scholarly journals Use of Mastectomy for Overdiagnosed Breast Cancer in the United States: Analysis of the SEER 9 Cancer Registries

2019 ◽  
Vol 2019 ◽  
pp. 1-14
Author(s):  
C. Harding ◽  
F. Pompei ◽  
D. Burmistrov ◽  
R. Wilson
Keyword(s):  
Breast Cancer ◽  
Cancer Registries ◽  
The United States ◽  
Breast Cancers ◽  
The Us ◽  
Study Population ◽  
Cancer Types ◽  
Surgical Treatments ◽  
Case Characteristics

Aim. We investigated use of mastectomy as treatment for early breast cancer in the US and applied the resulting information to estimate the minimum and maximum rates at which mastectomy could plausibly be undergone by patients with overdiagnosed breast cancer. Little is currently known about overtreatments undergone by overdiagnosed patients. Methods. In the US, screening is often recommended at ages ≥40. The study population was women age ≥40 diagnosed with breast cancer in the US SEER 9 cancer registries during 2013 (n=26,017). We evaluated first-course surgical treatments and their associations with case characteristics. Additionally, a model was developed to estimate probability of mastectomy conditional on observed case characteristics. The model was then applied to evaluate possible rates of mastectomy in overdiagnosed patients. To obtain minimum and maximum plausible rates of this overtreatment, we respectively assumed the cases that were least and most likely to be treated by mastectomy had been overdiagnosed. Results. Of women diagnosed with breast cancer at age ≥40 in 2013, 33.8% received mastectomy. Mastectomy was common for most investigated breast cancer types, including for the early breast cancers among which overdiagnosis is thought to be most widespread: mastectomy was undergone in 26.4% of in situ and 28.0% of AJCC stage-I cases. These rates are substantively higher than in many European nations. The probability-based model indicated that between >0% and <18% of the study population could plausibly have undergone mastectomy for overdiagnosed cancer. This range reduced depending on the overdiagnosis rate, shrinking to >0% and <7% if 10% of breast cancers were overdiagnosed and >3% and <15% if 30% were overdiagnosed. Conclusions. Screening-associated overtreatment by mastectomy is considerably less common than overdiagnosis itself but should not be assumed to be negligible. Screening can prompt or prevent mastectomy, and the balance of this harm-benefit tradeoff is currently unclear.

Surgical Pathology–Based Outcomes Assessment of Breast Cancer Early Diagnosis

2001 ◽  
Vol 125 (3) ◽  
pp. 325-331
Author(s):  
Raouf E. Nakhleh ◽  
Richard J. Zarbo
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
The United States ◽  
Surgical Pathology ◽  
Detection Methods ◽  
Mortality Data ◽  
Breast Cancers ◽  
Improvement Program ◽  
Clinical Method

Abstract Objective.—To develop breast cancer outcomes data relating pathologic tumor variables at diagnosis with clinical method of detection. Design.—Anatomic pathologists assessed 30 consecutive breast cancers at each institution, resulting in an aggregate database of 4232 breast cancers. Setting.—Hospital-based laboratories from the United States (98%), Canada, Australia, and Belgium. Participants.—One hundred ninety-nine laboratories in the 1999 College of American Pathologists Q-Probes voluntary quality improvement program. Main Outcome Measures.—Pathologic variables indicative of favorable outcomes included percentage of carcinomas detected at the in situ stage, tumors ≤1 cm in diameter, and invasive cancers with lymph nodes negative for metastases. Results.—All outcomes measures, including percent in situ carcinomas (26.9% vs 13.8%), tumor size ≤1 cm (57.8% vs 36.5%), and lymph node–negative status (77.8% vs 64%), were more favorable when tumors were detected by screening mammography (P &lt; .001) compared to all other detection methods. Conclusions.—This study demonstrates an opportunity for pathologists to develop outcomes information of interest to health care organizations, providers, patients, and payers by integrating routine oncologic surgical pathology and clinical breast cancer detection data. Such readily obtained interim outcomes data trended and benchmarked over time can demonstrate the relative clinical efficacy of preventive breast care provided by health care systems long before mortality data are available.

