Management of Male Breast Cancer: ASCO Guideline

PURPOSE

To develop recommendations concerning the management of male breast cancer.

METHODS

ASCO convened an Expert Panel to develop recommendations based on a systematic review and a formal consensus process.

RESULTS

Twenty-six descriptive reports or observational studies met eligibility criteria and formed the evidentiary basis for the recommendations.

RECOMMENDATIONS

Many of the management approaches used for men with breast cancer are like those used for women. Men with hormone receptor-positive breast cancer who are candidates for adjuvant endocrine therapy should be offered tamoxifen for an initial duration of five years; those with a contraindication to tamoxifen may be offered a gonadotropin-releasing hormone agonist/antagonist plus aromatase inhibitor. Men who have completed five years of tamoxifen, have tolerated therapy, and still have a high risk of recurrence may be offered an additional five years of therapy. Men with early-stage disease should not be treated with bone-modifying agents to prevent recurrence, but could still receive these agents to prevent or treat osteoporosis. Men with advanced or metastatic disease should be offered endocrine therapy as first-line therapy, except in cases of visceral crisis or rapidly progressive disease. Targeted systemic therapy may be used to treat advanced or metastatic cancer using the same indications and combinations offered to women. Ipsilateral annual mammogram should be offered to men with a history of breast cancer treated with lumpectomy regardless of genetic predisposition; contralateral annual mammogram may be offered to men with a history of breast cancer and a genetic predisposing mutation. Breast magnetic resonance imaging is not recommended routinely. Genetic counseling and germline genetic testing of cancer predisposition genes should be offered to all men with breast cancer.

Prevalence of psychiatric comorbidities among women undergoing free tissue autologous breast reconstruction

BACKGROUND AND OBJECTIVES

Autologous breast reconstruction (BR) can be a stressful life event. Therefore, women undergoing mastectomy and autologous BR are required to have sufficient coping mechanisms. Although mental health problems are widespread, information regarding the prevalence of psychiatric diagnosis among these patients is scarce.

METHODS

Retrospective analysis was performed using data from a large tertiary teaching hospital and the Nationwide Inpatient Sample (NIS) database. Patients undergoing autologous BR after mastectomy were included and evaluated for psychiatric disorders. Prevalence of each disorder, timing of diagnosis (preoperative or postoperative), and data per age group were reviewed.

RESULTS

Between 2004 and 2014, 817 patients were included from the institutional database and 26 399 from the NIS database. Preoperatively, 15.3% of the patients were diagnosed with a psychiatric disorder within our institution and 17.6% nationwide (P < 0.001). Postoperatively, 20.5% of the institutional patients were diagnosed with a psychiatric disorder. No major differences in prevalence were seen between age groups.

CONCLUSIONS

Approximately, one in six patients were diagnosed with a psychiatric comorbidity preoperatively. Postoperatively, an additional 20.5% developed a psychiatric disorder. There was no difference in prevalence and timing of diagnosis between age groups.

Locoregional Treatment for Early-Stage Breast Cancer: Current Status and Future Perspectives

BACKGROUND

The locoregional recurrence of breast cancer has been reduced due to the multidisciplinary approach of breast surgery, systemic therapy and radiation. Early detection and better surgical techniques contribute to an improvement in breast cancer outcomes.

PURPOSE OF REVIEW

The purpose of this review is to have an overview and summary of the current evidence behind the current approaches to the locoregional treatment of breast cancer and to discuss its future direction.

SUMMARY

With improved surgical techniques and the use of a more effective neoadjuvant systemic therapy, including checkpoint inhibitors and dual HER2-directed therapies that lead to a higher frequency of pathologic complete responses and advances in adjuvant radiation therapy, breast cancer patients are experiencing better locoregional control and reduced local and systemic recurrence. De-escalation in surgery has not only improved the quality of life in the majority of breast cancer patients, but also maintained the low risk of recurrence. There are ongoing clinical trials to optimize radiation therapy in breast cancer. More modern radiation technologies are evolving to improve the patient outcome and reduce radiation toxicities.

