Comorbidities, age and period of diagnosis influence treatment and outcomes in early breast cancer

Minicozzi, Pamela; Eycken, Liesbet Van; Molinié, F.; Innos, Kaire; Guevara, Marcela; Marcos‐Gragera, Rafael; Castro, Clara; Rapiti, Elisabetta; Katalinic, Alexander; Gual-de-Torrella, Ana; Žagar, Tina; Bielska–Lasota, Magdalena; Rossi, Paolo Giorgi; Larrañaga, Nerea; Bastos, Joana; Sánchez, María José; Sant, Milena

doi:10.1002/ijc.31974

Cited by 30 publications

(37 citation statements)

References 31 publications

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“…Factors associated with treatment noncompliance. In agreement with previous studies, tumor characteristics (pre-surgical tumor size, grade, proxy subtype) and age at diagnosis were associated with initiation of recommended treatment [22][23][24] . Many factors can potentially influence a patient's decision to go along with recommended treatment: previous experiences and personal values 17 , fear of treatment-related side effects 18 , financial ability, age, education and health status, among others 19,20 .…”

Section: Discussionsupporting

confidence: 91%

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Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Sim

et al. 2020

Sci Rep

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Breast cancer survival has improved with significant progress in treatment and disease management. However, compliance with treatment varies. Treatment guidelines for older patients are unclear. We aim to identify predictors of noncompliance with recommended therapy in a large breast cancer population and assess the impact of noncompliance on survival. Our study included 19,241 non-metastatic female breast cancer patients, of whom 3,158 (16%) died within 10 years post-diagnosis (median survival = 5.8 years). We studied the association between treatment noncompliance and factors with logistic regression, and the impact of treatment noncompliance on survival with a flexible parametric survival model framework. The highest proportion of noncompliance was observed for chemotherapy (18%). Predictors of noncompliance with chemotherapy, radiotherapy and endocrine therapy included age, tumor size, nodal involvement and subtype (except radiotherapy). Factors associated with not receiving surgery included age and subtype. Treatment noncompliance was associated with worse overall survival for surgery (HR: 2.26 [1.80-2.83]), chemotherapy (1.25 [1.11-1.41]), radiotherapy (2.28 [1.94-2.69]) and endocrine therapy (1.70 [1.41-2.04]). Worse survival was similarly observed in older patients for whom guidelines generally do not apply. Our results highlight the importance of following appropriate treatment as recommended by current guidelines. Older patients may benefit from similar recommendations. Breast cancer is the leading type of cancer among Asian women, with an increasing number of cases diagnosed every year 1. Between 2003 and 2008, there were more than 2 million women living with breast cancer in SouthEast Asia, where a population of over 650 million women resides 2. As breast cancer is common, the number of lives claimed by the disease is high. On average ~100,000 deaths from breast cancer were recorded every year in the same region 3. With significant progress in treatment and disease management, a growing number of women are surviving breast cancer 4. However, breast cancer survival can vary between countries. While 90% of patients in the United States live at least five years after the cancer is found 5 , the corresponding proportion is lower in SouthEast Asia. In a report by Bhoo-Pathy et al., five-year overall survival rates were estimated to range from 58.5% to 75.8% in SouthEast Asia 6. Several professional organizations and consensus groups exist to translate evidence-based medicine into recommendations for best patient care 7. Examples of providers of such clinical practice guidelines include the

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Section: Discussionsupporting

confidence: 91%

“…treatment in older patients 35 . Clinicians are less likely to recommend aggressive or invasive treatment such as chemotherapy or surgery for older women due to the increased likelihood of existing comorbidities 23,24 . Nonetheless, older patients can benefit from optimal anti-cancer therapy.…”

Section: Treatment Compliance and Overall Survival The High Mortalitmentioning

confidence: 99%

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Sim

et al. 2020

Sci Rep

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“…It is known that older patients or patients with comorbidities often receive non-standard treatments. A recent analysis of 7581 early stage BC patients diagnosed in 9 European countries analyzed the influence of comorbidities on receiving standard treatments and found that mastectomy was mainly given to elderly women and women with comorbidities [38]. There are several other limitations to effectiveness research due to unpredictable confounding factors and consequently, misinterpretations of treatment and mortality effects should be avoided [39].…”

