scholarly journals Trends in Epidemiology and Management of Breast Cancer in Women Under 46 Years: Institutional Experience from a Tertiary Cancer Centre in Eastern India

2021 ◽  
Vol 8 (7) ◽  
pp. 278-285
Author(s):  
Sourav Kumar Ghosh ◽  
Sanskriti Poddar ◽  
Krishnangshu Bhanja Choudhury
Keyword(s):  
Breast Cancer ◽  
Locally Advanced ◽  
Breast Conservation ◽  
Radical Mastectomy ◽  
Staging System ◽  
Relevant Information ◽  
Breast Conservation Surgery ◽  
Age Group ◽  
Curative Intent ◽  
The Impact

Background: Breast cancer in younger women is a growing burden both in developed and Asian subcontinent. Despite studies showing varying results about the impact of age on treatment outcome and suboptimal survival, very few robust Indian studies have thrown light on this biologically different entity. Methods: Histologically / cytologically confirmed cases of non-sarcomatous, female ductal breast carcinoma patients of age group less than and equal to 45 years of all stages attending radiotherapy department of R.G Kar Medical College between January 2016-December 2018 were included in the study. Relevant information was obtained from patient`s files/case records. Database was locked on 31st March 2021.The baseline demographic profile, cancer subsites along with treatment provided were analysed using SPSS version 16 (IBM Inc, Armonk, New York, U.S.). Descriptive data are provided. Results: Total 272 patients were eligible for the study as per the inclusion criteria with median age of 39 years (22-45 years). Majority were urban married Hindu females. Majority were locally advanced and node positive high grade disease as per AJCC 7th staging system. Modified radical mastectomy was significantly higher than breast conservation surgery as the surgical modality (76 vs. 8.9%). 31.2%, 54.5% patients received neoadjuvant and adjuvant chemotherapy respectively.61% patients received curative intent radiotherapy either in conventional or hypofractionated schedule. Myelosuppression and oral mucositis were the major treatment related adverse events. Overall median PFS was 48 months. Conclusion: Breast cancer in younger age group is distinct in terms of disease biology. Effective screening and diagnostics modalities with focus on mass awareness amongst patients and health care workers are the cornerstone of improving outcome and survival. Keywords: breast cancer, young females, retrospective single institutional study.

Efficacy and safety of neoadjuvant docetaxel, carboplatin, trastuzumab, and pertuzumab (TCH-P) in HER2-positive breast cancer: An Indian experience.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12619-e12619
Author(s):  
Ajay Gogia ◽  
Shalabh Arora ◽  
SVS Deo ◽  
Sandeep Mathur ◽  
Dayanand Sharma
Keyword(s):  
Breast Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Breast Conservation ◽  
Radical Mastectomy ◽  
Stage Ii ◽  
Breast Conservation Surgery ◽  
Secondary Outcome ◽  
Her2 Positive ◽  
Positive Breast Cancer

e12619 Background: Dual targeted therapy with chemotherapy is one of the therapeutic approaches as neoadjuvant treatment in HER2/neu positive breast cancer (BC). However the safety and efficacy data of dual-targeted, chemotherapy regimen (docetaxel, carboplatin, trastuzumab, & pertuzumab [TCH-P] is limited from the Indian subcontinent. Methods: This retrospective study aims to evaluate the efficacy and toxicity of neoadjuvant TCH-P regimen in early, locally advanced, and oligometastatic (OM) HER2-positive BC, at All India Institute of Medical Sciences, New Delhi, India, in between the period 2015-2020. Total 6 cycles of 3-weekly neoadjuvant chemotherapy (NACT) protocol containing docetaxel (75 mg/m2), carboplatin (AUC = 6), trastuzumab (8 mg/kg loading followed by 6 mg/kg) and pertuzumab ( 840 mg loading followed by 420 mg) were planned. Subcutaneous peg-filgrastim was prophylactically administered on day 2 of each cycle. The primary outcome was the pathological complete response (pCR), which was defined as an absence of invasive and noninvasive cancer in breast or lymph node and secondary outcome were clinical overall response rate (ORR), rate of breast conservation surgery( BCS) for patients for whom modified radical mastectomy( MRM)was planned and toxicity. Results: Forty-five patients with a median age of 48 years (31-65) were included in this study. The TNM (AJCC-7th edition) stage distribution was stage II, 14 (31.1%); stage III, 29 (64.5%); and stage IV (OM), 2 (4.4%). Clinical node positivity disease was found in 26 (57.8%) cases. Nineteen (42.2%) patients had hormone-positive and 26(57.8%) cases were premenopausal. The clinically ORR and CR were seen in 100% and 60% respectively. Overall pCR rate was observed in 25 (55.6%) patients (70% in stage II). BCS was performed in 23(51.1%) cases. In 12(26.6%) cases, planned MRM was changed to BCS following NACT. Grade 3 and 4 toxicities were diarrhea 7 cases, thrombocytopenia in 6, neutropenia in 4, febrile neutropenia in 1, and anemia in 2 cases. Ten patients required dose modification and interruption. No patient had congestive heart failure or induction death. Conclusions: This is the first study of the non-anthracycline-based neoadjuvant protocol in HER2 positive BC from India. The TCH-P is an effective, safe, and well-tolerated, protocol with a path CR rate of 55.6% and 26.6% BCS conversion rate from planned MRM.

