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False-positive mammography results and risk for cancer death
False-positive mammography results are common, but
Women with a false-positive mammography result had 61% greater risk of developing breast cancer and an 84% greater risk of dying of breast cancer, compared with those who did not have a false-positive result.
However, the investigators also found that the risk for breast cancer varied by individual characteristics such as age and breast density.
The analysis provides clues about which patients with false-positive mammography results will go on to develop breast cancer and “can be used to develop individualized risk-based breast cancer screening,” said the investigators, led by Xinhe Mao, MSc, of Karolinska Institute, Stockholm.
The findings were published online in JAMA Oncology.
About 11% of women in the United States and 2.5% in Europe will receive a false-positive result after a single mammography screening, and previous research shows that these women have a higher risk of developing breast cancer, compared with women without false-positive results. Still, whether this risk for breast cancer varies by individual characteristics and whether an association between a false-positive mammography result and mortality exists remain unclear.
To assess long-term outcomes after a false-positive result, the study investigators compared 45,213 women who had a false-positive mammography result between 1991 and 2017 with 452,130 controls matched for age, calendar year of mammography, and screening history. These data came from the Stockholm Mammography Screening program and Swedish nationwide registers. The analysis also included 1,113 women with a false-positive result and 11,130 matched controls with information on mammographic breast density from the Karolinska Mammography Project for Risk Prediction of Breast Cancer study.
Among women with a false-positive result, the 20-year cumulative breast cancer incidence was 11.3% compared with 7.3% among those without a false-positive (adjusted hazard ratio, 1.61).
Breast cancer risk was higher in older women – those aged 60-75 years (HR, 2.02) – vs younger women aged 40-49 years (HR, 1.38). Breast cancer risk was also higher among women with less dense breasts (HR, 4.65) vs more dense breasts (HR, 1.60) and those who underwent a biopsy during recall (HR, 1.77) vs those who did not (HR, 1.51).
After a false-positive result, cancers were more likely to occur on the ipsilateral side to the false-positive result (HR, 1.92) versus the contralateral (HR, 1.28) and were more common during the first 4 years of follow-up (HR, 2.57 in the first 2 years and 1.93 between 2 and 4 years). No statistical differences were observed based on tumor characteristics, aside from tumor size (HR, 1.78 for tumors ≥ 20 mm vs. 1.47 for smaller tumors).
The prognosis of patients with breast cancer did not differ on the basis of whether they had false-positive results before diagnosis (HR, 1.05 for a false-positive result versus no false-positive result; 95% CI, 0.89-1.25).
This study is the first to show that “women with a false-positive result are at increased risk of death from breast cancer,” Ms. Mao and colleagues concluded. This finding is “most probably associated with the increased breast cancer incidence,” given that the prognosis of patients with breast cancer was similar among those who had a false-positive result versus those who did not.
The authors noted that the increased risk for breast cancer after a false-positive result could suggest that false positives indicate the presence of small tumors that were missed or generally indicate a higher risk for breast cancer. Other factors, such as hormones or genetics, may be at play as well, but would need to be investigated in further studies, Ms. Mao and colleagues noted.
When individualizing surveillance after a false-positive result, age and breast density should be considered, the authors explained. Clinicians may also want to provide more intensive surveillance in the years after a false-positive result as well as education to patients about the risks associated with a false-positive result.
Overall, the findings indicate that clinicians “ should stress the importance of continued screening in women with false-positive results, given their higher risk of cancer, especially within the first 5 or so years after a false-positive result,” Diana L. Miglioretti, PhD, professor and division chief of biostatistics at the University of California, Davis, said in an interview.
Dr. Miglioretti, who has led research on false-positive mammography results and approaches to reduce false positives, noted that “this is a very important study confirming prior work by the Breast Cancer Surveillance Consortium showing individuals with false-positive screening mammography results are at increased risk of developing breast cancer in the future.”
The new evidence demonstrated an increased risk for death from breast cancer in patients who have a false-positive result is particularly worrisome because some studies suggest that women with false-positive results are less likely to return for screening, perhaps because of their negative experience, Dr. Miglioretti said.
However, her own research has shown that providing immediate screening mammography interpretation and same-day diagnostic workup to individuals who have not had a mammogram in the past 5 years and to younger women could prevent 40% of people from needing to return for diagnostic workup later and potentially reduce time to diagnosis for those with cancer.
It is “important that radiology facilities find ways to reduce false-positive results and the anxiety associated with these results,” Dr. Miglioretti said.
This study was supported by grants from the Swedish Research Council, the Swedish Cancer Society, the Stockholm County Council, and FORTE. Ms. Mao is supported by a grant from the China Scholarship Council. Dr. Miglioretti received funding from PCORI and NCI and royalties from Elsevier.
A version of this article first appeared on Medscape.com.
False-positive mammography results are common, but
Women with a false-positive mammography result had 61% greater risk of developing breast cancer and an 84% greater risk of dying of breast cancer, compared with those who did not have a false-positive result.
However, the investigators also found that the risk for breast cancer varied by individual characteristics such as age and breast density.
The analysis provides clues about which patients with false-positive mammography results will go on to develop breast cancer and “can be used to develop individualized risk-based breast cancer screening,” said the investigators, led by Xinhe Mao, MSc, of Karolinska Institute, Stockholm.
The findings were published online in JAMA Oncology.
About 11% of women in the United States and 2.5% in Europe will receive a false-positive result after a single mammography screening, and previous research shows that these women have a higher risk of developing breast cancer, compared with women without false-positive results. Still, whether this risk for breast cancer varies by individual characteristics and whether an association between a false-positive mammography result and mortality exists remain unclear.
