Cancer Recurrence In Women Research Articles

P-366 Short- and long-term safety outcomes in patients undergoing fertility preservation (FP) with controlled ovarian stimulation prior to chemotherapy

Abstract Study question The Impact of pre-chemotherapy fertility preservation (FP) with controlled ovarian stimulation (COS) on mortality and complications in cancer patients Summary answer The 5-year survival was higher in women who proceeded with FP than those who did not. What is known already FP in the form of egg/embryo freezing is a well-established option to preserve fertility in patients requiring gonadotoxic treatment. This method introduces a slight delay in chemotherapy initiation, raising theoretical concerns about its impact on long-term patient outcomes. Additionally, safety concerns exist for estrogen-sensitive pathologies. However, data on safety outcomes, especially mortality and cancer recurrence in women undergoing fertility preservation, remain limited. Study design, size, duration This study utilized a prospectively collected database of 603 patients referred from the UK South and South East cancer network for fertility preservation to a tertiary Assisted Conception Unit between 2003 and 2019. Participants/materials, setting, methods All female patients attended the Fertility Preservation Service post-cancer diagnosis to discuss options. Patient demographics, stimulation details, and treatment outcomes were recorded. Living status was confirmed up to January 2024 through Health Record Registry. Data analysis included basic demographics, hazard ratios, and 5-year survival analysis, with a log-rank test comparing patients who received or did not receive fertility preservation treatment. Main results and the role of chance As many as 603 patients were counselled re: FP over the studied period. The biggest majority of patients n = 320 (53%) had a diagnosis of breast cancer, followed by 67 patients (11.1%) presenting with lymphomas. The majority of counselled patients (n = 340 (56.4%)) went ahead with fertility preservation. Mean age of participants was 32.7 with an average BMI of 24.6, average AMH of 19.2 pmol/L, and median AFC of 15. Short term complication was estimated at 2% of the sample. Successful stimulation was noted in almost all cases (cancellation rate 1.5%) requiring on average 14 days to complete the treatment. A short protocol was mainly used (98% of cases) with a median daily FSH injection at 300 IU/L and an average oocyte yield of 14. Mortality in patients who received fertility preservation was estimated and the respective hazard ratio was 0.74 (95% CI 0.47 to 1.15, p = 0.18). With regards to survival, the log-rank test yielded a chi-square value of 3.9 with 1 degree of freedom. The resulting p-value was 0.05, indicating a statistically significant difference in survival probabilities between patients who underwent fertility preservation compared to those who did not (p = 0.05). Limitations, reasons for caution Information on the cause of death was unavailable, limiting the ability to minimize bias and estimate disease recurrence. However, the young age of the patient population reduces the likelihood of death due to unrelated medical conditions. Wider implications of the findings The data suggests that fertility preservation with controlled ovarian stimulation is a safe option for cancer patients. This finding provides reassurance to patients considering this well-established fertility treatment, offering realistic chances of survival. Trial registration number not applicable

Expression of immune-related genes and breast cancer recurrence in women with ductal carcinoma in situ

Background and aimDuctal carcinoma in situ (DCIS) is a non-obligate precursor of invasive breast cancer with highly variable clinical behavior, but risk stratification is still challenging. We sought to identify immune-related gene expression signatures of pure DCIS associated with different risks of breast cancer recurrence. MethodsA retrospective nested case-control study of 143 pure DCIS was performed including 70 women with subsequent ipsilateral breast event (IBE, in situ or invasive; cases) and 73 DCIS women with no IBE and matched for age, tumor size, treatment, hormone receptors/HER2 status, and follow-up time (controls). RNA was extracted from DCIS samples and subjected to next-generation sequencing gene expression analysis of 395 immune-related genes. Correlations between DCIS immune-related gene expression and IBE were analyzed using weighted Cox regression for nested case-control data. ResultsEight immune-related genes were differentially expressed between cases and controls. MAGEA10 expression (present vs. absent) and high expression levels of IFNA17 and CBLB (Q4 vs. Q1) were observed more frequently in DCIS of women with subsequent IBE, mainly invasive (p-valueFDR < 0.05). Conversely, expression of IL3RA1, TAGAP, TNFAIP8, and high expression levels of CCL2 and LRP1 were associated with a lower risk of IBE (p-valueFDR < 0.05). ConclusionThis exploratory analysis of pure DCIS showed significant differences in immune-related gene expression profiles between women with and with no subsequent IBE, particularly as invasive IBE. These results, after additional validation, could improve risk stratification and management of DCIS patients.