scholarly journals Immunohistochemistry profile and its relation with prognosis in locally advanced breast cancer

2019 ◽  
Vol 6 (12) ◽  
pp. 4507
Author(s):  
Naseef Kannanavil ◽  
Nabeel Thommil Padinjarenalakath ◽  
Ahsan Vilayapoyilil ◽  
Abidali Karatparambil
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Locally Advanced ◽  
Radical Mastectomy ◽  
Response To Therapy ◽  
Advanced Breast ◽  
Age Group ◽  
Modified Radical Mastectomy ◽  
Number Of Patients ◽  
Related Mortality

Background: Breast cancer is one of the most common malignancy and leading cause of cancer related deaths in women worldwide. Immunohistochemistry (IHC) is done to characterize intracellular proteins or cell-surface antigens and is used to assess tumour subtypes, confirm diagnosis, predict prognosis and response to therapy. The aim of the present study was to evaluate the relationship of IHC profile- ER, PR and HER2 neu and prognosis of patients who underwent modified radical mastectomy for locally advanced breast cancer.Methods: A retrospective cohort study was conducted at MES Medical College Hospital from October 2015 to November 2017 in patients who underwent modified radical mastectomy for locally advanced breast carcinoma. A total of 65 women were enrolled in the study. 5 years survival was taken as the prognostic indicator.Results: Majority of the patients belong to the age group of 40-49 years with 40% patients followed by 33.84% patients in the age group of 50-59 years. Maximum number of patients was found in 2B stage of tumour. Maximum patients belonged to the ER/PR+, HER2- subgroup (27), followed by triple negative (ER/PR-, HER2) subgroup (16). There was no disease related mortality in ER/PR+, HER2+ and ER/PR+, HER2- subgroups. There were 1 and 2 disease related mortality in ER/PR-, HER2+ and triple negative subgroups respectively.Conclusions: In the present study the worst prognosis was observed in triple negative (ER/PR-,HER2-) IHC subgroup followed by the HER2 enriched (ER/PR-, HER2+) subgroup. 

scholarly journals Is quality of life after mastectomy comparable to that after breast conservation surgery? A 5-year follow up study from Mumbai, India

2019 ◽  
Vol 29 (3) ◽  
pp. 683-692
Author(s):  
K. V. Deepa ◽  
A. Gadgil ◽  
Jenny Löfgren ◽  
S. Mehare ◽  
Prashant Bhandarkar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Breast Conservation ◽  
Radical Mastectomy ◽  
Breast Conservation Surgery ◽  
Breast Cancer Surgery ◽  
Significant Difference ◽  
Domain Scores