To assess long-term outcomes after a false-positive result, the study investigators compared 45,213 women who had a false-positive mammography result between 1991 and 2017 with 452,130 controls matched for age, calendar year of mammography, and screening history. These data came from the Stockholm Mammography Screening program and Swedish nationwide registers. The analysis also included 1,113 women with a false-positive result and 11,130 matched controls with information on mammographic breast density from the Karolinska Mammography Project for Risk Prediction of Breast Cancer study.
Among women with a false-positive result, the 20-year cumulative breast cancer incidence was 11.3% compared with 7.3% among those without a false-positive (adjusted hazard ratio, 1.61).
Breast cancer risk was higher in older women – those aged 60-75 years (HR, 2.02) – vs younger women aged 40-49 years (HR, 1.38). Breast cancer risk was also higher among women with less dense breasts (HR, 4.65) vs more dense breasts (HR, 1.60) and those who underwent a biopsy during recall (HR, 1.77) vs those who did not (HR, 1.51).
After a false-positive result, cancers were more likely to occur on the ipsilateral side to the false-positive result (HR, 1.92) versus the contralateral (HR, 1.28) and were more common during the first 4 years of follow-up (HR, 2.57 in the first 2 years and 1.93 between 2 and 4 years). No statistical differences were observed based on tumor characteristics, aside from tumor size (HR, 1.78 for tumors ≥ 20 mm vs. 1.47 for smaller tumors).
The prognosis of patients with breast cancer did not differ on the basis of whether they had false-positive results before diagnosis (HR, 1.05 for a false-positive result versus no false-positive result; 95% CI, 0.89-1.25).
This study is the first to show that “women with a false-positive result are at increased risk of death from breast cancer,” Ms. Mao and colleagues concluded. This finding is “most probably associated with the increased breast cancer incidence,” given that the prognosis of patients with breast cancer was similar among those who had a false-positive result versus those who did not.
The authors noted that the increased risk for breast cancer after a false-positive result could suggest that false positives indicate the presence of small tumors that were missed or generally indicate a higher risk for breast cancer. Other factors, such as hormones or genetics, may be at play as well, but would need to be investigated in further studies, Ms. Mao and colleagues noted.
When individualizing surveillance after a false-positive result, age and breast density should be considered, the authors explained. Clinicians may also want to provide more intensive surveillance in the years after a false-positive result as well as education to patients about the risks associated with a false-positive result.
Overall, the findings indicate that clinicians “ should stress the importance of continued screening in women with false-positive results, given their higher risk of cancer, especially within the first 5 or so years after a false-positive result,” Diana L. Miglioretti, PhD, professor and division chief of biostatistics at the University of California, Davis, said in an interview.
Dr. Miglioretti, who has led research on false-positive mammography results and approaches to reduce false positives, noted that “this is a very important study confirming prior work by the Breast Cancer Surveillance Consortium showing individuals with false-positive screening mammography results are at increased risk of developing breast cancer in the future.”
The new evidence demonstrated an increased risk for death from breast cancer in patients who have a false-positive result is particularly worrisome because some studies suggest that women with false-positive results are less likely to return for screening, perhaps because of their negative experience, Dr. Miglioretti said.
However, her own research has shown that providing immediate screening mammography interpretation and same-day diagnostic workup to individuals who have not had a mammogram in the past 5 years and to younger women could prevent 40% of people from needing to return for diagnostic workup later and potentially reduce time to diagnosis for those with cancer.
It is “important that radiology facilities find ways to reduce false-positive results and the anxiety associated with these results,” Dr. Miglioretti said.
This study was supported by grants from the Swedish Research Council, the Swedish Cancer Society, the Stockholm County Council, and FORTE. Ms. Mao is supported by a grant from the China Scholarship Council. Dr. Miglioretti received funding from PCORI and NCI and royalties from Elsevier.
A version of this article first appeared on Medscape.com.
False-positive mammography results are common, but
Women with a false-positive mammography result had 61% greater risk of developing breast cancer and an 84% greater risk of dying of breast cancer, compared with those who did not have a false-positive result.
However, the investigators also found that the risk for breast cancer varied by individual characteristics such as age and breast density.
The analysis provides clues about which patients with false-positive mammography results will go on to develop breast cancer and “can be used to develop individualized risk-based breast cancer screening,” said the investigators, led by Xinhe Mao, MSc, of Karolinska Institute, Stockholm.
The findings were published online in JAMA Oncology.
About 11% of women in the United States and 2.5% in Europe will receive a false-positive result after a single mammography screening, and previous research shows that these women have a higher risk of developing breast cancer, compared with women without false-positive results. Still, whether this risk for breast cancer varies by individual characteristics and whether an association between a false-positive mammography result and mortality exists remain unclear.
To assess long-term outcomes after a false-positive result, the study investigators compared 45,213 women who had a false-positive mammography result between 1991 and 2017 with 452,130 controls matched for age, calendar year of mammography, and screening history. These data came from the Stockholm Mammography Screening program and Swedish nationwide registers. The analysis also included 1,113 women with a false-positive result and 11,130 matched controls with information on mammographic breast density from the Karolinska Mammography Project for Risk Prediction of Breast Cancer study.
Among women with a false-positive result, the 20-year cumulative breast cancer incidence was 11.3% compared with 7.3% among those without a false-positive (adjusted hazard ratio, 1.61).
