Breast Cancer

Targeting cancer screenings based on idiopathic inflammatory myositis (IIM) subtype, autoantibodies, and age may help to maximize cancer detection while limiting false positives.

In a retrospective, single-center study conducted at Johns Hopkins University in Baltimore, researchers found that when screening patients with IIM for cancer via CT imaging, the diagnostic yield (number of cancers detected/tests performed) was highest in patients with dermatomyositis and the autoantibody anti–TIF1-gamma. Screening patients below age 40 years was associated with lower diagnostic yields and higher false positives, regardless of subtype.

Because of the well-known association between IIM and contemporaneous cancer, newly diagnosed patients with IIM often undergo screening. Yet, there is little research on the most efficient assessment approaches, Christopher Mecoli, MD, an assistant professor of medicine at John Hopkins University School of Medicine and lead author of the study, told this news organization. “There has been a lot written about how these patients should be evaluated for cancer. Unfortunately, the majority of literature is based on eminence,” he said. This study is “one of the first pieces of real data to inform that conversation,” he added.

The research was published online in Arthritis Care & Research.

In the study, Dr. Mecoli and colleagues looked at 1,086 patients enrolled in the center’s Myositis Research Registry from 2003 through 2020. The analysis included patients with a diagnosis of dermatomyositis, polymyositis, immune-mediated necrotizing myopathy (IMNM), and antisynthetase syndrome (ASyS). The researchers also looked at myositis-specific autoantibodies, including anti–TIF1-gamma, –Jo1, and –HMGCR. Patients were excluded from the analysis if they had a cancer diagnosis prior to their IIM onset.

Among patients included in the analysis, the average age of IIM onset was 49 years, and median follow-up duration was 5.3 years. Most patients were female (71%), 68% were white, 21% were Black, 3.6% were Asian, and 7.4% had a listed race of other or unknown. About 66% of all patients received a chest CT scan within 3 years of IIM onset, and 51% received an abdomen/pelvis CT in that same time frame. False positives were defined as the percentage of scans that led to a noncancerous biopsy.

During the study period, 62 patients had a cancer diagnosis within the first 3 years of IIM onset, with the most common cancers being breast (19%), melanoma (13%), and cervical/uterine (10%). Of 1,011 chest scans performed, 9 led to a cancer diagnosis (0.9%), compared with 12 of the 657 abdomen/pelvis (a/p) CT scans (1.8%). Patients with the dermatomyositis-specific autoantibody anti–TIF1-gamma had the highest diagnostic yield (2.9% in chest CT and 2.4% in a/p CT). Regardless of autoantibodies, dermatomyositis patients above 40 years of age had a diagnostic yield of 1.4% in chest CT and 2.7% in a/p CT. For patients under the age of 40 with polymyositis, IMNM, and ASyS, the diagnostic yield for all CT scans was 0.0%. The diagnostic yield in patients under 40 with dermatomyositis was also low (0.0% in chest CT, 0.8% in a/p CT).

The false-positive rate for all chest CT scans was 2.8%, with patients with IMNM and ASyS having the highest frequency of false positivity (both 4.4%). “Based on our data, CT chest imaging in ASyS and IMNM patients are associated with the most harm from a cancer screening perspective,” the authors write. In a/p CT, patients with dermatomyositis under 40 and patients with ASyS had the highest false-positive rates (4.9% and 3.8%, respectively).

“Age was a really big deal in terms of predicting diagnostic yield and false-positivity rate,” Dr. Mecoli said, particularly in patients with dermatomyositis. “This subgroup has historically been thought to have the biggest dissociation with cancer,” he said, but in patients under 40, “it doesn’t look like CT scans were that helpful. They were not picking up a lot of cancers, and they were leading to a lot of false-positive results.”

Still, Rohit Aggarwal, MD, of the division of rheumatology and clinical immunology at the University of Pittsburgh, Pennsylvania, noted that the diagnostic yields of 1%-2% and even 2%-4% in higher-risk populations were high. By comparison, lung cancer screening trials had a diagnostic yield of about 1%, and trials examining CT screening for colorectal cancers had diagnostic yields of 0.5%, the authors write.

“The key message for me is that we should definitely perform CT scans of the chest, abdomen, and pelvis within 3 years of diagnosis – typically at presentation – if the patient has any risk factor for increased risk of cancer, which include dermatomyositis and age above 40,” Dr. Aggarwal toldthis news organization. He was not involved with the research. There are also other clinical factors to consider that were not included in the study, he added, such as severe dysphagia, patients with refractory treatment, and male sex.

Both Dr. Aggarwal and Dr. Mecoli agreed that there are limitations to this single-center, retrospective study that make it difficult to generalize the results. Similar studies should be conducted at other institutions to see if these associations hold true, Dr. Mecoli said. A prospective study could also help control for factors such as selection bias, Dr. Aggarwal added. “I don’t think these are definitive data, but I think these data were needed at retrospective levels” to plan future research, he said.

The study was supported in part by grants from the National Institutes of Health, the Jerome L. Greene Foundation, the Donald B. and Dorothy L. Stabler Foundation, the Huayi and Siuling Zhang Discovery Fund, and Dr. Peter Buck. Dr. Mecoli and Dr. Aggarwal have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Targeting cancer screenings based on idiopathic inflammatory myositis (IIM) subtype, autoantibodies, and age may help to maximize cancer detection while limiting false positives.

In a retrospective, single-center study conducted at Johns Hopkins University in Baltimore, researchers found that when screening patients with IIM for cancer via CT imaging, the diagnostic yield (number of cancers detected/tests performed) was highest in patients with dermatomyositis and the autoantibody anti–TIF1-gamma. Screening patients below age 40 years was associated with lower diagnostic yields and higher false positives, regardless of subtype.

