Symposium report: breast cancer in India—trends, environmental exposures and clinical implications

Abstract Purpose Incidence of breast cancer (BC), particularly in young women, are rising in India. Without population-based mammography screening, rising rates cannot be attributed to screening. Investigations are needed to understand the potential drivers of this trend. Methods An international team of experts convened to discuss the trends, environmental exposures, and clinical implications associated with BC in India and outlined recommendations for its management. Results Panels were structured across three major BC themes (n = 10 presentations). The symposium concluded with a semi-structured Think Tank designed to elicit short-term and long-term goals that could address the challenges of BC in India. Conclusion There was consensus that the prevalence of late-stage BC and the high BC mortality rates are associated with the practice of detection, which is primarily through clinical and self-breast exams, as opposed to mammography. Triple-Negative BC (TNBC) was extensively discussed, including TNBC etiology and potential risk factors, the limited treatment options, and if reported TNBC rates are supported by rigorous scientific evidence. The Think Tank session yielded long-term and short-term goals to further BC reduction in India and included more regional etiological studies on environmental exposures using existing India-based cohorts and case–control studies, standardization for molecular subtyping of BC cases, and improving the public’s awareness of breast health.

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The effects of erythropoiesis-stimulating agents on the short-term and long-term survivals in metastatic breast cancer patients receiving chemotherapy: a SEER population-based study

Breast Cancer Research and Treatment ◽

10.1007/s10549-015-3532-y ◽

2015 ◽

Vol 153 (2) ◽

pp. 407-416 ◽

Cited By ~ 1

Author(s):

Yinzhi Lai ◽

Zhong Ye ◽

Jesse M. Civan ◽

Chun Wang ◽

Massimo Cristofanilli ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Cancer Patients ◽

Metastatic Breast ◽

Population Based ◽

Breast Cancer Patients ◽

Short Term ◽

Population Based Study ◽

Erythropoiesis Stimulating Agents

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523Use of beta blockers and death from breast cancer in New Zealand breast cancer patients

International Journal of Epidemiology ◽

10.1093/ije/dyab168.587 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Oliver Scott ◽

Sandar TinTin ◽

Alana Cavadino ◽

Mark Elwood

Keyword(s):

Breast Cancer ◽

New Zealand ◽

Beta Blockers ◽

Cancer Registries ◽

Population Based ◽

Breast Cancer Patients ◽

Short Term ◽

Breast Cancer Death ◽

Increased Risk

Abstract Background Beta blockers (BB), used for a range of cardiovascular indications, have been associated with improved, worsened, and unchanged breast cancer outcomes in previous studies. This study examines the association between the use of BBs and death from breast cancer in a large, representative sample of New Zealand women. Methods Women diagnosed with a first primary breast cancer between 2007 and 2016 were identified from four population-based regional NZ breast cancer registries and linked to pharmaceutical data, hospital discharges, and death records. The median follow up time was 4.51 years. Cox proportional hazard models were used to assess the hazard of breast cancer specific death (BCD) associated with post-diagnostic BB use. Results Of the 14,976 women included in analysis, 21% used a BB after diagnosis. Although not significant, beta blocker use increased the risk of BCD (adjusted hazard ratio: 1.08; 95% CI: 0.93-1.26). The increased risk was seen only in those with at least one cardiac condition, and was also reduced by lagging the exposure, suggesting effects of BB use close to the end of life. The increased risk was also confined to short term use (0-3 months). BB use for more than 1 year was associated with a decreased risk of BCD, and the risk steadily decreased to HR 0.53 (95% CI: 0.33-0.85) for use for 3+ years. Conclusions Any increased risk associated with BB use is likely to be due to a combination of confounding by indication and short-term use. Long-term BB use may confer some protection for BCD. Key messages The effect of beta blockers is difficult to separate from the indications for the drug. While there was no significant overall effect, there was a suggestion that beta blockers may be protective for breast cancer death with long-term exposure.

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Population-Based Estimates of the Age-Specific Cumulative Risk of Breast Cancer for Pathogenic Variants in CHEK2: Findings from the Australian Breast Cancer Family Registry

Cancers ◽

10.3390/cancers13061378 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1378

Author(s):

Tú Nguyen-Dumont ◽

James G. Dowty ◽

Jason A. Steen ◽

Anne-Laure Renault ◽

Fleur Hammet ◽

...