Disruptions in Cancer Care Due to the COVID-19 Pandemic and Fear of Cancer Recurrence in Women with Breast Cancer: A Mixed-Methods Study.

This study investigated if fear of cancer recurrence (FCR) levels and the proportion of women having a clinical level of FCR differed by whether women had or had not experienced disruptions in their cancer tests and treatments due to the pandemic. We conducted a mixed-methods study between November 2020 and March 2021 among women diagnosed with breast cancer in the previous five years at the time of their entry in the study. Women completed a questionnaire online assessing disruptions in breast cancer tests and treatments due to the pandemic and the severity subscale of the Fear of Cancer Recurrence Inventory. Semi-structured interviews were also conducted with a subsample of 24 participants and were thematically analyzed. The proportion of patients with a clinical level of FCR was significantly higher among those who experienced the postponement or cancellation of diagnostic and disease progression tests (e.g., blood tests, X-rays, or magnetic resonance imaging; adjusted PR = 1.27 95% CI = 1.13-1.43). Qualitative findings suggest that FCR was exacerbated by the pandemic context. In particular, perceived or actual barriers to care access due to the pandemic were identified as significant FCR-enhancing factors. These results highlight the need to keep diagnostic and progression tests as timely as possible to prevent increases in FCR levels and offer counselling about FCR when postponing or cancellation are inevitable.

Fear of Cancer Recurrence in Women with Gynecological Cancer: A Systematic Review

Fear of Cancer Recurrence in Women with Gynecological Cancer: A Systematic Review

Fear of recurrence in women with ovarian cancer: A qualitative evidence synthesis

PurposeApproximately 80% of ovarian cancers recur after first-line treatments. Women with ovarian cancer (OC) are therefore particularly vulnerable to experiencing fear of cancer recurrence (FCR). This study aimed to synthesise experiences of fear of cancer recurrence among women living with ovarian cancer. MethodA qualitative evidence synthesis (QES) was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. A systematic search of seven databases was undertaken to identify all available qualitative research exploring fear of cancer recurrence in women with OC. Thematic synthesis of extracted data from included studies was undertaken and managed in NVivo. ResultsTwenty-two papers reporting on eighteen studies were included in the synthesis. Three main themes were developed (triggers, responses, and coping) and included ten subthemes. FCR was triggered by factors relating to awareness of prognosis, treatment, and negative communication. Women responded to FCR by performing body checking and protecting their families. FCR led to adverse effects on women's wellbeing as it exacerbated uncertainty about their future. Women attempted to cope with FCR through seeking support, regaining control, and redirecting negative thoughts and actions. ConclusionsWomen use a variety of approaches to manage their fear of recurrence. Further research on the most appropriate interventions for FCR tailored specifically to the needs of women with OC is needed.

Is de-escalation of treatment by omission of radiotherapy associated with fear of cancer recurrence in women with early breast cancer? An exploratory study

PurposeSafe de-intensification of adjuvant radiotherapy (RT) for early breast cancer (BC) is currently under evaluation. Little is known about the patient experience of de-escalation or its association with fear of cancer recurrence (FCR), a key issue in survivorship. We conducted a cross-sectional study to explore this association.MethodsPsychometrically validated measures including the Fear of Cancer Recurrence Inventory-Short Form were completed by three groups of women with early BC: Women in the PROSPECT clinical trial who underwent pre-surgical MRI and omitted RT (A), women who underwent pre-surgical MRI and received RT (B); and women who received usual care (no MRI, received RT; C). Between group differences were analysed with non-parametric tests. A subset from each group participated in a semi-structured interview. These data (n = 44) were analysed with directed content analysis.ResultsQuestionnaires from 400 women were analysed. Significantly lower FCR was observed in Group A (n = 125) than in Group B (n = 102; p = .002) or Group C (n = 173; p = .001), and when participants were categorized by RT status (omitted RT vs received RT; p < .001). The proportion of women with normal FCR was significantly (p < .05) larger in Group A (62%) than in Group B (35%) or Group C (40%). Two qualitative themes emerged: ‘What I had was best’ and ‘Coping with FCR’.ConclusionsOmitting RT in the setting of the PROSPECT trial was not associated with higher FCR than receiving RT. Positive perceptions about tailored care, lower treatment burden, and trust in clinicians appear to be protective against FCR.

