Duration Of Endocrine Therapy Research Articles

Clinical features and death risk factors of pneumocystis jirovecii pneumonia in kidney disease patients with immunosuppressive therapy

To investigate the clinical features and death risk factors of pneumocystis jirovecii pneumonia (PJP) in kidney disease patients with immunosuppressive patients. A Retrospective case series study was performed in 52 PJP patients with kidney disease who received immunosuppressive therapy in Nephrology or Respiratory department of Peking University First Hospital from January 1, 2006 to August 31, 2021. Patients were divided into survival group (36 cases) and death group (16 cases) according to their clinical outcomes. Univariate analysis was performed to compare the differences of clinical features between the two groups. Multivariate logistic regression model was used to analyze the death risk factors. The results showed that the median serum creatinine was 192.5 (109.8, 293.7) μmol/L, and the incidence of acute kidney injury was 63.5% (33/52). Univariate analysis showed that age (t=1.197,P=0.030), C-reactive protein level (t=2.378,P=0.022), time from onset to diagnosis (χ2=6.62,P=0.010), PJP severity (χ2=5.482,P=0.019), complicated with septic shock (χ2=3.997,P=0.046), mechanical ventilation (χ2=11.755,P=0.001), and blood purification therapy (χ2=4.748,P=0.029) were statistically significant. There were no statistically significant differences between the two groups in gender, duration and dosage of hormone therapy before PJP onset, intravenous methylprednisolone pulse therapy, immunosuppressant use, and serum creatinine level before and after hospitalization for anti-PJP treatment (all P>0.05). Multivariate analysis showed that the time from onset to diagnosis of PJP was >10 days (OR=40.945, 95%CI: 1.738-451.214; P=0.021) and severe PJP (OR=25.502, 95%CI: 1.426-74.806; P=0.028) was an independent death risk factor for kidney disease complicated with PJP of immunosuppressive therapy. In conclusion, the time from onset to diagnosis of PJP and PJP severity are independent death risk factors in patients with kidney disease complicated with PJP of immunosuppressive therapy. Close attention should be paid to oxygenation condition and early diagnosis can prevent the aggravation of PJP and improve the prognosis.

Abstract PO3-11-06: Return to work in Brazilian women on adjuvant endocrine therapy

Abstract Background: Breast cancer is the most common cancer in women and its diagnosis and treatment may adversely impact the return to work (RTW). Previous work showed that RTW varies from as low at 27% to as high as 93%. There are few data about RTW in Latin America population. This study aims to investigate the RTW in Brazilian woman with early breast cancer treated with adjuvant endocrine therapy (ET) and its relations to patients’ characteristics, duration of ET, healthcare insurance, quality of life (QOL), sexual disfunction and adherence. Methodology: Women with a past history of early-stage estrogen receptor-positive (ER+) invasive carcinoma of the breast on adjuvant endocrine therapy for at least 6 months were invited to participate in this study and evaluated about RTW. We interviewed patients and asked about employment before cancer diagnosis and about absence from work (yes/no) after diagnosis, return to work (yes/no), time off (< 06 months, 6-12 months, 13-24 months, > 24 months), and difficulties in RTW (yes/no). EORTC QLQ C30 and BR-23, female sex function index questionnaires (FSFI) and adherence to endocrine therapy (MMAS-8) were evaluated. Demographic and medical information, having or not private health insurance (yes versus public), degree of education (completed high school vs not) were reviewed from medical records. Data collection was done with RedCap software. Qualitative variables were compared between groups using the Chi-square or exact Chi-square test and for quantitative variables the non-parametric Mann-Whitney test was used. Multivariable analysis was performed using Poisson regression. P < 0.05 was considered significant. Analyzes were performed in SAS 9.4. Results: From June 2021 to May 2023, a total of 461 women with ER+ early-stage breast cancer from 12 Brazilian institutions were included in this analysis. The mean age was 56.02 years (range 22-93 ), 47.7% were non-white and 38.7% were premenopausal. A total of 233 women (50.6%) had private insurance and the remaning were treated in public institutions. Median duration of ET usewas 2.78 years (range 6 months- 9.61 years). A total of 266 (64.88%) of women worked before cancer diagnosis and were evaluated about RTW. RTW rates at 6 months, 12 months and 24 months after diagnosis were 32.7%, 53% and 69.9% respectively. A total of 31.2% of women did not RTW at 2 years. A total of 53 (37.5%) of woman reported to face difficulties to RTW. Characteristics associated with RTW were age >60 years (p=0.004), white race (p=0.014), higher education level (p< 0.0001), stage I disease (p=0.018), private healthcare insurance (p< 0.0001). In the multivariable analysis, not having private health insurance, yonger age, lower EORTC QLQ-C30 physical functioning score and higher EORTC QLQ-BR23 arm symptoms scores were associated with not returning to work in this population (p < 0.05). Conclusion: Almost one third of the patients who were employed before cancer diagnosis did not RTW after treatment in Brazil. At 12 months, RTW rate was 53% higher than previous data in Latin America. Healthcare insurance, age and quality of life were related to RTW. It is crucial to identify the barriers and improve work conditions to increase RTW after breast cancer treatment as RTW have been shown to be beneficial to patients’ physical, mental health and quality of life. Variables with adjusted prevalence ratios for the occurrence of absence from work XX XX PR: Prevalence ratio; EORTC : European Organisation for Research and Treatment of Cancer XX XX Citation Format: Daniele Assad-Suzuki, Andrea Shimada, Danielle Santos, Cristiano Souza, Fernanda Moura, Sulene Oliveira, Anna Luiza Galvão, Bruno Souza, Amanda Castro, Monalisa Andrade, Yuri Beckedorff, Maria Cristina Magalhães, Carlos Paiva, Heloísa Resende, Daniela Pereira, Angelica Rodrigues, Daniela Rosa, Romualdo Barroso-Sousa. Return to work in Brazilian women on adjuvant endocrine therapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-06.

