Impact of Routine Pathology Review on Treatment for Node-Negative Breast Cancer

2012 ◽  
Vol 30 (18) ◽  
pp. 2227-2231 ◽  
Author(s):  
Hagen F. Kennecke ◽  
Caroline H. Speers ◽  
Catherine A. Ennis ◽  
Karen Gelmon ◽  
Ivo A. Olivotto ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Tumor Biology ◽  
Node Negative ◽  
Node Negative Breast Cancer ◽  
Secondary Pathology ◽  
Cancer Agency ◽  
The Impact ◽  
Pathology Review

Purpose Routine secondary pathology review influences diagnosis and treatment among patients diagnosed with breast cancer. The impact of review on patients with node-negative breast cancer and the nature of the pathology elements leading to management changes are not well described. Methods Patients with node-negative, invasive, or in situ breast cancer and evaluable nodes referred to the British Columbia Cancer Agency during two time periods between 2004 and 2007 were included. Pathologists with expertise in breast cancer reviewed the original reports and slides. Biomarker testing was not routinely repeated. Medical record review was conducted to determine whether original pathology was changed and whether recommended therapy was affected. Results Among 906 eligible patients, 405 (45%) received a pathology review. Univariate comparisons revealed that reviewed patients were younger (P < .001) and more likely to have close margins (P < .001), whereas other characteristics were similar. A total of 102 pathology changes were documented among 81 patients (20%). The most frequently changed elements were grade (40%) and lymphovascular (26%), nodal (15%), and margin (12%) status. These changes resulted in 27 treatment modifications among 25 patients (6%). Treatment changes were primarily related to nodal and margin status, and only two of 27 were related to measurement of tumor biology in women with estrogen receptor–positive, node-negative breast cancer. Conclusion Reported rates of change are significant and warrant routine secondary pathology review among patients with node-negative breast cancer or ductal carcinoma in situ before final treatment is recommended. Review remains relevant in the era of gene expression signatures to determine margin and nodal status.

Hypofractionated Versus Standard Fractionated Radiotherapy in Patients With Early Breast Cancer or Ductal Carcinoma In Situ in a Randomized Phase III Trial: The DBCG HYPO Trial

2020 ◽  
Vol 38 (31) ◽  
pp. 3615-3625 ◽  
Author(s):  
Birgitte V. Offersen ◽  
Jan Alsner ◽  
Hanne M. Nielsen ◽  
Erik H. Jakobsen ◽  
Mette H. Nielsen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Locoregional Recurrence ◽  
Ductal Carcinoma ◽  
Risk Difference ◽  
Node Negative ◽  
Node Negative Breast Cancer

PURPOSE Given the poor results using hypofractionated radiotherapy for early breast cancer, a dose of 50 Gy in 25 fractions (fr) has been the standard regimen used by the Danish Breast Cancer Group (DBCG) since 1982. Results from more recent trials have stimulated a renewed interest in hypofractionation, and the noninferiority DBCG HYPO trial (ClincalTrials.gov identifier: NCT00909818 ) was designed to determine whether a dose of 40 Gy in 15 fr does not increase the occurrence of breast induration at 3 years compared with a dose of 50 Gy in 25 fr. PATIENTS AND METHODS One thousand eight hundred eighty-two patients > 40 years of age who underwent breast-conserving surgery for node-negative breast cancer or ductal carcinoma in situ (DCIS) were randomly assigned to radiotherapy at a dose of either 50 Gy in 25 fr or 40 Gy in 15 fr. The primary end point was 3-year grade 2-3 breast induration assuming noninferiority regarding locoregional recurrence. RESULTS A total of 1,854 consenting patients (50 Gy, n = 937; 40 Gy, n = 917) were enrolled from 2009-2014 from eight centers. There were 1,608 patients with adenocarcinoma and 246 patients with DCIS. The 3-year rates of induration were 11.8% (95% CI, 9.7% to 14.1%) in the 50-Gy group and 9.0% (95% CI, 7.2% to 11.1%) in the 40-Gy group (risk difference, −2.7%; 95% CI, −5.6% to 0.2%; P = .07). Systemic therapies and radiotherapy boost did not increase the risk of induration. Telangiectasia, dyspigmentation, scar appearance, edema, and pain were detected at low rates, and cosmetic outcome and patient satisfaction with breast appearance were high with either no difference or better outcome in the 40-Gy cohort compared with the 50-Gy cohort. The 9-year risk of locoregional recurrence was 3.3% (95% CI, 2.0% to 5.0%) in the 50-Gy group and 3.0% (95% CI, 1.9% to 4.5%) in the 40-Gy group (risk difference, −0.3%; 95% CI, −2.3% to 1.7%). The 9-year overall survival was 93.4% (95% CI, 91.1% to 95.1%) in the 50-Gy group and 93.4% (95% CI, 91.0% to 95.2%) in the 40-Gy group. The occurrence of radiation-associated cardiac and lung disease was rare and not influenced by the fractionation regimen. CONCLUSION Moderately hypofractionated breast irradiation of node-negative breast cancer or DCIS did not result in more breast induration compared with standard fractionated therapy. Other normal tissue effects were minimal, with similar or less frequent rates in the 40-Gy group. The 9-year locoregional recurrence risk was low.

