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Record SM, Thomas SM, Tian WM, van den Bruele AB, Chiba A, DiLalla G, DiNome ML, Kimmick G, Rosenberger LH, Woriax HE, Hwang ES, Plichta JK. Anatomy Versus Biology: What Guides Chemotherapy Decisions in Older Patients With Breast Cancer? J Surg Res 2024; 296:654-664. [PMID: 38359680 PMCID: PMC10947834 DOI: 10.1016/j.jss.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/08/2024] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION With the increasing utilization of genomic assays, such as the Oncotype DX recurrence score (RS), the relevance of anatomic staging has been questioned for select older patients with breast cancer. We sought to evaluate differences in chemotherapy receipt and/or survival among older patients based on RS and sentinel lymph node biopsy (SLNB) receipt/result. METHODS Patients aged ≥ 65 diagnosed with pT1-2/cN0/M0 hormone-receptor-positive (HR+)/HER2-breast cancer (2010-2019) were selected from the National Cancer Database. Logistic regression was used to identify factors associated with chemotherapy receipt. Cox proportional hazards models were used to estimate the association of RS/SLNB group with overall survival. A cost-benefit study was also performed. RESULTS Of the 75,428 patients included, the majority had an intermediate RS (58.2% versus 27.9% low, 13.8% high) and were SLNB- (85.1% versus 11.6% SLNB+, 3.3% none). Chemotherapy was recommended for 13,442 patients (17.8%). After adjustment, chemotherapy receipt was more likely with higher RS and SLNB+. After adjustment, SLNB receipt/result was only associated with overall survival among those with an intermediate RS. However, returning to the OR for SLNB is not cost-effective. CONCLUSIONS SLNB receipt/result was associated with survival for those with an intermediate RS, but not a low or high RS, suggesting that an SLNB may indeed be unnecessary for select older patients with breast cancer.
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Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, North Carolina; Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - William M Tian
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Astrid Botty van den Bruele
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Akiko Chiba
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Gayle DiLalla
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Maggie L DiNome
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Gretchen Kimmick
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Hannah E Woriax
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina.
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Botty van den Bruele A, Paul MA, Thomas SM, Sammons SL, DiNome ML, Plichta JK, Record SM, Woriax H, Chiba A, Rosenberger LH, Hwang ES. Axillary nodal disease burden is not associated with an elevated 21-gene recurrence score in post-menopausal women presenting with a clinically negative axilla. Am J Surg 2024:S0002-9610(24)00067-9. [PMID: 38350748 DOI: 10.1016/j.amjsurg.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/14/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The predictive and prognostic value of the recurrence score (RS) has emphasized the importance of tumor biology and has reduced the prognostic implications of limited nodal burden in post-menopausal women with HR+/HER2-invasive breast cancer (IBC). It is unclear whether routine axillary staging has a continued role in the management of small, clinically node negative (cN0) HR+/HER2- IBC. We sought to estimate the association of RS with pN stage. METHODS Patients >50yo diagnosed with cN0, HR+/HER2- IBC (2015-2019) with an available RS were identified from the National Cancer Database. The clinicopathologic characteristics and rates of pN-stage (pN0, pN1, pN2/3) were compared for RS of ≤25 vs. >25. RESULTS The median patient age was 64.1 (IQR 58-69) and the majority (75%) of tumors displayed ductal histology. Most (81.6%) were cT1 on presentation and pT1 (74.7%) on final pathology. There were 130,568 (86.2%) with a RS ≤ 25 and 20,879 (13.8%) with a RS > 25. On final pathology, 128,995 (85.2%) were pN0 and 21,991 (14.5%) pN1. Of the pN1, 2699 (12.3%) yielded a RS > 25. There were 461 (0.3%) patients with pN2-pN3 disease. Of those, 57 (12.4%) had RS > 25. CONCLUSION In our analysis, pN0 and pN1 tumors are biologically similar by gene expression assay in postmenopausal patients with similar proportions of high RS. These data support the notion that tumor biology examined via RS may have more prognostic and predictive value than metastatic dissemination to limited lymph nodes. These findings support the ongoing evaluation of routine axillary staging in postmenopausal patients with HR+/HER2- IBC.