Because of the well-known association between IIM and contemporaneous cancer, newly diagnosed patients with IIM often undergo screening. Yet, there is little research on the most efficient assessment approaches, Christopher Mecoli, MD, an assistant professor of medicine at John Hopkins University School of Medicine and lead author of the study, told this news organization. “There has been a lot written about how these patients should be evaluated for cancer. Unfortunately, the majority of literature is based on eminence,” he said. This study is “one of the first pieces of real data to inform that conversation,” he added.

The research was published online in Arthritis Care & Research.

In the study, Dr. Mecoli and colleagues looked at 1,086 patients enrolled in the center’s Myositis Research Registry from 2003 through 2020. The analysis included patients with a diagnosis of dermatomyositis, polymyositis, immune-mediated necrotizing myopathy (IMNM), and antisynthetase syndrome (ASyS). The researchers also looked at myositis-specific autoantibodies, including anti–TIF1-gamma, –Jo1, and –HMGCR. Patients were excluded from the analysis if they had a cancer diagnosis prior to their IIM onset.

Among patients included in the analysis, the average age of IIM onset was 49 years, and median follow-up duration was 5.3 years. Most patients were female (71%), 68% were white, 21% were Black, 3.6% were Asian, and 7.4% had a listed race of other or unknown. About 66% of all patients received a chest CT scan within 3 years of IIM onset, and 51% received an abdomen/pelvis CT in that same time frame. False positives were defined as the percentage of scans that led to a noncancerous biopsy.

During the study period, 62 patients had a cancer diagnosis within the first 3 years of IIM onset, with the most common cancers being breast (19%), melanoma (13%), and cervical/uterine (10%). Of 1,011 chest scans performed, 9 led to a cancer diagnosis (0.9%), compared with 12 of the 657 abdomen/pelvis (a/p) CT scans (1.8%). Patients with the dermatomyositis-specific autoantibody anti–TIF1-gamma had the highest diagnostic yield (2.9% in chest CT and 2.4% in a/p CT). Regardless of autoantibodies, dermatomyositis patients above 40 years of age had a diagnostic yield of 1.4% in chest CT and 2.7% in a/p CT. For patients under the age of 40 with polymyositis, IMNM, and ASyS, the diagnostic yield for all CT scans was 0.0%. The diagnostic yield in patients under 40 with dermatomyositis was also low (0.0% in chest CT, 0.8% in a/p CT).

The false-positive rate for all chest CT scans was 2.8%, with patients with IMNM and ASyS having the highest frequency of false positivity (both 4.4%). “Based on our data, CT chest imaging in ASyS and IMNM patients are associated with the most harm from a cancer screening perspective,” the authors write. In a/p CT, patients with dermatomyositis under 40 and patients with ASyS had the highest false-positive rates (4.9% and 3.8%, respectively).

“Age was a really big deal in terms of predicting diagnostic yield and false-positivity rate,” Dr. Mecoli said, particularly in patients with dermatomyositis. “This subgroup has historically been thought to have the biggest dissociation with cancer,” he said, but in patients under 40, “it doesn’t look like CT scans were that helpful. They were not picking up a lot of cancers, and they were leading to a lot of false-positive results.”

Still, Rohit Aggarwal, MD, of the division of rheumatology and clinical immunology at the University of Pittsburgh, Pennsylvania, noted that the diagnostic yields of 1%-2% and even 2%-4% in higher-risk populations were high. By comparison, lung cancer screening trials had a diagnostic yield of about 1%, and trials examining CT screening for colorectal cancers had diagnostic yields of 0.5%, the authors write.

“The key message for me is that we should definitely perform CT scans of the chest, abdomen, and pelvis within 3 years of diagnosis – typically at presentation – if the patient has any risk factor for increased risk of cancer, which include dermatomyositis and age above 40,” Dr. Aggarwal toldthis news organization. He was not involved with the research. There are also other clinical factors to consider that were not included in the study, he added, such as severe dysphagia, patients with refractory treatment, and male sex.

Both Dr. Aggarwal and Dr. Mecoli agreed that there are limitations to this single-center, retrospective study that make it difficult to generalize the results. Similar studies should be conducted at other institutions to see if these associations hold true, Dr. Mecoli said. A prospective study could also help control for factors such as selection bias, Dr. Aggarwal added. “I don’t think these are definitive data, but I think these data were needed at retrospective levels” to plan future research, he said.

The study was supported in part by grants from the National Institutes of Health, the Jerome L. Greene Foundation, the Donald B. and Dorothy L. Stabler Foundation, the Huayi and Siuling Zhang Discovery Fund, and Dr. Peter Buck. Dr. Mecoli and Dr. Aggarwal have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Targeting cancer screenings based on idiopathic inflammatory myositis (IIM) subtype, autoantibodies, and age may help to maximize cancer detection while limiting false positives.

In a retrospective, single-center study conducted at Johns Hopkins University in Baltimore, researchers found that when screening patients with IIM for cancer via CT imaging, the diagnostic yield (number of cancers detected/tests performed) was highest in patients with dermatomyositis and the autoantibody anti–TIF1-gamma. Screening patients below age 40 years was associated with lower diagnostic yields and higher false positives, regardless of subtype.

