Breast Cancer Deaths In Women Research Articles

Abstract 3225: Time since last birth in relation to breast cancer mortality

Abstract Women who develop breast cancer less than 10 years after giving birth have been shown to have a poorer prognosis than women with a longer time since their last birth. Only a few studies have examined this relation separately by molecular features of the tumor; two observed poorer outcomes for women with hormone receptor positive tumors. A better understanding of the relation between time since last birth and risk of recurrence and death could lead to targeted treatments and/or surveillance of young women who develop breast cancer within 10 years of giving birth. There has been little research on this topic among Black women, who have a higher incidence of breast cancer at young ages compared to White women. We assessed the relation of time since last birth to breast cancer mortality according to estrogen receptor (ER) status of the primary tumor among breast cancer patients who are participants in the prospective Black Women’s Health Study (BWHS). The BWHS includes 59,000 U.S. Black women who enrolled in the study in 1995 and have been followed by biennial questionnaire since then. The present analysis was restricted to parous women diagnosed before age 50 (N=658) because older patients would have been unlikely to have given birth within the past 10 years. ER status was positive for 348 cases, negative for 199, and unknown for 111. Follow-up time was from time of diagnosis to death or the end of 2018, whichever came first. Cox regression analysis, adjusted for age and stage at diagnosis, was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for breast cancer specific death for women diagnosed <10 years since last birth relative to women diagnosed ≥10 years since last birth. The median age at diagnosis was 44, with 41% of cancers diagnosed at stage I, 43% at stage II, and 16% at stage III. About a third (31%) had given birth &lt10 years before diagnosis. During follow-up, there were 159 total deaths, 132 of which were due to breast cancer. Among women diagnosed with ER-positive breast cancer, the HR for breast cancer death for women who gave birth &lt10 years prior to diagnosis relative to women who had not had a recent birth was 2.45 (95% 1.07-5.58). The association was even stronger among women who survived the first five years, with an HR of 3.38 (95% CI 1.34-8.51). Time since last birth was not associated with ER-negative breast cancer mortality (HR 1.06, 95% CI 0.46-2.46). Late recurrences are a particular problem with ER-positive breast cancer. The present findings suggest a relatively short interval (e.g., &lt10 years) between childbirth and a breast cancer diagnosis may increase risk of a late recurrence and death from ER-positive breast cancer. Greater awareness of this association may lead to improved surveillance of survivors of early-onset breast cancer. Citation Format: Gary R. Zirpoli, Nelsy Castro-Webb, Kimberly A. Bertrand, Julie R. Palmer. Time since last birth in relation to breast cancer mortality [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3225.

Biological features of ductal carcinoma in situ: clinical role and basis for treatment individualization

Ductal carcinoma in situ (DCIS) is an extremely heterogeneous disease in terms of clinical manifestations, morphological changes, and expression of biomarkers, which determine the risk of subsequent development of an invasive breast cancer (BC). Diagnosis and treatment of DCIS prevents the development of invasive tumors (which reduces the potential risk of death from BC); however, the prognostic value of local treatment depends on the biological characteristics of its. The tumor grade, presence of comedonecrosis and expression of estrogen receptors are the key prognostic factors in DCIS for the treatment tactics and prognosis. The clinical symptoms of DCIS are very scarce, the most of tumors is diagnosed by screening mammography; the typical sign of DCIS is malignant microcalcifications or changes of breast architectonic. The sensitivity of mammography, ultrasound and MRI directly depend on the biological characteristics of DCIS. Surgical treatment (breast-conserving surgery or mastectomy) significantly reduces the risk of BC death in women with DCIS G2/G3, and radiotherapy after breast-conserving surgery reduce the risk of local recurrence of non-invasive and invasive BC. The choice of the local treatment (breast-conserving surgery radiation therapy vs mastectomy) depend on such factors as: tumor size, localization, clear margins, and biological characteristics of DCIS. In contrast to invasive cancers, the negative margin in DCIS is more than 2 mm from the tumor. Regional lymph node involvement in DCIS occurs in less than 1% of cases; however, microinvasion is found in analyze the surgical specimen in 15% of patients, which raises the question about regional staging. Risk factors for microinvasion in DCIS are age less than 55 years, tumor lesion size more than 4.0 cm, DCIS grade G3, and tumor palpability. Adjuvant endocrine therapy with tamoxifen significantly reduces the 10-year risk of invasive recurrence by 51%, the risk of contralateral BC by 50% and the risk of death by 40%, but only for hormone-positive DCIS. HER2 overexpression is found in DCIS significantly often (up to 40% of cases) than in invasive BC, HER2+ status correlates with DCIS high grade G3, the presence of comedonecrosis and with increased risk of relapse (both non-invasive and invasive) but is not a reason for anti-HER2 therapy. DCIS low risk and DCIS high risk have not only different morphological characteristics, but also different models of biological behavior, which must be considered in the different choice of treatment tactics.

