Breast cancer mortality hot spots among Black women with de novo metastatic breast cancer

Abstract Background Black women living in southern states have the highest breast cancer mortality rate in the US. The prognosis of de novo metastatic breast cancer is poor. Given these mortality rates, we are the first to link nationally representative data on breast cancer mortality hot spots (counties with high breast cancer mortality rates) with cancer mortality data in the US and investigate the association of geographic breast cancer mortality hot spots with de novo metastatic breast cancer mortality among Black women. Methods We identified 7,292 Black women diagnosed with de novo metastatic breast cancer in SEER. The county-level characteristics were obtained from 2014 County Health Rankings and linked to SEER. We used Cox proportional hazards models to calculate adjusted hazard ratios (aHRs) and 95% confidence interval (CIs) for mortality between hot spot and non-hot spot counties. Results Among 7,292 patients, 393 (5.4%) resided in breast cancer mortality hot spots. Women residing in hot spots had similar risks of breast cancer-specific mortality (aHR = 0.99; 95% CI = 0.85-1.15) and all-cause mortality (aHR = 0.97; 95% CI = 0.84-1.11) as women in non-hot spots after adjusting for individual and tumor-level factors, and treatments. Additional adjustment for county-level characteristics did not impact mortality. Conclusion Living in a breast cancer mortality hot spot was not associated with de novo metastatic breast cancer mortality among Black women. Future research should begin to examine variation in both individual and population-level determinants, as well in molecular and genetic determinants that underlie the aggressive nature of de novo metastatic breast cancer.

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Using Simulation Modeling to Inform Strategies to Reduce Breast Cancer Mortality in Black Women in the District of Columbia

Epidemiology Research International ◽

10.1155/2012/241340 ◽

2012 ◽

Vol 2012 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Aimee M. Near ◽

Jeanne S. Mandelblatt ◽

Clyde B. Schechter ◽

Michael A. Stoto

Keyword(s):

Breast Cancer ◽

Black Women ◽

Adjuvant Treatment ◽

Cancer Mortality ◽

Simulation Modeling ◽

Breast Cancer Mortality ◽

District Of Columbia ◽

Cancer Control ◽

The Past ◽

The Us

Background. Black women in the District of Columbia (DC) have the highest breast cancer mortality in the US. Local cancer control planners are interested in how to most efficiently reduce this mortality. Methods. An established simulation model was adapted to reflect the experiences of Black women in DC and estimate the past and future impact of changes in use of screening and adjuvant treatment. Results. The model estimates that the observed reduction in mortality that occurred from 1975 to 2007 attributable to screening, treatment, and both was 20.2%, 25.7%, and 41.0% respectively. The results suggest that, by 2020, breast cancer mortality among Black women in DC could be reduced by 6% more by initiating screening at age 40 versus age 50. Screening annually may also reduce mortality to a greater extent than biennially, albeit with a marked increase in false positive screening rates. Conclusion. This study demonstrates how modeling can provide data to assist local planners as they consider different cancer control policies based on their individual populations.

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Survival in Women with De Novo Metastatic Breast Cancer: A Comparison of Real-World Evidence from a Publicly-Funded Canadian Province and the United States by Insurance Status

Current Oncology ◽

10.3390/curroncol29010034 ◽

2022 ◽

Vol 29 (1) ◽

pp. 383-391

Author(s):

Marie-France Savard ◽

Elizabeth N. Kornaga ◽

Adriana Matutino Kahn ◽

Sasha Lupichuk

Keyword(s):

Breast Cancer ◽

Health Care ◽

Metastatic Breast Cancer ◽

De Novo ◽

Private Insurance ◽

Metastatic Breast ◽

The United States ◽

Insurance Status ◽

The Us ◽

Privately Insured

Metastatic breast cancer (MBC) patient outcomes may vary according to distinct health care payers and different countries. We compared 291 Alberta (AB), Canada and 9429 US patients < 65 with de novo MBC diagnosed from 2010 through 2014. Data were extracted from the provincial Breast Data Mart and from the National Cancer Institute’s SEER program. US patients were divided by insurance status (US privately insured, US Medicaid or US uninsured). Kaplan-Meier and log-rank analyses were used to assess differences in OS and hazard ratios (HR) were estimated using Cox models. Multivariate models were adjusted for age, surgical status, and biomarker profile. No difference in OS was noted between AB and US patients (HR = 0.92 (0.77–1.10), p = 0.365). Median OS was not reached for the US privately insured and AB groups, and was 11 months and 8 months for the US Medicaid and US uninsured groups, respectively. The 3-year OS rates were comparable between US privately insured and AB groups (53.28% (51.95–54.59) and 55.54% (49.49–61.16), respectively). Both groups had improved survival (p < 0.001) relative to the US Medicaid and US uninsured groups [39.32% (37.25–41.37) and 40.53% (36.20–44.81)]. Our study suggests that a universal health care system is not inferior to a private insurance-based model for de novo MBC.