Because of the well-known association between IIM and contemporaneous cancer, newly diagnosed patients with IIM often undergo screening. Yet, there is little research on the most efficient assessment approaches, Christopher Mecoli, MD, an assistant professor of medicine at John Hopkins University School of Medicine and lead author of the study, told this news organization. “There has been a lot written about how these patients should be evaluated for cancer. Unfortunately, the majority of literature is based on eminence,” he said. This study is “one of the first pieces of real data to inform that conversation,” he added.

The research was published online in Arthritis Care & Research.

In the study, Dr. Mecoli and colleagues looked at 1,086 patients enrolled in the center’s Myositis Research Registry from 2003 through 2020. The analysis included patients with a diagnosis of dermatomyositis, polymyositis, immune-mediated necrotizing myopathy (IMNM), and antisynthetase syndrome (ASyS). The researchers also looked at myositis-specific autoantibodies, including anti–TIF1-gamma, –Jo1, and –HMGCR. Patients were excluded from the analysis if they had a cancer diagnosis prior to their IIM onset.

Among patients included in the analysis, the average age of IIM onset was 49 years, and median follow-up duration was 5.3 years. Most patients were female (71%), 68% were white, 21% were Black, 3.6% were Asian, and 7.4% had a listed race of other or unknown. About 66% of all patients received a chest CT scan within 3 years of IIM onset, and 51% received an abdomen/pelvis CT in that same time frame. False positives were defined as the percentage of scans that led to a noncancerous biopsy.

During the study period, 62 patients had a cancer diagnosis within the first 3 years of IIM onset, with the most common cancers being breast (19%), melanoma (13%), and cervical/uterine (10%). Of 1,011 chest scans performed, 9 led to a cancer diagnosis (0.9%), compared with 12 of the 657 abdomen/pelvis (a/p) CT scans (1.8%). Patients with the dermatomyositis-specific autoantibody anti–TIF1-gamma had the highest diagnostic yield (2.9% in chest CT and 2.4% in a/p CT). Regardless of autoantibodies, dermatomyositis patients above 40 years of age had a diagnostic yield of 1.4% in chest CT and 2.7% in a/p CT. For patients under the age of 40 with polymyositis, IMNM, and ASyS, the diagnostic yield for all CT scans was 0.0%. The diagnostic yield in patients under 40 with dermatomyositis was also low (0.0% in chest CT, 0.8% in a/p CT).

The false-positive rate for all chest CT scans was 2.8%, with patients with IMNM and ASyS having the highest frequency of false positivity (both 4.4%). “Based on our data, CT chest imaging in ASyS and IMNM patients are associated with the most harm from a cancer screening perspective,” the authors write. In a/p CT, patients with dermatomyositis under 40 and patients with ASyS had the highest false-positive rates (4.9% and 3.8%, respectively).

“Age was a really big deal in terms of predicting diagnostic yield and false-positivity rate,” Dr. Mecoli said, particularly in patients with dermatomyositis. “This subgroup has historically been thought to have the biggest dissociation with cancer,” he said, but in patients under 40, “it doesn’t look like CT scans were that helpful. They were not picking up a lot of cancers, and they were leading to a lot of false-positive results.”

Still, Rohit Aggarwal, MD, of the division of rheumatology and clinical immunology at the University of Pittsburgh, Pennsylvania, noted that the diagnostic yields of 1%-2% and even 2%-4% in higher-risk populations were high. By comparison, lung cancer screening trials had a diagnostic yield of about 1%, and trials examining CT screening for colorectal cancers had diagnostic yields of 0.5%, the authors write.

“The key message for me is that we should definitely perform CT scans of the chest, abdomen, and pelvis within 3 years of diagnosis – typically at presentation – if the patient has any risk factor for increased risk of cancer, which include dermatomyositis and age above 40,” Dr. Aggarwal toldthis news organization. He was not involved with the research. There are also other clinical factors to consider that were not included in the study, he added, such as severe dysphagia, patients with refractory treatment, and male sex.

Both Dr. Aggarwal and Dr. Mecoli agreed that there are limitations to this single-center, retrospective study that make it difficult to generalize the results. Similar studies should be conducted at other institutions to see if these associations hold true, Dr. Mecoli said. A prospective study could also help control for factors such as selection bias, Dr. Aggarwal added. “I don’t think these are definitive data, but I think these data were needed at retrospective levels” to plan future research, he said.

The study was supported in part by grants from the National Institutes of Health, the Jerome L. Greene Foundation, the Donald B. and Dorothy L. Stabler Foundation, the Huayi and Siuling Zhang Discovery Fund, and Dr. Peter Buck. Dr. Mecoli and Dr. Aggarwal have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Key clinical point: A pro-inflammatory diet, as indicated by an increasing Dietary Inflammatory Index (DII), is associated with an increased risk of developing breast cancer (BC).

Major finding: Compared with the first DII quintile group (≥–25.91 to <–2.76), the hazard ratios for developing BC were 1.14 (95% CI 1.05-1.24) and 1.13 (95% CI 1.04-1.23) in the fourth (≥1.22 to <3.02) and fifth (≥3.02 to ≤13.37) DII quintile groups, respectively. The risk for BC was increased by 4% for 1 standard deviation increase in DII.

Study details: Findings are from a large population-based cohort study including 67,879 women without cancer who completed a dietary questionnaire, of which 5686 participants developed BC.

Disclosures: The E3N cohort is funded by the Mutuelle Générale de l’Education Nationale, France, and others. The authors declared no conflicts of interest.

Source: Hajji-Louati M et al. Dietary Inflammatory Index and risk of breast cancer: Evidence from a prospective cohort of 67,879 women followed for 20 years in France. Eur J Nutr. 2023 (Mar 4). Doi: 10.1007/s00394-023-03108-w

Key clinical point: A pro-inflammatory diet, as indicated by an increasing Dietary Inflammatory Index (DII), is associated with an increased risk of developing breast cancer (BC).