The Efficacy of Mindfulness-Based Cognitive Therapy on Disease Perception, Body Image, and Fear of Cancer Recurrence in Women with Breast Cancer

Background: Currently, the prevalence of breast cancer and its debilitating consequences are increasing, causing adverse personal, family, and social effects in patients. Therefore, patients with breast cancer should try to reduce the injuries described above through various treatment methods. Objectives: This study aimed to assess the efficacy of mindfulness-based cognitive therapy (MBCT) on disease perception, body image, and fear of cancer recurrence in women with breast cancer. Methods: This applied study was designed based on a pre-test and post-test. The study included 30 participants, 15 test groups (15 people), and 15 control groups (15 people). A test group was used for MBCT, while the other was not exposed to the intervention. Eight 90-minute sessions were held weekly for the test group for two months. The research tools included the Broadbent Illness Perception Questionnaire (BIPQ), Multidimensional Body-Self Relations Questionnaire (MBSRQ), and Fear of Cancer Recurrence Inventory Questionnaire (FCRIQ). Finally, the resulting data were analyzed by SPSS software Version 25. Results: The statistical test of covariance analysis showed that the MBCT method significantly affects disease perception, body image, and fear of disease recurrence in women with breast cancer (P &lt; 0.05). Conclusions: Based on the results, the MBCT method can help manage breast cancer in women. Therefore, breast cancer patients can improve their quality of life and life expectancy by learning this treatment method.

Gene Expression and Benefit of Chemotherapy in Women With Node-Negative, Estrogen Receptor-Positive Breast Cancer.

The 21-gene recurrence score (RS) assay quantifies the likelihood of distant recurrence in women with estrogen receptor-positive, lymph node-negative breast cancer treated with adjuvant tamoxifen. The relationship between the RS and chemotherapy benefit is not known. The RS was measured in tumors from the tamoxifen-treated and tamoxifen plus chemotherapy-treated patients in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B20 trial. Cox proportional hazards models were utilized to test for interaction between chemotherapy treatment and the RS. A total of 651 patients were assessable (227 randomly assigned to tamoxifen and 424 randomly assigned to tamoxifen plus chemotherapy). The test for interaction between chemotherapy treatment and RS was statistically significant (P = .038). Patients with high-RS (≥ 31) tumors (ie, high risk of recurrence) had a large benefit from chemotherapy (relative risk, 0.26; 95% CI, 0.13 to 0.53; absolute decrease in 10-year distant recurrence rate: mean, 27.6%; SE, 8.0%). Patients with low-RS (< 18) tumors derived minimal, if any, benefit from chemotherapy treatment (relative risk, 1.31; 95% CI, 0.46 to 3.78; absolute decrease in distant recurrence rate at 10 years: mean, -1.1%; SE, 2.2%). Patients with intermediate-RS tumors did not appear to have a large benefit, but the uncertainty in the estimate can not exclude a clinically important benefit. The RS assay not only quantifies the likelihood of breast cancer recurrence in women with node-negative, estrogen receptor-positive breast cancer, but also predicts the magnitude of chemotherapy benefit.

Evaluating the Effectiveness of Cognitive-Behavioral Therapy on Disease Perception, Body Image and Fear of Cancer Recurrence in Women with Breast Cancer

Background: One of the treatment methods that can improve the psychological symptoms of people with cancer is cognitive-behavioral therapy (CBT). Objectives: The main purpose of this study is to evaluate the effectiveness of CBT on disease perception, body image and fear of cancer recurrence in women with breast cancer. Methods: The present study was an applied and quantitative research. In terms of method, this research was completely experimental and had a pre-test-post-test design with an experimental group and a control group, which was followed up for six months. The statistical population of the present study included all women with breast cancer referred to the oncology department of Omid Hospital in Isfahan. Thirty people were selected by simple random method and were assigned to the experimental group (15 people) and the control group (15 people). For data analysis, mixed variance analysis with repeated measurements was used by SPSS-ver. 22 software. Research tools included Broadbent Illness Perception, Multidimensional Body-Self Relations and Fear of Cancer Recurrence Inventory questionnaires. Results: The results of the study based on the statistical test of covariance analysis showed that CBT was significant on disease perception, body image and fear of disease recurrence in women with breast cancer (P &lt; 0.05). Conclusions: Based on the results of the present study, it can be concluded that cognitive-behavioral therapy can be useful in the management of breast cancer in women. Therefore, it is suggested that this treatment method be used intermittently for the management of breast cancer by the patients themselves.

