5-year Breast Cancer Survival Research Articles

Abstract PO3-10-07: Leveraging AI to identify factors influencing access to care and their association with overall survival- a multiracial Breast Cancer cohort

Abstract Introduction: Data from the Centers for Disease Control and Prevention (CDC) labels each US state based on its 5-Year Relative Survival of Breast Cancer (BC) patients (pts). Data is categorized into four “survival groups'', each representing a range of 5-year survival percentages. Using real-world data, this study characterized the populations in each survival group, examining pt knowledge and education about their disease as well as preferences and factors influencing their decision to explore clinical trial (CT) opportunities. Methods: Leal is an AI-based platform that employs self-reported medical profiles to match cancer pts with CTs. This study involved a diverse cohort of 14,509 BC pts who completed the questionnaire. The geographic distribution of pts across US states was analyzed, taking into account the state’s 5-year BC survival %. Four groups were defined as follows: Group A (86.4 - 89.4%), Group B (89.4 - 90.4%), Group C (90.4 - 91.5%), and Group D (92.0 - 95.0%). Parameters such as race, willingness to travel, insurance coverage, performance of genetic testing, and biomarker knowledge were considered in the analysis. Results: We found significant variations in registration rates on the Leal platform across groups. The Highest registration rate was recorded for Group D which has the highest 5-year survival rate (p< 0.0001). Group A which has the lowest 5-year relative survival had a significantly higher proportion of African Americans compared to group D (14% vs 4%, p < 0.0001). Moreover, while there was no difference in the percentage of pts undergoing Next-Generation Sequencing (NGS) in both groups, a larger proportion of pts in Group D demonstrated proficiency in interpreting the test reports (p = 0.05). Although no significant differences were found in the proportion of pts who were aware of their treatment (tx) history between the two groups, whites in both groups exhibited greater knowledge of their tx (p = 0.001). Additionally, pts in Group D showed a significantly higher willingness to travel longer distances to participate in CTs (p=0.001), and a larger percentage of them had insurance coverage. Conclusions: This study used data from CDC that categorized US states into four groups based on BC pts’ 5-Year Survival. CT participation is associated with better clinical outcomes, especially for pts with poorer prognosis. In agreement, we show a higher signup rate to the Leal platform in States with higher 5-year relative survival, possibly pointing to higher CT education and knowledge among pts in those states. This is further supported by higher proficiency in interpreting NGS reports, resulting in better-optimized CT options on the Leal platform. Group A was also characterized by a reduced willingness to travel for a CT and a larger proportion of pts without health insurance. Those are significant barriers for CT enrollment, and ultimately limit access to optimal care and may impact outcomes. Gaps in knowledge of key disease parameters such as tx history were observed for African Americans, regardless of geographic location, highlighting the need to focus on minority populations even in states where the survival rate is relatively high. In agreement, the proportion of African Americans in group A was markedly higher, correlating with current disparities in access to tx and poorer outcomes. AI-based platforms are optimized for the exact identification of barriers to access to care and for enabling relevant healthcare and support organizations to effectively address individual patient issues, consequently increasing access to CTs, particularly among different racial and ethnic populations. Citation Format: Michal Safran, Yelena Lapidot, Tzvia Bader, Avital Gaziel. Leveraging AI to identify factors influencing access to care and their association with overall survival- a multiracial Breast Cancer cohort [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-10-07.

The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: protocol for a prospective, multicentre cohort study.