Abstract PO3-11-05: Sexual dysfunction among Brazilian women with early breast cancer on adjuvant endocrine therapy (ET)

Abstract Background: Sexual dysfunction is a common health problem in women, and it can occur during breast cancer treatment and survivorship. This study aims to determine the frequency of sexual disfunction among Brazilian women with early breast cancer on adjuvant endocrine therapy and to explore its relationships with patients’ clinical and social characteristics, adherence to ET, quality of life, return to work and healthcare insurance. Methodology: Women with history of early-stage ER+ invasive carcinoma of the breast on adjuvant endocrine therapy for at least 6 months were invited to participate of this study. Sexual dysfunction was evaluated using the Female Sexual Function Index questionnaire (FSFI). A score of < 26.55 in FSFI indicates sexual dysfunction. We evaluated sexually active patients (women should have at least one sexual intercourse in the previous four weeks). Demographic and medical information, site of treatment (private versus public), degree of education (completed high school vs not) were reviewed from medical records. Quality of life was assessed using EORTC QLQ C30 and BR-23 forms and adherence to ET was assessed by the Morisky Medication Adherence Scale (MMAS-8). Additionally, patients were interviewed about return to work. Data collection was performed using RedCap software and statistical analyzes were performed on the software R (R Core Team (2022). Qualitative variables were compared between groups using the Chi-square or exact Chi-square test and for quantitative variables the non-parametric Mann-Whitney test was used. Multivariable analysis was performed using Poisson regression. P < 0.05 was considered significant. Analyzes were performed in SAS 9.4. Results: From June 2021 to May 2023, a total of 461 women with ER+ early-stage breast cancer from 12 Brazilian institutions were included in this analysis. The mean age was 56.0 years (range 22-93 ), 47.7% were non-white and 38.7% were premenopausal. A total of 233 women (50.6%) had private insurance and the remaining were treated in public institutions. Median duration of ET use was 2.78 years (range 6 months- 9.61 years).Only 249 (54%) out of 461 patients who accepted to participate in this study declared to have sexual intercourse in the previous 4 weeks before evaluation and composes the population of this analysis. Sexual disfunction according results of FSFI questionnaire was found in 113 (53.3%) participants. Age was significantly associated with sexual dysfunction with women > 40 years-old having higher rates (95.3%) compared with versus younger patients (4.71% p=0.0069). Patients without sexual dysfunction had significantly higher EORTC QLQ C30 Global health status, Physical Functioning, Emotional Functioning, Sexual Functioning and Sexual Enjoyment scores than those with sexual dysfunction (p = 0.0060, p = 0.0242, p = 0 .0353, p = 0.0002 and p < 0.0001 respectively). ET duration between 2 and 5 years vs < 2 years, higher vs lower education level, EORTC QLQ-BR23 breast symptom and sexual functioning higher scores were significantly associated with the occurrence of sexual dysfunction in multivariated analysis (p < 0.05). Conclusion: In our study, only 54% of women evaluated had sexual intercourse in the previous four weeks and from those women 53.3% reported sexual dysfunction. Factors related to sexual dysfunction were higher education level, ET duration between 2 and 5 years, breast symptom and sexual functioning higher scores. div style=margin-top:10px; margin-bottom:20px;>Characteristic with adjusted prevalence ratios for the occurrence of sexual disfunction XX XX PR: prevalence ratio, EORTC: European Organisation for Research and Treatment of Cancer Citation Format: Daniele Assad-Suzuki, Fernanda Moura, Danielle Santos, Sulene Oliveira, Cristiano Souza, Heloísa Resende, Andrea Shimada, Anna Luiza Galvão, Bruno Souza, Amanda Castro, Monalisa Andrade, Yuri Beckedorff, Maria Cristina Magalhães, Carlos Paiva, Angelica Rodrigues, Daniela Pereira, Daniela Rosa, Romualdo Barroso-Sousa. Sexual dysfunction among Brazilian women with early breast cancer on adjuvant endocrine therapy (ET) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-05.

Abstract ED01-01: Optimizing endocrine therapy in premenopausal women

Abstract Premenopausal women with early-stage hormone receptor (HR)-positive breast cancer are candidates for adjuvant endocrine therapy and have several treatment options. The clinical team should assess an individual woman’s risk of recurrence, estimate benefits from specific endocrine manipulations, and consider co-morbidities, adverse event profile and host factors. Risk stratification strategies including clinic-pathologic features, genomic assays and composite scores can guide recommendations regarding type and duration of endocrine therapy, in particular in node-negative disease. Adjuvant tamoxifen for 5 to 10 years significantly reduces breast cancer recurrence and death. Premenopausal women who are at high risk of recurrence benefit from ovarian function suppression (OFS) with tamoxifen or an aromatase inhibitor for 5 years. Those include women with high-risk clinico-pathological features and younger age, and for whom chemotherapy is commonly recommended. There are currently no available data regarding the use of extended OFS beyond 5 years. Newer data support the addition of CDK 4/6 inhibitors to endocrine therapy in women with high-risk disease. Endocrine therpay is associated with frequent bothersome and few significant side effects that can negatively impact quality of life and adherence to treatment. Clinicians must carefully weigh the benefits associated with specific endocrine therapies, and possible short- and long-term side effects to individualize therapy, and to consider interventions to enhance adherence. Citation Format: V. Stearns. Optimizing endocrine therapy in premenopausal women [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr ED01-01.