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Affiliation(s)
- Astrid Botty van den Bruele
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA.
| | - Morgan A Paul
- Duke Cancer Institute, Duke University, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Sarah L Sammons
- Department of Medicine, Dana Farber Cancer Institute, Boston, MA, USA
| | - Maggie L DiNome
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Sydney M Record
- Department of Surgery, Duke University, Durham, NC, USA; Department of Medicine, Dana Farber Cancer Institute, Boston, MA, USA
| | - Hannah Woriax
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Akiko Chiba
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Laura H Rosenberger
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
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Record SM, Thomas SM, Ntowe K, Chiba A, Plichta JK. BRCA1/2 mutation carriers & risk reducing mastectomy: Who undergoes surgery and potential benefits. Am J Surg 2024; 227:146-152. [PMID: 37827871 PMCID: PMC10842097 DOI: 10.1016/j.amjsurg.2023.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/29/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Risk-reducing mastectomy (RRM) is the most effective breast cancer risk-reduction strategy in BRCA1/2 mutation carriers. We examined factors associated with RRM and its relationship with overall survival (OS). METHODS Patients aged 18-80y at diagnosis of their BRCA1/2 mutation were selected from our institutional database and stratified by RRM receipt. Differences were tested; unadjusted OS was estimated. RESULTS Of the 306 patients, median age was 43y; median follow-up was 41.6mo. Patients undergoing RRM were more often married with a history of pregnancy (both p ≤ 0.05). Of female patients, 23.1% underwent RRM. Two patients had malignancy detected at RRM, and one developed breast cancer after RRM. Higher unadjusted OS was observed with RRM (p = 0.02). CONCLUSIONS Our analyses suggest that family-structure may play a role in a patient's decision to undergo RRM. We also demonstrated RRM is likely associated with improved survival, potentially underscoring the importance of this option for BRCA1/2 mutation carriers.
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Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA; Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Koumani Ntowe
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Akiko Chiba
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Record SM, Chanenchuk T, Altieri M, Cannada L, Guetter CR, Joseph KA, Maxwell J, Reyna C, Sumra H, Tan S, Tasnim S, Yu YR, Plichta JK. One step ahead: Finding mentors at all stages of a surgical career. Am J Surg 2023; 226:729-731. [PMID: 37414608 DOI: 10.1016/j.amjsurg.2023.06.036] [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: 04/03/2023] [Revised: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University School of Medicine, DUMC Box 3704, 2301 Erwin Rd., Durham, NC, 27710, USA.
| | - Tori Chanenchuk
- Department of Surgery, Duke University School of Medicine, DUMC Box 3704, 2301 Erwin Rd., Durham, NC, 27710, USA.
| | - Maria Altieri
- Department of Surgery, Penn Medicine, 3400 Spruce St, Philadelphia, PA, 19104, USA.
| | - Lisa Cannada
- Department of Orthopedic Surgery, Charlotte Novant Health, University of North Carolina School of Medicine, 1901 Randolph Road, Charlotte, NC, 28207, USA.
| | - Camila R Guetter
- Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis St., Boston, MA, 02215, USA.
| | - Kathie-Ann Joseph
- Department of Surgery, NYU Grossman School of Medicine, 424 East 34th Street, New York, NY, 10016, USA; NYU Langone Health Institute of Health Equity, 180 Madison Avenue, New York, NY, 10016, USA.
| | - Jessica Maxwell
- Department of Surgery, University of Nebraska Medical Center, 620 S 42nd St, Omaha, NE, 68105, USA.
| | - Chantal Reyna
- Department of Surgery, Crozer Health System, 1 Medical Center Blvd, Upland, PA, 19013, USA.
| | - Hibba Sumra
- Department of Surgery, Advocate Aurora Health, 2535 S Martin Luther King Dr, Chicago, IL, 60616, USA.
| | - Sanda Tan
- Department of Surgery, HCA Florida Healthcare 2130 E Johnson Ave Suite 130-A, Pensacola, FL, 32514, USA.
| | - Sadia Tasnim
- Department of Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Yangyang R Yu
- Department of Surgery, University of California Irvine, Gillespie Neuroscience Research Facility, #2226, Irvine, CA, 92617, USA.
| | - Jennifer K Plichta
- Department of Surgery, Duke University School of Medicine, DUMC Box 3704, 2301 Erwin Rd., Durham, NC, 27710, USA; Duke Cancer Institute, Duke University Medical Center, 20 Duke Medicine Cir, Durham, NC, 27710, USA; Department of Population Health Sciences, Duke University Medical Center, 215 Morris St, Durham, NC, 27701, USA.
