Abstract P2-05-31: High-risk breast cancer is less likely to occur in the ductal hyperplasia lesions or low-grade DCIS ∼ Consideration of long-term follow-up observation after surgical biopsy

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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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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Long-Term Efficiency and Toxicity of Adjuvant Dose-Dense Sequential Adriamycin-Paclitaxel-Cyclophosphamide Chemotherapy in High-Risk Breast Cancer

Oncology ◽

10.1159/000315734 ◽

2010 ◽

Vol 78 (3-4) ◽

pp. 271-273

Author(s):

Gyöngyi Kelemen ◽

Gabriella Uhercsák ◽

Katalin Ormándi ◽

József Eller ◽

László Thurzó ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Dose Dense ◽

High Risk Breast Cancer ◽

High Risk Breast ◽

Risk Breast Cancer

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Anthracycline-based sequential adjuvant chemotherapy in operable breast cancer: Five-year results of a randomized study by the Michelangelo Foundation

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.535 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 535-535 ◽

Cited By ~ 1

Author(s):

A. Moliterni ◽

M. Mansutti ◽

D. Aldrighetti ◽

L. Merlini ◽

L. Zuccarino ◽

...

Keyword(s):

Breast Cancer ◽

Systemic Treatment ◽

Randomized Study ◽

Operable Breast Cancer ◽

Sequential Chemotherapy ◽

High Risk Breast Cancer ◽

High Risk Breast ◽

Risk Breast Cancer

535 Background: Anthracycline-based sequential chemotherapy significantly improves efficacy outcomes compared to CMF alone. Methods: 806 eligible patients with operable breast cancer were enrolled into a randomized study (ratio 1:1:1:1) of sequential chemotherapy. In a 2×2-type design patients were allocated to first receive 4 cycles of AT (doxorubicin, A 60 mg/m2 iv + paclitaxel, T 200 mg/m2 as 3 h inf q 3wks) or EV (epirubicin, E 75 mg/m2 iv + vinorelbine, V 25 mg/m2 iv D1,8 q3wks) followed either by 4 monthly cycles of iv CMF or 6 cycles of q3w T alone (100 mg/m2 as 1h inf D1,8). Tamoxifen was recommended for 5 yr after chemotherapy in patients with HR+ tumors. Patients with tumors > 2 cm in diameter were allowed to start primary chemotherapy with 4 cycles of either AT or EV followed by surgery and postoperative systemic treatment as detailed above. Aim of the study was to test the role of T vs V when combined with an anthracycline during the first 4 cycles of the regimen as well as the role of CMF vs T during the last 4 cycles. Results: At a median follow-up of approximately 48 months, the 5 year freedom from progression (FFP) and overall survival (OS) for the main endpoints were as in the Table : The four treatment sequences were fairly well tolerated, with only 1 treatment-related death after EV. Type and severity of hematological toxicities were similar in all treatment arms. The incidence of reversible G2–3 neurotoxicity was 21.9% after AT, 5.3% after EV and 29.1% after sequential T. Chemical phlebitis was more frequent after EV (6.5%) then after AT (0.3). Conclusions: The results indicate that vinorelbine-epirubicin and classical CMF when appropriately used in a sequential modality for high-risk breast cancer are as valid and less neurotoxic an option of adjuvant therapy than the more widely used taxane-containing adjuvant regimens. Supported in part by Bristol-Myers Squibb, Pierre Fabre and Pharmacia. [Table: see text] [Table: see text]

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