Effect of Postoperative Radiotherapy In Women With Localized Pure Mucinous Breast Cancer After Lumpectomy: A Population-Based Study

Abstract PurposePure mucinous breast cancer (PMBC) is a rare subtype of invasive breast cancer with favorable prognosis, in which the effect of postoperative radiotherapy remains unclear. We aimed to investigate the prognostic value of postoperative radiotherapy in women with localized PMBC after lumpectomy.MethodsWe conducted a retrospective cohort study to compare the effectiveness of postoperative radiotherapy (RT) and omitting postoperative radiotherapy (non-RT) in patients with first primary T1-2N0M0 (T ≤ 3cm) PMBC who underwent lumpectomy between 1998 and 2015 using the Surveillance, Epidemiology, and End Results (SEER) database. Breast cancer-specific survival (BCSS) was compared between RT and non-RT groups using Kaplan–Meier method and Cox proportional hazards regression model. Propensity score matching (PSM) was carried out to balance cohort baselines. In addition, an exploratory analysis was performed to verify the effectiveness of RT in subgroup patients. Results Overall, 5352(68.2%) and 2494(31.8%) eligible patients with tumor size ≤ 3cm localized PMBC received lumpectomy with postoperative RT and lumpectomy without postoperative RT respectively. The median follow-up duration was 92 months. The 15-year BCSS was 94.39% (95% CI, 93.08% to 95.35%) in the RT group versus 91.38% (95% CI, 88.86% to 93.35%) in the non-RT group (P < 0.001). The adjusted hazard ratio for BCSS was 0.64 (95%CI, 0.49 to 0.84; P = 0.001) for RT group versus non-RT group. After PSM, similar results were yielded. Adjuvant RT reduced the 15-year risk of breast cancer death from 7.92% to 6.15% (P = 0.039). The adjusted hazard ratio for BCSS were 0.66 (95%CI, 0.47 to 0.92; P = 0.014) for RT group versus non-RT group. The benefit of RT was well consistent across all subgroups.ConclusionAmong women with T1-2N0M0 (tumor size ≤ 3cm) PMBC, the addition of RT after lumpectomy was significantly associated with a reduced incidence of breast cancer death compared with non-RT, and the magnitude of benefit may be modest. This suggests that postoperative RT is recommended in the treatment of localized PMBC.

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Breast Density Does Not Influence Breast Cancer Death Among Breast Cancer Patients

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djs392 ◽

2012 ◽

Vol 104 (16) ◽

pp. NP-NP

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Breast Density ◽

Cancer Death ◽

Breast Cancer Patients ◽

Breast Cancer Death

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Trends in breast cancer survival by race-ethnicity in Florida.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18556 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18556-e18556

Author(s):

Robert Brooks Hines ◽

Asal Johnson ◽

Eunkyung Lee ◽

Stephanie Erickson ◽

Saleh M.M. Rahman

Keyword(s):

Breast Cancer ◽

Ethnic Disparities ◽

Cancer Death ◽

Cancer Outcomes ◽

Subdistribution Hazard ◽

Breast Cancer Death ◽

Breast Cancer Outcomes ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

e18556 Background: Considerable efforts to improve disparities in breast cancer outcomes for underserved women have occurred over the past 3 decades. This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period to assess potential improvement in racial-ethnic disparities. Methods: This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990-2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no) as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic white (HW), and Hispanic black (HB). Cumulative incidence estimates of 5- and 10-year breast cancer death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution hazard ratios (sHR) for the relative rate of breast cancer death accounting for competing causes. Results: Compared to NHW women, minority women were more likely to be younger, be uninsured or have Medicaid as health insurance, live in high poverty neighborhoods, have more advanced disease at diagnosis, have high grade tumors, have hormone receptor negative tumors, and receive chemotherapy as treatment. Minority women were less likely to receive surgery. Over the course of the study, breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement in breast cancer survival for nearly all metrics compared to non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women having twice the rate of 5-year (sHR = 2.04: 95% CI; 1.91-2.19) and 10-year (sHR = 2.02: 95% CI; 1.89-2.16) breast cancer death. Conclusions: Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, additional targeted approaches are needed to reduce the poorer survival in black (especially NHB) women. Our next step is to conduct a mediation analysis of the most important factors driving racial/ethnic disparities in breast cancer outcomes for women in Florida.

