Two years of tamoxifen or no adjuvant systemic therapy for patients with high-risk breast cancer: long-term follow-up of the Copenhagen breast cancer trial

Purpose Postmastectomy radiotherapy (RT) in high-risk breast cancer patients can reduce locoregional recurrences (LRRs) and improve disease-free and overall survival. The aim of this analysis was to examine the overall disease recurrence pattern among patients randomly assigned to receive treatment with or without RT. Patients and Methods A long-term follow-up was performed among the 3,083 patients from the Danish Breast Cancer Cooperative Group 82 b and c trials, except in those already recorded with distant metastases (DM) or contralateral breast cancer (CBC). The end points were LRR, DM, and CBC, and the follow-up continued until DM, CBC, emigration, or death. Information was selected from medical records, general practitioners, and the National Causes of Death Registry. The median potential follow-up time was 18 years. Results The 18-year probability of any first breast cancer event was 73% and 59% (P < .001) after no RT and RT, respectively (relative risk [RR], 0.68; 95% CI, 0.63 to 0.75). The 18-year probability of LRR (with or without DM) was 49% and 14% (P < .001) after no RT and RT, respectively (RR, 0.23; 95% CI, 0.19 to 0.27). The 18-year probability of DM subsequent to LRR was 35% and 6% (P < .001) after no RT and RT, respectively (RR, 0.15; 95% CI, 0.11 to 0.20), whereas the probability of any DM was 64% and 53% (P < .001) after no RT versus RT, respectively (RR, 0.78; 95% CI, 0.71 to 0.86). Conclusion Postmastectomy RT changes the disease recurrence pattern in high-risk breast cancer patients; fewer patients have LRR as first site of recurrence, and overall fewer patients have DM.

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Predicting reattendance at a high-risk breast cancer clinic

Palliative & Supportive Care ◽

10.1017/s1478951515000164 ◽

2015 ◽

Vol 13 (5) ◽

pp. 1441-1448 ◽

Cited By ~ 3

Author(s):

Sarah R. Ormseth ◽

David K. Wellisch ◽

Adam E. Aréchiga ◽

Taylor L. Draper

Keyword(s):

Breast Cancer ◽

High Risk ◽

Perceived Risk ◽

Depressive Symptomatology ◽

High Risk Breast Cancer ◽

High Risk Breast ◽

Risk Breast Cancer ◽

Cancer Clinic ◽

High Risk Clinic

AbstractObjective:The research about follow-up patterns of women attending high-risk breast-cancer clinics is sparse. This study sought to profile daughters of breast-cancer patients who are likely to return versus those unlikely to return for follow-up care in a high-risk clinic.Method:Our investigation included 131 patients attending the UCLA Revlon Breast Center High Risk Clinic. Predictor variables included age, computed breast-cancer risk, participants' perceived personal risk, clinically significant depressive symptomatology (CES–D score ≥ 16), current level of anxiety (State–Trait Anxiety Inventory), and survival status of participants' mothers (survived or passed away from breast cancer).Results:A greater likelihood of reattendance was associated with older age (adjusted odds ratio [AOR] = 1.07, p = 0.004), computed breast-cancer risk (AOR = 1.10, p = 0.017), absence of depressive symptomatology (AOR = 0.25, p = 0.009), past psychiatric diagnosis (AOR = 3.14, p = 0.029), and maternal loss to breast cancer (AOR = 2.59, p = 0.034). Also, an interaction was found between mother's survival and perceived risk (p = 0.019), such that reattendance was associated with higher perceived risk among participants whose mothers survived (AOR = 1.04, p = 0.002), but not those whose mothers died (AOR = 0.99, p = 0.685). Furthermore, a nonlinear inverted “U” relationship was observed between state anxiety and reattendance (p = 0.037); participants with moderate anxiety were more likely to reattend than those with low or high anxiety levels.Significance of Results:Demographic, medical, and psychosocial factors were found to be independently associated with reattendance to a high-risk breast-cancer clinic. Explication of the profiles of women who may or may not reattend may serve to inform the development and implementation of interventions to increase the likelihood of follow-up care.

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Receipt of adjuvant systemic therapy among patients with high-risk breast cancer detected by mammography screening

Breast Cancer Research and Treatment ◽

10.1007/s10549-008-9950-3 ◽

2008 ◽

Vol 113 (3) ◽

pp. 559-566 ◽

Cited By ~ 5

Author(s):

Lauro Bucchi ◽

Flavia Foca ◽

Alessandra Ravaioli ◽

Rosa Vattiato ◽

Chiara Balducci ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Systemic Therapy ◽

Mammography Screening ◽

Adjuvant Systemic Therapy ◽

High Risk Breast Cancer ◽

High Risk Breast ◽

Risk Breast Cancer

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Long-term follow-up of autologous hematopoietic stem cell transplantation for stage II/III breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.7121 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 7121-7121

Author(s):

Andrew D. Meyer ◽

Angelica L. Tolentino ◽

Jacob D. Bitran ◽

Leonard M. Klein

Keyword(s):

Breast Cancer ◽

High Risk ◽

High Dose Chemotherapy ◽

High Dose ◽

Secondary Malignancies ◽

Study Population ◽

High Risk Breast Cancer ◽

High Risk Breast ◽

Risk Breast Cancer

7121 Background: In the 1980s and 1990s, adjuvant chemotherapy with high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) was utilized for the treatment of high-risk breast cancer. Previous studies showed that ASCT significantly reduced the risk of relapse in these patients, but failed to provide evidence of improved overall survival when compared with standard therapy in randomized trials. Due to the mortality, morbidity, and cost associated with ASCT and lack of a clear overall survival benefit, the use of HDC with ASCT for high-risk breast cancer was halted. In this retrospective, observation study, we analyzed the toxicity and efficacy of ASCT in high-risk breast cancer at a large community hospital. Methods: The study population consisted of 57 women diagnosed with high-risk primary breast cancer who underwent treatment with HDC followed by ASCT from 1991-1999. Women receiving treatment for metastatic breast cancer were excluded. The medical records of the study population were retrospectively reviewed, with particular attention to long-term toxicities and efficacy. Results: Fifty seven patients were evaluated: 54 with ductal and/or lobular breast cancer and 3 with inflammatory breast cancer. Median age was 44 years (29- 61). Twenty six patients (46%) were alive at time of review. Twelve patients (21%) experienced a recurrence of their breast cancer. Four patients (7%) developed secondary malignancies. Two patients (4%) experienced cardiac toxicities. Estrogen/progesterone receptor-positive breast cancers accounted for 42% of recurrences, 100% of secondary malignancies, and 50% of cardiac toxicities. HER-2/neu status analysis revealed amplification in 17% of breast cancer recurrences, but in no cases of secondary malignancy or cardiac toxicity. Conclusions: High-dose chemotherapy and ASCT can be effective in reducing long-term recurrences in women with high-risk, Stage II/III breast cancer. This treatment, however, carries an associated risk of secondary malignancies and cardiac toxicities. Estrogen/progesterone receptor-positive breast cancer appears to have a greater association with disease recurrence and secondary malignancies.

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