Abstract Purpose Breast cancer is the commonest cancer in women worldwide. Surgery is a central part of the treatment. Modified radical mastectomy (MRM) is often replaced by breast conserving therapy (BCT) in high-income countries. MRM is still the standard choice, in low- and middle-income countries (LMICs) as radiotherapy, a mandatory component of BCT is not widely available. It is important to understand whether quality of life (QOL) after MRM is comparable to that after BCT. This has not been studied well in LMICs. We present, 5-year follow-up of QOL scores in breast cancer patients from India. Methods We interviewed women undergoing breast cancer surgery preoperatively, at 6 months after surgery, and at 1 year and 5 years, postoperatively. QOL scores were evaluated using FACT B questionnaire. Average QOL scores of women undergoing BCT were compared with those undergoing MRM. Total scores, domain scores and trends of scores over time were analyzed. Results We interviewed 54 women with a mean age of 53 years (SD 9 ± years). QOL scores in all the women, dipped during the treatment period, in all subscales but improved thereafter and even surpassed the baseline in physical, emotional and breast-specific domains (p < 0.05) at 5 years. At the end of 5 years, there was no statistically significant difference between the MRM and BCT groups in any of the total or domain scores. Conclusion QOL scores in Indian women did not differ significantly between MRM and BCT in the long term. Both options are acceptable in the study setting.

Paget Disease of the Breast With Invasion From Nipple Skin Into the Dermis: An Unusual Type of Skin Invasion Not Associated With an Adverse Outcome

2013 ◽  
Vol 137 (1) ◽  
pp. 72-76 ◽  
Author(s):  
Mary Ann Sanders ◽  
Laura Dominici ◽  
Christine Denison ◽  
Mehra Golshan ◽  
Tad Wiecorek ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Locally Advanced ◽  
Breast Conservation ◽  
Staging System ◽  
Li Fraumeni Syndrome ◽  
Paget Disease ◽  
Skin Invasion ◽  
Pathology Reports ◽  
Invasive Carcinomas

Context.—Paget disease is an uncommon skin manifestation of breast cancer, associated with either invasive carcinoma or ductal carcinoma in situ in the underlying breast. In very rare cases, tumor cells within the epidermis invade through the basement membrane of the skin into the dermis. Objectives.—To identify a series of cases of Paget disease with direct dermal invasion and to investigate the clinicopathologic features and outcome. Design.—Cases were identified during a 6-year period from the files of 2 hospitals. The clinical histories, imaging studies, and pathology reports were reviewed. Results.—Seven patients were identified, 5 with microinvasion (&lt;0.1 cm) and 2 with 0.2- or 0.3-cm invasive carcinomas in the dermis. No lymphovascular invasion was seen. Sentinel nodes were negative in 3 patients who underwent biopsy. Five patients were treated with breast conservation with radiation. Three patients were at high risk for breast cancer because of prior breast cancer, Li-Fraumeni syndrome, or radiation for Hodgkin disease. The latter 2 patients underwent bilateral mastectomies. Three patients received hormonal therapy and 1 oophorectomy. No patient received chemotherapy. At follow-ups ranging from 4 to 66 months (median, 20 months), there have been no recurrences. Conclusions.—Patients with direct dermal invasion from Paget disease had a favorable outcome during the available follow-up period. This type of dermal involvement must be distinguished from locally advanced invasive carcinomas with skin invasion classified as T4b in the American Joint Cancer Commission staging system, as cancers with other types of skin invasion are associated with a poor prognosis.

scholarly journals Inequalities in breast-conserving surgery for female breast cancer in Świętokrzyskie Province, Poland

2021 ◽  
Author(s):  
Agnieszka Paszko ◽  
Dominik Maślach ◽  
Małgorzata Żendzian-Piotrowska ◽  
Michalina Krzyżak
Keyword(s):  
Breast Cancer ◽  
Rural Women ◽  
Rural Areas ◽  
Breast Conservation ◽  
Breast Conserving Surgery ◽  
Female Breast Cancer ◽  
Breast Conservation Surgery ◽  
Disease Stage ◽  
Age Group ◽  
Breast Radiotherapy

