Detection Of Breast Cancer Recurrence Research Articles

Evaluating the utility of routine survivorship exams in breast cancer: Modality of detection of recurrence in a prospective cohort study.

1629 Background: National Comprehensive Cancer Network surveillance guidelines for invasive breast cancer recommend a history and physical exam every 3-12 months for the first 5 years, followed by annually, and mammography every 12 months. However, frequent in-office visits create time toxicity for breast cancer survivors, may have low utility in recurrence detection, and can create false reassurance. This study evaluates the modality of breast cancer recurrence in an integrated health system with access to primary and specialty care. Methods: We investigated mode of detection of recurrent breast cancer in the Pathways Study, a prospective cohort study of adult women diagnosed with and treated for invasive breast cancer in Kaiser Permanente Northern California, with enrollment from 2006 to 2013, and follow-up through December 2021. In this analysis, we included 4,431 women diagnosed at Stages I-III. Cohort members were followed for recurrences, deaths, and other outcomes. Of primary interest was modality of detection of recurrence, categorized as patient-driven symptoms, surveillance mammogram, diagnostic testing (i.e., other surveillance imaging for recurrence such as PET CT or MRI), routine clinical breast exam, or incidental finding. Results: A total of 617 (13.9%) women were identified as having breast cancer recurrence. Patients with recurrence shared similar demographic characteristics to those without recurrence. The recurrence population had median age of 59.2 years, BMI of 28.2 kg/m2, and racial/ethnic composition of 63% white,13% Hispanic,12% Asian, and 10% black. The median time from diagnosis to recurrence was 4 years. Seventy percent of recurrences were found to have distant metastatic disease, of which only 6.7% had concurrent local nodal and/or breast involvement. For those without metastases, 17.7% had recurrence localized in the ipsilateral breast, 2.8% in both the breast and locoregional nodes, and 9.3% only in locoregional nodes. Most recurrences were detected by patient driven symptoms (69.4%). Among the total cases, 8.1% of patients were diagnosed by routine mammogram, 10.9% with diagnostic testing and 4.5% by incidental finding. Recurrences in 6.8% of patients were detected by routine physician exam. Overall survival for those with recurrence was 31.1% and most deaths were attributed to breast cancer (89%). Conclusions: Our study, the largest investigation of breast cancer recurrence modality of detection in a US community oncology setting with comprehensive care, revealed the majority of recurrences were identified through patient self-detection with only 6.8% detected by physician exam. Most recurrences were distant, underscoring the need for alternative screening modalities to detect metastatic recurrences earlier, especially in the context of emerging treatments and improved survival rates for oligometastatic disease.

Impact of COVID-19 on post-treatment breast cancer surveillance and outcomes.

e23114 Background: Little is known about the impact of the COVID-19 pandemic on post-treatment surveillance for patients diagnosed with breast cancer. Disruptions in recommended cancer surveillance screening to detect progression or recurrence could impact long-term outcomes. In this study, we compared use of recommended surveillance screening in pre- and post-COVID time periods for patients diagnosed with breast cancer within a large integrated healthcare system, Kaiser Permanente Southern California (KPSC). We also evaluated detection of breast cancer recurrence or progression. Methods: We identified patients in post-treatment surveillance for early-stage breast cancer in two time periods, pre-COVID and post-COVID. Pre-COVID included patients diagnosed 01/01/2015-12/31/2016 with 2 years of follow-up time through 12/31/2019; post-COVID included patients diagnosed 06/01/2018-05/31/2020 with 2 years of follow-up time through 05/31/2023. Eligible patients were diagnosed with stage 0-II breast cancer and received curative surgery. We excluded patients with multiple cancers, and those who disenrolled from the health plan, died, or were referred to hospice within the 2-year surveillance period. Based on NCCN guidelines, we identified the proportion of patients who underwent annual breast imaging during each year of the surveillance period. A log Poisson model examined the association between imaging and COVID period; covariates included patient age, race/ethnicity, cancer stage, treatment, and comorbidity score. We identified cancer recurrence or progression using diagnostic, treatment, and imaging codes. Results: We identified 3,369 pre-COVID patients and 3,925 post-COVID patients; groups were similar (Table 1). A significantly smaller proportion of post-COVID patients received surveillance screening (first surveillance year: 85% in the pre-COVID group vs. 77% post-COVID, p = 0.001; second year: 83% vs. 80%, p = 0.01). Patients were 4% less likely to receive imaging post-COVID compared to pre-COVID (adjusted OR 0.96, 95% CI: 0.94-0.98). Similar percentages of patients had breast cancer recurrence or progression in the pre-COVID (2.7%) and post-COVID (2.5%) periods (p-value = 0.44). Conclusions: Fewer post-treatment breast cancer patients received recommended annual breast cancer screening for surveillance in the post-COVID period compared to pre-COVID, but breast cancer recurrence or progression was similar between groups. Given the less frequent surveillance in the post-COVID period, cancer recurrence and progression should be evaluated over 5- and 10-year periods as data become available. [Table: see text]

Regularly scheduled physical examinations and the detection of breast cancer recurrences.