Abstract PO5-11-10: Quality of life in Brazilian women with early breast cancer on adjuvant endocrine therapy

Abstract Background: There is a significant scarcity of quality of life (QOL) data among the Brazilian population with breast cancer. This study aims to evaluate QOL in Brazilian women with early breast cancer treated with adjuvant endocrine therapy (ET) and to explore its relationships with patients’ clinical and social characteristics, type and duration of endocrine therapy and type of healthcare insurance. Methodology: Women with a history of early-stage estrogen-receptor positive invasive carcinoma of the breast on adjuvant endocrine therapy for at least 6 months were invited to participate of this study. QOL assessment was conducted using the EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires. Demographic and medical information were collected from medical records. Data collection performed using RedCap software. Qualitative variables were compared between groups using the Chi-square or exact Chi-square test and for quantitative variables the non-parametric Mann-Whitney test was used. Multivariable analysis was performed using Multiple linear regression models with Stepwise procedure. P < 0.05 was considered significant. Analyzes were performed in SAS 9.4. Results: From June 2021 to May 2023, a total of 461 women with ER+ early-stage breast cancer from 12 Brazilian institutions were included in this analysis. A total of 233 women (50.54%) were treated in private institutions. Mean age was 56.02 years (range 22-93), 47.69% were non-white and 38.7% were premenopausal. A total of 62.34% had prior lumpectomy, 43.1% had tumor stage II, 61.69% received prior chemotherapy and 15.18% were HER2 positive. Regarding ET, 45.2% were on aromatase inhibitors (AI), 40.61% on tamoxifen (TMX) and 14.19% on ovarian function suppression plus ET (OFS). Median duration of ET use was 2.78 years. From the adjustment of the multiple regression model, it was found that the variable patients with a higher educational level were a significant predictor for the Physical Functioning score (p < 0.0001). The Role Functioning score had the variables treatment in a private hospital (p = 0.0462) and a higher educational level (p = 0.0357) as significant predictors. The variables age > 60 years (p = 0.0006) and marital status: single (p = 0.0267) were significant predictors for the Emotional Functioning score. Cognitive Functioning was correlated with the variables age > 60 years (p < 0.0001) and treatment duration < 2 years (p = 0.0475). Social Functioning had significant predictors such as hormone therapy with AI (p = 0.0305) and hormone therapy with TMX (p = 0.0267) when compared to OFS, as well as treatment duration < 2 years (p = 0.0175). The variable age > 60 years was a predictor for the Fatigue score (p = 0.0233). The Pain score correlated with variables such as higher educational level (p = 0.0003) and treatment duration < 2 years (p = 0.0032). The variables treatment in a public hospital (p = 0.0066), age < 60 years (p = 0.0471), and treatment duration < 2 years (p = 0.0054) were predictors for a higher Arm Symptoms score. Regarding the Breast Symptoms score, the variables treatment in a public hospital (p = 0.0005), Caucasian ethnicity (p = 0.0006), radiation therapy (p = 0.0098), and treatment duration < 2 years (p = 0.0203) were predictors for the total score. Body Image correlated with variables such as age > 60 years (p = 0.0322), surgical approach: mastectomy (p = 0.0445), tumor size < 50mm (p = 0.0446), and radiation therapy (p = 0.0405). The Global health status score did not correlate with any variable. Conclusion: Lower educational level, age< 60 years, duration of ET less than 2 years had a significant impact in many domains of QOL. Radiotherapy was the treatment modality with more impact in QOL scores. The identification of modifiable factors related to QOL in this study provides valuable insights for the development of a customized intervention in Brazilian population. Citation Format: Danielle Santos, Cristiano Souza, Maria Cristina Magalhães, Daniela Pereira, Fernanda Moura, Sulene Oliveira, Anna Luiza Galvão, Bruno Souza, Amanda Castro, Monalisa Andrade, Andrea Shimada, Yuri Beckedorff, Carlos Paiva, Heloísa Resende, Angelica Rodrigues, Daniela Rosa, Daniele Assad-Suzuki, Romualdo Barroso-Sousa. Quality of life in Brazilian women with early breast cancer on adjuvant endocrine therapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-10.

Abstract PO2-11-03: A long-term follow-up of patients who interrupted endocrine therapy to become pregnant following breast cancer surgery

Abstract Introduction: Regarding discontinue adjuvant endocrine therapy to attempt pregnancy, Pregnancy Outcome and Safety of Interrupting Therapy for Women with Endocrine Responsive Breast Cancer (POSITIVE) clinical trials have revealed temporary interruption of endocrine therapy to attempt pregnancy did not confer short-term risk of breast cancer events. However, that report involved a short observation period, longer-term follow-up is required. This study was aimed to evaluate the safety of endocrine therapy interruption with long-term followed-up data base. Methods: This was a retrospective study using surveying of medical chart data between June 2007 and November 2015 at St. Luke’s International Hospital. The subjects were 65 patients with estrogen-receptor positive primary breast cancer (clinical stage I-III) who had been performed fertility preservation prior to starting breast cancer treatment. Adjuvant endocrine therapy completion was defined as 120 months (10 years) and discontinuation was defined as < 120 months. Using the definition, we classified the patients into an endocrine therapy interruption-group and a continuation-group. The primary outcome was the breast cancer free interval (BCFI). We defined breast cancer events as local, regional, or distant recurrence of invasive breast cancer or new contralateral invasive breast cancer during follow-up. Results: Median follow-up period was 110 (range, 36–181) months. The number of adjuvant endocrine therapy interruption-group was 30 and continuation-group was 35. Among 65 patient, the mean patient age in the interruption vs. continuation groups were as follows: 38(range, 26-48) years vs. 36.5 (range, 26–45) years at breast cancer diagnosis and HER2 positive breast cancer was identified in 4 (11.4%) vs 4 (13.3%) patients. Clinical stages were Stage I, 9 (30%) vs. 11 (31.4%) patients; Stage II, 18 (60%) vs. 18 (51.4%) patients; and Stage III, 3 (10%) vs. 6 (17.1%) patients. Chemotherapy was administered in 17 (56.7%) and 23 (65.7%) patients, respectively. The median duration of endocrine therapy before interruption was 25.5 months: 3 (10%) patients received endocrine therapy for 0–18 months, 16 (53.3%) for 18–30 months, and 11 (36.7%) for >30 months. The BCFI was 124 and 119 months in the interruption and continuation groups, respectively (p = 0.16). There were 6 (20%) and 9 (25.7%) breast cancer events in the interruption-group and continuation-group, respectively (p = 0.4). All the pregnancies were in the endocrine therapy interruption group (17 pregnancies, 16 deliveries), with one pregnancy involving the delivery of twins. Three pregnancies were spontaneous. Endocrine therapy was resumed in 16 (59.3%) patients in the interruption-group (median time to resumption, 20.5 months). One patient developed distant metastasis during endocrine therapy interruption period. Conclusion: Among patients who performed fertility preservation prior to starting breast cancer treatment, our long-term follow-up data, almost 9 years, suggested that the BCFI was not statistically different between endocrine therapy interruption-group and continuation-group. A limitation of this study is that only three cases of Stage III breast cancer were included in the interruption group. Therefore, we consider that careful decisions should be made regarding interruption of endocrine therapy. Citation Format: Risa Kasahara, Atsuko Kitano, Fumi Akitani, Kyoko Shiota, Kumiko Kida, Junko Takei, Atsushi Yoshida. A long-term follow-up of patients who interrupted endocrine therapy to become pregnant following breast cancer surgery [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-11-03.

