scholarly journals Outcomes after Mastectomy and Lumpectomy in Octogenarians and Nonagenarians with Early-Stage Breast Cancer

2017 ◽  
Vol 83 (8) ◽  
pp. 887-894 ◽  
Author(s):  
Ameliay Merrill ◽  
Doris R. Brown ◽  
Heidi D. Klepin ◽  
Edward A. Levine ◽  
Marissa Howard-Mcnatt
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Early Stage ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Local Treatment ◽  
Breast Conservation ◽  
Early Stage Breast Cancer ◽  
Risk Of Death ◽  
Increased Risk

Prospective studies have shown equal outcomes after mastectomy or breast conservation in patients with invasive breast cancer; however, many of these studies excluded elderly patients. We identified patients in their eighties and nineties with clinical stage 0 to II breast cancer undergoing mastectomy or lumpectomy with or without radiation from the prospective sentinel lymph node database at Wake Forest Baptist Health and analyzed their treatment and survival. Of 92 patients, 24 (26.1%) underwent mastectomy, 22 (23.9%) lumpectomy with radiation, and 46 (50.0%) lumpectomy alone. Significant differences were noted in tumor size (P = 0.018), nodal status (P = 0.013), and stage (P = 0.011) between the groups. Only 7.6 per cent of patients had chemotherapy, whereas 51.1 per cent took antiestrogen therapy. Recurrence occurred in 11 patients. In univariate analysis, overall survival did not differ by surgery. Age was the only factor that increased risk of death (HR = 1.19, P = 0.028). In this age group, neither tumor factors nor the type of local treatment significantly influenced overall survival. Octogenarians and nonagenarians with early-stage breast cancer undergoing breast-conserving surgery with or without radiation have equivalent survival to patients having a mastectomy.

Factors Affecting Choice of Treatment for Early-Stage Breast Cancer in West Virginia: A 10-Year Experience from a Rural Tertiary Care Center

2017 ◽  
Vol 83 (7) ◽  
pp. 709-716
Author(s):  
Patrick D. Suggs ◽  
Tyler L. Holliday ◽  
Stephanie N. Thompson ◽  
Bryan K. Richmond
Keyword(s):  
Breast Cancer ◽  
West Virginia ◽  
Early Stage ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Breast Conservation ◽  
Early Stage Breast Cancer ◽  
Treatment Modalities ◽  
Insurance Status ◽  
Care Hospital

Recent literature shows changing trends in use of breast conservation surgery (BCS), mastectomy, and contralateral prophylactic mastectomy (CPM) in women with early-stage breast cancer (ESBC). We analyzed factors associated with selection of these treatment modalities in a rural West Virginia tertiary care hospital. We conducted a 10-year analysis of women treated for ESBC at our institution from the institutional cancer registry. Variables were compared between patients choosing BCS versus mastectomy. In women who chose mastectomy, predictors for choice of CPM were also examined. Variables with P < 0.05 on univariate analysis were entered into a multivariate logistic regression model to define independent predictors of treatment choice. The mastectomy rate increased from 18.0 per cent in 2006 to 40.2 per cent in 2013. On multivariate analysis, insurance status (P < 0.001), comorbidities (P = 0.001), and surgeon graduation after 1987—a surrogate for surgeon age—(P = 0.010) predicted receipt of mastectomy. Of those receiving mastectomy, 106 (25.1%) elected CPM. CPM rates increased from 8.0 per cent in 2006 to 45.0 per cent in 2013. Younger age at diagnosis (P < 0.001) and use of preoperative MRI (P = 0.012) independently predicted use of CPM versus unilateral mastectomy. Rates of mastectomy and CPM in ESBC have increased in West Virginia over time. Independent predictors of selecting mastectomy over BCS included insurance status, surgeon age, and associated comorbidities. Younger patients and patients receiving preoperative MRI were more likely to choose CPM. Awareness of these factors will aid in counseling women with ESBC and allow clinicians to address potential biases or disparities that may affect treatment choices. Further prospective study of these findings is warranted.

