bims-eabrec Biomed News
on Early breast cancer in young women
Issue of 2023–01–08
eight papers selected by
Rakesh Kumar, Swami Rama University
  1. Recommendations for the diagnosis and treatment of patients with early breast cancer: update 2023.
  2. Young Black Women May be More Likely to Have First Mammogram Cancers: A New Perspective in Breast Cancer Disparities.
  3. Clinicopathologic features, treatment, and prognosis of pregnancy-associated breast cancer.
  4. Lack of Prognostic Value of Pretreatment Neutrophil-to-Lymphocyte Ratio in Early Breast Cancer.
  5. Impact of age on indication for chemotherapy in early breast cancer patients: results from 104 German institutions from 2008 to 2017.
  6. Treatment Outcomes according to the EndoPredict Score in ER-Positive, HER2-Negative Early Breast Cancer.
  7. Liquid biopsy for monitoring of tumor dormancy and early detection of disease recurrence in solid tumors.
  8. "Double awareness"-adolescents and young adults coping with an uncertain or poor cancer prognosis: A qualitative study.
  1. Curr Opin Obstet Gynecol. 2023 Feb 01. 35(1): 67-72
    Recommendations for the diagnosis and treatment of patients with early breast cancer: update 2023.
    Melitta M Köpke, Bahriye Aktas, Nina Ditsch.
       PURPOSE OF REVIEW: In recent years, the therapy of breast carcinoma has evolved at a rapid pace. Therapies from metastasis are pushing into the (neo)adjuvant treatment of breast carcinoma at ever shorter intervals.
    RECENT FINDINGS: Biomarker-based therapeutic approaches became more and more en vogue to guide (neo)adjuvant endocrine therapy and chemotherapy.
    SUMMARY: This article reviews recent data developments in early breast cancer (EBC) and current recommendations in diagnosis and therapy.
    DOI:  https://doi.org/10.1097/GCO.0000000000000835
  2. Ann Surg Oncol. 2023 Jan 05.
    Young Black Women May be More Likely to Have First Mammogram Cancers: A New Perspective in Breast Cancer Disparities.
    Avia D Wilkerson, Megan Obi, Camila Ortega, Audry Sebikali-Potts, Wei Wei, Holly J Pederson, Zahraa Al-Hilli.
       INTRODUCTION: Black women are diagnosed with breast cancer at earlier ages and are 42% more likely to die from the disease than White women. Recommendations for commencement of screening mammography remain discordant. This study sought to determine the frequency of first mammogram cancers among Black women versus other self-reported racial groups.
    METHODS: In this retrospective cohort study, clinical and mammographic data were obtained from 738 women aged 40-45 years who underwent treatment for breast cancer between 2010 and 2019 within a single hospital system. First mammogram cancers were defined as those with tissue diagnoses within 3 months of baseline mammogram. Multivariate logistic regression was applied to assess variables associated with first mammogram cancer detection.
    RESULTS: Black women were significantly more likely to have first mammogram cancer diagnoses (39/82, 47.6%) compared with White women (162/610, 26.6%) and other groups (16/46, 34.8%) [p < 0.001]. Black women were also more likely to have a body mass index > 30 (p < 0.001), higher clinical T categories (p = 0.02), and present with more advanced clinical stages (p = 0.03). Every month delay in mammographic screening beyond age 40 years (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.05-1.07; p < 0.0001), Black race (OR 2.24, 95% CI 1.10-4.53; p = 0.03), and lack of private insurance (OR 2.41, 95% CI 1.22-4.73; p = 0.01) were associated with an increased likelihood of cancer detection on first mammogram.
    CONCLUSION: Our findings suggests that Black women aged 40-45 years may be more likely to have cancer detected on their first mammogram and would benefit from starting screening mammography no later than age 40 years, and for those with elevated lifetime risk, even sooner.