Keyword(s):

Breast Cancer ◽

Cumulative Risk ◽

Population Based ◽

Case Control ◽

Cancer Information ◽

Case Control Studies ◽

Breast Cancer Family ◽

Pathogenic Variants ◽

Increased Risk ◽

Control Family

Case-control studies of breast cancer have consistently shown that pathogenic variants in CHEK2 are associated with about a 3-fold increased risk of breast cancer. Information about the recurrent protein-truncating variant CHEK2 c.1100delC dominates this estimate. There have been no formal estimates of age-specific cumulative risk of breast cancer for all CHEK2 pathogenic (including likely pathogenic) variants combined. We conducted a population-based case-control-family study of pathogenic CHEK2 variants (26 families, 1071 relatives) and estimated the age-specific cumulative risk of breast cancer using segregation analysis. The estimated hazard ratio for carriers of pathogenic CHEK2 variants (combined) was 4.9 (95% CI 2.5–9.5) relative to non-carriers. The HR for carriers of the CHEK2 c.1100delC variant was estimated to be 3.5 (95% CI 1.02–11.6) and the HR for carriers of all other CHEK2 variants combined was estimated to be 5.7 (95% CI 2.5–12.9). The age-specific cumulative risk of breast cancer was estimated to be 18% (95% CI 11–30%) and 33% (95% CI 21–48%) to age 60 and 80 years, respectively. These findings provide important information for the clinical management of breast cancer risk for women carrying pathogenic variants in CHEK2.

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Prediction of long-term cumulative incidences based on short-term parametric model for competing risks: application in early breast cancer

Breast Cancer Research and Treatment ◽

10.1007/s10549-016-3789-9 ◽

2016 ◽

Vol 156 (3) ◽

pp. 577-585 ◽

Cited By ~ 2

Author(s):

B. Cabarrou ◽

L. Belin ◽

S. M. Somda ◽

M. C. Falcou ◽

J. Y. Pierga ◽

...

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Competing Risks ◽

Parametric Model ◽

Short Term

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BMET-30. TREATMENT OPTIONS OF LONG TERM SURVIVORS WITH LEPTOMENINGEAL METASTASES AND BREAST CANCER

Neuro-Oncology ◽

10.1093/neuonc/now212.130 ◽

2016 ◽

Vol 18 (suppl_6) ◽

pp. vi33-vi33 ◽

Cited By ~ 2

Author(s):

Caroline Chaul-Barbosa ◽

Aki Morikawa ◽

Sujata Patil ◽

Adrienne Boire ◽

Lilly Jordan ◽

...

Keyword(s):

Breast Cancer ◽

Treatment Options ◽

Leptomeningeal Metastases ◽

Long Term Survivors

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Invasive breast cancer and breast cancer mortality after ductal carcinoma in situ in women attending for breast screening in England, 1988-2014: population based observational cohort study

BMJ ◽

10.1136/bmj.m1570 ◽

2020 ◽

pp. m1570 ◽

Cited By ~ 4

Author(s):

Gurdeep S Mannu ◽

Zhe Wang ◽

John Broggio ◽

Jackie Charman ◽

Shan Cheung ◽

...

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Breast Screening ◽

Ductal Carcinoma ◽

Breast Cancer Mortality ◽

Population Based ◽

Breast Screening Programme ◽

Observational Cohort

AbstractObjectiveTo evaluate the long term risks of invasive breast cancer and death from breast cancer after ductal carcinoma in situ (DCIS) diagnosed through breast screening.DesignPopulation based observational cohort study.SettingData from the NHS Breast Screening Programme and the National Cancer Registration and Analysis Service.ParticipantsAll 35 024 women in England diagnosed as having DCIS by the NHS Breast Screening Programme from its start in 1988 until March 2014.Main outcome measuresIncident invasive breast cancer and death from breast cancer.ResultsBy December 2014, 13 606 women had been followed for up to five years, 10 998 for five to nine years, 6861 for 10-14 years, 2620 for 15-19 years, and 939 for at least 20 years. Among these women, 2076 developed invasive breast cancer, corresponding to an incidence rate of 8.82 (95% confidence interval 8.45 to 9.21) per 1000 women per year and more than double that expected from national cancer incidence rates (ratio of observed rate to expected rate 2.52, 95% confidence interval 2.41 to 2.63). The increase started in the second year after diagnosis of DCIS and continued until the end of follow-up. In the same group of women, 310 died from breast cancer, corresponding to a death rate of 1.26 (1.13 to 1.41) per 1000 women per year and 70% higher than that expected from national breast cancer mortality rates (observed:expected ratio 1.70, 1.52 to 1.90). During the first five years after diagnosis of DCIS, the breast cancer death rate was similar to that expected from national mortality rates (observed:expected ratio 0.87, 0.69 to 1.10), but it then increased, with values of 1.98 (1.65 to 2.37), 2.99 (2.41 to 3.70), and 2.77 (2.01 to 3.80) in years five to nine, 10-14, and 15 or more after DCIS diagnosis. Among 29 044 women with unilateral DCIS undergoing surgery, those who had more intensive treatment (mastectomy, radiotherapy for women who had breast conserving surgery, and endocrine treatment in oestrogen receptor positive disease) and those with larger final surgical margins had lower rates of invasive breast cancer.ConclusionsTo date, women with DCIS detected by screening have, on average, experienced higher long term risks of invasive breast cancer and death from breast cancer than women in the general population during a period of at least two decades after their diagnosis. More intensive treatment and larger final surgical margins were associated with lower risks of invasive breast cancer.

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