Abstract PO-149: Ethnic/racial differences in later stage diagnoses, NCCN adherent care and survival in California

Introduction: California is home to the largest ethnic/racial diversity in the US, with 39% Latino, 37% White, 15% Asian American, 6% African American, 3% multiracial, &lt;1% American Indian, and &lt;1% Pacific Islander. The top five site specific cancer incidence rates are prostate, breast, lung and bronchus, colon and rectum, and corpus uteri, while the top five mortality rates are lung and bronchus, prostate, colon and rectum, breast and pancreas. However, incidence and mortality rates vary considerably between Asian Pacific Islanders, Blacks, Hispanics, and Whites. The purpose of this observational study was to explore factors that could contribute to higher cancer mortality, including later stage diagnoses and receipt of National Comprehensive Cancer Network (NCCN) adherent care by site in California. Methods: This is a retrospective population-based cohort study of patients with seven types of invasive cancer using the California Cancer Registry from 2004-2016. Patient characteristics included race/ethnicity (including Chinese, Japanese, Filipino, Korean, Vietnamese and Asian Indian subgroups), insurance, socioeconomic status, tumor stage and grade. Adherence with NCCN guidelines was defined by appropriate surgical, radiation, and chemo- or hormonal therapies. Multivariate logistic regression model was fit to evaluate the relationship between patient and tumor characteristics and guideline adherence. Disease-specific survival analyses used multivariate proportional hazards model. All multivariate analyses controlled for age, year, insurance type, SES, marital status, sex, and tumor stage and grade. Results: Overall, less than half of all cancer patients received NCCN adherent care, and patients receiving non-adherent care had worse disease-specific survival. Compared to Whites, Blacks had the highest proportions of later stage diagnoses for breast, cervical and ovarian cancers; they were also less likely to receive guideline adherence care for breast, colon, and ovarian cancers. Hispanics had the highest proportion of later stage diagnoses for gastric cancer; they were also less likely to receive guideline adherent care for breast and liver cancers. Filipinos had the highest proportion of later stage diagnosis for liver cancer; Koreans had the highest proportions for colon and rectum cancers, and were less likely to receive guideline adherent care for colon cancer. Blacks had significantly lower survival for breast, colon, stomach, ovarian and cervical cancers; Hispanics, Filipinos and Vietnamese had significantly lower survival for gastric cancer. Conclusions: Significant improvements are needed in cancer early detection, quality care and survival among California’s ethnic/racial populations. Unfortunately, the current COVID-19 pandemic has exacerbated racial and ethnic disparities in screening and early detection, and compounded the difficulties in access to quality cancer care.

Citation Format: Sora P. Tanjasiri, Kiran Clair, Jenny Chang, Argyrios Ziogas, Greg Gin, Kari J. Kansal, Jason Zell, Robert Bristow. Ethnic/racial differences in later stage diagnoses, NCCN adherent care and survival in California [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-149.

Disparities in Receipt of National Comprehensive Cancer Network Guideline-Adherent Care and Outcomes among Women with Triple-Negative Breast Cancer by Race/Ethnicity, Socioeconomic Status, and Insurance Type

BACKGROUND

The National Comprehensive Cancer Network guidelines were designed to improve patient outcomes. Here, we examine factors that may contribute to outcomes and guideline adherence in patients with triple-negative breast cancer.

METHODS

This was a retrospective cohort study of women with triple-negative breast cancer using the California Cancer Registry. Adherent treatment was defined as the receipt of a combination of surgery, lymph node assessment, adjuvant radiation, and/or chemotherapy. A multivariable logistic regression was used to determine the effects of independent variables on adherence to the NCCN guidelines. Disease-specific survival was calculated using Cox regression analysis.

RESULTS

A total of 16,858 women were analyzed. Black and Hispanic patients were less likely to receive guideline-adherent care (OR 0.82, 95%CI 0.73-0.92 and OR 0.87, 95%CI 0.79-0.95, respectively) compared to White patients. Hazard ratios adjusted for adherent care showed that Black patients had increased disease-specific mortality (HR 1.28, 95%CI 1.16-1.42, p < 0.0001) compared to White patients.

CONCLUSIONS

A significant majority of breast cancer patients in California continue to receive non-guideline-adherent care. Non-Hispanic Black patients and patients from lower SES quintile groups were less likely to receive guideline-adherent care. Patients with non-adherent care had worse disease-specific survival compared to recipients of NCCN guideline-adherent care.