scholarly journals Long-term prognosis of young breast cancer patients (≤40 years) who did not receive adjuvant systemic treatment: protocol for the PARADIGM initiative cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e017842 ◽  
Author(s):  
Gwen MHE Dackus ◽  
Natalie D ter Hoeve ◽  
Mark Opdam ◽  
Willem Vreuls ◽  
Zsuzsanna Varga ◽  
...  
Keyword(s):  
Breast Cancer ◽  
The Netherlands ◽  
Cancer Patients ◽  
Cancer Registry ◽  
Systemic Treatment ◽  
Young Patients ◽  
Breast Cancer Patients ◽  
Adjuvant Systemic Treatment ◽  
Netherlands Cancer Registry ◽  
Young Breast Cancer

IntroductionCurrently used tools for breast cancer prognostication and prediction may not adequately reflect a young patient’s prognosis or likely treatment benefit because they were not adequately validated in young patients. Since breast cancers diagnosed at a young age are considered prognostically unfavourable, many treatment guidelines recommend adjuvant systemic treatment for all young patients. Patients cured by locoregional treatment alone are, therefore, overtreated. Lack of prognosticators for young breast cancer patients represents an unmet medical need and has led to the initiation of the PAtients with bReAst cancer DIaGnosed preMenopausally (PARADIGM) initiative. Our aim is to reduce overtreatment of women diagnosed with breast cancer aged≤40 years.Methods and analysisAll young, adjuvant systemic treatment naive breast cancer patients, who had no prior malignancy and were diagnosed between 1989 and 2000, were identified using the population based Netherlands Cancer Registry (n=3525). Archival tumour tissues were retrieved through linkage with the Dutch nationwide pathology registry. Tissue slides will be digitalised and placed on an online image database platform for clinicopathological revision by an international team of breast pathologists. Immunohistochemical subtype will be assessed using tissue microarrays. Tumour RNA will be isolated and subjected to next-generation sequencing. Differences in gene expression found between patients with a favourable and those with a less favourable prognosis will be used to establish a prognostic classifier, using the triple negative patients as proof of principle.Ethics and disseminationObservational data from the Netherlands Cancer Registry and left over archival patient material are used. Therefore, the Dutch law on Research Involving Human Subjects Act (WMO) is not applicable. The PARADIGM study received a ‘non-WMO’ declaration from the Medical Ethics Committee of the Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, waiving individual patient consent. All data and material used are stored in a coded way. Study results will be presented at international (breast cancer) conferences and published in peer-reviewed, open-access journals.

scholarly journals Clinical utility of genomic signatures in young breast cancer patients: a systematic review

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Cynthia Villarreal-Garza ◽  
Ana S. Ferrigno ◽  
Cynthia De la Garza-Ramos ◽  
Regina Barragan-Carrillo ◽  
Matteo Lambertini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Young Women ◽  
Young Patients ◽  
Distant Recurrence ◽  
Similar Rate ◽  
Breast Cancer Patients ◽  
Genomic Signatures ◽  
Hormone Sensitive ◽  
Young Breast Cancer

Abstract Risk stratification by genomic signatures has been shown to improve prognostication and guide treatment decisions among patients with hormone-sensitive breast cancer. However, their role in young women has not been fully elucidated. In this review, a systematic search was conducted for published articles and abstracts from major congresses that evaluated the use of genomic signatures in young breast cancer patients. A total of 71 studies were analyzed, including 561,188 patients of whom 27,748 (4.9%) were young. Women aged ≤40 years were subjected to genomic testing at a similar rate to older women but had a higher proportion of intermediate- to high-risk tumors when classified by EndoPredict (p = 0.04), MammaPrint (p < 0.01), and Oncotype DX (p < 0.01). In young women with low genomic risk, 6-year distant recurrence-free survival was 94%, while 5-year overall survival was nearly 100%. Nonetheless, young patients classified as low-risk had a higher tendency to receive chemotherapy compared to their older counterparts. In conclusion, genomic tests are useful tools for identifying young patients in whom chemotherapy omission is appropriate.

A Delphi consensus study among patients and clinicians in the Netherlands on the procedure of informing young breast cancer patients about Fertility Preservation

2012 ◽  
Vol 51 (8) ◽  
pp. 1062-1069 ◽  
Author(s):  
Mirjam M. Garvelink ◽  
Moniek M. ter Kuile ◽  
Leoni A. Louwé ◽  
Carina G. J. M. Hilders ◽  
Anne M. Stiggelbout
Keyword(s):  
Breast Cancer ◽  
The Netherlands ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Breast Cancer Patients ◽  
Delphi Consensus ◽  
Young Breast Cancer

Long-term outcome of breast cancer patients diagnosed ≤40 years according to breast cancer subtype in the absence of adjuvant systemic therapy: The PARADIGM initiative.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 535-535
Author(s):  
Gwen Dackus ◽  
Natalie D ter Hoeve ◽  
Mark Opdam ◽  
Willem Vreuls ◽  
Esther A Koop ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Systemic Treatment ◽  
Young Patients ◽  
Breast Cancer Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Adjuvant Systemic Treatment

535 Background: Young age at breast cancer diagnosis is considered a poor prognostic factor. As a result, many treatment guidelines advice adjuvant systemic treatment for young patients. Answering prognostic questions on young patients has therefore become a challenge. The PARADIGM (PAtients with bReast cAncer DIaGnosed preMenopausally) project aims to assess the long-term outcome of women diagnosed with breast cancer ≤40 years in the absence of adjuvant systemic therapy, using real world data from the nationwide Netherlands Cancer Registry (NCR) coupled with tissue biobanking. Methods: All women ≤40 years, diagnosed in the Netherlands between 1989-2000 with a primary invasive, histologically proven, TanyN0M0 breast cancer, without adjuvant systemic treatment were identified through the NCR. Back then N0 patients were considered low risk and did not receive adjuvant systemic treatment. Tissue specimens were revised by a team of dedicated breast pathologists. Cox regression was performed to estimate hazard ratios for recurrence-free (RFS) and overall survival (OS) according to immunohistochemical (IHC) subtype. Analyses were adjusted for grade, pathological T-stage, histological subtype and radiotherapy. Results: We included 2310 patients with a mean follow-up of 15.4 years (range 0-25 years). OS for the whole cohort was 68% and RFS 58.4% at 25 years. In total 740 deaths and 1043 recurrences were observed. Hormone receptor (HR)+/HER2+ patients had a significantly worse OS when compared to HR-HER2+ patients (adjusted Hazard Ratio 1.58; 95% confidence interval 1.05-2.38; p=0.029). No difference was observed between HR-HER2+ and the triple negative and HR+/HER2- subgroups at 25-years. RFS was similar for all IHC subtypes. Conclusions: In this large cohort of non-adjuvant systemically treated young breast cancer patients with long-term follow-up HR+/HER2+ patients have a significantly worse survival when compared to triple negative, HR-/HER2+ and HR+/HER2- patients. The latter three subtypes have similar OS at 25 years. Future molecular studies have been planned to distinguish the favorable from the unfavorable prognostic patients.

Sign in / Sign up

Export Citation Format

Share Document