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Epidemiology of De Novo Metastatic Breast Cancer

Clinical Breast Cancer ◽

10.1016/j.clbc.2021.01.017 ◽

2021 ◽

Author(s):

Karen Daily ◽

Emily Douglas ◽

Paul A Romitti ◽

Alexandra Thomas

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

De Novo ◽

Metastatic Breast

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Locoregional Therapy for the Primary Tumour in Women with a De Novo Diagnosis of Metastatic Breast Cancer

Current Breast Cancer Reports ◽

10.1007/s12609-021-00408-0 ◽

2021 ◽

Author(s):

Katie Miller ◽

Kieran Horgan ◽

David Dodwell

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

De Novo ◽

Primary Tumour ◽

Metastatic Breast ◽

Locoregional Therapy

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Real-world Indian scenario of CDK4/6 inhibitors (palbociclib and ribociclib) with endocrine therapy in upfront hormone positive metastatic breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e13028 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e13028-e13028

Author(s):

Ajay Gogia ◽

Shalabh Arora ◽

Priyanshu Choudhary ◽

Rakesh Kumar ◽

Sanjay Thulkar ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Endocrine Therapy ◽

Real World ◽

De Novo ◽

Metastatic Breast ◽

Common Side Effect ◽

Drug Discontinuation ◽

Grade 3 ◽

Visceral Disease

e13028 Background: CDK4/6 inhibitors (CDKi), in combination with endocrine therapy (ET), has become the standard of care in the treatment of hormone positive (HR+)/ HER2 neu negative metastatic breast cancer (MBC) patients. We evaluated clinical outcomes and toxicity in MBC patients, who have received ET with two CDKi, namely palbociclib and ribociclib. Methods: This is an ambispective, single institutional analysis of de-novo HR+ MBC patients treated with CDKi (palbociclib 125 mg and ribociclib 600 mg once a day for 21 days /28 days cycle) from November 2016- October 2020 at AIIMS, New Delhi, India. The primary endpoint was progression-free survival (PFS) and the secondary endpoint was response rate and toxicity. A total of 157 female patients were recruited in this study however the response and toxicity data were available in 120 cases. All premenopausal women received ovarian suppression or ovarian ablation. Results: A total of 120 patients were included in this study with a median age of 57 years (35-75) and 93 (77.5%) cases were postmenopausal. Twenty-three (19.1%) patients had a bone-only disease, 49 (40.9%) had bone and visceral disease and 48 (40%) had only visceral disease. In this study 91 (75.9%) patients received palbociclib and 29 (24.2%) received ribociclib. The median PFS was 18 months (4-36). Twenty four (20%) patients achieved a complete response, 69 (57.5%) patients attained partial response, 18(15%) patients had stable disease and 9 (7.5%) had disease progression. Grade 3–4 neutropenia, thrombocytopenia, and anaemia were observed in 18(15%), 8 (6.7%), and 4 (3.3%) cases respectively. None of the patients developed febrile neutropenia. Cutaneous, renal, hepatic, and gastrointestinal toxicity was observed in 1,1,3,4 cases respectively. Prolonged QTc was observed in one case. Grade 3 fatigue was observed in 7 cases. Dose interruption/delay (mean dose delay of 7 days), dose modification, and drug discontinuation were observed in 24 (20%), 12 (10%), and 10 (8.3%) of cases respectively. Conclusions: This is one of the largest real-world Indian data on CDK4/6 inhibitors on upfront HR+ MBC. Side effects are less than published literature with similar efficacy. Neutropenia was the most common side effect which was managed by brief dose interruption.

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Occult Breast Carcinoma Presenting as Scalp Metastasis

Case Reports in Oncology ◽

10.1159/000484346 ◽

2017 ◽

Vol 10 (3) ◽

pp. 992-997 ◽

Cited By ~ 2

Author(s):

Ricardo L.B. Costa ◽

Rubens B. Costa-Filho ◽

Marilin Rosa ◽

Brian J. Czerniecki

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Breast Tumor ◽

Rare Case ◽

De Novo ◽

Metastatic Breast ◽

Primary Breast Tumor ◽

Occult Breast Cancer ◽

Scalp Metastasis ◽

Occult Breast Carcinoma

Breast cancer is the most common tumor among women, and approximately 6% of the patients have de novo metastatic breast cancer. Occult breast cancer accounts for only 0.1–0.8% of the cases and most commonly presents with axillary lymphadenopathy. Scalp metastases are rare and have been described as a sign of progression or widespread metastatic disease. Here, we describe a rare case of de novo metastatic breast cancer to the scalp as the single site of spread and without an identifiable primary breast tumor.