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Identification of a subgroup of patients with breast cancer and histologically positive axillary nodes receiving adjuvant chemotherapy who may benefit from postoperative radiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.7.1107 ◽

1988 ◽

Vol 6 (7) ◽

pp. 1107-1117 ◽

Cited By ~ 164

Author(s):

B Fowble ◽

R Gray ◽

K Gilchrist ◽

R L Goodman ◽

S Taylor ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Tumor Size ◽

Primary Tumor ◽

Postoperative Radiotherapy ◽

Eastern Cooperative Oncology Group ◽

Distant Metastases ◽

Primary Tumor Size ◽

Axillary Nodes ◽

Postmastectomy Radiation

Risk factors for isolated local-regional (LR) recurrence following mastectomy for breast cancer were analyzed in a review of 627 women entered into Eastern Cooperative Oncology Group (ECOG) adjuvant chemotherapy trials between 1978 and 1982. Premenopausal patients were randomized to cyclophosphamide, methotrexate, and fluorouracil (5-FU) (CMF), cyclophosphamide, methotrexate, 5-FU, and prednisone (CMFP), or cyclophosphamide, methotrexate, 5-FU, prednisone, and tamoxifen (CMFPT). Postmenopausal patients were randomized to observation, CMFP, or CMFPT. Median follow-up time was 4.5 years. At 3 years, 225 patients relapsed and in 70 (31% of failures, 11% of all patients) the initial site was LR without distant metastases. In a multivariate analysis, the risk of an isolated LR recurrence significantly correlated with the number of positive axillary nodes, the primary tumor size, the presence of tumor necrosis, and the number of axillary nodes examined. Factors that significantly discriminated between an isolated LR recurrence and distant metastasis were the number of positive nodes and primary tumor size. Patients with four to seven positive nodes or tumor size greater than or equal to 5 cm had a chance of developing an isolated LR recurrence almost equal to the risk of distant metastases. These findings suggest a potential for improved survival in this subset of patients with the addition of postmastectomy radiation to chemotherapy, and continue to emphasize the presence of a group of patients at high risk for isolated LR recurrence despite adjuvant chemotherapy.

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Is Breast Cancer Ever Cured? Follow-Up Study of 5623 Breast Cancer Patients

Tumori Journal ◽

10.1177/030089169107700603 ◽

1991 ◽

Vol 77 (6) ◽

pp. 465-467 ◽

Cited By ~ 4

Author(s):

Stefano Ciatto ◽

Rita Bonardi

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Systemic Disease ◽

Cancer Death ◽

Breast Cancer Patients ◽

Death Rates ◽

Breast Cancer Death ◽

Long Term Follow Up

The authors evaluated 5623 cases of primary breast cancer followed for 1 to 21 years. Overall and breast cancer death rates were determined and compared to expected rates. Breast cancer patients showed overall and breast cancer death rates significantly higher than expected and which persisted at long-term follow-up. The observed/expected overall death ratios for follow-up periods of 0–5, 6–10, 11–15 or 16–20 years were 3.61, 2.55, 1.60 and 2.11, respectively. Death rates from breast cancer at 5, 10, 15 and 20 years were 20%, 32%, 40% and 48% respectively. The evidence of a persistent excess mortality even after long-term follow-up suggests the hypothesis that breast cancer is a systemic disease when clinically diagnosed. This study provided no evidence of a « clinical » cure for breast cancer patients. Even for N- patients the 5, 10, 15 and 20 year death rates from breast cancer were 12%, 20%, 28% and 38%, respectively. N- breast cancer, which is currently considered as a localized disease cured by surgery in most cases, would be better regarded to as a slow-growing metastatic disease, although « personal » cure may be achieved in many subjects dying of causes other than breast cancer.

