Association of Breast Cancer Screening Behaviors With Stage at Breast Cancer Diagnosis and Potential for Additive Multi-Cancer Detection via Liquid Biopsy Screening: A Claims-Based Study

PurposeTo evaluate mammography uptake and subsequent breast cancer diagnoses, as well as the prospect of additive cancer detection via a liquid biopsy multi-cancer early detection (MCED) screening test during a routine preventive care exam (PCE).MethodsPatients with incident breast cancer were identified from five years of longitudinal Blue Health Intelligence® (BHI®) claims data (2014-19) and their screening mammogram and PCE utilization were characterized. Ordinal logistic regression analyses were performed to identify the association of a biennial screening mammogram with stage at diagnosis. Additional screening opportunities for breast cancer during a PCE within two years before diagnosis were identified, and the method extrapolated to all cancers, including those without recommended screening modalities.ResultsClaims for biennial screening mammograms and the time from screening to diagnosis were found to be predictors of breast cancer stage at diagnosis. When compared to women who received a screening mammogram proximal to their breast cancer diagnosis (0-4 months), women who were adherent to guidelines but had a longer time window from their screening mammogram to diagnosis (4-24 months) had a 87% increased odds of a later-stage (stages III or IV) breast cancer diagnosis (p-value <0.001), while women with no biennial screening mammogram had a 155% increased odds of a later-stage breast cancer diagnosis (p-value <0.001). This highlights the importance of screening in the earlier detection of breast cancer. Of incident breast cancer cases, 23% had no evidence of a screening mammogram in the two years before diagnosis. However, 49% of these women had a PCE within that time. Thus, an additional 11% of breast cancer cases could have been screened if a MCED test had been available during a PCE. Additionally, MCED tests have the potential to target up to 58% of the top 5 cancers that are the leading causes of cancer death currently without a USPSTF recommended screening modality (prostate, pancreatic, liver, lymphoma, and ovarian cancer).ConclusionThe study used claims data to demonstrate the association of cancer screening with cancer stage at diagnosis and demonstrates the unmet potential for a MCED screening test which could be ordered during a PCE.

Inflammatory Potential of the Diet and Risk of Breast Cancer in the European Investigation Into Cancer and Nutrition (EPIC) Study

Objectives We aimed to evaluate the association between the inflammatory potential of the diet and the risk of breast cancer overall, by tumour subtypes and according to menopausal status. Methods A total of 318,686 women from the European Prospective Investigation into Cancer and Nutrition (EPIC) were followed for 14 years, among whom 13,246 incident breast cancer cases were identified. Dietary inflammatory potential was characterized by an inflammatory score of the diet (ISD). Multivariable Cox regression models were used to assess the potential effect of the ISD on the risk of overall breast cancer and by tumour subtypes by means of the hazard ratio (HR) and 95% confidence interval (95% CI). Results ISD was positively associated with breast cancer risk. Adjusted for relevant confounders, each increase of one standard deviation (1-SD) of the score increased by 4% the risk of breast cancer (HR 1.04; 95% CI: 1.01–1.07). Women in the highest quintile of the ISD (indicating most pro-inflammatory diet) had a 12% increase in risk compared with those in the lowest quintile (HR 1.12; 95% CI: 1.04–1.21) with a significant trend. The association was more pronounced among premenopausal women, with increased risk of 8% for 1-SD increase of the score (HR 1.08; 95% CI: 1.01–1.14). The pattern of the association was quite homogeneous by tumour subtypes based on hormone receptor status. There were no significant interactions between ISD and body mass index, physical activity or alcohol consumption. Conclusions Women consuming more pro-inflammatory diets as measured by ISD are at increased risk for breast cancer, especially premenopausal women. Funding Sources

Sense of coherence and risk of breast cancer

Sense of coherence (SoC) is the origin of health according to Antonovsky. The link between SoC and risk of cancer has however rarely been assessed. We performed a cohort study of 46,436 women from the Karolinska Mammography Project for Risk Prediction of Breast Cancer (Karma). Participants answered a SoC-13 questionnaire at recruitment to Karma and were subsequently followed up for incident breast cancer. Multivariate Cox models were used to assess the hazard ratios (HRs) of breast cancer in relation to SoC. We identified 771 incident cases of breast cancer during follow-up (median time: 5.2 years). No association was found between SoC, either as a categorical (strong vs. weak SoC, HR: 1.08, 95% CI: 0.90–1.29) or continuous (HR: 1.08; 95% CI: 1.00–1.17 per standard deviation increase of SoC) variable, and risk of breast cancer. In summary, we found little evidence to support an association between SoC and risk of breast cancer.

