Referral, Receipt, and Completion of Chemotherapy in Patients With Early-Stage Breast Cancer Older Than 65 Years and at High Risk of Breast Cancer Recurrence

Purpose Some women with early-stage breast cancer are at higher risk of recurrence and can benefit from chemotherapy. We describe patterns of referral, receipt, and completion of chemotherapy among older women at high risk of recurrence. Patients and Methods A total of 2,124 women age 65 years or older who were diagnosed with early-stage breast cancer between 1990 and 1994 and 1996 to 1999 were included; 1,090 of these were at high risk of recurrence. We reviewed medical records to categorize chemotherapy outcomes as follows: did not discuss or were not referred to a medical oncologist (n = 133); discussed and/or referred to a medical oncologist but received no chemotherapy (n = 742); received an incomplete chemotherapy course (n = 29), or received a completed chemotherapy course (n = 186). Results Overall, 19.7% of high-risk women received any chemotherapy, and 86.5% of these women completed their chemotherapy courses. Just greater than 10% of high-risk women did not have a discussion about chemotherapy as part of breast cancer treatment documented in the medical record; these women also received fewer diagnostic assessments of their initial tumors. Conclusion Individuals who receive chemotherapy for early-stage breast cancer are a select subgroup of patients at high risk of recurrence. This study identifies characteristics of women who were referred for and who received chemotherapy, and this study plays an important role in understanding generalizability of studies that examine chemotherapy treatment effectiveness. Outcomes after breast cancer could continue to be improved with increased receipt of chemotherapy among older women at high risk of breast cancer recurrence.

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Does Size Matter: Examining the Association of BMI with Breast Cancer Recurrence and Survival in an Early Stage Breast Cancer Cohort with a High Median BMI

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2014.05.176 ◽

2014 ◽

Vol 90 (1) ◽

pp. S47-S48 ◽

Cited By ~ 1

Author(s):

C. Bergom ◽

T. Kelly ◽

M. Bedi ◽

H. Saeed ◽

P. Prior ◽

...

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Cancer Recurrence ◽

Early Stage Breast Cancer ◽

Breast Cancer Recurrence ◽

Breast Cancer Cohort ◽

Size Matter ◽

High Median

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Post-diagnosis weight gain and breast cancer recurrence in women with early stage breast cancer

Breast Cancer Research and Treatment ◽

10.1007/s10549-006-9179-y ◽

2006 ◽

Vol 99 (1) ◽

pp. 47-57 ◽

Cited By ~ 97

Author(s):

Bette J. Caan ◽

Jennifer A. Emond ◽

Loki Natarajan ◽

Adrienne Castillo ◽

Erica P. Gunderson ◽

...

Keyword(s):

Breast Cancer ◽

Weight Gain ◽

Early Stage ◽

Cancer Recurrence ◽

Early Stage Breast Cancer ◽

Breast Cancer Recurrence

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Prediction of early and late distant recurrence in early-stage breast cancer with Breast Cancer Index.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.594 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 594-594

Author(s):

Yi Zhang ◽

Catherine A. Schnabel ◽

Brock Schroeder ◽

Piiha-Lotta Jerevall ◽

Rachel Catherine Jankowitz ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Cancer Patients ◽