P007 Tamoxifen reduced breast cancer recurrence in women with DCIS who underwent mastectomy

P007 Tamoxifen reduced breast cancer recurrence in women with DCIS who underwent mastectomy

D-Dimers Variability in the Perioperative Period of Breast Cancer Surgery Helps to Predict Cancer Relapse: A Single-Centre Prospective Study.

The importance of D-dimers (DD) assessment in the diagnostic algorithm of venous thromboembolic (VTE) disease is well known. Increase of DD concentration may be also associated with neoplastic disease. Many studies documented that high concentration of DD before solid tumour surgery indicates more advanced disease and poor life expectancy. The prognostic value of the DD concentration variability in the perioperative period, in women undergoing breast cancer surgery, has not been analysed so far. Thus, the aim of the present prospective study was to assess whether the trend of DD concentration changes in the perioperative period may predict cancer recurrence in women undergoing breast cancer surgery. 189 consecutive women with histopathological diagnosis of breast cancer (BC) referred for surgical treatment were included. DD concentration was measured twice in each patient: at the time of admission to hospital and at the time of discharge home. Enoxaparin in standard dose of 40mg daily s. c. was used as primary VTE prophylaxis in all of the patients. The recurrence of BC, within 1year observation time, occurred in 13 patients (6.8%), in 11 (5.8%) patients with DD increase after surgery and only in 2 (1.1%) without an increase in DD, P = .0179. Increase in DD concentration after BC surgery was an independent positive predictor of disease relapse (OR 8.600, LCI 1.451, UCI 96.80, P = .0371) together with the lack of postoperative radiotherapy (OR 6.009, LCI 1.305, UCI 31.95, P = .0245), whereas the lack of postoperative chemotherapy predicted no BC relapse (OR .07355, LCI .0056, UCI .58, P = .0245). Increase of DD in the early postoperative period may be considered as additional independent predictor of recurrence of BC within 1 year.

Fear of Cancer Recurrence in Women with Breast Cancer: A Cross-Sectional Study after Mastectomy

Aim: The aim of this study was to determine the fear of cancer recurrence in women with breast cancer after mastectomy.&#x0D; Material and Methods: Data were collected between March and September 2021 with the Personal Information Form and the Fear of Cancer Recurrence Inventory via social media. The sample consisted of 127 women with breast cancer, who were registered in the general surgery service of a training and research hospital in Turkey, could be reached by phone and had a social media account. Descriptive statistics, independent groups t test, One-Way ANOVA and Mann-Whitney U test analysis were used in the analysis of the data. &#x0D; Results: It was determined that the Fear of Cancer Recurrence Inventory mean score was 126.12±24.88 and the coping strategies sub-dimension mean score was 30.96±6.00. It was determined that there was a significant difference between the mean score of the Fear of Cancer Recurrence Inventory and the duration of diagnosis, the status of receiving radiotherapy and chemotherapy, the status of experiencing treatment-related side effects, and the status of doing any sports/exercise (p

Radiomics Nomogram: Prediction of 2-Year Disease-Free Survival in Young Age Breast Cancer.

