Economic benefit of expanding mammography screening for breast cancer in Colombia: A cost modelling analysis.

INTRODUCTION Colombia has a population of roughly 49 million people of predominantly Mestizo ethnicity. Cancer has become a growing public health problem in Colombia with nearly 71,000 newly diagnosed malignant tumors per year. It is expected that by 2035, 150,000 new cases of cancer will be diagnosed, making Colombia an intermediate country with regards to global cancer incidence according to IARC. METHODS Epidemiological data on breast cancer is scarce and varied due to multiple sources of information. These numbers are obtained thru population-based cancer registries that represent 4 distinct regions of the country. Other data originate from non-governmental institutions and healthcare providers within Colombia. The Colombian National Cancer Institute publishes a Cancer Mortality Atlas annually. RESULTS Local cancer registries have shown increases in breast cancer incidence in Colombia. In 2007, age-standardized incidence rate was 27.8 per 100,000 persons increasing to 49.7 cases per 100,000 persons in 2012. Approximately, 2200 women die every year in Colombia due to breast cancer with rates increasing historically, but now are stabilizing. Advanced breast cancers are most frequently found among women without health insurance, while early breast cancers are usually found among working women and those covered by private health insurance. Early breast cancer screening was made mandatory as public policy in the year 2000. However, only 30% of health care coverage was reported, translating to very low coverage by opportunistic screening programs with only 33% of women having had a mammography. In 2012, a National Cancer Control Plan was planned and implemented. It aims to increase early stage cancer diagnosis, increase biannual screening coverage, and guarantee timely access to diagnosis and treatment. A national health survey in 2015 showed only 48% of women had an annual mammographic screening. Multiple disparities have been found with regards to screening and early diagnosis such as economic strata, health insurance coverage, origin, and accessibility. Specifically, data shows that 23% needed to travel in order to obtain access to mammography. Often it is necessary for some patients to sue healthcare insurance systems to obtain specific health care, causing an increase in time to diagnosis and treatment. In 2016, on average a 90-day period was reported from time of onset of symptoms to suspected diagnosis of breast cancer, while the time to the initiation of treatment was 100 days for chemotherapy and close to 120 days for surgery. DISCUSSION These data serve to impact the landscape of breast cancer and improve patient outcomes in Colombia. While the National Cancer Plan has led to major changes, a big challenge remains related to the delays between suspicion of breast cancer and diagnosis and treatment. Quality of care provided by private and public insurance administrators is also of concern. General practitioners should receive more detailed training in breast cancer detection and management. The healthcare system should provide quality cancer care with urgent improvement in mammography, especially in more rural areas. Widely, more timely and appropriate follow-up is needed. Citation Format: Duarte C, Salazar A, Strasser-Weippl K, de Vries E, Wiesner C, Krush L, Goss PE. Breast cancer in Colombia: A growing challenge for the health care system [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-12.

To provide a comprehensive overview of breast cancer in Colombia. Data on breast cancer in Colombia are scarce. We present incidence data from population-based cancer registries that represent 4 distinct regions of the country. Other data originate from non-governmental institutions and healthcare providers within Colombia, official sources, expert opinion, Colombian legislation, and the Cancer Mortality Atlas publishes by Colombian National Cancer Institute. In Colombia, the age-standardized incidence rate remained relatively stable between 2012 and 2020 (43.1 to 47.8 cases per 100,000 women-years); Additionally, survival since 1995 has presented a substantial improvement from 65.7 to 72.1. In 33% of cases, the diagnosis of breast cancer was made in advanced stages, stage III or higher. The health demography survey conducted in 2015 showed that the participation in mammography screening in women aged 40 to 69 remains low 48.1%. Some limitations regarding access to early detection and diagnosis include economic strata, health insurance coverage, origin, and accessibility. On average, a 90-day period was reported from onset of symptoms to diagnosis of breast cancer. The first action towards improving outcomes in breast cancer should be to improve stage at diagnosis and timely access to care.