Major finding: Compared with the first DII quintile group (≥–25.91 to <–2.76), the hazard ratios for developing BC were 1.14 (95% CI 1.05-1.24) and 1.13 (95% CI 1.04-1.23) in the fourth (≥1.22 to <3.02) and fifth (≥3.02 to ≤13.37) DII quintile groups, respectively. The risk for BC was increased by 4% for 1 standard deviation increase in DII.

Study details: Findings are from a large population-based cohort study including 67,879 women without cancer who completed a dietary questionnaire, of which 5686 participants developed BC.

Disclosures: The E3N cohort is funded by the Mutuelle Générale de l’Education Nationale, France, and others. The authors declared no conflicts of interest.

Source: Hajji-Louati M et al. Dietary Inflammatory Index and risk of breast cancer: Evidence from a prospective cohort of 67,879 women followed for 20 years in France. Eur J Nutr. 2023 (Mar 4). Doi: 10.1007/s00394-023-03108-w

Key clinical point: A pro-inflammatory diet, as indicated by an increasing Dietary Inflammatory Index (DII), is associated with an increased risk of developing breast cancer (BC).

Major finding: Compared with the first DII quintile group (≥–25.91 to <–2.76), the hazard ratios for developing BC were 1.14 (95% CI 1.05-1.24) and 1.13 (95% CI 1.04-1.23) in the fourth (≥1.22 to <3.02) and fifth (≥3.02 to ≤13.37) DII quintile groups, respectively. The risk for BC was increased by 4% for 1 standard deviation increase in DII.

Study details: Findings are from a large population-based cohort study including 67,879 women without cancer who completed a dietary questionnaire, of which 5686 participants developed BC.

Disclosures: The E3N cohort is funded by the Mutuelle Générale de l’Education Nationale, France, and others. The authors declared no conflicts of interest.

Source: Hajji-Louati M et al. Dietary Inflammatory Index and risk of breast cancer: Evidence from a prospective cohort of 67,879 women followed for 20 years in France. Eur J Nutr. 2023 (Mar 4). Doi: 10.1007/s00394-023-03108-w

Key clinical point: Patients with breast cancer (BC) were significantly more likely to develop hypothyroidism, especially if they received radiation therapy to the supraclavicular region.

Major finding: BC survivors vs control individuals without BC had a 48% increased risk for hypothyroidism (pooled relative risk [RR] 1.48; 95% CI 1.17-1.87), with the risk being even higher in patients with BC who had received radiation therapy to supraclavicular lymph nodes vs breast and chest wall only (pooled RR 1.69; 95% CI 1.16-2.46).

Study details: Findings are from a meta-analysis of 20 studies including women with BC who had or had not received radiation therapy.

Disclosures: This study was supported by The Independent Research Fund Denmark, Medicine, and the Eva and Henry Frænkels Foundation, Denmark.. The authors declared no conflicts of interest.

Source: Solmunde E et al. Breast cancer, breast cancer-directed radiation therapy and risk of hypothyroidism: A systematic review and meta-analysis. Breast. 2023;68:216-224 (Feb 18). Doi: 10.1016/j.breast.2023.02.008

Key clinical point: Patients with breast cancer (BC) were significantly more likely to develop hypothyroidism, especially if they received radiation therapy to the supraclavicular region.

Major finding: BC survivors vs control individuals without BC had a 48% increased risk for hypothyroidism (pooled relative risk [RR] 1.48; 95% CI 1.17-1.87), with the risk being even higher in patients with BC who had received radiation therapy to supraclavicular lymph nodes vs breast and chest wall only (pooled RR 1.69; 95% CI 1.16-2.46).

Study details: Findings are from a meta-analysis of 20 studies including women with BC who had or had not received radiation therapy.

Disclosures: This study was supported by The Independent Research Fund Denmark, Medicine, and the Eva and Henry Frænkels Foundation, Denmark.. The authors declared no conflicts of interest.

Source: Solmunde E et al. Breast cancer, breast cancer-directed radiation therapy and risk of hypothyroidism: A systematic review and meta-analysis. Breast. 2023;68:216-224 (Feb 18). Doi: 10.1016/j.breast.2023.02.008

Key clinical point: Patients with breast cancer (BC) were significantly more likely to develop hypothyroidism, especially if they received radiation therapy to the supraclavicular region.

Major finding: BC survivors vs control individuals without BC had a 48% increased risk for hypothyroidism (pooled relative risk [RR] 1.48; 95% CI 1.17-1.87), with the risk being even higher in patients with BC who had received radiation therapy to supraclavicular lymph nodes vs breast and chest wall only (pooled RR 1.69; 95% CI 1.16-2.46).

Study details: Findings are from a meta-analysis of 20 studies including women with BC who had or had not received radiation therapy.

Disclosures: This study was supported by The Independent Research Fund Denmark, Medicine, and the Eva and Henry Frænkels Foundation, Denmark.. The authors declared no conflicts of interest.

Source: Solmunde E et al. Breast cancer, breast cancer-directed radiation therapy and risk of hypothyroidism: A systematic review and meta-analysis. Breast. 2023;68:216-224 (Feb 18). Doi: 10.1016/j.breast.2023.02.008

Key clinical point: Delay in adjuvant endocrine therapy (ET) worsened survival outcomes in patients with hormone receptor-positive (HR+) breast cancer (BC) who received adjuvant radiotherapy after neoadjuvant chemotherapy.