Simple SummaryBreast cancer in young women under 40 years of age shows a poor prognosis, and its treatment is difficult due to premenopausal status and fertility preservation. The early prediction of prognosis of young age breast cancer would be helpful for planning treatment and postoperative surveillance. In this study, the radiomics-based nomogram for the prediction of recurrence shows good predictive ability, especially 2-year disease-free survival after surgery. Several radiomics features presumed to be unique imaging features of young age breast cancer were also observed: tumor homogeneity and tumor sphericity. As these radiomics features are quantitative parameters extracted through the texture analysis of breast MRI, they may reflect the information of tumors more objectively, such as the tumor microenvironment. Furthermore, these results will be the basis for identifying the unique biology of young age breast cancer through multi-omics studies such as radio-genomics.This study aimed to predict early breast cancer recurrence in women under 40 years of age using radiomics signature and clinicopathological information. We retrospectively investigated 155 patients under 40 years of age with invasive breast cancer who underwent MRI and surgery. Through stratified random sampling, 111 patients were assigned as the training set, and 44 were assigned as the validation set. Recurrence-associated factors were investigated based on recurrence within 5 years during the total follow-up period. A Rad-score was generated through texture analysis (3D slicer, ver. 4.8.0) of breast MRI using the least absolute shrinkage and selection operator Cox regression model. The Rad-score showed a significant association with disease-free survival (DFS) in the training set (p = 0.003) and validation set (p = 0.020) in the Kaplan–Meier analysis. The nomogram was generated through Cox proportional hazards models, and its predictive ability was validated. The nomogram included the Rad-score and estrogen receptor negativity as predictive factors and showed fair DFS predictive ability in both the training and validation sets (C-index 0.63, 95% CI 0.45–0.79). In conclusion, the Rad-score can predict the disease recurrence of invasive breast cancer in women under 40 years of age, and the Rad-score-based nomogram showed reasonably high DFS predictive ability, especially within 2 years of surgery.

Predictors for the Recurrence of Clinically Uterine-Confined Endometrial Cancer and the Role of Cytokeratin Immunohistochemistry Stain in the Era of Sentinel Lymph Node Mapping

Simple SummarySentinel lymph node (SLN) mapping in women with endometrial cancer is gradually gaining popularity worldwide. The objectives of this retrospective study were to elucidate the predictors for cancer recurrence in the era of SLN mapping, and to compare the clinical outcomes between SLN mapping and traditional lymphadenectomy, as well as to investigate the role of cytokeratin immunohistochemistry stain in detecting lymph node metastases. Para-aortic lymph node metastasis was found to be the sole predictor for cancer recurrence. Cytokeratin immunohistochemistry stain detects more lymph node metastases. In addition, both SLN mapping and traditional lymphadenectomy have similar probabilities of cancer recurrence.Background: The primary objective of this study was to elucidate the predictors for cancer recurrence in women with clinically uterine-confined endometrial cancer in the era of sentinel lymph node (SLN) mapping. Methods: All consecutive women with clinically determined uterine-confined endometrial cancer who had lymph node assessment by either SLN mapping or traditional pelvic lymphadenectomy were reviewed. Results: Women in the SLN mapping group had lower total dissected pelvic nodes, lower incidence of para-aortic lymph node dissection, less intraoperative blood loss and lower complication rates, but a longer operation time compared to the traditional lymphadenectomy group. Para-aortic lymph node metastasis (hazard ratio = 7.60, p = 0.03) was the sole independent predictor for recurrence-free survival. In addition, the utilization of cytokeratin immunohistochemistry stain detected more lymph node metastases (adjusted odds ratio = 3.04, p = 0.03). Recurrence-free survival did not differ between SLN mapping and traditional lymphadenectomy groups (p = 0.24). Conclusions: Para-aortic lymph node metastasis is an important predictor of cancer recurrence. Women with negative hematoxylin and eosin stain should undergo cytokeratin immunohistochemistry stain to increase the detection rate of positive lymph node metastasis. Besides, the probabilities of recurrence seem to be similar between SLN mapping and traditional lymphadenectomy groups in women with clinically uterine-confined endometrial cancer.

Abstract P1-22-03: Expression of immune-related genes and breast cancer recurrence in women with ductal carcinoma in situ