PURPOSEBreast cancer care requires a multimodal approach and a multidisciplinary team who must work together to obtain good clinical results. The fragmentation of care can affect the breast cancer care; however, it has not been measured in a low-resource setting. The aim of this study was to identify fragmentation of care, the geographic variation of this and its association with 4-year overall survival (OS), and costs of care for patients with breast cancer enrolled in Colombia's contributory health care system.MATERIALS AND METHODSA retrospective cohort study was conducted using administrative databases. Women with breast cancer who were treated from January 1, 2013, to December 31, 2015, were included. Fragmentation of care was the exposure, which was measured by the number of different health care provider institutions (HCPIs) that treated a patient during the first year after diagnosis. Crude mortality rates were estimated, survival functions were calculated using the nonparametric Kaplan-Meier approach, and adjusted hazard ratios (HRs) were estimated using multivariate Cox regression model to identify the association of fragmentation with 4-year OS. The association between fragmentation and costs of care was assessed using a multivariate linear regression model.RESULTSA total of 10,999 patients with breast cancer were identified, and 1,332 deaths were observed. The 4-year crude mortality rate was 31.97 (95% CI, 30.25 to 33.69) per 1,000 person-years for the whole cohort, and the highest rate was in the cohort defined for the fourth quartile of the fragmentation measurement (eight or more HCPIs), 40.94 (95% CI, 36.49 to 45.39). The adjusted HR for 4-year OS was 1.04 (95% CI, 1.01 to 1.07) for each HCPI additional. The cost of care is increased for each additional HCPIs (cost ratio, 1.25; 95% CI, 1.23 to 1.26).CONCLUSIONFragmentation of care decreases overall 4-year OS and increases the costs of care in women with breast cancer for Colombia.

BACKGROUND:Sentinel lymph node biopsy in breast cancer is considered the standard of staging in cases of clinically negative lymph nodes. Its omission in favor of axillary dissection generates significant morbidity.OBJECTIVE:To determine the total number of sentinel node biopsy procedures in breast cancer in Colombia from 2017 through 2020, model and analyze them as if they were performed only in stage I breast cancer patients, and integrate their results into the concepts of quality of medical care.METHODS:Search in a database of the Ministry of Health and Social Protection of Colombia with sentinel lymph node biopsy codes, and filters of breast cancer and year. Their results are contrasted with the number of cases in stage I of breast cancer.RESULTS:Breast cancer TNM staging was reported in 22154 cases, 3648 stage I. In the same time frame, the number of sentinel lymph node biopsies for breast cancer in Colombia was 1045, 28.64% of the total cases reported in stage I.CONCLUSIONS:Colombia is far from complying with the standard indicator of sentinel lymph node biopsy. It is recommended to concentrate breast cancer cases in hospitals that provide the conditions for its performance.