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Changes in Overall Survival Over Time for Patients With de Novo Metastatic Breast Cancer

10.20944/preprints202105.0093.v1 ◽

2021 ◽

Author(s):

Toshiaki Iwase ◽

Tushaar Vishal Shrimanker ◽

Ruben Rodriguez-Bautista ◽

Onur Sahin ◽

Anjali James ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Metastatic Breast Cancer ◽

De Novo ◽

Metastatic Breast ◽

Locoregional Therapy ◽

Cancer Center ◽

Her2 Positive ◽

Time Periods ◽

Over Time

The purpose of this study was to determine the change in overall survival (OS) for patients with de novo metastatic breast cancer (dnMBC) over time. We conducted a retrospective cohort study with 1981 patients with dnMBC diagnosed between January 1995 and December 2017 at The University of Texas MD Anderson Cancer Center. OS was measured from the date of diagnosis of dnMBC. OS was compared between patients diagnosed during different time periods: 5-year periods and periods defined according to when key agents were approved for clinical use. The median OS was 3.4 years. The 5- and 10-year OS rates improved over time across both types of time periods. A subgroup analysis showed that OS improved significantly over time for the estrogen-receptor-positive/HER2-positive (ER+/HER2+) subtype, and exhibited a tendency toward improvement over time for the ER-negative (ER-)/HER2+ subtype. Median OS was significantly longer in patients with non-inflammatory breast cancer (P = .02) and in patients with ER+ disease, progesterone-receptor-positive disease, HER2+ disease, lower nuclear grade, locoregional therapy, and metastasis to a single organ (all P &lt;.0001). These findings showed that OS at 5 and 10 years after diagnosis in patients with dnMBC improved over time. The significant improvements in OS over time for the ER+/HER2+ subtype and the tendency toward improvement for ER-/HER2+ subtype suggest the contribution of HER2-targeted therapy to survival.

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Real-world starting dose and outcomes of palbociclib plus an aromatase inhibitor for metastatic breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e13021 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e13021-e13021

Author(s):

Debra A. Patt ◽

Xianchen Liu ◽

Benjamin Li ◽

Lynn McRoy ◽

Rachel M. Layman ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Aromatase Inhibitor ◽

Real World ◽

Metastatic Breast ◽

Routine Practice ◽

First Line ◽

Starting Dose ◽

The Us

e13021 Background: Palbociclib (PA) has been approved for HR+/HER2–advanced/metastatic breast cancer (mBC) in combination with an aromatase inhibitor (AI) or fulvestrant for more than 6 years. Regardless of the labeled recommended starting dose of 125mg/day, some patients initiate palbociclib at lower doses in routine practice. This study described real-world starting dose, patient characteristics, and effectiveness outcomes of first line PA+ AI for mBC in the US clinical setting. Methods: We conducted a retrospective analysis of Flatiron Health’s nationwide longitudinal electronic health records, which came from over 280 cancer clinics representing more than 2.2 million actively treated cancer patients in the US. Between February 2015 and September 2018, 813 HR+/HER2– mBC women initiated PA+AI as first-line therapy and had ≥ 3 months of potential follow-up. Patients were followed from start of PA+AI to December 2018, death, or last visit, whichever came first. Real-world progression-free survival (rwPFS) was defined as the time from the start of PA+AI to death or disease progression. Real-world tumor response (rwTR) was assessed based on the treating clinician’s assessment of radiologic evidence for change in burden of disease over the course of treatment. Multivariate analyses were performed to adjust for demographic and clinical characteristics. Results: Of 813 eligible patients, 68.3% were white, median age was 65.0 years, and 42.9% had visceral disease (lung and/or liver). Median duration of follow-up was 21.0 months. 805 patients had records of PA starting dose, with 125mg and 75/100mg/day being 86.5% and 13.5%, respectively. Patients who started at 75/100mg/day were more likely to be ≥75 years than those who started at 125mg/day (38.5% vs 17.1%). Other baseline and disease characteristics were generally evenly distributed. Patients who started at 125mg/day had longer median rwPFS (27.8 vs 18.6 months, adjusted HR=0.74, 95%CI=0.52-1.05) and higher rwTR (54.0% vs. 40.4%) than those patients who started 100/75mg/day (adjusted OR=1.76, 95%CI=1.13-2.74). Table presents results in detail. Conclusions: Most patients in this study initiated palbociclib at 125mg/day and dose adjustment was similar regardless of starting dose. These real-world findings may support initiation of palbociclib at a dose of 125mg/day in combination with AI for the first-line treatment of HR+/HER2- mBC. [Table: see text]

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