Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network

Abstract Background Limited published literature exists on women with triple-negative breast cancer (TNBC) diagnosed over the age of 60 years with breast cancer gene (BRCA) pathogenic variants. Our study determined whether the rate of BRCA pathogenic variants in a prospective cohort of TNBC patients outside the definition of current clinical genetic testing (GT) guidelines warrants a change in recommendations. Methods A prospective study of 395 women with TNBC underwent genetic counseling and 380 (96.2%) underwent clinical BRCA GT regardless of age of diagnosis beginning January 2014 to October 2015 at The University of Texas MD Anderson Cancer Center, Houston. TNBC patients older than 60 years who did not meet clinical GT guidelines had comprehensive sequencing and large rearrangement GT as part of the research protocol. Results Fifty-one of 380 (13.4%) women with TNBC who underwent clinical BRCA GT were BRCA positive. Of the 86 patients diagnosed at age over 60 years and underwent GT, only two (2.3%) were positive for BRCA. These two patients would have met clinical testing criteria due to family or ancestral history. Conclusions Our study does not support universal BRCA testing for TNBC patients diagnosed older than 60 years as their only risk factor for a BRCA pathogenic variant. Both of the positive BRCA patients older than 60 years identified would have met current National Comprehensive Cancer Network criteria for testing. Therefore, our study demonstrates that the National Comprehensive Cancer Network guidelines provide sufficient criteria for identifying BRCA pathogenic variants in women with TNBC at 60 years or younger.

Download Full-text

Predictive Factors and Patterns of Recurrence in Patients with Triple Negative Breast Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-014-3546-4 ◽

2014 ◽

Vol 21 (7) ◽

pp. 2165-2171 ◽

Cited By ~ 24

Author(s):

Lauren Steward ◽

Leah Conant ◽

Feng Gao ◽

Julie A. Margenthaler

Keyword(s):

Breast Cancer ◽

Triple Negative Breast Cancer ◽

Predictive Factors ◽

Triple Negative ◽

Patterns Of Recurrence

Download Full-text

BRCA1/2 mutation prevalence among triple-negative breast cancer patients from a large commercial testing cohort.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1544 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1544-1544 ◽

Cited By ~ 2

Author(s):

Kristilyn Dillman Zonno ◽

Rajesh R. Kaldate ◽

Christopher Arnell ◽

Jennifer Saam ◽

Brian Abbott ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

African Ancestry ◽

Parp Inhibitors ◽

Ashkenazi Jewish ◽

Breast Cancer Patients ◽

Cancer Network ◽

Testing Criteria

1544 Background: BRCA1/2 deleterious mutation identification among triple-negative breast cancer (TNBC) patients has gained importance due to cancer-risk management implications for patients and their relatives, and also has an emerging role in guiding treatment selection for therapies such as PARP inhibitors. The National Comprehensive Cancer Network (NCCN) currently recommends BRCA1/2 testing for TNBC patients diagnosed at age <60. Mutation prevalence among TNBC patients has previously been studied only in small regionalized cohorts. A recent study in unselected patients using the updated definitive criteria for TNBC reported mutation prevalence as 10.6%. Methods: Following the 2011 NCCN Hereditary Breast and Ovarian Cancer (HBOC) Testing Criteria update, serial cohorts of > 5,000 Ashkenazi Jewish and > 65,000 non-Ashkenazi Jewish breast cancer patients undergoing commercial BRCA1/2 testing were analyzed. Age at diagnosis, ethnicity, and provider-reported TN status were obtained from test requisition forms completed by ordering providers, and correlated with test results. Neither the accuracy nor definitive criteria used for TN status reported was independently verified. Results: Incidence of TNBC was reported as 9.7% among non-Ashkenazi patients and 16.5% within the subset with African ancestry. Incidence of TNBC was reported as 4.5% among Ashkenazi patients, but this is likely affected by test ordering for this population. The Table displays the BRCA1/2mutation rates classified by ethnicity and age-group. Conclusions: This study provides the most robust estimate to date of BRCA1/2 mutation prevalence among TNBC patients of all ages. The mutation rates seen among TNBC patients diagnosed after age 60 also illustrate the importance of testing such patients who may not meet the current NCCN HBOC testing criteria. [Table: see text]

Download Full-text

Are patients with triple-negative breast cancer screened for BRCA mutations according to NCCN guidelines?

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.28_suppl.7 ◽

2015 ◽

Vol 33 (28_suppl) ◽

pp. 7-7

Author(s):

Staci Aubry ◽

Lindsay Floch Petersen ◽

Kelly Burgess ◽

Ruta D. Rao ◽

Katherine Kopkash ◽

...