Abstract Background. Ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive breast cancer (IBC). High variability in clinical outcomes and propensity for invasion among DCIS is reported, but identifying high-risk DCIS remains a major clinical challenge. Therefore, biomarkers to differentiate patients with indolent DCIS from those who would benefit from therapy are warranted. There are recent data on the role of the tumor immune microenvironment in the progression from DCIS to IBC and the risk of recurrences. However, no comprehensive information on the clinical actionability of DCIS immune-biology is available. We hypothesize that immune escape mechanisms might play a critical role in the transition from DCIS to IBC. Here, we sought to establish whether immune-related gene expression signatures of DCIS might identify women at high risk of disease recurrence and/or progression. Methods. We performed a retrospective nested case-control study including women with pure DCIS, diagnosed between 2009 and 2015 at European Institute Oncology (median follow-up 39,5 months) treated with conserving surgery +/- adjuvant therapy (endocrine therapy or radiotherapy). The study group (cases) was composed of women with DCIS and subsequent ipsilateral breast events (IBE, in situ or invasive). Controls were selected in a 1.1 ratio among DCIS without IBE, matched for age, tumor size, treatment, and hormone receptors (HR), and HER2 status. Stromal tumor-infiltrating lymphocytes (sTILs) were assessed according to the International Immuno-Oncology Biomarker Working Group on Breast Cancer guidelines. RNA extracted from formalin-fixed paraffin-embedded blocks was subjected to gene expression analysis using a next-generation sequencing assay (Oncomine™ Immune Response Research Assay) targeting 395 immune-related genes. Samples that achieve run quality parameters (mapped reads &amp;gt;1 million, valid reads &amp;gt;800.000) were further processed with the Affymetrix Transcriptome Analysis Console software to compare the gene expression between cases and controls (ANOVA, gene-level fold change &amp;lt;-2 or &amp;gt;2).Results. A total of 116 patients were included, 58 cases and 58 controls. High sTILs count was significantly associated with high-grade DCIS (p=&amp;lt;0,0001), the presence of necrosis (p=0,0210) and HER2 expression (p=&amp;lt;0,0001) in both groups. No significant association between sTILs count and the probability of relapse was observed. Gene expression data were available for 56 cases and 56 controls that achieved sequencing quality parameters. Overall, five genes were differentially expressed between cases and controls. In particular, cases showed upregulation of IFNA17 (p-value &amp;lt;0,0001; FDR p-value &amp;lt;0.0001), IFNB1 (p-value &amp;lt;0,0001; FDR p-value &amp;lt;0.0001), PECAM-1 (p-value &amp;lt;0,0001; FDR p-value &amp;lt;0.0001) and significant lower expression of CCL2 (p-value &amp;lt;0,0001; FDR p-value &amp;lt;0.0001) as compared to control group. Other genes that were upregulated in DCIS with IBE included FCGR2B, CD3D, CD40LG, while TCF7, CDKN3, ADORA2A were found to be downregulated (p-value &amp;lt;0.05).Conclusion. Quantitative TILs density assessment remains of modest significance in DCIS prognostication in terms of risk of IBE. We showed that pure DCIS displayed significant differences in the expression of immune-related genes between women with and without subsequent breast cancer recurrence regardless of HR and HER2 status. The activation of immune-related pathways might play a part in the development of IBE in patients with a diagnosis of DCIS. The evaluation of immune-related gene expression profiles might improve risk stratification in patients with DCIS. Citation Format: Elena Guerini Rocco, Caterina Fumagalli, Alberto Concardi, Sergio V. Taormina, Aliana Guerrieri-Gonzaga, Federica Corso, Sara Gandini, Bernardo Bonanni, Giuseppe Viale, Massimo Barberis, Nicola Fusco, Lazzeroni Matteo. Expression of immune-related genes and breast cancer recurrence in women with ductal carcinoma in situ [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-22-03.

The Breast Cancer Weight Loss trial (Alliance A011401): A description and evidence for the lifestyle intervention.

The Breast Cancer Weight Loss (BWEL) trial is a randomized controlled trial designed to determine whether weight loss after a breast cancer diagnosis can reduce the risk of cancer recurrence in women with overweight or obesity. The BWEL trial will compare the efficacy of a telephone-based weight-loss intervention plus health education materials versus health education materials alone on invasive disease-free survival in 3,181 women with stage II or III breast cancer and BMI > 27 kg/m2 . This report provides a detailed description of the goals and methods of the lifestyle intervention and the evidence supporting the intervention used in the BWEL trial. The intervention's primary goal for participants is to achieve and maintain a weight loss ≥ 10% of baseline weight through increased physical activity and caloric restriction. The evidence supporting the diet, physical activity, and behavioral components of this telephone-based weight-loss intervention, as well as strategies to promote participant engagement and retention, is described. The intervention is provided through 42 sessions delivered by trained health coaches over a 2-year period. If the BWEL lifestyle intervention is successful in improving cancer outcomes, then weight loss will be incorporated into the care of thousands of breast cancer patients.

