Effect of Obesity on Prognosis After Early-Stage Breast Cancer

2011 ◽  
Vol 29 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Marianne Ewertz ◽  
Maj-Britt Jensen ◽  
Katrín Á. Gunnarsdóttir ◽  
Inger Højris ◽  
Erik H. Jakobsen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Adjuvant Treatment ◽  
Proportional Hazards ◽  
Early Stage ◽  
Cancer Recurrence ◽  
Distant Metastases ◽  
Cox Proportional Hazards ◽  
Early Stage Breast Cancer ◽  
The Impact

Purpose This study was performed to characterize the impact of obesity on the risk of breast cancer recurrence and death as a result of breast cancer or other causes in relation to adjuvant treatment. Patients and Methods Information on body mass index (BMI) at diagnosis was available for 18,967 (35%) of 53,816 women treated for early-stage breast cancer in Denmark between 1977 and 2006 with complete follow-up for first events (locoregional recurrences and distant metastases) up to 10 years and for death up to 30 years. Information was available on prognostic factors and adjuvant treatment for all patients. Univariate analyses were used to compare the associations of known prognostic factors and risks of recurrence or death according to BMI categories. Cox proportional hazards regression models were used to assess the influence of BMI after adjusting for other factors. Results Patients with a BMI of 30 kg/m2 or more were older and had more advanced disease at diagnosis compared with patients with a BMI below 25 kg/m2 (P < .001). When data were adjusted for disease characteristics, the risk of developing distant metastases after 10 years was significantly increased by 46%, and the risk of dying as a result of breast cancer after 30 years was significantly increased by 38% for patients with a BMI of 30 kg/m2 or more. BMI had no influence on the risk of locoregional recurrences. Both chemotherapy and endocrine therapy seemed to be less effective after 10 or more years for patients with BMIs greater than 30 kg/m2. Conclusion Obesity is an independent prognostic factor for developing distant metastases and for death as a result of breast cancer; the effects of adjuvant therapy seem to be lost more rapidly in patients with breast cancer and obesity.

Effect of Pregnancy on Overall Survival After the Diagnosis of Early-Stage Breast Cancer

2001 ◽  
Vol 19 (6) ◽  
pp. 1671-1675 ◽  
Author(s):  
Shari Gelber ◽  
Alan S. Coates ◽  
Aron Goldhirsch ◽  
Monica Castiglione-Gertsch ◽  
Gianluigi Marini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Proportional Hazards ◽  
Comparison Group ◽  
Early Stage ◽  
Pregnant Patient ◽  
Subsequent Pregnancy ◽  
Cox Proportional Hazards ◽  
Early Stage Breast Cancer ◽  
Study Group ◽  
The Impact

PURPOSE: To evaluate the impact of subsequent pregnancy on the prognosis of patients with early breast cancer. PATIENTS AND METHODS: One hundred eight patients who became pregnant after diagnosis of early-stage breast cancer were identified in institutions participating in International Breast Cancer Study Group (IBCSG) studies. Fourteen had relapse of breast cancer before their first subsequent pregnancy. The remaining 94 patients (including eight who relapsed during pregnancy) formed the study group reported here. A comparison group of 188 was obtained by randomly selecting two patients, matched for nodal status, tumor size, age, and year of diagnosis from the IBCSG database, who were free of relapse for at least as long as the time between breast cancer diagnosis and completion of pregnancy for each pregnant patient. Survival comparison used Cox proportional hazards regression models. RESULTS: Overall 5- and 10-year survival percentages (± SE) measured from the diagnosis of early-stage breast cancer among the 94 study group patients were 92% ± 3% and 86% ± 4%, respectively. For the matched comparison group survival was 85% ± 3% at 5 years and 74% ± 4% at 10 years (risk ratio, 0.44; 95% confidence interval, 0.21 to 0.96; P = .04). CONCLUSION: Subsequent pregnancy does not adversely affect the prognosis of early-stage breast cancer. The superior survival seen in this and other controlled series may merely reflect a healthy patient selection bias, but is also consistent with an antitumor effect of the pregnancy.

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

2009 ◽  
Vol 27 (6) ◽  
pp. 919-926 ◽  
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.