Section: Discussionmentioning

confidence: 99%

Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

Corradini

Reitz

Pazos

et al. 2019

Cancers

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Although the organ preservation strategy by breast-conserving surgery (BCS) followed by radiation therapy (BCT) has revolutionized the treatment approach of early stage breast cancer (BC), the choice between treatment options in this setting can still vary according to patient preferences. The aim of the present study was to compare the oncological outcome of mastectomy versus breast-conserving therapy in patients treated in a modern clinical setting outside of clinical trials. 7565 women diagnosed with early invasive BC (pT1/2pN0/1) between 1998 and 2014 were included in this study (median follow-up: 95.2 months). In order to reduce selection bias and confounding, a subgroup analysis of a matched 1:1 case-control cohort consisting of 1802 patients was performed (median follow-up 109.4 months). After adjusting for age, tumor characteristics and therapies, multivariable analysis for local recurrence-free survival identified BCT as an independent predictor for improved local control (hazard ratio [HR]:1.517; 95%confidence interval:1.092–2.108, p = 0.013) as compared to mastectomy alone in the matched cohort. Ten-year cumulative incidence (CI) of lymph node recurrences was 2.0% following BCT, compared to 5.8% in patients receiving mastectomy (p < 0.001). Similarly, 10-year distant-metastasis-free survival (89.4% vs. 85.5%, p = 0.013) was impaired in patients undergoing mastectomy alone. This translated into improved survival in patients treated with BCT (10-year overall survival (OS) estimates 85.3% vs. 79.3%, p < 0.001), which was also significant on multivariable analysis (p = 0.011). In conclusion, the present study showed that patients treated with BCS followed by radiotherapy had an improved outcome compared to radical mastectomy alone. Specifically, local control, distant control, and overall survival were significantly better using the conservative approach. Thus, as a result of the present study, physicians should encourage patients to receive BCS with radiotherapy rather than mastectomy, whenever it is medically feasible and appropriate.

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“…Extended female hormone exposure by the use of hormone-replacement therapy or early menarche or late menopause also increases the risk for breast cancer [3]. Mutations in the BRCA1 and BRCA2 genes represent a predisposing factor for breast cancer [5], similarly to a family history of breast cancer or personal history of neoplastic diseases or breast cancer [3] Finally, dense breast is an independent risk factor of breast cancer [1,6]. Physical activity, successful pregnancies, and lactation are protective factors [2,3].…”

Section: Breast Cancer a Leading Cause Of Death Among Womenmentioning

confidence: 99%

Microbiome—Microbial Metabolome—Cancer Cell Interactions in Breast Cancer—Familiar, but Unexplored

Mikó

Kovàcs

Sebő³

et al. 2019

Cells

151

201

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Breast cancer is a leading cause of death among women worldwide. Dysbiosis, an aberrant composition of the microbiome, characterizes breast cancer. In this review we discuss the changes to the metabolism of breast cancer cells, as well as the composition of the breast and gut microbiome in breast cancer. The role of the breast microbiome in breast cancer is unresolved, nevertheless it seems that the gut microbiome does have a role in the pathology of the disease. The gut microbiome secretes bioactive metabolites (reactivated estrogens, short chain fatty acids, amino acid metabolites, or secondary bile acids) that modulate breast cancer. We highlight the bacterial species or taxonomical units that generate these metabolites, we show their mode of action, and discuss how the metabolites affect mitochondrial metabolism and other molecular events in breast cancer. These metabolites resemble human hormones, as they are produced in a “gland” (in this case, the microbiome) and they are subsequently transferred to distant sites of action through the circulation. These metabolites appear to be important constituents of the tumor microenvironment. Finally, we discuss how bacterial dysbiosis interferes with breast cancer treatment through interfering with chemotherapeutic drug metabolism and availability.

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Comorbidities, age and period of diagnosis influence treatment and outcomes in early breast cancer

Cited by 30 publications

References 31 publications

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

Microbiome—Microbial Metabolome—Cancer Cell Interactions in Breast Cancer—Familiar, but Unexplored

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