Distant Metastasis ◽

Early Stage ◽

Distant Recurrence ◽

Early Stage Breast Cancer ◽

Breast Cancer Patients ◽

Risk Of Recurrence ◽

Breast Cancer Index

594 Background: Breast Cancer Index (BCI) is a continuous risk index based on the combination of HOXB13:IL17BR (H:I) and the Molecular Grade Index (MGI) that estimates the individual risk of recurrence in ER+, LN- breast cancer patients. In the current study, a modified BCI model was developed using untreated breast cancer patients in order to evaluate its pure prognostic value, and to better optimize BCI for both early and late risk assessment. Methods: A model was built by linearly combining H:I and MGI weighted by their corresponding Cox regression coefficients using ER+ LN- patients from the untreated arm of the prospective Stockholm trial (N=283). Validation was performed in 2 independent ER+, LN- cohorts: the TAM arm of the Stockholm trial (N=317), and a multisite cohort of TAM-treated patients (N=358). Correlation of BCI with distant metastasis was evaluated by Kaplan-Meier analysis using the log rank test, and multivariate analysis adjusting for standard prognostic factors was performed using Cox proportional hazards. Results: The BCI linear model was significantly associated with risk of cumulative (0-10y), early (<5y) and late (≥5y) distant metastasis. Based on pre-specified cutpoints, BCI classified 64% and 55% patients as low-, 21% and 22% as intermediate-, and 16% and 23% as high-risk, with 10-y rates of distant recurrence (95% CI) of 4.8% (1.7-7.8%) and 6.6% (2.9–10.0%), 11.7% (3.1–19.5%) and 23.3% (12.3-33.0%), 21.1% (18.5–32.0%) and 35.8% (24.5–45.5%), in the Stockholm TAM and multisite cohort, respectively. Conclusions: BCI demonstrated significant prognostic performance beyond clinicopathological factors to predict cumulative, early and late risk of recurrence in early stage breast cancer patients. Use of BCI at diagnosis should enable clinicians to identify patients who are at high risk of late recurrence and may benefit from an additional 5y of hormonal therapy. [Table: see text]

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21-Gene Recurrence Assay Associated With Favorable Metabolic Profiles in HR-Positive, HER2-Negative Early-Stage Breast Cancer Patients

Frontiers in Endocrinology ◽

10.3389/fendo.2021.725161 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yifei Zhu ◽

Tiange Wang ◽

Yiwei Tong ◽

Xiaosong Chen ◽

Kunwei Shen

Keyword(s):

Breast Cancer ◽

Insulin Resistance ◽

Cancer Patients ◽

Early Stage ◽

Cancer Recurrence ◽

Early Stage Breast Cancer ◽

Breast Cancer Recurrence ◽

Metabolic Profiles ◽

Breast Cancer Patients ◽

C Peptide

BackgroundComprehensive investigations of the associations between 21-gene recurrence assay and metabolic profiles in Chinese breast cancer patients are limited.MethodsWe evaluated the relations of the 21-gene recurrence risk score (RS) and the expression of cancer-related genes with metabolic factors and biomarkers of insulin and the insulin-like growth factor (IGF) axis, and examined the interactions between the 21-gene RS and these metabolic profiles on breast cancer recurrence in Chinese women with HR-positive, HER2-negative early-stage breast cancer.ResultsThe 21-gene RS was inversely associated with body mass index ([BMI]β: −0.178 kg/m2; P=0.040), the homeostasis model assessment of insulin resistance index ([HOMA-IR] β: −0.031; P=0.042), insulin (β: −0.036 uIU/ml; P=0.009), and C-peptide (β: −0.021 ug/L; P=0.014) and was positively associated with high-density lipoprotein cholesterol (β: 0.025 mmol/L; P=0.004), which were driven by the relation patterns between specific cancer-related genes and these metabolic profiles. Each 10-unit increase in the 21-gene RS was associated with 28% (95% CI: 5–47%) higher risk of breast cancer recurrence; this association was also observed in patients with favorable metabolic profiles in relevant to an absence of obesity, insulin resistance, hyperglycemia, hypertension, or dyslipidemia (28–44% higher risk) and among women with a low level of insulin, C-peptide, or the IGF1/IGFBP3 ratio (41–155% higher risk).ConclusionsThe 21-gene RS was related to favorable metabolic profiles including lower BMI, HOMA-IR, insulin, and C-peptide, and higher HDL in Chinese breast cancer patients, and its prognostic impact on breast cancer recurrence was more likely to present among patients with relatively favorable metabolic profiles.

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Alcohol Consumption and Breast Cancer Recurrence and Survival among Women with Early-Stage Breast Cancer.

10.1158/0008-5472.sabcs-09-17 ◽

2009 ◽

Cited By ~ 2

Author(s):

M. Kwan ◽

L. Kushi ◽

E. Weltzien ◽

A. Castillo ◽

B. Caan

Keyword(s):

Breast Cancer ◽

Alcohol Consumption ◽

Early Stage ◽

Cancer Recurrence ◽

Early Stage Breast Cancer ◽

Breast Cancer Recurrence

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Dietary Patterns and Breast Cancer Recurrence and Survival Among Women With Early-Stage Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2008.19.4035 ◽

2009 ◽

Vol 27 (6) ◽

pp. 919-926 ◽

Cited By ~ 100

Author(s):

Marilyn L. Kwan ◽

Erin Weltzien ◽

Lawrence H. Kushi ◽

Adrienne Castillo ◽

Martha L. Slattery ◽

...