    DOI:  https://doi.org/10.1245/s10434-022-12995-y
  3. Front Oncol. 2022 ;12 978671
    Clinicopathologic features, treatment, and prognosis of pregnancy-associated breast cancer.
    Yuechong Li, Yingjiao Wang, Qiang Sun, Songjie Shen.
       Purpose: To identify the clinicopathological features, treatment, and prognosis of patients with breast cancer, who were diagnosed during and after pregnancy.
    Methods: We searched for patients with pregnancy-associated breast cancer (PABC) using the big data query and analysis system of Peking Union Medical College Hospital from between January 1, 2013, and December 31, 2021, and matched each patient with two non-PABC patients by age at diagnosis, year at diagnosis, and tumor stage. The clinicopathologic features, treatment, and outcomes of breast cancer during pregnancy (BC-P) and breast cancer during the first-year post-partum (BC-PP) were examined retrospectively in two case-control studies.
    Results: Eighteen BC-P cases, 36 controls for BC-P cases, 62 BC-PP cases, and 124 controls for BC-PP cases were enrolled in our study. The expression of HER-2 and Ki-67 was higher in BC-PP cases than in its controls (P=0.01, 0.018, respectively). Patients with BC-PP were more likely to choose mastectomy than breast-conserving surgery (P=0.001). There were no significant differences in event-free survival (EFS) between patients with BC-P and BC-PP and their controls.
    Conclusion: BC-P and BC-PP patients displayed adverse clinicopathological features in our population. However, when matched by age at diagnosis, year of diagnosis, and tumor stage, BC-P and BC-PP patients did not show inferior outcomes to controls, probably due to aggressive multimodality therapy.
    Keywords:  clinical features; event-free survival; pregnancy-associated breast cancer; prognosis; treatment
    DOI:  https://doi.org/10.3389/fonc.2022.978671
  4. Breast Care (Basel). 2022 Dec;17(6): 546-553
    Lack of Prognostic Value of Pretreatment Neutrophil-to-Lymphocyte Ratio in Early Breast Cancer.
    Maria Del Rosario Sifón, Nicolas Marcolini, Maria Julia Barber, Ignacio Mclean, Manglio Rizzo, Sergio Rivero, Maria Victoria Costanzo, Adrian Nervo, Gabriel Crimi, Florencia Perazzo, Estrella Mariel Levy, Pablo Mandó.
       Background: Breast cancer is a highly heterogeneous disease with large differences in the risk of recurrence. An elevated neutrophil-to-lymphocyte ratio (NLR) is correlated with a poor prognosis in a variety of tumors, and although it is still controversial in breast cancer, there are multiple studies, including meta-analysis, suggesting this. The purpose of this study was to analyze the prognostic value of preoperative NLR in an Argentine population of patients with nonmetastatic breast cancer, not exposed to neoadjuvant treatment.
    Methods: Retrospective multicenter cohort study that includes patients over 18 years of age from three centers in the city and province of Buenos Aires who have had surgery for early breast cancer between January 1, 1999, and December 31, 2014. Based on the previous literature, a cutoff value of 2.0 was defined.
    Results: A total of 791 patients were eligible for the analysis. Median age was 55 years (IQR 45-65). Median NLR was 1.92 (IQR 1.50-2.56). The distribution of groups according to the 8th edition of the AJCC was 54.1% for stage I, 35.6% stage II, and 10.4% stage III. Among the different tumor phenotypes, 79.0% were HR+/HER2-, 11.4% were HR+ or-/HER2+, and 9.2% were HR-/HER2-. With a median follow-up of 5.3 years, 112 patients (14.2%) had disease recurrence. Stage III patients had a higher NLR than stage I and stage II patients (p = 0.002). The rest of the clinical and pathological characteristics did not show differences in the groups according to NLR. There were no differences in relapse-free survival according to the NLR (p = 0.37), and it did not change after adjusting for other prognostic variables.