Association between immunity and prognostic factors in early stage breast cancer patients before adjuvant treatment

2000 ◽  
Vol 59 (3) ◽  
pp. 279-287 ◽  
Author(s):  
Marzio E.E. Sabbioni ◽  
Hans Peter Siegrist ◽  
Marisa Bacchi ◽  
Jürg Bernhard ◽  
Monica Castiglione ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients

Neutropenic complications with neo/adjuvant adriamycin and cyclophosphamide in early stage breast cancer patients: A prospective study at the McGill University health center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12127-e12127
Author(s):  
Ramy Saleh ◽  
Arielle Elkrief ◽  
Elmira Afshar ◽  
Laurent Azoulay ◽  
Sarkis H. Meterissian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prospective Study ◽  
Health Center ◽  
Proportional Hazards ◽  
Early Stage ◽  
Cox Proportional Hazards ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Glucose Levels ◽  
Mcgill University

e12127 Background: We prospectively investigated the incidence of neutropenic complications (NC) with neo/adjuvant AC (doxorubicin and cyclophosphamide) chemotherapy (CTX) among early-stage breast cancer (ESBC) patients. NC was defined as febrile neutropenia (FN), dose delay/reduction or need of granulocyte colony-stimulating factors (G-CSF) to proceed with CTX. Methods: This was a single-center, observational, prospective cohort study conducted at the McGill University Health Center. All ESBC patients who received AC regimen as neo/adjuvant CTX between February 2016 and February 2017 were included. Hazard ratios (HRs) with 95% confidence intervals (CIs) of predictors of NC were estimated using Cox-proportional hazards models. Results: A total of 118 patients, corresponding to 409 cycles of AC were analyzed. Most patients underwent Q3week cycles (83.1%). Median age was 52 years old (IQR 43-61). Prophylactic G-CSF was given to 20 dose-dense patients and 10 Q3weeks patients. In patients not receiving prophylactic G-CSF, 57 (65.5%) manifested at least one episode of NC (corresponding to an incidence rate of 26.4%/cycle of CTX [95% CI: 20.0%-34.2%]), of which 9 developed FN requiring hospital admission. In the final prediction model, body mass index < 25 kg/m2(HR: 2.36, 95% CI: 1.16-4.78) and increasing glucose levels (HR: 1.56, 95% CI: 1.14-2.14) were significantly associated with NC. Baseline absolute neutrophil count (ANC) was protective. Conclusions: The incidence of NC in our prospective study is significantly higher than previously reported in retrospective studies (26.4% vs. 12%). Normal BMI and high glucose were associated with the highest risk of NC. More importantly, 65% of ESBC on AC will require G-CSF during their treatment due to a NC episode. [Table: see text]

Prognostic value of histopathology, stromal tumor infiltrating lymphocytes (sTILs) and adjuvant chemotherapy (AdjCT) in early stage triple negative breast cancer (TNBC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 533-533
Author(s):  
Roberto Antonio Leon-Ferre ◽  
Mei-Yin Polley ◽  
Heshan Liu ◽  
Judith A. Gilbert ◽  
Victoria Cafourek ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Proportional Hazards ◽  
Multivariate Analyses ◽  
Early Stage ◽  
Tumor Infiltrating Lymphocytes ◽  
Invasive Disease ◽  
Cox Proportional Hazards ◽  
Prognostic Impact ◽  
N Stage ◽  
The Impact