Despite a UK 5-year breast cancer survival rate of 86.6%, patients may develop breast cancer recurrence within the same breast after breast conserving surgery, as well as in the remaining skin or chest wall after mastectomy or in the ipsilateral lymph glands. These recurrences, collectively termed locoregional recurrence (LRR), occur in around 8% of patients within 10 years of their original diagnosis. Currently, there is a lack of robust information on the presentation and prevalence of LRR with no UK-specific clinical guidelines available for the optimal management of this patient group. Additionally, there is a need to identify patterns of LRR presentation and their progression, which will enable prognostic factors to be determined. This will subsequently enable the tailoring of treatment and improve patient outcome. The MARECA study is a prospective, multicentre cohort study recruiting patients diagnosed with breast cancer LRR +/- associated distant metastases. Over 50 UK breast units are participating in the study with the aim of recruiting at least 500 patients over a recruitment period of 24 months. The data collected will detail the tumour pathology, imaging results, surgical treatment, radiotherapy and systemic therapy of the primary and recurrent breast cancer. Study follow-up will be for up to 5 years following LRR diagnosis to determine subsequent oncological outcomes and evaluate potential prognostic factors. This study will address the current knowledge gap and identify subgroups of patients who have less successful treatment outcomes. The results will determine the current management of LRR and the prognosis of patients diagnosed with breast cancer LRR +/- distant metastases in the UK, with the aim of establishing best practice and informing future national guidelines. The results will direct future research and inform the design of additional interventional trials and translational studies.

Multiple mediation analysis of racial disparity in breast cancer survival

BackgroundRacial (Black vs. White) disparities in breast cancer survival have proven difficult to mitigate. Targeted strategies aimed at the primary factors driving the disparity offer the greatest potential for success. The purpose of this study was to use multiple mediation analysis to identify the most important mediators of the racial disparity in breast cancer survival. MethodsThis was a retrospective cohort study of non-Hispanic Black and non-Hispanic White women diagnosed with invasive breast cancer in Florida between 2004 and 2015. Cox regression was used to obtain unadjusted and adjusted hazard ratios (HR) with 95% confidence intervals (CI) for the association of race with 5- and 10-year breast cancer death. Multiple mediation analysis of tumor (advanced disease stage, tumor grade, hormone receptor status) and treatment-related factors (receipt of surgery, chemotherapy, radiotherapy, and hormone therapy) was used to determine the most important mediators of the survival disparity. ResultsThe study population consisted of 101,872 women of whom 87.0% (n = 88,617) were White and 13.0% were Black (n = 13,255). Black women experienced 2.3 times (HR, 2.27; 95% CI, 2.16–2.38) the rate of 5-year breast cancer death over the follow-up period, which decreased to a 38% increased rate (HR, 1.38; 95% CI, 1.31–1.45) after adjustment for age and the mediators of interest. Combined, all examined mediators explained 73% of the racial disparity in 5-year breast cancer survival. The most important mediators were: (1) advanced disease stage (44.8%), (2) nonreceipt of surgery (34.2%), and (3) tumor grade (18.2%) and hormone receptor status (17.6%). Similar results were obtained for 10-year breast cancer death. ConclusionThese results suggest that additional efforts to increase uptake of screening mammography in hard-to-reach women, and, following diagnosis, access to and receipt of surgery may offer the greatest potential to reduce racial disparities in breast cancer survival for women in Florida.

Factors associated with breast cancer recurrence and survival at Sangre Grande Hospital, Trinidad.

The aim of this study is to determine the demographic, pathological, and treatment-related factors that predict recurrence and survival in a Trinidadian cohort of breast cancer patients. The inclusion criteria for this study were female, over 18years, and with a primary breast cancer diagnosis confirmed by a biopsy report occurring between 2010 and 2015 at Sangre Grande Hospital, Trinidad. Univariate associations with 5-year recurrence-free survival and 5-year overall survival were calculated using the Kaplan-Meier method for categorical variables and Cox Proportional Hazards for continuous variables. A multivariate model for prediction of recurrence and survival was determined using Cox regression. For the period 2010-2015, 202 records were abstracted. Five-year overall survival and recurrence-free survival rates were found to be 74.3% and 56.4%, respectively. Median times from first suspicious finding to date of biopsy report, date of surgery, and date of chemotherapy were 63days, 125days, and 189days, respectively. In the univariate analysis, age (p = 0.038), stage (p < 0.001), recurrence (p = 0.035), surgery (p = 0.016), ER (p < 0.001) status, PR status (p < 0.001), and subtype (p < 0.001) were significantly associated with survival. Additionally, stage (p = 0.004), N score (p = 0.002), ER (p = 0.028) status, PR (p = 0.018) status, and subtype (p = 0.025) were significantly associated with recurrence. In the Cox multivariate model, Stage 4 was a significant predictor of survival (HR 6.77, 95% CI [0.09-2.49], p = 0.047) and N3 score was a significant predictor of recurrence (HR 4.47, 95% CI [1.29-15.54], p = 0.018). This study reports a 5-year breast cancer survival rate of 74.3%, and a recurrence-free survival rate of 56.4% in Trinidad for the period 2010-2015.