    Conclusion: We consider it is important to determine the efficacy of prognostic markers that are easily accessible and of simple, systematic application. However, NLR does not appear to be an independent prognostic factor for recurrence in our population. In this sense, we consider it is important to publish negative results in order to avoid publication bias.
    Keywords:  Early breast cancer; Neutrophil-to-lymphocyte ratio; Prognostic factor
    DOI:  https://doi.org/10.1159/000525287
  5. Arch Gynecol Obstet. 2023 Jan 05.
    Impact of age on indication for chemotherapy in early breast cancer patients: results from 104 German institutions from 2008 to 2017.
    Ann Sophie Hoffmann, André Hennigs, Manuel Feisst, Mareike Moderow, Sabine Heublein, Thomas Maximilian Deutsch, Riku Togawa, Benedikt Schäfgen, Markus Wallwiener, Michael Golatta, Jörg Heil, Fabian Riedel.
       PURPOSE: Today, the decision to treat patients with chemotherapy for early breast cancer (EBC) is made based on the patient's individual risk stratification and tumor biology. In cases with chemotherapy indication, the neoadjuvant application (NACT) is the preferred option in comparison with primary surgery and adjuvant chemotherapy (ACT). Age remains a relevant factor in the decision-making process. The aim of the present study was to illustrate the impact of age on the use of systemic therapy in clinical routine.
    METHODS: The study separately analyzed chemotherapy use among six age cohorts of EBC patients who had been treated at 104 German breast units between January 2008 and December 2017.
    RESULTS: In total, 124,084 patients were included, 46,279 (37.3%) of whom had received chemotherapy. For 44,765 of these cases, detailed information on treatment was available. Within this cohort, chemotherapy was administered as NACT to 14,783 patients (33.0%) and as ACT to 29,982 (67.0%) patients. Due to the higher prevalence of unfavorable tumor subtypes, younger patients had a higher rate of chemotherapy (≤ 29y: 74.2%; 30-39y: 71.3%) and a higher proportion of NACT administration ( ≤ 29y: 66.9%; 30-39y: 56.0%) in comparison with elderly patients, who had lower rates for overall chemotherapy (60-69y: 37.5%; ≥ 70y: 17.6%) and NACT (60-69y: 25.5%; ≥ 70y: 22.8%). Pathologic complete response was higher in younger than in older patients (≤ 29y: 30.4% vs. ≥ 70y: 16.7%), especially for HER2- subtypes.
    CONCLUSION: The data from the nationwide German cohort reveal relevant age-dependent discrepancies concerning the use of chemotherapy for EBC.
    Keywords:  Age; Early breast cancer; Elderly patients; Neoadjuvant chemotherapy; Pathological complete response
    DOI:  https://doi.org/10.1007/s00404-022-06902-9
  6. Breast Care (Basel). 2022 Dec;17(6): 561-566
    Treatment Outcomes according to the EndoPredict Score in ER-Positive, HER2-Negative Early Breast Cancer.
    Wonguen Jung, Kyubo Kim, Byung-In Moon.
       Purpose: The purpose of this study was to evaluate the treatment outcomes of estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2-) breast cancer according to the risk group using EndoPredict (EP) score.
    Patients and Methods: Between 2015 and 2019, 207 patients with ER+/HER2- pN0-N1 early breast cancer who underwent surgery, EP test, and adjuvant radiotherapy were accrued. The EPclin score, which combines the molecular EP score with nodal status and tumor size, was calculated, and patients were divided into EPclin low- or high-risk groups by the cutoff value of 3.3.
    Results: There were 154 and 53 patients in the EPclin low- and high-risk groups, respectively. Forty-one patients (81.1%) of the high-risk group received adjuvant chemotherapy, while only 1 (0.6%) of the low-risk group did. With a median follow-up of 54.1 months (range 8.2-76.6), the 5-year disease-free survival rates of low- and high-risk groups were 100% and 88.9%, respectively (p < 0.001).