Major finding: An interval of >14 weeks between surgery and receipt of ET was associated with worse recurrence-free survival (hazard ratio 3.20; P = .02).

Study details: This study analyzed 179 patients with HR+ BC from a multi-institutional database who received adjuvant radiotherapy, of which 68 patients received adjuvant ET before or during radiotherapy and 111 patients received ET after cessation of radiotherapy.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Sutton TL et al. Delayed adjuvant endocrine therapy is associated with decreased recurrence-free survival following neoadjuvant chemotherapy for breast cancer. Am J Surg. 2023 (Feb 24). Doi: 10.1016/j.amjsurg.2023.02.020

Key clinical point: Delay in adjuvant endocrine therapy (ET) worsened survival outcomes in patients with hormone receptor-positive (HR+) breast cancer (BC) who received adjuvant radiotherapy after neoadjuvant chemotherapy.

Major finding: An interval of >14 weeks between surgery and receipt of ET was associated with worse recurrence-free survival (hazard ratio 3.20; P = .02).

Study details: This study analyzed 179 patients with HR+ BC from a multi-institutional database who received adjuvant radiotherapy, of which 68 patients received adjuvant ET before or during radiotherapy and 111 patients received ET after cessation of radiotherapy.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Sutton TL et al. Delayed adjuvant endocrine therapy is associated with decreased recurrence-free survival following neoadjuvant chemotherapy for breast cancer. Am J Surg. 2023 (Feb 24). Doi: 10.1016/j.amjsurg.2023.02.020

Key clinical point: Delay in adjuvant endocrine therapy (ET) worsened survival outcomes in patients with hormone receptor-positive (HR+) breast cancer (BC) who received adjuvant radiotherapy after neoadjuvant chemotherapy.

Major finding: An interval of >14 weeks between surgery and receipt of ET was associated with worse recurrence-free survival (hazard ratio 3.20; P = .02).

Study details: This study analyzed 179 patients with HR+ BC from a multi-institutional database who received adjuvant radiotherapy, of which 68 patients received adjuvant ET before or during radiotherapy and 111 patients received ET after cessation of radiotherapy.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Sutton TL et al. Delayed adjuvant endocrine therapy is associated with decreased recurrence-free survival following neoadjuvant chemotherapy for breast cancer. Am J Surg. 2023 (Feb 24). Doi: 10.1016/j.amjsurg.2023.02.020

Key clinical point: Estrogen therapy with or without the concurrent use of adjuvant aromatase inhibitors (AI) or tamoxifen did not increase the risk for mortality in women with early hormone receptor-positive (HR+) breast cancer (BC).

Major finding: No association was observed between BC mortality risk and receipt of estrogen therapy concurrent with AI, tamoxifen, or both AI and tamoxifen, although estrogen therapy without concurrent AI or tamoxifen was associated with decreased BC mortality risk (adjusted odds ratio 0.61; 95% CI 0.43-0.87).

Study details: Findings are from a population-based nested case-control study including patients with HR+ BC who received local estrogen therapy or AI, tamoxifen, or AI and tamoxifen sequentially, of which 1262 women died due to BC and were matched to 12,620 alive control individuals.

Disclosures: This study was supported by Bröstcancerförbundet, Sweden,and ALF Funding Region Örebro County, Sweden. The authors declared no conflicts of interest.

Source: Sund M et al. Estrogen therapy after breast cancer diagnosis and breast cancer mortality risk. Breast Cancer Res Treat. 2023 (Feb 11). Doi: 10.1007/s10549-023-06871-w

Key clinical point: Estrogen therapy with or without the concurrent use of adjuvant aromatase inhibitors (AI) or tamoxifen did not increase the risk for mortality in women with early hormone receptor-positive (HR+) breast cancer (BC).

Major finding: No association was observed between BC mortality risk and receipt of estrogen therapy concurrent with AI, tamoxifen, or both AI and tamoxifen, although estrogen therapy without concurrent AI or tamoxifen was associated with decreased BC mortality risk (adjusted odds ratio 0.61; 95% CI 0.43-0.87).

Study details: Findings are from a population-based nested case-control study including patients with HR+ BC who received local estrogen therapy or AI, tamoxifen, or AI and tamoxifen sequentially, of which 1262 women died due to BC and were matched to 12,620 alive control individuals.

Disclosures: This study was supported by Bröstcancerförbundet, Sweden,and ALF Funding Region Örebro County, Sweden. The authors declared no conflicts of interest.

Source: Sund M et al. Estrogen therapy after breast cancer diagnosis and breast cancer mortality risk. Breast Cancer Res Treat. 2023 (Feb 11). Doi: 10.1007/s10549-023-06871-w

Key clinical point: Estrogen therapy with or without the concurrent use of adjuvant aromatase inhibitors (AI) or tamoxifen did not increase the risk for mortality in women with early hormone receptor-positive (HR+) breast cancer (BC).

Major finding: No association was observed between BC mortality risk and receipt of estrogen therapy concurrent with AI, tamoxifen, or both AI and tamoxifen, although estrogen therapy without concurrent AI or tamoxifen was associated with decreased BC mortality risk (adjusted odds ratio 0.61; 95% CI 0.43-0.87).

Study details: Findings are from a population-based nested case-control study including patients with HR+ BC who received local estrogen therapy or AI, tamoxifen, or AI and tamoxifen sequentially, of which 1262 women died due to BC and were matched to 12,620 alive control individuals.

Disclosures: This study was supported by Bröstcancerförbundet, Sweden,and ALF Funding Region Örebro County, Sweden. The authors declared no conflicts of interest.