Rationale and purpose: Triple negative breast cancers (TNBCs), characterized by lack of hormone receptors' expression in absence of HER2 amplification, partially overlap with the basal-like subtype, with frequent occurrence in BRCA1 mutation carriers (BRCA1+). TNBCs are often associated with earlier onset, interval cancer diagnosis, larger size and aggressive clinical course with peak risk of recurrence at 1-3 years and increased mortality rate in the first 5 years. Thus, when screening women at high risk of breast cancer, special attention should be paid to patient outcome for TNBCs in comparison with non-TNBCs. Our aim was to compare TNBCs and non-TNBCs diagnosed during a prospective, non-randomized, multimodality screening study – including clinical breast examination (CBE), mammography, ultrasound (US) and magnetic resonance imaging (MRI) – on women at familial/genetic high risk of breast cancer conducted in 18 centres from June 2000 to March 2008 (ISS-HIBCRIT-1; Sardanelli F et al, Invest Radiol 2011). Methods: Comparisons were performed using Mann-Whitney U, Fisher exact and χ2 tests. Results: Among the 44 patients diagnosed with invasive cancers, 14 (31%) were TNBCs and 30 (69%) non-TNBCs, the former being 13 invasive ductal (IDC) and 1 atypical medullary carcinoma, the latter also including 15/30 lobular subtypes and/or DCIS component (p=0.005). Of the 14 TNBCs, 10 (71%) were found in BRCA1+, 2 (14%) in BRCA2+ and 2 (14%) in BRCA-untested women with strong family history of breast/ovarian cancer; the same data for 30 non-TNBCs were 9 (30%), 6 (20%) and 15 (50%) respectively (p=0.028). We had only three interval cancers, all TNBCs. The median age at diagnosis was 49 years (range 36-62) for TNBCs and 53 years (range 35-72) for non-TNBCs (p=n.s). TNBCs presented a higher rate (11/14, 79%) of pathological grade 3 IDCs compared with non-TNBCs (8/30, 27%) (p=0.002). The mean tumor size was 1.6 cm for TNBCs and 1.2 cm for non-TNBCs (p=n.s). Nodal status was negative in 12/14 (86%) TNBCs and in only 16/30 (53%) non-TNBCs (p=0.038). MRI similarly outperformed CBE, mammography and US in both TNBCs and non-TNBCs. Clinical course and survival could be monitored for 40/44 patients (91%), 13 TNBCs and 27 non-TNBCs, with a follow-up of 5.8 and 6.3 years (p=n.s) respectively. The rate of disease-free patients for over 5 years was 8/13 (62%; mean disease-free interval 7.0 years, range 5.0-8.0) for TNBCs and 17/27 (63%; mean 7.2 years, range 5.2-9.9) for non-TNBCs. Death due to BC occurred for 2/13 TNBC (15%, at 3.5 and 4.2 years) and 3/27 non-TNBC patients (11%; at 2.0, 4.9 and 5.7 years). The rate of locoregional relapse was 1/13 (8%, at 4.4 years) and 5/27 (19%; mean time of 5.0 years, range 2.4-7.0) respectively. Distant recurrence was reported for only 2 non-TNBC patients. Conclusion: TNBCs showed stronger association with BRCA1+ status, lower rate of lobular subtypes or DCIS component, and less frequent nodal involvement. Despite a more frequent pathological grade 3 and the tendency to be diagnosed as interval cancers, under the current treatment protocols TNBCs showed relapse and BC-related death rates and over-5-year disease-free intervals similar to those of non-TNBCs. These data provide outcome evidence supporting the value of entering women at high risk of TNBC (in particular BRCA1+) in intensive screening programs including MRI. Citation Format: Franca Podo, Filippo Santoro, Siranoush Manoukian, Clelia de Giacomi, Laura Cortesi, Lorenzo Preda, Stefano Corcione, Francesco Sardanelli. High-risk patients found affected with breast cancer during a multimodality screening program: Triple negative versus non-triple negative breast cancers. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B13.