Regional, racial, gender, and tumor biology disparities in breast cancer survival rates in Africa: A systematic review and meta-analysis.

BackgroundThe survival rates from breast cancer in Africa are poor and yet the incidence rates are on the rise. In this study, we hypothesized that, in Africa, a continent with great disparities in socio-economic status, race, tumor biology, and cultural characteristics, the survival rates from breast cancer vary greatly based on region, tumor biology (hormone receptor), gender, and race. We aimed to conduct the first comprehensive systematic review and meta-analysis on region, gender, tumor-biology and race-specific 5-year breast cancer survival rates in Africa and compared them to 20-year survival trends in the United States.MethodsWe searched MEDLINE, EMBASE, and Cochrane Library to identify studies on breast cancer survival in African published before October 17, 2018. Pooled 5-year survival rates of breast cancer were estimated by random-effects models. We explored sources of heterogeneity through subgroup meta-analyses and meta-regression. Results were reported as absolute difference (AD) in percentages. We compared the survival rates of breast cancer in Africa and the United States.FindingsThere were 54 studies included, consisting of 18,970 breast cancer cases. There was substantial heterogeneity in the survival rates (mean 52.9%, range 7–91%, I2 = 99.1%; p for heterogeneity <0.0001). Meta-regression analyses suggested that age and gender-adjusted 5-year survival rates were lower in sub-Saharan Africa compared to north Africa (AD: –25.4%; 95% CI: –34.9 - –15.82%), and in predominantly black populations compared to predominantly non-black populations (AD: –25.9%; 95% CI: 35.40 - –16.43%). Survival rates were 10 percentage points higher in the female population compared to male, but the difference was not significant. Progesterone and estrogen receptor-positive breast cancer subtypes were positively associated with survival (r = 0.39, p = 0.08 and r = 0.24, p = 0.29 respectively), but triple-negative breast cancer was negatively associated with survival. Survival rates are increasing over time more in non-black Africans (55% in 2000 versus 65% in 2018) compared to black Africans (33% in 2000 versus 40% in 2018); but, the survival rates for Africans are still significantly lower when compared to black (76% in 2015) and white (90% in 2015) populations in the United States.ConclusionRegional, sub-regional, gender, and racial disparities exist, influencing the survival rates of breast cancer in Africa. Therefore, region and race-specific public health interventions coupled with prospective genetic studies are urgently needed to improve breast cancer survival in this region.

Impact of experience in breast cancer surgery on survival: the role of quality of care in a registry-based cohort.

Previous studies have suggested that the surgeon's experience in breast cancer surgery may affect patient survival. In this registry-based retrospective cohort study, we examined whether quality of care could partly explain this association. All invasive breast cancers operated on in the private sector between 2000 and 2009 were identified in the Geneva Cancer Registry and followed up for 5 years. Surgeons were classified according to their experience into three categories: ≤5, 6-10, >10 breast cancer operations performed per year. We extracted patient and tumour characteristics. Quality of care was scored as the proportion of 11 quality indicators correctly fulfilled for each patient. Breast cancer-specific mortality was examined with a Cox model adjusted for variables known to affect survival, surgeon experience, and quality of care. A total of 1489 patients were operated on by 88 surgeons; 50 patients (3.4%) died from breast cancer during the 5 years of follow-up. Socioeconomic status and country of birth of the patients, as well as period of diagnosis, differed according to the surgeons' experience. Quality of care provided improved with surgeons' experience. Surgeons performing >10 operations/year more frequently assessed histology before surgery, excised sentinel lymph nodes, removed ≥10 lymph nodes, and prescribed adjuvant radiotherapy when indicated. Crude breast cancer-specific mortality was lower in patients treated by surgeons performing >10 compared with ≤5 operations/year (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.17-0.67; p = 0.002). The strength of the association decreased after adjustment for patient and tumour characteristics (HR 0.45, 95% CI 0.21-0.94; p = 0.034) and decreased further after adjustment for quality of care (HR 0.51, 95% CI 0.24-1.08, p = 0.078). The association between surgeon's experience and 5-year breast cancer survival is at least partly explained by quality of care, patient and tumour characteristics. Further investigations on the impact of other quality indicators such as multidisciplinary networks are needed.