scholarly journals Survival After Early-Stage Breast Cancer of Women Previously Treated for Depression: A Nationwide Danish Cohort Study

2017 ◽  
Vol 35 (3) ◽  
pp. 334-342 ◽  
Author(s):  
Nis P. Suppli ◽  
Christoffer Johansen ◽  
Lars V. Kessing ◽  
Anita Toender ◽  
Niels Kroman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cohort Study ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Specific Survival ◽  
Regression Analyses ◽  
Cancer Specific Survival ◽  
Increased Risk ◽  
Previously Treated

Purpose The aim of this nationwide, register-based cohort study was to determine whether women treated for depression before primary early-stage breast cancer are at increased risk for receiving treatment that is not in accordance with national guidelines and for poorer survival. Material and Methods We identified 45,325 women with early breast cancer diagnosed in Denmark from 1998 to 2011. Of these, 744 women (2%) had had a previous hospital contact (as an inpatient or outpatient) for depression and another 6,068 (13%) had been treated with antidepressants. Associations between previous treatment of depression and risk of receiving nonguideline treatment of breast cancer were assessed in multivariable logistic regression analyses. We compared the overall survival, breast cancer–specific survival, and risk of death by suicide of women who were and were not treated for depression before breast cancer in multivariable Cox regression analyses. Results Tumor stage did not indicate a delay in diagnosis of breast cancer in women previously treated for depression; however, those given antidepressants before breast cancer had a significantly increased risk of receiving nonguideline treatment (odds ratio, 1.14; 95% CI, 1.03 to 1.27) and significantly worse overall survival (hazard ratio, 1.21; 95% CI, 1.14 to 1.28) and breast cancer–specific survival (hazard ratio, 1.11; 95% CI, 1.03 to 1.20). Increased but nonsignificant estimated risks were also found for women with previous hospital contacts for depression. In subgroup analyses, the association of depression with poor survival was particularly strong among women who did not receive the indicated adjuvant systemic therapy. Conclusion Women previously treated for depression constitute a large subgroup of patients with breast cancer who are at risk for receiving nonguideline breast cancer treatment, which probably contributes to poorer overall and breast cancer–specific survival.

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

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.

How much is too much? Multidisciplinary management of elderly early-stage breast cancer (BC) patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12525-e12525
Author(s):  
Elizabeth R. Berger ◽  
Srinivasa Sevilimedu Veeravalli ◽  
Monica Morrow ◽  
Alexandra S. Heerdt
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Early Stage ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Breast Conservation ◽  
Treatment Decision ◽  
Early Stage Breast Cancer ◽  
The Impact ◽  
Breast Procedure

e12525 Background: Optimal approach to early-stage breast cancer (BC) management in women ≥70y is unclear. Studies have demonstrated improved local control but no survival advantage with use of radiation therapy (RT) after breast-conservation therapy (BCT). The impact on survival of other management decisions, including breast procedure, axillary staging (AS), systemic treatment, and patient comorbidities is unknown. We evaluate the effect of each treatment decision on overall survival (OS), disease-free survival (DFS), and breast-cancer specific survival (BCSS). Methods: Patients age ≥70y with cT1N0/ER+/HER2- tumors undergoing surgery from 2011-2013 were identified from a prospectively maintained, single-institution database. Clinicopathologic features were evaluated. 10-year estimated mortality from comorbidity was calculated using a Suemoto index (SI). Univariate and multivariable associations were assessed using Cox modeling. Kaplan-Meier method was used to estimate OS and DFS. Results: 338 patients were identified: 312 (92%) underwent BCT; 26 (8%) had mastectomy. Median age was 75.5y (70-101); median tumor size was 1.0cm (0.1-1.9); median SI was 42.5(22-99). With a median follow-up of 60 mos, 25 patients died—1 from BC, for an OS rate of 92.8% and BCSS of 99.7%. 9 patients developed a locoregional recurrence and 1 developed distant recurrence, representing a 5-year DFS rate of 97.8%. There were no differences in DFS by age groups (≤75, 76-80, > 80; p = 0.1). On univariate analysis, DFS did not vary by age, breast procedure, or receipt of chemotherapy. It was improved in those who had AS and a lower SI (p < 0.01). OS was better in those patients who had AS, had recurrence score performed and had radiation therapy, reflecting lower SI. On multivariable analysis, lack of AS (HR 10.5, p < 0.01) and higher SI (HR 1.03, p < 0.01) were the only variables associated with worse OS. Lack of AS became non-significant in those > 80y. No treatment decision led to improved BCSS. When comparing patients with local or systemic recurrence vs those without recurrence, there was no difference in OS (p = 0.4) or BCSS (p = NS). Conclusions: Decisions in early-stage BC in the elderly are complex due to competing morbidities. While DFS and OS may vary based on treatment variables, no specific care component affected BCSS. Treatment discussions in elderly BC patients should emphasize the risks/benefits of each care component, taking into consideration the patient’s comorbidities and allowing for the patient’s understanding of outcomes and quality of life.

