Second Malignancies After Treatment of Early-Stage Breast Cancer: Lumpectomy and Radiation Therapy Versus Mastectomy

2000 ◽  
Vol 18 (12) ◽  
pp. 2406-2412 ◽  
Author(s):  
Edward Obedian ◽  
Diana B. Fischer ◽  
Bruce G. Haffty
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Hormone Therapy ◽  
Detailed Analysis ◽  
Cancer Patients ◽  
Early Stage ◽  
Contralateral Breast ◽  
Second Malignancies ◽  
Breast Cancer Patients

PURPOSE: To determine the risk of second malignancies after lumpectomy and radiation therapy (LRT), and to compare it with that in a similar cohort of early-stage breast cancer patients undergoing mastectomy without radiation (MAST). PATIENTS AND METHODS: Between January 1970 and December 1990, 1,029 breast cancer patients at our institution underwent LRT. A cohort of 1,387 breast cancer patients who underwent surgical treatment by mastectomy (MAST), and who did not receive postoperative radiation during the same time period, served as a comparison group. Second malignancies were categorized as contralateral breast versus nonbreast. In the cohort of patients undergoing LRT, a detailed analysis was carried out with respect to age, disease stage, smoking history, radiation therapy technique, dose, the use of chemotherapy or hormone therapy, and other clinical and/or pathologic characteristics. RESULTS: As of March 1999, the median follow-up was 14.6 years for the LRT group and 16 years for the MAST group. The 15-year risk of any second malignancy was nearly identical for both cohorts (17.5% v 19%, respectively). The second breast malignancy rate at 15 years was 10% for both the MAST and LRT groups. The 15-year risk of a second nonbreast malignancy was 11% for the LRT and 10% for the MAST group. In the subset of patients 45 years of age or younger at the time of treatment, the second breast and nonbreast malignancy rates at 15 years were 10% and 5% for patients undergoing LRT versus 7% and 4% for patients undergoing mastectomy (P, not statistically significant). In the detailed analysis of LRT patients, second lung malignancies were associated with a history of tobacco use. There were fewer contralateral breast tumors in patients undergoing adjuvant hormone therapy, although this did not reach statistical significance. The adjuvant use of chemotherapy did not significantly affect the risk of second malignancies. CONCLUSION: There seems to be no increased risk of second malignancies in patients undergoing LRT using modern techniques, compared with MAST. Continued monitoring of these patient cohorts will be required in order to document that these findings are maintained with even longer follow-up periods. With nearly 15 years median follow-up periods, however, these data should be reassuring to women who are considering LRT as a treatment option.

ASTRO suitability criteria assessment in early-stage breast cancer patients treated with intraoperative radiation therapy (IORT) plus 21 gene recurrence score (RS) assay result guided adjuvant medical therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12598-e12598
Author(s):  
Barbara Stewart Schwartzberg ◽  
Kathryn T. Howell ◽  
Joyce A Moore ◽  
Devchand Paul
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Endocrine Therapy ◽  
Medical Therapy ◽  
Early Stage ◽  
Breast Cancer Patients ◽  
Single Institution ◽  
Single Fraction