Abstract PO1-02-04: The efficacy of endocrine therapy during the waiting period for surgery for hormone receptor-positive breast cancer

Abstract Background: Although neoadjuvant endocrine therapy has been used to improve breast conservation rate, its prognostic relevance is unknown. The search for a valid prognostic factor equivalent to pCR in neoadjuvant chemotherapy is a current challenge in neoadjuvant endocrine therapy. In this study, we investigated the efficacy of short term neoadjuvant endocrine therapy utilizing the waiting period for surgery and the prognostic factor including Preoperative Endocrine Prognostic Index (PEPI) score. Methods: A total of 480 patients with StageⅠ-Ⅲ hormone receptor-positive, HER2-negative breast cancer was treated with endocrine therapy during the waiting period for surgery between October 2012 and December 2021. Premenopausal and postmenopausal patients received tamoxifen (TAM) and non-steroidal aromatase inhibitor (AI), respectively. The primary endpoint was change in tumor size by ultrasound and Ki67 expression before and after short term endocrine therapy. The secondary endpoint was prognosis of patients divided by PEPI score which was calculated using tumor size, lymph node metastasis, Ki67 expression, and ER Allred score. This study was approved by the institutional review board of Teikyo University. Results: Median age and tumor size of the entire 480 patients was 55 years (range, 31 - 89), 1.65 cm (range, 0.4 – 7.5), respectively. The median duration of endocrine therapy was 39 days (range, 1-90). 19 (0.3 %) pts were clinically node-positive. Of the entire 480 patients, 211 and 269 patients had TAM and AI, respectively. After short term endocrine therapy, the tumor size was significantly reduced from 1.83cm to 1.62cm in AI group (p=0.02), although TAM did not decrease the tumor size (p=0.89). The Ki67 expression was significantly decreased from 16.4% to 11.3% in TAM group (p=0.002), and from 15.9% to 6.98% in AI group (p < 0.001). There were significant differences in the distribution of PEPI scores between TAM and AI group (p < 0.05) (Table). At the median follow-up of 1012 days, patients with PEPI score ≥ 4 showed worse disease-free survival compared with patients with PEPI score < 4 in TAM group (Figure1). Overall survival is not available because there were no deaths in TAM group. At the median observation period of 833 days, patients with PEPI score ≥ 4 showed worse disease-free survival compared with patients with PEPI score < 4 in AI group (Figure2). In terms of mortality, patients with PEPI score ≥ 4 had worse overall survival than patients with PEPI score 0 and 1-3 (p=0.07). Conclusions: These results suggested that neoadjuvant endocrine therapy during the waiting period for surgery might be effective in reducing Ki67 expression level and PEPI score might be useful in predicting the prognosis of hormone receptor positive breast cancer patients. Table. Distribution of PEPI score Figure 1. Disease-free survival in patients treated with tamoxifen Figure 2. Disease-free survival in patients treated with non-steroidal aromatase inhibitor Citation Format: Yuka Maeda, Saki Naruse, Yuka Isono, Ayana Sato, Akiko Matsumoto, Tatsuhiko Ikeda, Hiromitsu Jinno. The efficacy of endocrine therapy during the waiting period for surgery for hormone receptor-positive breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-02-04.

Ethnic variation in lower face anthropometry on facial computed tomography scans for patients seeking facial feminization surgery

BackgroundFacial feminization surgery (FFS) is the most common form of facial gender-affirming surgery. One of the current knowledge gaps is the understanding of racial group differences in baseline craniofacial norms for transgender and nonbinary patients. MethodsAll patients who sought consultation for FFS with a completed craniofacial computed tomographic (CT) scan at a single institution between the years of 2018 to 2023 were included. Patients with previous facial surgeries were excluded. Chart reviews were conducted for patient characteristics, including race, age, hormone therapy duration, and prior gender-affirming surgeries. Racial categorizations included White, Latinx, African American, or Asian. Patients with other or multiracial identity were excluded. Measurements of the lower face were derived from preoperative facial CT scans. Comparative analyses were performed on all measurements between racial groups. Results204 patients were included with an average age of 32.0±10.2 years and a median hormone duration of 2.0 years. Notable racial group differences were: 1. Zygomatic width was largest in Asian patients (13.5±0.6cm) compared to all other racial groups (p=0.03), 2. Nasolabial angle was smallest in African American patients (82.5±13.1 degrees, p<0.001), 3. Lower face height was largest in African American patients (6.9±0.7cm, p<0.001) and 4. Lateral mandibular flare was largest in African American patients (0.4±0.1cm) and smallest in Latinx patients (0.2±0.1cm, p<0.001). ConclusionsSpecific target areas of FFS should be carefully considered to account for possible baseline ethnic differences. Relative facial proportions may also be a more salient surgical planning tool for TGNB patients rather than absolute measurements alone.

Prevalence and impact of fertility concerns in young women with breast cancer

Survey data from the Mayo Clinic Breast Disease Registry were used to assess fertility counseling and fertility preservation strategies in a modern cohort of young women with breast cancer. One hundred respondents were identified who were under age 50 at the time of breast cancer diagnosis and who expressed interest in future childbearing near the time of diagnosis and/or 1 year later. Ninety-three percent of the 81 respondents to the year one survey recalled fertility counseling prior to cancer treatment. Most who reported a high level of fertility concern declared that this concern had impacted their treatment decisions, often shortening their planned duration of endocrine therapy. Approximately half had taken steps to preserve future fertility, and a third had used a gonadotropin-releasing hormone agonist either alone or combined with another method (e.g., embryo or oocyte cryopreservation).