Follow-up care of early breast cancer (EBC) patients usually includes routinely scheduled physical examinations. While ASCO guidelines recommend a physical exam every three to six months for the first three years, little evidence supports this schedule. We evaluated recurrence detection of patients transferred into a single centre survivorship program that follows ASCO recommendations. Patients with EBC referred to the Wellness Beyond Cancer Program (WBCP) who had breast cancer recurrence between February 1, 2013, and January 1, 2019 were reviewed. Descriptive analyses were used to present patient and disease characteristics stratified by type of recurrence and mode of cancer detection. Of 206 recurrences, 135 were distant recurrences (65.5%), 41 were ipsilateral breast recurrences (19.9%), and 30 were contralateral breast primaries (14.6%). Distant recurrences were primarily detected via patient-reported symptoms (125/135, 92.6%). 53.7% (22/41) of ipsilateral breast recurrences were detected by patients and 41.5% (17/41) by routine imaging. Contralateral breast primaries were primarily detected by imaging 83.3% (25/30) and patient-reported symptoms 16.7% (5/30). Only 2/206 (1.14%) recurrences/new primaries were detected by healthcare providers at routinely scheduled follow-up visits. Despite following ASCO guidelines, healthcare providers rarely detect recurrences at routinely scheduled follow-up appointments. Our data suggests that approximately 35, 000 follow-up visits were required for healthcare providers to detect these 2 recurrences. While reduced in-person visits may affect other aspects of follow-up care (e.g. toxicity management), it appears unlikely, provided patients attend regular screening tests, that less frequent in-person follow-up is associated with worse breast cancer-related outcomes.

Diagnostic ultrasound of the chest wall in the symptomatic patient after mastectomy

BackgroundLack of standardized imaging recommendations among mastectomy patients has led to variability in how recurrences are detected. ObjectiveTo describe the findings and assess the diagnostic efficacy of ultrasound in the evaluation of symptomatic post-mastectomy patients. Materials and methodsThis single institution, retrospective study included 749 consecutive diagnostic chest wall ultrasound examinations performed in mastectomy patients, from January 2016 to June 2017. Chest wall ultrasound evaluated the mastectomy bed with or without reconstruction. Electronic health records were queried for the primary breast cancer histology prior to mastectomy, clinical symptoms prompting the diagnostic ultrasound, ultrasound findings, subsequent cytology and pathology, and follow-up data. Excluded were patients with a known recurrence, asymptomatic patients, and those with <2 years of clinical or imaging follow-up. Descriptive and comparative statistical analyses were performed. ResultsAmong the 749 ultrasounds performed, 58 malignancies were identified for a 7.7% (58/749) malignancy rate, with a median tumor size of 20 mm.Patients diagnosed with a malignancy most often presented with a palpable abnormality (79.3%, 46/58) or skin changes (13.8%, 8/58) and rarely with pain (1.7%, 1/58). Patients who underwent a biopsy yielding a benign result most often presented with a palpable abnormality (41.5%, 287/691), pain (25.6%,177/691), or postoperative swelling/suspected fluid collection (17.8%, 123/691).Diagnostic ultrasound yielded a 91.4% sensitivity (95% CI 81.0, 97.1), 96.1% specificity (95% CI 94.4, 97.4), 66.3% PPV3 (95% CI 57.4, 74.1), and 99.3% negative predictive value (95% CI 98.3, 99.7) for cancer detection. There were 5 false negative ultrasound cases after a skin punch biopsy was performed due to clinically suspicious skin changes. ConclusionsChest wall ultrasound has a high sensitivity and negative predictive value for detection of breast cancer recurrence in symptomatic patients after mastectomy. Skin changes remain an important clinical manifestation of a cancer recurrence.

Follow-Up Strategies and Detection of Recurrent Breast Cancer in the Modern Era.