Clinical and pathological features and risk factors for primary breast cancer patients.

BACKGROUNDBreast cancer is the most common malignancy in women all around the world. According to the latest statistics in 2018, there were more than 2.08 million new breast cancer cases all around the world and more than 620000 deaths; the proportion of breast cancer deaths in women with cancer is 15%. By studying age, clinicopathological characteristics and molecular classification, age at menarche, age at birth, number of births, number of miscarriages, lactation time, surgical history of benign breast lesions, history of gynecological diseases, and other factors, we retrospectively summarized and compared the disease history of patients with primary breast cancer and patients with benign thyroid tumors admitted to our hospital in the past 10 years to explore the clinicopathological characteristics and risk factors for primary breast cancer.AIMTo investigate the clinical and pathological features and risk factors for primary breast cancer treated at our center in order to provide a reference for the prevention and treatment of breast cancer in the Zhuhai-Macao region.METHODSThrough a retrospective case-control study, 149 patients with primary breast cancer diagnosed and treated at Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2013 to March 2020 were included as a case group, and 165 patients with benign breast tumors diagnosed and treated from January 2019 to March 2020 were included as a control group. The data collected included age, age at menarche, age at first birth, number of births, number of miscarriages, lactation time, history of surgery for benign breast lesions, history of familial malignant tumors, history of gynecological diseases, history of thyroid diseases, and the tumor characteristics of the patients in the case group including pathological diagnosis, pathological type, tumor size, lymph node metastasis, distant metastasis, stage, and molecular classification, among others. In the case group, the chi-square test was used to analyze the clinical and pathological features of patients in three age groups (< 40, 40-59, and ≥ 60 years). A multifactor logistic regression analysis was used to analyze correlations between the two groups.RESULTSAmong 149 patients with primary breast cancer, the average age was 48.20 ± 12.06 years, and the proportion of patients at 40-59 years old was the highest, accounting for 61.8% of cases. The molecular type was mainly luminal B type, accounting for 69.2% of cases, and at the time of diagnosis, the tumor stage was mainly stage I/II, accounting for 62.4% of cases. There were no statistically significant differences in the distributions of tumor location, pathological type, tumor size, lymph node metastasis, stage, or molecular classification among the three age groups (< 40, 40-59, and ≥ 60 years) (P ≥ 0.05). The differences in the distribution of distant metastasis among the three age groups (< 40, 40-59, and ≥ 60 years) were statistically significant (P < 0.01). The differences in lactation time, history of familial malignant tumors, history of gynecological diseases, and history of thyroid diseases between the two groups were not statistically significant (P ≥ 0.05). The differences in age at disease diagnosis, age at menarche, and history of surgery for benign breast lesions were statistically significant (P < 0.01). The difference in age at first birth was also statistically significant (P < 0.05).CONCLUSIONThe highest incidence of breast cancer in the Zhuhai-Macao region is present among women aged 40-59 years. There is a larger proportion of stage I/II patients, and the luminal B type is the most common molecular subtype. Distant metastasis occurs mainly in the ≥ 60-year-old group at the first diagnosis; increased age, late age at menarche, and late age at first birth may be risk factors for primary breast cancer, and a history of surgery for benign breast lesions may be a protective factor for primary breast cancer.