The novel cardio‐oncology drug, NP‐6A4, regulates the growth of multiple breast cancer cell lines through distinct cell‐specific mechanisms

While chemotherapeutic agents (anthracyclins, kinase‐inhibitors) have improved 5‐year breast cancer survival, their cardiovascular toxicity cause alarming increase in life‐threatening heart disease for millions of cancer survivors. Therefore, developing new cardio‐oncology drugs to protect heart during and after chemotherapy is an immediate critical need. Although literature indicate that Angiotensin II type 2 receptor AT2R attenuates cardiac damage, to date there are no AT2R agonists that are used in clinic to treat heart disease. NP‐6A4 is an AT2R peptide agonist that has recently received orphan drug designation for pediatric cardiomyopathy from the FDA. Our previous studies indicated that NP‐6A4 treatment (1.8mg/kg/day) could improve cardiac function and attenuate cardiomyopathy in diabetic rats and protect human cardiovascular cells from acute nutrient stress. We hypothesized that since AT2R is a regulator of cell growth, NP‐ 6A4‐AT2R signaling will attenuate breast cancer cell growth. Here we report NP‐6A4 treatment of triple negative breast cancer cells (MDA‐MB‐231) and estrogen positive breast cancer cells (MCF‐7) resulted in significant (p&lt;0.05) suppression of cell index (as determined by real time cell analyzer), and survival (as determined by MTS assay), albeit the underlying mechanisms were different. NP‐6A4 treatment of MCF‐7 cells augmented Tamoxifen‐induced inhibition of cell growth (p&lt;0.05), and suppressed proliferation marker Ki67 (20%) and phosphokinases CREB (32%), Jun N‐terminal kinase (JNK) (51%) and Erk1/2 (41%). In MDA‐MB‐231 cells, NP‐6A4 treatment caused increase in apoptotic marker Caspase 3 (2.3‐fold increase), but suppressed its inhibitor phosphokinase p38 (37%) (p&lt;0.05), and also suppressed phosphokinases CREB (30%), JNK (51%) and Erk1/2 (33%). However, doxorubicin (anthracycline)‐induced cell death was not reversed by NP‐6A4. NP‐6A4 treatment increased different tumor suppressors: ATIP 1 mRNA in MCF‐7 and ATIP‐3 mRNA in MDA‐MB‐231 (p&lt;0.05). These data suggest that NP‐6A4 differentially regulates human breast cancer cell growth and has high potential as a synergistic cardio‐oncology drug for breast cancer treatment.Support or Funding InformationThis work was supported by NIH grants: 1R01HL118376‐01 and 1R01HL138988‐01A1This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Abstract 4226: Challenges to breast cancer early detection in the developing, high income country of Trinidad and Tobago