e12598 Background: A patient subset consented in an institutional review board-approved single institution clinical trial designed to determine the efficacy and outcome of single fraction IORT received adjuvant medical therapy recommendations based on their RS results. Patients were categorized according to American Society for Radiation Oncology (ASTRO) suitability criteria for accelerated partial breast irradiation. Comparison was made between ASTRO suitability criteria, RS and post-IORT outcomes. Methods: Outcome of pts completing single fraction (20Gy) IORT per protocol using disposable balloon electronic brachytherapy and RS assessment were reviewed. Data collection included demographics, pathology, RS, medical therapy, local (LR) and axillary (AR) recurrences, and survival. Results: From Nov 2011 – Jan 2016, 115 pts (aged 43 – 84, mean 63 years) completed both IORT per protocol and RS assessment. Pts with estrogen receptor positive invasive carcinomas (range 0.2 – 2.4 cm, median size 0.9 cm) and RS results were categorized by ASTRO suitability criteria, LR and AR, as shown in Table 1. The recurrence rate at mean follow-up of 6.8 years was 3.5%. There were 3 LR (RS 0, 17, 18) and 1 AR (RS 19). There has been no breast cancer related death. Adjuvant endocrine therapy was recommended to all pts. Twenty-three (20%) patients received chemotherapy, including 12 (71%) pts in the high RS (RS >25) groups. Chemotherapy was not given to any pt with a RS <18. One LR (RS 0, ASTRO Suitable, age 65, 1.5 cm) declined endocrine therapy. Ten (19%) pts with RS of 11 – 25 received chemotherapy. One LR (RS 17, ASTRO suitable, age 64, 1.5 cm) and 1 axillary recurrence (RS 19, ASTRO Suitable, age 66, 1.3 cm), neither receiving chemotherapy, were compliant with endocrine therapy. One LR (RS 18, ASTRO Suitable, age 51, 0.6 cm) was treated with cyclophosphamide and docetaxel. Seven (78%) pts with RS of 26 - 30 and 5 (63%) pts with RS >30 received chemotherapy, with no recurrences in these groups. Conclusions: One hundred fifteen pts treated with single fraction IORT per protocol and RS guided adjuvant medical therapy at a single institution were found to have a 3.5% recurrence rate at mean follow-up of 6.8 years. ASTRO suitability criteria and high RS results (RS > 25) did not correlate with recurrence. The success of IORT observed in this trial as local therapy for early-stage breast cancer patients was independent of genomic factors or patient suitability criteria. Recurrence rates were comparable to those reported in IORT peer-reviewed published data and treatments using breast conserving surgery plus whole breast radiation therapy. [Table: see text]

scholarly journals Risk of contralateral breast cancer according to first breast cancer characteristics among women in the USA, 1992–2016

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Cody Ramin ◽  
Diana R. Withrow ◽  
Brittny C. Davis Lynn ◽  
Gretchen L. Gierach ◽  
Amy Berrington de González
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cumulative Incidence ◽  
Contralateral Breast Cancer ◽  
Breast Cancer Treatment ◽  
Contralateral Breast ◽  
Breast Cancer Patients ◽  
Younger Women ◽  
Er Positive

Abstract Background Estimates of contralateral breast cancer (CBC) risk in the modern treatment era by year of diagnosis and characteristics of the first breast cancer are needed to assess the impact of recent advances in breast cancer treatment and inform clinical decision making. Methods We examined CBC risk among 419,818 women (age 30–84 years) who were diagnosed with a first unilateral invasive breast cancer and survived ≥ 1 year in the US Surveillance, Epidemiology, and End Results program cancer registries from 1992 to 2015 (follow-up through 2016). CBC was defined as a second invasive breast cancer in the contralateral breast ≥ 12 months after the first breast cancer. We estimated standardized incidence ratios (SIRs) of CBC by year of diagnosis, age at diagnosis, and tumor characteristics for the first breast cancer. Cumulative incidence of CBC was calculated for women diagnosed with a first breast cancer in the recent treatment era (2004–2015, follow-up through 2016). Results Over a median follow-up of 8 years (range 1–25 years), 12,986 breast cancer patients developed CBC. Overall, breast cancer patients had approximately twice the risk of developing cancer in the contralateral breast when compared to that expected in the general population (SIR = 2.21, 95% CI = 2.17–2.25). SIRs for CBC declined by year of first diagnosis, irrespective of age at diagnosis and estrogen receptor (ER) status (p-trends < 0.001), but the strongest decline was after an ER-positive tumor. The 5-year cumulative incidence of CBC ranged from 1.01% (95% CI = 0.90–1.14%) in younger women (age < 50 years) with a first ER-positive tumor to 1.89% (95% CI = 1.61–2.21%) in younger women with a first ER-negative tumor. Conclusion Declines in CBC risk are consistent with continued advances in breast cancer treatment. The updated estimates of cumulative incidence inform breast cancer patients and clinicians on the risk of CBC and may help guide treatment decisions.

