Utility and factors associated with imaging early-stage breast cancer: Are we choosing wisely?

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 52-52
Author(s):  
Ana I. Velazquez Manana ◽  
Nina Nguyen ◽  
Carlos Rodriguez Bonilla ◽  
Theresa Shao
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Early Stage ◽  
Positive Lymph Node ◽  
Young Age ◽  
Stage I ◽  
Choosing Wisely ◽  
Factors Associated ◽  
Routine Imaging

52 Background: Breast cancer (BC) is the most common malignancy in women with estimated care costs of $20.50 billion/year by 2020. In 2012, ASCO released the Choosing Wisely Initiative which recommended against the use of routine imaging in patients with newly diagnosed early stage BC. We examined the adherence rate and factors associated with non-adherence in patients with early stage BC treated within a large health care system. Methods: We identified all women with stage I-II BC diagnosed between January 1, 2014 and December 31, 2015 from the Cancer Registry of Mount Sinai Health System. Demographic, clinical and treatment related factors were collected. Medical records were reviewed to identify patients who had routine staging scan. Data of initial and follow-up imaging over 1-year period were collected. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from logistic regression models. Results: Among 733 BC patients, the median age at diagnosis was 58 (range 26-98). One hundred thirty nine patients (19%) had routine imaging with a mean number of initial scans of 1.53 and 59 (42%) patients had at least 1 subsequent scan in the 1-year follow up (range 1-4 scans/year). PET/CT was the most frequent modality, followed by CT. Medical oncologist was the ordering provider in 52% of the cases and surgical oncologist in 44.6%. Routine scan identified no cases of metastatic disease. False-positive findings were identified in 43% and incidental findings in 8% of cases. Total cost of imaging in this group was $4480/patient. Young age ( < 50), TN disease, tumor size > 2cm and positive lymph node were associated with increased staging scan on univariate and multivariate analysis. Conclusions: Our study highlights the prevalence of unnecessary scan in up to 19% of patients with stage I-II BC. Routine imaging resulted in increased radiation exposure and additional cost of $4480/patient. The presence of T2 tumor, positive lymph node, TN disease and young age were associated with increased staging scan. Further educational efforts are needed to avoid unnecessary scans in patients with early stage BC. [Table: see text]

scholarly journals Factors Associated With Follow-Up Care Among Women With Early-Stage Breast Cancer

2019 ◽  
Vol 15 (1) ◽  
pp. e1-e9
Author(s):  
Farah F. Quyyumi ◽  
Jason D. Wright ◽  
Melissa K. Accordino ◽  
Donna Buono ◽  
Cynthia W. Law ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Stage I ◽  
Early Stage Breast Cancer ◽  
Radiation Oncologist ◽  
Medical Oncologist ◽  
Data Set ◽  
Factors Associated ◽  
Follow Up Care

PURPOSE: Follow-up guidelines vary widely among national organizations for patients with early-stage breast cancer treated with curative intent. We sought to evaluate the patterns and predictors of provider follow-up care within the first 5 years after diagnosis. METHODS: Using the SEER-Medicare linked data set, we evaluated patients who were diagnosed with stage I and II breast cancer who underwent breast-conserving surgery from 2002 to 2007 with follow-up until 2012. We defined discontinuation of follow-up as > 12 months from the previous physician visit without a visit claim from either a surgeon, medical oncologist, or radiation oncologist. We performed a multivariable logistic regression and Cox proportional hazards regression analysis to determine factors associated with the discontinuation of follow-up care. RESULTS: Of the 30,053 patients enrolled in our initial cohort, 25,781 (85.8%) saw a medical oncologist and 21,612 (71.9%) saw a radiation oncologist in the first year in addition to a surgeon. Over the 5 years, 6,302 patients (21.0%) discontinued follow-up visits. Discontinuation of physician visits increased with increasing age. Women with stage II cancer ( v stage I) were less likely to discontinue follow-up visits (odds ratio, 0.78; 95% CI, 0.73 to 0.83). Time to early discontinuation was greater for patients with hormone receptor–negative tumors (hazard ratio, 1.14; 95% CI, 1.05 to 1.24). Women who were diagnosed more recently were less likely to discontinue seeing any physician. CONCLUSION: Twenty-one percent of patients with early-stage breast cancer discontinued seeing any oncology provider over the 5 years after diagnosis. Coordination of follow-up care between oncology specialists may reduce discontinuation rates and increase clinical efficiency.