e12017 Background: Cancer antigen 15–3 (CA 15–3) and carcinoembryonic antigen (CEA), are often used in follow up care of breast cancer and provide important clues to the clinicians for disease progression in metastatic and recurrent breast cancer. Triple-negative breast cancers are frequently defined as a single group identifiable using routine clinical tests. They are negative for estrogen receptor (ER), progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER-2), the so-called triple-negative breast cancers. In this study we compared the tumor markers of triple negative breast cancer and non-triple negative patients. Methods: We retrospectively analyzed serum CEA and CA 15–3 levels of both triple negative and non-triple negative breast cancer patients at the time of first diagnosis and when they developed metastatic disease. Results: 544 consecutive nonmetastatic breast cancer patients presenting at Hacettepe University Institute of Oncology, Ankara, Turkey, with a median age of 49 were evaluated. 15.1% of the patients were triple negative breast cancer. At the time of diagnosis triple negative group had lower serum CEA (2.5 ± 5.9 vs 4.0 ±16.4 p = 0.35) and CA 15–3 (23.7 ± 14.6 vs 37.1 ± 117; p = 0.021) levels compared to non-triple negative group. In patients who developed metastasis during follow up; the CEA (3.2 ± 3.8 vs 29.6 ± 106.4 p = 0.022) and CA15–3 (46.9 ± 46.3 vs 203.2 ± 534 p = 0.008) levels were also significantly lower in triple negative breast cancer group compared to non-triple negative group.In non-triple negative breast cancer patients who developed metastasis, mean serum levels of CEA and CA15–3 significantly increased compared to baseline, whereas in triple negative group who developed metastasis CEA and CA 15–3 levels did not differ significantly. Conclusions: While being a good laboratory parameter in the follow-up of patients with breast cancer metastases, tumor markers may not show the increased tumor burden in the triple-negative breast cancer patients. No significant financial relationships to disclose.

Background: Breast cancer (BC) in women under 50 years represents a biologically aggressive disease with distinct genomic features and higher hereditary burden. Latin American data on this subgroup remain limited. We aimed to describe the clinical and molecular characteristics of young BC patients in a comprehensive cancer center in Colombia, and to evaluate the yield of genetic testing. Methods: A retrospective cohort of 113 women <50 years diagnosed with BC at the Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC) between 2019 and 2024 was analyzed. Demographic, clinical, histopathologic, imaging, and molecular data were extracted. Tumor subtypes were defined based on ER, PR, and HER2 status. Germline sequencing was performed in 95% of cases (n=108). Chi-squared and t-tests were used to assess associations between mutation status, age, and clinical variables. Results: Among 108 women diagnosed with breast cancer at ≤50 years of age who underwent comprehensive germline genetic testing, 76 patients (70.4%) had complete immunohistochemical data, enabling subtype classification. The most common subtype was Luminal (n=36, 47.4%), followed by triple-negative (n=18, 23.7%) and HER2-enriched tumors (n=8, 10.5%). The luminal group showed a mutation frequency of 13.9% (5/36), while HER2-enriched tumors exhibited a rate of 12.5% (1/8). BRCA1 was the most frequent germline mutation in triple-negative tumors, identified in 18.2% (2/11) of cases. In contrast, Luminal and HER2-enriched subtypes showed a predominance of non-canonical mutations, including genes such as MUTYH, POLE, and APC, detected in 40.9% (9/22) and 14.3% (2/14) of cases, respectively. When considering all germline findings, 47 out of 108 patients (43.5%) harbored at least one germline alteration. The most frequently altered genes across the cohort were BRCA1 (7.4%), PALB2 (5.6%), BRCA2 (3.7%), and CHEK2 (1.9%). Additionally, 24.1% had variants in non-canonical genes, including both pathogenic and uncertain significance variants. Patients carrying germline mutations were diagnosed at a significantly younger age (mean 34.9 ± 6.1 years) compared to non-carriers (mean 41.8 ± 5.4 years; p < 0.001), emphasizing the contribution of hereditary predisposition to early-onset breast cancer and supporting the implementation of broad germline testing in all young patients, irrespective of tumor subtype. Conclusions: Germline pathogenic variants are frequent in early-onset breast cancer, particularly in triple-negative and Luminal subtypes. BRCA1 predominates in triple-negative cases, while PALB2 and CHEK2 are found in hormone receptor–positive tumors. Additionally, 24.1% of patients carried alterations in non-canonical genes, reflecting marked genomic heterogeneity. Mutation carriers were diagnosed at a significantly younger age, supporting early and comprehensive genetic testing in all young patients to guide personalized care and familial risk assessment. Citation Format: M. A. Bravo, D. C. Sotelo-Rodríguez, J. Caicedo, S. Cervera, A. Ruiz-Patiño, W. A. Mantilla, S. X. Franco. Genomic characterization and genetic testing gaps in early-onset breast cancer in Colombia [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-01-21.