Abstract Trinidad and Tobago (T&amp;T) has one of the highest breast cancer (BC) mortality rates in the Americas. For the period 1995-2007, 5-year BC survival rates in T&amp;T were approximately 30%. One possible explanation for T&amp;T’s low BC survival rates could be late presentation and detection. Currently, opportunistic BC screening programs exist in the public and private sectors and some advocate for an organized national BC screening program. However, the World Health Organization (WHO) only recommends the implementation of organized BC screening in high resource settings. Thus, the purpose of this study was to conduct a situational analysis of breast cancer early detection services in the public and private sector to identify gaps in service and determine if a national organized screening program is warranted. The quality, availability, affordability and accessibility of BC screening services in the public and private sector was assessed with an online survey using the Cancer Control WHO Guide for Effective Programs framework. The inter-rater reliability and validity was assessed during a pilot phase at two public institutions. All public and private facilities and NGOs with BC early detection services were invited to participate in the survey. A focus group with key radiologists in T&amp;T was held to review the results of the study, identify unaddressed challenges and make recommendations for improvement. Significant challenges exist in service availability and access, physical and human resources, program monitoring and evaluation, quality control mechanisms, follow-up diagnostics and care. Specifically, services are largely monopolized by the private sector at a cost to nationals. Public services which are free, are restricted to major hospitals where wait times extend to 3-6 months, thus contributing to a disparity in access. Both sectors cite a lack of trained staff such as specialist breast radiographers and radiologists. There is also a lack of preventative maintenance and investment in new machinery. No quality control guidelines or manuals for machinery use exist in the public sector. Across both sectors, 70% of institutions have no program evaluation. Other systemic problems such as long wait times for pathology reports also undermine the efficacy of current BC early detection efforts. An organized national breast cancer screening program is not recommended for T&amp;T at this time. More pressing concerns across the cancer care continuum need to be first addressed particularly in strengthening human and physical resource capacity and service quality for detection, diagnosis, and follow-up care. Also, research into factors such as time-to-treat, frequency of late stage presentation and misdiagnosis warrant further attention if T&amp;T is to improve its BC survival rate. Note: This abstract was not presented at the meeting. Citation Format: Kimberly Badal, Fidel Rampersad, Hamish Mohammed, Murrie Moosoodeen, Siva Konduru, Nalini Kokaram Maharaj, Adaila Russel, Melissa Nathan, Marisa Nimrod, Wayne A. Warner, Rajini Haraksingh, Adetunji Toriola. Challenges to breast cancer early detection in the developing, high income country of Trinidad and Tobago [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4226. doi:10.1158/1538-7445.AM2017-4226

Worse Breast Cancer Outcomes for Southern Nevadans, Filipina and Black Women.

Breast cancer is the second deadliest cancer for women in the demographically unique mountainous west state of Nevada. This study aims to accurately characterize breast cancer survival among the diverse women of the flourishing Silver State. Nevada Central Cancer Registry data was linked with the National Death Index and the Social Security Administration Masterfile. Overall 5-yearage-adjusted cause-specific survival, survival stratified by race/ethnicity, and stage-specific survival stratified by region of Nevada were calculated. Adjusted hazard ratios were computed with Cox proportional hazards regression.11,111 cases of breast cancer were diagnosed from 2003 to 2010. Overall 5-year breast cancer survival in Nevada was 84.4%, significantly lower than the US, at 89.2%. Black and Filipina women had a higher risk of death than white women. Poor survival in the racially and ethnically diverse Las Vegas metropolitan area, with a large foreign-born population, drives Nevada's low overall survival. System-wide changes are recommended to reduce the racial/ethnic disparities seen for black and Filipina women and improve outcomes for all.

"From Patient to Survivor": Women's Experience With Breast Cancer After 5 Years.

Women who have survived breast cancer for 5 years without recurrence are not subject to active follow-up because of limited resources. Their life experiences more than 5 years subsequent to diagnosis and treatment are unknown. The aim of this study was to understand the life experiences and care needs of women who have survived breast cancer for more than 5 years in Taiwan. A purposive sampling was used. Women diagnosed with breast cancer more than 5 years previously and without recurrence were recruited in this study. The interviews were conducted in a comfortable and convenient place decided by the participants. The interviews were converted into transcripts and analyzed using content analysis. Thirteen women participated in this study whose ages were between 48 and 72 years. Five main themes were identified: (1) fear of recurrence, with women attempting to use ways to reduce recurrence, including dependence on drugs, desire for information, and promoting health; (2) hoping for alleviation of adverse effects; (3) seeking a body image; (4) expectations for the patient-physician relationship; (5) concerns of a mother; and (6) positive thinking. Taiwanese women with post 5-year breast cancer survival continue to have physiological and emotional needs. They long for attention and care from their healthcare team. It is pivotal to formulate a care plan suitable for 5-year-plus survivors of breast cancer and to assist them in gaining an understanding of the latest treatments and self-care information. It is crucial that nurses play a greater role in caring for long-term survivors.