Breast cancer risk was higher in older women – those aged 60-75 years (HR, 2.02) – vs younger women aged 40-49 years (HR, 1.38). Breast cancer risk was also higher among women with less dense breasts (HR, 4.65) vs more dense breasts (HR, 1.60) and those who underwent a biopsy during recall (HR, 1.77) vs those who did not (HR, 1.51).
After a false-positive result, cancers were more likely to occur on the ipsilateral side to the false-positive result (HR, 1.92) versus the contralateral (HR, 1.28) and were more common during the first 4 years of follow-up (HR, 2.57 in the first 2 years and 1.93 between 2 and 4 years). No statistical differences were observed based on tumor characteristics, aside from tumor size (HR, 1.78 for tumors ≥ 20 mm vs. 1.47 for smaller tumors).
The prognosis of patients with breast cancer did not differ on the basis of whether they had false-positive results before diagnosis (HR, 1.05 for a false-positive result versus no false-positive result; 95% CI, 0.89-1.25).
This study is the first to show that “women with a false-positive result are at increased risk of death from breast cancer,” Ms. Mao and colleagues concluded. This finding is “most probably associated with the increased breast cancer incidence,” given that the prognosis of patients with breast cancer was similar among those who had a false-positive result versus those who did not.
The authors noted that the increased risk for breast cancer after a false-positive result could suggest that false positives indicate the presence of small tumors that were missed or generally indicate a higher risk for breast cancer. Other factors, such as hormones or genetics, may be at play as well, but would need to be investigated in further studies, Ms. Mao and colleagues noted.
When individualizing surveillance after a false-positive result, age and breast density should be considered, the authors explained. Clinicians may also want to provide more intensive surveillance in the years after a false-positive result as well as education to patients about the risks associated with a false-positive result.
Overall, the findings indicate that clinicians “ should stress the importance of continued screening in women with false-positive results, given their higher risk of cancer, especially within the first 5 or so years after a false-positive result,” Diana L. Miglioretti, PhD, professor and division chief of biostatistics at the University of California, Davis, said in an interview.
Dr. Miglioretti, who has led research on false-positive mammography results and approaches to reduce false positives, noted that “this is a very important study confirming prior work by the Breast Cancer Surveillance Consortium showing individuals with false-positive screening mammography results are at increased risk of developing breast cancer in the future.”
The new evidence demonstrated an increased risk for death from breast cancer in patients who have a false-positive result is particularly worrisome because some studies suggest that women with false-positive results are less likely to return for screening, perhaps because of their negative experience, Dr. Miglioretti said.
However, her own research has shown that providing immediate screening mammography interpretation and same-day diagnostic workup to individuals who have not had a mammogram in the past 5 years and to younger women could prevent 40% of people from needing to return for diagnostic workup later and potentially reduce time to diagnosis for those with cancer.
It is “important that radiology facilities find ways to reduce false-positive results and the anxiety associated with these results,” Dr. Miglioretti said.
This study was supported by grants from the Swedish Research Council, the Swedish Cancer Society, the Stockholm County Council, and FORTE. Ms. Mao is supported by a grant from the China Scholarship Council. Dr. Miglioretti received funding from PCORI and NCI and royalties from Elsevier.
A version of this article first appeared on Medscape.com.
FROM JAMA ONCOLOGY
Factors associated with improved prognostic outcomes in locally advanced BC
Key clinical point: In women with locally advanced breast cancer (LABC) who received neoadjuvant treatment (NAT) followed by breast surgery, the type of breast surgery, pathological complete response (pCR), body mass index (BMI), and pretreatment stage of tumors were the significant predictors of survival outcomes.
Major finding: Overall survival was significantly improved in patients with LABC who did vs did not achieve pCR (odds ratio [OR] 0.42; P = .008). However, it was much worsened in patients who underwent mastectomy vs breast-conserving surgery (BCS; OR 1.678; P = .024), had higher vs lower BMI (OR 1.031; P = .017), and had stage IIIB or IIIC vs IIB tumors (OR 2.450; P < .001).
Study details: Findings are from a retrospective cohort study including 530 patients with LABC, of which 24.6% of patients underwent BCS after receiving NAT.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Nobrega GB et al. Locally advanced breast cancer: Breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment. Front Oncol. 2023;13:1293288 (Nov 6). doi: 10.3389/fonc.2023.1293288
Key clinical point: In women with locally advanced breast cancer (LABC) who received neoadjuvant treatment (NAT) followed by breast surgery, the type of breast surgery, pathological complete response (pCR), body mass index (BMI), and pretreatment stage of tumors were the significant predictors of survival outcomes.
Major finding: Overall survival was significantly improved in patients with LABC who did vs did not achieve pCR (odds ratio [OR] 0.42; P = .008). However, it was much worsened in patients who underwent mastectomy vs breast-conserving surgery (BCS; OR 1.678; P = .024), had higher vs lower BMI (OR 1.031; P = .017), and had stage IIIB or IIIC vs IIB tumors (OR 2.450; P < .001).
Study details: Findings are from a retrospective cohort study including 530 patients with LABC, of which 24.6% of patients underwent BCS after receiving NAT.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Nobrega GB et al. Locally advanced breast cancer: Breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment. Front Oncol. 2023;13:1293288 (Nov 6). doi: 10.3389/fonc.2023.1293288
Key clinical point: In women with locally advanced breast cancer (LABC) who received neoadjuvant treatment (NAT) followed by breast surgery, the type of breast surgery, pathological complete response (pCR), body mass index (BMI), and pretreatment stage of tumors were the significant predictors of survival outcomes.