Omission of adjuvant chemotherapy in elderly patients with early stage breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12032-12032 ◽  
Author(s):  
Sung Jun Ma ◽  
Oluwadamilola Temilade Oladeru ◽  
Anurag K Singh
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Elderly Patients ◽  
Elderly Population ◽  
Early Stage ◽  
Univariate Analysis ◽  
Early Stage Breast Cancer ◽  
Study Cohort ◽  
Entire Study

12032 Background: Breast cancer incidence in elderly population over 70 years is anticipated to grow up to 35% by 2030. However, this elderly population is under-represented in the TAILORx (Trial Assigning Individualized Options for Treatment) with less than 5% of the entire study cohort. As the omission of radiation therapy among the elderly with favorable prognosis is a reasonable alternative option, omission of chemotherapy has not been prospectively investigated. To address this knowledge gap, we conducted an observational cohort study to evaluate the omission of chemotherapy in elderly patients with early breast cancer. Methods: The National Cancer Database (NCDB) was queried for patients above the age of 70 diagnosed with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, pT1-2N0 breast cancer who underwent hormone therapy with or without chemotherapy (2010-2015). Kaplan-Meier method and Cox multivariable analysis (MVA) were performed for survival analysis. Propensity score matching in a 1:1 ratio without any replacement was used to address selection bias. Sensitivity analysis was performed on a subgroup of those with a high 21-gene recurrence score (RS) > 25. Results: A total of 12004 patients were identified, including 10802 and 1202 patients with and without adjuvant chemotherapy, respectively. The median follow up was 38.2 months (IQR 22.5-57.2). On univariate analysis, chemotherapy was not associated with improved overall survival (HR 0.96, p = 0.71), ineligible for inclusion in the final MVA model. On interaction analysis, the use of chemotherapy had no interaction with RS (p = 0.46), age (p = 0.08), tumor size (p = 0.23), tumor grade (p = 0.42), and comorbidity score (p = 0.22). On 1030 and 689 matched pairs for all RS and RS > 25, respectively, there was no association of overall survival with chemotherapy (all RS: HR 0.76, p = 0.08; RS > 25: HR 0.74, p = 0.10). Conclusions: For elderly patients with early stage breast cancer, the addition of adjuvant chemotherapy may not be associated with improved survival even in the setting of high RS > 25. Given the toxicity profile of systemic therapy, shared decision making between clinicians and elderly patients is needed to individualize treatment options.

scholarly journals De-escalation of radiation therapy in patients with stage I, node-negative, HER2-positive breast cancer

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jose G. Bazan ◽  
Sachin R. Jhawar ◽  
Daniel Stover ◽  
Ko Un Park ◽  
Sasha Beyer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Local Therapy ◽  
Adjuvant Radiation ◽  
Her2 Positive ◽  
Node Negative ◽  
Risk Of Death ◽  
Her2 Breast Cancer ◽  
Neoadjuvant Systemic Therapy ◽  
Increased Risk