    Conclusions: The EPclin score was associated with recurrences in ER+/HER2- early breast cancer.
    Keywords:  Breast cancer; EndoPredict; Radiotherapy; Treatment outcome
    DOI:  https://doi.org/10.1159/000525838
  7. Cancer Metastasis Rev. 2023 Jan 06.
    Liquid biopsy for monitoring of tumor dormancy and early detection of disease recurrence in solid tumors.
    Isabel Heidrich, Benjamin Deitert, Stefan Werner, Klaus Pantel.
      Cancer is one of the three leading causes of death worldwide. Even after successful therapy and achieving remission, the risk of relapse often remains. In this context, dormant residual cancer cells in secondary organs such as the bone marrow constitute the cellular reservoir from which late tumor recurrences arise. This dilemma leads the term of minimal residual disease, which reflects the presence of tumor cells disseminated from the primary lesion to distant organs in patients who lack any clinical or radiological signs of metastasis or residual tumor cells left behind after therapy that eventually lead to local recurrence. Disseminated tumor cells have the ability to survive in a dormant state following treatment and linger unrecognized for more than a decade before emerging as recurrent disease. They are able to breakup their dormant state and to readopt their proliferation under certain circumstances, which can finally lead to distant relapse and cancer-associated death. In recent years, extensive molecular and genetic characterization of disseminated tumor cells and blood-based biomarker has contributed significantly to our understanding of the frequency and prevalence of tumor dormancy. In this article, we describe the clinical relevance of disseminated tumor cells and highlight how latest advances in different liquid biopsy approaches can be used to detect, characterize, and monitor minimal residual disease in breast cancer, prostate cancer, and melanoma patients.
    Keywords:  Breast cancer; Circulating tumor DNA; Circulating tumor cells; Disseminated tumor cells; Melanoma; Minimal residual disease; Prostate cancer
    DOI:  https://doi.org/10.1007/s10555-022-10075-x
  8. Front Psychol. 2022 ;13 1026090
    "Double awareness"-adolescents and young adults coping with an uncertain or poor cancer prognosis: A qualitative study.
    Vivian W G Burgers, Martin J van den Bent, Judith A C Rietjens, Daniëlle C Roos, Annemiek Dickhout, Suzanne A Franssen, Marloes J Noordoek, Winette T A van der Graaf, Olga Husson.
       Introduction: Adolescents and young adults with an uncertain or poor cancer prognosis (UPCP) are confronted with ongoing and unique age-specific challenges, which forms an enormous burden. To date, little is known about the way AYAs living with a UPCP cope with their situation. Therefore, this study explores how AYAs with a UPCP cope with the daily challenges of their disease.
    Method: We conducted semi-structured in-depth interviews among AYAs with a UPCP. Patients of the three AYA subgroups were interviewed (traditional survivors, new survivors, low-grade glioma survivors), since we expected different coping strategies among these subgroups. Interviews were analyzed using elements of the Grounded Theory by Corbin and Strauss. AYA patients were actively involved as research partners.
    Results: In total 46 AYAs with UPCP participated, they were on average 33.4 years old (age range 23-44) and most of them were woman (63%). Most common tumor types were low-grade gliomas (16), sarcomas (7), breast cancers (6) and lung cancers (6). We identified seven coping strategies in order to reduce the suffering from the experienced challenges: (1) minimizing impact of cancer, (2) taking and seeking control, (3) coming to terms, (4) being positive, (5) seeking and receiving support, (6) carpe diem and (7) being consciously alive.
    Conclusion: This study found seven coping strategies around the concept of 'double awareness' and showcases that AYAs are able to actively cope with their disease but prefer to actively choose life over illness. The findings call for CALM therapy and informal AYA support meetings to support this group to cope well with their disease.
    Keywords:  CALM therapy; adolescents and young adults; coping; qualitative research; uncertain or poor cancer prognosis
    DOI:  https://doi.org/10.3389/fpsyg.2022.1026090
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