Major finding: Overall survival was significantly improved in patients with LABC who did vs did not achieve pCR (odds ratio [OR] 0.42; P = .008). However, it was much worsened in patients who underwent mastectomy vs breast-conserving surgery (BCS; OR 1.678; P = .024), had higher vs lower BMI (OR 1.031; P = .017), and had stage IIIB or IIIC vs IIB tumors (OR 2.450; P < .001).
Study details: Findings are from a retrospective cohort study including 530 patients with LABC, of which 24.6% of patients underwent BCS after receiving NAT.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Nobrega GB et al. Locally advanced breast cancer: Breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment. Front Oncol. 2023;13:1293288 (Nov 6). doi: 10.3389/fonc.2023.1293288
Meta-analysis shows increased wound infection and cutaneous contraction risks after PMRT in BC
Key clinical point: Patients with breast cancer (BC) who underwent post-mastectomy breast reconstruction followed by post-mastectomy radiotherapy (PMRT) had an increased risk for postoperative complications, such as infections and contractures, than those who did not receive PMRT.
Major finding: Patients who did vs did not receive PMRT had a significantly higher risk for postoperative wound infections (odds ratio [OR] 1.95; P = .003) and skin contractures (OR 7.24; P = .005).
Study details: Findings are from a meta-analysis of 11 studies including 2288 patients with BC who underwent breast reconstruction, of which 516 patients received PMRT after breast reconstruction.
Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.
Source: Huang N, Lu L, et al. Effect of radiation therapy during surgery on postoperative wound complications after breast reconstruction in patients with breast cancer: A meta-analysis. Int Wound J. 2023 (Oct 31). doi: 10.1111/iwj.14473
Key clinical point: Patients with breast cancer (BC) who underwent post-mastectomy breast reconstruction followed by post-mastectomy radiotherapy (PMRT) had an increased risk for postoperative complications, such as infections and contractures, than those who did not receive PMRT.
Major finding: Patients who did vs did not receive PMRT had a significantly higher risk for postoperative wound infections (odds ratio [OR] 1.95; P = .003) and skin contractures (OR 7.24; P = .005).
Study details: Findings are from a meta-analysis of 11 studies including 2288 patients with BC who underwent breast reconstruction, of which 516 patients received PMRT after breast reconstruction.
Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.
Source: Huang N, Lu L, et al. Effect of radiation therapy during surgery on postoperative wound complications after breast reconstruction in patients with breast cancer: A meta-analysis. Int Wound J. 2023 (Oct 31). doi: 10.1111/iwj.14473
Key clinical point: Patients with breast cancer (BC) who underwent post-mastectomy breast reconstruction followed by post-mastectomy radiotherapy (PMRT) had an increased risk for postoperative complications, such as infections and contractures, than those who did not receive PMRT.
Major finding: Patients who did vs did not receive PMRT had a significantly higher risk for postoperative wound infections (odds ratio [OR] 1.95; P = .003) and skin contractures (OR 7.24; P = .005).
Study details: Findings are from a meta-analysis of 11 studies including 2288 patients with BC who underwent breast reconstruction, of which 516 patients received PMRT after breast reconstruction.
Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.
Source: Huang N, Lu L, et al. Effect of radiation therapy during surgery on postoperative wound complications after breast reconstruction in patients with breast cancer: A meta-analysis. Int Wound J. 2023 (Oct 31). doi: 10.1111/iwj.14473
Robotic nipple-sparing mastectomy may soon become a feasible option in BC
Key clinical point: Robotic nipple-sparing mastectomy (RNSM) may soon become a viable option for breast cancer (BC) surgery as it is associated with lower postoperative complication rates than conventional NSM (CNSM).
Major finding: RNSM vs CNSM was associated with a significantly lower rate of nipple necrosis, a major postoperative complication (odds ratio 0.54; P = .03), and intraoperative blood loss (mean difference [MD] −53.18 mL; P < .00001), but a significantly higher operating time (MD +58.81 min; P < .001).
Study details: Findings are from a meta-analysis of seven studies including 1674 women with BC who underwent RNSM (50.9%) or CNSM (49.1%).
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Nessa A et al. Postoperative complications and surgical outcomes of robotic versus conventional nipple-sparing mastectomy in breast cancer: Meta-analysis. Br J Surg. 2023 (Oct 27). doi: 10.1093/bjs/znad336
Key clinical point: Robotic nipple-sparing mastectomy (RNSM) may soon become a viable option for breast cancer (BC) surgery as it is associated with lower postoperative complication rates than conventional NSM (CNSM).
Major finding: RNSM vs CNSM was associated with a significantly lower rate of nipple necrosis, a major postoperative complication (odds ratio 0.54; P = .03), and intraoperative blood loss (mean difference [MD] −53.18 mL; P < .00001), but a significantly higher operating time (MD +58.81 min; P < .001).
Study details: Findings are from a meta-analysis of seven studies including 1674 women with BC who underwent RNSM (50.9%) or CNSM (49.1%).
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Nessa A et al. Postoperative complications and surgical outcomes of robotic versus conventional nipple-sparing mastectomy in breast cancer: Meta-analysis. Br J Surg. 2023 (Oct 27). doi: 10.1093/bjs/znad336
Key clinical point: Robotic nipple-sparing mastectomy (RNSM) may soon become a viable option for breast cancer (BC) surgery as it is associated with lower postoperative complication rates than conventional NSM (CNSM).