Regular history assessments and physical examination with annual breast imaging have been recommended as the standard surveillance protocol for breast cancer patients who underwent curative-intent therapy. Based on randomized studies conducted in the 2000s, surveillance with regular chest or abdominal imaging, chemistry panels, or tumor marker measurements does not improve survival in such patients. Given the remarkable recent improvements of systemic therapy, we hypothesized that more intensive surveillance may lead to early detection and improve treatment outcomes in the modern era. We retrospectively evaluated the follow-up strategies and benefits of investigations used in usual practice. Breast cancer patients who had initial adjuvant therapy were recruited and classified according to the receipt of standard follow-up (history, physical examination, and annual breast imaging) or alternative follow-up (surveillance with at least annual chest or abdominal imaging or biannual liver function testing). The primary outcome was overall survival. Secondary outcomes included disease-free survival and the indicator of recurrence detection. Of 412 recruited patients, 213 (51.7%) and 199 patients (49.3%) were included in the standard follow-up group and alternative follow-up group, respectively. Among 90 patients (21%) with disease recurrence, the most frequent indicators of recurrence were newly reported symptoms or physical examination abnormalities (64%), followed by abnormal breast imaging (23%) and abnormal chest X-ray (10%). After a median follow-up of 85 months, approximately 90% of patients remained alive after 5 years in both groups. The mean overall survival was similar between the standard and alternative follow-up groups (154.5 months vs. 151.9 months, p = 0.54). There was no difference in terms of the proportion of interval visits, specific cancer treatment received, and disease-free survival. Standard follow-up with history assessments, physical examination, and annual breast imaging remains the recommended surveillance strategy in the modern era. Alternative follow-up strategy did not improve oncologic outcomes.

Comparing the Efficiency of Imaging Modalities in Detection of Recurrent Breast Cancer.

To investigate the effectiveness of the different imaging modalities in detecting recurrence in breast cancer follow-up. Sixty-four women with recurrent breast cancer were examined between January 2020 and July 2022. Recurrency was divided into four categories: local; regional; second primary; and distant metastasis. The detectability of recurrent lesions with mammography (MG), ultrasound (US) and magnetic resonance imaging (MRI), was evaluated. In addition, recurrences that firstly appeared by positron emission tomography (PET) scan were recorded. Twenty-seven (42.2%) recurrences were local, 10 (15.6%) were regional and 27 (42.2%) were second primary. Forty-six (71.9%) of them were determined to have invasive carcinoma, 8 (12.5%) were ductal carcinoma in situ, and 10 (15.6%) were axillary metastases. Eight (12.5%) of them were first diagnosed by PET-computed tomography/MRI. Among the available images performed, 78.7% could be detected pathologically by MG, 95.2% by US, and 100% by MRI. Distant metastasis associated with other types of recurrence was detected in 6 (9.4%) cases. MRI is the most powerful imaging modality in detecting recurrent breast cancer. With the addition of US to routine MG follow-up, a higher rate and early detection of recurrent cancers can be achieved.

Analysis of detection of breast cancer recurrences during intensive follow-up after treatment of primary breast cancer

Introduction: Since the outbreak of the COVID-19 pandemic, the paradigm has evolved such that virtual breast cancer clinics and surveillance has dominated patient follow-up. Breast cancer patients are routinely followed up for years in surgical, medical oncology and radiation oncology clinics. However, controversies surround follow-up, and its value is uncertain. The aim of this study was to assess whether breast cancer recurrences presenting at our breast unit were detected clinically or radiologically and proportion of the recurrences detected during routine physical exam.

Trends in Annual Surveillance Mammography Participation Among Breast Cancer Survivors From 2004 to 2016.

Annual mammography is recommended for breast cancer survivors; however, population-level temporal trends in surveillance mammography participation have not been described. Our objective was to characterize trends in annual surveillance mammography participation among women with a personal history of breast cancer over a 13-year period. We examined annual surveillance mammography participation from 2004 to 2016 in a nationwide sample of commercially insured women with prior breast cancer. Rates were stratified by age group (40-49 vs 50-64 years), visit with a surgical/oncology specialist or primary care provider within the prior year, and sociodemographic characteristics. Joinpoint models were used to estimate annual percentage changes (APCs) in participation during the study period. Among 141,672 women, mammography rates declined from 74.1% in 2004 to 67.1% in 2016. Rates were stable from 2004 to 2009 (APC, 0.1%; 95% CI, -0.5% to 0.8%) but declined 1.5% annually from 2009 to 2016 (95% CI, -1.9% to -1.1%). For women aged 40 to 49 years, rates declined 2.8% annually (95% CI, -3.4% to -2.1%) after 2009 versus 1.4% annually in women aged 50 to 64 years (95% CI, -1.9% to -1.0%). Similar trends were observed in women who had seen a surgeon/oncologist (APC, -1.7%; 95% CI, -2.1% to -1.4%) or a primary care provider (APC, -1.6%; 95% CI, -2.1% to -1.2%) in the prior year. Surveillance mammography participation among breast cancer survivors declined from 2009 to 2016, most notably among women aged 40 to 49 years. These findings highlight a need for focused efforts to improve adherence to surveillance and prevent delays in detection of breast cancer recurrence and second cancers.