The impact of routine pathology review on treatment for node-negative breast cancer.

2010 ◽  
Vol 28 (15_suppl) ◽  
pp. 6046-6046
Author(s):  
H. F. Kennecke ◽  
C. Speers ◽  
K. A. Gelmon ◽  
I. Olivotto ◽  
M. Hayes
Keyword(s):  
Breast Cancer ◽  
Node Negative ◽  
Node Negative Breast Cancer ◽  
The Impact ◽  
Pathology Review

scholarly journals A population-based study of the impact of the St-Gallen treatment guidelines on survival of women with node-negative breast cancer

The Breast ◽  
2003 ◽  
Vol 12 ◽  
pp. S17-S18
Author(s):  
N. Hebert-Croteau ◽  
J. Brisson ◽  
J. Latreille ◽  
M. Rivard ◽  
G. Martin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Guidelines ◽  
Population Based ◽  
Population Based Study ◽  
Node Negative ◽  
Node Negative Breast Cancer ◽  
The Impact

scholarly journals Ductal Carcinoma In Situ of the Breast: Can Biomarkers Improve Current Management?

2014 ◽  
Vol 60 (1) ◽  
pp. 60-67 ◽  
Author(s):  
John Bartlett ◽  
Sharon Nofech-Moses ◽  
Eileen Rakovitch
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Invasive Breast Cancer ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Low Risk ◽  
Diagnostic Biomarkers ◽  
Repeated Calls ◽  
The Impact

Abstract BACKGROUND Screening for invasive cancer has led to a marked increase in the detection of ductal carcinoma in situ (DCIS). DCIS is, if appropriately managed, a low-risk disease which has a small chance of impacting on patient life expectancy. However, despite significant advances in prognostic marker development in invasive breast cancer, there are no validated diagnostic assays to inform treatment choice for women with DCIS. Therefore we are unable to target effective treatment strategies to women at high risk and avoid over-treatment of women at low risk of progression to invasive breast cancer. Paradoxically, one effect of this uncertainty is undertreatment of some women. CONTENT We review current practice and research in the field to identify key challenges in the management of DCIS. The impact of clinical research, particularly on the over and undertreatment of women with DCIS is assessed. We note slow progress toward development of diagnostic biomarkers and highlight key opportunities to accelerate advances in this area. SUMMARY DCIS is a low-risk disease, its incidence is increasing, and current treatment is effective. However, many women are either over- or undertreated. Despite repeated calls for development of diagnostic biomarkers, progress in this area has been slow, reflecting a relative lack of investment of research effort and funding. Given the low event rate in treated patients and the lateness of recurrences, many previous studies have only limited power to identify independent prognostic and predictive biomarkers. However, the potential for such biomarkers to personalize treatment for DCIS is extremely high.

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