Major finding: RNSM vs CNSM was associated with a significantly lower rate of nipple necrosis, a major postoperative complication (odds ratio 0.54; P = .03), and intraoperative blood loss (mean difference [MD] −53.18 mL; P < .00001), but a significantly higher operating time (MD +58.81 min; P < .001).
Study details: Findings are from a meta-analysis of seven studies including 1674 women with BC who underwent RNSM (50.9%) or CNSM (49.1%).
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Nessa A et al. Postoperative complications and surgical outcomes of robotic versus conventional nipple-sparing mastectomy in breast cancer: Meta-analysis. Br J Surg. 2023 (Oct 27). doi: 10.1093/bjs/znad336
Adjuvant chemotherapy beneficial in small-size node-negative TNBC
Key clinical point: Adjuvant chemotherapy significantly improved the overall survival (OS) outcomes in patients with small-size (T1b and T1c) node-negative triple-negative breast cancer (TNBC).
Major finding: Adjuvant chemotherapy led to significantly better OS outcomes in patients with T1b TNBC (adjusted hazard ratio [aHR] 0.52; P < .001) and improved both OS (aHR 0.54; P < .001) and breast cancer-specific survival (aHR 0.79; P = .043) in those with T1c TNBC.
Study details: This retrospective study analyzed the data from the Surveillance, Epidemiology, and End Results (SEER) database and included 11,510 women with T1b (n = 3388) or T1c (n = 8122) node-negative TNBC, of whom 8029 patients received adjuvant chemotherapy.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Carbajal-Ochoa W et al. Benefit of adjuvant chemotherapy in lymph node-negative, T1b and T1c triple-negative breast cancer. Breast Cancer Res Treat. 2023 (Oct 13). doi: 10.1007/s10549-023-07132-6
Key clinical point: Adjuvant chemotherapy significantly improved the overall survival (OS) outcomes in patients with small-size (T1b and T1c) node-negative triple-negative breast cancer (TNBC).
Major finding: Adjuvant chemotherapy led to significantly better OS outcomes in patients with T1b TNBC (adjusted hazard ratio [aHR] 0.52; P < .001) and improved both OS (aHR 0.54; P < .001) and breast cancer-specific survival (aHR 0.79; P = .043) in those with T1c TNBC.
Study details: This retrospective study analyzed the data from the Surveillance, Epidemiology, and End Results (SEER) database and included 11,510 women with T1b (n = 3388) or T1c (n = 8122) node-negative TNBC, of whom 8029 patients received adjuvant chemotherapy.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Carbajal-Ochoa W et al. Benefit of adjuvant chemotherapy in lymph node-negative, T1b and T1c triple-negative breast cancer. Breast Cancer Res Treat. 2023 (Oct 13). doi: 10.1007/s10549-023-07132-6
Key clinical point: Adjuvant chemotherapy significantly improved the overall survival (OS) outcomes in patients with small-size (T1b and T1c) node-negative triple-negative breast cancer (TNBC).
Major finding: Adjuvant chemotherapy led to significantly better OS outcomes in patients with T1b TNBC (adjusted hazard ratio [aHR] 0.52; P < .001) and improved both OS (aHR 0.54; P < .001) and breast cancer-specific survival (aHR 0.79; P = .043) in those with T1c TNBC.
Study details: This retrospective study analyzed the data from the Surveillance, Epidemiology, and End Results (SEER) database and included 11,510 women with T1b (n = 3388) or T1c (n = 8122) node-negative TNBC, of whom 8029 patients received adjuvant chemotherapy.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Carbajal-Ochoa W et al. Benefit of adjuvant chemotherapy in lymph node-negative, T1b and T1c triple-negative breast cancer. Breast Cancer Res Treat. 2023 (Oct 13). doi: 10.1007/s10549-023-07132-6
Pregnancy is safe for women with a prior diagnosis of HR+ early BC
Key clinical point: Pregnancy had no detrimental effects on survival outcomes and can be considered safe for young women who were previously diagnosed with and underwent treatment for hormone receptor-positive (HR+) early breast cancer (BC).
Major finding: Patients with a history of HR+ BC who did vs did not conceive after treatment showed better overall survival outcomes (hazard ratio 0.46; P < .005); however, the disease-free survival outcomes were comparable for both groups (P = .781).
Study details: Findings are from a meta-analysis of eight retrospective cohort studies including 3805 young women with HR+ invasive early BC, of whom 1285 women conceived post treatment.
Disclosures: This study was partially supported by the Italian Association for Cancer Research and the Italian Ministry of Health. Several authors declared receiving research support, honoraria, research funding, personal fees, grants, or consulting fees from or having ties with various sources.
Source: Arecco L et al. Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: A systematic review and meta-analysis. ESMO Open. 2023;8(6):102031 (Oct 23). doi: 10.1016/j.esmoop.2023.102031
Key clinical point: Pregnancy had no detrimental effects on survival outcomes and can be considered safe for young women who were previously diagnosed with and underwent treatment for hormone receptor-positive (HR+) early breast cancer (BC).
Major finding: Patients with a history of HR+ BC who did vs did not conceive after treatment showed better overall survival outcomes (hazard ratio 0.46; P < .005); however, the disease-free survival outcomes were comparable for both groups (P = .781).
Study details: Findings are from a meta-analysis of eight retrospective cohort studies including 3805 young women with HR+ invasive early BC, of whom 1285 women conceived post treatment.
Disclosures: This study was partially supported by the Italian Association for Cancer Research and the Italian Ministry of Health. Several authors declared receiving research support, honoraria, research funding, personal fees, grants, or consulting fees from or having ties with various sources.