Plasma Levels and Diagnostic Utility of VEGF in a Three-Year Follow-Up of Patients with Breast Cancer.

Breast cancer is the most common malignancy in women globally. The increasing worldwide incidence of this type of cancer illustrates the challenge it represents for healthcare providers. Therefore, new tumor markers are constantly being sought. The aim of this study was to assess plasma concentrations and the diagnostic power of VEGF in 100 patients with early-stage breast cancer, both before and after surgical treatment and during a three-year follow-up. The control groups included 50 subjects with benign breast tumors (fibroadenoma) and 50 healthy women. The VEGF concentration was determined using enzyme-linked immunosorbent assay (ELISA) and the CA 15-3 concentration was determined by chemiluminescent microparticle immunoassay (CMIA). We observed significantly higher preoperative plasma concentrations of VEGF and CA 15-3 in patients with breast cancer. VEGF, similar to CA 15-3, demonstrated high diagnostic utility in the assessment of the long-term efficacy of surgical removal of the tumor. Determinations of VEGF had the highest diagnostic usefulness in the detection of breast cancer recurrence (SE 40%, SP 92%, PPV 67%, NPV 79%). Additionally, the highest values of SE, NPV and AUC were observed during the combined analysis with CA 15-3 (60%; 84%; 0.7074, respectively). Our study suggests a promising diagnostic utility of VEGF in the early stages of breast cancer and in the evaluation of the efficacy of the surgical treatment of breast cancer as well as the detection of breast cancer recurrence, particularly in a combined analysis with CA 15-3 as a new diagnostic panel.

Circulating Tumor DNA as a Predictive Marker of Recurrence for Patients With Stage II-III Breast Cancer Treated With Neoadjuvant Therapy.

BackgroundPatients with stage II to III breast cancer have a high recurrence rate. The early detection of recurrent breast cancer remains a major unmet need. Circulating tumor DNA (ctDNA) has been proven to be a marker of disease progression in metastatic breast cancer. We aimed to evaluate the prognostic value of ctDNA in the setting of neoadjuvant therapy (NAT).MethodsPlasma was sampled at the initial diagnosis (defined as before NAT) and after breast surgery and neoadjuvant therapy(defined as after NAT). We extracted ctDNA from the plasma and performed deep sequencing of a target gene panel. ctDNA positivity was marked by the detection of alterations, such as mutations and copy number variations.ResultsA total of 95 patients were enrolled in this study; 60 patients exhibited ctDNA positivity before NAT, and 31 patients exhibited ctDNA positivity after NAT. A pathologic complete response (pCR) was observed in 13 patients, including one ER(+)Her2(-) patient, six Her2(+) patients and six triple-negative breast cancer (TNBC) patients. Among the entire cohort, multivariate analysis showed that N3 classification and ctDNA positivity after NAT were independent risk factors that predicted recurrence (N3, hazard ratio (HR) 3.34, 95% confidence interval (CI) 1.26 – 8.87, p = 0.016; ctDNA, HR 4.29, 95% CI 2.06 – 8.92, p < 0.0001). The presence of ctDNA before NAT did not affect the rate of recurrence-free survival. For patients with Her2(+) or TNBC, patients who did not achieve pCR were associated with a trend of higher recurrence (p = 0.105). Advanced nodal status and ctDNA positivity after NAT were significant risk factors for recurrence (N2 – 3, HR 3.753, 95% CI 1.146 – 12.297, p = 0.029; ctDNA, HR 3.123, 95% CI 1.139 – 8.564, p = 0.027). Two patients who achieved pCR had ctDNA positivity after NAT; one TNBC patient had hepatic metastases six months after surgery, and one Her2(+) breast cancer patient had brain metastasis 13 months after surgery.ConclusionsThis study suggested that the presence of ctDNA after NAT is a robust marker for predicting relapse in stage II to III breast cancer patients.