Source: Sund M et al. Estrogen therapy after breast cancer diagnosis and breast cancer mortality risk. Breast Cancer Res Treat. 2023 (Feb 11). Doi: 10.1007/s10549-023-06871-w

Key clinical point: Preoperative magnetic resonance imaging (MRI) of the breast increased mastectomy rates but did not affect the local recurrence and overall survival (OS) rates in patients with breast cancer (BC) who were eligible for breast-conserving surgery (BCS).

Major finding: Among BCS-eligible patients, surgical procedure was changed to mastectomy in 8.3% vs 0.4% of patients in the MRI vs routine radiologic exam group, respectively. There was no difference in local recurrence-free survival (hazard ratio [HR] 0.72; log-rank test P = .7) and OS (HR 1.37; log-rank test P = .8) between both patient populations.

Study details: Findings are from the phase 3 BREAST-MRI study including 524 patients with stage 0-III BC who were eligible for BCS and were randomly assigned to undergo preoperative MRI or radiologic exam routine with mammography and ultrasound.

Disclosures: This publication was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo, Brazil (FAPESP 2018/24224-9). The authors declared no conflicts of interest.

Source: Mota BS et al. Effects of preoperative magnetic resonance image on survival rates and surgical planning in breast cancer conservative surgery: Randomized controlled trial (BREAST-MRI trial). Breast Cancer Res Treat. 2023 (Feb 14). Doi: 10.1007/s10549-023-06884-5

Key clinical point: Preoperative magnetic resonance imaging (MRI) of the breast increased mastectomy rates but did not affect the local recurrence and overall survival (OS) rates in patients with breast cancer (BC) who were eligible for breast-conserving surgery (BCS).

Major finding: Among BCS-eligible patients, surgical procedure was changed to mastectomy in 8.3% vs 0.4% of patients in the MRI vs routine radiologic exam group, respectively. There was no difference in local recurrence-free survival (hazard ratio [HR] 0.72; log-rank test P = .7) and OS (HR 1.37; log-rank test P = .8) between both patient populations.

Study details: Findings are from the phase 3 BREAST-MRI study including 524 patients with stage 0-III BC who were eligible for BCS and were randomly assigned to undergo preoperative MRI or radiologic exam routine with mammography and ultrasound.

Disclosures: This publication was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo, Brazil (FAPESP 2018/24224-9). The authors declared no conflicts of interest.

Source: Mota BS et al. Effects of preoperative magnetic resonance image on survival rates and surgical planning in breast cancer conservative surgery: Randomized controlled trial (BREAST-MRI trial). Breast Cancer Res Treat. 2023 (Feb 14). Doi: 10.1007/s10549-023-06884-5

Key clinical point: Preoperative magnetic resonance imaging (MRI) of the breast increased mastectomy rates but did not affect the local recurrence and overall survival (OS) rates in patients with breast cancer (BC) who were eligible for breast-conserving surgery (BCS).

Major finding: Among BCS-eligible patients, surgical procedure was changed to mastectomy in 8.3% vs 0.4% of patients in the MRI vs routine radiologic exam group, respectively. There was no difference in local recurrence-free survival (hazard ratio [HR] 0.72; log-rank test P = .7) and OS (HR 1.37; log-rank test P = .8) between both patient populations.

Study details: Findings are from the phase 3 BREAST-MRI study including 524 patients with stage 0-III BC who were eligible for BCS and were randomly assigned to undergo preoperative MRI or radiologic exam routine with mammography and ultrasound.

Disclosures: This publication was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo, Brazil (FAPESP 2018/24224-9). The authors declared no conflicts of interest.

Source: Mota BS et al. Effects of preoperative magnetic resonance image on survival rates and surgical planning in breast cancer conservative surgery: Randomized controlled trial (BREAST-MRI trial). Breast Cancer Res Treat. 2023 (Feb 14). Doi: 10.1007/s10549-023-06884-5

Key clinical point: Vaginal laser treatment was not superior in improving sexual function and was less well tolerated than sham laser therapy (SLT) in survivors of breast cancer (BC) with genitourinary syndrome of menopause (GSM) who received treatment with aromatase inhibitors (AI).

Major finding: At 6 months, patients receiving fractional carbon dioxide laser therapy (CLT) and those receiving SLT had similar improvement in the female sexual function index score (P = .15), with the CLT vs SLT group having a significantly lower mean tolerance score (3.3 vs 4.1; P = .007).

Study details: Findings are from the randomized clinical trial LIGHT including 84 patients with BC who were receiving AI for GSM and were randomly assigned to receive a first-line therapy based on nonhormonal moisturizers and vaginal vibrator stimulation with fractional CLT or SLT.

Disclosures: This study was funded by grants from Instituto de Salud Carlos III and the European Union, with various items provided by DEKA, IntherPharma, CumLaude Lab, and BCNatal. The authors declared no conflicts of interest.

Source: Mension E et al. Effect of fractional carbon dioxide vs sham laser on sexual function in survivors of breast cancer receiving aromatase inhibitors for genitourinary syndrome of menopause: The LIGHT randomized clinical trial. JAMA Netw Open. 2023;6(2):e2255697 (Feb 10). Doi: 10.1001/jamanetworkopen.2022.55697

Key clinical point: Vaginal laser treatment was not superior in improving sexual function and was less well tolerated than sham laser therapy (SLT) in survivors of breast cancer (BC) with genitourinary syndrome of menopause (GSM) who received treatment with aromatase inhibitors (AI).

Major finding: At 6 months, patients receiving fractional carbon dioxide laser therapy (CLT) and those receiving SLT had similar improvement in the female sexual function index score (P = .15), with the CLT vs SLT group having a significantly lower mean tolerance score (3.3 vs 4.1; P = .007).