Association of Occupation and Breast Cancer Mortality in the State of Vermont, 1989-1993

&#x0D; &#x0D; &#x0D; &#x0D; Vermont’s breast cancer death rate is among the highest in the U.S. This study analyzed the association between breast cancer mortality and occupation in Vermont women. Given that Vermont is a rural state, one initial hypothesis was that occupational exposure to pesticides might partly explain the high death rate. Death certificate data from 1989-1993 were analyzed to determine relative risk of breast cancer death according to occupation. Case-control analysis demonstrated increased relative risk of breast cancer death for women in two broad occupational groups: 1) Executive, Administrator and Managers and 2) Professionals. Decreased relative risk of breast cancer death was seen for the occupational group of Homemaker. Data indicated that women in the occupational group of Farming, Forestry, and Fishing were not at increased risk of dying from breast cancer. The associations of occupation and breast cancer mortality in Vermont women do not differ significantly from those seen in larger U.S. studies.&#x0D; &#x0D; &#x0D; &#x0D;

Participation in Mammography Screening Accomplishes an Enduring and Significant Reduction in Breast Cancer Mortality in the Era of Modern Therapy: An Observational Study Spanning 52 Years

Background: A significant decrease in breast cancer mortality has been demonstrated in populations invited to mammography screening. There have been questions regarding the value of mammography in the era of modern therapies, and the relative contribution of mammography screening and modern therapy on mortality reduction. Aim: We have sought to clarify the extent to which early detection through mammography screening contributes to the reduction of breast cancer death in the era of modern adjuvant therapies. We address this question by studying five decades of continuous data from a stable population spanning the pre- and postscreening and adjuvant therapy periods. Methods: We analyzed changes in breast cancer mortality in a stable population in Dalarna County, Sweden, among women aged 40-69 years during the 52 years from 1964 through 2015. Mortality data were obtained from the National Cause of Death Register in Sweden, and incidence data from the Swedish National Cancer Registry. Crude and incidence-based mortality rates were compared among four successive 13-year periods: the prescreening period from 1964 through 1976, the Swedish Two-County randomized screening trial period from 1977 through 1989, and two service screening periods from 1990-2002 and from 2003-2015. Furthermore, we measured the effect of early detection upon breast cancer mortality in women exposed to mammography screening by comparison with breast cancer death in women not exposed to mammography screening, within these three screening periods. Data were analyzed by Poisson regression, with corrections for lead time and self-selection bias. Results: There were 5844 incident cases and 1425 breast cancer deaths during the 52 years of observation. The relative breast cancer mortality rates associated with exposure to screening, adjusted for self-selection bias, were 0.46 (95% CI 0.30-0.69) in the trial period (1977-1989), 0.44 (95% CI 0.30-0.65) in the 1990-2002 period, and 0.37 (95% CI 0.24-0.56) in the 2003-2015 period. The significant reductions in incidence-based breast cancer mortality associated with exposure to screening were independent of contemporaneous changes in therapy. Conclusion: The combination of early detection of breast cancer through mammography screening and the resultant earlier treatment has significantly reduced breast cancer mortality in Dalarna County in the women exposed to screening, compared with the women not participating in screening, by a factor of 2.2 in the screening trial period, increasing to a factor of 2.7 in the most recent service screening period. These mortality benefits can be attributed to the far greater effectiveness of modern therapeutic methods upon cancers detected at screening compared with the poorer effectiveness of the same therapeutic methods in women not participating in screening.

Limitations in the Effect of Screening on Breast Cancer Mortality.

PurposeRandomized, controlled trials showed that screening reduces breast cancer mortality rates, but some recent observational studies have concluded that programmatic screening has had minor effect on breast cancer mortality rates. This apparent contradiction might be explained by the use of aggregated data in observational studies. We assessed the long-term effect of screening using individual-level data.Materials and MethodsUsing data from mammography screening in the Copenhagen and Danish national registers, we compared the observed breast cancer mortality rate in women invited to screening with the expected rate in absence of screening. The effect was examined using the “naïve model,” which included all breast cancer deaths; the “follow-up model,” which counted only breast cancer deaths in women diagnosed after their first invitation to screening; and the “evaluation model,” which is similar to the follow-up model during screening age, but after screening age, which counted only breast cancer deaths and person-years in women diagnosed during screening age.ResultsWe included 18,781,292 person-years, 976,743 of which were from women invited to screening. The naïve and follow-up models showed, respectively, 10% and 11% reduction in breast cancer mortality after invitation to screening. However, many breast cancer deaths occurred in women whose cancer was diagnosed when they were no longer eligible for screening. Accounting for this dilution, the evaluation model showed a 20% (95% CI, 10% to 29%) reduction in breast cancer mortality after invitation to screening.ConclusionScreening had a clear long-term beneficial effect with a 20% reduction in breast cancer–associated mortality in the invited population. However, this effect was, by nature, restricted to breast cancer deaths in women who could potentially benefit from screening. Our study highlights the complexity in evaluating the long-term effect of breast cancer screening from observational data.