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Record SM, Hwang ESS, Chiba A. How to Navigate the Treatment Spectrum from Multimodality Therapy to Observation Alone for ductal carcinoma in situ. Surg Oncol Clin N Am 2023; 32:663-673. [PMID: 37714635 DOI: 10.1016/j.soc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
DCIS detection has increased dramatically since the introduction of screening mammography. Current guidance concordant care recommends surgical intervention for all patients with DCIS, followed by radiation and/or endocrine therapy for some. Adjuvant therapies after surgical excision have reduced recurrence rates but not breast cancer mortality. Given the lack of evidence of current treatment regimens and the morbidity associated with these treatments, there is concern that DCIS is over-treated. Active surveillance may be a favorable alternative for selected patients and is currently being investigated through four international clinical trials.
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Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, 40 Duke Medicine Circle, 124 Davison Building, Durham, NC 27710, USA. https://twitter.com/sydney_record
| | - Eun-Sil Shelley Hwang
- Department of Surgery, Duke University Medical Center, 40 Duke Medicine Circle, 124 Davison Building, Durham, NC 27710, USA; Duke Cancer Institute, 20 Duke Medicine Circle, Durham, NC 27710, USA. https://twitter.com/drshelleyhwang
| | - Akiko Chiba
- Department of Surgery, Duke University Medical Center, 40 Duke Medicine Circle, 124 Davison Building, Durham, NC 27710, USA; Duke Cancer Institute, 20 Duke Medicine Circle, Durham, NC 27710, USA; Department of Surgery, 508 Fulton Street, Durham, NC 27705, USA.
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Miller KN, Thomas SM, Record SM, Rosenberger LH, DiNome ML, DiLalla G, Force JM, Hwang ES, Plichta JK. ASO Visual Abstract: Neoadjuvant Chemotherapy and Endocrine Therapy for Older Patients with Estrogen Receptor Positive Breast Cancer-Comparison of Approaches. Ann Surg Oncol 2023; 30:6151. [PMID: 37516728 DOI: 10.1245/s10434-023-14010-4] [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] [Indexed: 07/31/2023]
Affiliation(s)
- Krislyn N Miller
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Maggie L DiNome
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Gayle DiLalla
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jeremy M Force
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Record SM, Thomas SM, Chanenchuk T, Baker JA, Grimm LJ, Plichta JK. Breast Cancer Risk Assessment and Screening Practices Reported Via an Online Survey. Ann Surg Oncol 2023; 30:6219-6229. [PMID: 37460738 PMCID: PMC10528282 DOI: 10.1245/s10434-023-13903-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Breast cancer screening guidelines differ between organizations, and significant variations in practice patterns exist. Previous evidence suggests that provider-level factors are the greatest contributors to risk assessment and screening practice variability. This study aimed to characterize provider factors associated with breast cancer risk assessment and screening practice patterns, and to assess perceived barriers to providing risk assessment. METHODS An online survey was distributed to providers at a single academic institution and to providers publicly via social media (January to August 2022). Respondents in the United States who care for adult women at risk for the development of breast cancer were included. RESULTS Most of the respondents in the 143 completed surveys were white/Caucasian (79%) females (90%) age 50 years or younger (79%), and whereas 97% discuss breast cancer screening with their patients, only 90% order screening mammograms. Risk factor assessment was common (93%), typically performed at the first visit (51%). Additional training in genetics or risk assessment was uncommon (17%), although the majority were interested but did not have the time or resources (55%). Although most (64%) did not perceive barriers to providing risk assessment or appropriate screening, the most common barriers were time (77%) and education (55%). Barriers were more common among family practice or obstetrics and gynecology (OB/GYN) providers and those who worked in an academic setting (all p < 0.05). CONCLUSIONS Breast cancer risk assessment and screening practices are highly variable. Although time is the major barrier to providing risk assessment, providers also need education. Primary care organizations could partner with breast cancer-focused societies for additional resources.