Imaging Surveillance of the Reconstructed Breast in a Subset of Patients May Aid in Early Detection of Breast Cancer Recurrence.

Objectives:The purpose of this study is to determine the biological markers more frequently associated with recurrence in the reconstructed breast, to evaluate the detection method, and to correlate recurrent breast cancers with the detection method.Material and Methods:An institutional review board-approved retrospective study was conducted at a single institution on 131 patients treated with mastectomy for primary breast cancer followed by breast reconstruction between 2005 and 2012. Imaging features were correlated with clinical and pathologic findings.Results:Of the 131 patients who met our inclusion criteria, 40 patients presented with breast cancer recurrence. The most common histopathologic type of primary breast cancer was invasive ductal carcinoma in 82.5% (33/40) of patients. Triple-negative breast cancer was the most common biological marker with 42.1% (16/38) of cases. Clinically, 70% (28/40) of the recurrences presented as palpable abnormalities. Of nine patients who underwent mammography, a mass was seen in eight patients. Of the 35 patients who underwent ultrasound evaluation, an irregular mass was found in 48.6% (17/35) of patients. Nine patients with recurrent breast cancer underwent breast MRI, and MRI showed an irregular enhancing mass in four patients, an oval mass in four patients, and skin and trabecular thickening in one patient. About 55% of patients with recurrent breast cancer were found to have distant metastases.Conclusion:Patients at higher risk for locoregional recurrence may benefit from imaging surveillance in order to detect early local recurrences.

SP8.1.5 Breast cancer follow up; Is routine mammography indicated?

Abstract Aim This paper aims to review the outcome from yearly mammography in detecting breast cancer recurrence and new primary tumours in patients with a history of breast cancer. Methods From 2014, following treatment for breast cancer, patients were enrolled in a program of self-directed aftercare (SDA). They were given open access to the Breast service. Regular planned appointments were not offered. All patients underwent annual mammography for 5 years. Retrospective analysis of the SDA database from 2014 to 2016 was undertaken, time to and mechanism of detection of breast cancer recurrence in this population was determined. Results 352 patient records were analysed (1760 mammograms), 29 recurrences were identified. 12 locoregional, 12 systemic, 5 locoregional and systemic. Median time to diagnosis of recurrence was 30 months. Locoregional recurrence was detected by surveillance mammography (4 patients), clinical examination following patient request (7 patients), non-breast radiological investigation (5), by non-breast cancer care Doctors (1). No contralateral cancers were detected in patients who had mastectomy or WLE. Conclusion Despite limited evidence for regular clinical assessment post breast cancer treatment, the practice remains recommended. In this study regular clinical review was replaced by open access. Annual mammography was retained. Mammographic value out-with detection of malignancy (new/recurrent) was not assessed. The number of tumours detected (4 out of 1760 mammograms) would suggest that non-stratified routine mammography is of limited value for most patients. Further study is required to determine the risk or value and the cost/benefit analysis of mammographic follow up of breast cancer.

Machine Learning Classifiers on Breast Cancer Recurrences

Breast cancer remains to be a leading cause of cancer-related deaths among women. Mortality is mainly attributed to metastasis and recurrence. Hence, early detection of breast cancer recurrence has become a real-world medical problem. Using data mining approaches, we compared four popular machine learning models (Logistic Regression, Naïve Bayes, K-Nearest Neighbors, and Support Vector Machines) on a high-dimensional but very small dataset, the Wisconsin Prognostic Breast Cancer Data Set for classifying breast cancer recurrences on four different configurations: a) only scaling applied, b) scaling with PCA, c) scaling with PCA and oversampling of minority class, and d) only with selected features (i.e. choose only one from each set of features that have high correlation with each other). Our results showed that Logistic Regression provided the best scores in almost all metrics (precision, recall, accuracy, f1 score (weighted), AUROC, AUPROC, and Cohen Kappa statistic in all four configurations, followed by Support Vector Machines, and then by K-Nearest Neighbors. Naive Bayes performed poorly especially in the scaling with PCA configuration, however, when we retained only one of many features that have high correlations with each other, Naïve Bayed performance improved. KNN improved its recall with oversampling while SVM’s accuracy score has been fairly constant in all four configurations. Based on this study, the Logistic Regression model can serve as a potential model for predicting breast cancer recurrence that would enable clinicians to propose treatment options based on whether patient’s features correspond to a good or bad prognosis (recurrence). This indicates the clinical utility of data mining methods for the early detection of breast cancer recurrence in post-surgical patients to save lives.