AbstractIn the modern era, highly effective anti-HER2 therapy is associated with low local-regional recurrence (LRR) rates for early-stage HER2+ breast cancer raising the question of whether local therapy de-escalation by radiation omission is possible in patients with small-node negative tumors treated with lumpectomy. To evaluate existing data on radiation omission, we used the National Cancer Database (NCDB) to test the hypothesis that RT omission results in equivalent overall survival (OS) in stage 1 (T1N0) HER2+ breast cancer. We excluded patients that received neoadjuvant systemic therapy. We stratified the cohort by receipt of adjuvant radiation. We identified 6897 patients (6388 RT; 509 no RT). Patients that did not receive radiation tended to be ≥70 years-old (odds ratio [OR] = 3.69, 95% CI: 3.02–4.51, p < 0.0001), to have ≥1 comorbidity (OR = 1.33, 95% CI: 1.06–1.68, p = 0.0154), to be Hispanic (OR = 1.49, 95% CI: 1.00–2.22, p = 0.049), and to live in lower income areas (OR = 1.32, 95% CI: 1.07–1.64, p = 0.0266). Radiation omission was associated with a 3.67-fold (95% CI: 2.23–6.02, p < 0.0001) increased risk of death. While other selection biases that influence radiation omission likely persist, these data should give caution to radiation omission in T1N0 HER2+ breast cancer.

scholarly journals The role of functional polymorphisms in oxidative stress-related genes on early-stage breast cancer survival

2021 ◽  
pp. 172460082110111
Author(s):  
Erika Korobeinikova ◽  
Rasa Ugenskiene ◽  
Ruta Insodaite ◽  
Viktoras Rudzianskas ◽  
Jurgita Gudaitiene ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Single Nucleotide Polymorphisms ◽  
Early Stage ◽  
Disease Free Survival ◽  
Early Stage Breast Cancer ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Free Survival ◽  
Disease Free

Background: Genetic variations in oxidative stress-related genes may alter the coded protein level and impact the pathogenesis of breast cancer. Methods: The current study investigated the associations of functional single nucleotide polymorphisms in the NFE2L2, HMOX1, P21, TXNRD2, and ATF3 genes with the early-stage breast cancer clinicopathological characteristics and disease-free survival, metastasis-free survival, and overall survival. A total of 202 Eastern European (Lithuanian) women with primary I–II stage breast cancer were involved. Genotyping of the single nucleotide polymorphisms was performed using TaqMan single nucleotide polymorphisms genotyping assays. Results: The CA+AA genotypes of P21 rs1801270 were significantly less frequent in patients with lymph node metastasis and larger tumor size ( P=0.041 and P=0.022, respectively). The TT genotype in ATF3 rs3125289 had significantly lower risk of estrogen receptor (ER), progesterone receptor (PR) negative, and human epidermal growth factor receptor 2 (HER2) positive status ( P=0.023, P=0.046, and P=0.040, respectively). In both, univariate and multivariate Cox analysis, TXNRD2 rs1139793 GG genotype vs. GA+AA was a negative prognostic factor for disease-free survival (multivariate hazard ratio (HR) 2.248; P=0.025) and overall survival (multivariate HR 2.248; P=0.029). The ATF3 rs11119982 CC genotype in the genotype model was a negative prognostic factor for disease-free survival (multivariate HR 5.878; P=0.006), metastasis-free survival (multivariate HR 4.759; P=0.018), and overall survival (multivariate HR 3.280; P=0.048). Conclusion: Our findings suggest that P21 rs1801270 is associated with lymph node metastasis and larger tumor size, and ATF3 rs3125289 is associated with ER, PR, and HER2 status. Two potential, novel, early-stage breast cancer survival biomarkers, TXNRD2 rs1139793 and ATF3 rs11119982, were detected. Further investigations are needed to confirm the results of the current study.

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