Background Breast conserving therapy and mastectomy have been shown to have similar overall survival outcomes in large trials. After many years of decline, mastectomy rates are on the rise for a variety of reasons. In this context, there is increasing discussion that the risk of loco-regional recurrence is complex and varies by breast cancer subtype. Several, pre-trastuzumab-era, reports have shown that loco-regional recurrence is higher for HER2+ and triple negative breast cancer (TNBC) patients who undergo breast conserving therapy (BCS) compared with women with hormone receptor positive (HR+) disease. Other literature has suggested that some breast cancer subtypes have better outcomes with BCS. To provide the most recent data on surgical choice by breast cancer subtype, we report BCS and mastectomy rates from 2010 SEER data. Surgical choice is presented for ductal carcinoma in situ (DCIS) and invasive breast cancer. For women with invasive disease the subcategories of HR+, HER2+ and TNBC are reported. Methods SEER data were used to identify incident breast cancer patients diagnosed in 2010. Only pathologically confirmed cases were included. In addition, individuals were excluded if they were diagnosed at autopsy or by death certificate, did not receive surgery or if the type of surgery was unknown. Patients were categorized as having received BCS or mastectomy and, for invasive disease, by receptor subtype (HR+, HER2+ and TNBC). For invasive cancers, patients with unknown receptor subtypes were excluded. Results SEER data for 2010 included 65,598 women, 13,849 (21.1%) women had DCIS and 51,749 (78.9%) had invasive disease (Table 1). For invasive cancers after excluding 5,062 patients with unknown receptor status, 12.1% were TNBC, 14.4% were HER2+, and 83.5% were HR+. Overall, 43.5% of women underwent mastectomy (33.2% for DCIS). Mastectomy rate increased by stage at diagnosis: 33.5% for Stage I, 53.9% for Stage II disease and 77.8% for Stage III (OR = 0.49, p<0.001 for Stage 1 compared to other stages). By age, mastectomy rates were 69.0% for <30, 53.4% for 30-49, 43.3% for 50-59, 39.0% for 60-69, 39.4% for 70-79 and 41.1% for 80+ (OR = 2.90, p<0.001 for women under 30 compared to older women). Conclusions In this large, recent series, 43.5% of women underwent mastectomy. This rate is among the highest reported from population-based registries and suggests a continued trend of increasing mastectomy rates. Women with HER2+ and TNBC were younger and significantly more likely to have mastectomy than their HR+ counterparts. Women with HER2+ breast cancer, in this trastuzumab-era cohort, were the subtype most likely to choose to undergo mastectomy. Monitoring for relapse events could contribute to a better understanding of how loco-regional recurrence risk might vary by subtype and surgical choice. Table 1: Percent receiving BCS and mastectomy by subtype for invasive cancersReceptor StatusNMean AgeBCS (%)Mastectomy (%)Odds Ratio*p valueFull cohort51,74961.354.145.9 HR+38,98161.855.744.30.68<0.001HER2+6,73858.143.056.01.61<0.001TNBC5,65858.849.150.91.26<0.001* Odds Ratio of undergoing mastectomy versus lumpectomy for this subtype compared to those not of this subtype. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-12.
Background: Women with breast cancer increasingly choose to undergo contralateral prophylactic mastectomy (CPM) even as the benefit of this procedure for woman at average risk for breast cancer remains uncertain. Many women with newly diagnosed breast cancer undergo pre-operative MRI for a variety of indications. Growing evidence suggests that obtaining a pre-operative MRI increases the likelihood that a patient will choose CPM. This study evaluates the relationship between a pre-operative MRI and the decision to pursue CPM, as well as the rate of contralateral MRI findings for which follow-up is recommended and the choice to undergo CPM. The pathology found in contralateral breasts in this series is also reported. Methods: Newly diagnosed breast cancer patients were prospectively enrolled in Breast Molecular Epidemiology Resource (B-MER) observational study at the University of Iowa from April 2010 through March 2013. Prophylactic mastectomy is defined as removal of the contralateral breast within 12 months of definitive mastectomy. Univariate logistic regression was used to identify factors predictive of undergoing CPM. Recommended follow-up of the contralateral breast MRI is defined as any imaging or procedure other than immediate ultrasound evaluation. Results: Among 134 patients (mean age 53) who underwent mastectomy, 53 (40%) underwent CPM. Univariate analysis revealed that patients undergoing CPM were more likely to have had a preoperative bilateral MRI (52%% vs. 28%, p = 0.006) and were more likely to have been given a recommendation for a follow-up test (79% vs, 40%, p = 0.007). Univariate Analysis of Odds of Electing to Undergo CPMVariableLevelOdds ratioP-valueAge5 year0.62<.001Breast MRIYes vs No2.740.006MRI follow-up recommendationYes or No5.530.007Nodal statusPositive vs Negative0.820.581History of benign breast biopsiesNo vs Yes1.850.209Family history of breast cancerYes vs No1.160.711ER/PR statusNegative vs Positive1.830.134Triple NegativeNo vs Yes1.910.196HER2 statusPositive vs Negative2.470.066BRCA testing doneYes vs No6.04<.001BRCA results*Positive vs Negative3.120.315Tobacco everYes or No1.390.354Alcohol everYes or No1.250.544* Indeterminate and not done levels were excluded from the analysis Univariate analysis also revealed associations between choice of CPM and younger age (p<0.001) and BRCA testing (p<0.001). In this series, CPM was not associated with nodal status, ER/PR status, history of benign breast biopsies, family history of breast cancer, BRCA result and tobacco or alcohol use, although there was a trend for association with HER2 status. Of the 53 patients who underwent CPM, one had proliferative disease with atypia, 34 had proliferative disease without atypia. A single patient had DCIS found in the contralateral breast which had not been identified on MRI. Conclusions: The use of preoperative breast MRI and abnormal imaging findings in the contralateral breast, for which follow-up was recommended, led to a higher CPM rate. Contralateral prophylactic mastectomy rarely uncovered occult malignancy. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-02-07.