Introduction: Breast cancer is the most common cancer among women in the world. Differences in the treatment of breast cancer may be observed by age, disease stage, place of residence and comorbid conditions. Aim: The aim of the study was to analyse the differences in the use of breast-conserving surgery among women in the Świętokrzyskie Province. Material and methods: The study included 483 female residents of Świętokrzyskie Province who were diagnosed with invasive breast cancer in 2013. Following indicators, recommended to evaluate the compliance with the best oncology practice, were calculated: a proportion of patients receiving post-operative breast radiotherapy after the breast-conserving surgery and a proportion of the breast-conservation surgery in pT1 cases. Results and discussion: The difference in the distribution of surgical procedures by age group (breast-conserving surgery vs. mastectomy) in pT1 cases was statistically significant (P = 0.006). The highest values of both indicators were observed in the age group recommended for breast cancer screening in Poland, while the lowest in women 70 years of age and older. Our study revealed a non-significantly higher proportion of patients receiving post-operative breast radiotherapy after breast conserving-surgery in urban than in rural women, amounting to 36.5% and 29.4%, respectively. Conclusions: Existing inequalities in the use of breast-conserving surgery indicate the need to consider the recommended breast cancer treatment to the highest possible proportion of patients residing in rural areas.

scholarly journals PROGNOSIS OF BREAST CANCER IN VERY YOUNG AGE (LESS THAN 30 YEARS)

2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Razia Bano ◽  
Mariam Salim ◽  
Amina Iqbal Khan ◽  
Akif Zaidi
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Local Recurrence ◽  
Triple Negative ◽  
Locally Advanced ◽  
Breast Conservation ◽  
Radical Mastectomy ◽  
Histopathological Diagnosis ◽  
Single Patient ◽  
Tumour Biology

Purpose: Breast cancer diagnosed at a younger age has aggressive biology being triple negative and high grade and is associated with poor prognosis.Materials and Methods: Retrospectively data of 121 patients age 30 years or younger registered during the year 2008 were reviewed. Data were extracted from the cancer registry department of the institute. Demographics studied were the age at diagnosis, gender, pregnancy or lactation association, family history of breast cancer, histopathological diagnosis, and stage of the disease, receptors, type of treatment, response, local recurrence, distant relapse, and survival. Results: A total of 121 patients with age 30 years or less were included. An only a single patient was male. The age range was from 20 to 30 years; bilateral involvement was seen in a single patient. Almost half 50.4% (n = 61) patients had locally advanced disease at presentation. Pregnancy/lactation-associated breast cancer was seen in 29.8% (n = 36). The most common stage was Stage III (52.1%) and Stage II (33.9%). Invasive ductal carcinoma was the most common histology 94.2% (n = 114) of patients; triple negative was the most common molecular subtype present in 46.3% (n = 56). Chemotherapy was received by 92.6% (n = 112), 88.4% (n = 107) patients received radiation therapy. Modi ed radical mastectomy was performed in 57% (n = 69), breast conservation surgery in 35.5% (n = 43), follow- up period was 5 years, local recurrence was observed in 12.4% (n = 15) and cancer related deaths were 42.1% (n = 51). Conclusions: Breast cancer in very young has very aggressive tumour biology, needs aggressive treatment with surgery, chemotherapy, radiation therapy and hormonal therapy. Key words: Breast cancer, pregnancy-associated aggressive tumour biology, triplenegative, young 

Clinical presentation of breast cancer: Age, stage, and treatment modalities in a contemporary cohort of Michigan women.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 1-1 ◽  
Author(s):  
D. R. Smith ◽  
J. Caughran ◽  
J. L. Kreinbrink ◽  
G. K. Parish ◽  
S. M. Silver ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Task Force ◽  
Breast Conservation ◽  
Screening Mammography ◽  
Breast Conservation Surgery ◽  
Treatment Modalities ◽  
Breast Cancers ◽  
Screening Guidelines ◽  
Treatment Type ◽  
The Impact