Clinical utility of tumour marker velocity of cancer antigen 15–3 (CA 15–3) and carcinoembryonic antigen (CEA) in breast cancer surveillance

BackgroundSerum tumour markers, cancer antigen 15–3 (CA 15–3) and carcinoembryonic antigen (CEA) are not routinely recommended for detecting breast cancer recurrence and monitoring treatment. In this study, we aim to evaluate the diagnostic accuracy of absolute CA 15–3 and CEA levels and report on the clinical utility of tumour marker velocity in breast cancer surveillance. Methods67 consecutive patients over a 15-year period (1998–2012) with available serial serum CA 15–3 and CEA measurements at recurrence were matched to a control group of patients. Tumour marker velocity was derived from the average change in consecutive tumour marker values over time, expressed in unit/year. Logistic regression analysis was performed to investigate the association between tumour characteristics, tumour marker velocity and disease recurrence. ResultsUsing the Youden index values, the optimal cut-off values for absolute CA 15–3 and CEA corresponded to the normal assay reference range while tumour marker velocity values were derived to be 2.5U/mL/year and 1.2ng/mL/year respectively. CA 15–3 velocity > 2.5U/mL/year had the highest AUROC value of 0.85 than CEA velocity alone. When either tumour marker velocity exceeded threshold values, the sensitivity, specificity, negative predictive value and positive predictive value were 94.0%, 73.1%, 92.5%, and 77.8% respectively. In the multivariate logistic regression analysis, having both CA 15–3 and CEA velocity exceeding the cut-off values was shown to be a significant predictor for disease recurrence (p = 0.01). ConclusionThese findings highlighted the clinical utility of serial tumour markers measurements and its velocity in breast cancer surveillance.

A Systematic Review of Estimating Breast Cancer Recurrence at the Population Level With Administrative Data.

Exact numbers of breast cancer recurrences are currently unknown at the population level, because they are challenging to actively collect. Previously, real-world data such as administrative claims have been used within expert- or data-driven (machine learning) algorithms for estimating cancer recurrence. We present the first systematic review and meta-analysis, to our knowledge, of publications estimating breast cancer recurrence at the population level using algorithms based on administrative data. The systematic literature search followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We evaluated and compared sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of algorithms. A random-effects meta-analysis was performed using a generalized linear mixed model to obtain a pooled estimate of accuracy. Seventeen articles met the inclusion criteria. Most articles used information from medical files as the gold standard, defined as any recurrence. Two studies included bone metastases only in the definition of recurrence. Fewer studies used a model-based approach (decision trees or logistic regression) (41.2%) compared with studies using detection rules without specified model (58.8%). The generalized linear mixed model for all recurrence types reported an accuracy of 92.2% (95% confidence interval = 88.4% to 94.8%). Publications reporting algorithms for detecting breast cancer recurrence are limited in number and heterogeneous. A thorough analysis of the existing algorithms demonstrated the need for more standardization and validation. The meta-analysis reported a high accuracy overall, which indicates algorithms as promising tools to identify breast cancer recurrence at the population level. The rule-based approach combined with emerging machine learning algorithms could be interesting to explore in the future.

Abstract P2-02-03: Impact of genetic testing for hereditary breast cancer on supplemental breast imaging and false positive biopsy rates among young breast cancer patients