Ductal Carcinoma In Situ: Challenges, Opportunities, and Uncharted Waters

2012 ◽  
pp. 40-44 ◽  
Author(s):  
Abigail W. Hoffman ◽  
Catherine Ibarra-Drendall ◽  
Virginia Espina ◽  
Lance Liotta ◽  
Victoria Seewaldt
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
The United States ◽  
Targeted Prevention ◽  
Breast Cancers ◽  
Increased Risk

Overview: Ductal carcinoma in situ (DCIS) is a heterogeneous group of diseases that differ in biology and clinical behavior. Until 1980, DCIS represented less than 1% of all breast cancer cases. With the increased utilization of mammography, DCIS now accounts for 15% to 25% of newly diagnosed breast cancer cases in the United States. Although our ability to detect DCIS has radically improved, our understanding of the pathophysiology and factors involved in its progression to invasive carcinoma is still poorly defined. In many patients, DCIS will never progress to invasive breast cancer and these women are overtreated. In contrast, some DCIS cases are clinically aggressive and the women may be undertreated. We are able to define some of the predictors of aggressive DCIS compared with DCIS of low malignant potential. However, our ability to risk-stratify DCIS is still in its infancy. Clinical risk factors that predict aggressive disease and increased risk of local recurrence include young age at diagnosis, large lesion size, high nuclear grade, comedo necrosis, and involved margins. Treatment factors such as wider surgical margins and radiation therapy reduce the risk of local recurrence. DCIS represents a key intermediate in the stepwise progression to malignancy, but not all aggressive breast cancers appear to have a DCIS intermediate, notably within triple-negative breast cancer. Ongoing studies of the genetic and epigenetic alterations in precancerous breast lesions (atypia and DCIS) as well as the breast microenvironment are important for developing effective early detection and individualized targeted prevention.

scholarly journals Biosimilars for breast cancer: a review of HER2-targeted antibodies in the United States

2019 ◽  
Vol 11 ◽  
pp. 175883591988704 ◽  
Author(s):  
Emily M. Miller ◽  
Lee S. Schwartzberg
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Early Stage ◽  
Cost Savings ◽  
The United States ◽  
Breast Cancers ◽  
Approval Process ◽  
Her2 Positive ◽  
The Us ◽  
Positive Breast Cancer

The utilization of trastuzumab biosimilar medications is of particular interest in HER2-positive breast cancer as these drugs have the potential for cost savings and increased utilization/access to HER2 targeted therapy in both early stage and metastatic HER2-positive breast cancers. Five trastuzumab biosimilars: MYL-1401O (Ogivri), CT-P6 (Herzuma), SB3 (Ontruzant), PF-05280014 (Trazimera), and ABP980 (Kanjinti), have now been approved by the US Food and Drug Administration (FDA) for use in HER2-positive breast cancers. This review provides an overview of these agents with special consideration of the development and approval process, including available clinical data results for these trastuzumab biosimilars. Adoption in the clinic will depend on the degree of comfort with the overall evidence.

A Multicentric non-interventional observational study to determine treatment patterns and response of drugs in various stages of breast cancer along with epidemiology

2020 ◽  
Vol 8 (2) ◽  
pp. 71-81
Author(s):  
Mukkamala Durga Niharika ◽  
Shaik Kulsumbi ◽  
Devagiri Anupama ◽  
Tadigiri Vineela Supriya ◽  
Kotari Navya ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Observational Study ◽  
Receptor Expression ◽  
Breast Cancer Patients ◽  
Female Patients ◽  
Life Threatening ◽  
Guntur District ◽  
Study Population ◽  
Hormone Receptor Expression

Cancer is a life-threatening disease which causes to lose cohesiveness and orderliness of normal tissue. These malignant cells can spread to any other organ through blood flow or lymphatic flow and develop malignancy over there; this phenomenon is called metastasis. The aim is to focus on treatment pattern and response of drugs in various stages of breast cancer along with epidemiology. It is a non- interventional multicentric observational study. Female patients confirmed with Breast cancer are included in the study. All the relevant data were collected on a patient demographic form after obtaining informed consent from individual patients. In our study, the mean age of presentation in breast cancer patients was 41.35 years. Further it was found that 40.5% (n = 81) majority-female patients with Breast cancer are from Guntur District and 21.5% (n= 43). The majority of women with Breast cancer have hormone receptor expression of ER+/PR+HER2- was found to be 33% (n= 50). In the study on analyzing comorbidities of the study population, it was noted that 28.5% of women were affected with Diabetes mellitus. In our study, it was found that most of the patients with Breast cancer have been most often prescribed with Adriamycin 27.86%. From these observations, we conclude that late menarche may be one of the etiological causes of breast cancer in women, Invasive carcinoma in situ is the most commonly reported breast cancer in the study. Patients have been diagnosed with breast cancer at their stage 3 of progression, which may be the reason for making it mandatory for more than 50% of patients to undergo 6 to 8 cycles of chemotherapy. Coming to the patterns of drug use, ADRIAMYCIN, CYCLOPHOSPHAMIDE and DOCETAXEL are the three most commonly used single drug and combinational drug therapies among the study population.