Background: In HR+/HER2- breast cancer (BC), most patients are diagnosed in early stages (ES) when treatment (tx) is administered with curative intent; however, cancer recurrence remains a significant problem in this population. In Colombia, regardless of this disease being a public health problem, there is no data regarding disease recurrence (DR) and few data on the natural history of the disease. We conducted a study to assess risk of DR and better understand clinical characteristics of stage II-III HR+HER2- BC patients. Methods: A retrospective analytical cohort study was conducted. Patients were selected from Suramericana database, one of the main health insurance companies in the country. Adults with a diagnosis (dx) of stage II-III HR+/HER2- BC between January 2017 and December 2022 were selected. Primary endpoint was local, regional, or distant recurrence after primary surgery. We calculated cumulative incidence and incidence rates (IR) of recurrence per 1000 person-years stratified by stage. Kaplan-Meier method was used to estimate cumulative probabilities during follow-up. Results: A total of 2142 patients were included. Median age at dx was 56 years, 99.3% of the patients were women and 57.7% were postmenopausal. Most pts (68.7%) were stage II, 43.9% had no nodal involvement at dx, and 54.7% had a Ki67 greater than 20%. A total of 1876 patients had surgical resection with median follow-up time of 24.7 months. Cumulative incidence of DR was 11.1% at 5 years, while the IR was 43.0 and 61.1 per 1000 person-years in stages II and III, respectively. Of the patients with DR, 56.6% were still receiving tx with endocrine therapy. Risk of DR was 5.9%, 13.1%, and 24.1% at 1, 3 and 5 years respectively. A significant increase of cumulative incidence of DR was observed in stage III (p=0.012, HR 1.43, 95%CI 1.08 - 1.91) and patients with high nodal involvement (p=0.004, HR 2.86 95%CI 1.56 - 5.24). Conclusions: Real world data from this cohort show a similar incidence of DR in Colombia to the reported in the international literature. Regardless of adjuvant tx with endocrine therapy, patients persist at risk of DR and more effective therapies are needed to provide better outcomes for patients in this potentially curative scenario. Citation Format: Marcela Chalela Jhon Bolaños, Carlos Bello, Carolina Benavides. Risk of Disease Recurrence Among Patients with Stage II and III HR-positive, HER2-negative Breast Cancer in Colombia: A Retrospective Cohort Study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P1-11-23.

Breast Cancer Survivors: Does the Screening MRI Debate Continue?