Abstract 13500: Association Between Breast Cancer and Cardiac Autonomic Function as Measured by Heart Rate Variability in the Women’s Health Initiative

Background: Autonomic dysfunction (AD) as measured by heart rate variability (HRV) is associated with increased risk of cardiovascular disease (CVD) and breast cancer. No study has utilized a large prospective multi-center cohort of diverse women to assess differences in HRV associated with incident breast cancer. Objectives: To identify heart rate variability changes in women with breast cancer compared to controls in the Women’s Health Initiative (WHI). Methods: In a retrospective cohort study, we utilized 5,031 women in the WHI CT cohort who were breast cancer free at baseline and compared 1) those with incident breast cancer v. 2) those who were breast cancer free during the ECG follow-up period as controls. HRV was calculated utilizing 10-second ECG with two measures of two-domain HRV: standard deviation of all normal-to-normal RR intervals (SDNN) and the root mean square of successive differences in normal-to-normal RR intervals (rMSSD). HRV was measured from ECGs collected at baseline, years 3, 6, and 9 in the comparison groups. An adjusted mixed linear model was used to evaluate the differences in SDNN and rMSSD comparing women with incident breast cancer to controls. Cardiovascular risk factors utilized in the adjusted model were determined via questionnaire at baseline. Results: At baseline, women with incident breast cancer diagnosed by years 3, 6, or 9 were significantly older (median age 63 vs. 61, P<0.0001) and had a higher prevalence of hypertension (35% vs. 32%, P=0.02). SDNN at years 3 and 6 in women with breast cancer compared to controls was significantly lower (P=0.0002, P=0.03 respectively). As well, rMSSD was significantly lower at year 3 compared to controls (P<0.0001) ( Figure 1 ). Conclusions: HRV as a measure of AD is significantly lower in women with incident breast cancer compared to women without breast cancer. Reduction in HRV is associated with CVD outcomes in the literature. Our study suggests HRV may predict CVD in breast cancer patients.

THE RELATIONSHIP OF MENARCHE AGE WITH BREAST CANCER EVENTS IN WOMEN AGE 25-50 YEARS IN THE SHORT CENTER OF INDONESIA BREAST CANCER FOUNDATION (YKPI) JAKARTA

Breast cancer is a cancer that occurs most often among women, which affects the 1,5 million women every year and cause the death toll due to cancer is found among women.In 2015, 570.000 women dying of breast cancer, which is about 15 % of cancer death among women.The incident breast cancer relating to the risk of breast cancer, the main risk factors associated with the incident breast cancer is the state of hormonal and genetic. Family history hormonal factors can be influenced by some one is the age of menarche To know relations age menarche with the occurrence of breast cancer in women age 25-55 years in women in Yayasan Kanker Payudara Indonesia ( YKPI ) in 2019. This is the kind of research quantitative research with a design research analytic used the cross sectional performed at Yayasan Kanker Payudara Indonesia (YKPI) Jakarta in 2019 , respondents were 30 .Uses the technique total sampling .An instrument used is the questionnaire and a observation and analysis techniques using spearman.The results of the analysis of 30 the smallest number of respondents there are 22 ( 100 % ) a woman whose period menarche at the age of ≤ 12 years the proportion who experienced breast cancer , from 30 the smallest number of respondents there are 20 ( 100 % ) a woman whose period menarche ≤ 12 year have been of breast cancer 8 ( 80 % ) a woman whose period menarche > 12 year have been of breast cancer , 2 ( 20% ) a woman whose period menarche & gt; 12 years they had experienced no cancer of the breast , sehigga ho refused to play host to which would mean there are even closer ties between the between the ages of menarche with an instance of cancer of the breast . P value = 0,007 .The value of persons of very = 0,800 As for advice for the research can be used as evalusi in providing information about breast cancer.