Source: Arecco L et al. Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: A systematic review and meta-analysis. ESMO Open. 2023;8(6):102031 (Oct 23). doi: 10.1016/j.esmoop.2023.102031
Key clinical point: Pregnancy had no detrimental effects on survival outcomes and can be considered safe for young women who were previously diagnosed with and underwent treatment for hormone receptor-positive (HR+) early breast cancer (BC).
Major finding: Patients with a history of HR+ BC who did vs did not conceive after treatment showed better overall survival outcomes (hazard ratio 0.46; P < .005); however, the disease-free survival outcomes were comparable for both groups (P = .781).
Study details: Findings are from a meta-analysis of eight retrospective cohort studies including 3805 young women with HR+ invasive early BC, of whom 1285 women conceived post treatment.
Disclosures: This study was partially supported by the Italian Association for Cancer Research and the Italian Ministry of Health. Several authors declared receiving research support, honoraria, research funding, personal fees, grants, or consulting fees from or having ties with various sources.
Source: Arecco L et al. Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: A systematic review and meta-analysis. ESMO Open. 2023;8(6):102031 (Oct 23). doi: 10.1016/j.esmoop.2023.102031
Screening programs can improve disease-free interval outcomes in BC
Key clinical point: Detection of breast cancer (BC) by screening vs clinical or other non-screening procedures led to significantly improved disease-free interval outcomes.
Major finding: After correcting for lead time bias, the 10-year disease-free interval was improved significantly in women with screen-detected vs clinically-detected cancer (adjusted hazard ratio [aHR] 0.77; 95% CI 0.68-0.87), with similar improvements observed in 5-year disease-free interval in women with screen-detected vs non-screen-related cancer (aHR 0.76; 95% CI 0.66-0.88).
Study details: Findings are from an analysis of two cohorts including 6215 and 15,176 women with invasive, non-metastatic BC who underwent surgery and were followed for 10 and 5 years, respectively, of which 55.8% of women in either of the cohorts had a screen-detected cancer.
Disclosures: This study did not declare any specific funding. S Siesling declared receiving support and serving as an advisor for various sources. The other authors declared no conflicts of interest.
Source: de Munck L et al. Method of primary breast cancer detection and the disease-free interval, adjusting for lead time. J Natl Cancer Inst. 2023 (Nov 3). doi: 10.1093/jnci/djad230
Key clinical point: Detection of breast cancer (BC) by screening vs clinical or other non-screening procedures led to significantly improved disease-free interval outcomes.
Major finding: After correcting for lead time bias, the 10-year disease-free interval was improved significantly in women with screen-detected vs clinically-detected cancer (adjusted hazard ratio [aHR] 0.77; 95% CI 0.68-0.87), with similar improvements observed in 5-year disease-free interval in women with screen-detected vs non-screen-related cancer (aHR 0.76; 95% CI 0.66-0.88).
Study details: Findings are from an analysis of two cohorts including 6215 and 15,176 women with invasive, non-metastatic BC who underwent surgery and were followed for 10 and 5 years, respectively, of which 55.8% of women in either of the cohorts had a screen-detected cancer.
Disclosures: This study did not declare any specific funding. S Siesling declared receiving support and serving as an advisor for various sources. The other authors declared no conflicts of interest.
Source: de Munck L et al. Method of primary breast cancer detection and the disease-free interval, adjusting for lead time. J Natl Cancer Inst. 2023 (Nov 3). doi: 10.1093/jnci/djad230
Key clinical point: Detection of breast cancer (BC) by screening vs clinical or other non-screening procedures led to significantly improved disease-free interval outcomes.
Major finding: After correcting for lead time bias, the 10-year disease-free interval was improved significantly in women with screen-detected vs clinically-detected cancer (adjusted hazard ratio [aHR] 0.77; 95% CI 0.68-0.87), with similar improvements observed in 5-year disease-free interval in women with screen-detected vs non-screen-related cancer (aHR 0.76; 95% CI 0.66-0.88).
Study details: Findings are from an analysis of two cohorts including 6215 and 15,176 women with invasive, non-metastatic BC who underwent surgery and were followed for 10 and 5 years, respectively, of which 55.8% of women in either of the cohorts had a screen-detected cancer.
Disclosures: This study did not declare any specific funding. S Siesling declared receiving support and serving as an advisor for various sources. The other authors declared no conflicts of interest.
Source: de Munck L et al. Method of primary breast cancer detection and the disease-free interval, adjusting for lead time. J Natl Cancer Inst. 2023 (Nov 3). doi: 10.1093/jnci/djad230
Is gel tamoxifen noninferior to oral tamoxifen in DCIS of the breast?
Key clinical point: Although local transdermal therapy with 4-hydroxytamoxifen was associated with low systemic exposure, it was not as effective as oral tamoxifen in suppressing proliferation in the ductal carcinoma in situ (DCIS) lesions of the breast.
Major finding: Posttreatment Ki67 labelling index was significantly higher in the transdermal 4-hydroxytamoxifen gel vs oral tamoxifen treatment group (3.3%; 80% CI 2.1%-4.6%), with the value exceeding the noninferiority margin of 2.6%. Grade 2 adverse events were reported by five patients in both groups.
Study details: Findings are from a phase 2 study including 107 patients with DCIS of the breast who were randomly assigned to receive oral tamoxifen or 4-hydroxytamoxifen gel treatment for 4-10 weeks, of which 90 patients completed the treatment and underwent surgery.