Introduction: Breast conserving therapy (BCT) is considered the treatment of choice for early stage breast cancer by National Cancer Institute guidelines. Little data exists on patient-reported satisfaction and quality of life outcomes after lumpectomy with radiation. This study aims to identify factors influencing satisfaction with cosmetic outcome and quality of life in patients receiving BCT using a validated instrument. Methods: All patients treated with lumpectomy and radiation for breast cancer at our institution from 1997-2012 received a mailed questionnaire containing the BREAST-Q breast conservation module (graciously provided by Dr A. Pusic, Memorial Sloan Kettering Cancer Center), a validated quality of life survey instrument. A retrospective chart review was performed for survey responders for demographic, treatment, and staging information. Scores were calculated for satisfaction with appearance of the breast, adverse effects of radiation, sexual wellbeing, psychosocial wellbeing and physical wellbeing: upper body and arm. Pearson correlation coefficients were obtained. Wilcoxon rank-sum and one-way ANOVA were used to identify associations between patient variables and satisfaction scores. Multivariate regression was used to assess confounding variables. Results: A total of 110 questionnaires (response rate of 29.5%) fit criteria for analysis. The mean age of respondents was 65.9±11.2 yrs, and mean time since diagnosis was 91.8±53.1 mos. We observed the strongest correlations between satisfaction with breast appearance and sexual wellbeing (r=0.66, p<0.01), breast appearance and psychosocial wellbeing (r=0.62, p<0.01), and fewer effects of radiation and physical wellbeing (r=0.65, p<0.01). Lumpectomy volume was associated with decreased satisfaction with breast appearance (r=-0.32, p <0.01) and psychosocial wellbeing (r=-0.19, p<0.05). There was no correlation between satisfaction with breast appearance and patient age, time since surgery, history of re-excision, stage or localization technique. Patients with older age at diagnosis reported significantly fewer effects of radiation and better psychosocial, physical, and sexual wellbeing (all p<0.05) (Table 1). The incidence of recurrence was 2.7% and did not impact satisfaction scores. Distribution of Satisfaction/Quality of Life Outcomes by Age at Diagnosis Satisfaction/Quality of Life*AgeNBreastAdverse Effects of RadiationPsychosocialSexualPhysical<451458±2282±1973±1945±2074±1645-553264±2683±1980±2054±2579±1756-602667±1794±983±2370±1885±1361-651267±2989±2383±2053±2983±17>652670±2391±1288±1663±2588±25All11065±2388±1682±2058±2482±19P 0.1590.0190.0140.0300.002*Rasch scores range from 0-100 where 100 indicates highest satisfaction Conclusions: In women undergoing BCT, patient satisfaction with appearance of the breast and psychosocial wellbeing at 7.6 years of follow-up correlated with the volume of tissue removed but no other patient or tumor characteristics. Increasing age at diagnosis was associated with greater satisfaction in multiple domains. These results emphasize the importance of precise surgical technique and patient selection in order to achieve long-term patient satisfaction with BCT. Citation Format: Welsh JL, Fu S, Liao J, Sugg SL, Scott-Conner CE, Weigel RJ, Erdahl LM, Lizarraga IM. Long-term patient satisfaction with cosmetic outcome and psychosocial wellbeing after breast conserving therapy is affected only by lumpectomy volume. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-11-04.
Background: Recent multi-center trial results are concerning for the ability to identify SLNs after NCT. SLN localization was shown to be less successful (80%) after NCT when compared with no NCT (99%) (SENTINA), and the SLN identification rate in Z1071 in which all patients received NCT was 93%. Purpose: To examine the effect of NCT, patient and disease characteristics, imaging and surgical technique on SLN localization rates in breast cancer patients undergoing chemotherapy. Methods: Retrospective, single institution study was performed on patients who underwent surgery for breast cancer from January 2008 to December 2013. All patients who underwent SLN biopsy and either adjuvant chemotherapy (ACT) or NCT, were included. All patients underwent lymphoscintigraphy, and SLN biopsy was performed with the definitive breast surgery. Results: 68 patients underwent NCT, and 133 underwent ACT. Our SLN localization rate was 198/201 (98.5%) overall; 98.6% (67 of 68) with NCT and 97.7% (130/133) with ACT (p=1.0). Compared with the NCT group, the ACT patients were significantly older, white, with more ER/PR positive tumors. The NCT group had more positive nodes on preop imaging (64% v. 20%, p<0.001), FNA (82% v. 22%, p<0.001), and a lower use of blue dye (37% v. 61%, p=0.05) but there were no differences in the number of SLN removed (1.43 v. 1.33 p=0.32), or nodes that were positive on intraoperative evaluation (30 v. 33%, p=0.75). Comparing the patients who had successful and failed SLN localization, there were no differences in demographics, tumor type, Stage, prior breast surgery, preoperative node positivity on imaging or FNA or timing of chemotherapy. Conclusion: In this single institution series, SLN non-localization was a rare event and not associated with NCT. We were unable to identify any patient or disease characteristics, imaging or surgical techniques associated with SLN non-localization. The etiology of the lower SLN identification rates with NCT in multi-institutional trials remains to be elucidated. Citation Format: Sugg S, Hayes R, Gbenon A, Lizarraga I, Erdahl L, Weigel R, Liao J, Menda Y, Scott-Conner C. Sentinel lymph node (SLN) localization is highly successful after neoadjuvant chemotherapy (NCT) for breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-11.
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