Stage one endometrioid endometrial adenocarcinoma: is there a role of traditional hospital follow-up in the detection of cancer recurrence in women after treatment?

ObjectiveTo investigate the rate of asymptomatic recurrence of stage 1 endometrioid endometrial cancer and assess the role of routine hospital follow-up after treatment.MethodsWe performed a retrospective case-note review study of women who were diagnosed with stage 1 endometrioid endometrial adenocarcinoma at Queen’s Hospital, Romford, between January 2008 and December 2016.ResultsWe included 299 patients with a median follow-up period of 44.4 months. All the patients underwent total hysterectomy and bilateral salpingo-oophorectomy. Adjuvant radiotherapy was offered to the patients subsequent to discussions in the multidisciplinary team meeting in accordance with the risk stratification criteria. There was no significant correlation between the risk factors and disease recurrence. In total, 11 patients presented with recurrent disease with original staging: 1a, n=6/199; and 1b, n=5/100. Four patients presented with vaginal bleeding due to vault recurrence and one patient with abdominal pain due to pelvic mass. Locoregional recurrence was an incidental finding in two other patients. Four patients presented with symptomatic distant metastases to the lung (n=2), liver (n=1), and bone (n=1). No asymptomatic recurrences were identified on routine follow-ups, despite several hospital appointments and clinical examinations. The recurrence rate for patients with stage 1a and 1b, grade 1, and grade 2 disease was 3.53%, and that for patients with stage 1a, grade 1, and grade 2 disease was 2.7%.ConclusionRoutine clinical examinations have a low yield in finding recurrence in asymptomatic women and should be questioned for their value, considering the limited resources of the National Health Service (NHS). Larger studies are required to support a stratified follow-up, which will include telephone and patient-initiated follow-up.

P–455 Breast cancer recurrence in women with and without controlled ovarian stimulation for fertility preservation. Cohort study

Abstract Study question Do patients diagnosed with breast cancer who undergo ovarian stimulation for fertility preservation prior to chemotherapy have a higher risk of recurrence of the disease? Summary answer There was no statistically significant difference in the hazard ratio for breast cancer recurrence in fertility preservation-stimulated women compared to non-stimulated ones What is known already While many women with early breast cancer benefit from chemotherapy treatments in increasing disease-free survival, they are also at risk of permanent chemotherapy induced ovarian failure. Oocyte cryopreservation with an adapted protocol with letrozole may reduce the possible deleterious effect of the hyper estrogenic state during the controlled ovarian hyperstimulation (COH). Although fertility preservation in women diagnosed with breast cancer seems safe, the follow-up periods of most studies are short in time. In addition, follow-up data of COH before neoadjuvant chemotherapy in women with hormone negative tumor receptors is still scarce and briefly reported. Study design, size, duration It was a retrospective cohort study, where 208 women with non-metastatic breast cancer were included. The recruitment period was from 01/01/2009 to 01/12/2019. The minimum follow-up period was 6 months, and the maximum, 130 months. Participants were divided into two cohorts, those who received controlled ovarian hyperstimulation prior to their cancer treatment and those who did not. Patients were followed until disease recurrence, death, loss to follow-up, or end of the study Participants/materials, setting, methods Setting: university hospital in Buenos Aires, Argentina. We included women aged 18 to 45 years with a recent histological diagnosis of non-metastatic breast cancer who had to receive chemotherapy with gonadal toxicity. We excluded patients with a history of previous chemotherapy or radiotherapy for another cancer disease, or menopause. Follow-up was at least an annual clinical check-up and breast imaging. Cohorts were analysed using a Cox-proportional hazards model, adjusted for propensity score for receiving stimulation. Main results and the role of chance We included 208 women, 39 in the COH group and 169 in the non-stimulated group (NSG). The only statistically significant difference was in age: median years 33.7 (interquartile range -IQR- 30.9 to 36.9) and 40.0 years (IQR 36.8 to 44.0), respectively. The median size of cancer nodules was 19.0 millimetres (IQR 10.0–30.0) and 17.0 (IQR 11.0–25.0), p 0.547; percentage of positive lymph nodes: 41.0% vs 39.3%, p 0.841; positive hormonal receptors: 84.6% vs 85.2%, p 0.925; percentage of neoadjuvant chemotherapy: 20.5% vs 11.4%, p 0.128. There were also no statistically significant differences regarding tumour stage, high Ki–67 labelling index, positive breast cancer genes (BRCA 1 or 2), and radiotherapy. Overall, 18.0% of patients had cancer recurrence in the COH group and 20.7% in the NSG (p 0.699). Crude cancer recurrence rates were similar: 5.96 per 100 patients/year (95%CI 2.84–12.50), and 4.65 per 100 patients/year (95%CI 3.34–6.47), respectively. The crude hazard ratio (HR), comparing the COH group vs the NSG was 1.32 (95%CI 0.58–2.97; p 0.507). The adjusted HR using a propensity score for receiving ovarian stimulation treatment was 1.08 (95%CI 0.39–2.98; p 0.887). Results were similar if adjusted for age, neoadjuvant chemotherapy, and other confounders. Limitations, reasons for caution This was a single-center retrospective cohort study. There might be unknown or residual confounders that could influence results. Nevertheless, we accounted for treatment bias using a propensity score for ovarian stimulation. Results should be extrapolated with caution, especially in other non-university institutions and populations. Wider implications of the findings: This study provides new evidence on the safety of controlled ovarian stimulation in breast cancer patients prior to chemotherapy treatment, in a Latin American population. Letrozole continues to show safety and efficacy as an adapted protocol in breast cancer. Trial registration number Not applicable

