Characteristics and clinical outcome of T1 breast cancer: a multicenter retrospective cohort study

Houvenaeghel, Gilles; Gonçalvès, Anthony; Classe, Jean Marc; Garbay, J. R.; Giard, S.; Charytensky, H.; Cohen, Monique; Bélichard, C.; Faure, C.; Uzan, Serge; Hudry, Delphine; Azuar, P.; Villet, R.; Gimbergues, Pierre; Lara, C. Tunon de; Martino, Marc; Lambaudie, Éric; Coutant, Charles; Dravet, F.; Chauvet, M-P; Ewald, E. Chereau; Penault‐Llorca, Frédérique; Esterni, Benjamin

doi:10.1093/annonc/mdt532

Cited by 46 publications

(44 citation statements)

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“…In statistical terms, the question is "Are there variables n 1 , n 2 , n 3 , ... n x , such that, after adjusting for n 1 , n 2 , n 3 , ... n x in a follow-up study, size is no longer predictive of survival?" For example, in a study of 5423 women with cancers of less than 2.0 cm, tumour size was not predictive of survival after adjustment for grade, hormone receptor status, and her2 expression 30 . Those data suggest that, as the mean size of breast cancers in a population diminishes, further reductions in size can achieve only marginally less benefit.…”

Section: -Alexander Pope An Essay On Criticismmentioning

confidence: 99%

“…The strongest relationship is seen with large cancers and node-positive cancers 29 . The relationship is attenuated among women with triple-negative cancers, with her2 (human epidermal growth factor receptor 2)-positive cancers, and with BRCA1-positive cancers 19,30 . Size does not predict mortality well for women with nonpalpable cancers 29 .…”

Section: -Alexander Pope An Essay On Criticismmentioning

confidence: 99%

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Reflections on Screening Mammography and the Early Detection of Breast Cancer

Narod

2014

Current Oncology

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A Countercurrents Series a with S.A. Narod md assigned surreptitiously to the mammography arm, which explains the lack of observed benefit 11 .The most recent nbss report 1 tallied the breast cancers that occurred in each of the two study arms after the screening period ended (that is, between years 6 and 25), counting 2584 cancers in the screening arm and 2609 cancers in the control arm. If the screening arm had been enriched for women at "high risk," that enrichment must have been performed in a peculiar fashion, using only risk factors that have a transient effect. Perhaps Dr. Mukherjee would care to explain what those factors were. It follows that the excess of cancers seen in the screening period (years 1-5: 666 vs. 524) was a result of early diagnosis and not from stacking the deck.In any case, compelling evidence against the criticism of assignment of high-risk women to the screening arm is provided in the most recent analysis 1 , and that criticism is no longer raised (although no one has retracted or apologized). Instead, critics now insist that many women with palpable lesions were sent directly to the screening arm by duplicitous research assistants. There is no reason to believe that such actions (which would involve a national conspiracy of dozens of coordinators who spoke two official languages) were taken, but even if they had been, the study and its conclusions would not necessarily be invalidated. Even if all the women with prevalent cancers had been shunted to the screening arm, the situation could still be remedied by ignoring all cancers found at the first screening round (prevalent cancers) and focusing instead on the incident cancers. Such a strategy is not uncommon in screening studies. In the nbss, no woman had the opportunity to "cross the floor" from one study arm to the other after initial assignment. Therefore, if we exclude all prevalent cases from the analysis and focus on women with no cancer at study entry, we can re-evaluate the benefit of mammography thereafter. The hazard ratio for death from breast cancers detected in screening rounds 2-5 was 0.90 (95% confidence interval: 0.69 to 1.16; p = 0.40).A little learning is a dangerous thing. -Alexander Pope, An Essay on CriticismIn the stormy aftermath of the recent publication of results from the 25-year Canadian National Breast Screening Study (nbss) 1 , various opinions questioning the validity of the study's results have been expressed 2-7 . I was a latecomer to the study. In 2005, I was charged with oversight of the final record linkage and the statistical analysis and interpretation of the final data set. Dr. Anthony Miller has been my mentor since 1987. Our first joint paper, on screening for cervical cancer, was published in 1991 8 . I chose not to respond to individual criticisms, but instead to collect my thoughts and to try to explain why the study authors saw no benefit from screening.Most of the criticism from the radiology community focuses on issues of study design (which they claim was inadequate) and on the quality ...