Background: Specific biomarkers can be essential for developing effective treatments for aggressive breast cancers, especially triple negative subtypes, for which treatment options are limited. Folate receptor alpha (FRα), a critical membrane protein for DNA synthesis and cell metabolism, has been suggested to participate in the transformation of breast cancer into aggressive subtypes. It has been shown to be strongly associated with poor prognosis in triple negative breast cancers (TNBC) as well as estrogen receptor (ER) positive and progesterone receptor (PR) negative subtypes. SOX10 is a nuclear transcription factor that participates in neural crest development and in the differentiation of cells of melanocytic lineage. Data suggests that SOX10 may contribute in stem cell or progenitor cell maintenance. Recently, SOX10 expression has also been documented in benign breast myoepithelial cells and in aggressive breast cancers. The correlation of FRα and SOX10 in breast cancer is not fully known. This is the first study to compare FRα and SOX10 immunohistochemical profiles in breast cancers with emphasis in TNBC. Design: 166 cases of whole breast cancer tissues were classified according to their ER, PR, and HER2 immunohistochemical (IHC) status. These same cases were then IHC stained for mouse monoclonal SOX10 and FRα. Cut-off values of 1% and 5% for SOX10 and FRα, respectively, were used to determine positivity. Results: SOX10 achieved a sensitivity of 42.1% (8/19) in ER+/PR-/HER2- cases and was negative in all ER+/PR-/HER2+ cases (p<0.05). FRα was positive in 7.6% (7/92) of ER+/PR+/HER2- cases and was negative in all ER+/PR+/HER2+ cases. SOX10 identified more ER+/PR-/HER2- cases (42.1%, 8/19) than ER+/PR+/HER2+ cases (7.7%, 1/13) (p<0.05). Similarly, FRα stained 52.6% (10/19) of ER+/PR-/HER2- cases and was negative in all ER+/PR+/HER2+ cases (p<0.005). SOX10 and FRα were observed in 3.3% (1/30) and 20% (6/30) of HER2+ cases, respectively. In ER-/PR-/HER2- (triple negative) cases, both markers were highly expressed with 40.0% (10/25) and 52.0% (13/25) positive cases with SOX10 and FRα, respectively, with 24.0% (6/25) of cases positive with both markers. Approximately one half of TNBC cases expressed SOX10 and FRα; however, most SOX10 positive TNBC cases did not overlap with FRα positive TNBC cases. Table 1: SOX10 and FRα expression in breast cancer subtypesER/PR/HER2 ClassificationSOX10+ (%)FRα+ (%)Co-expression of SOX10 and FRα (%)ER+/PR+/HER2+ (n=13)1 (7.7%)0 (0.0%)0 (0.0%)ER+/PR+/HER2- (n=92)6 (6.5%)7 (7.6%)2 (2.2%)ER+/PR-/HER2+ (n=10)0 (0%)5 (50.0%)0 (0.0%)ER+/PR-/HER2- (n=19)8 (42.1%)10 (52.6%)5 (26.3%)HER2+ (n=30)1 (3.3%)6 (20.0%)0 (0.0%)ER-/PR-/HER2- (n=25)10 (40.0%)13 (52.0%)6 (24.0%) Conclusion: SOX10 and FRα were frequently expressed in triple negative breast cancers and in progesterone receptor negative breast cancers. Our data suggests that there may be different mechanisms by which SOX10 and FRα are implicated in aggressive breast cancers. These findings may help achieve a better understanding of the two different pathways involving stem cells (SOX10) and growth factors (FRα), their potential prognosis and their therapeutic management in the future. Citation Format: Laura L Hoang, Weimin Qi, Charlie Yu, David Tacha. SOX10 and folate receptor alpha are frequently expressed in triple negative and progesterone receptor negative breast cancers [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-01-13.

Objective To study the expressions of integrin β1 and p73 in triple negative (ER-、PR-、HER2-) breast cancers and evaluate its clinical significance, exploring the relationship between clinicopathological parameters. Methods The immunohistochemistry SP methods was used to evaluate the expression of integrinβ1 and p73 in 93 cases of triple negative breast cancer,58 cases of none triple negative breast cancer. The correlation of integrinβ1 and p73 exprssion with clinicopathologic characteristics and between the two proteins were analyzed. Results The expression of integrinβ1 in the triple negative breast cancers was significantly higher than those of none triple negative breast cancer(83.87% vs 67.24%), with a significant difference(χ2=5.66,P=0.017). The expression of p73 in the triple negative breast cancers was significantly higher than those of none triple negative breast cancer (65.59% vs 46.55%), with a significant difference(χ2=5.33,P=0.021). In triple negative breast cancers,integrinβ1 expression was associated with axillary lymph node metastasis(χ2=6.206,P=0.021)and TNM stage(χ2=4.854,P=0.041), but it was not correlated with patients age(χ2=0.121,P=0.783), tumor size(χ2=1.402,P=0.271)and histologic grade(χ2=1.042,P=0.376). p73 expression was associated with histologic grade(χ2=5.503,P=0.020),axillary lymph node metastasis(χ2=4.626,P=0.047)and TNM stage(χ2=5.828,P=0. 024), but it was not correlated with patients age(χ2=0.858,P=0.387), tumor size(χ2=0.875,P=0.388).Correlation analysis showed that integrinβ1 expression was positively correlated with p73 expression in triple negative breast cancers(r=0.359,P=0.000). Conclusions p73 has its tissue specificity, both integrinβ1 and p73 protein may participate in the development of triple negative breast cancers, and could serve as an important potential marker in the aspect of invasiveness and metastasis in triple negative breast cancers. Key words: breast neoplasms; Triple negative; immunohistochemistry; integrinβ1; p73