Study details: Findings are from the randomized clinical trial LIGHT including 84 patients with BC who were receiving AI for GSM and were randomly assigned to receive a first-line therapy based on nonhormonal moisturizers and vaginal vibrator stimulation with fractional CLT or SLT.

Disclosures: This study was funded by grants from Instituto de Salud Carlos III and the European Union, with various items provided by DEKA, IntherPharma, CumLaude Lab, and BCNatal. The authors declared no conflicts of interest.

Source: Mension E et al. Effect of fractional carbon dioxide vs sham laser on sexual function in survivors of breast cancer receiving aromatase inhibitors for genitourinary syndrome of menopause: The LIGHT randomized clinical trial. JAMA Netw Open. 2023;6(2):e2255697 (Feb 10). Doi: 10.1001/jamanetworkopen.2022.55697

Key clinical point: Vaginal laser treatment was not superior in improving sexual function and was less well tolerated than sham laser therapy (SLT) in survivors of breast cancer (BC) with genitourinary syndrome of menopause (GSM) who received treatment with aromatase inhibitors (AI).

Major finding: At 6 months, patients receiving fractional carbon dioxide laser therapy (CLT) and those receiving SLT had similar improvement in the female sexual function index score (P = .15), with the CLT vs SLT group having a significantly lower mean tolerance score (3.3 vs 4.1; P = .007).

Study details: Findings are from the randomized clinical trial LIGHT including 84 patients with BC who were receiving AI for GSM and were randomly assigned to receive a first-line therapy based on nonhormonal moisturizers and vaginal vibrator stimulation with fractional CLT or SLT.

Disclosures: This study was funded by grants from Instituto de Salud Carlos III and the European Union, with various items provided by DEKA, IntherPharma, CumLaude Lab, and BCNatal. The authors declared no conflicts of interest.

Source: Mension E et al. Effect of fractional carbon dioxide vs sham laser on sexual function in survivors of breast cancer receiving aromatase inhibitors for genitourinary syndrome of menopause: The LIGHT randomized clinical trial. JAMA Netw Open. 2023;6(2):e2255697 (Feb 10). Doi: 10.1001/jamanetworkopen.2022.55697

Key clinical point: Endocrine therapy (ET) did not have any detrimental effect on cognitive abilities in women aged ≥70 years with early breast cancer (BC).

Major finding: Patients receiving ET had a Mini-Mental State Examination (MMSE) score of 28.1, with mild and severe cognitive impairments observed in 25% and 2% of patients, respectively. The MSME score improved by 0.4 points (P = .013) after 15 months and by 0.5 points (P = .018) after 27 months in patients receiving ET.

Study details: Findings are from the observational CLIMB study including 273 women with stage I-III BC who were ≥70 years old, of which 48% received ET.

Disclosures: This study was funded by the KWF Dutch Cancer Society. The authors declared no conflicts of interest.

Source: Baltussen JC et al. Association between endocrine therapy and cognitive decline in older women with early breast cancer: Findings from the prospective CLIMB study. Eur J Cancer. 2023 (Feb 16). Doi: 10.1016/j.ejca.2023.02.008

Key clinical point: Endocrine therapy (ET) did not have any detrimental effect on cognitive abilities in women aged ≥70 years with early breast cancer (BC).

Major finding: Patients receiving ET had a Mini-Mental State Examination (MMSE) score of 28.1, with mild and severe cognitive impairments observed in 25% and 2% of patients, respectively. The MSME score improved by 0.4 points (P = .013) after 15 months and by 0.5 points (P = .018) after 27 months in patients receiving ET.

Study details: Findings are from the observational CLIMB study including 273 women with stage I-III BC who were ≥70 years old, of which 48% received ET.

Disclosures: This study was funded by the KWF Dutch Cancer Society. The authors declared no conflicts of interest.

Source: Baltussen JC et al. Association between endocrine therapy and cognitive decline in older women with early breast cancer: Findings from the prospective CLIMB study. Eur J Cancer. 2023 (Feb 16). Doi: 10.1016/j.ejca.2023.02.008

Key clinical point: Endocrine therapy (ET) did not have any detrimental effect on cognitive abilities in women aged ≥70 years with early breast cancer (BC).

Major finding: Patients receiving ET had a Mini-Mental State Examination (MMSE) score of 28.1, with mild and severe cognitive impairments observed in 25% and 2% of patients, respectively. The MSME score improved by 0.4 points (P = .013) after 15 months and by 0.5 points (P = .018) after 27 months in patients receiving ET.

Study details: Findings are from the observational CLIMB study including 273 women with stage I-III BC who were ≥70 years old, of which 48% received ET.

Disclosures: This study was funded by the KWF Dutch Cancer Society. The authors declared no conflicts of interest.

Source: Baltussen JC et al. Association between endocrine therapy and cognitive decline in older women with early breast cancer: Findings from the prospective CLIMB study. Eur J Cancer. 2023 (Feb 16). Doi: 10.1016/j.ejca.2023.02.008

Key clinical point: Patients with breast cancer (BC) should be recommended to undergo primary breast surgery within 8 weeks from BC diagnosis for best survival outcomes.

Major finding: Overall survival outcomes were worsened by ≥15% when the interval between BC diagnosis and surgery was ≥9 weeks compared with 0-4 weeks (hazard ratio at 9 weeks 1.15; P < .001).

Study details: Findings are from a case series study including 373,334 female patients with stage I-III BC who underwent primary breast surgery.

