PurposeThe aim of this study was to examine molecular subtype conversions in patients who underwent neoadjuvant chemotherapy (NAC) and analyze their clinical implications.Materials and MethodsWe included consecutive breast cancer patients who received NAC at the National Cancer Center, Korea, between August 2002 and June 2011, and had available data on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) receptor status prior to NAC. Molecular subtypes, hormone receptor (HR) status, and ER and PR Allred scores before and after NAC were compared, and the long-term outcomes were analyzed.ResultsOf 322 patients, 32 (9.9%) achieved a pathologic complete response after NAC. HR+/HER2– tumors tended to convert into triple negative (TN) tumors (10.3%), whereas 34.6% of TN tumors gained HR positivity to become HR+/HER2– tumors. Clinical outcomes of molecular subtype conversion groups were compared against patients who remained as HR+/HER2– throughout. The HR+/HER2– to TN group had significantly poorer recurrence-free survival (RFS) (hazard ratio, 3.54; 95% confidence interval [CI], 1.60 to 7.85) and overall survival (OS) (hazard ratio, 3.73; 95% CI, 1.34 to 10.38). Patients who remained TN throughout had the worst outcomes (for RFS: hazard ratio, 3.70; 95% CI, 1.86 to 7.36; for OS: hazard ratio, 5.85; 95% CI, 2.53 to 13.51), while those who converted from TN to HR+/HER2–showed improved comparable survival outcomes.ConclusionMolecular subtypes of breast cancers changed frequently after NAC, resulting in different tumor prognostication. Tumor subtyping should be repeated after NAC in patients with breast cancer.

Introduction: Singapore is the first Asian country to establish a nationwide breast screening programme, but our breast cancer screening uptake lags behind the Western countries. This survey focused on the subject of screening mammography, to assess the reasons for non-attendance and explore ways to improve our screening uptake. Materials and Methods: Females ≥21 years old were approached at primary healthcare clinics to participate in this survey, which questioned their knowledge, perception and expectations of breast screening. Results: There were 1011 respondents. Of the 740 respondents ≥40 years old, 332 respondents (45.5%) went for regular mammogram screening. Women who had lower household incomes [<$2000 (OR 0.49; 95% CI, 0.28 to 0.85); $2000 to $3999 (OR 0.59; 95% CI, 0.36 to 0.97)], did not know anyone with breast cancer (OR 0.62; 95% CI, 0.42 to 0.92), did not perform breast self-examination (OR 0.42; 95% CI, 0.28 to 0.62), had lower knowledge scores (OR 0.34; 95% CI 0.22 to 0.51), did not attend other health screening (OR 0.14; 95% CI, 0.05 to 0.41), and perceived mammography as embarrassing (OR 0.55; 95% CI, 0.31 to 0.96), were less likely to attend mammographic screening. Many did not know that screening is for the asymptomatic (51.2%), or the age to start screening (46.3%). Most respondents preferred to have their mammograms in the polyclinics (62.2%) and their screening reminders to be through short messaging service (SMS) (46.0%). Conclusion: Our results show the current influences on Singapore women’s screening practices, and also revealed that their understanding of mammogram screening is limited despite a high level of breast cancer awareness. Key words: Breast screening, Breast cancer, Asian women

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Introduction: The numbers of elderly patients with breast cancers are increasing with an ageing population, yet clinical research on these patients is still lacking. This study aims to examine the differences between elderly patients and their younger counterparts, with a view to optimize management plans for the former. Methods: Patients ≥ 40 years old with histologically proven breast cancer between 1991 and 2008 were identified from our database, and grouped according to age for analyses: old elderly (≥75 years), young elderly (65 to 74 years) and young (40 to 64 years). Clinicopathologic characteristics, treatment and survival rates were compared across the 3 groups. Results: There were 103 (11.53%) old elderly, 147 (16.5%) young elderly and 643 (72.0%) young patients. The 2 elderly groups presented at later stages, received less adjuvant or palliative chemotherapy (P < 0.001), and less adjuvant radiotherapy (P < 0.001), compared to the younger patients. Both breast cancer specific survival (CSS) and overall survival (OS) in the old elderly (CSS: 64.7% (95% confidence interval [CI]: 53.4%-73.8%), OS: 46.4% (95% CI: 35.6%-56.4%)) and young elderly group (CSS: 82.4% (95% CI: 74.4%-88.0%) OS: 78.6% (95% CI: 70.4%-84.8%)) were lower than the young patient group (CSS: 84.9% (95% CI: 81.6%-87.7%), OS: 83.4% (95% CI: 80.0%-86.3%)) at 5 years. Conclusion: Our findings showed that clinicopathologic characteristics of elderly breast cancer patients differed from their younger counterparts. Poorer survival outcomes among our elderly patients may be the result of their under-treatment.