10-year follow-up of the efficacy of clodronate on bone mineral density (BMD) in early stage breast cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 676-676 ◽  
Author(s):  
T. Saarto ◽  
L. Vehmanen ◽  
C. Blomqvist ◽  
I. Elomaa
Keyword(s):  
Breast Cancer ◽  
Bone Loss ◽  
Postmenopausal Women ◽  
Cancer Patients ◽  
Early Stage ◽  
Statistical Significance ◽  
Lumbar Vertebrae ◽  
Breast Cancer Patients ◽  
Mineral Density

676 Background: We have previously reported that clodronate prevents bone loss in breast cancer patients (JCO 1997;15:1341, BJC 1997;75(4):602 and EJC 2001;37:2373). Here we report the 10-year follow-up data. Methods: 268 pre- (PRE) and postmenopausal (POST) node positive breast cancer patients were randomized to clodronate (CL), orally 1.6 g daily, or control groups for 3 years. PRE were treated with adjuvant chemotherapy and POST with antiestrogens (AE), tamoxifen 20 mg or toremifene 60 mg, for 3 years. The BMD of the lumbar vertebrae L1–4 (BMDLS) and femoral neck (BMDFN) was measured before the treatment and at 1, 2, 3, 5 and 10 years. 93 patients were eligible for 10-year analyses: 53 PRE and 40 POST. 132 patients had metastatic disease or died and 39 were either lost to follow-up or had to be excluded because having diseases or medications that influences bone metabolism. Results: PRE: BMDLS decreased -12.4% in the control and −8.7% in the CL group in 10 years: from 0 to 3 years −6.9 % vs. −4.2% and from 3 to 10 years −5.5% and −4.5%, respectively. BMDFN decreased −8.8% and −7.2%: from 0 to 3 years −2.9% vs. −2.6% and from 3 to 10 years −5.9% vs. −4.6%, respectively. POST: BMDLS decreased −3.0% in the AE and −1.7% in the AE+CL group in 10 years: from 0 to 3 years −1.5% vs. + 1.2% and from 3 to 10 years −1.5% vs. −2.9%, respectively. BMDFN decreased −7.7% and −6.0%: from 0 to 3 years −0.1% vs. +1.9% and from 3 to 10 years −7.6% vs. −7.9%, respectively. These differences do not reach statistical significance. At 10-years 18 patients had osteoporosis in LS and 15 in FN. Only 4 patients who had osteoporosis at 10 years had normal BMD before the therapy. Conclusions: As reported previously, clodronate prevents the bone loss during treatment in pre- and postmenopausal women. This beneficial effect seems to be maintained at least for 7 years after treatment termination in premenopausal. In postmenopausal women the effect seems to diminish within time. Due to small numbers of patients these differences are no longer statistically significant. Patients at risk of developing osteoporosis are among those who has pretreatment osteopenia i.e. baseline BMD measurement has predictive value. No significant financial relationships to disclose.

scholarly journals Radiation Therapy Resources and Guideline-Concordant Radiotherapy for Early-Stage Breast Cancer Patients in an Underserved Region

2013 ◽  
Vol 48 (4) ◽  
pp. 1433-1449 ◽  
Author(s):  
Nengliang Yao ◽  
Stephen A. Matthews ◽  
Marianne M. Hillemeier ◽  
Roger T. Anderson
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients

Cardiac effects of adjuvant doxorubicin and radiation therapy in breast cancer patients.

1998 ◽  
Vol 16 (11) ◽  
pp. 3493-3501 ◽  
Author(s):  
C L Shapiro ◽  
P H Hardenbergh ◽  
R Gelman ◽  
D Blanks ◽  
P Hauptman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Cardiac Events ◽  
Female Population ◽  
Cardiac Effects ◽  
Dose Volume ◽  
Increased Risk