533 Background: Current guidelines define TNBC as complete absence of estrogen (ER) and progesterone receptor (PR), without HER2 amplification. However, the prognostic impact of clinical and histopathological factors, sTILs, and AdjCT in TNBC meeting these strict criteria is unknown. Methods: From a cohort of 9985 women who underwent upfront surgery for M0 breast cancer (BC) at Mayo Clinic Rochester from 1985-2012, 1159 pts with ER negative or low (≤10%) BC were identified for central ER/PR/HER2 staining and HER2 FISH (IHC2+ only) to select those with TNBC by modern definitions. Cox proportional hazards models were used to assess the impact of clinicopathological variables on invasive disease-free (IDFS) and overall survival (OS). Results: Tumors from 605 pts (median age 56.3 yrs) met criteria for TNBC (ER < 1%, PR < 1% and HER2 0, 1 or 2+ and FISH negative). 51% were T1, 65% N0, 88% grade 3, and 75% had Ki67 > 15%. Histologically, 39% were anaplastic, 26% invasive ductal, 16% medullary, 8% metaplastic, 6% apocrine and 5% others. Median sTILs was 20% (0-90%). 55% pts received AdjCT [21% anthracycline (A), 19% A + taxane, and 15% other]. Median follow-up for IDFS and OS were 7.4 and 10.6 yrs, respectively. Multivariate analyses demonstrated that higher N stage (p < 0.01), lower sTILs (p = 0.01) and no AdjCT (p < 0.01) were independently associated with worse IDFS and OS. Histology (medullary subtype) was associated with better IDFS in univariate (HR 0.56, 95% CI, 0.35-0.89) but not in multivariate analyses, once sTILs were accounted for. Among systemically untreated pts (n = 182), higher N (p < 0.01) and lower sTILs (p = 0.04) were associated with worse IDFS. For systemically untreated T1N0 pts (n = 111), the 5-yr IDFS was 70% (95% CI, 61-81) [T1a: 83% (95% CI, 63-100), T1b: 68% (95% CI, 52-88) and T1c: 67% (95% CI, 55-83)], compared to 78% (95% CI, 68-84) for T1N0 pts treated with AdjCT. Conclusions: In TNBC pts, N stage, sTILs and receipt of AdjCT were independently prognostic for IDFS and OS. sTILs remained prognostic for IDFS in systemically untreated TNBC. In N0 TNBC, the risk of recurrence or death was substantial in the absence of chemotherapy, even for those with T1 tumors.

Driving quality improvement with public reporting: Use of imaging tests outside guidelines for early-stage breast cancer in Ontario.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 193-193 ◽  
Author(s):  
Colleen Bedford ◽  
Angel Arnaout ◽  
Rebecca Anas ◽  
Christina Catley ◽  
Mark Clemons ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Improvement ◽  
Cancer Patients ◽  
Early Stage ◽  
Distant Metastases ◽  
Public Reporting ◽  
Early Stage Breast Cancer ◽  
System Quality ◽  
Breast Cancer Patients ◽  
The Impact

193 Background: Most patients diagnosed with breast cancer will have early stage (stage I or II) disease, with low chance of distant metastases. Thus most guidelines, including Choosing Wisely, recommend against imaging tests for distant metastases in asymptomatic early stage breast cancer. Despite this, most (86%) of these patients in Ontario received these tests from which they are not likely to benefit and may result in investigations that can be invasive and delay treatment. Publicly reported indicators, such as those in Ontario’s Cancer System Quality Index (CSQI), can bring research findings to action by identifying areas for improvement and facilitating ongoing assessment. In practice, this can be challenging due to limitations in administrative data. Moreover, relatively few quality improvement indicators focus on efficiency, the dimension of quality looking at best use of resources to achieve desired outcomes. We sought to examine trends in the use of imaging tests in early stage breast cancer and to drive quality improvement efforts via public reporting. Methods: Data from the Ontario Cancer Registry, the Discharge Abstract Database and the Ontario Health Insurance database was used to identify how many Ontario breast cancer patients diagnosed with early stage breast cancer received staging tests from 2012–2014. Imaging tests included were ultrasound, CT scan, MRI, x-ray and bone scan. The results were subsequently shared with the Regional Cancer Centres and publically released in the CSQI. Results: From 2012 to 2014, 75.1, 72.7 and 71.3% respectively of early stage breast cancer patients received at least one imaging test for staging. This is much higher than the 5-10% of patients expected to need tests due to symptoms or comorbidities. While the regional variation ranged from 47-80%, the rates were high across the province with no clear pattern. Conclusions: Public reporting may be having some effect on overtesting, but rates remain high. Following outreach by the Cancer Quality Council of Ontario and Cancer Care Ontario, targeted regional interventions are being developed and implemented, the impact of which will be assessed and reported in future releases of the CSQI.