Abstract Introduction Annual mammography screening is recommended for women diagnosed with breast cancer for the early detection of local recurrence and new breast primaries. Younger women have higher breast density, which lowers the sensitivity of mammography for early detection. The American Cancer Society recommends breast MRI as an adjunct to mammography for women with known hereditary breast cancer syndromes. However, there is insufficient evidence on the use of breast MRI or ultrasound as an adjunct to screening mammography among young women with a personal history of breast cancer. Our objective was to investigate factors associated with use of supplemental screening among young breast cancer patients and the impact of supplemental screening on detection of breast cancer recurrence and false positive biopsy rates. Methods We conducted a retrospective analysis of women diagnosed with stage 0-III breast cancer at age 50 years or younger at Columbia University Irving Medical Center in New York, NY between 2007 and 2017. Patients were excluded if they had stage IV disease at diagnosis, bilateral mastectomy, or no breast imaging available in the CUIMC electronic health record (EHR). All clinical data was extracted from the EHR and tumor registry, including receipt and results of genetic testing. Supplemental screening was defined as use of breast ultrasound or MRI in the absence of breast symptoms and in the setting of a normal mammogram. Breast cancer recurrence and false positive biopsy were defined as any breast biopsy which did or did not show ductal carcinoma in situ (DCIS) or invasive carcinoma, respectively. Univariate and multivariate analyses were performed to assess the association between demographic and clinical factors and our main outcomes of supplemental screening and false positive biopsy. Results Among 681 evaluable women, mean age at diagnosis was 44 years (SD, 4.9) with 41.6% white, 28.2% Hispanic, 12.6% black, 11.7% Asian, and 5.9% other race/ethnicity. About 62.7% had private insurance and 23.1% Medicaid, and 47% had undergone genetic testing, including 20 (2.9%) with pathogenic variants. Over half (51%) had supplemental screening with either breast MRI or ultrasound, 130 (19.1%) had a false positive biopsy, and 52 (7.6%) had a breast cancer recurrence, with about half (51.9%) screen-detected. In multivariate analysis, supplemental screening was less likely among black and Hispanic women compared to whites (odds [OR]=0.56, 95% confidence interval [CI]=0.33-0.97 and OR=0.46, 95% CI=0.30-0.72, respectively), those with Medicaid compared to private insurance (OR=0.46, 95% CI=0.30-0.71), and women with lower breast density (OR=0.63, 95% CI=0.43-0.92). False positive biopsies were more frequent among women who underwent supplemental screening compared to those who did not (26.4% vs. 11.4%, p&amp;lt;0.001), however, screen-detected breast cancer recurrences were comparable (4.0% vs. 3.9%, p=0.209). Supplemental screening was associated with a greater than 2-fold increased risk of false positive biopsy (OR=2.77, 95% CI=1.78-4.32). Compared to young breast cancer patients who did not undergo genetic testing, women with pathogenic variants had a trend toward more supplemental screening (OR=2.28, 95% CI=0.82-6.36) and more false positive biopsies (OR=2.75, 95% CI=0.96-7.85). Conclusions Our findings suggest that decisions to engage in supplemental screening are influenced by insurance coverage and breast density. Furthermore, patients who receive supplemental screening were significantly more likely to have false positive biopsies, but had no difference in screen-detected breast cancer recurrences. Prospective studies are needed to better define optimal screening strategies for young breast cancer survivors. Citation Format: Vicky Ro, Ziyi Zhao, Samuel Pan, Katherine D. Crew. Impact of genetic testing for hereditary breast cancer on supplemental breast imaging and false positive biopsy rates among young breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-02-03.

Proteomic Analysis of Inflammatory Biomarkers Associated With Breast Cancer Recurrence.

Breast cancer is the most frequent cancer detected for women, and while our ability to treat breast cancer has improved substantially over the years, recurrence remains a major obstacle. Standard screening for new and recurrent breast cancer involves clinical breast imaging. However, there is no clinically approved noninvasive body fluid test for the early detection of recurrent breast cancer. Materials and Method: In this study, we analyzed serum samples from both recurrent and nonrecurrent breast cancer patients by different proteomics methods to identify biomarkers in patients with recurrence of disease. Comparative data analysis identified several histone deacetylase (HDAC) proteins, which were found at significantly higher levels in the serum of recurrent breast cancer patients: HDAC9 (C-term) (P=0.0035), HDAC5 (C-term) (P=0.013), small ubiquitin-like modifier 1 (N-term) (P=0.017), embryonic stem cell-expressed Ras (inter) (P=0.018), and HDAC7 (C-term) (P=0.020). Chronic inflammation plays a critical role in the development of the breast cancer recurrence, and we identified several proinflammatory cytokines that were present at elevated levels only in recurrent breast cancer patient serum. Our data indicated that the epigenetic regulation of inflammatory processes plays a critical role in breast cancer recurrence. The identified proteins could lay the groundwork for the development of a serum-based breast cancer recurrence assay.

