pregnancy, is affected by the high oestrogen concentrations with aggressive growth as the outcome. Pregnancy after treatment of breast cancer does not appear to have a negative influence on the prognosis.
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Affiliation(s)
- N T Kroman
- Afdeling for epidemiologisk forskning, Statens Serum Institut, København, Center for Epidemiologisk Grundforskning
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Kroman N, Holtveg H, Wohlfahrt J, Mouridsen H, Melbye M. Is breast conserving surgery a risk factor in young breast cancer patients? Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kroman NT, Blichert-Toft M. [Breast conserving surgery in breast cancer]. Ugeskr Laeger 2001; 163:780. [PMID: 11228809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- N T Kroman
- H:S Rigshospitalet, kirurgisk afdeling, endokrin- og mammakirurgisk afsnit
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Kroman NT, Jensen MB, Wohlfahrt J, Mouridsen H, Andersen PK, Melbye M. [Should all younger patients with breast cancer be offered adjuvant cytotoxic chemotherapy?]. Ugeskr Laeger 2000; 162:3184-8. [PMID: 10850209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The aim of the study was to investigate whether young age at diagnosis is a negative prognostic factor in primary breast cancer and how stage of disease at diagnosis and treatment may influence such an association. It was conducted as a retrospective cohort study based on a population-based data-base of breast cancer diagnosis with detailed information on tumour characteristics, treatment regimens, and vital status and included 10,356 patients with primary breast cancer less than 50 years of age at diagnosis. The main outcome measures were relative risk of dying within the first ten years after diagnosis according to age at diagnosis, adjusted for effect of known prognostic factors and expected mortality. Overall, young patients with low risk disease who did not receive adjuvant treatment had a significantly increasing risk of dying with decreasing age at diagnosis (adjusted relative risk: 45-49 years: 1 (reference); 40-44 years: 1.12 (0.89-1.40); 35-39 years: 1.40 (1.10-1.78); < 35 years: 2.18 (1.64-2.89). However, a similar trend was not seen in young patients who received adjuvant cytotoxic therapy. We found the same difference as above when comparing women receiving no treatment with those receiving adjuvant cytotoxic therapy within strata of node negative patients and patients with the same tumour size. In conclusion, the negative prognostic effect of young age is almost exclusively seen in women diagnosed with low risk disease not receiving adjuvant cytotoxic therapy, whereas young women who receive adjuvant cytotoxic therapy have the same prognosis as middle-aged women. These results suggest that young women with breast cancer, on the basis of age alone, should be regarded as high risk patients and be given adjuvant cytotoxic therapy.
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Affiliation(s)
- N T Kroman
- Afdelingen for epidemiologisk forskning, Statens Serum Institut, København
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Kroman N, Jensen MB, Wohlfahrt J, Mouridsen HT, Andersen PK, Melbye M. Factors influencing the effect of age on prognosis in breast cancer: population based study. BMJ 2000; 320:474-8. [PMID: 10678859 PMCID: PMC27289 DOI: 10.1136/bmj.320.7233.474] [Citation(s) in RCA: 261] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate whether young age at diagnosis is a negative prognostic factor in primary breast cancer and how stage of disease at diagnosis and treatment influences such an association. DESIGN Retrospective cohort study based on a population based database of patients with breast cancer containing detailed information on tumour characteristics, treatment regimens, and survival. SETTING Denmark. SUBJECTS 10 356 women with primary breast cancer who were less than 50 years old at diagnosis. MAIN OUTCOME MEASURES Relative risk of dying within the first 10 years after diagnosis according to age at diagnosis after adjustment for known prognostic factors and expected mortality. RESULTS Overall, young women with low risk disease who did not receive adjuvant treatment had a significantly increased risk of dying; risk increased with decreasing age at diagnosis (adjusted relative risk: 45-49 years (reference): 1; 40-44 years: 1.12 (95% confidence interval 0.89 to 1.40); 35-39 years: 1.40 (1.10 to 1.78); <35 years: 2.18 (1.64 to 2.89). However, no similar trend was seen in patients who received adjuvant cytotoxic treatment. The increased risk in younger women who did not receive adjuvant treatment compared with those who did remained when women were grouped according to presence of node negative disease and by tumour size. CONCLUSION The negative prognostic effect of young age is almost exclusively seen in women diagnosed with low risk disease who did not receive adjuvant cytotoxic treatment. These results suggest that young women with breast cancer, on the basis of age alone, should be regarded as high risk patients and be given adjuvant cytotoxic treatment.