1 Background: The U.S. Preventative Services Task Force (USPSTF) revised their breast cancer screening recommendations in 2009 changing their stance on age and frequency of mammography screening to biannual exams starting at age 50. The purpose of this study is to analyze data from a statewide breast cancer registry managed by the Michigan Breast Oncology Quality Initiative (MiBOQI) to determine the impact of these new recommendations on diagnosing and treating breast cancer. Methods: De-identified data were collected on women participating in the MiBOQI registry at seventeen statewide institutions from 2006-2009. Data included method of detection, cancer stage, age at detection, treatment type, and patient demographics. Participants were stratified based on age, and data analyzed using NCSS software (chi-square and t-tests). Results:5903 women with breast cancer with an average age at diagnosis of 59.4 years were included. 65.5% of breast cancers were detected via mammography, 29.8% by palpation, and 4.7% by other methods. In women under 50 years of age, cancers were detected by mammography in 48.3% (69.3% >50yr) and by palpation in 46.1% (24.1% >50yr). Patients with palpable presentations were younger (55.8 yr vs. 61.2 yr; p <0.001). Cancers with a palpable presentation were diagnosed at higher stages (50.0% stage II) than with mammography (52.5% stage I; p<0.001). Breast conservation surgery occurred more frequently than mastectomy (palpation 54.2%; mammography 72.9%, p<0.001) but cancers detected through palpation were more likely to undergo mastectomy procedures. Conclusions: Results of this study validate the importance of annual screening mammography in women older than 50 years, and women aged 40 to 49 years recently omitted from screening guidelines. There was an increased prevalence of palpation for the method of detection in women less than 50 years of age. If screening mammography is omitted in this group, cancers when detected may be of a more advanced stage and result in more mastectomies. This study also supports the use of palpation as a method of detection despite recent recommendations against teaching self breast exams by USPSTF.

Trends in rates of modified radical mastectomies and bilateral mastectomies in unilateral breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 569-569
Author(s):  
Ajaz Bulbul ◽  
Tareq Braik ◽  
Sadaf Rashad ◽  
Emilio Araujo Mino ◽  
Adrianna Bautista ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Clinical Outcomes ◽  
Recurrence Rate ◽  
Early Stage ◽  
Breast Conservation ◽  
Radical Mastectomy ◽  
Breast Conservation Surgery ◽  
Bilateral Mastectomy ◽  
Unilateral Breast Cancer

569 Background: Women with unilateral breast cancer (BC) without genetic predisposition have a low risk for local and contralateral recurrence with breast conservation surgery (BCS) and adjuvant treatment. We aimed to study the pattern of surgical care across centers in rural New Mexico and its correlation to clinical outcomes. Methods: We retrospectively evaluated 533 patients with Stage 1-3 BC diagnosed between January 1989 to October 2015. Clinical Outcomes with BCS, sentinel lymph node dissection (SLND), simple mastectomy (SM), modified radical mastectomy (MRM) and Bilateral Mastectomy (BM) were studied. Descriptive statistics were performed to describe the proportion of surgery types. Predictors of clinical outcomes were evaluated by multivariate logistic regression. Results: Out of 533 patients, 510 (82%) had early stage (0-3) resectable BC. Among these, 48% (246/510) had either MRM (209/510) or BM (37/510). MRM was performed in 3% of stage 0 (6/209), 23% (49/209) stage I, 46%(97/209) of stage II and 27% (57/209) of Stage III patients. Overall, the rate of SLND was 42% among Early stage Breast cancer. Of 41 patients treated with bilateral mastectomy, 10 were positive for BRCA mutation, 6 for family history and 3 for contralateral disease. Median age of BM was 53 +12 y. The local recurrence rate was 8.8% (45/510), and metastatic recurrence rate was 15.5% (79/510). Lymphedema rate was 9.2% (47/510). Using MRM as reference, the Odds Ratio (OR) for lymphedema after BM and BCT were 2.15 (95% CI, 0.84-5.50) and 0.58 (0.28-1.22), respectively. With 9.6 years of median follow up, the predictive probabilities of lymphedema after BCT, SM, MRM and BM were 1%, 4%, 9% and 18%. The OR for local recurrence in women with BCT were 1.46 (95th C/I: 0.72-2.95), SM 0.27 (0.03-2.13), BM 2.06 (95th C/I:0.70-6.06). Conclusions: Less BCT and more aggressive procedures are being performed, and the latter is associated with more lymphedema. No significant differences were noted in local recurrences. Presence of a genetic mutation was not the sole indicator of BM’s in our patient population. There is a need for evidence-based shared decision-making and surgical management of breast cancer, especially in a rural community setting.

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