Disclosures: This study was supported by grants from the US National Cancer Institute and other sources. LG Wilke declared being the founder of and stock owner in Elucent Medical. BM Hanlon declared receiving grants from the US National Institutes of Health outside the submitted work.

Source: Wiener AA et al. Reexamining time from breast cancer diagnosis to primary breast surgery. JAMA Surg. 2023 (Mar 1). Doi: 10.1001/jamasurg.2022.8388

Key clinical point: Patients with breast cancer (BC) should be recommended to undergo primary breast surgery within 8 weeks from BC diagnosis for best survival outcomes.

Major finding: Overall survival outcomes were worsened by ≥15% when the interval between BC diagnosis and surgery was ≥9 weeks compared with 0-4 weeks (hazard ratio at 9 weeks 1.15; P < .001).

Study details: Findings are from a case series study including 373,334 female patients with stage I-III BC who underwent primary breast surgery.

Disclosures: This study was supported by grants from the US National Cancer Institute and other sources. LG Wilke declared being the founder of and stock owner in Elucent Medical. BM Hanlon declared receiving grants from the US National Institutes of Health outside the submitted work.

Source: Wiener AA et al. Reexamining time from breast cancer diagnosis to primary breast surgery. JAMA Surg. 2023 (Mar 1). Doi: 10.1001/jamasurg.2022.8388

Key clinical point: Patients with breast cancer (BC) should be recommended to undergo primary breast surgery within 8 weeks from BC diagnosis for best survival outcomes.

Major finding: Overall survival outcomes were worsened by ≥15% when the interval between BC diagnosis and surgery was ≥9 weeks compared with 0-4 weeks (hazard ratio at 9 weeks 1.15; P < .001).

Study details: Findings are from a case series study including 373,334 female patients with stage I-III BC who underwent primary breast surgery.

Disclosures: This study was supported by grants from the US National Cancer Institute and other sources. LG Wilke declared being the founder of and stock owner in Elucent Medical. BM Hanlon declared receiving grants from the US National Institutes of Health outside the submitted work.

Source: Wiener AA et al. Reexamining time from breast cancer diagnosis to primary breast surgery. JAMA Surg. 2023 (Mar 1). Doi: 10.1001/jamasurg.2022.8388

Key clinical point: Adjuvant treatment with paclitaxel and trastuzumab demonstrated very good long-term survival outcomes in patients with small, node-negative, human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC).

Major finding: After a median follow-up of 10.8 years, only 31 invasive disease-free survival events occurred, of which six were locoregional ipsilateral recurrences, nine were new contralateral breast cancers, six were distant recurrences, and 10 were all-cause deaths. The 10-year invasive disease-free survival rate was >90% (91.3%; 95% CI 88.3%-94.4%).

Study details: Findings are from the phase 2 APT study including 406 patients with small (≤3 cm), node-negative, HER2+ BC who received adjuvant paclitaxel+trastuzumab for 12 weeks followed by trastuzumab for 40 weeks to complete a full year of trastuzumab treatment.

Disclosures: This study was funded by Genentech. The authors declared receiving consulting or advisory board fees, grant support, payment, or having other ties with several sources.

Source: Tolaney SM et al. Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer: Final 10-year analysis of the open-label, single-arm, phase 2 APT trial. Lancet Oncol. 2023;24(3):273-285 (Feb 27). Doi: 10.1016/S1470-2045(23)00051-7

Key clinical point: Adjuvant treatment with paclitaxel and trastuzumab demonstrated very good long-term survival outcomes in patients with small, node-negative, human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC).

Major finding: After a median follow-up of 10.8 years, only 31 invasive disease-free survival events occurred, of which six were locoregional ipsilateral recurrences, nine were new contralateral breast cancers, six were distant recurrences, and 10 were all-cause deaths. The 10-year invasive disease-free survival rate was >90% (91.3%; 95% CI 88.3%-94.4%).

Study details: Findings are from the phase 2 APT study including 406 patients with small (≤3 cm), node-negative, HER2+ BC who received adjuvant paclitaxel+trastuzumab for 12 weeks followed by trastuzumab for 40 weeks to complete a full year of trastuzumab treatment.

Disclosures: This study was funded by Genentech. The authors declared receiving consulting or advisory board fees, grant support, payment, or having other ties with several sources.

Source: Tolaney SM et al. Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer: Final 10-year analysis of the open-label, single-arm, phase 2 APT trial. Lancet Oncol. 2023;24(3):273-285 (Feb 27). Doi: 10.1016/S1470-2045(23)00051-7

Key clinical point: Adjuvant treatment with paclitaxel and trastuzumab demonstrated very good long-term survival outcomes in patients with small, node-negative, human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC).

Major finding: After a median follow-up of 10.8 years, only 31 invasive disease-free survival events occurred, of which six were locoregional ipsilateral recurrences, nine were new contralateral breast cancers, six were distant recurrences, and 10 were all-cause deaths. The 10-year invasive disease-free survival rate was >90% (91.3%; 95% CI 88.3%-94.4%).

Study details: Findings are from the phase 2 APT study including 406 patients with small (≤3 cm), node-negative, HER2+ BC who received adjuvant paclitaxel+trastuzumab for 12 weeks followed by trastuzumab for 40 weeks to complete a full year of trastuzumab treatment.

Disclosures: This study was funded by Genentech. The authors declared receiving consulting or advisory board fees, grant support, payment, or having other ties with several sources.

Source: Tolaney SM et al. Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer: Final 10-year analysis of the open-label, single-arm, phase 2 APT trial. Lancet Oncol. 2023;24(3):273-285 (Feb 27). Doi: 10.1016/S1470-2045(23)00051-7