Disclosures: This trial was sponsored by the US National Cancer Institute. Some authors declared receiving grant funding from various sources or holding a patent.
Source: Khan SA et al. Presurgical oral tamoxifen vs transdermal 4-hydroxytamoxifen in women with ductal carcinoma in situ: A randomized clinical trial. JAMA Surg. 2023 (Oct 23). doi: 10.1001/jamasurg.2023.5113
Key clinical point: Although local transdermal therapy with 4-hydroxytamoxifen was associated with low systemic exposure, it was not as effective as oral tamoxifen in suppressing proliferation in the ductal carcinoma in situ (DCIS) lesions of the breast.
Major finding: Posttreatment Ki67 labelling index was significantly higher in the transdermal 4-hydroxytamoxifen gel vs oral tamoxifen treatment group (3.3%; 80% CI 2.1%-4.6%), with the value exceeding the noninferiority margin of 2.6%. Grade 2 adverse events were reported by five patients in both groups.
Study details: Findings are from a phase 2 study including 107 patients with DCIS of the breast who were randomly assigned to receive oral tamoxifen or 4-hydroxytamoxifen gel treatment for 4-10 weeks, of which 90 patients completed the treatment and underwent surgery.
Disclosures: This trial was sponsored by the US National Cancer Institute. Some authors declared receiving grant funding from various sources or holding a patent.
Source: Khan SA et al. Presurgical oral tamoxifen vs transdermal 4-hydroxytamoxifen in women with ductal carcinoma in situ: A randomized clinical trial. JAMA Surg. 2023 (Oct 23). doi: 10.1001/jamasurg.2023.5113
Key clinical point: Although local transdermal therapy with 4-hydroxytamoxifen was associated with low systemic exposure, it was not as effective as oral tamoxifen in suppressing proliferation in the ductal carcinoma in situ (DCIS) lesions of the breast.
Major finding: Posttreatment Ki67 labelling index was significantly higher in the transdermal 4-hydroxytamoxifen gel vs oral tamoxifen treatment group (3.3%; 80% CI 2.1%-4.6%), with the value exceeding the noninferiority margin of 2.6%. Grade 2 adverse events were reported by five patients in both groups.
Study details: Findings are from a phase 2 study including 107 patients with DCIS of the breast who were randomly assigned to receive oral tamoxifen or 4-hydroxytamoxifen gel treatment for 4-10 weeks, of which 90 patients completed the treatment and underwent surgery.
Disclosures: This trial was sponsored by the US National Cancer Institute. Some authors declared receiving grant funding from various sources or holding a patent.
Source: Khan SA et al. Presurgical oral tamoxifen vs transdermal 4-hydroxytamoxifen in women with ductal carcinoma in situ: A randomized clinical trial. JAMA Surg. 2023 (Oct 23). doi: 10.1001/jamasurg.2023.5113
Dual HER2 inhibition with pyrotinib-trastuzumab-docetaxel confers survival benefits in untreated HER2+ metastatic BC
Key clinical point: Pyrotinib+trastuzumab+docetaxel was more effective than placebo+trastuzumab+docetaxel in improving progression-free survival (PFS) outcomes and showed a manageable safety profile in patients with untreated human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (BC).
Major finding: PFS improved by 59% with pyrotinib+trastuzumab+docetaxel vs placebo+trastuzumab+docetaxel treatment (24.3 vs 10.4 months; hazard ratio 0.41; stratified 1-sided P < .001). The most frequently reported grade ≥3 adverse events in the pyrotinib vs placebo treatment arm were decreased neutrophil count (63% vs 65%), decreased white blood cell count (53% vs 51%), and diarrhea (46% vs 3%).
Study details: Findings are from the phase 3 PHILA trial including 590 female patients with untreated HER2+ metastatic BC who were randomly assigned to receive pyrotinib or placebo, both in combination with trastuzumab and docetaxel.
Disclosures: This study was funded by Jiangsu Hengrui Pharmaceuticals, China, and other sources. Three authors declared being employees of Jiangsu Hengrui Pharmaceuticals, and two other authors reported ties with various sources.
Source: Ma F et al, on behalf of the PHILA Investigators. Pyrotinib versus placebo in combination with trastuzumab and docetaxel as first line treatment in patients with HER2 positive metastatic breast cancer (PHILA): Randomised, double blind, multicentre, phase 3 trial. BMJ. 2023;383:e076065 (Oct 31). doi: 10.1136/bmj-2023-076065
Key clinical point: Pyrotinib+trastuzumab+docetaxel was more effective than placebo+trastuzumab+docetaxel in improving progression-free survival (PFS) outcomes and showed a manageable safety profile in patients with untreated human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (BC).
Major finding: PFS improved by 59% with pyrotinib+trastuzumab+docetaxel vs placebo+trastuzumab+docetaxel treatment (24.3 vs 10.4 months; hazard ratio 0.41; stratified 1-sided P < .001). The most frequently reported grade ≥3 adverse events in the pyrotinib vs placebo treatment arm were decreased neutrophil count (63% vs 65%), decreased white blood cell count (53% vs 51%), and diarrhea (46% vs 3%).
Study details: Findings are from the phase 3 PHILA trial including 590 female patients with untreated HER2+ metastatic BC who were randomly assigned to receive pyrotinib or placebo, both in combination with trastuzumab and docetaxel.
Disclosures: This study was funded by Jiangsu Hengrui Pharmaceuticals, China, and other sources. Three authors declared being employees of Jiangsu Hengrui Pharmaceuticals, and two other authors reported ties with various sources.