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Section: -Alexander Pope An Essay On Criticismmentioning

confidence: 99%

Section: -Alexander Pope An Essay On Criticismmentioning

confidence: 99%

Reflections on Screening Mammography and the Early Detection of Breast Cancer

Narod

2014

Current Oncology

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“…These results correspond approximately to the literature. For example, Houvenaeghel et al [2] analysed 5,423 patients with T1 BC and showed a 10-year RFS of 83.8% and an OAS of 90.7%. Fisher et al [8] also described an 8-year OAS of 92%.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, especially the incidence of small BCs (pT1), including pT1mic ( ≤ 0.1 cm), pT1a (>0.1 cm and ≤ 0.5 cm), pT1b (>0.5 cm and ≤ 1.0 cm), and pT1c (>1.0 cm and ≤ 2.0 cm), has increased over time. pT1 BCs, and in particular pT1 pN0 BCs, normally carry good prognosis, with cancer-specific survival rates after 5-10 years as high as 90 or 95% [2] . There is an ongoing discussion about the benefit of adjuvant systemic therapy (AST) for these small BCs.…”

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confidence: 99%

Are There Breast Cancer Patients with Node-Negative Small Tumours, Who Do Not Benefit from Adjuvant Systemic Therapy?

Stüber

Novopashenny²,

Diessner³

et al. 2017

Oncology

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Objective: To identify subgroups of patients with pT1 pN0 breast cancer (BC) who might not profit from adjuvant systemic therapy (AST). Methods: Data of 3,774 pT1 pN0 BC patients from 17 certified BC centres within the BRENDA study group were collected between 1992 and 2008 and retrospectively analysed. Uni- and multivariate analyses were performed using Kaplan-Meier methods and Cox regression models. Results: 279 (7.4%) of the pT1 pN0 BC patients were T1a, 944 (25.0%) were T1b and 2,551 (67.6%) were T1c. There was no significant difference (p > 0.1) in recurrence-free survival (RFS)/overall survival (OAS) between patients with pT1a, pT1b, and T1c. Patients receiving any type of AST had a better outcome compared to women without AST after adjusting for age, tumour size, and intrinsic subtypes (RFS: p < 0.001; OAS: p < 0.001). AST was the most important prognostic parameter for RFS followed by intrinsic subtypes and age. Conclusion: Patients with pT1 pN0 BC profit from AST independently of molecular subtypes, tumour size, age or comorbidity, with 5-year RFS of more than 95%. The correct definition of subgroups of patients who do not need AST is still an open question.

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“…However, it has been shown that about 25% of all relapses of small lobular/ductal cancers occur beyond 10 years (7). High grade, young age, high proliferation, and vascular invasion are considered adverse prognostic signs even among T 1a,b N 0 tumors, suggesting a potential benefit of more aggressive therapy in women diagnosed with tumors harboring any or all of these features (8)(9)(10)(11). Furthermore, the classification of breast cancers into different subtypes (luminal A, luminal B, triple negative, and HER2 positive), appears also to affect prognosis and treatment decisions in such early cases (10,12,13).…”

Section: Introductionmentioning

confidence: 99%

New Strategies in Breast Cancer: The Significance of Molecular Subtypes in Systemic Adjuvant Treatment for Small T1a,bN0M0 Tumors

Sonnenblick

Fumagalli

Azim

et al. 2014

Clinical Cancer Research

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Awareness of breast cancer heterogeneity has strikingly increased in the past decade in parallel with the development of high-throughput molecular tests. Beyond the clear usefulness of antiestrogen treatment in luminal tumors and trastuzumab in HER2-positive tumors, breast cancer subtypes may have additional clinical and predictive roles that can be relevant to clinical practice. In this article, we discuss the significance of molecular subtypes in the systemic treatment of early-stage breast tumors smaller than 1 cm (T 1a,b N 0 M 0 ) and suggest new strategies for future treatment recommendations for these patients. Clin Cancer Res; 20(24); 6242-6. Ó2014 AACR.

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Characteristics and clinical outcome of T1 breast cancer: a multicenter retrospective cohort study

Cited by 46 publications

References 30 publications

Reflections on Screening Mammography and the Early Detection of Breast Cancer

Reflections on Screening Mammography and the Early Detection of Breast Cancer

Are There Breast Cancer Patients with Node-Negative Small Tumours, Who Do Not Benefit from Adjuvant Systemic Therapy?

New Strategies in Breast Cancer: The Significance of Molecular Subtypes in Systemic Adjuvant Treatment for Small T1a,bN0M0 Tumors

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