Long-Term Impact of Various Endocrine Therapy Regimens on Mortality, Local Recurrence, and Metastasis in Breast Cancer: A 25-Year Retrospective Study

Background: This retrospective cohort study explores the long-term effects of different endocrine therapy regimens on mortality, local recurrence, and metastasis in breast cancer patients. Methods: Data from the Referral Cancer Research Center of Shahid Beheshti University of Medical Sciences were analyzed. Records of 2,262 histologically confirmed breast cancer patients, with 25 years of follow-up were included. We collected patient data, including treatment modalities, and details of the endocrine therapy, and conducted statistical analysis to assess treatment-outcome associations. Results: Patients had an average age of 49.45 years, and 99.1% were female. The average tumor size was 2.8 cm, with a 12.3% mortality rate. Positive expression of human epidermal growth factor receptor 2, progesterone receptor, and estrogen receptor was found in 17.3%, 71.8%, and 70.6% of patients, respectively. Tamoxifen was administered to 1,700 patients, letrozole to 715, and exemestane to 540, with an average endocrine therapy duration of 5.2 years. Letrozole treatment duration (P = 0.001) and lymph node involvement (P = 0.028) were independent predictive variables for local recurrence, with longer letrozole therapy associated with lower recurrence. Conclusion: Estrogen receptor expression and endocrine therapy duration are independent predictive markers for recurrence and mortality. Longer letrozole therapy predicts lower local recurrence. Endocrine therapy duration inversely relates to mortality, recurrence, and local recurrence.

Impact of the preoperative hormone therapy duration on the satisfaction of transgender men after chest masculinization surgery

Introduction Chest masculinization is currently the most commonly performed gender-affirming surgery. It is often preceded by testosterone replacement therapy, whose duration is not agreed upon before surgery. Our study evaluates the postoperative satisfaction of transgender men who have undergone chest masculinization surgery according to their preoperative hormonal treatment duration. Material and methods We conducted a single-center prospective study conducted from 2021 to 2022. All transgender men older than 18 years who had chest masculinization surgery were included. Demographic data, medical history, operative data, and duration of preoperative hormone therapy were collected. Participants completed the BREAST-Q© and BODY-Q© questionnaires pre- and postoperatively. Results Forty-six patients were included, with a median age of 21 years (18–45 years). The median preoperative testosterone duration was 596 days (186–4479 days). A significant improvement was found in BREAST-Q© (psychosocial, sexual and physical well-being; satisfaction with chest) and BODY-Q© (satisfaction with chest and nipples) parameters (p < 0.01). There was no significant correlation between preoperative hormone therapy time and chest satisfaction of BREAST-Q© (ρ = 0.069; R2 = 0.002; p = 0.647) and BODY-Q© (ρ = –0.114; R2 = 0.007; p = 0.450). Conclusion All patients in our study were exposed to exogenous testosterone for at least six months. Our study suggests that satisfaction remains unchanged with a longer duration of usage, indicating that an extended period of hormone impregnation may not be necessary before performing chest masculinization surgery in transgender men. Furthermore, the findings confirm a significantly high post-operative satisfaction rate among participants, emphasizing the positive impact of this type of surgery.

Duration of Feminizing Hormone Therapy on Facial Fat Volumes.

Gender-affirming feminizing hormone therapy induces body fat redistribution. However, the amount and timing of facial fat changes in response to feminizing hormone therapy are unknown, albeit relevant to counseling and surgical planning for facial gender-affirming surgery. In this work, we assessed the influence of feminizing hormone therapy duration on malar and temporal fat volume. Malar and temporal fat volumes were compared using computed tomography in transfeminine patients (age 20-29 years, body mass index [BMI] 18.5-24.9) treated with feminizing hormone therapy for <2 years versus ≥2 years. Patients with prior surgical or non-surgical facial soft-tissue interventions were excluded. Multivariable linear regressions evaluated the contribution of hormone therapy duration to malar and temporal fat volumes. 45 patients were included with 30 patients (66.7%) treated with feminizing hormone therapy for ≥2 years and 15 patients (33.3%) treated for <2 years (median[interquartile range, IQR]: 44.5[33.5-65.6] vs. 15.0[11.0-18.0] months, p<0.001). Patients treated with hormone therapy for ≥2 years demonstrated a 1.6-fold greater malar fat volume (5.5[4.2-6.3] vs. 3.4[2.3-4.2] cm 3,p<0.001) and 1.4-fold greater temporal fat volume (2.8[2.4-3.6] cm 3 vs. 2.0[1.7-2.4] cm 3, p=0.01) compared to those treated for <2 years. When accounting for other contributory variables such as BMI, skull size, and total soft-tissue depth in multivariable linear regression models, hormone therapy duration ≥2 years independently predicted higher malar (β=0.51, p<0.001) and temporal (β=0.32, p=0.02) fat volumes. Feminizing hormone therapy increases malar and temporal fat volumes by approximately 2 cm 3 and 0.8 cm 3 for each area, respectively, after 2 years of treatment.

Survival Outcomes in Premenopausal Patients With Invasive Lobular Carcinoma.