Abstract P3-17-03: DCIS and the risk of breast cancer death - A case control study

Abstract Introduction The risk of breast cancer death after a primary ductal carcinoma in situ (DCIS) is less than 2 % after 10 years. Whereas in situ recurrences do not influence survival, a 17-fold elevated risk of breast cancer specific mortality has been shown for invasive recurrences. Adjuvant radiotherapy (RT) effectively reduces recurrences after breast conserving surgery (BCS) for DCIS, but no studies have been able to demonstrate a survival benefit from adjuvant RT treatment or from choosing mastectomy instead of BCS. Here patient and tumour related risk factors for breast cancer death in women with a pure primary DCIS were studied. Patients and methods Women registered with a primary DCIS, between 1992-2012 in three of Sweden´s health care regions with a population of approximately 5.2 million, were enrolled in a nested case-control study. Out of 6,964 women with DCIS, 96 patients who later died from breast cancer were identified. Four controls per case (n=318) were randomly selected by incidence density sampling. We retrieved medical records and pathology reports and calculated OR with 95% CIs for various variables using conditional logistic regression. Results Of the 96 cases, 10 patients developed distant metastasis without a known local recurrence. In 56 patients death was preceded by an invasive ipsilateral recurrence and in 3 patients by a recurrent ipsilateral DCIS. Seven patients had invasive breast events in both the ipsilateral and the contralateral breast. Seventeen patients had contralateral invasive breast cancer and 3 patients contralateral DCIS. Multifocality and tumour size over 25mm (OR 2.6 (1.6 to 4.2)), positive or uncertain margin status (OR 2.8 (1.6 to 4.9)) and detection outside screening (OR 2.1 (1.2 to 3.9)) increased the risk of breast cancer death in univariate analysis, when adjusted for age and year of diagnosis. Suspicion of micro-invasion and nuclear grade 3 was associated with a nonsignificant increased risk, OR 1.8 (0.6 to 5.0) and 2.6 (0.9-6.5), respectively. The risk was not affected by age or treatment. Tumour size and margin status remained significant in the multivariable analysis, when adjusted for treatment and for contralateral breast cancer (OR 2.0 (1.2 to 3.7)). Conclusion In the present study, large tumours and positive or uncertain margin status were significant risk factors for later breast cancer death after a primary DCIS. More extensive treatment was not related to a lower risk. The significance of tumour biology and nuclear grade will be further examined and evaluated. Citation Format: Wadsten C, Garmo H, Fredriksson I, Sund M, Wärnberg F. DCIS and the risk of breast cancer death - A case control study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-17-03.

Abstract P3-07-06: Survival benefit increases after breast conserving therapy compared to mastectomy when axillary node status is positive in early stage breast cancer: A registry based follow-up study of Norwegian women with screening and interval detected breast cancer pr

Abstract BACKGROUND: Recent register studies on early stage breast cancer have shown better survival when women underwent breast-conserving treatment (BCT) compared to mastectomy (MTX). It is unclear if this is due to selection effects or to a systemic benefit of BCT compared to MTX. If there is a systemic benefit this could theoretically be more prominent in some subgroups of breast cancer. The aim of this study is to evaluate if there are any subgroups with early stage breast cancer that benefits more of BCT compared to MTX. METHOD: A cohort of 6.629 women aged 50-69 with primary operable breast cancer detected in the screening programme (on screening or between screening, interval cancer) were selected from January 1998 until December 2009 and followed up until end of 2010. Life tables for overall survival (OS) and breast cancer specific survival (BCSS) were calculated in surgery groups and stages. Corresponding Kaplan-Meier plots were stratified in T1N1M0 and Ductal Carcinoma. OS and BCSS were compared using Cox proportional hazard for estimating hazard ratio between BCT and MTX in crude and adjusted analysis. RESULTS: 5-years BCSS in T1N0M0 was 99% for both surgical cohorts (BCT and MTX). 5-years BCSS in T1N1M0 was 98% for women undergoing BCT and 91% for women undergoing MTX. Respectively, 10-years BCSS in T1N1M0 was 96% for women undergoing BCT and 83% for women undergoing MTX. In adjusted analysis, HR for breast cancer death for women with stage T1N1M0 undergoing MTX compared to BCT was 3.12 (95% CI: 1.71-5.72). Respectively, 3.67 (95% CI: 1.20-11.22) stratified on grade III and 4.89 (67 (95% CI: 1.25-19.01) stratified on hormone receptor negative disease. CONCLUSION: The benefit of BCT compared to MTX seems to increase with increasing severity of the breast cancer disease, positive nodal status (N1), grade III and hormone receptor negative disease. These finding indicate a systemic benefit of BCT compared to MTX. Citation Format: Olaf Johan Hartmann-Johnsen, Ellen Schlichting, Rolf Kaaresen, Jan Franz Nygaard. Survival benefit increases after breast conserving therapy compared to mastectomy when axillary node status is positive in early stage breast cancer: A registry based follow-up study of Norwegian women with screening and interval detected breast cancer pr [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 P3-07-06.