Hypofractionated radiation treatment following mastectomy in early breast cancer: the Christchurch experience.

Although hypofractionated radiotherapy (HFRT) has become an accepted option for whole-breast irradiation after breast-conserving surgery, there is limited evidence to support HFRT to the chest wall following mastectomy. We retrospectively analysed post-mastectomy patients treated with HFRT in Christchurch to determine whether HFRT yields acceptable efficacy and toxicity. The Christchurch oncology database was used to identify breast cancer patients treated with adjuvant HFRT to the chest wall following a mastectomy between 2003 and 2008. Eligible post-mastectomy patients were treated with 40 Gy in 16 daily fractions. Treatment outcomes assessed included local recurrence-free survival, breast cancer survival, overall survival and acute toxicities. One hundred thirty-three patients were identified. The median follow-up period was 5.03 years. Three patients had a local recurrence as a first event, resulting in 5-year local recurrence-free survival of 97.6%. Five-year overall survival and 5-year breast cancer survival were 74.7% and 77.7%, respectively. The prospectively assessed acute toxicities were mostly grade 1. In particular, the incidence of grade 2 skin toxicity was 10.7%, and no patients experienced grade 3 skin toxicity. The high local control rate with HFRT, combined with acceptable toxicity and the practical benefits of a shorter treatment time, supports its ongoing use in the eligible patient group. A randomised controlled trial would be necessary to more completely assess the acute and long-term toxicity of HFRT compared with standard fractionation.

Black-White Differences in Breast Cancer Outcomes Among Older Medicare Beneficiaries

Black-White Differences in Breast Cancer Outcomes Among Older Medicare Beneficiaries

Racial and Ethnic Differences in Adjuvant Hormonal Therapy Use

In the United States, 5-year breast cancer survival is highest among Asian American women, followed by non-Hispanic white, Hispanic, and African American women. Breast cancer treatment disparities may play a role. We examined racial/ethnic differences in adjuvant hormonal therapy use among women aged 18-64 years, diagnosed with hormone receptor-positive breast cancer, using data collected by the Northern California Breast Cancer Family Registry (NC-BCFR), and explored changes in use over time. Odds ratios (OR) comparing self-reported ever-use by race/ethnicity (African American, Hispanic, non-Hispanic white vs. Asian American) were estimated using multivariable adjusted logistic regression. Analyses were stratified by recruitment phase (phase I, diagnosed January 1995-September 1998, phase II, diagnosed October 1998-April 2003) and genetic susceptibility, as cases with increased genetic susceptibility were oversampled. Among 1385 women (731 phase I, 654 phase II), no significant racial/ethnic differences in use were observed among phase I or phase II cases. However, among phase I cases with no susceptibility indicators, African American and non-Hispanic white women were less likely than Asian American women to use hormonal therapy (OR 0.20, 95% confidence interval [CI]0.06-0.60; OR 0.40, CI 0.17-0.94, respectively). No racial/ethnic differences in use were observed among women with 1+ susceptibility indicators from either recruitment phase. Racial/ethnic differences in adjuvant hormonal therapy use were limited to earlier diagnosis years (phase I) and were attenuated over time. Findings should be confirmed in other populations but indicate that in this population, treatment disparities between African American and Asian American women narrowed over time as adjuvant hormonal treatments became more commonly prescribed.

The role of mammography screening attendance and detection mode in predicting breast cancer survival-Is there added prognostic value?