Oncologists’ perspectives on omission of sentinel lymph node biopsy in women >70 years with early-stage hormone receptor-positive breast cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 48-48
Author(s):  
Christina Ahn Minami ◽  
Ava F. Bryan ◽  
Anna C. Revette ◽  
Rachel A. Freedman ◽  
Tari A. King ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Choosing Wisely ◽  
Hormone Receptor Positive ◽  
Node Biopsy ◽  
Radiation Oncologists

48 Background: Trial data show that omission of surgical axillary staging does not affect overall survival in women >70 with cT1N0 hormone receptor-positive (HR+) breast cancer, and the Society of Surgical Oncology’s Choosing Wisely recommendations advise against routine use of sentinel lymph node biopsy (SLNB) in patients with early-stage HR+ cancers. Despite this, almost 80% of women eligible for omission still undergo SLNB. We sought to explore oncologists’ perspectives of omission of SLNB in this patient population. Methods: We conducted an exploratory qualitative study using semi-structured telephone interviews with surgical, medical, and radiation breast oncologists throughout North America from 3/2020 to 1/2021. Purposive snowball sampling ensured a range of practice types. Interviews were transcribed and a team trained in qualitative analysis undertook thematic analysis guided by grounded theory to identify emergent themes. Results: Participants included sixteen surgical, six medical, and seven radiation oncologists (55% female) (Table). Overall, while oncologists in all fields expressed acceptance regarding SLNB omission in certain women >70 with cT1N0 HR+ disease, many viewed it as a complex choice based on patient comorbidities, chronologic age, patient preferences, and disease factors. Although patients’ physiologic age and life expectancy were also important decisional factors, almost all participants assessed these subjectively despite knowing that validated tools existed. Most surgeons perceived the data backing the Choosing Wisely recommendation as weak, although knowledge of specific supporting studies was low. While all participants agreed that SLNB omission does not affect survival, several radiation oncologists expressed anxiety about resultant increased regional recurrence risk. In the absence of known nodal status, medical and radiation oncologists stated they were more likely to order additional imaging, rely on OncotypeDX scores to make systemic therapy decisions, add high tangents, and be reluctant to offer partial breast irradiation. Conclusions: While surgeons are aware of the Choosing Wisely recommendation, high SLNB rates in patients eligible for omission may be driven by perceptions of the quality of the supporting data and differing ideas regarding appropriate candidacy for omission. There are downstream effects of SLNB omission on medical and radiation oncology treatment decision making and surgeons should engage in multidisciplinary discussion prior to surgery.[Table: see text]

scholarly journals Sentinel Lymph Node Biopsy Pathology and 2-Year Postsurgical Recurrence of Breast Cancer in Kenyan Women

2018 ◽  
pp. 1-7
Author(s):  
Nathan R. Brand ◽  
Ronald Wasike ◽  
Khalid Makhdomi ◽  
Rajendra Chauhan ◽  
Zahir Moloo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Lymph Node Biopsy ◽  
Stage I ◽  
Stage Ii ◽  
Node Biopsy

Purpose The goal of this study was to describe the pathologic findings and early follow-up experience of patients who underwent a sentinel lymph node biopsy (SLNB) at Aga Khan University Hospital (AKUH) between 2008 and 2017. Patients and Methods We performed a retrospective analysis of women with breast cancer who underwent an SLNB at AKUH between 2008 and 2017. The SLNB was performed on patients with stage I and stage II breast cancer, and identification of the sentinel lymph node was made by radioactive tracer, blue dye, or both, per availability and surgeon preference. Demographic, surgical, and pathologic data, including immunohistochemistry of the surgical sample for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2, were abstracted from the patient records. Follow-up data were available for a subset of patients. Results Between 2008 and 2017, six surgeons performed SLNBs on 138 women, 129 of whom had complete records and were included in the study. Thirty-one of 129 (24%) had a positive SLNB, including 10 of 73 (14%) with stage I and 21 of 56 (38%) with stage II disease. Seventy-eight patients (60%) received systemic adjuvant chemotherapy and 79 (62%) received radiation therapy, and of the 102 patients who were estrogen receptor positive, 86 (85%) received endocrine therapy. Seventy-nine patients were observed for > 2 years, and, of these, four (5.1%) had a regional recurrence. Conclusion The SLNB positivity rates were similar to those of high-income country (HIC) cohorts. However, preliminary data suggest that recurrence rates are elevated at AKUH as compared with those of HIC cohorts, perhaps because of a lower use of radiotherapy and chemotherapy at AKUH compared with HIC cohorts or because of differences in the characteristics of the primary tumor in patients at AKUH as compared with those in HICs.

Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer: Update of the ASCO Endorsement of the Cancer Care Ontario Guideline

2019 ◽  
Vol 37 (22) ◽  
pp. 1965-1977 ◽  
Author(s):  
N. Lynn Henry ◽  
Mark R. Somerfield ◽  
Vandana G. Abramson ◽  
Nofisat Ismaila ◽  
Kimberly H. Allison ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Lymph Node ◽  
Systemic Therapy ◽  
Early Stage ◽  
Positive Lymph Node ◽  
Adjuvant Systemic Therapy ◽  
Node Negative ◽  
Therapy Decision ◽  
Chemoendocrine Therapy

PURPOSE To update the American Society of Clinical Oncology endorsement of the Cancer Care Ontario recommendations on the Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer. METHODS Two phase III trials—the Trial Assigning Individualized Options for Treatment (TAILORx) in women with hormone receptor–positive, node-negative tumors and the Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy (MINDACT) trial—provided the evidence for this update. UPDATED RECOMMENDATIONS Shared decision making between clinicians and patients is appropriate for adjuvant systemic therapy for breast cancer. For patients older than age 50 years and whose tumors have Onco type DX recurrence scores less than 26, and for patients age 50 years or younger whose tumors have Onco type DX recurrence scores less than 16, there is little to no benefit from chemotherapy. Clinicians may offer endocrine therapy alone for these patients. For patients age 50 years or younger with recurrence scores of 16 to 25, clinicians may offer chemoendocrine therapy. Patients with recurrence scores greater than 30 should be considered candidates for chemoendocrine therapy. Based on informal consensus, the Panel recommends that oncologists may offer chemoendocrine therapy to patients with Onco type DX scores of 26 to 30. The MammaPrint assay could be used to guide decisions on withholding adjuvant systemic chemotherapy in patients with hormone receptor–positive lymph node–negative breast cancer and in select patients with lymph node–positive cancers. In both patients with node-positive and node-negative disease, evidence of clinical utility of the MammaPrint assay was only apparent in those determined to be at high clinical risk; the Panel thus did not recommend use of MammaPrint assay in patients determined to be at low clinical risk. Remaining recommendations from the 2016 ASCO guideline endorsement are unchanged. Additional information is available at www.asco.org/breast-cancer-guidelines .

Recurrence Score across the age spectrum: Is there an age discrimination?

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 27-27
Author(s):  
Franz Omar Smith ◽  
Marie Catherine Lee ◽  
Geza Acs ◽  
William J. Fulp ◽  
Ji-Hyun Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Lymph Node ◽  
Treatment Planning ◽  
Tumor Size ◽  
Predictive Power ◽  
Early Stage ◽  
Recurrence Score ◽  
Positive Lymph Node ◽  
Node Negative

27 Background: Treatment planning for early-stage estrogen receptor (ER) positive, lymph node negative breast cancer was based on prognostic factors with limited predictive power such as age. The Recurrence Score (RS) from the Oncotype DX assay (ODX) provides predictive power transcending age but is rarely applied to the elderly or young patients (pts). We examined our experience with RS along the age continuum. Methods: Retrospective review was conducted of prospectively gathered breast cancer pts having a RS obtained as part of their cancer care. Eligibility for performance of the ODX was based on NCCN guidelines or physician discretion. Comparisons on RS were made by age groups (young: <45yrs; middle: >45yrs -<70yrs: elderly: >70yrs) using general linear regression model and the exact Wilcoxon Rank Sum Test. Results: 677pts had 681 tumors with RS available (89 young, 476 middle and 112 elderly pts). Median RS for the study pts was 17 (range 0-85) and 16, 17, and 15 for the young, middle, and elderly respectively. Median age was 58yrs (range: 27-95); young, middle, and elderly was 42, 58, and 74yrs respectively. Age as a continuous or categorical variable was not predictive of RS (p value = 0.38, 0.58 respectively). No significant differences were seen between age cohorts for histology, mitotic rate, lymphovascular invasion (LVI), grade, nodal status, stage, or strength of ER positivity. Mastectomy rates were higher in the young (57.5%), compared to the middle (42.5%) and elderly (39.6%) (p=0.02). Median invasive tumor size was 1.6, 1.5, and 1.5cm for young, middle, and elderly. Larger tumor size, as a continuous variable, equaled higher RS (p=0.046). Other significant factors predicting higher RS were increased mitosis (p<0.001), LVI (p=0.013), high grade (p<0.001), and weak (<10%) ER positivity (p<0.001). Nodal status, stage, and histology did not affect RS. Conclusions: Age has limited predictive power for treatment planning for breast cancer. Age alone should not preclude recommendations for performance of ODX in estrogen receptor positive lymph node negative early stage breast cancer as the RS distribution across the spectrum of age is well matched.