24P - CRP and Granulocyte-to-Lymphocyte Ratio as Predictors of Breast Cancer Death in American Non-Institutionalized Women

Background: Inflammation plays an important role in breast cancer development and progression. We aimed to investigate the association between serum inflammatory markers C-reactive protein (CRP), absolute granulocyte count (AGC) and granulocyte and granulocyte-to-lymphocyte (G/L) ratio in relation to breast cancer death in a population-based setting. Methods: This study was based on the Third National Health and Nutrition Examination Survey (NHANES III) conducted during 1988-1994 and the linked mortality follow-up data through December 31, 2006. We selected 8,184 women aged 20 and older with baseline measurements of CRP, AGC and G/L ratio. Cox proportional hazards regression was used to assess CRP, AGC and G/L ratio in relation to risk of breast cancer death as well as death from all cancer and all causes, while taking into account age, race, and other risk factors for breast cancer. Results: During mean follow-up of 167 months, 59 women died from breast cancer. A positive association was found between log-transformed CRP, AGC and G/L ratio and risk of breast cancer death (HR 1.63 (95% CI; 1.00-2.67), 3.69 (1.15-11.87) and 3.21 (1.39-7.41) per unit increase in log CRP, AGC, and G/L ratio, respectively), although the association with AGC was not seen after adjustment for BMI. CRP, AGC and G/L ratio were also strongly linked to cardiovascular and all-cause mortality. No statistically significant trend was observed for all-cancer death. Stratification by overweight status showed a persistent association between CRP, G/L ratio and breast cancer death in women with BMI ≥ 25 kg/m2 (HR 1.77 (95%CI: 1.02-3.05) and 4.44 (1.29-15.27) for every increase in log CRP and G/L ratio, respectively). Conclusions: CRP and G/L ratio are consistent predictors of breast cancer death, cardiovascular and all-cause mortality. Our findings imply that the biological mechanisms linking obesity and inflammation may be important in breast cancer risk stratification. Finally, future studies are needed to explore the role of these markers as simple prognostic tools in assessing breast cancer. Disclosure: All authors have declared no conflicts of interest.

Exercise in the prevention and rehabilitation of breast cancer

Breast cancer is the most common type of cancer among women worldwide. Several epidemiological studies have shown an inverse relationship between the risk of breast cancer and physical activity levels, whereas exercise training has been recognized as a significant means in the rehabilitation process of breast cancer survivors. The relative risk reduction of breast cancer for women who engaged in moderate to vigorous physical activity for 3-5 days peek week ranged between 20-40 %. Furthermore, several studies demonstrated a 24-67 % reduction in the risk of total deaths and 50-53 % reduction in the risk of breast cancer deaths in women who are physically active after breast cancer diagnosis compared with sedentary women. Breast cancer survivors should be encouraged to participate in rehabilitation programs in order to obtain numerous physiological and psychological benefits. These include reductions in fatigue and improvements in immune function, physical functioning, body composition, and quality of life. Based on recent scientific evidence, a complete rehabilitation program for patients with breast cancer should combine both strength and aerobic exercise in order to maximize the expected benefits.