scholarly journals Psychosocial Factors and Survival of Young Women With Breast Cancer: A Population-Based Prospective Cohort Study

2008 ◽  
Vol 26 (28) ◽  
pp. 4666-4671 ◽  
Author(s):  
Kelly-Anne Phillips ◽  
Richard H. Osborne ◽  
Graham G. Giles ◽  
Gillian S. Dite ◽  
Carmel Apicella ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Psychosocial Factors ◽  
Proportional Hazards ◽  
Early Stage ◽  
Disease Free Survival ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Important Influence ◽  
Survival Models

Purpose Most women with early-stage breast cancer believe that psychosocial factors are an important influence over whether their cancer will recur. Studies of the issue have produced conflicting results. Patients and Methods A population-based sample of 708 Australian women diagnosed before age 60 years with nonmetastatic breast cancer was observed for a median of 8.2 years. Depression and anxiety, coping style, and social support were assessed at a median of 11 months after diagnosis. Hazard ratios for distant disease-free survival (DDFS) and overall survival (OS) associated with psychosocial factors were estimated separately using Cox proportional hazards survival models, with and without adjustment for known prognostic factors. Results Distant recurrence occurred in 209 (33%) of 638 assessable patients, and 170 (24%) of 708 patients died during the follow-up period. There were no statistically significant associations between any of the measured psychosocial factors and DDFS or OS from the adjusted analyses. From unadjusted analyses, associations between greater anxious preoccupation and poorer DDFS and OS were observed (P = .02). These associations were no longer evident after adjustment for established prognostic factors; greater anxious preoccupation was associated with younger age at diagnosis (P = .03), higher tumor grade (P = .02), and greater number of involved axillary nodes (P = .008). Conclusion The findings do not support the measured psychosocial factors being an important influence on breast cancer outcomes. Interventions for adverse psychosocial factors are warranted to improve quality of life but should not be expected to improve survival.

scholarly journals Loco-regional recurrence trend and prognosis in young women with breast cancer according to molecular subtypes: analysis of 1099 cases

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yang Li ◽  
Su Lu ◽  
Yuhan Zhang ◽  
Shuaibing Wang ◽  
Hong Liu
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Molecular Subtypes ◽  
Early Stage ◽  
Young Patients ◽  
Distant Metastases ◽  
Early Stage Breast Cancer ◽  
Regional Recurrence ◽  
Her2 Status ◽  
Over Time

Abstract Background The number of young patients diagnosed with breast cancer is on the rise. We studied the rate trend of local recurrence (LR) and regional recurrence (RR) in young breast cancer (YBC) patients and outcomes among these patients based on molecular subtypes. Methods A retrospective cohort study was conducted based on data from Tianjin Medical University Cancer Institute and Hospital for patients ≤ 35 years of age with pathologically confirmed primary invasive breast cancer surgically treated between 2006 and 2014. Patients were categorized according to molecular subtypes on the basis of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. The 5-year rates for LR, RR, and distant metastases (DM) were estimated by Kaplan-Meir statistics. Nelson-Aalen cumulative-hazard plots were used to describe local recurrence- and distant metastasis-free intervals. Results We identified 25,284 patients with a median follow-up of 82 months, of whom 1099 (4.3%) were YBC patients ≤ 35 years of age. The overall 5-year LR, RR, and DM rates in YBC patients were 6.7%, 5.1%, and 16.6%, respectively. The LR and RR rates demonstrated a decreasing trend over time (P = 0.028 and P = 0.015, respectively). We found that early-stage breast cancer and less lymph node metastases increased over time (P = 0.004 and P = 0.007, respectively). Patients with HR−/HER2+ status had a significantly higher LR (HR 20.4; 95% CI, 11.8–35.4) and DM (HR 37.2; 95% CI, 24.6–56.3) at 10 years. Breast-conserving surgery (BCS) or mastectomy did not influence rates of LR and RR. In the overall population, the 5-year survival of YBC patients exceeded 90%. Conclusions The rates of LR and RR with YBC patients demonstrated a downward trend and the proportion of early-stage breast cancer increased between 2006 and 2014. We report the highest LR rates in this young population were associated with HR−/HER2+ tumors.

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