Keyword(s):

Breast Cancer ◽

Dietary Patterns ◽

Dietary Pattern ◽

Breast Cancer Survivors ◽

Proportional Hazards ◽

Early Stage ◽

Cancer Recurrence ◽

Cox Proportional Hazards ◽

Early Stage Breast Cancer ◽

Breast Cancer Recurrence

Purpose To determine the association of dietary patterns with cancer recurrence and mortality of early-stage breast cancer survivors. Patients and Methods Patients included 1,901 Life After Cancer Epidemiology Study participants diagnosed with early-stage breast cancer between 1997 and 2000 and recruited primarily from the Kaiser Permanente Northern California Cancer Registry. Diet was assessed at cohort entry using a food frequency questionnaire. Two dietary patterns were identified: prudent (high intakes of fruits, vegetables, whole grains, and poultry) and Western (high intakes of red and processed meats and refined grains). Two hundred sixty-eight breast cancer recurrences and 226 all-cause deaths (128 attributable to breast cancer) were ascertained. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs. Results Increasing adherence to a prudent dietary pattern was associated with a statistically significant decreasing risk of overall death (P trend = .02; HR for highest quartile = 0.57; 95% CI, 0.36 to 0.90) and death from non–breast cancer causes (P trend = .003; HR for highest quartile = 0.35; 95% CI, 0.17 to 0.73). In contrast, increasing consumption of a Western dietary pattern was related to an increasing risk of overall death (P trend = .05) and death from non–breast cancer causes (P = .02). Neither dietary pattern was associated with risk of breast cancer recurrence or death from breast cancer. These observations were generally not modified by physical activity, being overweight, or smoking. Conclusion Women diagnosed with early-stage breast cancer might improve overall prognosis and survival by adopting more healthful dietary patterns.

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Alcohol Consumption and Breast Cancer Recurrence and Survival Among Women With Early-Stage Breast Cancer: The Life After Cancer Epidemiology Study

Journal of Clinical Oncology ◽

10.1200/jco.2010.29.2730 ◽

2010 ◽

Vol 28 (29) ◽

pp. 4410-4416 ◽

Cited By ~ 123

Author(s):

Marilyn L. Kwan ◽

Lawrence H. Kushi ◽

Erin Weltzien ◽

Emily K. Tam ◽

Adrienne Castillo ◽

...

Keyword(s):

Breast Cancer ◽

Alcohol Consumption ◽

Early Stage ◽

Cancer Recurrence ◽

Breast Cancer Diagnosis ◽

Early Stage Breast Cancer ◽

Breast Cancer Recurrence ◽

Obese Women ◽

Breast Cancer Death ◽

Increased Risk

Purpose To examine the association of alcohol consumption after breast cancer diagnosis with recurrence and mortality among early-stage breast cancer survivors. Patients and Methods Patients included 1,897 LACE study participants diagnosed with early-stage breast cancer between 1997 and 2000 and recruited on average 2 years postdiagnosis, primarily from the Kaiser Permanente Northern California Cancer Registry. Alcohol consumption (ie, wine, beer, and liquor) was assessed at cohort entry using a food frequency questionnaire. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% CI with adjustment for known prognostic factors. Results Two hundred ninety-three breast cancer recurrences and 273 overall deaths were ascertained after an average follow-up of 7.4 years. Nine hundred fifty-eight women (51%) were considered drinkers (> 0.5 g/d of alcohol), and the majority drank wine (89%). Drinking ≥ 6 g/d of alcohol compared with no drinking was associated with an increased risk of breast cancer recurrence (HR, 1.35; 95% CI, 1.00 to 1.83) and death due to breast cancer (HR, 1.51; 95% CI, 1.00 to 2.29). The increased risk of recurrence appeared to be greater among postmenopausal (HR, 1.51; 95% CI, 1.05 to 2.19) and overweight and obese women (HR, 1.60; 95% CI, 1.08 to 2.38). Alcohol intake was not associated with all-cause death and possibly associated with decreased risk of non–breast cancer death. Conclusion Consuming three to four alcoholic drinks or more per week after a breast cancer diagnosis may increase risk of breast cancer recurrence, particularly among postmenopausal and overweight/obese women, yet the cardioprotective effects of alcohol on non–breast cancer death were suggested.

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