Differences in Time Burden across Local Therapy Strategies for Early-stage Breast Cancer

Breast-conserving therapy has been established as a standard treatment for women with early-stage breast cancer. Whole-breast irradiation has traditionally been utilized to consolidate local therapy following conservative surgery. Recently, the need for whole-breast irradiation after breast-conserving surgery has become controversial, with some investigators advocating accelerated partial breast irradiation as an alternative. Accelerated partial breast irradiation is delivered over a shorter period and only to a portion of the breast. This review will examine the emerging role of accelerated partial breast irradiation in the treatment of early-stage breast cancer and review the biologic rationale for, techniques of, and limitations of partial breast irradiation following breast-conserving surgery.

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Local Therapy Decision-Making and Contralateral Prophylactic Mastectomy in Young Women with Early-Stage Breast Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-015-4572-6 ◽

2015 ◽

Vol 22 (12) ◽

pp. 3809-3815 ◽

Cited By ~ 47

Author(s):

Shoshana M. Rosenberg ◽

Karen Sepucha ◽

Kathryn J. Ruddy ◽

Rulla M. Tamimi ◽

Shari Gelber ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Young Women ◽

Prophylactic Mastectomy ◽

Early Stage ◽

Local Therapy ◽

Contralateral Prophylactic Mastectomy ◽

Early Stage Breast Cancer ◽

Therapy Decision

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Effect of hormone receptor status and local treatment on overall survival for early-stage breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.26_suppl.60 ◽

2014 ◽

Vol 32 (26_suppl) ◽

pp. 60-60

Author(s):

Catherine Parker ◽

Heather Y. Lin ◽

Yu Shen ◽

Liang Li ◽

Meeghan Ann Lautner ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Early Stage ◽

Cox Model ◽

Local Treatment ◽

Local Therapy ◽

Stage I ◽

Early Stage Breast Cancer ◽

Matched Cohort ◽

Double Robust

60 Background: Mastectomy and breast conserving therapy (BCT) have been established as interventions with equivalent survival for early stage breast cancer. However, trials comparing these approaches pre-date the understanding of breast cancer heterogeneity. We hypothesized that if heterogeneity is considered, the surgical approach may impact survival. Methods: Using the National Cancer Database (NCDB) from 2004 to 2005, we evaluated the overall survival (OS) of women with Stage I breast cancer who underwent mastectomy, BCT (surgery with radiation), or breast conserving surgery (BCS, surgery without radiation). Since only ER and PR data were available, we categorized tumors as ER and/or PR positive (HR+) or ER and PR negative (HR-). We performed propensity score-matched analysis using the covariates associated with the choice of surgical therapy. We used the Cox proportional hazards model for analyses of OS in pre-matched and matched cohorts. Double robust estimation under the Cox model was used in the analyses of the matched cohort. Results: A total of 16,646 female patients met study criteria: 1,845 (11%) received BCS, 11,214 (67%) received BCT, and 3,587 (22%) underwent mastectomy. Patients undergoing BCT had superior survival outcomes compared to those undergoing mastectomy or BCS (5-year OS was 96% vs 90% vs 87% respectively, p<0.001). After adjusting for other risk factors, BCT remained significantly associated with OS (HR 0.57 [95% CI 0.50, 0.66] for BCT vs BCS; HR 0.67 [95% CI 0.6, 0.76] for BCT vs mastectomy). In the matched cohort (1706 patients in each treatment group), comparison of OS in multivariate analysis confirmed the survival benefit associated with BCT over mastectomy (HR 0.73 [95% CI, 0.59, 0.89]) in the HR+ subset but not in the HR- subset (HR 0.91 [95%CI 0.62, 1.34]) of patients. BCT showed better OS than BCS in both HR+ and HR- subsets (HR 0.63 [95% CI, 0.52, 0.77], HR 0.67 [95%CI 0.46, 0.98] respectively). No differences were seen in OS between mastectomy and BCS in either HR+ or HR- cohorts (HR 0.87 [95%CI. 0.73, 1.03]), HR 0.73 [95%CI 0.51, 1.06] respectively). Conclusions: When tumor heterogeneity is considered, type of local therapy appears to impact the survival of women with Stage I breast cancer.

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Trends in Local Therapy Utilization and Cost for Early-Stage Breast Cancer in Older Women: Implications for Payment and Policy Reform

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2016.01.059 ◽

2016 ◽

Vol 95 (2) ◽

pp. 605-616 ◽

Cited By ~ 8

Author(s):

Shervin M. Shirvani ◽

Jing Jiang ◽

Anna Likhacheva ◽

Karen E. Hoffman ◽

Simona F. Shaitelman ◽

...

Keyword(s):

Breast Cancer ◽

Older Women ◽

Policy Reform ◽

Early Stage ◽

Local Therapy ◽

Early Stage Breast Cancer

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Endocrine therapy non-persistence in young women with early-stage breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.531 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 531-531 ◽

Cited By ~ 1

Author(s):

Shoshana M. Rosenberg ◽

Shari I. Gelber ◽

Kathryn Jean Ruddy ◽

Rulla Tamimi ◽

Johanna Wasserman ◽

...

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Young Women ◽

Early Stage ◽

Local Therapy ◽

Symptom Burden ◽

Treatment Decision ◽

Decisional Conflict ◽

Early Stage Breast Cancer ◽

Categorical Variables

531 Background: The greatest age disparity in early stage breast cancer (BC) outcomes is in young women with hormone receptor positive (HR+) BC. While differences in biology may play a role, understanding the role of non-persistence (early discontinuation) with endocrine therapy (ET) is critical given the demonstrated efficacy of ET in this population. Methods: As part of a prospective cohort that enrolled women with BC diagnosed (dx) at age ≤40 between 2006-2016, we identified women with HR+, Stage I-III BC. Socio-demographic and treatment information, fertility concerns and confidence with the ET treatment decision were assessed by survey within 1 yr of dx. Medical record review was used to ascertain stage and HR status. Women who initiated ET but did not report taking tamoxifen or an aromatase inhibitor at 3 yrs post-diagnosis (or last follow-up if <3 yrs) were classified as non-persistent. Chi-square tests were used to compare categorical variables between persisters and non-persisters and stepwise multivariable regression to evaluate predictors of non-persistence. Results: In 538 women who initiated ET, median age at dx was 36; 10% were non-persistent. Discontinuation of ET was more likely in those who were less confident with their ET decision compared to those who were more confident (25/179, 14% vs 18/263, 7%, p=0.01). A greater proportion of women concerned about fertility discontinued vs. women not concerned (29/213,14% vs 25/319, 8%, p=0.03), and fertility concerns were associated with non-persistence in multi-variable analyses (OR: 1.85, 95% CI 1.05-3.26, p=0.03). Age at dx, race, education, employment, financial comfort, marital status, parity, stage, chemotherapy and local therapy were not associated with non-persistence. Conclusions: A significant minority of women with HR+ BC discontinued ET within 3 yrs. The association between fertility concerns expressed soon after dx and non-persistence underscores a need to address psychosocial issues that can impact treatment decisions in young women. Strategies to reduce decisional conflict and increasing confidence with the choice to take ET, may influence persistence. Future work will evaluate the contribution of other factors (eg symptom burden) to non-persistence.

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