Disparities in breast cancer mortality trends in a middle income country

In recent decades, breast cancer cases have increased steadily worldwide. However, the increases do not hold across all demographics and breast cancer cases in low and middle income countries have increased much faster than the global trend. Colombia is not an exception. Breast cancer was the most frequent tumor and the second cause of cancer-related deaths in women in 2008, with an estimated of 6,700 new cases and 2,100 deaths. We present here an analysis of breast cancer mortality rates and trends in Colombia, over the period 1985-2008. We studied overall and age-specific changes in breast cancer mortality using change-point Poisson regression models. Between 1985 and 2008, there were 32,375 breast cancer deaths in women in Colombia. Breast cancer mortality increased since 1985, although the annual increase varied between age groups and socioeconomic levels. Only in women aged 45-64 years old that live in areas of high socioeconomic levels, breast cancer mortality was stable or decreasing. Hence, successful cancer control is possible in middle income countries, as shown by the progress observed in certain groups. The development of an integrated strategy of early detection and early access to proper treatment, suitable for areas with limited resources, is an urgent necessity.

Effectiveness of population‐based service screening with mammography for women ages 40 to 49 years

BACKGROUND: The effectiveness of mammography screening for women ages 40 to 49 years still is questioned, and few studies of the effectiveness of service screening for this age group have been conducted. METHODS: Breast cancer mortality was compared between women who were invited to service screening at ages 40 to 49 years (study group) and women in the same age group who were not invited during 1986 to 2005 (control group). Together, these women comprise the Mammography Screening of Young Women (SCRY) cohort, which includes all Swedish counties. A prescreening period was defined to facilitate a comparison of mortality in the absence of screening. The outcome measure was refined mortality, ie, breast cancer death for women who were diagnosed during follow-up at ages 40 to 49 years. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated. RESULTS: There was no significant difference in breast cancer mortality during the prescreening period. During the study period, there were 803 breast cancer deaths in the study group (7.3 million person-years) and 1238 breast cancer deaths in the control group (8.8 million person-years). The average follow-up was 16 years. The estimated RR for women who were invited to screening was 0.74 (95% CI, 0.66-0.83), and the RR for women who attended screening was 0.71 (95% CI, 0.62-0.80). CONCLUSIONS: In this comprehensive study, mammography screening for women ages 40 to 49 years was efficient for reducing breast cancer mortality. Cancer 2011. © 2010 American Cancer Society.

Effectiveness of population‐based service screening with mammography for women ages 40 to 49 years

The effectiveness of mammography screening for women ages 40 to 49 years still is questioned, and few studies of the effectiveness of service screening for this age group have been conducted. Breast cancer mortality was compared between women who were invited to service screening at ages 40 to 49 years (study group) and women in the same age group who were not invited during 1986 to 2005 (control group). Together, these women comprise the Mammography Screening of Young Women (SCRY) cohort, which includes all Swedish counties. A prescreening period was defined to facilitate a comparison of mortality in the absence of screening. The outcome measure was refined mortality, ie, breast cancer death for women who were diagnosed during follow-up at ages 40 to 49 years. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated. There was no significant difference in breast cancer mortality during the prescreening period. During the study period, there were 803 breast cancer deaths in the study group (7.3 million person-years) and 1238 breast cancer deaths in the control group (8.8 million person-years). The average follow-up was 16 years. The estimated RR for women who were invited to screening was 0.74 (95% CI, 0.66-0.83), and the RR for women who attended screening was 0.71 (95% CI, 0.62-0.80). In this comprehensive study, mammography screening for women ages 40 to 49 years was efficient for reducing breast cancer mortality.

Predictors of Local Recurrence in a Population-Based Cohort of Women with Ductal Carcinoma In Situ Treated with Breast Conserving Surgery Alone