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Behavior of breast cancer in young women: A Surveillance Epidemiology and End Results (SEER) database review.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.6 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 6-6

Author(s):

Anteneh A. Tesfaye ◽

Mohammad Mozayen ◽

Ioana Morariu ◽

David S. Eilender

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Young Women ◽

Tumor Size ◽

Hormone Receptor ◽

Age Groups ◽

Tumor Grade ◽

Seer Database ◽

Chi Square ◽

Cancer Specific Survival

6 Background: Advanced age is a major risk factor for breast cancer in women. Small sized studies have reported variable outcome of breast cancer in young women. Our study was done to evaluate tumor characteristic and cancer specific survival among young women. Methods: The 1973-2009 SEER database was reviewed for women with breast cancer diagnosed between 2004 and 2009. Patients were grouped by age into: A (≤35 years), B (36-50 years) and C (>50 years). Age, ethnicity, staging, lymph nodes status, micrometastasis in negative lymph nodes, tumor size, tumor grade, hormone receptor status were extracted. Data and survival were analyzed using chi square, Kaplan-Meier, Life table, and Cox proportional hazard model. The primary outcome was 5-year cancer-specific survival. Results: A total of 248,280 patients were included in the study, group A, B and C making 2.8%, 25.5% and 71.7% of study subjects respectively. The median tumor size was 2.4, 1.9, and 1.6 cm in groups A, B and C respectively (p=0.0001). Positive lymph nodes were seen in 52.5%, 43% and 34% in groups A, B and C respectively (p=0.0001). Regional disease was seen in 47.5%, 39.5% and 29.9% in groups A, B and C respectively (p=0.0001). Higher Grade histology was seen in 63.5%, 44.3% and 33.8% in groups A, B and C respectively (p=0.0001). ER-PR negative were found in 42.1%,26.4%, 22.6% of Groups A, B and C respectively (p=0.0001). Five year cancer specific survival was 82%, 89%, 86% in groups A, B and C respectively (p=0.0001). Independent prognostic factors are given in the table. Conclusions: Breast cancer is uncommon among young women (age <35). Compared to other age groups, breast cancer in young women presents with bigger tumor, higher nodal positivity, an advanced stage, higher tumor grade, higher hormone receptor negativity, and worse 5-year cancer-specific survival. [Table: see text]

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Cardiac autonomic dysfunction in breast cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.10057 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 10057-10057 ◽

Cited By ~ 1

Author(s):

David Payne ◽

Syed Mahmood ◽

Ann H. Partridge ◽

Anju Nohria ◽

John Groarke

Keyword(s):

Breast Cancer ◽

Exercise Capacity ◽

Autonomic Dysfunction ◽

Breast Cancer Survivors ◽

Prognostic Significance ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Peak Exercise ◽

Cardiac Autonomic Dysfunction ◽

All Cause Mortality

10057 Background: Cardiac autonomic dysfunction (AD) has been associated with increased cardiovascular (CV) and all-cause mortality in several diseases. We evaluated the prevalence, functional and prognostic significance of cardiac AD in a cohort of breast cancer (BC) survivors referred for exercise treadmill testing (ETT). Methods: Cardiac AD was defined as the presence of both an elevated resting heart rate (HR ≥ 80 beats per minute) and abnormal HR recovery (HRR ≤ 12 beats per minute if active cool down, or ≤ 18 beats per minute if passive recovery) at 1 minute after peak exercise. Presence of cardiac AD, exercise capacity, and all-cause mortality were assessed in 448 women (age 62.6±10.0 years), 8.7 [range 4.5, 14.3] years from BC diagnosis, compared to 448 cancer-free, age- and sex-matched controls, all of whom were clinically referred for ETT. Results: Elevated resting HR (23.7% vs. 17.0%, p = 0.013), abnormal HRR (25.9% vs. 20.3%, p = 0.048), and cardiac AD (8.0% vs. 4.2%, p = 0.025) were more prevalent in BC survivors than controls. BC survivors with cardiac AD had reduced exercise capacity compared to those without AD (Table). Among controls, cardiac AD was not associated with decreased exercise capacity. Among BC survivors (age-adjusted hazard ratio 1.90 (95% CI 0.78-4.62) and controls (age-adjusted hazard ratio 4.09 (95% CI 0.49-34.18), cardiac AD was not associated with increased all-cause mortality. Conclusions: Among patients referred for ETT, BC survivors have an increased prevalence of cardiac AD relative to controls. Cardiac AD is associated with decreased exercise capacity, but not increased all-cause mortality, in BC survivors. Available strategies to modulate cardiac AD may improve functional capacity in BC survivors. Table: Impact of markers of cardiac AD on exercise capacity. [Table: see text]

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