IntroductionThe aim of this study was to examine whether screening exposure status, defined as detection mode (screening, interval or symptomatic) combined with breast cancer screening attendance prior to diagnosis, had any additional value over detection mode in predicting breast cancer survival. We also assessed the effect of hormone replacement therapy (HRT) on the association of detection mode with breast cancer survival. MethodsWe analysed and compared the associations of both screening exposure status and detection mode with 5-year breast cancer survival on a cohort of 3013 breast cancer patients, aged 50–74 years in Sweden. We used Cox proportional hazards modelling with adjustments for tumour size, grade, estrogen receptor (ER) and progesterone receptor (PR) status and lymph node involvement. We repeated the analyses after stratification for HRT use. ResultsMultivariate hazard ratios (HR) for cancers detected in patients at subsequent screens, interval cancers and symptomatic cancers in patients with and without previous screening attendance were 1.3 (95%CI 0.7–2.3), 1.8 (95%CI 1.0–3.2), 1.8 (95%CI 0.9–3.6) and 2.2 (95%CI 1.2–4.1) respectively, compared with cancers detected at the first screen. The regression model including screening exposure status had no additional prognostic value over the model including detection mode (P=0.63). HRT users showed a more favourable survival than non-users; this was not influenced by detection mode. ConclusionThe number of routine screening examinations attended in the 5-year period prior to diagnosis had no additional prognostic value over detection mode in predicting breast cancer survival.

MTHFR genotypes and breast cancer survival after surgery and chemotherapy: a report from the Shanghai Breast Cancer Study

Methylenetetrahydrofolate reductase (MTHFR) regulates the intracellular folates pool for DNA synthesis and methylation. Sequence variations in MTHFR (nucleotides 677 (C-->T) and 1298 (A-->C)) result in allozymes with decreased activity. The 677TT genotype is associated with increased toxicity of methotrexate and increased clinical response to 5-fluorouracil in treatment of cancers including breast cancer. We evaluated MTHFR genotypes and breast cancer survival in a cohort of 1067 Chinese women diagnosed with breast cancer between 1996 and 1998 who received surgery and chemotherapy. Life table method was used to calculate 5-year survival rates. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) after adjusting for potential confounding factors. Median follow-up time was 5.2 years; 5-year survival was 84.6%. Sixty-six percent carried a 677T allele and 31% carried a 1298 C allele. We found that overall 5-year breast cancer survival did not differ significantly across all genotypes (85.3% for 677 CC and 83.8% for 677TT; 83.8% for 1298 AA and 79.1% for 1298 CC). However, carrying the 677T allele was associated with non-significant increased risk of death for subjects with late stage disease (stages III-IV) (HR=1.80, 95% CI: 0.79-4.14 for TT vs. CC, p for trend=0.15), particularly among those who had survived past the second year (HR=2.97, 95% CI: 1.10-7.98, p for trend=0.04). The A1298C genotypes were not significantly associated with risk of death. This study suggests that the MTHFR C677T polymorphisms may affect long-term survival from advanced breast cancer.

Race, income, and survival from breast cancer at two public hospitals

Some studies have shown that adjustment for socioeconomic status reduces breast cancer survival differences between blacks and whites. The purpose of this study is to evaluate the effect of age, race, stage, treatment, and income status on breast cancer survival among women attending public hospitals in Chicago, Illinois. Hospital Cancer Registry data on 887 black women and 265 white women with breast cancer onset between 1973-1985 were analyzed using Cox regression and Kaplan-Meier techniques. The purpose was to examine the effect of age, race, stage, treatment, and income on breast cancer survival. Black women with breast cancer were younger and poorer than white women with breast cancer. There were no significant differences between blacks and whites with regard to stage, estrogen receptor status, or type of treatment. Black women had lower 5-year breast cancer survival rates compared to white women (50.2% versus 60.2%; P = 0.05), and survival was lower when adjusted for stage and age. However, when adjusted for income in addition to stage and age, the effect of race on survival was reduced (from relative risk = 1.26; 95% confidence interval = 1.02, 1.57 to relative risk = 1.17%; 95% confidence interval = 0.95, 1.38). Income influences breast cancer survival differences between blacks and whites in this population.