OP0123 RISK OF BREAST CANCER BEFORE AND AFTER RHEUMATOID ARTHRITIS, AND THE IMPACT OF HORMONAL FACTORS

Background:Large cohort studies have consistently reported decreased occurrence of breast cancer among women with RA. However, both the reasons behind this decreased risk and if it is present already before RA diagnosis, is unclear. The occurrence of RA following breast cancer is clinically and etiologically important also for other reasons. Long-term adjuvant anti-hormonal treatment with tamoxifen or aromatase inhibitors has become mainstay for estrogen receptor positive breast cancer, but are often associated with arthralgia as a side effect. Some studies have suggested that these therapies not only induce arthralgia, but also inflammatory arthritis.Objectives:To examine the risk of incident breast cancer in women with RA, and the risk of RA in women with a history of breast cancer, taking anti-hormonal treatment for breast cancer into account.Methods:Using nationwide Swedish registers, women with new-onset RA diagnosed 2006-2016 were identified. Each RA patient was matched on age, sex, and place of residence to 5 randomly selected control subjects from the general population. Through register linkages, we collected information on breast cancer, breast cancer risk factors (age at childbirth, number of children, hormone replacement therapy), and socio-economy. The relative risk of breast cancer after RA was assessed using Cox regression, and the relative risk of RA in women with a history of breast was assessed using conditional logistic regression.Results:The risk of incident breast cancer in women with RA was reduced and the association was not attenuated by adjustment for breast cancer risk factors (HR=0.80, 95%CI 0.68-0.93)(Table 1). The risk was similar among seronegative RA, (HR=0.77, 95%CI 0.58-1.02), and seropositive RA, (HR=0.81, 95%CI, 0.67-0.98), and for all age groups. We noted reduced risks for all TNM stages, and for both pre- and postmenopausal breast cancer (assessed with age cutoff 50 years). The risk of RA in women with a history of breast cancer was similarly reduced (OR=0.87, 95%CI, 0.79-0.95). Odds ratios (OR) stratified by serostatus and age at RA diagnosis yielded similar results. There was no clear trend in the level of risk reduction when examining the risk by menopausal status, or cancer stage at breast cancer diagnosis. Women with breast cancer treated with tamoxifen (OR=0.86, 95%CI 0.62-1.20), or aromatase inhibitors (OR=0.97, 95%CI 0.69-1.37), did not have an increased risk of RA compared to women with breast cancer treated differently.Table 1.Risk of breast cancer in women with RA, overall and by serostatus (events and hazard ratios), and risk of RA in women with a history of breast cancer, overall and by serostatus (events and odds ratios)No. of breast cancers, patients with RANo. of breast cancers, comparators/controlsRR (95% CI)Risk of breast cancer in women with RA19011910.80 (0.68-0.93)Seronegative RA553460.77 (0.58-1.02)Seropositive RA1247720.81 (0.67-0.98)Risk of RA in women with breast cancer55531930.87 (0.79-0.95)Seronegative RA1579210.85 (0.71-1.01)Seropositive RA36720880.88 (0.78-0.98)Conclusion:There is a decreased risk of breast cancer in patients with RA, and a similar decrease in risk of breast cancer before RA diagnosis. We did not find evidence to support that the decreased risk of breast cancer was due to known risk determinants. Furthermore, adjuvant anti-hormonal therapy as used in secondary breast cancer pharmacoprevention did not seem to increase the risk of RA.Disclosure of Interests:Hjalmar WADSTRÖM: None declared, Andreas Pettersson: None declared, Karin Ekström Smedby: None declared, Johan Askling Grant/research support from: JA acts or has acted as PI for agreements between Karolinska Institutet and the following entities, mainly in the context of the ARTIS national safety monitoring programme of immunomodulators in rheumatology: Abbvie, BMS, Eli Lilly, Merck, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB Pharma