The disparate prognostic implications between invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) have been demonstrated. However, information on premenopausal patients remains insufficient. To examine long-term survival outcomes of ILC and IDC in premenopausal patients using national databases. This cohort study used the Surveillance, Epidemiology, and End Results (SEER), Korean Breast Cancer Registry (KBCR), and Asan Medical Center Research (AMCR) databases to identify premenopausal patients with stage I to III ILC or IDC between January 1, 1990, and December 31, 2015. The median follow-up time was 90 (IQR, 40-151) months in the SEER database, 94 (IQR, 65-131) months in the KBCR database, and 120 (IQR, 86-164) months in the AMCR database. Data were analyzed from January 1 to May 31, 2023. The primary outcome was breast cancer-specific survival (BCSS), which was analyzed according to histological type, and the annual hazard rate was evaluated. Survival rates were analyzed using a log-rank test and a Cox proportional hazards regression model with time-varying coefficients. Multivariable analysis was performed by adjusting for tumor characteristics and treatment factors. A total of 225 938 women diagnosed with IDC or ILC and younger than 50 years were identified. Mean (SD) age at diagnosis was 42.7 (5.3) years in the SEER database, 41.8 (5.5) years in the KBCR database, and 41.8 (5.5) years in the AMCR database. In terms of race (available for the SEER database only), 12.4% of patients were Black, 76.1% were White, 11.0% were of other race (including American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander), and 0.5% were of unknown race). Patients with ILC had better BCSS in the first 10 years after diagnosis than those with IDC (hazard ratios [HRs], 0.73 [95% CI, 0.68-0.78] in the SEER database, 1.20 [95% CI, 0.91-1.58] in the KBCR database, and 0.50 [95% CI, 0.29-0.86] in the AMCR database), although BCSS was worse after year 10 (HRs, 1.80 [95% CI, 1.59-2.02] in the SEER database, 2.79 [95% CI, 1.32-5.88] in the KBCR database, and 2.23 [95% CI, 1.04-4.79] in the AMCR database). Similar trends were observed for hormone receptor-positive tumors (HRs, 1.55 [95% CI, 1.37-1.75] in the SEER database, 2.27 [95% CI, 1.01-5.10] in the KBCR database, and 2.12 [95% CI, 0.98-4.60] in the AMCR database). Considering the annual hazard model of BCSS, IDC events tended to decline steadily after peaking 5 years before diagnosis. However, the annual peak event of BCSS was observed 5 years after diagnosis for ILC, which subsequently remained constant. These findings suggest that premenopausal women with ILC have worse BCSS estimates than those with IDC, which can be attributed to a higher late recurrence rate of ILC than that of IDC. Histological subtypes should be considered when determining the type and duration of endocrine therapy in premenopausal women.

Treatments and Prognosis of the Breast Ductal Carcinoma In Situ

IntroductionWith progress in treatments, breast ductal carcinoma in situ (DCIS) outcomes have substantially improved. However, as various treatment methods are used in different countries and institutions, consensus on the optimal treatment method is lacking. This study aimed to analyze the prognostic factors and provide a reference for optimizing the clinical treatment of DCIS. Patients and MethodsThis retrospective clinical study collected data from DCIS patients at the Sun Yat-sen University Cancer Center from 2010 to 2017. The Kaplan–Meier method and Cox regression model were used to assess disease-free survival (DFS), overall survival (OS), and local control (LC) rates. ResultsAmong the 483 included patients, 83.6% (404) underwent mastectomies. The median follow-up time was 101 months. The number of patients undergoing breast-conserving surgery (BCS) with radiotherapy has gradually increased. Axillary lymph node dissection was the main surgery performed from 2010 to 2015, and the proportion of sentinel lymph node biopsies (SLNBs) has increased. LC and DFS rates with BCS without radiotherapy were significantly lower than those with mastectomy (P = .002; P < .001). Additionally, the patients who did not undergo axillary surgery had worse LC and OS rates than those who underwent SLNB (P = .028 and P = .038). Endocrine therapy (ET) or its duration had no significant effect on prognosis. ConclusionIn conclusion, BCS without radiotherapy and lack of axillary surgery were independent prognostic factors. We recommend performing BCS with radiotherapy and SLNB more in clinical practice, as well as shortening the ET duration.

SAT416 The Incidence Of Autoimmune Disease In Transgender People After Initiation Of Gender-Affirming Hormone Therapy

Abstract Disclosure: C. Wiepjes: Advisory Board Member; Self; Novartis Pharmaceuticals. M. Den Heijer: None. Background Autoimmune diseases are more common in women than in men, possibly caused by differences in sex hormones. Generally, estrogen has an immunoenhancing effect, while testosterone has an immunosuppressive effect. However, it is not known whether gender-affirming hormone therapy in transgender people affects the risk of developing autoimmune diseases. Therefore, we aimed to compare the incidence of autoimmune diseases in trans women and trans men during hormone therapy with rates from the general population. Methods All people who visited the gender identity clinic in Amsterdam, the Netherlands, between 1972 and 2018 were included (n=8831). The medical records were screened for the occurrence of autoimmune diseases. In addition, the cohort was linked to a nationwide health data registry with medical diagnoses, as not all people received their check-ups at our clinic and in order to compare with a control population. These additional diagnoses were available from 2012-2017 and based on Diagnosis-Treatment-Combination codes. People were excluded for analyses if they did not use gender-affirming hormones (n=3022), did not have a follow-up visit (n=345), could not be linked with the nationwide health data registry (n=630), used alternating testosterone and estradiol (n=38), or had an autoimmune disease before start of hormone therapy (n=112). Standardized incidence ratios (SIR) were computed for trans women and trans men compared with the general population. Results In total, 4684 people were included, of which 2830 trans women and 1854 trans men. Median age at start of hormone therapy was 29 years (IQR 22 to 40) in trans women and 22 years (IQR 18 to 29) in trans men. Median follow-up time was 10 years (IQR 3 to 22, max 59) in trans women (total 38326 person years) and 4 years (IQR 1 to 13, max 48) in trans men (total 16548 person years). In total, 55 trans women and 48 trans men developed an autoimmune disease, after a median duration of hormone therapy of 7 years (IQR 2 to 17) in trans women and 5 years (IQR 1 to 12) in trans men. In the analyses with first autoimmune disease between 2012 and 2017, 25 trans women had an event, while 31 cases (SIR 0.81, 95%CI 0.52 to 1.16) were expected compared to cis men and 47 cases (SIR 0.54, 95%CI 0.35 to 0.77) compared to cis women. In trans men, 27 people had an event, while 15 cases were expected compared to cis men (SIR 1.81, 95%CI 1.19 to 2.55) and 23 cases were expected compared to cis women (SIR 1.16, 95%CI 0.77 to 1.64). Conclusion The risk of developing autoimmune diseases in trans women using gender-affirming hormones was similar to the risk in cis men, whereas trans men had a similar risk as cis women. This implies that gender-affirming hormone therapy does not influence the risk of developing autoimmune diseases. For further research it is interesting to see whether the severity of autoimmune diseases changes in trans people starting gender-affirming hormones. Presentation: Saturday, June 17, 2023