Introduction: Triple negative breast cancer (TNBC) represents 10-20% of all breast cancer entities [1][2] and has a known aggressive behavior and poor outcome. Patients treated in the setting of randomized clinical trials often do not represent actual treatment characteristics in real-life scenarios. To determine the stage-related survival and effect of surgical performance in TNBC with current multimodal treatment, we set out to analyze data of a large population-based registry of primary breast cancers which covering >50% of all breast cancer cases in Germany. Patients and methods: We analyzed data from a prospectively collected cancer registry of >200 certified breast units of the West-German Breast Center (WBC) in Germany from 2009-2011. From a cohort of 39570 primary breast cancer patients treated in this period, 12759 underwent adjuvant systemic therapy, out of which 2037 were TNBC cases with adjuvant chemotherapy. Inclusion criteria were triple negative breast cancers (Her2-new1+/2+ (Fish negative) and estrogen receptor (ER) and progesterone receptor (PR) <10%) and adjuvant chemotherapy, unilateral and non-metastasized breast cancer. Only those patients were included who have been followed-up within the first 3 years. Exclusion criteria were neoadjuvant chemotherapy, bilateral breast cancer and metastatic disease. The use of first, second and third generation chemotherapy was analyzed as well as the effect of clear/unclear resection margins and its impact on survival data. Results: 2037 patients were eligible for this study. Overall survival rates were as follows: T1 a and T1b 100 %, T1c 90,7 %, T2 90,9 %, T3 68,1 % and T4 64,3 %. No statistical differences were detected in between stages T1 and T2, and also not in between T3 and T4. Combining T1/T2 and T3/T4 and performing group-wise comparisons, differences for combined stages were highly statistically significant (3,9 x E-09). Inflammatory TNBC was prognostically worst with a survival-rate of 33,3 % at 24-months. (p<0,001) Unclear resection-margins versus clear margins in TNBC exerted a negative impact on DFS (87 vs. 73 %; p=0,00002) and DDFS (p=0,0004). Age was an independent risk factor for survival with a cut-off at 35 years.(p=0,044) Third-generation chemotherapies (anthracycline+taxanes) were associated with a significant improved overall-survival at 24-months compared to first generation chemotherapies (non-anthracycline, non-taxane) (95 % vs. 87 %; p=0,0029) Conclusion: Standard 3rd generation (anthracycline- and taxane-containing) chemotherapy and optimal surgical performance with clear margins is vital for patients with early, triple-negative breast cancer (TNBC). Within T1 and T2 stages, no stage-related deterioration of prognosis was detected, however these stages were markedly different from stages T3/T4, declining from 90-100% to 64-68 %. This analysis of a large database of a population-based study demonstrates that tumor size, margins and guideline-adapted chemotherapy matter in triple-negative, early breast cancer. [1] Schwentner et al. 2013 [2] Elsawaf et al. 2013. Citation Format: Peter Kern, Gunter von Minckwitz, Carolin Pütter, Annika Flach, Sofia Pavlidou, Rainer Kimmig, Mahdi Rezai. Stage-related risk categorization and influence of free margins on survival in triple negative early breast cancer - a population-based study of 2037 TNBC patients with adjuvant chemotherapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-01.