To identify prognostic indicators of local recurrence (LR) in patients with ductal carcinoma in situ (DCIS) of the breast treated with breast conserving surgery (BCS) alone. A retrospective study was conducted of all women with pure DCIS, diagnosed 1985-1999, referred for tertiary oncologic opinion in British Columbia, treated with BCS without adjuvant radiotherapy. Kaplan-Meier local control (LC) and breast cancer specific survival (BCSS) estimates for the entire group were plotted. Stratified analyses identified subgroups with high Kaplan-Meier 10-year LR. Cox multivariate modeling was used to assess predictors of LR. Kaplan-Meier BCSS rates were compared between two cohorts: those who experienced LR and those who did not have LR. A total of 460 women comprised the study cohort. Median follow-up was 9.4 years. The 15-year LC and BCSS rates were 82% and 97%, respectively. Stratified analyses of LR identified comedo histology, high nuclear grade, tumor size >4 cm or indeterminate size, and positive margins to be associated with significantly higher LR risk, with 10-year LR risks approximating 15-30%. The 10-year BCSS rates for the LR group were 94% compared with 99% for the NoLR group. On Cox regression modeling, high nuclear grade, the presence of comedocarcinoma, and positive margins were significant factors for higher risk of LR. Women with DCIS treated with BCS alone had higher LR risk, and those with a LR were more likely to die of breast cancer. Optimal local treatment is mandatory to minimize the risk of breast cancer death for women with this curable disease.

Early Diagnosis of Hereditary Breast Cancer by Magnetic Resonance Imaging: What Is Realistic?

Early Diagnosis of Hereditary Breast Cancer by Magnetic Resonance Imaging: What Is Realistic?

Breast Cancer in Young Women: Poor Survival Despite Intensive Treatment

BackgroundBreast cancer is uncommon in young women and correlates with a less favourable prognosis; still it is the most frequent cancer in women under 40, accounting for 30–40% of all incident female cancer. The aim of this study was to study prognosis in young women, quantifying how much stage at diagnosis and management on the one hand, and tumour biology on the other; each contribute to the worse prognosis seen in this age group.Methodology/Principal FindingsIn a registry based cohort of women aged 20–69 (n = 22 017) with a primary diagnosis of invasive breast cancer (1992–2005), women aged 20–34 (n = 471), 35–39 (n = 858) and 40–49 (n = 4789) were compared with women aged 50–69 years (n = 15 899). The cumulative 5-year relative survival ratio and the relative excess mortality (RER) were calculated. The cumulative 5-year relative survival ratio was lowest in women aged 20–34. The RER was 2.84 for women aged 20–34 and decreased with increasing age (RER 1.76 and 1.17 for women aged 35–39 and 40–49, respectively). The excess risk was, however, present only in disease stages I and II. For women aged 20–34 with stage I disease RER was 4.63, and 6.70 in the subgroup with tumour size 1–10 mm. The absolute difference in stage I between the youngest and the reference groups amounted to nearly 8%, with a 90% 5-year survival in women aged 20–34. In stages IIa and IIb, the relative excess risk was not as dramatic, but the absolute differences approached 15%. The youngest women with small tumours generally received more aggressive treatment than women in older age groups.ConclusionsAfter correction for stage, tumour characteristics and treatment, age remained an independent risk factor for breast cancer death in women <35 years of age. The excess risk for young women was only seen in early stages of disease and was most pronounced in women with small tumours. Young women affected by breast cancer have a high risk of dying compared to their middle-aged counterparts even if diagnosed early and receiving an intense treatment.

Qualitative Age-Interactions in Breast Cancer

A qualitative age-interaction is defined as the reversal of relative risks or rates according to age at onset. Once thought rare, qualitative age-interactions are commonly reported in studies that examine the etiology, prognosis, and treatment of breast cancer. Thus, nulliparity, obesity, and oral contraceptives decrease breast cancer risk in younger women but increase risk in older women. High-risk tumors are more common in younger women, whereas low-risk tumors are more common among the elderly, with bimodal peak frequencies at ages 50 and 70, respectively. Curves depicting the annual hazard of breast cancer death for women with high-risk (early-onset) and low-risk (late-onset) tumors are shaped differently and move in opposite directions. Additionally, mammography screening and neo-adjuvant chemotherapy seem to have opposing effects in women with early and late-onset tumors. Taken together, these qualitative age-interactions may indicate that early and late-onset breast cancers are different diseases, derived from different pathways.