OR31-02 Persistence Of Gender Identity And Hormone Therapy Use In Transgender Adolescents: A Retrospective Cohort Study

Abstract Disclosure: P. Gupta: None. B.C. Patterson: None. S. Gold: None. L. Chu: None. H. Yeung: None. M. Goodman: None. V. Tangpricha: None. Introduction: Adolescents with gender dysphoria often seek feminizing or masculinizing hormone therapy to affirm their gender identity. While receipt of gender-affirming hormone therapy (GAHT) has been associated with improved quality of life and well-being, the incidence of discontinuation of GAHT and the reasons for discontinuation are not known. The purpose of this study was to 1) assess the discontinuation rate of GAHT, and 2) explore the reasons for GAHT discontinuation. Methods: This was a retrospective cohort study approved by Emory University’s and Children’s Healthcare of Atlanta’s Institutional Review Board. Medical charts of transgender adolescents seen at Children’s Healthcare of Atlanta were reviewed. Patients met the inclusion criteria if they were prescribed GAHT (estradiol or testosterone) between 01/01/2016 to 01/01/2019. We defined continuation of GAHT if the participant was still taking estradiol or testosterone as of 01/01/2019. If the participant stopped taking hormonal therapy prior to 01/01/19, they were deemed to have discontinued hormonal therapy and the reason for discontinuation was collected from the chart if documented. If the reason was not documented or if the status of hormone discontinuation was not known, the participant was contacted via telephone to ascertain whether still taking GAHT or not and to ascertain the GAHT discontinuation reason if not taking GAHT as a part of phase II of the study. Results: This study included 82 participants; 36 (43.9%) transgender girls, 45 (54.9%) transgender boys, and 1 (1.2%) non-binary adolescent. The mean age of participants was 16.7 (SD= 1.7) years and the majority were white (N= 71; 86.6 %) and non-Hispanic or Latino (N=76; 92.7%). The majority (N= 59, 72.0 %) of the participants were privately insured. The mean duration of hormonal therapy was 21.5 (SD= 15.4) months spanning over a maximum of 66 months. Only 3 participants had discontinued GAHT therapy: one participant stopped hormonal therapy due to insurance issues, one participant stopped GAHT temporarily to conceive a baby and one stopped testosterone to transition to a non-binary gender. No participant re-transitioned to the gender congruent with the sex assigned at birth. Conclusion: Discontinuation of GAHT in this group of transgender adolescents was infrequent. No participant re-transitioned to the gender congruent with the sex assigned at birth while 3 participants discontinued GAHT due to external factors. Pediatric providers should prescribe GAHT in accordance with the Endocrine Society guidelines if the adolescent needing GAHT meets the diagnosis of gender dysphoria, has parental consent, and is pubertal. Presentation: Sunday, June 18, 2023

SAT399 Are Gender-affirming Hormone Therapy Duration And Body Mass Index Associated With Bone Mineral Density In Transgender And Gender Diverse Adults?

Abstract Disclosure: S.J. Iwamoto: None. J.D. Rice: None. N.J. Nokoff: None. K.L. Moreau: None. M. Cornier: None. M.E. Wierman: None. M.P. Mancuso: None. M.S. Rothman: None. Background: Sex steroids play crucial roles in bone mineral density (BMD) accrual and maintenance. Data on gender-affirming hormone therapy’s (GAHT) bone effects in transgender and gender diverse (TGD) adults have been limited to non-U.S. cohorts with higher gonadectomy and smoking rates. A higher prevalence of low BMD has been seen in TGD adults prior to initiating feminizing, compared to masculinizing, GAHT (fGAHT, mGAHT). Both fGAHT and mGAHT maintain lumbar spine (LS) BMD and increase Z-scores. Adult femoral neck (FN) and total hip (TH) site data are limited. The associations of GAHT duration and body mass index (BMI) with bone health among U.S. TGD adults are understudied. Objectives: To evaluate the associations between BMDs and Z-scores with GAHT duration and BMI among nonsmoking TGD adults aged 18-40 years, without prior gonadectomy, taking estrogen+spironolactone (fGAHT) or testosterone (mGAHT) for &amp;gt;1 year. Hypotheses: BMDs and Z-scores among fGAHT and mGAHT are within expected male and female reference ranges. Increasing GAHT duration and BMI are each associated with increasing BMDs and Z-scores at FN, TH and LS sites. Methods: Cross-sectional study of FN, TH, and LS bone density outcomes measured by total body dual-energy X-ray absorptiometry (DXA) in 30 adults receiving GAHT within a metropolitan area. Means±standard deviations were calculated. Associations between BMDs and Z-scores and the predictors, GAHT duration and BMI, were estimated for each of the three sites using linear regression. Results: Among fGAHT (n=15, n=0 non-White or Hispanic, age 28.7±4.8 years, GAHT 3.1±2.1 years, estradiol 189.7±119.6 pg/mL, total testosterone 97.6±99.5 ng/dL), mean BMI was in the overweight range (27.6±6.4 kg/m2) and mean total body percent fat was 33.7±7.3%. Among mGAHT (n=15, n=3 non-White, n=2 Hispanic, age 28.5±5.7 years, GAHT 4.0±2.0 years, estradiol 46.8±24.0 pg/mL, total testosterone 544.6±332.8 ng/dL), mean BMI was also in the overweight range (BMI 25.3±5.9 kg/m2) and mean total body percent fat was 29.8±7.1%. Both fGAHT and mGAHT groups had BMDs and Z-scores within expected male and female reference ranges at all three sites. Increasing BMI among mGAHT, but not fGAHT, was associated with increasing FN and TH, not LS, BMDs and Z-scores using male and female references (p&amp;lt;0.05). GAHT duration was not associated with BMDs or Z-scores. Conclusions: Z-scores in nonsmoking TGD adults taking fGAHT or mGAHT for &amp;gt;1 year, without prior gonadectomy, and with average BMIs in the overweight range, were reassuringly within the expected ranges for age. Increasing BMI, but not GAHT duration, was associated with higher FN and TH, but not LS, BMDs and Z-scores among mGAHT only. Larger studies, especially prospective, are needed to understand the associations between body composition changes (for example, lean mass and fat mass), normal or low BMIs, and gonadectomy with BMDs and Z-scores. Presentation: Saturday, June 17, 2023