Keyword(s):

Breast Cancer ◽

African American ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Brca Testing ◽

Brca Mutations ◽

Exact Test ◽

Nccn Guidelines ◽

Primary Payer ◽

Cancer Network

7 Background: Ten to 25 percent of patients diagnosed with breast cancer have triple negative breast cancer (TNBC), defined as tumors negative for estrogen, progesterone, and Her2-neu receptors. TNBC is more aggressive than receptor positive cancer. The National Comprehensive Cancer Network (NCCN) recommends BRCA genetic testing for women less than age 60 when diagnosed with TNBC. Methods: The Commission on Cancer registry tumor database was queried for TNBC from 2006 to 2013. Patient demographics were analyzed. Data regarding pathologic details and BRCA testing was collected. Analyses using the Fisher's exact test were conducted. Results: TNBC tumors were identified in the database (n = 173). Sixty-one percent (105/173) of patients were less than 60 years of age, therefore BRCA testing was indicated. Fifteen patients were BRCA positive. Eighty-three percent (87/105) of patients underwent BRCA testing. Seventeen percent (18/105) of patients did not receive BRCA testing that should have under the current guidelines. Patients that did not undergo recommended BRCA testing were more likely to be greater than or equal to 55 years of age (p = 0.002), African-American (p = 0.001), have Medicaid listed as a primary payer (p = 0.021), and have American Joint Commission on Cancer (AJCC) stage 3 disease (p = 0.014). Conclusions: Risk factors for not completing BRCA testing include older age, African-American race, Medicaid insurance status, and stage 3 disease. Health provider awareness of this opportunity for improvement is important to decrease these health disparities. [Table: see text]

Download Full-text

Clinicopathologic features and prognosis of triple-negative breast cancer: 10-years experience from Kuwait.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.15_suppl.e11500 ◽

2011 ◽

Vol 29 (15_suppl) ◽

pp. e11500-e11500

Author(s):

M. El-Sherify ◽

M. S. Fayaz ◽

S. Abuzalouf ◽

A. AL Basmy ◽

N. Nazmy

Keyword(s):

Breast Cancer ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Clinicopathologic Features

Download Full-text

Racial/ethnic disparities in clinicopathologic features and treatment modalities of triple-negative breast cancer in black premenopausal women.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.26_suppl.58 ◽

2014 ◽

Vol 32 (26_suppl) ◽

pp. 58-58

Author(s):

Muhammad S Hamid ◽

Raji Shameem ◽

Anita Pudusseri ◽

Robert Graham ◽

Dana Shani ◽

...

Keyword(s):

Breast Cancer ◽

Black Women ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Surgical Intervention ◽

Ethnic Disparities ◽

Premenopausal Women ◽

Adjuvant Radiation ◽

Clinicopathologic Features ◽

Racial Ethnic

58 Background: Triple-negative breast cancer (TNBC) is a distinct breast cancer subtype associated with poor outcomes. Previous literature has reported an increased prevalence of TNBC in premenopausal black women. However, clinicopathologic features and treatment disparities of TNBC require further investigation. Methods: We used the Surveillance Epidemiology and End Results (SEER) database to collect data for premenopausal, estrogen receptor–negative, progesterone receptor–negative, and HER2 receptor–negative invasive breast-cancer cases diagnosed in 2010. Blacks were compared to the referent non-Hispanic white (NHW) cohort. Variables explored include: age at diagnosis, summary stage, tumor size, presence of metastasis at diagnosis, birth country, marital status, radiation, surgery (total and partial mastectomy), and radiation/surgery sequence. The Kruskall-Wallis test and the Z-test were used to investigate for any racial/ethnic disparities that may exist. Results: Compared to NHW, black patients had more regional disease (42.3% vs. 36.1%, p < 0.05) and distant metastasis (7.37% vs. 4.67%, p < 0.05) at the time of diagnosis, They were more likely to be single (44.0% vs. 17.1%, p < 0.05), born in the United States (39.4% vs. 32.5%, p < 0.05), have fewer cases in the “40-49 years” age range (68.6% vs. 73.0%, p < 0.05), and present with tumor size > 20 mm (26.1% vs. 36.6%, p < 0.05) compared to NHW. While black women received surgical intervention (11.5% vs. 6.8%, p < 0.05) more commonly, adjuvant radiation (41.0% vs. 33.3%, p < 0.05) was utilized less after segmental mastectomy compared to NHW. Conclusions: Poor prognostic tumor characteristics were significantly more likely to be present in black premenopausal women with TNBC compared with NHW patients. Black women were more likely to receive surgical intervention, however, adjuvant radiation was administered significantly less. Further research is necessary to clarify if these disparities have an impact on survival outcomes.

Download Full-text