BackgroundRecent data from the ACOSOG Z0011 trial suggest that axillary lymph node dissection (ALND) may not be necessary for patients with positive sentinel lymph node biopsy (SLNB) receiving breast-conserving surgery (BCS) with irradiation. However, consensus statements and guidelines have recommended that patients undergoing mastectomy with tumor-positive sentinel node undergo completion ALND. In this study, we compared the locoregional recurrence rate of patients with tumor-positive sentinel nodes among three groups: mastectomy with SLNB, mastectomy with ALND and BCS with SLNB.MethodWe identified 6,163 women with invasive breast cancer who underwent surgical resection at our institution between January 2000 and December 2011. Clinicopathologic data obtained from the prospectively collected medical database were analyzed retrospectively. Among the patients with sentinel node positive, mastectomy with SLNB was performed in 39 cases, mastectomy with ALND in 181 cases, and BCS with SLNB in 165 cases. The primary end point was the loco-regional recurrence rate.ResultsClinicopathologic characteristics were similar among the groups. There were no cases of loco-regional recurrence in the sentinel groups. At a median follow-up of 61.0 months (last follow-up May 2013), the loco-regional recurrence rate of each group was 0% for BCS with SLNB and mastectomy with SLNB only, and 1.7% for mastectomy with ALND (p=0.182).ConclusionIn our study, there was no significant difference in loco-regional recurrence rates between groups. This result lends weight to the argument that SLNB without ALND may be a reasonable management for selected patients with appropriate surgery and adjuvant systemic therapy.

Background/purpose: Increased serum HER2 levels have been shown to correlate with higher tumor burden and poorer clinical outcomes in metastatic breast cancer, but there is little data regarding the significance of serum HER2 levels at diagnosis in the operable breast cancer. We evaluated the association between baseline serum HER2 levels and clinicopathologic parameters, and the correlation of baseline serum HER2 levels with clinical outcome by molecular subtype in operable breast cancer patients. Methods: We included patients with stage I-III breast cancer diagnosed at our center between October 2004 and December 2011. Baseline serum HER2 levels were measured by chemiluminescence immunoassay at diagnosis. Patients were categorized into 4 molecular subtype groups by their hormone receptor (HR) status and HER2 status: HR+/HER2-, HR+/HER2+, HR-/HER2+ and HR-/HER2-. HR and HER2 status were determined by immuhohistochemistry (IHC) in all tumors, and fluorescence in situ hybridization (FISH) assay was performed whenever the HER2 status was equivocal. Results: There were 439 consecutive stage I-III breast cancer patients, of which 271 (61.7%) were HR+/HER2-, 75 (17.1%) were HR+/HER2+, 30 (6.8%) were HR-/HER+ and 63 (14.4%) were HR-/HER2-. A total of 192 patients underwent neoadjuvant chemotherapy and the remaining 235 patients did not. Of these 235 patients, 204 underwent adjuvant chemotherapy. High serum HER2 levels (≥15 ng/ml) were reported in 51 patients (11.6%) and HER2-positive status in tumor tissue was observed in 105 patients (23.9%). High serum HER2 levels were significantly associated with tumor size &gt; 2cm (p=0.032), high histologic grade (0.048), negative HR status and neoadjuvant chemotherapy usage. Patients who had high baseline serum HER2 levels had a worse disease free survival (DFS) (p&lt;0.001). Especially, high baseline serum HER2 levels were associated with worse DFS in HR+/HER2-, HR+/HER2+ and HR-/HER2+ subtypes (p=0.005, 0.001 and 0.027 respectively). However there was no significant correlation between baseline serum HER2 and DFS in the HR-HER2- subtype (p=0.614). Conclusions: This is the largest study in the evaluation of serum HER2 levels at diagnosis on the prognosis of patients with operable breast cancer. Our results showed that baseline serum HER2 level is a good prognostic marker in patients with operable breast cancer. High serum HER2 levels at diagnosis were associated with worse DFS, especially in patients of HR+/HER2-, HR+/HER2+ and HR-/HER2+ subtypes. Citation Format: Moo Hyun Lee, Siew Kuan Lim, Ji Young You, Eun Jin Song, So-Youn Jung, See Youn Lee, Han-Sung Kang, Eun Sook Lee. The significance of serum HER2 levels at diagnosis on outcome of breast cancer patients by molecular subtype [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-02-04.

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