Sentinel Lymph Node Biopsy Versus Axillary Dissection in Node-Negative Early-Stage Breast Cancer: 15-Year Follow-Up Update of a Randomized Clinical Trial

2016 ◽  
Vol 23 (8) ◽  
pp. 2494-2500 ◽  
Author(s):  
Giuseppe Canavese ◽  
Paolo Bruzzi ◽  
Alessandra Catturich ◽  
Daniela Tomei ◽  
Franca Carli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Axillary Dissection ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Node Negative ◽  
Node Biopsy

Factors associated with follow-up physician visits among women with early stage breast cancer.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 6531-6531
Author(s):  
Farah Quyyumi ◽  
Melissa Kate Accordino ◽  
Donna Buono ◽  
Alfred Neugut ◽  
Grace Hillyer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Physician Visits ◽  
Factors Associated

Use of a novel convolutional neural network-based mammographic evaluation to assess response to adjuvant endocrine therapy in women with early-stage breast cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 530-530
Author(s):  
Julia Elizabeth McGuinness ◽  
Vicky Ro ◽  
Simukayi Mutasa ◽  
Richard Ha ◽  
Katherine D. Crew
Keyword(s):  
Breast Cancer ◽  
Neural Network ◽  
Prognostic Factors ◽  
Convolutional Neural Network ◽  
Endocrine Therapy ◽  
Risk Score ◽  
Early Stage ◽  
Stage I ◽  
Risk Scores

530 Background: The standard of care for early-stage hormone receptor (HR)-positive breast cancer (BC) is 5-10 years of adjuvant endocrine therapy (ET), which leads to a 50-60% relative risk reduction in BC recurrence. However, 10-40% of patients may relapse up to 20 years (y) after diagnosis, and there is a need for biomarkers of response to ET. We developed a novel, fully-automated convolutional neural network (CNN)-based mammographic evaluation that accurately predicts BC risk, which is being evaluated as a pharmacodynamic response biomarker to adjuvant ET. Methods: We conducted a retrospective cohort study among women with HR-positive stage I-III unilateral BC diagnosed at Columbia University Irving Medical Center from 2007-2017, who received adjuvant ET and had at least 2 mammograms of the contralateral breast (baseline and annual follow-up). Demographics, clinical characteristics, BC treatments, and relapse status were extracted from the electronic health record and New York-Presbyterian Hospital Tumor Registry. We performed CNN analysis of mammograms at baseline (start of ET) and annual follow-up. Our primary endpoint was change in CNN risk score, expressed as a continuous variable (range, 0-1). We used two-sample t-tests to assess for differences in mean CNN scores between patients who relapsed or remained in remission. We evaluated if CNN score at baseline and change from baseline were associated with relapse using logistic regression, with adjustment for known prognostic factors. Results: Among 870 evaluable women, mean age at diagnosis was 59.5y (standard deviation [SD], 12.4); 60.3% had stage I tumors, 72.6% underwent lumpectomy, and 45.8% received chemotherapy. With a median follow-up of 4.9y, there were 68 (7.9%) breast cancer relapses (36 distant, 26 local, 6 new primary). Median number of evaluable mammograms per patient was 5 (range, 2-13). Mean baseline CNN risk scores were significantly higher among women who relapsed compared to those in remission (0.258 vs 0.237, p = 0.022), which remained significant after adjustment for known prognostic factors. There was a significant difference in mean absolute change in CNN risk score from baseline to 1y follow-up between those who relapsed vs. remained in remission (0.001 vs. -0.022, p = 0.027), but this was no longer significant in multivariable analysis. Conclusions: We demonstrated that higher baseline CNN risk score was an independent predictor of BC relapse. A greater decrease in mean CNN risk scores at 1-year follow-up after initiating adjuvant ET was seen among BC patients who remained in remission compared to those who relapsed. Therefore, baseline CNN risk scores may identify patients at high-risk for breast cancer recurrence to target for more intensive adjuvant treatment. Early changes in CNN risk scores may be used to predict response to long-term ET in the adjuvant setting.

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