PURPOSE To assess the cardiac effects of two different cumulative doses of adjuvant doxorubicin and radiation therapy (RT) in breast cancer patients. PATIENTS AND METHODS Two hundred ninety-nine breast cancer patients were prospectively randomized to receive either five cycles (CA5) or 10 cycles (CA10) of adjuvant treatment with cyclophosphamide (500 mg/ m2) and doxorubicin (45 mg/m2) administered by intravenous bolus every 21 days. One hundred twenty-two of these patients also received RT. Estimates of the cardiac RT dose-volume were retrospectively categorized as low, moderate, or high. The risk of major cardiac events (congestive heart failure, acute myocardial infarction) was assessable in 276 patients (92%), with a median follow-up time of 6.0 years (range, 0.5 to 19.4). RESULTS The estimated risk (95% confidence interval) of cardiac events per 100 patient-years was significantly higher for CA10 than for CA5 [1.7 (1.0 to 2.8) v 0.5 (0.1 to 1.2); P=.02]. The risk of cardiac events in CA5 patients, irrespective of the cardiac RT dose-volume, did not differ significantly from rates of cardiac events predicted for the general female population by the Framingham Heart Study. In CA10 patients, the incidence of cardiac events was significantly increased (relative risk ratio, 3.6; P < .00003) compared with the Framingham population, particularly in groups that also received moderate and high dose-volume cardiac RT. CONCLUSION Conventional-dose adjuvant doxorubicin as delivered in the CA5 regimen by itself, or in combination with locoregional RT, was not associated with a significant increase in the risk of cardiac events. Higher doses of adjuvant doxorubicin (CA10) were associated with a threefold to fourfold increased risk of cardiac events. This appears to be especially true in patients treated with higher dose-volumes of cardiac RT. Larger studies with longer follow-up periods are needed to confirm these results.

Method of detection of local recurrence in patients following breast conserving surgery and its utility for surveillance

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 611-611
Author(s):  
B. Taback ◽  
N. Hansen ◽  
K. Conway ◽  
A. Giuliano
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Cancer Patients ◽  
Ductal Carcinoma ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Conclusive Evidence ◽  
Breast Cancer Patients ◽  
Asymptomatic Patients

611 Background: It is estimated that approximately 10% of all breast cancer patients will develop local recurrence (LR) at 10 years. Routine surveillance for detection of early breast cancer recurrence is widely performed despite lack of conclusive evidence for an improvement in patient quality of life or potential for cure. A number of historical studies evaluating the effectiveness of routine screening for LR following treatment for early-stage breast cancer have suggested that the diagnosis of LR is more frequent during a routine visit and occurring in asymptomatic patients. However, differentiating the method of detection is not often elucidated. In this study we evaluated the manner in which patients presented with an isolated LR in clinical practice. Methods: Our routine patient follow-up consists of physical exam and mammogram every 6 mos for the first 2 years following breast conserving surgery (BCS) and yearly thereafter. We queried our prospectively collected breast cancer database (1632 patients from July 1986 - July 2004) for patients with an isolated LR following BCS (n=59 (3.6%); two patients had bilateral LRs). Medical records were not available for three patients. Results: At a median follow-up of 45 mos (range: 5–122 mos) there were 58 evaluable LRs: 15 DCIS, 31 infiltrating ductal carcinoma (IDC), 6 infiltrating lobular (ILC), 2 mixed IDC/ILC, 3 invasive cancers NOS and 1 unknown. Patient presentation was as follows: 25 were diagnosed by self-exam, 28 on screening mammogram, 2 were diagnosed by physician (includes one referral), and 3 unknown. Mammogram detected recurrences were more frequent among patients with DCIS whereas self-detected recurrences were more common in patients with IDC (79% vs 33% and 21% vs 67%, respectively; P<0.2). Mean tumor size was larger in self-presentation (2.1 cm; range: 0.8–4.5 cm) than in mammogram detected group (1.6 cm; range 0.4–6 cm). Conclusions: These findings demonstrate the value of mammography as compared to patient detected LRs. Whether a survival advantage exists remains uncertain. Nevertheless routine physician examination in this setting is highly insensitive and its further utility must be considered when devising cost-effective strategies for surveillance of breast cancer patients. No significant financial relationships to disclose.