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Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Tori Chanenchuk
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jay A Baker
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Lars J Grimm
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Record SM, Thomas SM, Tori Chanenchuk, Baker JA, Grimm LJ, Plichta JK. ASO Visual Abstract: Breast Cancer Risk Assessment and Screening Practices Reported via an Online Survey. Ann Surg Oncol 2023; 30:6230-6231. [PMID: 37537486 DOI: 10.1245/s10434-023-14043-9] [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] [Indexed: 08/05/2023]
Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Tori Chanenchuk
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jay A Baker
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Lars J Grimm
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Miller KN, Thomas SM, Record SM, Rosenberger LH, DiNome ML, DiLalla G, Force JM, Hwang ES, Plichta JK. Neoadjuvant Chemotherapy and Endocrine Therapy for Older Patients with Estrogen Receptor Positive Breast Cancer: Comparison of Approaches. Ann Surg Oncol 2023; 30:6141-6150. [PMID: 37466869 PMCID: PMC10529791 DOI: 10.1245/s10434-023-13880-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/14/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Benefits of a pathologic complete response (pCR) following neoadjuvant therapy are well established, yet outcomes for older women are understudied. We sought to examine the pCR and overall survival (OS) rates of women with estrogen receptor (ER) positive breast cancer across age groups. METHODS Women diagnosed with cT1-4, N0-3, M0, ER+/HER2- breast cancer (2010-2018) who underwent neoadjuvant chemotherapy (NACT) or neoadjuvant endocrine therapy (NET) followed by surgery were selected from the National Cancer Database and categorized by age. Differences were tested, and Cox proportional hazards models were used to estimate the association of response with OS after adjustment for covariates. RESULTS In the 43,009-patient cohort, 84.8% received NACT and 15.2% received NET. Of those aged ≥ 70 (N = 5623), 51.0% received NACT, and 49.0% received NET. Compared with younger women receiving NACT, older women were less likely to have a breast or nodal pCR [no pCR by age: 85.1% (≥ 70 years) vs 82.2% (50-69 years) vs 77.7% (< 50 years), p < 0.001]. Rates of pCR were similarly low for all women receiving NET [no pCR by age: 95.6% (≥ 70 years) vs 95% (50-69 years) vs 96% (< 50 years), p = 0.06]. After adjustment, pCR after NACT was not associated with OS for older patients, but better survival outcomes were noted for older patients achieving pCR after NET. CONCLUSION For women with ER+/HER2- breast cancer, pCR rates after NACT are lower in older women compared with younger women, and are equally low after NET for all women. However, pCR after NET is associated with improved OS among older women, unlike pCR after NACT.
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Affiliation(s)
- Krislyn N Miller
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Sydney M Record
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Maggie L DiNome
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Gayle DiLalla
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jeremy M Force
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Record SM, Chanenchuk T, Parrish KM, Kaplan SJ, Kimmick G, Plichta JK. Prognostic Tools for Older Women with Breast Cancer: A Systematic Review. Medicina (Kaunas) 2023; 59:1576. [PMID: 37763695 PMCID: PMC10534323 DOI: 10.3390/medicina59091576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Background: Breast cancer is the most common cancer in women, and older patients comprise an increasing proportion of patients with this disease. The older breast cancer population is heterogenous with unique factors affecting clinical decision making. While many models have been developed and tested for breast cancer patients of all ages, tools specifically developed for older patients with breast cancer have not been recently reviewed. We systematically reviewed prognostic models developed and/or validated for older patients with breast cancer. Methods: We conducted a systematic search in 3 electronic databases. We identified original studies that were published prior to 8 November 2022 and presented the development and/or validation of models based mainly on clinico-pathological factors to predict response to treatment, recurrence, and/or mortality in older patients with breast cancer. The PROBAST was used to assess the ROB and applicability of each included tool. Results: We screened titles and abstracts of 7316 records. This generated 126 studies for a full text review. We identified 17 eligible articles, all of which presented tool development. The models were developed between 1996 and 2022, mostly using national registry data. The prognostic models were mainly developed in the United States (n = 7; 41%). For the derivation cohorts, the median sample size was 213 (interquartile range, 81-845). For the 17 included modes, the median number of predictive factors was 7 (4.5-10). Conclusions: There have been several studies focused on developing prognostic tools specifically for older patients with breast cancer, and the predictions made by these tools vary widely to include response to treatment, recurrence, and mortality. While external validation was rare, we found that it was typically concordant with interval validation results. Studies that were not validated or only internally validated still require external validation. However, most of the models presented in this review represent promising tools for clinical application in the care of older patients with breast cancer.