scholarly journals Role of the NUDT Enzymes in Breast Cancer

2021 ◽  
Vol 22 (5) ◽  
pp. 2267
Author(s):  
Roni H. G. Wright ◽  
Miguel Beato
Keyword(s):  
Breast Cancer ◽  
Signaling Pathways ◽  
Cancer Progression ◽  
Breast Cancers ◽  
Metastatic Colonization ◽  
Hormone Receptor Positive ◽  
Aggressive Cancer ◽  
Cancer Types ◽  
Metastatic Process

Despite global research efforts, breast cancer remains the leading cause of cancer death in women worldwide. The majority of these deaths are due to metastasis occurring years after the initial treatment of the primary tumor and occurs at a higher frequency in hormone receptor-positive (Estrogen and Progesterone; HR+) breast cancers. We have previously described the role of NUDT5 (Nudix-linked to moiety X-5) in HR+ breast cancer progression, specifically with regards to the growth of breast cancer stem cells (BCSCs). BCSCs are known to be the initiators of epithelial-to-mesenchyme transition (EMT), metastatic colonization, and growth. Therefore, a greater understanding of the proteins and signaling pathways involved in the metastatic process may open the door for therapeutic opportunities. In this review, we discuss the role of NUDT5 and other members of the NUDT family of enzymes in breast and other cancer types. We highlight the use of global omics data based on our recent phosphoproteomic analysis of progestin signaling pathways in breast cancer cells and how this experimental approach provides insight into novel crosstalk mechanisms for stratification and drug discovery projects aiming to treat patients with aggressive cancer.

Real-world utilization and costs with biosimilar and reference filgrastim in patients with breast cancer receiving myelosuppressive chemotherapy in a community oncology setting from 2015 to 2017.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 57-57
Author(s):  
Robert M. Rifkin ◽  
Lisa Herms ◽  
Chuck Wentworth ◽  
Anupama Vasudevan ◽  
Kimberley Campbell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Real World ◽  
Initial Period ◽  
The United States ◽  
Time Frame ◽  
Real World Data ◽  
Electronic Health Record Data ◽  
Myelosuppressive Chemotherapy ◽  
Community Oncology ◽  
The Us

57 Background: Biosimilars have potential to reduce healthcare costs and increase access in the United States, but lack of uptake has contributed to lost savings. Filgrastim-sndz was the first FDA-approved biosimilar, and much can be learned by evaluating its uptake. In February 2016, the US Oncology Network converted to filgrastim-sndz as its short-acting granulocyte colony-stimulating factor (GCSF) of choice for prevention of febrile neutropenia (FN) following myelosuppressive chemotherapy (MCT). To understand utilization and cost patterns, this study analyzes real-world data of GCSFs within a community oncology network during the initial period of conversion to the first biosimilar available in the US. Methods: This descriptive retrospective observational study used electronic health record data for female breast cancer (BC) patients receiving GCSF and MCT at high risk of FN. Patient cohorts were defined by first receipt of either filgrastim or filgrastim-sndz during the 410 days before and after biosimilar conversion. Healthcare resource utilization (HCRU) and costs for GCSF and complete blood counts (CBC) were collected at GCSF initiation through the earliest of 30 days following end of MCT, loss to follow up, death, or data cutoff. Results: 146 patients were identified: 81 (55.5%) filgrastim and 65 (44.5%) filgrastim-sndz. No directional differences existed in baseline characteristics between the cohorts. Higher proportions of filgrastim-sndz patients received dose-dense MCT (33.8% vs 22.2%). Time trends show an initial spike in HCRU and cost for filgrastim-sndz patients after formulary conversion, which subsequently decreased and converged to that of the filgrastim cohort after 12 months. When aggregated, the overall median total administration counts, per patient per month (PPPM) and dosage, were marginally higher for filgrastim-sndz (5 vs 3; 2.9 vs 1.4; 1920 vs 1440 mcg, respectively). Median PPPM costs were higher for filgrastim-sndz ($803 vs $545). Median CBC utilization and costs were higher for filgrastim-sndz (2.8 vs 2.5; $28 vs $23, respectively). Conclusions: This study provides insight into real-world HCRU and cost patterns after formulary conversion to a biosimilar for BC patients receiving MCT and GCSF. As a descriptive study, causal inferences cannot be made and an underlying effect from index chemotherapy cannot be excluded. Convergence of HCRU and costs after 12 months suggests that overall results may be driven by behavior at initial formulary switch. Since filgrastim-sndz was the first US biosimilar approved, the uptake may be indicative of an experience with biosimilar acceptance in general. Future real-world studies of biosimilars must consider inconsistent utilization and practice trends during the time frame directly following formulary conversion.