Objective: To study expressions of matrix metalloproteinase-13 (PCNA) in triple negative (ER-, PR-, HER2-) breast cancers and evaluate their clinical significance. Methods: The immunohistochemistry SP method was used to evaluate the expressions of PCNA in 32 cases of triple negative breast cancers, 24 cases of HR breast cancer (ER+/PR+, HER-2-), 12 cases of HER2 breast cancer (ER-, PR-, HER2+) and 12 cases of breast fibroadenoma and their correlations to clinicopathologic features were analyzed. Results: The expressions of PCNA were significantly higher in the triple negative breast cancers than in breast fibroadenoma and HR breast cancers (P<0.05). Furthermore, the expression of PCNA was significantly higher in the triple negative breast cancers than in HER2 breast cancers (P <0.05). In the triple negative breast cancers, PCNA expression was associated with axillary lymph node metastasis and TNM stage (P <0.05), but it was not correlated with patients age (P >0.05). Correlation analysis showed that PCNA expression was positively correlated in the triple negative breast can cers, HR breast cancers and HER2 breast cancers (P <0.05). Conclusion: There is a close relationship between PCNA the occurrence and development of triple negative breast cancers, and PCNA could serve as important indexes in the aspect of invasiveness and metastasis in triple negative breast cancers. Citation Format: Peng Jiaping, meng qun. Expressions of PCNA in triple-negative breast cancers and their clinical significance. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B104.

Every year approximately 25% of women diagnosed with breast cancer are younger than 50 years of age, and almost 10% of them have a BRCA mutation. Not all potential carriers are identified by existing criteria for BRCA testing. We estimated the costs and benefits of different BRCA testing criteria for women with breast cancer younger than 50 years. We developed a Markov Monte Carlo simulation to compare six criteria for BRCA mutation testing: (1) no testing (reference); (2) medullary breast cancer in patients younger than 50 years; (3) any breast cancer in patients younger than 40 years; (4) triple negative (TN) breast cancer in patients younger than 40 years; (5) TN breast cancer in patients younger than 50 years; (6) any breast cancer in patients younger than 50 years. Net health benefits were life expectancy and quality-adjusted life expectancy, and primary outcome was the incremental cost-effectiveness ratio (ICER). The model estimated the number of new breast and ovarian cancer cases. BRCA mutation testing for all women with breast cancer who were younger than 50 years could prevent the highest number of breast and ovarian cancer cases, but with unfavorable ICERs. Testing women with TN breast cancers who were younger than 50 years was cost-effective with an ICER of $8,027 per year of life gained ($9,084 per quality-adjusted life-year), and could reduce subsequent breast and ovarian cancer risks by 23% and 41%, respectively, compared with the reference strategy. Testing women with TN breast cancers who were younger than 50 years for BRCA mutations is a cost-effective strategy and should be adopted into current guidelines for genetic testing.

In Europe and the United States, the proportion of women receiving mammographic screening for breast cancer has increased to 60-80%, resulting in an increase in the detection of early-stage cancer and a reduction in the mortality rate. The objectives of breast cancer screening have thus already been achieved there. In Japan, both the incidence and mortality of breast cancer have increased recently. Breast cancer screening has long been performed by clinical breast examination (CBE) alone. A reduction in the mortality of breast cancer cannot be expected from CBE. Mammographic screening for breast cancer was recommended in a notification issued by Ministry of Health, Labour and Welfare in 1999. An important aspect of mammographic screening is quality control. The Central Committee on Quality Control of Mammographic Screening(Central Committee)was organized by six screening-related societies, and attempts have since been made to establish a quality control system. Both the social recognition of the Central Committee and its cooperation with the "Quality Control Committee " of each community will become important. The cover rate of nationwide breast cancer screening by CBE alone is 12-13%, while the implementation rate of mammographic screening is presently very low and its cover rate is considered to be about 2%. With such a low cover rate, it is absolutely impossible to reduce the mortality of breast cancer. To achieve this, the administration and clinicians will be required to cooperate with each other to increase the spread and cover rate of high-quality mammographic screening.