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Affiliation(s)
- Sydney M. Record
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Tori Chanenchuk
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Kendra M. Parrish
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Gretchen Kimmick
- Duke Cancer Institute, Duke University, Durham, NC 27710, USA
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Jennifer K. Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
- Duke Cancer Institute, Duke University, Durham, NC 27710, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC 27710, USA
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Tian WM, Sergesketter AR, Yi VN, Sizemore JA, Record SM, Zeng SL, Phillips BT. Social Media Usage by United States Plastic Surgery Subspecialty Fellowship Programs. Plast Reconstr Surg Glob Open 2023; 11:e5132. [PMID: 37483893 PMCID: PMC10358790 DOI: 10.1097/gox.0000000000005132] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/01/2023] [Indexed: 07/25/2023]
Abstract
Social media can be a powerful tool for plastic surgery training programs. Previous studies have shown the value social media may have in integrated residency program recruitment and program reputation. These findings may generalize to fellowship programs, but this space has not been comprehensively studied to date. Therefore, this study aims to characterize plastic surgery fellowship programs' social media usage and identify subsequent opportunities for program leadership to generate engagement. Methods United States plastic surgery fellowship programs in four major subspecialties (hand, microsurgery, craniomaxillofacial, and aesthetic) were identified and evaluated for social media presence on Instagram, Facebook, and Twitter. Platform-specific parameters were collected and statistically analyzed in aggregate. Results There were a total of 25 Instagram accounts, four Facebook accounts, and three Twitter accounts across all investigated subspecialties. Hand surgery had the greatest social media presence on Instagram (19.5%) and Twitter (3.4%). Microsurgery had the greatest presence on Facebook (4.7%). Between 2015 and 2022, Instagram was the platform with the greatest increase in adoption by fellowship programs. Geographically, microsurgery and craniomaxillofacial accounts were primarily owned by Midwest programs (66.7%, 100%), and aesthetic primarily by programs in the South (83.3%). Number of Instagram posts and followers were not significantly correlated with hospital reputation (P = 0.12, P = 0.63). Conclusions Social media is underutilized by plastic surgery fellowship programs. While Instagram metrics such as posts and followers are not correlated with hospital reputation, the skewed distributions of fellowship accounts, both geographically and across platforms, represent areas of potential growth.
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Affiliation(s)
| | - Amanda R. Sergesketter
- Department of Surgery, Division of Plastic and Maxillofacial Surgery, Duke University Medical Center, Durham, N.C
| | - Victoria N. Yi
- From the Duke University School of Medicine, Durham, N.C
| | | | | | - Steven L. Zeng
- From the Duke University School of Medicine, Durham, N.C
| | - Brett T. Phillips
- Department of Surgery, Division of Plastic and Maxillofacial Surgery, Duke University Medical Center, Durham, N.C
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Record SM, Plichta JK. De-Escalation of Axillary Surgery for Older Patients with Breast Cancer: Supporting Data Continue to Accumulate. Ann Surg Oncol 2023; 30:3882-3884. [PMID: 36820936 PMCID: PMC10441034 DOI: 10.1245/s10434-023-13299-5] [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: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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