Source: Ma F et al, on behalf of the PHILA Investigators. Pyrotinib versus placebo in combination with trastuzumab and docetaxel as first line treatment in patients with HER2 positive metastatic breast cancer (PHILA): Randomised, double blind, multicentre, phase 3 trial. BMJ. 2023;383:e076065 (Oct 31). doi: 10.1136/bmj-2023-076065
Key clinical point: Pyrotinib+trastuzumab+docetaxel was more effective than placebo+trastuzumab+docetaxel in improving progression-free survival (PFS) outcomes and showed a manageable safety profile in patients with untreated human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (BC).
Major finding: PFS improved by 59% with pyrotinib+trastuzumab+docetaxel vs placebo+trastuzumab+docetaxel treatment (24.3 vs 10.4 months; hazard ratio 0.41; stratified 1-sided P < .001). The most frequently reported grade ≥3 adverse events in the pyrotinib vs placebo treatment arm were decreased neutrophil count (63% vs 65%), decreased white blood cell count (53% vs 51%), and diarrhea (46% vs 3%).
Study details: Findings are from the phase 3 PHILA trial including 590 female patients with untreated HER2+ metastatic BC who were randomly assigned to receive pyrotinib or placebo, both in combination with trastuzumab and docetaxel.
Disclosures: This study was funded by Jiangsu Hengrui Pharmaceuticals, China, and other sources. Three authors declared being employees of Jiangsu Hengrui Pharmaceuticals, and two other authors reported ties with various sources.
Source: Ma F et al, on behalf of the PHILA Investigators. Pyrotinib versus placebo in combination with trastuzumab and docetaxel as first line treatment in patients with HER2 positive metastatic breast cancer (PHILA): Randomised, double blind, multicentre, phase 3 trial. BMJ. 2023;383:e076065 (Oct 31). doi: 10.1136/bmj-2023-076065
Meta-analysis shows benefits of regional node irradiation in early BC
Key clinical point: Regional node radiotherapy improved breast cancer (BC) mortality rates in women with early-stage BC who had received other effective local and systemic therapies.
Major finding: Regional node radiotherapy reduced the risk for overall BC recurrence and mortality by 10% (rate ratio [RR] 0.90; P = .0020) and 9% (RR 0.91; P = .012), respectively. In the newer trials that assessed more tailored radiotherapy approaches, a more prominent reduction was observed in the overall BC recurrence (RR 0.88; P = .00083) and mortality (RR 0.87; P = .0010) rates along with 10% improvement in overall mortality (P = .0022).
Study details: Findings are from a meta-analysis of 16 trials including 14,324 patients with early BC, with 8 of the 16 trials being newer and including 12,167 patients.
Disclosures: This study was funded by Cancer Research UK and the UK Medical Research Council. Some authors declared receiving institutional grants, honoraria, payments, or research funding from and having other ties with several sources.
Source: Early Breast Cancer Trialists' Collaborative Group. Radiotherapy to regional nodes in early breast cancer: An individual patient data meta-analysis of 14 324 women in 16 trials. Lancet. 2023 (Nov 3). doi: 10.1016/S0140-6736(23)01082-6
Key clinical point: Regional node radiotherapy improved breast cancer (BC) mortality rates in women with early-stage BC who had received other effective local and systemic therapies.
Major finding: Regional node radiotherapy reduced the risk for overall BC recurrence and mortality by 10% (rate ratio [RR] 0.90; P = .0020) and 9% (RR 0.91; P = .012), respectively. In the newer trials that assessed more tailored radiotherapy approaches, a more prominent reduction was observed in the overall BC recurrence (RR 0.88; P = .00083) and mortality (RR 0.87; P = .0010) rates along with 10% improvement in overall mortality (P = .0022).
Study details: Findings are from a meta-analysis of 16 trials including 14,324 patients with early BC, with 8 of the 16 trials being newer and including 12,167 patients.
Disclosures: This study was funded by Cancer Research UK and the UK Medical Research Council. Some authors declared receiving institutional grants, honoraria, payments, or research funding from and having other ties with several sources.
Source: Early Breast Cancer Trialists' Collaborative Group. Radiotherapy to regional nodes in early breast cancer: An individual patient data meta-analysis of 14 324 women in 16 trials. Lancet. 2023 (Nov 3). doi: 10.1016/S0140-6736(23)01082-6
Key clinical point: Regional node radiotherapy improved breast cancer (BC) mortality rates in women with early-stage BC who had received other effective local and systemic therapies.
Major finding: Regional node radiotherapy reduced the risk for overall BC recurrence and mortality by 10% (rate ratio [RR] 0.90; P = .0020) and 9% (RR 0.91; P = .012), respectively. In the newer trials that assessed more tailored radiotherapy approaches, a more prominent reduction was observed in the overall BC recurrence (RR 0.88; P = .00083) and mortality (RR 0.87; P = .0010) rates along with 10% improvement in overall mortality (P = .0022).
Study details: Findings are from a meta-analysis of 16 trials including 14,324 patients with early BC, with 8 of the 16 trials being newer and including 12,167 patients.
Disclosures: This study was funded by Cancer Research UK and the UK Medical Research Council. Some authors declared receiving institutional grants, honoraria, payments, or research funding from and having other ties with several sources.
Source: Early Breast Cancer Trialists' Collaborative Group. Radiotherapy to regional nodes in early breast cancer: An individual patient data meta-analysis of 14 324 women in 16 trials. Lancet. 2023 (Nov 3). doi: 10.1016/S0140-6736(23)01082-6