The difference in local, regional and distant breast cancer recurrence between the immediate and delayed DIEP flap procedure; a retrospective cohort study

PurposeIt has been hypothesized that autologous breast reconstruction can cause reactivation of dormant micro metastases by its extensive tissue trauma, influencing the risk of breast cancer recurrence. However, about the specific effect of timing on breast cancer recurrence in the deep inferior epigastric perforator (DIEP) flap reconstruction is not much known. In this study the rate of local, regional and distant recurrence between patients undergoing an immediate and delayed autologous DIEP flap breast reconstruction were evaluated.MethodsIn this retrospective cohort study, breast cancer patients undergoing a DIEP flap breast reconstruction between 2010 and 2018 in three hospitals in the Netherlands were evaluated. Cox proportional hazards regression analyses were performed to assess the impact of different factors on breast cancer recurrence. The primary endpoint was local breast cancer recurrence. Secondary endpoints were regional and distant recurrence.ResultsA total of 919 DIEP-flap reconstructions were done in 862 women of which 347 were immediate- and 572 were delayed DIEP flap reconstructions. After a median follow-up of 46 months and 86 months respectively (p < 0.001), local breast cancer recurrence occurred in 1.5% and in 1.7% of the patients resulting in an adjusted hazard ratio of 2.890 (p = 0.001, 95% CI 1.536, 5437).ConclusionThis study suggests an increased risk for breast cancer recurrence in women receiving a delayed DIEP flap reconstruction as compared to women receiving an immediate DIEP flap reconstruction. However, these data should be interpreted carefully as a result of selection bias.

A qualitative exploration of fear of cancer recurrence in Turkish cancer survivors who were referred for colposcopy.

We aimed to qualitatively explore factors related to fear of cancer recurrence in women who had a risk of cervical cancer relapse/metastasis and to identify the psychological effect of gynaecological examination and colposcopy in cancer survivors. We conducted the present descriptive study with a qualitative design based on the thematic analysis approach on ten women who under suspicion of new cancer and were admitted to the Gynaecological Oncology Polyclinic of Akdeniz University for colposcopy between July and October 2017 via in-depth interviews. As a result of the interviews, we identified three main themes: colposcopy-related fear, emotions associated with fear of cancer recurrence, and fear of being diagnosed with cancer. Moreover it was determined that women experienced a fear of death, fear of family being affected, fear of stigmatisation by society, and fear of not coping with the treatment process. We found that women with cancer history and undergoing colposcopy because of abnormal cervical cytology in routine oncology controls experienced a significant fear of cancer recurrence. We found that gynaecological examination and colposcopy caused anxiety in patients. Healthcare professions should be aware and help women to cope with the fear of cancer recurrence in the colposcopy process and should determine the social care needs of these patients.