GIS, Spatial Analysis, and Modeling

2019 ◽  
pp. 1284-1297
Author(s):  
Khadijeh Rouzbehani ◽  
Ghazaleh Sajjadi ◽  
Mohamad Rahim Hatami
Keyword(s):  
Breast Cancer ◽  
United States ◽  
At Risk ◽  
The United States ◽  
Background Information ◽  
Health Related Research ◽  
Health Related ◽  
Physical Environmental Factors ◽  
International Strategies

Breast cancer is a major health issue in all countries affecting thousands of women. Its causes are unknown and the national and international strategies to reduce its morbidity and mortality levels are based on early detection of cancer through screening and treatment according to clinical guidelines. Thus, knowledge of which women are at risk and why they are at risk is therefore essential component of disease prevention and screening. In 2015, an estimated 231,840 new cases of invasive breast cancer are expected to be diagnosed in women in the United States, along with 60,290 new cases of non-invasive (in situ) breast cancer. The purpose of this study is to provide a more detailed analysis of the breast cancer distribution in the United States by comparing the spatial distribution of breast cancer cases against physical environmental factors using Geographic Information System (GIS). Further, it gives background information to the GIS and its applications in health-related research.

GIS, Spatial Analysis, and Modeling

2017 ◽  
pp. 16-29
Author(s):  
Khadijeh Rouzbehani ◽  
Ghazaleh Sajjadi ◽  
Mohamad Rahim Hatami
Keyword(s):  
Breast Cancer ◽  
United States ◽  
At Risk ◽  
The United States ◽  
Background Information ◽  
Health Related Research ◽  
Health Related ◽  
Physical Environmental Factors ◽  
International Strategies

Breast cancer is a major health issue in all countries affecting thousands of women. Its causes are unknown and the national and international strategies to reduce its morbidity and mortality levels are based on early detection of cancer through screening and treatment according to clinical guidelines. Thus, knowledge of which women are at risk and why they are at risk is therefore essential component of disease prevention and screening. In 2015, an estimated 231,840 new cases of invasive breast cancer are expected to be diagnosed in women in the United States, along with 60,290 new cases of non-invasive (in situ) breast cancer. The purpose of this study is to provide a more detailed analysis of the breast cancer distribution in the United States by comparing the spatial distribution of breast cancer cases against physical environmental factors using Geographic Information System (GIS). Further, it gives background information to the GIS and its applications in health-related research.

scholarly journals Declining Incidence of Contralateral Breast Cancer in the United States From 1975 to 2006

2011 ◽  
Vol 29 (12) ◽  
pp. 1564-1569 ◽  
Author(s):  
Hazel B. Nichols ◽  
Amy Berrington de González ◽  
James V. Lacey ◽  
Philip S. Rosenberg ◽  
William F. Anderson
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Contralateral Breast Cancer ◽  
Temporal Trends ◽  
The United States ◽  
Incidence Rates ◽  
Contralateral Breast ◽  
Breast Cancers ◽  
Annual Percent Change ◽  
Er Positive

Purpose Contralateral breast cancer (CBC) is the most frequent new malignancy among women diagnosed with a first breast cancer. Although temporal trends for first breast cancers have been well studied, trends for CBC are not so well established. Patients and Methods We examined temporal trends in CBC incidence using US Surveillance, Epidemiology, and End Results database (1975 to 2006). Data were stratified by estrogen receptor (ER) status of the first breast cancer for the available time period (1990+). We estimated the annual percent change (EAPC) in CBC rates using Poisson regression models adjusted for the age at and time since first breast cancer diagnosis. Results Before 1985, CBC incidence rates were stable (EAPC, 0.27% per year; 95% CI, −0.4 to 0.9), after which they declined with an EAPC of −3.07% per year (95% CI, −3.5 to −2.7). From 1990 forward, the declines were restricted to CBC after an ER-positive cancer (EAPC, −3.18%; 95% CI, −4.2 to −2.2) with no clear decreases after an ER-negative cancer. Estimated current age-specific CBC rates (per 100/year) after an ER-positive first cancer were: 0.45 for first cancers diagnosed before age 30 years and 0.25 to 0.37 for age 30 years or older. Rates after an ER-negative cancer were higher: 1.26 before age 30 years, 0.85 for age 30 to 35 years, and 0.45 to 0.65 for age 40 or older. Conclusion Results show a favorable decrease of 3% per year for CBC incidence in the United States since 1985. This overall trend was driven by declining CBC rates after an ER-positive cancer, possibly because of the widespread usage of adjuvant hormone therapies, after the results of the Nolvadex Adjuvant Trial Organisation were published in 1983, and/or other adjuvant treatments.

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