Prevalence of early-stage prostate and estrogen receptor positive (ER+) breast cancer patients receiving primary androgen deprivation therapy (ADT) and aromatase inhibitors (AIs) in the United States (U.S.)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22126-e22126
Author(s):  
A. Barlev ◽  
M. Yong ◽  
G. Cherkowski ◽  
K. Cetin ◽  
J. Fryzek
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Clinical Practice ◽  
Hormone Therapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Breast Cancer Patients ◽  
Claims Database ◽  
Breast And Prostate Cancer ◽  
The U.S

e22126 Background: AIs and ADT are used to prevent recurrence of breast and prostate cancers but have been shown to accelerate bone loss. We estimated the prevalence of early-stage ER+ breast and prostate cancer patients on hormone therapy in the U.S., as this is not well-described in the literature. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) Program, published literature, clinical practice, and a large claims database were used. We began with the American Cancer Society's estimated number of new breast and prostate cancer cases for the year 2008. We then assessed the number of patients with localized/regional disease and ER+ tumors and those receiving primary ADT (both chemical and surgical) or AI therapy by applying proportions from SEER, published literature, clinical practice, and the claims database. Using these incident case counts, we calculated the 5-year prevalence using appropriate cohort-specific survival rates to sum the number of new and surviving cases over a 5-year period. Results: The estimated 5-year prevalence of early-stage ER+ breast cancer for women aged ≥50 years in the U.S. was 607,411, of which 293,904 (48.4%) were on AI therapy based on the claims database. However, because this data source was limited to women aged <65 years, we also used estimates from clinical practice to capture AI use for women of all ages. Based on clinical practice, 402,637 (66.3%) to 460,156 (75.8%) of early-stage ER+ breast cancer patients were on AI therapy. For early-stage prostate cancer, the estimated 5-year prevalence for all ages was 1,024,238, of which 141,451 (13.8%) were on primary ADT. However, these figures may underestimate current usage of hormone therapies, as our data and the literature show increasing trends in ADT and AI use for early-stage disease. Conclusions: Based on a combination of population-based data and the published literature, approximately half of all early-stage ER+ breast cancer patients and a modest proportion of early-stage prostate cancer patients are on hormone therapy in the U.S. [Table: see text]

Recurrence patterns among T1-2N0 triple-negative breast cancer patients following mastectomy.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 93-93
Author(s):  
Rebekah Young ◽  
Kimberly Gergelis ◽  
Shalom Kalnicki ◽  
Jana Lauren Fox
Keyword(s):  
Breast Cancer ◽  
Retrospective Study ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Breast Cancer Patients ◽  
Single Institution ◽  
Early Stage Disease ◽  
Increased Risk

93 Background: Women with early-stage TN breast cancers are at increased risk for recurrence (RR) compared to other molecular subtypes, and are often treated with mastectomy without local adjuvant therapy. We wish to evaluate the RR for these women. Methods: In this single institution retrospective study, women with T1-2N0 TN breast cancer who underwent mastectomy between 2008-12 were identified from tumor registry. Adjuvant chemotherapy was allowed, but adjuvant radiotherapy (RT) was excluded. Of 3,000 cases reviewed, 52 women were identified. Median age was 58.5 (30–90). Lesions were high-grade (83%), and T1-2 (47%, 53%). 21 women (42%) had at least 1 risk factor. 5 women were BRCA+. Women underwent total mastectomy or modified radical mastectomy, and the majority (84%) had adjuvant chemotherapy. Results: At a median follow-up of 3.5 years (6-71 months), there were 8 recurrences (15.4%). 3 (5.8% of cohort) were locoregional (LR) only (2 chest wall (CW) and 1 ipsilateral axilla), 6 (11.5%) involved a concurrent LR and distant recurrence, and 2 (3.8%) were distant only. Median time to recurrence was 17.3 months. The isolated LR recurrences (LRR) were at 14, 15.6 and 15.1 months. Most women (41, 78.8%) were alive with NED. 3 were alive with disease, underdoing treatment, and 1 woman was disease free after treatment for CW recurrence. 8 patients (15.4%) are deceased, half from their cancer. On univariate analysis, there was no significant correlation (p>0.05) between age or high-risk features and RR (STATA v 11). Conclusions: T1-2N0 breast cancer patients are believed to have a low RR following mastectomy. TN disease, however, is more aggressive, and the question of irradiating early stage disease after mastectomy has arisen. A single institution, retrospective study found women with T1-2N0 TN disease fare better with BCT that includes RT, compared to mastectomy alone. Other studies have shown no statistical difference in RR between these 2 groups. We found an isolated LRR rate at 3.5 years of 5.8%. Follow-up and ultimately prospective data is needed to determine whether the isolated LRR warrants a change in treatment recommendations for this pt subset.

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