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Affiliation(s)
- N Kroman
- Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, DK 2300 Copenhagen, Denmark
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Kroman N, Thorpe SM, Wohlfahrt J, Andersen KW, Mouridsen HT. Variations in prognostic factors in primary breast cancer throughout the menstrual cycle. Eur J Surg Oncol 2000; 26:11-6. [PMID: 10718172 DOI: 10.1053/ejso.1999.0732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS We investigated whether menstrual cycle dependent variations in prognostic factors are detectable in malignant breast tissue. METHODS Since 1977 the Danish Breast Cancer Cooperative Group has collected population-based information about primary clinical data, treatment regimens and follow-up status on Danish women with breast cancer. Information about last menstrual periods prior to surgery was obtained from files recorded at the time of admission for primary surgery. Included in this study were 1060 patients self-reported to be regularly menstruating and with a menstrual period within 6 weeks of surgery and who were operated in a single-step procedure. None of the patients were current users of exogenous hormones at the time of surgery. Variations of prognostic factors throughout the menstrual cycle were evaluated. RESULTS Overall, no significant correlation between endogenous hormone fluctuations and oestrogen receptor (ER) status and progesterone receptor (PgR) status were found. Furthermore, we observed no cycle-dependent variation for mitotic index, lymph node involvement or tumour size. CONCLUSIONS The classical prognostic factors in breast cancer did not differ significantly throughout the menstrual cycle in the present study.
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Affiliation(s)
- N Kroman
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen.
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Abstract
Reproductive factors are known to be aetiologically important in breast cancer, but less is known regarding their effect on breast cancer prognosis. We have investigated the prognostic effect of age at first birth and total parity using data from the Danish Breast Cancer Cooperative Group that, since 1977, has collected population-based information on tumour characteristics, treatment regimes and follow-up status on Danish women with breast cancer. Details of pregnancy history were added from the Danish Civil Registration System and the National Birth Registry. Included in the study were 10,703 women with primary breast cancer. After adjusting for age and stage of disease (tumour size, axillary nodal status and histological grading), the number of full-term pregnancies was found without prognostic value. However, women with primary childbirth between 20 and 29 years experienced a significantly reduced risk of death compared with women with primary childbirth below the age of 20 years [20-24 years: relative risk (RR) = 0.88, 95% confidence interval (CI) 0.78-0.99; 25-29 years: RR = 0.80, 95% CI 0.70-0.91]. Further adjustment for oestrogen receptor status did not influence these results. The effect was not modified by age at diagnosis, tumour size or nodal status. In conclusion, low age at first childbirth, but not parity, was associated with a poor prognosis of breast cancer. We speculate whether women who develop breast cancer despite an early first full-term pregnancy might represent a selected group with a more malignant disease.
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Affiliation(s)
- N Kroman
- Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen
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Kroman N, Jensen M, Wohlfahrt J, Mouridsen H, Andersen P, Melbye M. Survival patterns according to age and treatment among breast cancer patients. Eur J Cancer 1998. [DOI: 10.1016/s0959-8049(98)80392-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kroman N, Wohlfahrt J, Andersen KW, Mouridsen HT, Westergaard T, Melbye M. Time since childbirth and prognosis in primary breast cancer: population based study. BMJ 1997; 315:851-5. [PMID: 9353505 PMCID: PMC2127579 DOI: 10.1136/bmj.315.7112.851] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate whether time since birth of last child was of prognostic importance in women with primary breast cancer. DESIGN Retrospective cohort study based on a population based database of breast cancer diagnoses with detailed information on tumour characteristics, treatment regimens, reproductive factors, and vital status. SETTING Denmark. SUBJECTS 5652 women with primary breast cancer aged 45 years or less at the time of diagnosis. MAIN OUTCOME MEASURES 5 and 10 year survival; relative risk of dying. RESULTS Women diagnosed in the first 2 years after last childbirth had a crude 5 year survival of 58.7% and 10 year survival of 46.1% compared with 78.4% and 66.0% for women whose last childbirth was more than 2 years before their diagnosis. After adjustment for age, reproductive factors, and stage of disease (tumour size, axillary nodal status, and histological grading), a diagnosis sooner than 2 years since last childbirth was significantly associated with a poor survival (relative risk 1.58, 95% confidence interval 1.24 to 2.02) compared with women who gave birth more than 5 years previously. Further analyses showed that the effect was not modified by age at diagnosis, tumour size, and nodal status. CONCLUSIONS A diagnosis of breast cancer less than 2 years after having given birth is associated with a particularly poor survival irrespective of the stage of disease at debut. Therefore, a recent pregnancy should be regarded as a negative prognostic factor and should be considered in counselling these patients and in the decisions regarding adjuvant treatment.
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Affiliation(s)
- N Kroman
- Surgical Department A, Hillerød Hospital, Denmark
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