PROSTATE-SPECIFIC ANTIGEN AND ITS MOLECULAR FORMS IN BLOOD SERUM OF HEALTHY WOMEN AND WOMEN WITH BREAST DISEASE

The purpose of the study was to provide data on the sources of prostate-specific antigen (Psa) in women, as well as on serum Psa levels in healthy women and in women with benign and malignant breast cancer. Material and methods. We analyzed 50 publications available from PubMed, Medline, Google scholar concerning non-prostatic sources of Psa and its use as a serum tumor-associated marker for benign and malignant breast tumors. Results. In our study, we focus on the recent findings on non-prostatic sources and regulation of Psa synthesis in women as well as on changes in serum concentrations of this marker in patients with benign and malignant breast tumors. Various Psa isoforms (total Psa and free Psa) and free/total ratio for the detection of breast cancer and the assessment of treatment response and early detection of breast cancer recurrence were analyzed. Conclusion . the results obtained highlight the value of the assessment of Psa isoforms for early detection, prediction of therapy response and detection of breast cancer relapse. However, further studies are needed to identify the role of Psa isoforms in the diagnosis and monitoring of breast cancer patients.

Detection of Breast Cancer Recurrence by Using Positron Emission Tomography with 18 Fluorodeoxyglucose (FDG-PET)-Computed Tomography (CT) and Tumor Markers

Abstract Background: Breast cancer is responsible for nearly 15% of death in female cancer related death in western countries and is cosidered the second leading cause to death due to cancer in females. In Egypt, it is the most common cancer in female, representing about 38.8% of total cancer cases in women. Early diagnosis of recurrent breast cancer is crucial to selection of the most appropriate therapy. FDG-PET/CT has been used for diagnosis, staging, monitoring response to therapy, and restaging patients with breast cancer. Although FDG-PET/CT may have limited diagnostic value in detecting small primary breast tumors, in staging of the axillary region, and in detecting osteoblastic metastases, it is superior to conventional imaging modalities in detecting distant metastases and in monitoring response to therapy. Aim of Study: To evaluate the role of PET/CT and tumor markers in detection of breast cancer recurrence in Clinical Radio-Diagnosis Department. Patients and Methods: Twenty five female patients their age was from 22-67 years (mean 43 years) all with breast cancer history and elevated serum tumor markers after their initial diagnosis were retrospectively evaluated. PET/CT results were confirmed by further imaging, and follow-up. Changes in further management based on PET/CT were recorded. Results: The patients' age was from 22-67 years. Most of them were (60%) were premenopausal. In this study, 92% had Infiltrating Ductal Carcinoma (IDC) while only 2 patients (8%) had Infiltrating Lobular Carcinoma (ILC), fourteen patients (56%) had recurrence of tumor, and 11 (44%) patients showed no further evidence of disease. Fourteen patients had abnormal PET/CT studies, and 11 patients had normal studies with an overall sensitivity, specificity, and accuracy of 85.7%, 81.8%, and 84%, respectively. PET/CT was compared with contrast-enhanced CT and had a higher sensitivity (85.7% vs. 71.4%), specificity (81.8% vs. 45.4%), and accuracy (84% vs. 60%). PET/CT was also compared with tumor markers and had a higher sensitivity (85.7% vs. 78.5%), specificity (81.8% vs. 18.1%), and accuracy (84% vs. 52%).Conclusion: FDG-PET/CT was superior to conventional imaging modalities in diagnosis of breast cancer recurrence.

Role of Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS) in Differentiating Post Therapeutic Changes from Recurrent Malignant Breast Lesions

AbstractBackground: Patients follow-up subsequent to conservative breast therapy (BCT) is essential due to tumor recurrence with rates ranging between 1% and 2% annually. It occurs commonly during a period of 3-7 years after being subjected to BCT. Timely and early detection of breast cancer recurrence is believed to remarkably improve and assist long-term sur-vival.Aim of Study: To assess new advances of Magnetic Res-onance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS) in diagnosis of recurrent breast cancer after conservative surgery, chemotherapy and radiotherapy and differentiate it from post therapeutic changes.Patients and Methods: The current study was conducted on 20 patients proved to be breast carcinoma by histopatho-logical grading. Six patients were presented with breast lump, three patients were presented by nipple discharge, four patients were presented by diffuse breast enlargement and seven patients were presented for post-operative follow-up at El-Demerdash Hospital during the period from October 2018 to April 2019.Results: A strong positive correlation is detected between choline peak findings and the level of Ki67, the higher the choline the higher the Ki67 the more aggressiveness is the tumor.Conclusion: Both dynamic contrast enhanced MRI and MRS are valuable tools in the evaluation of post-operative breast having high sensitivity and specificity to differentiate between benign post-operative changes and recurrent malignant tumor. On the other hand, MRI on the breast can assist to avoid unnecessary interventions and optimizes diagnosis of recurrence in its early stages.