Are International Guidelines for the Prescription of Adjuvant Treatment for Early Breast Cancer Followed in Clinical Practice? Results of a Population-Based Study on 1547 Patients

Palazzi, Mauro; Tomasi, Dolores De; D'Affronto, C.; Richetti, A.; Valli, M.; Meregalli, S.; Asnaghi, D.; Arienti, Virginia; Cavallini, Dario; Pradella, R.; Cafaro, Ines; Baroncelli, Gianni; Lorenzo, Innocenzo Di; Agostini, Antonio De; Parrinello, Giovanni; Bertoni, F.

doi:10.1177/030089160208800614

Cited by 20 publications

(10 citation statements)

References 3 publications

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“…These problems could lead to overtreatment or undertreatment in Ki-67 Expression in Early Breast Cancerclinical practice. 3,39,40 One problem is that the number of patients in the low-risk group is too small. In this study, only 196 patients (18.4%) were classified in the low-risk group.…”

Section: Discussionmentioning

confidence: 99%

Ki-67 Expression Gives Additional Prognostic Information on St. Gallen 2007 and Adjuvant! Online Risk Categories in Early Breast Cancer

et al. 2009

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Background. We sought to determine the significance of Ki-67, one of the tumor cell proliferation markers, as a useful prognostic factor in early breast cancer. Results. Univariate analysis determined that tumor size, lymph node involvement, histologic grade, estrogen receptor, progesterone receptor, bcl-2, and Ki-67 (C10%) were statistically significant for both overall survival (OS) and distant metastasis-free survival (DFS). Of these factors, lymph node involvement and high Ki-67 expression were identified as independent prognostic factors for OS and DFS on the basis of multivariate analysis. The survivals of intermediate-and high-risk groups according to 2007 St. Gallen consensus were further separated by Ki-67 expression level (5-year DFS rate = 91.9% vs. 86.3% for Ki-67 \ 10% and C10%, respectively in intermediate-risk group (P = .01); 5-year DFS rate = 82.5% vs. 61.4% for Ki-67 \ 10% and C10%, respectively in high-risk group (P = .01)). The survivals of low-and high-risk groups according to Adjuvant! Online were further separated by Ki-67 expression level (5-year DFS rate = 97.8% vs. 89.5% for Ki-67 \ 10% and C10%, respectively in low-risk group (P = .02); 5-year DFS rate = 9.4% vs. 82.6% for Ki-67 \ 10% and C10% in highrisk group (P = .005)). Conclusions. Ki-67 is an independent prognostic factor for DFS and OS in early breast cancer and can provide additional prognostic information on the risk stratification with the use of the 2007 St. Gallen consensus and Adjuvant! Online.

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Section: Discussionmentioning

confidence: 99%

Ki-67 Expression Gives Additional Prognostic Information on St. Gallen 2007 and Adjuvant! Online Risk Categories in Early Breast Cancer

et al. 2009

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“…A recent study showed that higher intermediate test scores [25][26][27][28][29][30] are more likely to yield a CT recommendation, demonstrating that all patients within the intermediate RS category are not considered by physicians to have the same risk for recurrence [20]. Until the results of the TAILORx trial emerge [41] (to assess CT benefit in patients with RS [11][12][13][14][15][16][17][18][19][20][21][22][23][24]), Irish oncologists will continue to balance additional clinico-pathological factors in making adjuvant treatment decisions.…”

Section: Discussionmentioning

confidence: 99%

“…There is a wide variation in adjuvant CT recommendations among medical oncologists, unexplained by clinicopathological factors such as age, tumour size and histology alone [3,[9][10][11][12][13][14]. The use of novel prognostic and predictive tools in evaluating prognosis and informing treatment decisions can aid the appropriate selection of patients for CT, and may therefore reduce the cumulative clinical burden and cost of breast cancer management [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Economic impact of 21-gene recurrence score testing on early-stage breast cancer in Ireland

Smyth

Watson

Walsh

et al. 2015

Breast Cancer Res Treat

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The 21-gene test is a validated multi-gene diagnostic test that predicts chemotherapy (CT) benefit in oestrogen receptor positive (ER+), lymph node-negative (N0) breast cancer (BC) patients (pts). Ireland was the first public health care system to reimburse this test in Europe. Study objectives were to assess the impact of this test on decision-making and to analyse the economic impact of testing. Between October 2011 and February 2013, a national, retrospective, cross-sectional observational study of ER+, N0 BC pts tested with the 21-gene test was conducted. Surveyed breast medical oncologists, provided the assumption for the decision impact analysis that grade (G) 1 pts would not have received CT before testing and G2/3 pts would have received CT before testing. Descriptive statistical analyses were performed. 592 pts were identified; Low, intermediate and high recurrence score were identified in 53, 36 and 10 % pts, respectively. 384 (70 %) pts had G2, 129 (22 %) G3 and 76 (13 %) G1 tumours. Post testing, 345 pts (59 %) experienced a change in CT decision; 339 changed to hormone therapy alone and 6 advised to receive CT. 172 (30 %) pts received CT, 12 (3.9 %) of pts with low scores, 108 (50.9 %) of intermediate risk and 50 (90.9 %) of pts with high risk scores. Net reduction in CT use was 58 % and net savings achieved were €793,565. Since public reimbursement, the introduction of the 21-gene test has resulted in a significant reduction in chemotherapy administration and cost savings for the Irish public healthcare system.

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“…However, all these factors were known at the department of this study and were taken into account. Therefore we had expected a much higher adherence rate [11][12][13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Chronic idiopathic axonal polyneuropathy revisited

Rosenberg

Vermeulen

2004

J Neurol

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Are International Guidelines for the Prescription of Adjuvant Treatment for Early Breast Cancer Followed in Clinical Practice? Results of a Population-Based Study on 1547 Patients

Abstract: Despite the availability of official and authoritative guidelines, adjuvant treatment prescription for early breast cancer in Lombardy in 1997 was suboptimal, especially in well-defined subgroups of patients.

Cited by 20 publications

References 3 publications

Ki-67 Expression Gives Additional Prognostic Information on St. Gallen 2007 and Adjuvant! Online Risk Categories in Early Breast Cancer

Ki-67 Expression Gives Additional Prognostic Information on St. Gallen 2007 and Adjuvant! Online Risk Categories in Early Breast Cancer

Economic impact of 21-gene recurrence score testing on early-stage breast cancer in Ireland

Chronic idiopathic axonal polyneuropathy revisited

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