Landscape of young breast cancer under 35 years in China over the past decades: a multicentre retrospective cohort study (YBCC-Catts study)

The proportion of young breast cancer patients in China is significantly higher than in Western countries, and the clinicopathological characteristics and clinical problems faced by patients in China are different from those in Western countries too, so there is an urgent need to conduct some studies for young breast cancer patients in Asia. This study consisted of two breast cancer cohorts in China. The population-based cohort involved breast cancer cases diagnosed in 2000-2017 via cancer registration system, and we describe the epidemiological characteristics of the young breast cancer in China. The hospital-based cohort, patients eligible for enrollment were breast cancer in young women (≤35 years old) from eight centres in different regions of China, diagnosed and treated for the first time in six time periods (i.e., 2000, 2003, 2006, 2009, 2012, and 2015). Patient demographic characteristics and clinical features were compared among the six time periods using a trend test. The Kaplan-Meier method was used to generate survival curves, and the log-rank test was performed to compare OS and DFS. Univariate and multivariate analyses were carried out using Cox proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CIs). In the population-based cohort, age-specific incidence and age-standardised percentages of breast cancer cases younger than 35 years were increased. The proportion of breast cancer under the age of 35 is increasing more rapidly in rural areas than in urban areas. In the hospital-based cohort, a total of 1308 young breast cancer patients (≤35 years old) were collected. Proportion of patients treated with adjuvant taxane or anthracycline combined with taxane is gradually increasing over the six time periods, and the proportion of patients undergoing breast-conserving surgery is gradually increasing too. Meanwhile, the patients treated with combined ovarian function suppression (OFS) endocrine therapy gradually increased, and the duration of endocrine therapy gradually longer. There is an increasing trend in 5-year disease-free survival (DFS) rate for the total population in the six time periods between 2000 and 2015, but no significant difference in overall survival (OS) rate was observed. Early staging and longer duration of endocrine therapy were factors associated with a favorable prognosis. The incidence of younger breast cancers under 35 years of age has gradually increased and the pattern of patient care has changed significantly over time, which may contribute to the improved prognosis of younger breast cancer patients. Beijing Medical Award Foundation (YXJL-2020-0941-0763), Beijing Hope Run Special Fund of Cancer Foundation of China (LC2021L04), Chinese Academy of Medical Sciences Clinical Translational and Medical Research Fund (2022-I2M-C&T-A-014).

Menopause age, reproductive span and hormone therapy duration predict the volume of medial temporal lobe brain structures in postmenopausal women

Medial temporal lobe (MTL) atrophy is correlated with risk and severity of Alzheimer disease (AD) pathology and cognitive decline. Increasing evidence suggest that oestrogens affect the aging of MTL structures. Here we investigate the relationship between reproductive hormone exposure, polygenic scores for AD risk and oestradiol concentration, MTL anatomy and cognitive performance in postmenopausal women. To this end, we used data from 10,924 female participants in the UK Biobank from whom brain MRI and genetic data were available. We fitted linear regression models to test whether the volume of structures comprising the MTL were predicted by a) timing related to menopause, b) the use and timing of hormone replacement therapy (HRT) and c) polygenic scores for AD risk and oestradiol concentration. Results showed that longer use of HRT was associated with larger parahippocampal volumes (2.53 mm3/year, p = 0.042). A later age of natural menopause, and a longer reproductive span, was associated with larger hippocampal (6.08 and 5.72 mm3/year, p = 0.0006 and 0.0005), parahippocampal (4.17 mm3 and 4.19 mm3/year, p = 0.00006 and 0.00001), amygdala (2.10 and 2.22 mm3/year, p = 0.028 and 0.01) and perirhinal cortical (2.56 and 2.95 mm3/year, p = 0.028 and 0.008) volumes. Superior prospective memory performance was associated with later age at natural menopause, and a longer reproductive span (ß = 0.05 and 0.05 respectively, p = 0.019 and 0.019). Polygenic scores for AD risk and for oestradiol concentration were not associated with MTL volume and did not interact with menopause-related factors to affect MTL structure. Our results suggest that HRT use did not have any detrimental effects on cognition or brain structure, whilst greater exposure to reproductive hormones across time is associated both with slightly larger volumes of specific MTL structures and marginally superior memory performance, independent of genetic risk for AD and genetic predisposition for higher oestradiol levels. However, the clinical utility of maintenance of oestrogens post-menopause for brain health and protection against cognitive decline is curtailed by the small effect sizes observed.

Extended Adjuvant Endocrine Therapy in Early Breast Cancer Patients-Review and Perspectives.

Seventy percent of all breast cancer subtypes are hormone receptor-positive. Adjuvant endocrine therapy in these patients plays a key role. Despite the traditional duration of a 5-year intake, the risk of relapse remains elevated in a substantial proportion of patients. Several trials report that the risk of late recurrence is reduced by the extension of adjuvant endocrine therapy beyond 5 years. However, the optimal duration of endocrine therapy is still a matter of debate. The newer data only show a marginal benefit resulting from extension beyond 7 to 10 years. Furthermore, extension may be associated with more side effects. Thus, the adequate selection of patients qualifying for an extended adjuvant therapy is of importance. Tools/genomic tests, which include the characteristics of the patient and the tumor, may help to better identify patients with a risk of a late relapse. Taken together, the magnitude of benefit for extended adjuvant endocrine therapy is based on the precise estimation of the risk of relapse after 5 years. This must be balanced against the long-term side effects of endocrine treatment and the competing risks. For patients with an intermediate risk, 7 years appears to be the optimal duration, and in those with high-risk features, endocrine therapy up to 10 years may be considered.