Parity in relation to survival following breast cancer

Aim The present study examines the association between parity and survival following breast cancer diagnosis. Methods Medical records of 4453 women diagnosed with breast cancer in Malmö, Sweden, between 1961 and 1991 were analysed. All women were followed until 31 December 2003, using the Swedish Cause-of-Death Registry. Breast cancer specific mortality rate was calculated in different levels of parity. Corresponding relative risks, with 95% confidence intervals (CI), were obtained using Cox's proportional hazards analysis. All analyses were adjusted for potential prognostic factors and stratified for age, menopausal status and diagnostic period. Results As compared to women with one child, nulliparity (RR 1.27: 95% CI 1.09–1.47), and high parity (four or more children) (1.49: 1.20–1.85) were positively associated with a high mortality from breast cancer. When adjusted for potential confounders, the association was only statistically significant for high parity (1.33: 1.07–1.66). In the analyses stratified on age and menopausal status, there was a similar positive association between high parity and breast cancer death in all strata, although only statistically significant among women older than 45 years of age or postmenopausal. Nulliparity was associated with breast cancer death in women that were younger than 45 years of age (1.28: 0.79–2.09) or premenopausal (1.30: 0.95–1.80), but these associations did not reach statistical significance. There was no association between nulliparity and breast cancer death in women older than 45 years of age or postmenopausal. All associations were similar in analyses stratified for diagnostic period. Conclusion Women with four or more children have a poor breast cancer survival as compared to women with one child.

Physical Activity and Survival after Diagnosis of Invasive Breast Cancer

Previous studies suggest that increased physical activity may lower the risk of breast cancer incidence, but less is known about whether levels of physical activity after breast cancer diagnosis can influence survival. We prospectively examined the relation between postdiagnosis recreational physical activity and risk of breast cancer death in women who had a previous invasive breast cancer diagnosed between 1988 and 2001 (at ages 20-79 years). All women completed a questionnaire on recent postdiagnosis physical activity and other lifestyle factors. Among 4,482 women without history of recurrence at the time of completing the questionnaire, 109 died from breast cancer within 6 years of enrollment. Physical activity was expressed as metabolic equivalent task-hours per week (MET-h/wk); hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated using Cox proportional hazards regression. After adjusting for age at diagnosis, stage of disease, state of residence, interval between diagnosis and physical activity assessment, body mass index, menopausal status, hormone therapy use, energy intake, education, family history of breast cancer, and treatment modality compared with women expending <2.8 MET-h/wk in physical activity, women who engaged in greater levels of activity had a significantly lower risk of dying from breast cancer (HR, 0.65; 95% CI, 0.39-1.08 for 2.8-7.9 MET-h/wk; HR, 0.59; 95% CI, 0.35-1.01 for 8.0-20.9 MET-h/wk; and HR, 0.51; 95% CI, 0.29-0.89 for > or =21.0 MET-h/wk; P for trend = 0.05). Results were similar for overall survival (HR, 0.44; 95% CI, 0.32-0.60 for > or =21.0 versus <2.8 MET-h/wk; P for trend <0.001) and were similar regardless of a woman's age, stage of disease, and body mass index. This study provides support for reduced overall mortality and mortality from breast cancer among women who engage in physical activity after breast cancer diagnosis.

Impact of Fraction Size on Cardiac Mortality in Women Treated With Tangential Radiotherapy for Localized Breast Cancer

To determine whether fraction size affects the risk of cardiac mortality in women treated with adjuvant radiotherapy (RT) for left-sided breast cancer. A population-based retrospective study of women with a diagnosis of localized breast cancer treated with adjuvant RT in British Columbia from 1984 to 2000. Cases were identified from the British Columbia Cancer Agency database. Overall and cardiac-specific survival were compared for women treated with RT for left- vs. right-sided breast cancer. We analyzed the impact of age (<or=60 vs. >60 years) at diagnosis and RT fraction size (<or=2 vs. >2 Gy) on risk of fatal cardiac events. We identified 3,781 women with left-sided and 3,666 women with right-sided breast cancer who received adjuvant RT. Median follow-up was 7.9 years. There were 52 vs. 47 breast cancer deaths in women treated for left- and right-sided breast cancer, respectively. There was no significant difference in cardiac mortality for women <or=60 or >60 years of age who received adjuvant RT for left-sided vs. right-sided cancer. There was no difference in cardiac mortality for women who received adjuvant RT with fraction sizes <or=2 vs. >2 Gy for left- or right-sided cancer. There was no evidence for increased risk of cardiac mortality in women treated with adjuvant RT after a median follow-up of 7.9 years in our cohort. Hypofractionated adjuvant RT regimens did not significantly increase the risk of cardiac mortality.